Addiction

Case 16

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Domestic Violence in First Nations People on the Vancouver Downtown Eastside and its Connection to the Highway of Tears

Objective:  To illustrate an all too common scenario of domestic and sexual violence involving the First Nations people in Canada.

Narrative Case

Yvonne was a 15 year old First Nations teenager from the Niiska nation in the
province of British Columbia in Canada. She was born on a First Nations reserve
where she was raised in a family where violence was the norm [1]. Her mother and father married at 16 years of age and had six living children and several miscarriages [2].  Her mother was an alcoholic and found it difficult to cope with the duties of motherhood and being a housewife.  She also had tremendous guilt as two of her children had been diagnosed with fetal alcohol syndrome and were extremely difficult to handle. Her father was a labourer and was often away from home working in the oil and gas industry in other parts of the province. When he did come home, he introduced his wife to cocaine, the habit of which he had acquired whilst away [3].  As soon as they were together, there were episodes of verbal abuse often followed by her father beating her mother [4].
 As the oldest of the six living children, Yvonne often took on the responsibility for her younger siblings [5]. She frequently had to miss school as she had to look after the house and her brothers and sisters.


 At age 14 years, her best friend, Brenda, urged her to move  with her to Vancouver. Brenda’s older sister had moved there a year ago and was making a good living as a waitress. The older sister said she could get them a similar job if they came
down and they could share her accommodation until they had money of their own.
 It was hard for Yvonne to tell her mother that she was going to leave, but felt
so hopeless that she thought this would be a chance to get away from her present life which was so miserable [6].


 Soon after arriving in Vancouver, Yvonne and Brenda found that things were not
as rosy as Brenda’s sister had promised. The sister’s accommodation consisted of a room with a single bed and a hot plate in a converted old hotel in the Downtown Eastside that the government had provided for those in dire need. The sister’s waitressing job had ended when she repeatedly missed work due to being hung over from using alcohol and drugs the night before. The sister had been befriended by this nice guy who turned out to be a pimp [7]. He kept the sister on drugs.
 Yvonne and Brenda could not find work and without work they could not afford to leave the sister’s accommodation. The pimp soon had them working for him as well.
 One day, Yvonne decided that she must leave and return home despite all the dangers in doing so.  She did not have the bus fare so was planning to hitchhike back home.  She was never seen again.  Her picture appears on the list of Missing Women– Prostitutes Kidnapped and Presumed Dead while hitchhiking along the Highway of Tears [8].

 

Learning Points

[1] Research indicates that males exposed to domestic violence as children are more likely to engage in domestic violence as adults; similarly, females are more likely to be victims.

[2]  Girls who marry before 18 years are more likely to experience domestic violence than their peers who marry later. Child brides often show signs symptomatic of sexual abuse and post-traumatic stress such as feelings of hopelessness, helplessness and severe depression.

[3] Women who have been abused are fifteen times more likely to abuse alcohol and nine times more likely to abuse drugs than women who have not been abused.

[4]  This is a typical pattern in Domestic Violence: alcohol and/or drug abuse leads to fighting and then reconciliation.  In many cultures a woman had little option but to endure the situation since leaving the man may make her more stigmatized or vulnerable or she may have no economic support without him.

[5]  Female children especially become ‘parentified’, taking on the role of ‘little mother’ in the household.  This pattern of caring for others – no matter how dysfunctional or even abusive they are – becomes entrenched and is repeated in adult life. Generally it is reinforced by cultural prescriptions of appropriate female roles and behaviours.

[6] Most people with this profile are running away from impoverished and/or neglectful and/or abusive families.  They are impulsive and aggressive – they have a fragile sense of self worth and cultural mores of masculinity may dictate that they not acknowledge this fragility but rather that they express aggressive and challenging behaviours.

[7] Adolescent girls who have been abused and neglected are easily attracted to a man who seems able to take care of them and offer protection.  There was also the social imperative that she be attached to a man – in most cultures this is necessary to provide a woman with status and with ‘protection’. In some cultures a woman has no social and/or economic option but to remain with her male partner.

[8] First Nations women disappear while hitchhiking along the Highway of Tears and are never found again.  The communities along the highway share a situation of colonization resulting in experiences of poverty, violence, cultural genocide, residential school impacts, addictions and displacement from land.  In 206 there was a Symposium to raise public awareness and create a call for action.  To see the full Highway of Tears Symposium Recommendations Report, please click here.

Background Information on Domestic Violence

Child marriage directly threatens the health and well-being of girls: complications from pregnancy and childbirth are the main cause of death among adolescent girls aged 15-19 years in developing countries. Girls aged 15 to 20 are twice as likely to die in childbirth as those in their 20s, and girls under the age of 15 are five times as likely to die.

Women who have been abused are fifteen times more likely to abuse alcohol and nine times more likely to abuse drugs than women who have not been abused.  The American Department of Justice, in 2002, found that 36% of victims in domestic violenceprograms also had substance abuse problems.

In a report from Statistics Canada on violent victimisation of Aboriginal women in 2009, 15% of Aboriginal women reported being a victim of spousal violence in the preceding five years compared with 6% of non-Aboriginal women, and 59% were more likely to report injury than the 41% of non-Aboriginal women.

From 1989 to 2006 nine young women went missing or were found murdered along the 724 kilometre length of highway 16 – now commonly referred to as the Highway of Tears. All but one of these victims were Aboriginal women.

First Nations women are overrepresented in prostitution, with an especially high number of Canadian youth in prostitution from First Nations.

 

References

  1.  Library and Archives Canada Cataloguing in Publication British Columbia. Missing Women Commission of Inquiry Forsaken [electronic resource] : the report of the Missing Women  Commission of Inquiry / Wally T. Oppal, Commissioner. Complete contents: Vol. I. The women, their lives and the framework of inquiry,  setting the context for understanding and change – v. II. Nobodies, how and why we  failed the missing and murdered women – v. III. Gone, but not forgotten, building the  women’s legacy of safety together – v. IV. The Commission’s process. – Executive summary. Issued also in printed form Includes bibliographical references. ISBN 978-0-9917299-7-5
  2. Serial murder investigation–British Columbia. 2. Missing persons–Investigation
  3. –British Columbia. 3. Murder victims–British Columbia. 4. Pickton, Robert
  4. William. 5. British Columbia. Missing Women Commission of Inquiry.
  5. Downtown-Eastside (Vancouver, B.C.). 7. Governmental investigations–British
  6. Columbia. I. Oppal, Wallace T II. Title.
  7. HV6762 B75 B75 2012 363.25’9523209711 C2012-980202-6
  8. http://highwayoftears.org/about-us/highway-of-tears
  9. http://highwayoftears.org/uploads/Highway%20of%20Tears%20Symposium%20Recommendations%20Report%20-%20January%202013.pdf
  10.  Child Marriage
  11. http://www.hrw.org/news/2013/06/14/q-child-marriage-and-violations-girls-rights
  12. http://www.icrw.org/child-marriage-facts-and-figures
  13. http://wcd.nic.in/childact/draftmarrige.pdf
  14. http://en.wikipedia.org/wiki/Child_marriage
  15. http://www.unicef.in/documents/childmarriage.pdf
  16. http://greaterkashmir.com/news/2011/Mar/29/the-practice-of-child-marriage-6.asp
  17. http://www.icrw.org/files/images/Child-Marriage-Fact-Sheet-Domestic-Violence.pdf
  18.  Violent victimization of Aboriginal women in the Canadian provinces, 2009
  19. http://www.statcan.gc.ca/pub/85-002-x/2011001/article/11439-eng.htm
  20. Report on Violence Against Women, Mental Health and Substance Abuse by Canadian Women’s Foundation.
  21. http://www.canadianwomen.org/sites/canadianwomen.org/files/PDF%20-%20VP%20Resources%20-%20BCSTH%20CWF%20Report_Final_2011_%20Mental%20Health_Substance%20use.pdf
  22.  Prostitution of Indigenous Women:  Sex Inequality and the colonization of Canada’s First Nations Women
  23. http://www.rapereliefshelter.bc.ca/learn/resources/prostitution-indigenous-women-sex-inequality-and-colonization-canadas-first-nations-

Case 12

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Children are at serious risk in households where there is domestic violence

Objectives

  1. To show how children who live in households where there is domestic violence are seriously at risk and need child protection.
  2. To illustrate how parents can manipulate health care professionals and deliberately set out to deceive them
  3. To demonstrate the need for all agencies involved with children to share information and to ensure it is formally documented.

Narrative Case

This case is about Daniel a 4 year old boy and his 27-year-old-mother Ms. Luscak, who has had four different partners and did not seem able to detect abusive relationships or learn from past experiences [1]. This was made worse by her alcohol misuse [2] and occasional violence towards her partners. Originally from Poland she spoke little English [3].

Daniel had 2 siblings, a 7 year old sister Anna by her first partner, and a 1 year old brother Adam by her fourth partner, Mr. A.  On 27 different occasions, the police were called to domestic violence incidents often complicated by both parents being drunk [4]. On 2 occasions Daniel’s mum took overdoses with the intention of committing suicide [5]. She suffered a number of serious incidents with partners including attempted strangulation, being threatened with a knife, suffering a hand fracture and rape allegations. When asked to press charges she withdrew her statements [6]. On numerous occasions the children were judged not to be at risk and left with the parents with sometimes children’s social care not being informed [7]. The family moved house on a number of occasions due to inability to pay the rent [8].

When pregnant with Adam, Mr. A urged Ms. Luscak to have a termination. She missed 4 antenatal appointments. At one stage she was hospitalised and Mr. A took the drip out of her arm and she self discharged. Ms. L phoned the midwife and told her there was  domestic violence, despite previously denying this fact to healthcare professionals [9].

In January 2011 Daniel had a spiral fracture to the left arm [10] reported as due to jumping off the settee with his sister the previous day. Bruises on his shoulder and lower tummy were said by his mother to be due to falling off his bike regularly. Meetings of health care professionals took place but the long history of domestic violence was not considered.[8] In September 2011, Daniel started school. There were frequent absences as for his sister Anna. On a number of occasions different members of staff noticed injuries including black bruises around the eyes, blood spots on the face, severe marks on the nose, spot bruises on the neck and forehead bruising.  They also became concerned as Daniel was getting markedly thinner and always seemed hungry, taking food from lunchboxes and rubbish bins. [11 ]His sister Anna was told by Ms L to say that Daniel had this pattern of behaviour at home, ate more food than she did and was constantly falling over. Daniel had poor English and although a cooperative boy was shy and reserved and did not talk to the teachers.

Daniel saw a Paediatrician in February 2012 who was unaware of the school’s concerns.  His mother was very convincing that Daniel had an eating disorder and fell over a lot. Tests for medical conditions were initiated.  Three weeks later Daniel died. At post-mortem he was found to have high sodium levels and over 40 injuries including an acute subdural haematoma and an older smaller one.  His mother and stepfather have been convicted of Daniel’s murder and his 2 siblings are in foster care. Daniel had been subject to the most appalling abuse including being starved at home, fed salt to make him sick if school said he had taken food, put in cold baths nearly drowning on one occasion, locked in a box room with the handle taken off the door, had a soiled mattress and urine soaked carpet. He had physical punishments given by his stepfather of situps for 1 hour, standing in the corner, squats and running on the spot which were planned in advance. He had no toys.[12] His sister Anna had tried to protect him as much as possible including physically. She confirmed that Daniel had been hit “many,many times” by the stepfather.

 

Learning Points

[1] Children in households with domestic violence are at serious risk and must be thought about carefully. There is a strong association between witnessing DV and severe PTSD symptoms: withdrawal, clinging, regressive behaviour, hyperactivity, aggression, difficulties in concentration (Kilpatrick et al, 1997).  Child witnesses are much more likely to grow up to be either victims (females) or perpetrators (males).

[2] This is a typical pattern in DV: alcohol and/or drug abuse leads to fighting and then reconciliation.  Often the man feels overcome with remorse after beating the woman and there are pleas for forgiveness, promises to reform, lovemaking and then further cycles. The perpetrator is often very loving and repentant following a violent outburst and this intensifies the partner’s attachment to him.

[3] Abuse of children is more prevalent in socially isolated or disadvantaged families, with alcohol and drug abuse and with domestic violence. This case has all these risk factors including the mother speaking little English.

[4] Every minute in the UK, the police receive a call from the public for assistance for domestic violence. This leads to police receiving an estimated 1,300 calls each day or over 570,000 each year.  However, only 23-35% of incidents of domestic violence are reported to the police.

[5]  Domestic violence commonly results in self-harm and attempted suicide.  Abused women are five times more likely to attempt suicide and one third of all female suicide attempts can be attributed to current or past experience of domestic violence.

[6] The low rate of conviction in cases of domestic violence can be attributed to the victim’s inability or unwillingness to give evidence (Cretney and Davis 1995).

[7] Interagency communication is vital and children’s social care should always be informed. In all the landmark cases in recent years in the UK, there has been lack of communication between agencies (Lord Laming 2003).

[8] Moving house several times is a typical pattern seen and the mother may lose all her possessions

[9] Domestic violence increases during a pregnancy and is the commonest cause of injury in pregnant women. Men often feel threatened by the prospect of having a child – economically they have little to offer and emotionally it means one more person to be cared for. This intensifies the man’s feelings of worthlessness and he defends against this by being more angry and violent. Bacchus (2004) reported 23% of women receiving care on antenatal and postnatal wards had a lifetime experience of domestic violence, and 3% had experienced violence in the current pregnancy.

[10] The possibility of abuse needs to be considered with spiral fractures and a judgment made as to whether the suggested mechanism of injury is plausible. In this case the issue was not considering other red flags i.e. the bruises on the abdomen which are unusual and for which there needs to be a clear explanation and the history of domestic violence.

[11] This eating behaviour is grossly abnormal and needed communicating to health care professional eg school nurse or general practitioner. Again there is lack of communication between different professionals.

[12] Health care professionals need to be able to “think the unthinkable” – this is a catalogue of abuse which if this was not a real case many would think was not possible

Background information

Background information on domestic violence

This is defined as abuse between persons in an intimate relationship, independent of gender, sexuality or marital status.  The term usually excludes abuse of children and the elderly.

Prevalence:

  • One incident of domestic violence is reported to the police every minute in the UK
  • On average, 2 women a week are killed by a current or former male partner.
  • 23% of women experience DV in their relationships at some time.
  • 45% female homicide victims are murdered by their partners. (Australian Bureau of Statistics: Women’s safety survey, 1996.) Women presenting to ER (Australian study)
  • 49% had experienced DV, 40% in the last 12/12.
  • 25% had a history of childhood abuse plus adult DV (Roberts et al, 1998).

 

Background of risks to children of domestic violence

Unicef figures estimate that globally the number of children exposed to domestic violence is 133-275 million. This varies by country: Developed countries 4.6-11.3million,

SubSaharan Africa 34.9-38.2 million and South Asia 40.7 – 88 million. At least 750,000 children a year witness domestic violence (Department of Health UK). Estimates vary from 30%-66% children are abused either physically or sexually by the same perpetrator. Children are completely dependent on adults and all children witnessing domestic violence are being emotionally abused

Children react in various ways to living with a violent person. Age, race, sex, culture, stage of development, and individual personality affect response. Children can be affected by tension, witnessing arguments, distressing behaviour or assaults. They may get caught in the middle of an incident, sometimes trying to make the violence stop; they may be in another room but be able to hear the abuse or see their mother’s physical injuries following an incident of violence; or they may be forced to take part in verbally abusing the victim. They experience a range of emotions including that they are to blame, anger, guilt, being alone, frightened, powerless, or confused. They may have ambivalent feelings, both towards the abuser, and towards the non-abusing parent.

Effects of domestic violence on children include:

    • Anxiety and depression
    • Difficulty sleeping.
    • Nightmares or flashbacks.
    • Physical symptoms such as headaches and abdominal pain
    • Enuresis
    • Temper tantrums
    • Behave as though they are much younger
    • School problems including truanting, sometimes staying at home to protect their mother
    • Aggression
    • Withdrawal from other people due to internalizing the distress
    • Lowered sense of self-worth
    • Start to use alcohol or drugs.
    • Self-harm eg overdoses or cutting themselves.
    • Develop an eating disorder.
    • Affecting social relationships – they may feel unable to or are prevented in bringing friends to the house

 

References

  1. Bacchus L, Mezey G, Bewley S, Hawort A, (2004) Prevalence of domestic violence when midwives routinely enquire in pregnancy. BJOG: An International Journal of Obstetrics & Gynaecology 111; 441-5.
  2. Cretney A, Davis G. (1995) Punishing violence. Routledge, London  
  3. Family Rights Group: www.frg.org.uk
  4. Lord Laming (2003). The Victoria Climbié Inquiry https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/273183/5730.pdf
  5. Mind ‘How to parent when you’re in crisis’. http://www.mind.org.uk
  6. Mullender, A. and Morley, R. ‘Children living with domestic violence’ (London: Whiting and Birch).
  7. Royal College of Psychiatrists (2004) ‘Mental health and growing up, 3rd edition: Domestic violence: Its effects on children’ Available from http://www.rcpsych.ac.uk/info/young.htm).
  8. NSPCC Children living with domestic abuse
  9. http://www.nspcc.org.uk/help-and-advice/worried-about-a-child/online-advice/domestic-violence/domestic-violence_wda86312.html
  10. Parentline Plus.  Support for parents under stress www.parentlineplus.org.uk
  11. Radford L, Aitken R,  Miller P, Ellis J, Roberts J, Firkic A. Meeting the needs of children living with domestic violence in London Research report. 2011 http://www.nspcc.org.uk/Inform/research/findings/domestic_violence_london_pdf_wdf85830.pdf
  12. Royal College of Psychiatrists (2004) ‘Mental health and growing up, 3rd edition: Domestic violence: Its effects on children’ Available from http://www.rcpsych.ac.uk/info/young.htm
  13. Save the Children and  Women’s Aid services.  Safe Learning – an insight into children’s experiences of domestic violence and how these may affect their learning, 2006
  14. Serious case review: Daniel Pelka http://www.coventrylscb.org.uk/dpelka.html
  15. The Hideout website
  16. http://www.thehideout.org.uk/under10/adults/effectonchildren/default.aspa
  17. UNICEF: behind Closed Doors the impact of domestic violence on children
  18. http://www.unicef.org/protection/files/BehindClosedDoors.pdf
  19. Women’s aid organization  – Statistics on Domestic Violence http://www.womensaid.org.uk/domestic_violence_topic.asp?section=0001000100220036sionTitle=statistics
  20. Women’s aid organization – Children and domestic violence http://www.womensaid.org.uk/domestic-violence-survivors-handbook.asp?section=000100010008000100380001.  

Case 7

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Honour as a Factor in Domestic Violence in India

Objectives:

  1. To demonstrate the impact that a woman’s sense of honour can have in domestic violence.
  2. To demonstrate the role of drug or alcohol abuse or addiction in domestic violence.

Narrative Case:

This is a true story of a lady aged 39 years who was my patient for many years. She was educated up to 7th Standard but did not complete high school as she was married off by her parents at the age of 17 years to a Police Constable. She had 2 children aged 19 years & 21 years, both being daughters. This did not satisfy the husband as he was keen on getting a son.

She used to come with some bruises off & on. Once she even had a fracture of the forearm. She said she had fallen. But some direct & indirect questioning led her to confess that she was facing Domestic Violence.

Her husband had become alcoholic & started an illicit relationship to fulfill his dream of getting a son. His job was with Crime Branch in the Police force & he was used to seeing violence in society. He would come home from work, get drunk & beat her up often. The girls used to get frightened but were not in a position to help. Money was in short supply as he had to support the other woman in his life.

We did a lot of counseling & called her daughters to discuss possible solutions. Her husband had never once accompanied her to a Doctor’s Clinic. The daughters denied any sexual assault by the father. They were interested in studies & getting a job & getting out of this household.  

The woman refused any sort of help. First of all, she could not make a Police case, as the husband was part of that force & had many friends. She did not want any neighbours to know & did not allow any counselor to visit their home. Her constant refrain was that she had to cope with it otherwise the daughter’s lives will be ruined. Any story of domestic violence would ruin the chances of marriage for her girls as arranged marriages are the norms in that society. Only her parents were sympathetic but they were old & sick & needed help themselves.

When last seen, she had become very thin & pale & developed hypertension. The violence was continuing. There was no social life with him & he was not interested in sex with her. He was spending more time with the other family. She was very sure for her decision to carry on. Some marriage proposals were coming for her daughters & her sole intention was to live for them. All she looked forwards to was to settle them well and see them happily married. As far as her own life she said she had no hopes for any happiness & wanted to live only for her children & to look after her old parents. She was never going to consider divorce or separation & come out openly with her life story. Rather than that “dishonour” she would rather die in one of the violent episodes.

Learning points:

This story brings out 3 issues.

  1. Some women refuse any help. For them it is a question of honour. They feel too ashamed to let others know about violence. They cannot accept being socially ostracized. Family support is not there if parents are old and poor.
  2. Secondly, we put so much faith in the Police Force. They are sensitized to issues of domestic violence. But they come from the same social background. Because they deal with crime and acts of violence, they are susceptible to alcoholism. This in turn makes them take out their frustrations at home. Counseling in such cases becomes extremely difficult. If this case had been registered against this constable he would certainly have lost his job & the family would have lost everything.
  3. Finally, addiction to alcohol is prevalent worldwide. It is the under lying cause in many cases of domestic violence. In India, there is Prohibition & alcohol sale is regulated. However, it has not reduced alcoholism since the laws were enacted 67 years ago.

Background Information:

This article highlights the high prevalence of violence against women in India, including a review of some cultural aspects of this violence:

http://www.trust.org/item/20141110100628-ax25b/?source=dpMostPopular

References:

  1. This article discusses son preference in India: http://www.trust.org/item/20141110100628-ax25b/?source=dpMostPopular
  2. This is a reference for drug and alcohol abuse and addiction in India: http://www.trust.org/item/20141110100628-ax25b/?source=dpMostPopular

Case 5

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Domestic violence leading to death by so-­called accident

Objectives

  1.   To show how detected but denied physical violence can lead to fatality.
  2.   To  show  how  law-­‐enforcement  and  hospital  staff  can  be  better  trained  to  pick  up on these cases and have better (legal) tools to intervene on time.

Narrative Case

A divorced woman of approximately 39 years (Sonia) with a daughter from her marriage goes to live with her new boyfriend. She was a clerk in a hospital and regularly came to work with cuts and bruises. Clearly they were from physical abuse but she insisted that they were the product of accidents and slip-­‐ups by her. In addition, she began to be drawn into the alcohol abuse perpetuated by her boyfriend. Possibly she did the latter to make the physical abuse less dreadful for her to undergo. In any case she never had the courage to get away from him. One day, upon not arriving at work, the police were dispatched to her home where she was found dead at the bottom of the stairs. The boyfriend said she fell while drunk and he didn’t find her until he himself was woken by police, as he was sleeping off his drunken stupor. The case was concurrently dismissed by prosecutors because of lack of evidence, although many believe it was at least manslaughter by the boyfriend.

Learning Points

[1]  Sometimes  the  obvious  should  lead  to  investigation,  even  if  the  party  involved denies wrongdoing, or covers up wrongdoing by their partner

[2] More  specific  training  could  be  given  to  law enforcement  and  or  hospital staff  to detect abuse sooner and be able to intervene more quickly.