The Guilt of the Abused

Pathologizing the Victim

by Dr. Sam Vaknin

It is telling that precious few psychology and psychopathology textbooks dedicate an entire chapter to abuse and violence. Even the most egregious manifestations – such as child sexual abuse – merit a fleeting mention, usually as a sub-chapter in a larger section dedicated to paraphilias or personality disorders.

Abusive behavior did not make it into the diagnostic criteria of mental health disorders, nor were its psychodynamic, cultural and social roots explored in depth. As a result of this deficient education and lacking awareness, most law enforcement officers, judges, counselors, guardians, and mediators are worryingly ignorant about the phenomenon.

Only 4% of hospital emergency room admissions of women in the United States are attributed by staff to domestic violence. The true figure, according to the FBI, is more like 50%. One in three murdered women was done in by her spouse, current or former.

The US Department of Justice pegs the number of spouses (mostly women) threatened with a deadly weapon at almost 2 million annually. Domestic violence erupts in a mind-boggling half of all American homes at least once a year. Nor are these isolated, "out of the blue", incidents.

Mistreatment and violence are part of an enduring pattern of maladaptive behavior within the relationship and are sometimes coupled with substance abuse. Abusers are possessive, pathologically jealous, dependent, and, often, narcissistic. Invariably, both the abuser and his victim seek to conceal the abusive episodes and their aftermath from family, friends, neighbors, or colleagues.

This dismal state of things is an abuser's and stalker's paradise. This is especially true with psychological (verbal and emotional) abuse which leaves no visible marks and renders the victim incapable of coherence.

Still, there is no "typical" offender. Maltreatment crosses racial, cultural, social, and economic lines. This is because, until very recently, abuse has constituted normative, socially-acceptable, and, sometimes, condoned, behavior. For the bulk of human history, women and children were considered no better than property.

Indeed, well into the 18th century, they still made it into lists of assets and liabilities of the household. Early legislation in America – fashioned after European law, both Anglo-Saxon and Continental – permitted wife battering for the purpose of behavior modification. The circumference of the stick used, specified the statute, should not exceed that of the husband's thumb.

Inevitably, many victims blame themselves for the dismal state of affairs. The abused party may have low self-esteem, a fluctuating sense of self-worth, primitive defense mechanisms, phobias, mental health problems, a disability, a history of failure, or a tendency to blame herself, or to feel inadequate (autoplastic neurosis).

She may have come from an abusive family or environment – which conditioned her to expect abuse as inevitable and "normal". In extreme and rare cases – the victim is a masochist, possessed of an urge to seek ill-treatment and pain. Gradually, the victims convert these unhealthy emotions and their learned helplessness in the face of persistent "gaslighting" into psychosomatic symptoms, anxiety and panic attacks, depression, or, in extremis, suicidal ideation and gestures.

From the Narcissistic Personality Disorders list – excerpt from my book "Toxic Relationships – Abuse and its Aftermath"

Therapists, marriage counselors, mediators, court-appointed guardians, police officers, and judges are human. Some of them are social reactionaries, others are narcissists, and a few are themselves spouse abusers. Many things work against the victim facing the justice system and the psychological profession.

Start with denial. Abuse is such a horrid phenomenon that society and its delegates often choose to ignore it or to convert it into a more benign manifestation, typically by pathologizing the situation or the victim – rather than the perpetrator.

A man's home is still his castle and the authorities are loath to intrude.

Most abusers are men and most victims are women. Even the most advanced communities in the world are largely patriarchal. Misogynistic gender stereotypes, superstitions, and prejudices are strong.

Therapists are not immune to these ubiquitous and age-old influences and biases.

They are amenable to the considerable charm, persuasiveness, and manipulativeness of the abuser and to his impressive thespian skills. The abuser offers a plausible rendition of the events and interprets them to his favor. The therapist rarely has a chance to witness an abusive exchange first hand and at close quarters. In contrast, the abused are often on the verge of a nervous breakdown: harassed, unkempt, irritable, impatient, abrasive, and hysterical.

Confronted with this contrast between a polished, self-controlled, and suave abuser and his harried casualties – it is easy to reach the conclusion that the real victim is the abuser, or that both parties abuse each other equally. The prey's acts of self-defense, assertiveness, or insistence on her rights are interpreted as aggression, lability, or a mental health problem.

The profession's propensity to pathologize extends to the wrongdoers as well. Alas, few therapists are equipped to do proper clinical work, including diagnosis.

Abusers are thought by practitioners of psychology to be emotionally disturbed, the twisted outcomes of a history of familial violence and childhood traumas. They are typically diagnosed as suffering from a personality disorder, an inordinately low self-esteem, or codependence coupled with an all-devouring fear of abandonment. Consummate abusers use the right vocabulary and feign the appropriate "emotions" and affect and, thus, sway the evaluator's judgment.

But while the victim's "pathology" works against her – especially in custody battles – the culprit's "illness" works for him, as a mitigating circumstance, especially in criminal proceedings. 

In his seminal essay, "Understanding the Batterer in Visitation and Custody Disputes", Lundy Bancroft sums up the asymmetry in favor of the offender:

"Batterers ...  adopt the role of a hurt, sensitive man who doesn't understand how things got so bad and just wants to work it all out 'for the good of the children.' He may cry ... and use language that demonstrates considerable insight into his own feelings. He is likely to be skilled at explaining how other people have turned the victim against him, and how she is denying him access to the children as a form of revenge ... He commonly accuses her of having mental health problems, and may state that her family and friends agree with him ...  that she is hysterical and that she is promiscuous. The abuser tends to be comfortable lying, having years of practice, and so can sound believable when making baseless statements. The abuser benefits ... when professionals believe that they can "just tell" who is lying and who is telling the truth, and so fail to adequately investigate.

Because of the effects of trauma, the victim of battering will often seem hostile, disjointed, and agitated, while the abuser appears friendly, articulate, and calm. Evaluators are thus tempted to conclude that the victim is the source of the problems in the relationship."

There is little the victim can do to "educate" the therapist or "prove" to him who is the guilty party. Mental health professionals are as ego-centered as the next person. They are emotionally invested in opinions they form or in their interpretation of the abusive relationship. They perceive every disagreement as a challenge to their authority and are likely to pathologize such behavior, labeling it "resistance" (or worse).

In the process of mediation, marital therapy, or evaluation, counselors frequently propose various techniques to ameliorate the abuse or bring it under control. Woe betides the party that dares object or turn these "recommendations" down. Thus, an abuse victim who declines to have any further contact with her batterer – is bound to be chastised by her therapist for obstinately refusing to constructively communicate with her violent spouse.

Better to play ball and adopt the sleek mannerisms of your abuser. Sadly, sometimes the only way to convince your therapist that it is not all in your head and that you are a victim – is by being insincere and by staging a well-calibrated performance, replete with the correct vocabulary. Therapists have Pavlovian reactions to certain phrases and theories and to certain "presenting signs and symptoms" (behaviors during the first few sessions). Learn these – and use them to your advantage. It is your only chance.