As physicians, we are not immune to intimate partner violence

In 2016 our colleague Dr. Elena Fric decided to leave her marriage, and a few weeks after that her body was found in a suitcase by the river in Kleinberg, Ont. Her two eldest children were close in age to mine, and she had a pre-schooler. Her husband was found guilty of second-degree murder. His first parole hearing will be in five years. 2030. I went to a few court dates to support her parents, honour her memory, and let the courts know that people were watching to ensure justice was served. Her murder made the world feel less safe. If even she was vulnerable, we were all vulnerable.Four years later, just before COVID shut the world down, another colleague Dr. Jennifer Kagan called me with unthinkable news. After years of raising alarm bells in the court system, her ex-husband murdered her four-year-old daughter Keira. Keira was a spectacular child who cared deeply about the world and lit up the room when she entered it. I mourn the nine-year-old she would have been today. She would have been spectacular.My life was forever changed by these events. I’ve been volunteering ever since to help keep doctor mamas and their families safe when they are experiencing Intimate Partner Violence (IPV). You might think these two incidents were isolated events, but out of my medical cohort of 80 women, I know six who fled abuse in their relationships. Intimate Partner Violence is an epidemic, a widespread occurrence of a particular undesirable phenomenon.We didn’t learn much about IPV in medical school. We learned to ask screening questions in the ER when people presented with fractures or needed stitches, but we didn’t learn how to recognize patterns of abuse in our relationships or our patients' relationships. It turns out that one of the most important concepts in IPV was described five years after I finished medical school.In 2006, sociologist Evan Stark coined the term coercive control (CC) in a book entitled Coercive Control: How Men Entrap Women in Everyday Life. CC has been described as “a strategic pattern of behaviour designed to exploit, control, create dependency and dominate.” Stark named a pattern of behaviour where “the victim becomes captive in an unreal world created by the abuser, entrapped in a world of confusion, contradiction and fear.”When I talk to peers experiencing coercive control, they often reach out for advice on how to help their partners understand how hurtful or frustrating their behaviours are. As helping people, we assume good intentions from our partners. Truthfully, these manipulative behaviours are intentional choices their partners make with the intent to exploit and control.Many victims of CC don’t even realize they are in an abusive relationship, as the societal narrative is that things aren’t that bad as long as he doesn’t hit you. That narrative is dangerously wrong. Multiple studies examining femicide have found that coercive control is a STRONGER predictor of homicide than escalating physical injuries. On average, in Canada, an abuser commits murder or attempted murder every single day.These numbers aren’t getting any better. The courts rarely enforce consequences on abusers. Before 2021, judges were not allowed to consider violence against the mother when they were determining parenting rights. You could beat the crap out of your wife and still win custody of your vulnerable children with no questions asked. Most Canadians still don’t recognize the hallmark patterns of abuse. People still tend to blame the victim rather than criticize the abuser. The first private member's bill to criminalize coercive control in Canada was brought forward in 2020 and is currently referred to committee after the second senate reading. Dr. Jennifer Kagan has pursued another legal avenue to protect families from abuse. She spearheaded a private member’s bill requiring that judges be educated on, and consider domestic violence and coercive control when issuing decisions. Family court is a nightmare of terrible decisions, partly because judges are appointed from all different specialities of law. You could be appointed a Family Court judge straight from being a tax lawyer, having never taken a course on family law. Keira’s Law requiring new judges to complete mandatory training about IPV legal concepts was passed on May 27, 2023.While we wait for our legal systems to do their job in protecting our most vulnerable, we can do our own work to recognize manipulative behaviour. It’s difficult to identify these behaviours unless we have the language for them. Here are some of the most common patterns that you may recognize:Blame: The hallmark phrase of abusers: “You MADE me do it!” Newsflash: they are grown. No one can make them do anything. The extent of their capacity to shift blame is described in the acronym DARVO: Deny, Attack, Reverse victim and offender.Gaslighting: You recall an event and they deny that it happened. Or you state a fact and they insist that you’re wrong. It makes you apologize for things that aren’t your fault and feels seriously destabilizing.Projection: All the bad things they’re doing at home and away from home, they accuse YOU of doing! You’re devastated because you have worked so hard to be a good partner and they still don’t trust you, so you work even harder to care for them.Narcissistic rant: When you try to discuss their problematic behaviour or set a boundary, they turn it around and it becomes a rage-filled diatribe about what a terrible person YOU are. Afterwards, they feel so much better but you feel empty and hopeless because nothing was resolved and you were just subjected to 30 minutes of abuse.Punishment: If you ask to have your needs met, or set a boundary, you KNOW something bad will happen. They’ll “forget” to pick you up to get to your work shift, or your homework file will be mysteriously deleted.Silent treatment: A technique designed to make you work even harder for their approval. Degradation: Subtle put-downs. Praising people who aren’t like you and being contemptuous about people like you.Moving the goalposts: No matter what you do, it’s never good enough.Hurt myself to hurt you: Threats of self-harm, or unnecessary self-flagellation, designed to make you feel bad for what you did.Having the language is so important, and reasserting reality with peers or loved ones when you see these behaviours occur can be an essential step towards helping them find the confidence to leave their situation. If these behaviours feel familiar to you, please access some of the resources in this newsletter to find support and stay safe. I imagine that many of you have stories about how IPV has impacted your own lives, or hurt your loved ones. Follow @KeirasLaw on Instagram for updates on Canada’s legislative changesIPV expert Pamela Cross has written a book offering practical and hopeful ideas for how each of us can engage in the vital work of eradicating IPV. I encourage you to purchase her book And Sometimes They Kill You and pass it on to a friend when you’ve read it. We should consider that knowledge is the immunization that helps to stop this epidemic.

As physicians, we are not immune to intimate partner violence

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