They are art as much as science, and require attention to interpersonal dynamics and the nuances of language and emotion. In this brief essay, I hope to highlight some of the clinical challenges for physicians, nurses, and other allied health professionals who listen to abuse stories. This article focuses on females as victims and males as perpetrators as this is by far the most common constellation for those who suffer the consequences of extreme violence. However, it should be noted that a relatively small percentage of men are battered by their female partners, and that battering does occur in gay and lesbian relationships in roughly the same proportion as in heterosexual relationships. Although violence causes physical pain that is severe, disfiguring, and even deadly at times, many victims say what is most painful about being abused is the mental anguish.
Many factors account for the silence of battered women.
They may fear that telling their story to others will precipitate retaliation or an escalation of violence. In this context, silence is a reasonable strategy as the majority of deaths occur when the woman has either left or is in the process of leaving her abuser. Or the woman might be financially or emotionally dependent on her partner and doubt her ability to cope without him. Many women stay with abusive partners because they do not want to deny the paternal relationship to their children. Victims' silence is not always imposed by direct violence or the threat of violence.