Issues in Family Violence

Fall 2001

An Aggravating Factor: Looking at how Mental Health Issues Impact Batterer Behavior

John Went

The fifth element in our abuser profile identifies two aggravating factors that exacerbate the severity, frequency and unpredictability of violent and abusive behavior: mental health issues and substance abuse. Safety planning for victims becomes much more complicated if these factors play a role in the abuse, and the abuser will have a more difficult time developing a non-violence plan that is effective. If the abuser is seeking help due to court or family pressure, these two aggravating factors must be assessed in order to promote safety for the victim and effective consequences for the abuser. Often, a man will have two or more simultaneous problems that interact with each other, and need separate interventions. In this article we address mental health as an aggravating factor. In our next publication we will examine substance abuse and battering.

Studies have suggested that abusive men are no more likely to have mental health problems than men in general. In Ed Gondolf's multi-site study of court ordered batterers, only about twenty-five percent displayed evidence of severe psychological issues. Those of us who have day-to-day interactions with abusers, or who have courageously analyzed our own abusive histories, are able to see this to be true, and recognize abuse as a power issue, not a mental health issue. For the average abusive man, a referral to a mental health program is unlikely to result in any change in his abusiveness.

On the other hand, certain psychological conditions render the standard abuser treatment programs to be ineffective and potentially dangerous to others with whom the man comes in contact, including the staff or clients of the program. These categories include any psychotic behavior or true paranoia.

If a psychotic man is truly misperceiving the people and things around him so that he is unable to distinguish what is real from what is not, he is unable to comprehend the meaning of his abuse program. His thoughts and emotions are disconnected from truth and he will not be able to appreciate his own contradictions. One such man I worked with looked at color photographs of his wife’s bloody face after an abusive incident and said, without emotion, “She must have fallen and hurt herself.” How is this different than the average abuser and how do you tell the difference? In his case, he was not simply denying his responsibility, as most abusive men are likely to do. His psychosis was evident in his lack of emotional connectedness to her condition, even when he believed his version of what had caused her trauma.

True paranoia is different from the standard paranoid thinking of most abusive men. Many abusive men incorrectly interpret their partner's actions, such as emotionally pulling away out of fear or disgust, as proof that their partners dislike them, may be leaving them, or may be having affairs. True paranoia however, has no basis in truth and cannot be talked through in such a way that his contradictions, or his responsibility, become clear. True paranoia will often become more firmly set in a man’s mind the more he talks about it, thereby increasing the danger to those around him. Men with such disconnections are highly dangerous and need a mental health program as a priority, not abuse treatment.

Other mental health categories are more difficult to sort out because they enhance control issues without being so obvious as psychosis or paranoia. If these men are first sent to an abuse program, a focus on control issues and helplessness may be helpful to sort out the mental health issues. If however, they are treated first in a mental health program, the mental health therapist may fail to take into account the man’s essential control issues that lead to the violence and abuse. The abusive man, now a mental health client, will not volunteer the emotional devastation his controlling has caused others, focusing instead on his own experience of his psychiatric condition. Besides encouraging his own self-centeredness, he may even persuade the therapist to be on his side by portraying his family as unsupportive rather than fearful or angry. The mental health system will thereby support continued abuse, mistakenly believing that ending the “condition” will end the control issues. In this setting, the cultural conditions that aid the abusive man will not be addressed at best, and, at worst, a whole new layer of cultural support will be added, leaving the victims even more helpless and hopeless.

A good example of the difficulties presented in sorting out battering and mental health issues is the variety of anxiety disorders that seem so commonplace in our society. Culturally, we seem to have little room for quiet and stillness, but great demands for production and competition. At the bottom of most anxiety is the fear of losing control, perhaps to illness, death, personal attack or some vague, indefinable fear. People with anxiety go to great lengths to either control or avoid the fear inducing stimulant, and will expect others in their family to help them on this quest. Abusive men do the same thing, but out of a sense of entitlement which supports their choice to use abusive and controlling behavior.

For example, a non-abusive man with obsessive-compulsive disorder (OCD) may expect his wife and children to keep the cereal boxes in a specific order in the cabinet and to always keep the cabinet door closed. He may be upset or agitated if it doesn’t go according to his needs. An abusive man with OCD goes beyond being disturbed, believing it is his right to determine the order in the cabinet, he forces others to live by his rules by whatever means works.

Posttraumatic Stress Disorder (PTSD) occurs following events that cause a person to believe death or severe injury is likely to occur. Some abusive men have suffered through a childhood with parents who were physically or sexually abusive, grown up in a neighborhood where street violence was commonplace or may have had to fight in a war. Abusive men with this disorder will often have a heightened sense of victimization, and the subsequent need to protect themselves at the slightest indication of “attack.” They learned, as children or soldiers, violence is an acceptable means of defense in a world where danger may come from anywhere, even an intimate partner or family member. Their vigilance for an attack will cause them to search for any sign that their physical or emotional state may be in jeopardy.

An abusive man with PTSD may therefore be keenly aware of his partner’s emotional state and will, very often, badger her with questions that seem like defensive, manipulative attacks. If he has PTSD, he believes he is gathering information to prevent her from hurting him. But on her side, he becomes an emotional, and potential physical threat if she does not intuit the correct answer. He will also be very emotionally and mentally distant from her to protect himself from intimacy.

Men with this disorder will be able, rather quickly, to recognize the contradictions in their belief system and behavior. Having experienced terror and fear, they can easily understand the terror and fear they have caused in their victims. What becomes more difficult, however, is their ability to “let down their guard," experience helplessness, and not react. If asked to do this by an abuser treatment program some PTSD men will have a sense of peacefulness and serenity, while others will become more intensely anxious and abusive. He may have increased “dissociation” (a feeling like he is disconnected from himself) and may increase his substance abuse to numb his feelings of fear and helplessness. This latter group may need to be treated in a mental health and/or substance abuse program prior to domestic abuse treatment.

The last group of mental health problems includes Depression and Bi-polar Disorder (or manic-depression). For the purposes of a program to end men’s abuse, these categories do not include a man who is “down” about an arrest, the loss of a partner, or various “self-esteem” concerns. Also, this category does not include the many manipulative attempts to control his partner’s behavior by threatening to kill himself. All of these situations are related to his abusive behavior and therefore must be resolved through the consequences developed in his community. He will feel better about himself once he has learned not to hurt the members of his family. However, since it is difficult for the average person to distinguish real threats from manipulation, any suicidal statements need to be assumed to be true. A call to 911 will often lead to clarity on this issue as well as a sense of security for the family.

Depression and manic-depression will severely limit a man’s ability to work with his own emotional connections to his family. He may be so depressed that he believes that there is nothing to live for, thereby being unable to set future, non-abusive goals. Or he may be so “up” as to be unable to notice the feelings and experience of those around him. Manic men (as well as many abusive men) will have unrealistic goals for family members, and believe strongly that his beliefs are the only correct beliefs. They will be awake for extended periods of time and expect their partners will be able to maintain this high energy level.

To repeat, abusive men are no more likely to have the above mental health issues as any other man. Therefore, the interpretation that signs of anxiety, PTSD or depression are the reasons for abusive behavior will lead the average counselor or mental health practitioner down a path that is dangerous for the victim and frustrating for the abuser who wants to stop his abuse.

For these men who actually have any of these mental health conditions, psychosis, or paranoia, safety planning for the victim and non-violence planning for the abuser becomes more complicated. But the interactive use of partner contact, a non-violence plan, and input from others in the abuser’s community could help sort out these mental health issues, which exacerbate the severity, frequency and unpredictability of abusive behavior.

From our perspective, within a treatment program for abusers, several factors may lead to a referral for a mental health evaluation. First, an increasing level of violence no matter what interventions the community uses. Second, a non-violence plan that seems to be going nowhere. And, most importantly, word from his partner or other community members about behavior relevant to various mental health categories such as anxiety, PTSD or depression. A decision will need to be made as to whether the mental health problems outweigh the need for a focus on his abuse, or whether continued work on his control issues will help his family to be safe and perhaps assist a mental health treatment professional in side-by-side work on both problems.

(c) 2001, The Non-Violence Alliance. Permission to reprint with the following information "Originally published in Issues in Family Violence, Volume 4, Issue 1 Fall 2001, The Non-Violence Alliance, www.endingviolence.com."