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Show Holistic Healing: Impact of Domestic Violence on Health Care Providers by Jo Ann S. Secrist, J.D. Introduction Socrates developed a theory of the constitution of the human soul, referred to as the tripartite structure of the soul consisting of the appetitive or impulsive element, often referred to as the body, the thought or reasoning element or the mind, and the element in the middle of the two which can take orders from the mind and control the body-the spirit or psyche (Plato, 1967). Historically, in times of sickness or injury, or just in time of need, individual professions were assigned the task of healing particular parts of the tripartite soul: the physician treated or healed the body or the mind; the ecclesiastical minister treated or healed the spirit or spiritual side of man, and the legal profession had jurisdiction to treat or heal damaged relationships between men. Domestic violence, however, erases the tidy lines of treatment and healing demarcation between the professions to create a professional bouillabaisse working together to fight back the rising tide of violence and crime which is rapidly becoming an epidemic in Utah and America. Domestic violence is a systematic pattern of physical, sexual, and psychological abuse predominantly directed by men against women--approximately 95% of the victims are women (Peachy, 1988). Domestic violence is a process by which the perpetrator maintains control and domination over the victim extended over a period of time. There are three phases of violence: first is known as the tension building stage or walking on eggshells period in which the victim does all in her power to avoid the abuse; the second phase is the acute battering stage when the victim is hit, kicked, choked, etc.; and finally, the honeymoon or hearts and flowers stage in which the perpetrator promises never to abuse again and the victim believes him (YWCA, 1994). Domestic violence is a crime and a health care issue; it is at times an issue of life and death, a long term disease if you will, that manifests itself in the cyclical violence that repeats itself again and again in the relationship getting more severe and frequent as time goes on. In addition, violence breeds violence by recreating itself in future generations modeling the patterns seen in the home. For the health care provider, it is not enough to stitch up the wounds and set the broken bones, only to send the patient or victim of abuse back into a dysfunctional home and the unhealthy arms of the abuser. The impact of domestic violence on the health care provider is three fold: first, the law requires health care providers to report domestic violence injuries to law enforcement which creates a partnership between the health care community and the criminal justice system; second, the partnership puts responsibility on health care providers to work with other professionals to help prevent, intervene and suppress domestic violence; and finally, the health care provider must get beyond the physical aspect of domestic violence and realize the psychological, emotional and spiritual components of the problem and do what is best to stop the violence, make the victim safer, and hold the perpetrator accountable for the crime; thus initiating the healing process for the whole victim and the whole family. Background In 1988, the Utah State Legislature passed a law, Utah Code Annotated § 26-23a-2, which requires health care providers to report to law enforcement "any wound or other injury inflicted by the person's own act or by the act of another by means of a knife, gun, pistol, explosive, infernal device, or deadly weapon, or by violation of any penal statute of this state . ." On December 8, 1993, in an attempt to clarify the meaning of the phrase any penal statute of this state . . ., the Utah Attorney General's Office offered an informal opinion which stated that the law includes any violation of a penal code, and the penal code includes the Cohabitant Abuse Act, Utah Code Annotated §30-6-1 et.seq., the law designed to make domestic violence a crime, protect the victim and enforce the law against the perpetrator of the abuse. For the first time since the inception of this law, domestic violence became an issue, concern and responsibility for health care providers. The reporting law created a nexus between health care providers and the criminal justice system creating questions of roles and responsibilities, of confidentiality and privileged Utah's Health: An Annual Review 1996 1 |
