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SOME VICTIMS BECOME VERY ISOLATED AS A RESULT OF THE PERPETRATORS’ CONTROL OVER THEIR ACTIVITIES AND CONTACTS WITH FRIENDS AND FAMILY MEMBERS Some of a victim’s behaviors in a health care setting can be understood in light of the control the perpetrator has managed to enforce through her isolation (e.g., her reluctance to commit to a particular treatment protocol that requires multiple appointments, her lack of confidence in her own abilities, or her fear of further harm). Without outside contact and information, it becomes more difficult for the victim to avoid the psychological control and threats of the perpetrator. Some victims come to believe their abuser when they say the victims would not survive alone if they left, while others resist such distortions. Even when the victim maintains contact with friends or extended family, those relationships are often mediated through the control of the perpetrator. Consequently, victims do not experience needed support and advocacy. The victim’s experience with others is repeatedly processed through the comments and interpretations of the abuser. Some perpetrators interrogate victims about every detail of their interactions with others and describe to the victims the nature of those relationships. The victims’ positive feedback or support from their other relationships is undermined by the perpetrators’ intrusions into those relationships. The more successful perpetrators are in isolating the victims, the more they control what the victims believe (Graham & Rawlings, 1991). 4. WHY SOME VICTIMS STAY/WHEN THEY LEAVE One of the most commonly asked questions about domestic violence is, “Why do victims stay in violent relationships?” The reality is that many victims leave. But to understand this process of leaving, one must once again consider what domestic violence is, what the perpetrator is doing, and what the victim’s options are in her community. The primary reason given by victims of domestic violence for staying or returning to the perpetrator (or for not following other health care provider recommendations) is fear of violence and the lack of real options for safety with their children. This fear of the violence is realistic. Research on battered women shows that the lethality of the perpetrator’s violence often increases when the perpetrator believes that the victim has left or is about to leave the relationship (Campbell, J., 1992, Wilson & Daly, 1993). The literature suggests several indicators for homicide against the victim: the perpetrators’ obsession with the victim, a pattern of escalating physical violence, increased risk-taking by the batterer, threats to kill the victim and self, substance abuse, and a gun in the household (Campbell, J., 1992; Saunders, 1994; Hart & Gondolf, 1984; Kellerman, et al., 1993). Some perpetrators repeatedly threaten or attempt to kill or seriously injure their victims, children or others when the victims attempt to leave relationships. The victim may have previously attempted to leave only to have been tracked down by the perpetrator, seriously injured and brought back. Perpetrators do not just let victims leave relationships. They will use violence and all other tactics of control to maintain the relationship. It is a myth that victims stay with perpetrators because they like to be abused. Even in cases where the victim was abused as a child, the victim does not seek out violence and does not want to be battered. Staying in or returning to the relationship may simply be safer than leaving. The reasons for staying in a violent relationship are multiple and vary for each victim. They include: a. Fear of the perpetrator’s violence; b. Immobilization by psychological and physical trauma; c. Connection to the perpetrator through his access to the children; d. Illness (e.g., HIV, MS) and dependance on the perpetrator for health care; e. Belief in cultural/family/religious values that encourage the maintenance of the family unit at all costs; f. Continual hope and belief in the perpetrator’s promises to change and to stop being violent; g. Belief that the perpetrator cannot survive (e.g., due to illness with AIDS) or will engage in self-destructive behavior if the victim leaves; h. Insufficient funding and resources nationwide that