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that control either through disinformation or intimidation. The tactics of control may be used to coerce the victim to stop talking about the abuse with the health care worker, to reunite with the perpetrator, to drop her objections to joint custody, etc. The following are examples of controlling behaviors that the health care practitioner may witness or hear about. CHAPTER 1 36 ■ Physical assaults or threats of violence against the victim, children, or sometimes the health care provider; threats of suicide; threats to take the children or harassment; ■ Stalking the victim to and from health care appointments; ■ Accompanying the victim to all appointments; sending the victim “looks” during appointments; refusing to let the victim be interviewed or examined alone; ■ Bringing family or friends to the medical facility to intimidate or cajole the victim or the health care provider; ■ Blaming the victim through long speeches about all the victim’s behaviors that supposedly “provoke” the abuse; ■ Crying and other displays of emotion or statements of profound devotion or remorse to the victim, alternated with threats or other psychological abuse; ■ Canceling the victim’s appointments with the health care provider; sabotaging her efforts to attend appointments by not providing child care, transportation, etc.; ■ “Physician-hopping” or “therapisthopping;” ■ Denying the victim access to the perpetrator’s medical records that may support her issues or attempting to control or gain access to her medical records; ■ Withholding medication; under- or over-medicating the victim; ■ Using the legal system against the victim by requesting mutual orders of protection, making false charges of harassment/abuse against the victim, filing multiple divorce proceedings; ■ Continually testing the limits of visitation/support agreements by arriving late or not showing at appointed times or arriving drunk; ■ Threatening and/or implementing custody fights; and ■ Using any evidence of damage resulting from the abuse as evidence that the victim is an unfit parent (victim’s counseling records, victim’s treatment for depression or other medical conditions, etc.). Sometimes in his attempts to control the victim, a perpetrator will attempt to control the health care provider with the same tactics of power and control used against the victim. ■ Portraying self as the good patient who constantly praises the health care provider; ■ Intimidating the health care provider with a variety of threats or acts; ■ Harassment of health care provider by repeated phone calls, civil suits or threats of legal action, or false reports to superiors concerning supposed breaches of confidentiality, inappropriate treatment, or rude behavior; ■ Splitting health care teams by creating divisiveness among professionals (e.g.,”The doc is one of those women’s libbers,” “The nurse doesn’t like me,” “He takes my wife’s side”). 4. DOMESTIC VIOLENCE PERPETRATORS MAY HAVE GOOD QUALITIES IN SPITE OF THEIR ABUSIVENESS Some domestic violence perpetrators may be good providers, hard workers, good conversationalists, witty, charming, attracUNDERSTANDING DOMESTIC VIOLENCE 37 tive, and intelligent, yet they still batter their victims. Sometimes health care providers as well as victims are misled by these positive qualities and assume that the violence did not really happen or is an aberration of the perpetrator’s real personality since only individuals who are “monsters” could commit such acts. They may believe that the violence can be ignored because such a “good” person will most certainly stop the abuse. The reality is that even seemingly normal and nice people may batter and may be very dangerous. Battering stops only when perpetrators are held responsible for both their abuse and for making the changes necessary to stop the violence. C. The Children Children, like the victim, appear in the health care system with a variety of physical injuries, illnesses or medical conditions directly related to the perpetrator’s abuse and with other health issues. Understanding the domestic violence etiology of those conditions is important both in treating the current conditions and in preventing future problems. Even if the child’s problem is not related to the domestic violence, treatment for any condition can be
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