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non-literate societies (Levinson, 1989; Campbell, J., 1993; Erchak & Rosenfeld, 1994) indicates that wife beating is more typical than husband beating in those societies and that the prevalence and severity of wife beating is influenced by a variety social factors within a particular society (e.g., tolerance of violence, competitiveness between men and women, presence of support networks for women). While a review of that literature is beyond the scope of this chapter, it is referenced here as a reminder that domestic violence is socially constructed and learned. While researchers seek to understand the significance of cultural differences as related to domestic violence,3 it is helpful for the health care provider to focus on what is known. Domestic violence occurs in all cultural/ethnic groups and has serious physical and emotional consequences for victims, their children and their communities. The health impact of domestic violence to victims has been documented in various ethnic groups: Latino, African American, Asian, Native American, and Caucasian. Cultural factors should not be used to dismiss the reality of domestic violence in a patient’s life. Perpetrators and others will sometimes offer various cultural rationalizations for the conduct (e.g., “That’s the way she knows I love her,” “It’s part of our culture,” “It is their way of life”) and there may be certain cultural specificity in the expression of those rationalizations (e.g., “______ women are very violent, too”). This “cultural defense” for domestic violence has even been inappropriately offered in courts in attempts to explain away domestic violence homicides. Culture sometimes shapes the specific tactic of control used by the perpetrator. Some perpetrators use cultural factors of the victims as a way to further the abusive control (e.g., immigrant status, language skills). Perpetrators may accuse victims of acting “uppity,” “American,” “white” or of being a “bitch” when they assert their human rights. These tactics of control are shaded with cultural issues to give the perpetrator dominance over the victim. While culture does not alter the reality CHAPTER 1 26 3 There is conflicting data in the U.S. as to whether domestic violence is more prevalent within one ethnic group when compared with other ethnic groups (Straus & Gelles, 1990). When differences have been found, various explanations for those differences have been suggested. More research is needed to fully understand the connection (see Hawkins, 1986. Lockhart, 1987; Brice-Baker, 1994; Marsh, 1993; Plass, 1993; Torres, 1993). of the health consequences of domestic violence, cultural factors can influence identification, assessment, and intervention for the problem. The cultural identities of both the patient and the health care provider may affect the identification and assessment of domestic violence. A health care provider unfamiliar with a particular ethnic group may misinterpret a patient’s actions as indicative of abuse (e.g., avoidance of eye contact) or as indicating that she is not a battered woman (e.g., a victim’s rage and threats against her abuser). Victims from different cultural groups have different values and beliefs about interpersonal communication, the role of health care providers, the role of police, and the role of family members which shape how they reveal or don’t reveal their experience of domestic violence. Cultural issues should be considered in designing effective responses and interventions for both the victims (Torres, 1993; Campbell, D., 1993; Ho, 1990; Hamptom, 1987; Jang, 1991; Plass, 1993) and the perpetrators (Williams, 1994). Just as health facilities have worked to offer all health care services in ways that are accessible to diverse populations with a variety of languages and ethnicities, responses to patients experiencing domestic violence must also be culturally appropriate. D. Domestic Violence vs. Illness-based Violence While domestic violence is learned, there is other violence that results from illness. A small percentage of violence against adult intimates is illness-based but is misidentified as domestic violence. This violence is caused by organic or psychotic impairments and is not part of a learned pattern of coercive control of an intimate partner. Individuals with diseases such as Alzheimer’s disease, Huntington’s Chorea, or