This list works. Use it
CMAJ 1998;158:1430
Dr. Brian F. Rudrick, in his letter "Familial abuse: a multifaceted problem" (CMAJ 1998;158[7]:866-7), presents good arguments but misses the point. Yes, women also abuse, and many items on "The eight types of abuse" list (CMAJ 1997;157[11]:1557-8) can be applied to women who abuse. However, the list and the accompanying article, "More than meets the eye: recognizing and responding to spousal abuse" (CMAJ 1997;157[11]:1555-6 [full text]), by Fern Martin and Dr. Catherine Younger-Lewis, address the abuse of women.
Why does this invariably happen? An article about the care of women is published, and someone objects that it appears to exclude men. If a medical journal published an article on a condition affecting children, say gastrointestinal disorders, would letters arrive asking "Why ignore adults? Don't we also suffer from GI disorders?"
The purpose of the article by Martin and Younger-Lewis and the exceptional list was to provide a tool for all physicians to help their patients discuss, and perhaps even address, abusive relationships. Remember the introductory paragraph: "This list is based on one made by men [italics mine] who were describing how they controlled or harmed their wives or girlfriends."
I speak as a woman who escaped 15 years ago from a long-term abusive relationship. The Lanark County Interval House list is the best thing I have ever read on abuse. As Martin and Younger-Lewis so eloquently state: "Many of the actions listed may be considered innocent when weighed in isolation. In combination and over a period of time, however, they may constitute a pattern of behaviour designed to break another person's spirit." The list validates the experience of a woman subjected to assaults on her spirit. If this list had been offered to me by my GP or my children's GP, it could have changed my life and given me the courage to leave years earlier.
Pay attention, physicians. This list works. Use it.
Jennifer Raiche
Gloucester, Ont.
raichj@cma.ca
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