World Health Organization, Copenhagen 1997.
" European Strategies to Combat Violence Against Women"
Violence against women and mental health
E. Reale, V. Sardelli
its unlimited burden of work and responsibility , is the
first factor risk of mental illness for women
The second risk factor is the violent pressures exerted by the
social and family environment.
are various kinds of family contexts and in most of them women are judged,
diminished and subjected to all sorts of pressures, included violence.
is the most typical instrument of pressure on women; it can assume various form
violence in the form of rape;
violence, threats and bowls;
and psychological violence (insults, depreciation and denial of autonomy).
takes place more frequently outside
the family environment, in connection with external relationships.
and psychological violence take place more frequently within family environment.
shall now consider family violence performed by male figures in order to point
out its link with mental health.
the family, the woman is subjected to verbal and psychological violence
consisting in abuses and critical judgments which tend to reduce her autonomy
and self-confidence, making her more available to others at the same time.
is not by chance that insults always refer to what she hasn't done - or to what
she hasn't done well - in order to be considered and physical violence make her
question her possible faults; she is therefore induced to suffer and accept
anything and to wonder: "maybe i have deserved it, it is my fault if this
has happened, maybe i should have behaved better".
combined with a sense of guilt and a feeling of being responsible, at first
prevents her from considering it as an unfair action and behaviour, as a serious
violation of her right, as an assault to her liberty and dignity.
denigration and insults form a powerful and specific risk factor for depression:
a depressed woman is a woman who has lost her self-confidence, who no more
trusts her capacity of being autonomous, who continuously questions herself and
her actions, who feels responsible for everything even when she is the abused
and beaten victim.
the burden of work is - as we have seen - a powerful element of stress for the
woman's general health, the lack of positive criticism, the erosion of her
self-esteem, the use of violence as a form of pressure in everyday life are
specific risk factors for depression.
do not take into consideration that their tiredness depends on their being
overburdened. Moreover, they can find no support nor understanding in the social
and family context; in fact, their tiredness will easily be dismissed with
comments such as: "You do not work, you do nothing; then, why do you feel
they are tired, women tend to reduce their work, to give up the tasks connected
to their female role, and sometimes to ask for help, support and understanding.
behaviour creates a conflict between the woman and her partner and context, and
it often produces violence as a form to force her back into her role and into
the burden of work she is required to cope with by other people's needs.
insults, the physical and verbal violence are present as caused by inadequacy
of women to female model. When the woman identifies
herself with that point of view ("I am inadequate"), she cannot react
to violence, she cannot even recognize it as such, she hides it to others
because she feels guilty. When woman is involved in violence and believes that
she has provoked it, she feels ashamed and hides herself to others. Many times
the so-called 'domestic accidents'
tend to hide an experience of violence. 70 per cent of women who need to go
to hospital as a consequence of "domestic accidents" do not declare
the real cause, that is that they have suffered violence from their partner.
are often advised by relatives to hide violence because the punishment of a
violent partner could have serious consequences for the children (a financial
and affective loss).
Let's now have a closer look on the effects that a denied and hidden
violence can have on women and their life.
times the woman continues her relationship with the violent man and submit
herself to his requests and behaviours; as a consequence:
- she feels
despised and worthless;
- she is
forced to increase her tasks or to cope with unpleasant tasks, conforming
herself to her partner's desires and orders;
- she tends
to limit, even to cancel her own needs.
is therefore the result of the powerful combination of all these risk factors:
1. an increase of the
burden of family duties;
2. a reduction or total
loss of personal interests and spaces;
3. a reduction or total
loss of external relationships (the woman has less time to spend outside the
family and, above all, she would feel ashamed in telling other people what she
is forced to suffer at home);
4. the failure of her
personal project concerning particularly the sentimental side of her life (an
aspect which is of great importance to women) and the painful disillusion of all
her expectations in love, support, trust and understanding from her partner;
or total loss of her self-esteem; at the same time she tends to feel responsible
and guilty to the way she is treated and judged: "nobody appreciates and
acknowledges what I do, I am unable to make myself respected... it is all my
fault, I am a total failure, I am hopeless";
6. negative judgments and strong pressures coming from the family context;
7. an increase of
feelings such as tiredness, lack of motivation, anxiety, uncertainty and fear
for the future.
these seven factors
(excess burden of work, restriction on personal
interests and activities, restriction of external relationships, failure of
personal plan, subjective perception of inadequacy, negatives judgments of the
familial context, the increase of physical ailments)
the perception of being unable to cope which that kind of situation, the feeling
of being unable to put up with it, combined with the awareness of being unable
to modify that situation (in those
cases in which the woman has already made an unsuccessful attempt to change),
all these perceptions lead the woman towards mental illness and depression.
feelings of tiredness fear and anxiety eventually lose their connection with the
unbearable condition of life that the woman considers unchangeable and against
which she has given up any attempt to fight; those feelings, then, become
symptoms, that is signs of an illness and a discomfort totally disconnected from
the woman's life with her burdens and sufferings.
Most cases of female depression refer to women who feel guilty for having
been insulted or assaulted.
and Psychiatry constitute an additional risk factor for women's mental health because
often doctors cannot understand the
reasons behind tiredness, fear, lack of motivation, sadness, lack of
self-confidence, and they can only confirm or certify to the woman that she
suffers from depression and anxiety, thus hiding and silencing the real reasons
of malaise and distress. These are linked to the female daily life and to the
oppression of the female role. The suffering
is then converted into pathology
which prevents the recognition of its real nature and makes the change of the
woman's life-style impossible.
and Psychiatry as they still are today are obviously inadequate and cannot
support women properly. The requests of women using mental health services have
no priority whatsoever; moreover, the services provided are inadequate to the
women's needs and their private lives is taken in no consideration. Women with
mental health problems more often turn to General Practitioners; they are more
frequently admitted to psychiatric hospitals, are twice as liable to get a
diagnosis of depression and anxiety, and are three times more likely to be
experience, as psychologists and clinical researchers, suggests that:
is then necessary to plan of health precautions (sanitary preventive
intervention) aiming to reveal the real problems hidden behind the symptoms, the
true nature of those sufferings diagnosed as psychic troubles.
preventive intervention must to
take in proper consideration:
overload connected with domestic work;
violence which is often hidden behind the woman's sense of guilt;
negative criticism from the social and family context which tends to overwhelm
women's self-confidence in their own capacities;
condition of isolation in which women live depriving them of any support from
other kinds of relationships.
clinical work with an individual woman suggests the necessity of utilizing a
specific protocol of intervention which:
the woman's everyday life and her personal history, in order to find out the
presence of external impositions in her choices;
how much external requests and pressures have been exercised on her in order to
obtain certain behaviours and services;
- finds out
those capacities and resources that the woman is no more aware of;
- helps and
supports her in the difficult task of changing her life-style, by planning with
her a new kind of life of which she is the centre and where she can therefore
re-affirm her rights to her own spaces, interests and personal relationships and
to new life goals.
period of clinic and psychological support to the woman considers, when
necessary, the possibility of her departure from the place where she usually
these cases it is necessary to bring to the surface the sense of guilt - which
can be rooted in previous cases of mothers who were also victims - and gradually
lead the woman to the recognition not only of the external violence but also of
her own image as a beaten, humbled woman and as a loser.
the cases of depressed women, their tale of violence comes out after some time
and it is as if they saw it for the first time; this is very painful and they
refuse to accept it, considering it their own fault and failure and thus
becoming, unintentionally, accomplices of (collusive with) the violent man.
unintentional complicity between the woman and her torturer, caused by a
mistaken concept of the female role as it is generally affirmed in the social
context, provokes an increase in violence itself. The violent man experiences in
person (in addition to what the traditional models have taught him) that there
is no opposition nor rebellion and that violence "pays".
other kind of situation this intervention has to consider is that of women
traumatized by one single episode or act of violence.
intervention has to be adequate to face situations of women who, after an act of
violence acknowledged as much and publicly declared, worsen their usual life-
style and show anxiety and depression symptoms which tend to last for some time.
experience in these cases is that one single violence, apart from its traumatic
effect , can often be related to previous situations characterized by
unacknowledged violence (criticism, oppression, etc.).
exposure to violence of one or more members of the family is a strong risk
factor of psychological destabilization not only for the woman, but also for the
children, especially the daughters.
our work with adolescents results
that, in contexts which are coercive and violent, daughters (usually the eldest
ones) are led to help and support their mother, both psychologically and
materially, and/or to play the role of moderators
in conflicts between their parents.
they assume an early adult attitude by taking, a burden of responsibility too
heavy for their age and very dangerous for the psychological development of
fact, this alliance creates a sort of identification with their mother and of
adaptation to the patterns of submission and passivity which are, then,
transmitted from generation to generation.
these psychological interventions on individual woman or groups of women who
have been subjected to violence, it is necessary to plan wider interventions of
a preventive kind.
interventions must have an informative and a formative character and may be
addressed to two main categories: women who risk violence and its psychological
consequences, and health operators working in those services open to requests of
help from women.
contents of these interventions are:
modification of domestic work models in the sense of a reduction of women's
overload and a sharing of those tasks and responsibilities normally attributed
modification of the female image as an individual dependent on other people's
needs and the affirmation of a positive model of a woman who can develop her
capacities freely, without those limits imposed and referred to gender;
training to identify the risk factors of psychic illness present in woman's
everyday life; special attention must be given to the ability to face requests
and violent behaviours from the context;
training to develop situations of social and psychological self-protection, such
as keeping a net of relationships outside the family which can be the major
opponent to the condition of isolation that favours the woman's dependence on
should develop training interventions on the daily life style addressed to women
first we should inform about
certain aspects of "the crisis" surrounding the female role.
Inadequate solutions to this problem would increase the risk of mental illness.
The goal of informative approach is to arouse women awareness of:
- how to
combat stress and other pathological problems linked
to female role;
- how to
change the pattern of subordination
and dependence ;
- how the
absence of reaction to violence is linked to illness and others psychological
we should develop the formation
addressed to medical and social workers
who come into contact with women's
disturbances, in order to:
the use of psyco-pharmacological drugs;
a medical and psychological approach which explains the connection
between illness- disturbances and everyday life
(homely work and violent pressure from
the family context)
order to reach these two goals the member states should organize:
programs for the prevention addressed to housewife and female workers
exposed to the risks of violence or
mental and physical disorders (female adolescents, women under excessive burdens,
with external work as well as housework , women with small children, etc).
information can be done by seminars, follow-up courses, and other courses
addressed to women who have responsibility
in the educational,
political and work institutions;
and training courses for public health workers which should be interested in the
public expense budget and in the refresh tasks scheduling.
women suffer from unsustainable life conditions: insulation, separation,
widowhood , unemployment,
lack of economical supports , small children, etc .
others are ill anxious,
no more speak about their difficulties linked to everyday life,
nor are able to recognize oppression,
violence, fatigue and tiredness.
are proposing two types of service for these women:
The first type of service
is addressed to women who have not yet developed an illness.
are preventive services which do not aim to cure an illness, but which attend
to prevent specific situations of distress. The goals of these
consultation services of
should be the reduction of the damage brought by the subordination and
violence in everyday life.
should listen to listen women's
life problems and make
awareness, abilities, skills oriented
to problem solving arouse in women.
services could organize:
training-courses, social and psychological support-groups, etc.
Each initiative is addressed
to women with specifical problem: women who have given up working
and/or few years after, women
having difficulties in social relationships, in organizing both housework and external work; ill-treated,
abused, alcoholic women, etc.
for health education with a view to :
- increasing women ability to communicate and express themselves emotionally;
increasing the ability of analyzing their life-style;
their image and their self-esteem;
the risks of symptoms of mental pathologies.
2. The second type of
service is addressed to women who have already begun to develop an illness and
manifest symptoms, and who have already had psychiatric treatment.
should encourage women to understand the way in which their daily lives
have led them to illness by using a method
which must be necessarily different from that traditionally adopted in
The specialised services should
offer practical help and necessary support
by creating a concrete alternative
to hospitals and to psychiatric cures.
services have the following goals:
- to reduce
or eliminate the use of specific therapheutical means, such as hospitalization,
drugs, or any other strategy that tends to impede or delay the
comprehension of the concrete and tangible causes of their illness;
- to consider the symptoms of mental illness as signs of unbearable life conditions;
- to create a new life-style for women's benefits in keeping with their interests, aptitudes and emotions