Medicalising domestic violence

The trivialising, media version of posttraumatic stress disorder (PTSD), where everyday life events are described as ‘traumatic’, fails to appreciate the precise nature of trauma causing PTSD. Such trauma involves ‘actual or threatened death or serious injury, or a threat to the physical integrity of self or others’ AND ‘intense fear, helplessness or horror’.¹ There is an implicit suggestion by Dr Fitzpatrick that domestic violence is an everyday, minor life event, similar to receiving bad news.² Police statistics maintain that domestic violence accounts for about half the women murdered in Britain. Those experiencing domestic violence may legitimately believe that their partners may kill them.

For a well-researched reply to Summerfield's paper equating PTSD to ‘victimhood’ and an inadequate ‘stiff upper lip’ see Mezey.³ Most psychiatric conditions reflect changes in human thinking over time³ and are part social construct. Chronic PTSD has neurobiochemical and anatomical consequences (for example, loss of hippocampus volume) that can be objectively monitored.^3,4 Not everyone with PTSD is seeking compensation. There is evidence for the liberating effect for patients in receiving an explanation of their life-disrupting PTSD symptoms.^3–5 In making a diagnosis of PTSD the patient's trauma is acknowledged and their symptoms are recognised as an understandable human response to extreme events. The diagnosis can lead to the victim achieving autonomy and rejecting ‘victimhood’.^3,4 PTSD can be successfully treated.⁴ In a general practice study, PTSD was present in 35% of those who had experienced domestic violence, and was indicative of experiencing the severe end of the spectrum of domestic violence.⁶ I agree with Dr Fitzpatrick that the outcomes of interventions in families' lives are not adequately researched.⁷ However, if the framework of PTSD helps a doctor recognise domestic violence when he would not otherwise have done so, then his patient at least has the opportunity of receiving a helpful intervention. Does Dr Fitzpatrick enquire as to the cause of the black eye, PTSD, depression or the bruise on the baby's belly? Or would this enquiry erode civil liberties and intervene in family life too much? Discussing safety and options for action with a woman experiencing domestic violence may erode her civil liberties but she might prefer that to being murdered or further damaged. While Dr Fitzpatrick's rosy view of ‘egalitarian and less abusive relations between the sexes’ may reflect a reality, it does not reflect the reality of the battered patient in front of him.