“I Started Avoiding It, What's the Point?”: Intimate Partner Violence Survivors’ Stories of Medical Disenfranchisement

Abstract

This study explores intimate partner violence (IPV) survivors’ experiences seeking healthcare. Interviews reveal that survivors are often treated by healthcare professionals that operate under the biomedical model, which encourages providers to objectively diagnose and treat IPV-related symptoms. Providers utilize the clinical gaze to isolate specific injuries and symptoms of violence without identifying how violence affects overall health and well-being. In doing so, providers may inadvertently establish women's bodies as malfunctioning or defective, leaving survivors to feel unsupported, stigmatized, and disempowered. This paper sheds light on how IPV survivors can become disenfranchised from the healthcare system.

Introduction

Intimate partner violence (IPV) results in a wide range of physical, mental, and sexual health-related symptoms for women experiencing violence. As a result, IPV survivors seek health care often (Tower et al., 2012). Although the healthcare system encounters incidences of IPV frequently, abuse remains an under recognized issue (Dicola & Spaar, 2016). For instance, health providers may treat physical symptoms of IPV, such as injuries, gynecological problems, or digestive issues, without connecting them to the underlying social cause—IPV (Sutherland et al., 2001). This paper explores interview findings from IPV survivors and highlights their experiences seeking care for violence-related symptoms. I draw from two key theoretical constructs, the biomedical model and the clinical gaze, to contextualize survivors’ experiences. Namely, I examine how objective and detached approaches to health care can lead to detrimental outcomes for women experiencing violence.

From the 18th to 19th centuries, the arrival of modern positivistic science created a fundamental shift in medicine—the arrival of the biomedical model (Bahadur & Rajbhandari, 2024). Under the biomedical model, the body is viewed as a machine and a sick body is one that is malfunctioning or defective (Bahadur & Rajbhandari, 2024). To treat sick bodies, medical experts develop and follow treatment trajectories that span diagnosis, intervention, and recovery (Tower et al., 2012). During treatment, healthcare providers must make objective observations of symptoms and maintain professional detachment (Wade & Halligan, 2004; Walter, 2004). One way to do this is to focus on isolated, diseased organs and ignore the social and personal realities of the patient (Bourgois, 2013).

Therefore, the introduction of the biomedical model transformed how providers view and interact with their patients. Michael Foucault (1963) was pivotal in theorizing about how providers began to focus on patients’ body parts and diseases, rather than patients as a whole person. According to Foucault (1963), providers evoke what he called the “clinical gaze” to objectively examine bodies. Doctors are first taught how to objectify bodies by dissecting cadavers in medical school (Walter, 2004). This teaches them to use the clinical gaze to see bodies objectively and with clinical detachment or to strip the body of its personhood (Walter, 2004). Doctors then are encouraged to isolate specific body parts and organs when diagnosing and treating patients.

Under the biomedical model, providers are viewed as experts over illness trajectories, and they control understandings of illness and the appropriate solutions (Tower et al., 2012). Providers are then able to evoke their authority to transform social issues, like violence, into manageable and treatable health problems (Lavis et al., 2005; Tower et al., 2012; Warshaw, 1989). For example, providers may transform an arm injury caused by violence into simply a “fracture.” In doing so, providers are given significant authority over how to treat symptoms of abuse, like a fracture, without acknowledging the cause of the fracture. As a result, physicians may make diagnoses of the body that undermine any underlying social contributors to poor health (Lavis et al., 2015), and the medical trajectory is viewed as the most appropriate solution to symptoms, rather than vital social resources.

Previous research demonstrates that women's experiences are particularly vulnerable to being transformed into medical conditions to be “fixed” by medical interventions, like violence. This was the case in 1979 when psychologist, Lenore Walker, suggested that Battered Women's Syndrome was a psychological explanation for IPV survivors’ compliant and submissive behavior. Women were pathologized for their passive and masochistic personalities under this syndrome (Sweet, 2014; Walker, 1979), which effectively reframed women as the issue to be fixed, rather than their partner's abusive behaviors. During this time, women suffering from abuse were frequently labeled as pathological, sick, or crazy (Stark et al., 1979). Rather than getting the help they needed to deal with symptoms associated with violence, their bodies were transformed as the site of disorder. This is a prime example of how medicine dominates understandings of health and illness, and the power the providers hold to transform social issues into manageable health problems.

When women's bodies are pathologized as malfunctioning, women are subjected to victim-blaming attitudes or are blamed for having poor health. As Sweet (2014) describes, “under the logic of health, those who cannot properly manage themselves as healthy subjects are called out for being expensive and detrimental to the system” (p. 50). Under the biomedical model, women's malfunctioning bodies are viewed as a problem, and women are blamed for not taking care of their bodies properly. Consequentially, women experiencing violence are reframed as the issue to be treated via medical interventions, and the context of IPV that is responsible for women's poor health goes unrecognized (Tower et al., 2012; Warshaw, 1989).

This paper explores IPV survivors’ experiences seeking care, and how their health outcomes are influenced by the persistence of the biomedical approach to medicine. Although Michel Foucault's work on the clinical gaze has been very influential within sociological research on health and illness, few studies have explored how his work applies to IPV survivors’ experiences in healthcare settings. This study addresses that gap by examining how the clinical gaze, as described by Foucault (1963) and others, influences IPV survivors’ interactions with healthcare professionals. The findings from this study indicate that the biomedical model prevails in approaching violence-related symptoms, and providers abide by the biomedical model by evoking the clinical gaze. This study is unique in that it explores how the biomedical approach to care can lead to a process of medical disenfranchisement for survivors. I conclude by considering how other models of care would be more beneficial for survivors seeking care and the limitations of this study.

Methods

I implemented a qualitative study design to understand IPV survivors’ experiences seeking healthcare. In general, qualitative analyses reveal stories about how people construct their realities and experiences, and stories can help us gain new insights and knowledge about various phenomenon (Lugmayr et al., 2017). For this study, interviews were best suited to elicit participants’ experiences seeking healthcare and their perceptions, feelings, and opinions regarding healthcare professionals’ treatment of the violence they experienced. I conducted 20 interviews with IPV survivors for this study. This study was approved by the Institutional Review Board (IRB) at North Carolina State University.

Inclusion Criteria and Ethical Considerations

To participate in this study, IPV survivors had to meet the following inclusion criteria: (1) be 18 years or older; (2) identify as women; (3) have been in an IPV relationship and have left abusive relationships 6 months ago or longer; (4) have sought health care; and (5) agree to be audio recorded.

The Belmont Report, which is used by IRBs to determine vulnerable populations, does not officially recognize survivors of violence as a vulnerable population. However, they face unique ethical considerations. As such, I implemented safety precautions throughout this study. Prior to the study, I limited my sample frame to women who have left abusive relationships 6 months ago or longer because I thought that this was an appropriate time for women to secure safety without excluding too many survivors interesting in participating. Beauchamp and Childress (2009) argue that excluding survivors from research completely because of fear of harm is paternalistic. Meanwhile, Lawless (2001) suggests waiting some time to include survivors in research because women who have just recently been out of a violent relationship may provide more fragmented and incoherent stories than women who have been out longer. Without clear guidance from the literature on how long women should be removed from violent relationships before engaging in research, I set 6 months as the time limit.

I carried out safety precautions during and after the study as well. During interviews, I checked in with women periodically to ensure they were okay, looked for both verbal and non-verbal cues of discomfort or distress, and reminded participants they could discontinue the interview at any point. Because women were located across the United States, I created a list of national resources that I sent survivors after the interviews to a safe email address in case interviewees needed support post-interview. Finally, all participants were assigned a pseudonym to protect their privacy and confidentiality.

Recruitment and Sample

To recruit women, I employed a convenience sampling strategy. Research has shown that convenience sampling is an effective method for recruiting IPV survivors due to the sensitivity and intensity of the subject (Renzetti et al., 2018). Following convenience sampling strategies, I recruited participants through Facebook and Reddit, two social media platforms. First, I located pages on each platform tailored to IPV survivors. Second, I either asked administrators of pages to post my recruitment flyer, or I posted myself when I could.

If survivors were interested in participating, they contacted me by email or called a Google Voice number I created for the study. Google Voice creates a phone number that will transfer incoming calls, and I used this to protect my own confidentiality. I deactivated the Google Voice number after recruitment. Upon contacting me, I screened participants to ensure they met the study inclusion criteria and then scheduled an interview.

It is important to note that recruitment and interviews occurred during the COVID-19 pandemic, from September 2020 to March 2021, which likely affected recruitment efforts. Recruiting during the pandemic potentially impacted women's availability and willingness to participate. Many low-income and/or minority populations were likely overburdened by the pandemic and/or working during the pandemic and unable to participate. Therefore, the pandemic likely affected both recruiting efforts and the final sample in this study.

The final sample for this study consisted of 20 survivors of IPV. Initially, 33 IPV survivors expressed interest in participating. Out of the 33, two did not attend our scheduled interviews, three canceled their interview and did not reschedule, four showed initial interest but did not schedule interviews, and four were excluded because they did not meet the study criteria. Participants ranged in age from 29–65, with an average age of 46. Women were located all over the USA in different time zones, from California to Maine. One participant lived in the UK but spent half her time in the USA. The sample was not very racially diverse; 14 identified as White (70%), three identified as Hispanic or Mexican (15%), two identified as mixed race (10%), and one identified as Black (5%). Participants’ education ranged from high school/GED to a master's degree.

Data Collection and Analysis

I conducted interviews virtually, and informed consent was audio-recorded prior to the start of interviews. Participants chose whether they wanted to participate in a Zoom or phone interview. Although interviews occurred virtually, this did not affect the quality of the interviews. In fact, previous research suggests that phone and Zoom interviews are conducive to quality, in-depth interviewing techniques (Reñosa et al., 2021; Sweet, 2002). To facilitate interviews, I followed a semi-structured interview guide, and I revised the interview guide iteratively following the first few interviews. I transcribed and anonymized the recorded interviews, and then analyzed them in Dedoose, a web-based qualitative analysis software.

Data analysis was ongoing throughout this study, and I followed a grounded theory approach, which includes collecting and analyzing data at the same time (Charmaz, 2014). During analysis, I created codes and categories to describe the data, wrote memos to elevate codes, and advanced theory at every step of the process, following grounded theory strategies (Glaser & Strauss, 1967). Through an iterative process of coding and memo-writing, I advanced the data to a conceptual and theoretical level, and those findings are presented in this article.

Findings

In this section, I examine IPV survivors’ stories of seeking health care. First, I highlight survivors’ narratives that describe how healthcare providers evoke the clinical gaze to treat IPV-related symptoms. Healthcare providers isolate specific body parts or symptoms to be treated medically. As a result, providers inadvertently pathologize women's bodies as the issue to be “fixed.” Second, I provide stories that exemplify how even when women disclose abuse to providers, they are often discouraged, invalidated, or shamed from discussing how abuse is affecting their overall health. Finally, I explore how survivors’ negative experiences seeking health care disenfranchise them from the healthcare system.

Providers Evoking the Clinical Gaze to Pathologize Survivors and Treat Abuse with Medical Interventions

Survivors often sought care for both physical and mental health care symptoms. While seeking care, women articulated how providers often attended to their physical and mental symptoms without addressing the cause of them. In this section, I describe how providers evoked the clinical gaze and pathologized women's bodies as the site of disease or disorder to be medically treated. Interview findings suggest that providers overlooked how abuse affected health, and how the biomedical model prevented them from looking at survivors’ health holistically. Instead, when providers could not offer a medical diagnosis for multifaceted symptoms, they blamed survivors for their bodies’ malfunction.

Most participants shared that they experienced severe physical injuries from abuse. Lily recalled an instance where her husband strangled her until she lost consciousness, and he knocked her teeth out. When Lilly regained consciousness, her husband said, “Oh, you’re alive. Thank God. I thought you were dead.” Lily had to have her mouth wired shut at the hospital following this incident, and she described how health professionals left her to deal with the emotional aftermath on her own—“I think they are so focused on like that crisis moment, her jaw is broken, let's wire it shut, and let her deal with her emotional mess.” This story shows how medical professionals evoked the clinical gaze to isolate Lily's jaw but disregarded the root cause of the injury. Although they fixed her injury, she could not recall healthcare providers giving her any additional resources about domestic violence support.

Survivors also described how healthcare professionals evoked the clinical gaze when they sought care for health concerns beyond injuries, such as heart problems. Celine explained:

I don’t know if I told [my doctor] about the abuse, he was a cardiologist…that was his zone that he stayed in, he didn’t really go outside of that… these doctors, I don’t think they go outside of their specialty field or feel comfortable doing that.

Celine described how her cardiologist evoked the clinical gaze to “stay in his zone.” In other words, her doctor examined only one body part, her heart, and did not look at Celine's health holistically to understand how other stressors, like abuse, could be affecting her heart health. Celine speculated that her provider may have been uncomfortable going outside his specialty.

From survivors’ stories, when providers do not address the root cause of symptoms or injuries, they may inadvertently pathologize women's bodies as the site of “disorder.” Most notably, I found this to be true in Tina's story. Tina recalled a suicide attempt, and following it, she was escorted to a hospital and then sent to a mental health living facility. During her time at the mental health facility, she recounted:

I was sent to a counselor. And for six months, I had to see her, and I never said a word to her—didn't say a word. I'd go in her office and sit down and stare at the floor, three days a week… And one day, I sat in her office and just started to cry. She cancelled all her appointments for the day. And I sat in her office for seven hours. And all I could do was ball. And I finally started to talk about what happened to my life and all that stuff. But in the meantime, they still had me see psychiatrists, psychologists, and all that stuff. So, they diagnosed me with bipolar two. But I never went on bipolar medication except for two months. They gave me lithium, and it destroyed my thyroid. What they did is put me on very high doses of anti-anxiety and depression medication.

Although Tina experienced a lot of traumas in her lifetime, health providers were quick to label her with a stigmatizing psychiatric disorder. In fact, they misdiagnosed her; Tina later explained that health providers eventually diagnosed her with Post-Traumatic Stress Disorder (PTSD), and she was misdiagnosed with Bipolar Two Disorder. Providers evoked the clinical gaze to diagnose Tina's mental health symptoms, and they pathologized Tina's body as the site of disorder, rather than understanding how trauma was affecting her physical and mental health. To treat Tina's “pathology,” providers prescribed her a medication that led to more health complications.

Although Tina's story is unique, she is not alone in being labeled with psychiatric conditions. In fact, many of the survivors I interviewed were diagnosed with mental health problems while seeking care. Following an abusive episode, Alyssa sought health care, and recalled this interaction:

So I went to the doctor, to you know, just to go to the doctor, and they're like, are you okay? Do you think he'll hurt you? And I'm like, no, I don't think so. So, they gave me Klonopin for my anxiety. And again, I was like absolutely hysterical in your office, couldn't you ask me more questions?

When Alyssa went to the doctor for help, doctors medicalized abuse and reduced it to her own pathology—anxiety. Later in Alyssa's story, she explained how she began seeing a counselor who knew a family doctor she started seeing, and they coordinated her care, which led to improved outcomes. She said, “[Doctors] started hearing me and things started to get better. Like I was getting actual care for the things I really needed. Not just like, oh it's anxiety.” Alyssa's story highlights the importance of assessing survivors holistically to avoid pathologizing them and reducing their trauma to a psychiatric disorder. When clinicians label psychological symptoms of violence as a disorder, this does not help to address abuse. Rather, health providers frame women as the problem to be fixed through medical interventions.

Many of the women in this study reported receiving medication to “fix” their symptoms. For example, Lindsay, who had disclosed abuse to her doctor described how her doctor prescribed her depression medication without taking the time to understand why she was feeling depressed: “I'd gone for antidepressants, I think, and I broke down in tears. And I said, I'm living through some domestic abuse. And he said, well, that's none of my business and he gave me some anti-depressants.” Lindsay's doctor evoked the clinical gaze and detached himself from the social cause of her symptoms but treated them with medication anyways.

Although survivors acknowledged that providers’ main priority is to treat their physical needs, they expressed that doctors should understand how abuse has affected their overall health, but they often do not. For example, Yasmin told me:

I think they probably should have asked [about abuse] maybe tried to put two and two together. I saw a new doctor yesterday, which is a neurologist, and I told her [about] the domestic violence situation, assaults, so on and so forth. And the reason I told her that is because she asked me if I had been under stress, and I said yes, doctor, I've been under severe stress, severe stress. Why I did not have a stroke is beyond me. I made a joke, and I said, I guess it's not my time to go, she was very stiff, she was good, but she was stiff, you know, you can't go beyond that.

Yasmin's narrative indicates that her admission of violence made her provider slightly uncomfortable. Yasmin felt as though her provider detached herself from Yasmin's lived experience of violence, and did not piece together how abuse was affecting her health concerns.

Sometimes survivors’ trauma manifested as a multitude of symptoms that doctors were unable to diagnose. As survivors searched for medical explanations for their symptoms, such as stomach pain, sleeplessness, and weight loss, they were often told there was nothing medically wrong and felt as if they were going crazy. This was the case for Rhonda who experienced a host of physical symptoms during and following her abusive relationship:

That's probably why [the doctors] never found anything because it was just your body is in such stress, constantly. You're living in constant stress mode all the time, just to survive. And so, it was probably bad, but no one, no one ever asked me [about abuse], that I remember. They just essentially said, it's in your head, I don't know why you're doing this. And then I had doctors that would prescribe some medicine… [after the relationship], I went through a time from, like, 2008 to 2016, where I was having problems, and I didn't know what the cause was, but I was losing weight. I had all these symptoms. I had joint pain. My stomach hurt when I ate. We did all these tests, and the first doctor I saw, she's like, it's all in your head. She never asked me about any, you know, if my marriage was good, nobody did.

Rhonda's providers conducted a series of biomedical tests, but they could never provide a clear diagnosis. In lieu of a clear diagnosis, Rhonda's providers told her that all her symptoms were in her head—invalidating her experiences.

From these stories, I argue that the biomedical model was prevalent in most survivors’ stories where providers evoked the clinical gaze to isolate symptoms, make a diagnosis, and medically treat symptoms. However, the clinical gaze allowed clinicians to detach women's health problems from the context in which they occurred, which led to repeat health problems for many women and invalidated the source of their symptoms. Interview findings suggest that when healthcare providers fail to consider survivors’ health in its entirety, they inadvertently attribute the responsibility for poor health outcomes to the survivors own malfunctioning and provide medications as a quick fix. Consequently, this attribution leads survivors to avoid seeking further medical assistance in the future.

Survivors’ Feelings of Discouragement, Invalidation, Stigma, and Shame While Seeking Care

Many survivors’ narratives revealed a pattern of disempowerment in medical encounters. According to survivors who disclosed abuse to their providers, they often felt discouraged, invalidated, ashamed, or stigmatized during medical interactions. Disclosing abuse to providers is already a daunting task, often driven by fear or discomfort, so it is essential for providers to respond positively, but that is not always the case. For instance, Yasmin articulated that she felt her disclosure of abuse to her doctor was pointless:

And when I told [my doctor about the abuse], I was alone, they could have pressed or asked me more questions. They did not. Like and I had to make a choice, do I keep blabbing—blah, blah, blah? Just tell them more information that is going to go nowhere and waste my time?

Upon disclosure, Yasmin felt unheard and unsupported by her provider's reaction, and chose to withhold further information, feeling discouraged from discussing abuse further with her provider.

Similarly, survivors also felt discourgaged from discussing how they believed their symptoms might be related to violence, as illustrated by Louisa's account:

I had talked to them about—how can I put it—just having been punched in the head so many times, or into brick walls—there was a lot of physical stuff. And I've kind of said, with my memory kind of shot, I kind of wonder [if it's related to abuse]. And rather than [providers] taking time to ask, it's always kind of switched over to, oh, it could just be anxiety. Well, it could be, but it also could be something else… I think that's something that when people are trying to talk about something, [providers] need to shut [their] mouth and listen, that's you know, it's helpful. It can help.

Louisa's providers did not listen to her explanation for her memory loss. Rather, her providers attributed Louisa's memory loss to anxiety, invalidating Louisa's understanding of the relationship between health and violence.

Additionally, survivors commonly reported feeling shame and stigma while seeking help, leading them to internalize a sense of unworthiness. For example, when I asked how health professionals made Nikki feel, she responded, “Gosh it's hard, like I didn't matter and that I must have deserved it and there was no fixing me, that I was too broken. That it was my fault.” Katy expressed similar sentiments as she was seeking help and explained how health providers exacerbated her shame:

I feel as a survivor, as a victim, you just feel like it's not important. It's not a big deal. And it shuts you into more, it just puts you into more shame. Or, like, it's not important, like, oh well, they didn't really ask about it, so it doesn't matter.

Nikki and Katy's experiences highlight how healthcare providers contributed to their feelings of shame and self-blame. Ultimately, survivors articulated stories of victim-blaming attitudes from their provides, which exacerbated their reluctance to seek further help.

Survivors Avoid Seeking Future Care—A Process of Medical Disenfranchisement

Survivors’ negative encounters with medical professionals often resulted in survivors avoiding future healthcare altogether. In other words, survivors became disenfranchised from the healthcare system. As providers pathologized women's bodies and/or discouraged, invalidated, or shamed survivors upon disclosure, women's trust in healthcare providers eroded, and survivors felt marginalized. Rhonda summarized this saying, “[My provider] was just very dismissive. And so that really turned me away, for many years, and it still does to this day, I don't like going to anybody.” Rhonda's experience exemplifies how dismissive attitudes from providers can deter survivors from seeking future care.

Like Rhonda, Lauren highlights how the failure of medical providers to address obvious signs of abuse further reinforces survivors’ decision to avoid seeking care.

That day when I went in with a broken rib, I mean, it was super obvious. I mean, I was covered in bruises. And no one asked me, no one asked me anything. So, it was just, I think women choose not to seek health care, because why? Nothing will be done.

Survivors’ stories underscore how healthcare providers’ failure to address abuse and listen to survivors’ concerns diminishes trust and leads to disenfranchisement from healthcare. Krystal's statement succinctly highlights the process of medical disenfranchisement following abuse—“I started avoiding it, what's the point?”

Discussion

The healthcare system's reliance on the biomedical model of illness and providers’ utilization of the clinical gaze work in tandem to pathologize women's bodies, control women's understandings of their health, and isolate IPV survivors from the healthcare system. This study challenges assumptions of the biomedical model and shows how providers’ objective treatment of violence does not lead to positive health outcomes for survivors of IPV. Moreover, providers’ clinical gaze works to control and maintain medical understandings of health, while dismissing women's understandings of how violence impacts their overall well-being. Consequentially, the healthcare system's approach to violence can disenfranchise survivors from the system.

This study adds to the body of literature that critiques the biomedical model. Wade and Halligan (2004) argue that the biomedical model cannot fully account for experiences of health and illness because the model relies on the assumptions that an illness has a single underlying cause, disease pathology is always the single cause, and removal of the disease will restore health. This study exemplifies that this illness pathology is not applicable to social determinants of health, like IPV. As other researchers have shown, complex issues like IPV do not have a clear medical diagnosis or treatment trajectory (Young-Wolff et al., 2016). Therefore, this study echoes prior research that demonstrates that disease and health are often the result of a mixture of psychological, social, and biological factors, and it highlights the shortcomings of the biomedical model in addressing abuse (Bahadur & Rajbhandari, 2024; Tower et al., 2012; Warshaw, 1989).

This study also contributes to post-structural critiques of medicine, which criticize it as a form of social control. Expanding on Foucault's (1963) work, I find that providers evoke the clinical gaze to isolate injuries and symptoms from their broader context—violence. Prior studies have shown that objectivity and detachment allow providers to maintain authority over what constitutes a health problem (Wade & Halligan, 2004). It also minimizes women's own understanding of how abuse has impacted their overall health and well-being. Thus, this study shows how providers may evoke the clinical gaze to maintain social control, power, and knowledge (Bahadur & Rajbhandari, 2024; Foucault, 1963). Following this logic, providers also utilize their authority to pathologize women's bodies and frame them as the issue to be fixed, rather than violence, which further victim-blames IPV survivors seeking care (Stark et al., 1979; Sweet, 2014).

Finally, when providers dictate survivors’ understanding of how abuse affects their health, trust between patients and providers is eroded. Medical trust is typically gauged by the extent to which patients believe that their doctor prioritizes their well-being above all else (Stepanikova et al., 2006). As this study has shown, participants often felt that their comprehensive needs were overlooked and their explanations of how abuse impacted their health were disregarded, leading to a breakdown in trust. Previous research finds that trust may be further eroded by a lack of patient-centered communication and substandard quality of care (McAlearney et al., 2012). The women interviewed expressed frustration when providers failed to acknowledge the significance of their lived experiences during interactions, a sentiment echoed in previous research (Nicolaidis et al., 2008). Trust in medical professionals is crucial as it encourages individuals to seek healthcare (Jacobs et al., 2006). As evidenced by this study, when trust diminishes, women disengage from the medical system, ceasing to seek care as they perceive it to be useless.

To combat the issues presented in this study, it is essential for the healthcare system to undergo serious changes (Lavis et al., 2005). One solution could be to adopt a social model of care when it comes to IPV. Contemporary research highlights the importance of addressing social determinants of health (SDOH), like income, education, and social support, to improve health outcomes (Andermann, 2018; Wilkinson & Pickett, 2010). I argue that IPV is another SDOH that impacts individuals’ health outcomes, but it is not widely recognized by the healthcare system as such. If IPV is addressed in healthcare settings, women may receive referrals to critical social resources to help address abuse (Spangaro et al., 2020). Moreover, healthcare is a critical space for connecting IPV survivors to resources because it is often the first location of formal help-seeking (Bacchus et al., 2003). However, research suggests that IPV remains largely underrecognized by healthcare professionals (Dicola & Spaar, 2016). This suggests that the biomedical model remains steadfast, especially when treating IPV, despite progress towards addressing SDOH.

Nonetheless, many structural barriers exist within the healthcare system that prevent providers from addressing abuse holistically. Research has documented multiple work priorities, fast-paced work environments, and lack of time (Beynon et al., 2012; Minsky-Kelly et al., 2005) as barriers to addressing violence. Healthcare providers also require more training on IPV signs and symptoms (Lavis et al., 2005). Although I am critical of the healthcare system in this article, I also recognize the institutional constraints that providers are operating from under, which prevents them from appropriately assessing for and responding to instances of violence. As Bourgois (2013) argues, the neoliberal state of our healthcare system places medical professionals in a double bind—“either they spend the time and energy necessary to listen to and fully treat the patient and put their job and clinic in economic jeopardy, or they move at a frenetic pace to keep their practice afloat and only partially attend to the patient in their presence” (33). Unfortunately, unless the healthcare system changes how it approaches medicine, improved outcomes for IPV survivors are unlikely to occur.

Conclusion

This study is also not without limitations. An intersectional analysis is missing from this paper. The lack of voices from women of color is not intentional, and it likely stems from limitations in sampling and recruitment, exacerbated by the challenges posed by the COVID-19 pandemic at the time the data was collected. However, it is important to acknowledge that women of color's experiences seeking care for violence are likely different. Most notably, it is likely that minority women are already disenfranchised from the healthcare system for many reasons. First, prior research documents how the healthcare system denies the existence of black women's pain, refuses to treat pain, and assumes that black women are incompetent and underserving of health care (Cottom, 2019). Second, not only are black patients often mistreated, but it's widely documented that minority patients distrust the healthcare system due to limited access, historical segregation, mistreatment, and maltreatment by healthcare professionals (Boulware et al., 2003; Brandon et al., 2005). Third, the healthcare system has subjected minority women to harm through forced sterilization and other controlling reproductive tactics throughout history (Luna, 2020; Roberts, 2017), which leaves them with little trust in the healthcare system. Given these factors, survivors of color are likely already disenfranchised from the medical system, and do not become so seeking care for IPV.

In conclusion, I draw from the framework of the biomedical model and the concept of the clinical gaze to illustrate the challenges of approaching health problems related to social issues via the biomedical model and the clinical gaze. This study highlights how imperative it is for the healthcare system to undergo systemic changes to empower healthcare providers to adopt a more social approach to addressing IPV within healthcare settings to combat disenfranchising IPV survivors from the healthcare system.

Author Biography

Shelly Maras, PhD, is an Evaluation Research Scientist at the University of North Carolina at Chapel Hill. She completed her PhD at North Carolina State University in Sociology. During this time, she conducted research on intimate partner violence survivors’ experiences seeking health care. She now works in evaluation research where she uses qualitative and mixed-methods to evaluate programs within a wide range of topic areas, primarily in public health.