Domestic violence is independent of education, economic situation, social class or culture

Objectives

1.  To show that domestic violence is independent of education, economic situation, social class or culture.
2.  To show that emotional abuse is often a precursor to serious acts of physical abuse.

Narrative Case

Dr. Bob Smith is a general surgeon and his wife, Dr. Carol Jones, is a general practitioner, both practising in an urban setting.  They have been in practice for ten years. They met in medical school and married in their first year of residency.  They have two children, ages 5 and 7.  [1]

Carol took three weeks off on maternity leave with each child, as her practice was still relatively new at that time and she did not feel she could take the year maternity leave that many of her friends in salaried positions could take. [2]

Things are not going well. Bob is on call every second night since the third general surgeon left for the States last year and the hospital has not been able to attract another surgeon.  He is so tired that he wonders at the completion of some surgeries whether he has done his best.  He is currently in the middle of a legal suit, which is taking so much of his time.  He finds that if he comes home at night and drinks vodka, he feels much more relaxed and yet does not have to worry about the smell of alcohol on his breath if he should get called back. [3] He does not want to seek help in case word of his difficulties negatively influences his medical practice.

Carol is becoming increasingly stressed as well.  Her office is always overbooked, as she has had to cut down to 3 days of office work, to be able to take care of the needs of the children.  She still has the office overhead to contend with, but not the volume of patients to justify the costs.  She is feeling more like a single parent, running the two children to lessons and sports by herself as Bob is always either at the office or the hospital.

On one particularly tiring day, Carol comes home after the children’s swimming lesson to find Bob drunk and asleep on the couch.  After putting the children to bed, Carol awakens Bob and confronts him with his increasing use of alcohol and withdrawal from family duties.  Bob is so angry that he hits Carol and blackens her eye.

At the office the next day, Carol makes up an excuse about a household injury to explain her black eye.  She realizes that Bob is a good husband and that the stress of work, the current litigation, both coupled with alcohol, brought out this atypical behaviour. [4]

After repeated episodes of physical abuse, their relationship deteriorates and Carol tells Bob that she is going to leave him and take the children.  Bob pleads for Carol to go to joint counselling, as he has not been himself and really does love them all.

Carol does not have much hope for success from the counselling, but feels guilty about leaving, so she gives counselling a try.  The female counsellor feels threatened dealing with two physicians.  After six sessions, nothing is resolved and Carol makes plans to leave with the children. [5]

Bob finishes his court case and is found guilty of malpractice.  He wonders what is the point in living—his reputation as a surgeon is tarnished, his wife and children are leaving him and he is exhausted and overworked.  He goes home and drinks.  When he hears Carol and the children driving into the garage, he picks up his hunting rifle, killing them and then turning it on himself. [6]

Learning points

[1] Medical marriages are often difficult.  The woman often has to take second place to her husband in career choice and academic advancement.

[2] Women physicians often have an excessive sense of commitment to make their work successful, just to show that they are capable of “having it all”-career, family, husband, etc.

[3] Bob realizes that he is not coping but as a physician and leader in the community does not want to let anyone know that he needs any help.  He turns to substance abuse.

[4]   Despite having counselled patients against staying in a relationship where there has been physical abuse, Carol makes excuses for Bob’s behaviour.

[5]  Being in a position of authority when seeking personal help is not always an advantage.  The male often presents a more threatening figure than the female and this may affect the performance of the caregiver and consequently the outcome.

[6]  Accustomed to being in control and being an authority figure, Bob cannot cope with all these loses and having humbled himself to go to counselling and that failing, he decides that there is only one alternative.  He struggles with feeling powerless in a society that tells him he should be powerful, with the seeming lack of options and with the socialization that has taught him not to seek help.  All this translates into violence against his female partner