Head trauma: A hidden harm for battered women

abuse-150x150Women suffer significant, sustained damage from head traumas inflicted on them during domestic abuse, and victims themselves, doctors, law enforcement, and too many others have underestimated the severity of this problem.

Here is the harsh reality of too many women’s terrifying experiences, as reported in a tough-to-read but important New York Times magazine article that quotes, among others, Eve M. Valera, an associate professor of psychiatry at Harvard University and a leading researcher on traumatic brain injuries among survivors of domestic violence:

“The Centers for Disease Control and Prevention estimates that one in five women in the United States experience severe intimate-partner violence over the course of their lifetimes, resulting in physical injuries, most commonly to the head, neck and face. Concussions are likely to appear with alarming regularity. Every year, hundreds of concussions occur in the [National Football League]; thousands occur in the military. Valera’s estimated number of annual brain injuries among survivors of domestic abuse: 1.6 million.

“But unlike injuries in sports, war or accidents, domestic assaults happen almost entirely out of view. Victims themselves may not be able to process or remember what happened, and their assaults are often not reported to the police. When Valera was a graduate student in psychology in the mid-1990s, she volunteered at domestic-violence shelters, where she heard stories about women whose heads were pummeled with baseball bats and work boots. There’s no way these women aren’t sustaining traumatic brain injuries, she thought. But when she looked for research on the impact of head injuries in women in general, she found that most research had been conducted on men.”

As writer Christa Hillstrom reported for the magazine, not only have experts provided too little rigorous research on women’s head traumas, they may be dismissive of the injuries in women and ignore fundamental biological differences between the sexes in when they study the issue. Hillstrom again quoted Valera about the evaluation of women abuse victims, even by sympathetic supporters at shelters for them:

“People might think, ‘Someone smacked her in the head or pushed her, no big deal,’ [Valera said, and she also remarked] ‘We can’t just generalize based on what we know about males,’ she says. Men and women have different hormones coursing through the brain; even the architecture of their neurons varies.”

While the New York Times noted that researchers have stepped up their study of female head trauma, the lack of attention the problem has received until recently likely has harmed victims and especially their potential recuperative care. Those treating abused women may have blamed an array of the symptoms they show on psychological problems — including post traumatic stress disorder or PTSD — that might resolve with counseling. That approach too often failed to help women who struggled still with memory, focus, problem-solving, irritability, and depression.

Instead, experts interviewed by the newspaper said they have begun treating women victims of violence in the same way that elite professional athletes get care for concussions and other repeated blows to the head. Patients get assessed for cognitive disorders, vision and hearing loss, dizziness, disturbances to their balance — and more. The abused women, many of whom were denied medical care by violent and controlling partners, express great relief when clinicians take seriously their health complaints and help them deal with them. A victim named only as “Becky” described this new experience with Dr. Glynnis Zieman, a neurologist at the Barrow Neurological Institute’s Concussion & Brain Injury Center in Arizona:

“Becky hadn’t been to a primary-care doctor in 20 years because her boyfriend would not allow it. When she finally ventured to medical clinics after she fled, her symptoms were dismissed. She was told to take ibuprofen for her migraines — her history with Percocet made doctors wary of prescribing anything stronger. Many looked skeptical when she told them how many years her boyfriend had hit her. They didn’t understand how hard it had been for her to leave, that the fog she lived through felt like day-to-day survival. ‘When you’ve got somebody second-guessing you, it almost makes you feel like, God, am I crazy?’ she says. She wasn’t sure Zieman would find anything physically wrong with her. Instead, Zieman told her that her brain was not functioning normally and that together they would figure out what to do.

“When Zieman asked how many times she had been hit in the head — five, 10, 15, more? — Becky initially thought she meant per day, not over the course of her life. ‘To be honest, there were some days that would have been five to 10 to 15 to 20,’ she says. ‘Every day was different.’”

Women abuse victims, the newspaper reported, may require treatment for pain, nerve damage, vision and hearing impairment. Hillstrom said experts are only beginning to determine the complexity of helping patients for sustained periods to deal with not only head trauma, psychological damage, and the harms caused by a whole other category of abuse — choking and strangulation, causing repeated periods of destructive oxygen starvation to the brain.

Hillstrom reported that the emerging information on domestic violence victims’ array of health issues is changing not only medical practice but also the way that the law and law enforcement consider cases involving women’s abuse. Lawmakers may need to rethink what constitutes “serious” misbehaviors (felonies) against women if they suffer significant harms from actions the law now may consider less serious, like choking and slapping. Police also must put into their daily work newfound knowledge about violence against women, the New York Times reported:

“In the Phoenix area, for example, the Maricopa County Collaboration on Concussions in Domestic Violence connects shelters, law enforcement and research institutions. Officers from the Tempe and Mesa Police Departments are trained to administer on-site eye-convergence tests to detect concussions and can take victims to a forensic nurse, who treats and documents criminally inflicted injuries. Jorge Lomeli, a sergeant on the Tempe Police Department’s domestic-violence unit, says the trainings taught everyone, from beat cops to detectives, that women displaying inconsistency, hostility and bewilderment aren’t necessarily being uncooperative. ‘It could be because they’re actually injured, that it’s not a visible injury,’ he says. ‘You have to realize that potentially inside their head, they’re trying to tell you a story, but it’s just not coming out.’”

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damages that can be inflicted on them by injuries to the spinal cord and brain, especially due to concussions and repeated blows to the head.

It is ghastly and unacceptable that so many women — yes, and young people in broken families, too — suffer violence and other forms of domestic abuse, causing them grievous, sustained injury, including head trauma. Good medical care can often minimize or prevent a significant brain injury. Or there can be other ways in which the brain injury could have been prevented, including by the timely intervention of others. If you see something, say something — do not let women and families be brutalized in silence or by neglect. And we can’t let victims, especially women, get short shrift in the health care system.

Women already experience too much mistreatment in our medical system. Lawsuits may be appropriate in some circumstances, depending on what an investigation by a qualified lawyer finds. But as black NFL players have found, even with the sway of well-paid pro athletes, it can require vigilance to ensure reforms occur and injustices do not occur when dealing with systemic efforts in battling concussions and other head harms.

By the way, as President Biden reminded during the State of the Union address, why hasn’t Congress acted to renew the Violence Against Women Act with its many vital ways to deal with heinous behaviors by abusers? We have much work to do to recognize and reduce domestic violence and the harms of head trauma.

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