Gendered Violence, Abuse and Mental Health in Everyday Lives

Beyond Trauma

Nicole Moulding

• Publisher: Routledge
• Year: 2015
• eBook ISBN: 9781317811213
• Edition: 1
• Topic: Social Sciences
• Subtopic: Health Care Delivery
• Index: Social Sciences

Gendered Violence, Abuse and Mental Health in Everyday Lives: Beyond Trauma offers new insights into the social dimensions of emotional distress in abuse-related mental health problems, and explores the many interconnections between gendered violence, different forms of abuse and poor mental health. Looking at how individuals can overcome the impact of abuse over the course of their lives, Moulding maps a feminist-informed recovery-oriented approaches to therapy and prevention.

Drawing on sociological perspectives and a wide range of international research, as well as original qualitative data presented here for the first time, this book:

-Demonstrates how gender and other social power relations play out in the specific emotional dimensions of some of the mental health problems most strongly linked to abuse, including post-traumatic stress disorder, anxiety, depression and eating disorders;

-Critiques the way that mainstream psychological theory and research pathologises the effects of abuse through various mental illness diagnoses, obscuring the nature of the individual emotional distress involved, its social context and relational nature;

-Outlines a feminist-informed, recovery-oriented approach that aims to reduce violence against women and children.

This innovative volume is an important contribution to the literature on the impact of violence and abuse on the lives and health of its survivors. It will be of interest to students and researchers from a range of disciplines and professions, including social work, gender studies, sociology, social policy, psychology, counselling, mental health, public health, medicine and nursing.

1 Introduction

An interconnected approach

Male-perpetrated violence and abuse against women and girls is a major social and public health problem across the globe (World Health Organization (WHO), 2013), and helping professionals come across it regularly in their day-to-day work. In addition to responding at the point of crisis, they will also see many women struggling down the track with emotional distress. However, while the idea that gendered violence and abuse is linked to later mental health problems is now widely accepted, this has not always been the case. Attention to the impact of male-perpetrated violence and abuse on women’s mental health has ebbed and flowed along with cyclic ‘re-discoveries’ of child sexual abuse, and with waves of concern and indifference about domestic violence and sexual assault. We seem to be going through a period of re-discovery of gendered violence and its effects at the moment with enquiries into institutionalised child sexual, physical and emotional abuse and regular media reports of domestic violence in Australia and elsewhere. While increased attention to gendered violence and abuse, and its negative impact on women, might provide opportunities for change, there are also risks associated with such a re-discovery, including the further promulgation of the ‘harm’ story of abuse (O’Dell, 2003), which assumes that gendered violence and abuse invariably result in psychological problems for women. At this point in time, psychological trauma models of the effects of gendered violence and abuse represent the dominant ‘harm’ story.

This book is not about revealing the ‘truth’ of gendered violence and abuse, and their impact on emotional wellbeing: there are many competing truths with their own contradictory evidence bases. Rather, what this book seeks to do is explore and examine gendered violence and mental health in an interconnected way, and at a number of different levels. A robust body of feminist research and scholarship already exists in this area, and has examined the impact of child sexual abuse (O’Dell, 2003; Warner and Wilkins, 2003; Warner, 2009) and domestic violence (Humphreys and Thiara, 2003; Laing and Toivonen, 2010; Laing, Irwin and Toivonen, 2010) on women’s mental health. This book builds on this work and seeks to be distinctive in two main ways. First, it considers the impact of a range of different types of gendered violence and abuse on women’s mental health, particularly childhood emotional abuse, childhood sexual abuse and domestic violence. Different types of abuse often occur together (Fleming et al., 1999; Humphreys and Thiara, 2003), and are known to have more negative effects when they do (Messman-Moore and Garrigus, 2007). More significantly, though, considering the diversity of gendered violence and abuse on women’s mental health acknowledges that similar systems of social meaning and gender power relations based on male privilege frame all types of gendered violence and abuse: as such, there are likely to be some commonalities in women’s understandings and experiences of mental health problems in contexts of violence and abuse. This is not to suggest that women’s experiences are the same, because they clearly are not, situated as they are within diverse power relations including those of class, race and sexuality, and I also attend to these in addition to gender relations.

The second point of difference is that this book seeks to engage with women’s understandings and experiences of gendered violence, abuse and mental health at a number of levels. Existing feminist research in this area tends to be either post-structural or materialist and structural feminist. The former tradition includes feminist scholarship into child sexual abuse and mental health (O’Dell, 2003; Warner, 2009) while the latter includes feminist attention to domestic violence and mental health (Humphreys and Thiara, 2003; Laing and Toivonen, 2010). As such, feminist work on child sexual abuse considers how gendered social discourses frame women’s understandings and experiences and takes a critical approach to the dominance of pathologising psycho-medical discourses in this area. The more materialist approaches to domestic violence and mental health tend to centre unequal gender and other social power relations and women’s own voices of their lived experiences. These different emphases to some extent reflect the different disciplinary backgrounds of the respective researchers, with many of the feminists who focus on child sexual abuse emanating from critical psychology, while feminists researching domestic violence often hail from social work, as I do myself. In the three research studies that represent the basis for most of this book, I attempt to navigate both the discursive and the material dimensions of women’s understandings and experiences of gendered violence, abuse and mental health. In order to do this, I adopt McNay’s (2004) concept of situated intersubjectivity, which understands the discursive aspects of identity and everyday intersubjective material power relations as inherently intertwined. McNay (2004) argues that the concept of situated intersubjectivity is a useful corrective to the individualising tendencies of post-structuralism because it explicitly embeds the subject in social relations, but also counteracts a materialist tendency to prioritise structures over experience by emphasising intention and agency on the part of the subject. Situated intersubjectivity is therefore a useful theoretical frame for researching women’s understandings and experiences of emotional distress in the context of violent and abusive social relations of gender because it enables attention to social discourses, women’s agency, the material impact of abuse on women’s bodies and emotions, and the structural power relations these are embedded within. However, attending to these different threads simultaneously is not straightforward, and I consider some of the challenges associated with this in the following chapters.

Taking a gender perspective

Child sexual abuse and domestic violence are widely understood to be gendered experiences because women and girls are so disproportionately affected, and males are overwhelmingly the perpetrators. Thus, it is hardly radical to assert that these problems are gendered. However, to include childhood emotional abuse as a gendered form of abuse is more unusual. My interests in childhood emotional abuse initially arose from work as a feminist social worker in women’s health. More recent emerging quantitative evidence reveals that childhood emotional abuse is the most common form of child abuse (Australian Institute of Health and Welfare (AIHW), 2014; Stoltenborgh, 2012) and it is increasingly linked by researchers to poor mental health (O’Dougherty Wright et al., 2009), even more strongly than for other forms of abuse (Schneider et al., 2007; O’Dougherty Wright et al., 2009). There is also some evidence that childhood emotional abuse is more commonly reported by women and girls (Cawson et al., 2000; Scher et al., 2004). However, understanding the gendered dimensions of non-sexual forms of abuse needs to extend beyond counts of who is abusing who to situate the phenomenon in its wider gendered social context (May-Chahal, 2006). The feminist research presented in this book on childhood emotional abuse therefore represents the first attempt to examine how gender discourses, practices and power relations frame this type of abuse.

I need to point out, though, that none of the research undertaken for this book is concerned with contributing to evidence about the causative links between abuse and particular categories of mental illness: the research presented here is qualitative and therefore cannot, and does not seek to, prove or disprove causation. Moreover, while the question of causation remains contested and even controversial for some, strong associations between gendered violence, abuse and mental health problems have already been demonstrated through quantitative research. On the basis of this, it has been estimated that childhood sexual abuse increases an individual’s risk of common mental health problems by as much as four times (Briere and Elliot, 1994). This does not mean that all people with mental health problems have been abused or that all people who are abused will experience mental health problems. Nor does it mean that abuse is the only ‘causative factor’ for mental health problems in individuals who have experienced abuse. What it does mean is that abuse substantially increases a person’s chances of experiencing mental health problems. Rather than causation, what this book is concerned with is how experiences of gendered violence and abuse are understood, lived and responded to. Mental health problems continue to be predominantly explained through medical and psychological theories and practices that pathologise the abused individual (and the perpetrator, too) as damaged and dysfunctional, largely ignoring the social contexts of abuse. Instead, this book explores the social dimensions of gendered violence and abuse, and its impact on emotional wellbeing. This includes how social power relations not only help to determine who gets abused, how and by who, but how these relations become deeply inscribed in the specific emotional and psychological dimensions of mental illnesses. Thus, I locate mental illness and its emotional distress in social relationships (Tew, 2008) rather than inside individuals alone, and therefore in the discourses, power relations and practices that structure these relationships.

Situating myself in feminism

During my social work studies in the early 1980s, along with many of my fellow students, I discovered feminism. For me, feminism was the foundational knowledge that enabled the naming of gender power relations and the difficulties experienced by women that seemed to flow from them. My honours-level thesis was on domestic violence and I went on to work as a social worker in women’s health and then community health. I became particularly interested in gender and mental health during this period, struck by how commonly experiences of gendered violence and abuse appeared as the backdrop to women’s struggles with anxiety, depression, eating disorders and more general feelings of low self-worth. When I came to do a PhD, I chose to focus on eating disorders because they seemed to demonstrate particularly well how gender discourses and practices can play out in so-called mental illness. I was especially fascinated by how psychiatry continued to reproduce pathologising, individualistic understandings and paternalistic treatments in spite of evidence that their approaches were out of step with women’s lived experiences and more often than not failed to bring about recovery (Moulding, 2003, 2006). However, as my research in this area progressed, I became increasingly aware of the spectre of violence and abuse once again in the backgrounds of many (not all) of the women I interviewed. And so I found that I had come full circle in confronting the impact of violence and abuse in women’s lives. However, feminist theorising, research and practice had changed enormously since the 1980s. While earlier feminist scholarship into both gendered violence and mental health was materialist and structuralist, post-structural feminism has enabled us to ask different questions and gain new insights into the complexities of gender discourses and mental health without losing sight of the social structures of male privilege in which women and children live. More recently, many feminists are now grappling with the challenge of uniting concerns over the discursive dimensions of women’s experience with their basis in material, structural gender power relations of male privilege (see McNay, 2004), and this book attempts to take up this challenge.

Outline of the book

The book is based on three research studies into gendered violence, abuse and mental health. In Chapter 2, I map existing understandings of the links between abuse and mental illness in the psycho-medical literature and contrast this with feminist research and scholarship on gendered violence, abuse and mental health. In Chapter 3, I explain further my theoretical and methodological approach to undertaking research into gendered violence, abuse and mental health, elaborating the feminist theoretical frame adopted for this research and outlining the methods used for the three studies. The subsequent chapters then present and discuss key findings from the three studies.

In the first study, which is presented in Chapter 4, I focus on childhood emotional abuse because, as noted earlier, it has not been studied by feminist scholars but has been linked the most strongly with mental health problems. This study therefore asked how gender (and race and class) frames childhood emotional abuse and, in turn, how it frames the subsequent mental health problems experienced by individuals.

For the second study, presented in Chapter 5, I focused on eating disorders as illustrative of a mental health problem that is not only strongly associated with abuse but is overwhelmingly diagnosed in women rather than men. Women diagnosed with eating disorders have been deeply pathologised in highly gendered ways within psycho-medicine (Moulding, 2003, 2006) and this study asked how experiences of violence and abuse might play out in the particular symptomologies associated with these conditions, and the social contexts and social meanings framing this.

Chapter 6 explores women’s narratives and experiences of mental health problems in response to domestic violence. The chapter examines how women construct the impact of domestic violence on their sense of themselves, their identities and emotions, and critically explores medical and psychological discourses commonly used in this area. In different ways, Chapters 4, 5 and 6 demonstrate how women’s emotional distress in response to gendered violence and abuse is framed by gendered discourses that involve fundamental contradictions about femininity and selfhood, which are also reproduced in the dominant psycho-medical discourses applied to understanding women’s mental health. Chapter 7 then considers the scope for feminist-informed intervention, both in terms of therapeutic interventions and prevention.

The development of appropriate responses to mental health problems in contexts of violence and abuse first involves taking a critical perspective on received wisdoms about how these experiences have been understood. The following chapter specifically explores the role of psycho-medical theory and research in individualising and pathologising mental health problems in contexts of abuse, followed by attention to feminist approaches that bring new understandings of women’s experiences beyond the narrow view of mainstream research.

References

Australian Institute of Health and Welfare (AIHW) (2014) Child Protection Australia 2012–2013. Canberra: Australian Government. Available at: www.aihw.gov.au/publication-detail/?id=60129547965, accessed 22 April 2015.

Briere, J. and Elliot, D.M. (1994) Immediate and long-term impacts of child sexual abuse, The Future of Children: Sexual Abuse of Children, 4(2), pp. 54–69.

Cawson, P., Wattam, C., Brooker, C. and Kelly, G. (2000) Child Maltreatment in the United Kingdom: A Study of the Prevalence of Child Abuse and Neglect. London: NSPCC.

Fleming, J., Mullen, P.E., Sibthorne, B. and Gammer, G. (1999) The long-term impact of child sexual abuse in Australian women, Child Abuse & Neglect, 23(2), pp. 145–159.

Humphreys, C. and Thiara, R. (2003) Mental health and domestic violence: ‘I call it symptoms of abuse’, British Journal of Social Work, 33(2), pp. 209–226.

Laing, L. and Toivonen, C. (2010) Evaluation of the Domestic Violence and Mental Health Pilot Project. Faculty of Education and Social Work, University of Sydney.

Laing, L., Irwin, J. and Toivonen, C. (2010) Women’s stories of collaboration between domestic violence and mental health services, Communities, Children and Families Australia, 5 (2), pp. 18–30.

McNay, L. (2004) Situated intersubjectivity. In B. Marshall and A. Witz (eds), Engendering the Social: Feminist Encounters with Sociological Theory. Maidenhead: Open University Press, pp. 171–186.

May-Chahal, C. (2006) Gender and child maltreatment: the evidence base, Social Work and Society, 4(1), pp. 53–68.

Messman-Moore, T.L. and Garrigus, A.S. (2007) The association of child abuse and eating disorder symptomatology: the importance of multiple forms of abuse and revictimization, ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Acknowledgements
• 1 Introduction: an interconnected approach
• 2 Putting gender in the frame
• 3 Researching gendered violence, abuse and mental health
• 4 Childhood emotional abuse: engendering selves, engendering bodies
• 5 Pleasure and pain: the management of abuse-related emotion in eating disorders
• 6 Domestic violence and emotional wellbeing
• 7 Putting abuse in its place: living well and challenging community denial
• 8 Final comments
• Index