When people think about domestic abuse or intimate partner violence, they often picture black eyes, bruises, or broken bones. But as terrible as these injuries are, some researchers say not enough attention has been paid to the unseen brain trauma women can sustain in these situations. One such researcher is Harvard Medical School’s Eve Valera, who uses advanced imaging techniques to examine the effects of traumatic brain injuries sustained by women in abusive relationships.
Valera will be appearing at an Ontario Brain Institute event focusing on concussions caused by intimate partner violence. TVO.org will be streaming the talk live on March 8 — International Women’s Day —starting at 6:30 p.m. TVO.org interviewed Valera in advance of the event.
Do we have any sense of how widespread the problem of traumatic brain injuries is among survivors of intimate partner violence?
Globally, about one in three women over the age of 15 will have reported some kind of physical or sexual violence against them. In [the U.S.] it might be closer to one in four. So partner violence is actually quite rampant and probably a lot more prevalent than most people actually believe, because a lot of it is hidden. When you get down to traumatic brain injuries, in 100 women I sampled, including women in shelters and not in shelters, 75 per cent reported at least one mild traumatic brain injury from a partner. And then if you ask about repetitive mild traumatic brain injuries, which are really the disconcerting issue here, 50 per cent reported. So we know very little, but, based on those numbers, there are a number of women out there who are sustaining brain injuries.
We talk about concussions in football and what that may lead to, and people worry about chronic traumatic encephalopathy (CTE). We should also be talking about the concussions in domestic violence and whether they may be leading to something akin to CTE, and we just don’t know.
A lot of attention in recent years has been paid to brain injuries in sports and in the military. Why do you think so little attention has been given to traumatic brain injuries when it comes to survivors of intimate partner violence?
I could give you my most negative perspective, which is that it’s a female problem, and males predominate in research. Women problems are not cared about as much, for whatever reason. So I think there’s a bit of misogyny there. It is also the case that when you do try to do research, it’s not an easy group to do research on, for very good reasons: (a) they may be in hiding, and (b) they do not necessarily trust a lot of people, because of what’s been done to them. They don’t want to be poked and prodded. They don’t even understand they might be sustaining brain injuries. And unless they’re going to understand or appreciate the potential impact of what’s being studied on their lives and the lives of other women like them, they’re going to be less likely to participate. And there’s a lot of stigma associated with this. People don’t want to admit that they’ve been in partner-abusive situations. It’s hard to admit that. And then they get blamed, and people look at them differently. And maybe they just don’t have time. They have to rebuild their lives. So there are challenges to studying this population. But that doesn’t mean it can’t be done.
You’ve scanned the brains of women who have suffered brain injury as a result of intimate partner violence. Is there anything different about the type of traumatic brain injury that these victims sustain as opposed to, say, a football player?
That’s the question of the year or the decade. Women are strangled quite a bit. So if you couple the potential trauma from a mild traumatic brain injury that may be caused by your head being smashed against a wall and ricocheting back and forth in your skull along with the strangulation that may be going on at the same time, you might have a different injury than you would, say, if you were on a football field. Ultimately, when we start doing the research more aggressively, and we have more people doing it, and we have more funding, we’ll probably find some sex effects. Right now, most of the research on mild traumatic brain injuries has been conducted on men. There have been few studies on women. And the studies that have been done on women — if anything, they suggest women take longer to recover from a mild traumatic brain injury. And given the same type of hit, a woman seems to sustain a concussion more easily.
Should the knowledge that survivors of domestic violence often suffer brain injuries inform how we treat survivors of domestic violence when they seek help?
That’s a great question, and that’s partly what I’m really trying to get out there. The first thing to do is ask. Know how to ask, actually. If you just say, “Hey, have you sustained any brain injuries?” they’ll be like, “What are you talking about?” Or they may say, “Well, probably” or “Maybe,” or maybe they’ll tell you about one time when they were knocked unconscious.
What I’ve done in my research — basically, I say, “After anything your partner did to you, did you ever lose consciousness? Did you ever feel really dizzy or disoriented or confused? Did you ever have some loss of memory around what happened?” Once they say yes to that, you say, “Okay, what happened?” Then you can ask, “How long were you unconscious? Or how long did the memory loss last? Or how long were you dizzy? How long did you have the headaches? Did you see stars or spots?” And find out how many times something like that has happened.
Once you do that, you may change your approach to how you work with the women. You’re probably not going to say, “Okay, here’s a list for things for you to do. Go to the courthouse, and get the order of protection. Once you do that, go over to the police station, and make sure you get a copy of all the reports. Once you do that, I want you to go home, and you need to make a safety plan…” But make sure everything is written down. Have them repeat things back to you. Make sure that they understand what you’re trying to tell them. And try to encourage them to get the rest that they need if they can. Now that can be difficult, because these women are often in very difficult situations with kids and whatnot. But see if they can give the brain the break it needs, as is done, for example, in the sports world or wherever else you’re talking about concussions.
This interview has been edited for length and clarity.
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