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Domestic Abuse and Chronic Pain Resources

Funded by a grant from the Women’s Fund for Scotland

In 2020, at the height of the Covid-19 pan­dem­ic, Pain Con­cern received a grant from the Wom­en’s Fund for Scot­land. With this fund­ing we cre­at­ed an extend­ed episode of our pod­cast, Air­ing Pain, on the top­ic of domes­tic vio­lence and chron­ic pain. We also pub­lished arti­cles writ­ten by domes­tic vio­lence sur­vivors and aca­d­e­mics in a spe­cial issue of our free online sup­ple­ment, Pain Press.

You can lis­ten to the pro­gramme and read all the arti­cles below.

The above fact sheet con­tains links to resources, stud­ies, guide­lines, research and char­i­ties for both health pro­fes­sion­als and those who are experiencing/have expe­ri­enced abuse.

Airing Pain 126. Domestic Violence and Chronic Pain

Spotlight on pain and domestic violence: there is more that we need to understand

by Dr Caroline Bradbury-Jones

I was delight­ed to take part in the recent Air­ing Pain pod­cast that explored the rela­tion­ship between domes­tic vio­lence and chron­ic pain. The pod­cast drew on a num­ber of per­spec­tives regard­ing the nature of pain, how it comes about, how it is expe­ri­enced and what can be done to tack­le the prob­lem. The invi­ta­tion to par­tic­i­pate was, in part, because my col­leagues and I have begun to inves­ti­gate this issue, specif­i­cal­ly the asso­ci­a­tion between domes­tic vio­lence and fibromyal­gia and chron­ic fatigue syn­drome. The pod­cast pro­vid­ed an oppor­tu­ni­ty for us to share our insights and, along­side the lived expe­ri­ences of a domes­tic vio­lence sur­vivor, give air­time to this com­plex problem. 

The pro­gramme explored the links between domes­tic vio­lence and chron­ic pain, illu­mi­nat­ing par­tic­u­lar­ly the human impacts. Since record­ing the inter­view, I have been reflect­ing on how far we have come with­in soci­ety in under­stand­ing the prob­lem of domes­tic vio­lence. I have asked myself crit­i­cal ques­tions regard­ing the many issues that remain poor­ly under­stood, and the ques­tions that remain unan­swered. I am a researcher, so the issues dis­cussed in this edi­to­r­i­al are through a research lens. 

I am going to begin by think­ing about how far we have come. It is only in the last decade or so that domes­tic vio­lence has crept from behind closed doors, out into the pub­lic domain. It is in this are­na that domes­tic vio­lence is dis­cussed far more wide­ly than it was a num­ber of years ago. It has made its way, as a top­ic, into con­tem­po­rary TV pro­grammes, soap operas and cov­er­age in news­pa­pers. Over­all, this release into pub­lic dis­course is a pos­i­tive move, because it pro­vides oppor­tu­ni­ty to air the issue and to chip away at ingrained stereo­types and myths about the prob­lem. It means that domes­tic vio­lence is an issue that is dis­cuss­able now; we can talk about it. This is impor­tant because it is such a sig­nif­i­cant prob­lem that is a scourge on soci­ety. Rates of domes­tic vio­lence are shock­ing­ly high. It is dif­fi­cult to present an accu­rate pic­ture of the extent of the prob­lem because it is large­ly under-report­ed, but it is like­ly that one-in-four, or even one-in-three, women in the UK have expe­ri­enced domes­tic vio­lence. It is impor­tant to acknowl­edge that men and boys expe­ri­ence domes­tic vio­lence, and so too those in same-sex rela­tion­ships, but vio­lence against women and girls, per­pe­trat­ed by males, is the most preva­lent form. 

When I first began to research the top­ic a num­ber of years ago, domes­tic vio­lence was very much a mar­gin­alised sub­ject. Researchers need 

fund­ing to sup­port the research they seek to under­take, but that becomes a real prob­lem when fund­ing agen­cies fail to see it as a pri­or­i­ty. While it is well-recog­nised that domes­tic vio­lence can, and does, have cat­a­stroph­ic impacts on lives, both in terms of health and social costs, it can be remark­ably tricky to secure fund­ing to inves­ti­gate the prob­lem. My obser­va­tion that domes­tic vio­lence has shift­ed from the mar­gins to the main­stream as regards soci­etal dis­course and aware­ness, is sure­ly indica­tive of a pos­i­tive move? I believe this to be the case. Fun­ders are now invit­ing appli­ca­tions specif­i­cal­ly about domes­tic vio­lence, and to that end, progress has been made. I think though, that some sub­jects are still at the periph­ery and war­rant far greater atten­tion. The rela­tion­ship between domes­tic vio­lence and pain is at the fore­front of my mind here, and this leads me to the crit­i­cal reflec­tions about what we still need to understand. 

I have been in the priv­i­leged posi­tion as a researcher on the top­ic of domes­tic vio­lence, to inter­view many sur­vivors. Real life sto­ries of vio­lence and abuse are pow­er­ful and dis­tress­ing. They leave an endur­ing print on one’s mem­o­ry. The real­i­ty of liv­ing with coer­cion, con­trol, gas light­ing and abuse in its myr­i­ad forms is a dif­fi­cult real­i­ty to hear. Yet it is one that I have lis­tened to over the years and from which, I hope, I have learned.  One thing that I have heard – repeat­ed­ly – is the sto­ry of pain. Domes­tic vio­lence sur­vivors talk of pain a great deal. For some (a minor­i­ty) the pain aris­es as a result of phys­i­cal injuries sus­tained as a con­se­quence of domes­tic vio­lence. For most though, the ori­gins of the pain are not phys­i­cal­ly root­ed, but tied up with com­plex biopsy­choso­cial rela­tion­ships that are not eas­i­ly tracked, nor artic­u­lat­ed. We know from large cohort stud­ies, such as the one men­tioned in the open­ing para­graph, that fibromyal­gia and chron­ic fatigue syn­drome are more com­mon in women with domes­tic vio­lence expe­ri­ence, than those with­out. Fur­ther stud­ies are required to explore this rela­tion­ship more ful­ly, includ­ing, for exam­ple, the risk fac­tors or how some groups may be dis­pro­por­tion­ate­ly affect­ed. What we need more than ever, though, are stud­ies that focus on the lived expe­ri­ence of pain and domes­tic vio­lence. We need stud­ies that get right to the heart of the prob­lem, from which we can under­stand not only what it is like but what can be done to bet­ter sup­port sur­vivors. Air­ing PainPain Press and an emerg­ing body of research may be indica­tive of the con­tem­po­rary spot­light on domes­tic vio­lence, but media and soci­etal dis­cours­es peak and wane. It is impor­tant there­fore to seize the oppor­tu­ni­ty now, so that we can shed far greater light on the prob­lem of pain and how it is lived, in the con­text of domes­tic violence.

Dr Car­o­line Brad­bury-Jones is a reg­is­tered nurse, mid­wife and health vis­i­tor. She is Pro­fes­sor of Gen­der Based Vio­lence and Health at the Uni­ver­si­ty of Birmingham

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Have you ever wondered why victims stay in abusive relationships?

by Kath Twigg

The answer is com­plex, and the phe­nom­e­non which caus­es vic­tims to become trapped not wide­ly under­stood:  it’s called ‘trau­mat­ic bond­ing’. In tox­ic and abu­sive rela­tion­ships the vic­tim becomes weak­ened and los­es per­spec­tive; instead of tak­ing pro­tec­tive mea­sures and walk­ing away, they look to the abuser for the solu­tion to their suf­fer­ing. They may try end­less­ly to per­suade the abuser to become, once again, the lov­ing per­son they thought they had met; against clear evi­dence to the con­trary, they per­sist in the irra­tional belief that things will turn out OK. The most trag­ic con­se­quence is the loss of self-regard and self-pro­tec­tion, sac­ri­ficed first to the desires and then to the dom­i­nance of another. 

This is no tem­po­rary blip or aber­ra­tion; often orig­i­nat­ing in past trau­ma, it is a deep seat­ed and entrenched psy­cho­log­i­cal process which can defy log­ic and cloud rea­son­ing. The slight­est indi­ca­tion that things may change can cause hope and expec­ta­tion to re-sur­face, and dan­gers which are all too clear to out­siders are ratio­nalised away. 

I know first-hand of the ter­ri­ble impris­on­ment of trau­mat­ic bond­ing, because it hap­pened to me. I spent my days as a senior man­ag­er in the crim­i­nal jus­tice field, where I was deal­ing with the impact of vio­lence and abuse dai­ly. I knew well that most vic­tims had suf­fered at the hands of a per­pe­tra­tor who was in a rela­tion­ship with them. Despite this knowl­edge and expe­ri­ence I lived in a rela­tion­ship char­ac­terised by coer­cive con­trol, threat­en­ing behav­iour and inci­dents of vio­lence. I was iso­lat­ed and depressed, try­ing des­per­ate­ly to main­tain an out­ward veneer of respectabil­i­ty whilst return­ing dai­ly to a sit­u­a­tion which many would have aban­doned long before. 

It’s hard to leave your home and every­thing you’ve worked for; it’s even hard­er to admit to the world that yet anoth­er of your rela­tion­ships has failed. These things, com­bined with the habit­u­al behav­iour I had acquired from many years of try­ing to mend rela­tion­ships which were beyond repair, ensured that I stayed for far too long, when all I real­ly need­ed to do was walk out through the door and ask for sup­port. Even when I found the courage to break away I near­ly didn’t make it, due to dis­tort­ed think­ing which re-sur­faced and caused me to believe that I could return to my tox­ic rela­tion­ship and it could all be put right. 

When oth­er peo­ple began to notice what was hap­pen­ing to me, I began to recog­nise that I had lost the per­son I used to be; the vibrant, pas­sion­ate and prin­ci­pled per­son who knew what she believed in and want­ed in life had dis­ap­peared. I start­ed to grieve for this per­son, to realise that I had lost myself and sac­ri­ficed all that was impor­tant to me on the altar of a rela­tion­ship that could nev­er work. All my ener­gy had been spent try­ing to regain what was only an illu­sion of hap­pi­ness and secu­ri­ty. Through the kind­ness of oth­ers, I was remind­ed of what healthy rela­tion­ships felt like. At times the poignan­cy was too much to bear.

and phys­i­cal health dete­ri­o­rat­ed, I was in con­stant pain, I devel­oped low­ered immu­ni­ty and often dragged myself to work, sup­press­ing my dis­tress and attempt­ing to project an image of a capa­ble and con­fi­dent pro­fes­sion­al to the world. The strain of doing this for so long even­tu­al­ly caught up with me. I began to be late for appoint­ments and couldn’t con­cen­trate or deal with sim­ple every­day tasks. I took a sev­er­ance pack­age and walked away from the long-term career I loved. When my rela­tion­ship final­ly end­ed I believed I could sim­ply put all the pain behind me and start again; I was wrong. The road to recov­ery has been long and hard and, at one point, almost cost me my life when I suc­cumbed to bac­te­r­i­al menin­gi­tis, which I put down to years of fail­ing to pause and take care of myself. The answer is not to push for­ward relent­less­ly, as I often did; doing so is part of the pat­tern of behav­iour which per­pet­u­ates abuse. It’s impor­tant to stop, acknowl­edge what you have expe­ri­enced and do what­ev­er feels right to help you to heal. I only learned this after many years of pain, when it was almost too late. 

There is no quick fix, or panacea. Enlight­en­ment comes grad­u­al­ly, through find­ing your true self, treat­ing that self as a pre­cious child and recog­nis­ing that you deserve kind­ness and com­pas­sion as much as any­one else. Love shouldn’t hurt.  There is no still point at which every­thing falls into place, there will always be chal­lenges and it is best to take time for this heal­ing to hap­pen, but with the right sup­port, and by always act­ing accord­ing to your cher­ished val­ues and beliefs, things will improve. 

Thank­ful­ly, I’m now free and many years away from these expe­ri­ences. I’m also in a hap­py and bal­anced rela­tion­ship with a beloved old friend, which came into my life when I stopped try­ing to make things hap­pen and expend­ing all my ener­gy in the wrong direc­tion. Writ­ing my sto­ry proved a pow­er­ful ther­a­peu­tic process. I‘m now a social work lec­tur­er and could have writ­ten an aca­d­e­m­ic book on trau­mat­ic bond­ing, but I found that writ­ing more freely allowed me to work through my thoughts, feel­ings and expe­ri­ences. As I wrote, the pat­tern of my life emerged on the paper, and the mirac­u­lous events which set me free organ­ised them­selves into a sto­ry which seems to touch those who read it in a way that aca­d­e­m­ic analy­sis nev­er could. I found myself describ­ing and pro­cess­ing deep emo­tions at the same time, sub­con­scious­ly heal­ing the pat­terns which had so blight­ed my life and rein­forc­ing the things I had achieved.  I final­ly knew who I was and was proud of myself. 

Through shar­ing my sto­ry I have come to realise that there is much hid­den abuse amongst peo­ple such as myself. Peo­ple who often feel a sense of fail­ure and iso­la­tion, believe that they should be able to cope and there­fore feel ashamed to dis­close their suf­fer­ing and ask for help. If this is you, by under­stand­ing the ori­gin of your life pat­terns, remem­ber­ing the self that was lost along the way and know­ing what kind of rela­tion­ships you deserve, you can make safer choic­es and find a hap­pi­er life.

Kath Twigg is a senior lec­tur­er in social work, train­er, men­tor and writer; her book, The Hall of Mir­rors, How to Change Life Pat­terns and Avoid Tox­ic Rela­tion­ships, is reviewed by Paul Evans below

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One Scottish domestic abuse survivor’s experience of pain

by Jennifer Bowey

I recent­ly spoke to a Scot­tish domes­tic abuse sur­vivor who wish­es to remain anony­mous, we’ve called her Alex. The fol­low­ing is an account of Alex’s expe­ri­ence of abuse in ear­ly life, which result­ed in health prob­lems and chron­ic pain that have per­sist­ed into her adult life. 

Alex details both emo­tion­al and phys­i­cal abuse per­pe­trat­ed by her bio­log­i­cal father. The abuse was direct­ed towards both her and her moth­er, which Alex reg­u­lar­ly bore wit­ness to. She recounts suf­fer­ing from anx­i­ety, sick­ness and pain as a result of these experiences:

‘I realised what I feel isn’t uni­ver­sal­ly felt when I began reflect­ing on the inci­dent and work­ing through things in ther­a­py now that I’m an adult. 

I feel anx­i­ety to the point of phys­i­cal pain in my chest, it aches like the way hunger makes your stom­ach ache, and I believe this is due to hav­ing to ‘walk on eggshells’ at such a young age.  After look­ing into this fur­ther with a ther­a­pist, I began to notice more spe­cif­ic things that also cause me pain. For exam­ple, I always thought that my head/hair was very sen­si­tive and hav­ing oth­ers brush my hair when I was young used to send me into fren­zies and make me phys­i­cal­ly sick.’

Alex elab­o­rates upon expe­ri­enc­ing acute scalp pain when­ev­er some­body touch­es her head or her hair. This has not only caused her severe per­son­al dis­tress, but has posed prob­lems when hav­ing rou­tine haircuts: 

‘I always expe­ri­ence pain when I vis­it hair salons, to the point where I’ve had to ask them to stop. I despise peo­ple touch­ing my head and feel 

hap­py wear­ing a hat. I always chalked this down to an indi­vid­ual quirk, some­thing too triv­ial or sil­ly to talk about. But in real­i­ty, it’s not.’ 

Hav­ing dis­cussed her pain with a ther­a­pist in adult­hood, Alex dis­cov­ered that an adverse child­hood expe­ri­ence of phys­i­cal abuse was the root cause of these intense feel­ings of pain: 

‘When I was about sev­en my dad became very dis­pleased at the mess of my room and pro­ceed­ed to pin me down (his knees on my arms) and run the hoover noz­zle over my skull for some time, threat­en­ing to get rid of it. I thought it was going to pull my hair out, I real­ly believed that. I remem­ber scream­ing in pain and I then froze com­plete­ly in shock. It was so painful, it ached for so long after and my mum had to sit and de-tan­gle my hair, which ached also. 

So, I often feel the sen­sa­tion of my hair being ripped out, when I’m fact it’s just the salon work­er gen­tly remov­ing knots. This was one inci­dent on one occa­sion and I feel it as if it’s hap­pen­ing to this day, abuse doesn’t just hurt at the time – it hurts long after too.’ 

In our Air­ing Pain pro­gramme on domes­tic vio­lence and chron­ic pain, Clin­i­cal Psy­chol­o­gist Dr Kate Gillan dis­cuss­es how abuse can cause height­ened sen­si­tiv­i­ty to pain. She explains how sur­vivors of trau­ma and abuse often devel­op a hyper­sen­si­tive ner­vous sys­tem, which exists in a per­sis­tent state of ampli­fied pain. They may expe­ri­ence pain even when some­body is only touch­ing them light­ly. The brain does not pro­duce an appro­pri­ate, mild response to nor­mal touch, but a height­ened pain response.

Jen­nifer Bowey is Project Co-ordi­na­tor with Pain Con­cern. She has writ­ten this case study in col­lab­o­ra­tion with a Scot­tish domes­tic abuse sur­vivor who wish­es to remain anony­mous. Our thanks go to our sur­vivor for shar­ing their story.

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Review of The Hall of Mirrors: How to Change Life Patterns and Avoid Toxic Relationships by Kath Twigg

by Paul Evans

A new edi­tion of Air­ing Pain for the New Year (2021) explores, as one con­trib­u­tor describes it, the ‘per­fect storm’ in which Covid-19, domes­tic vio­lence, social iso­la­tion and chron­ic pain con­verge with poten­tial­ly dev­as­tat­ing con­se­quences.

Research by the Uni­ver­si­ty of Birm­ing­ham showed that UK domes­tic abuse vic­tims are three times more like­ly to devel­op severe men­tal ill­ness­es, and a fol­low-up study by the Uni­ver­si­ties of Birm­ing­ham and War­wick found that women who have expe­ri­enced domes­tic abuse are almost twice as like­ly to devel­op fibromyal­gia and chron­ic fatigue syn­drome (CFS) than those who have not. 

In mak­ing this pro­gramme, I spoke to lead­ing researchers, clin­i­cal psy­chol­o­gists in the fields of chron­ic pain and domes­tic vio­lence relat­ed trau­ma, and health­care pro­fes­sion­als work­ing with sur­vivors.

How­ev­er, it is the tes­ti­mo­ny of a sur­vivor of two abu­sive mar­riages, Kath Twigg, which real­ly opens the lid on how per­sis­tent phys­i­cal and men­tal, coer­cive abuse, will destroy mind, body and soul.

In her book, The Hall of Mir­rors: How to Change Life Pat­terns and Avoid Tox­ic Rela­tion­ships, she tells her sto­ry and, with the ben­e­fit of expe­ri­ence, offers strate­gies for oth­er vic­tims of domes­tic abuse, be they men or women, to take back con­trol of their lives.

How­ev­er, to treat it pure­ly as a self-help book as the title might sug­gest, is to do it a great dis­ser­vice. It is a well writ­ten, easy to read, and com­pelling auto­bi­o­graph­i­cal account of her dev­as­tat­ing jour­ney through two mar­riages to men who abused her both phys­i­cal­ly and mentally.

It is not a ‘rant’ about the fail­ings of two abu­sive men (the read­er must make her or his own judge­ment on that), but an account of how years of coer­cive abuse altered the mind­set of this pro­fes­sion­al, intel­li­gent woman 

to put up with the abuse and abuser for years, ignor­ing the warn­ings and well-mean­ing advice of friends:

He would only have to hit me once and I’d be gone. Why ever do you stay?

I lost count of the num­ber of times she uses the word ‘ashamed’:

I was too ashamed to con­fide in friends or fam­i­ly, not wish­ing to be seen as a fail­ure or a bur­den. I tried to pre­tend that all was well, a process made eas­i­er by isolation.’

I told no-one about the vio­lent inci­dent … for many years I had felt ashamed of my failed rela­tion­ships.’

So, who should read this book?
 
A self-help book? Yes, there are short ‘exer­cis­es’ at the end which are sim­ple ques­tions vic­tims, be they women or men, might ask them­selves to gain greater self-aware­ness of how the abuse is affect­ing the way they are deal­ing with it, and there­fore how to address it.
 
But it’s more than just a self-help book. It is for friends, fam­i­ly, care pro­fes­sion­als, col­leagues, in-fact, every­one in the social cir­cle of the abused to gain insight and under­stand­ing of the psy­cho­log­i­cal dam­age wrought by domes­tic abuse, and there­fore to know how best to sup­port the vic­tim through a tox­ic rela­tion­ship.
 
I found it easy and com­pelling to read, albeit out of my com­fort zone because it made me think about rela­tion­ships in my own social cir­cle.
 
The Hall of Mir­rors: How to Change Life Pat­terns and Avoid Tox­ic Rela­tion­ships by Kath Twigg is avail­able from Ama­zon as a Kin­dle down­load or paper­back.  Details from www.kathtwigg.co.uk.

Paul Evans is the pro­duc­er of Air­ing Pain.

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