Targeting violence: A long road to recovery

On March 23, 2015, Maxine was brutally beaten and raped by a man in Des Moines.

She started drinking heavily the next day.

Maxine had already escaped a controlling, unhealthy marriage to a man she was in a relationship with for about a decade, she said, and the drinking helped her deal with the blame she placed on herself for the things that happened in her life.

It wasn't until mid-April that she finally sought help.

'I realized I needed something more than that,' said Maxine, whom The Gazette is not identifying by last name for privacy purposes.

By her account, she's had a slow but steady climb to recovery ever since.

More than 10 million women and men experience domestic violence each year and another 2 million women are raped each year, according to the Centers for Disease Control and Prevention. Domestic violence affects people of both genders and all sexual orientation, races and ethnicities, and education and income levels.

But intimate partner violence and sexual violence disproportionally affects women — with 22 percent of women being the victim of physical violence by a partner compared with 14 percent of men. Likewise, more than 19 percent of women have been raped compared with about 2 percent of men, according to the CDC.

Here in Iowa, 15,000 people sought domestic violence services in fiscal year 2014, including 2,500 in Eastern Iowa.

Impact on health

Intimate partner violence and sexual violence can leave lasting marks both physically and mentally, experts said.

For women who experienced intimate partner violence, about 20 percent dealt with one or more PTSD symptoms, 13.4 percent were physically injured and 6.9 percent needed medical care, according to a CDC survey.

University of Iowa researchers said women in physically and emotionally abusive relationships deal with depression, have high levels of stress and anxiety, attempt suicide, struggle with substance abuse and experience PTSD.

'Intimate partner violence does not cause someone to be mentally ill but it does have adverse effect on mental health,' said Corinne Peek-Asa, the associate dean of research at UI's College of Public Health.

'For those who are traumatized over long periods of time, it can alter the brain,' she added. Peek-Asa said this is a survival technique but it makes the victim not trust her or his own decision making skills, which can prevent them from leaving or reaching out for help.

They also deal with serious physical health issues, with research showing women can develop asthma, chronic pain and irritable bowel syndrome.

Audrey Saftlas, a UI professor of epidemiology who has conducted research on how intimate partner violence adversely effects birth outcomes, said these women are more likely to have preterm deliveries, give birth to babies with low birth weights, have babies that are small for gestational age and are at increased risk to miscarry. Saftlas and Peek-Asa also did a 2010 study that identified the prevalence of intimate partner violence among women seeking abortion services.

The study — which assessed physical and sexual violence through computer-based questionnaires — found that 11.5 percent of respondents reported being physically hurt by someone in the past year and 10 percent identified a current or former partner as the perpetrator. Likewise, 4.7 percent reported sexual violence in the past year, with 2.5 percent reporting sexual intimate partner violence.

Saftlas and Peek-Asa expressed need for more community-based interventions and resources. Screenings have been developed and are used in emergency rooms at hospitals across the country and in the Corridor, Peek-Asa said, but women are often not given more resources or help.

'We need many, many options for families,' she said.

Recovery

But leaving an abusive partner is difficult, experts say, because the abused is often isolated, financially dependent and has nowhere to go. On average, it takes a person seven times to leave before staying away for good.

Those who leave can find themselves homeless or stalked by their former partner, experts said, and some are even the victims of homicide. About 33 percent of female homicide victims are murdered by their current or former partner every year. according to the American Bar Association.

'The separation is an extremely high-risk time,' Saftlas said.

And even then, domestic violence and sexual violence survivors are on a long and winding road to recovery — one that can be riddled with stops, including depression, substance abuse and post-traumatic stress disorder.

'Healing isn't moving from A to B,' said Nelly Hill, a domestic violence program coordinator at Waypoint Services, which provides help to women dealing with domestic violence and homelessness in Benton, Black Hawk, Buchanan, Delaware, Dubuque, Jones and Linn counties. 'This is an ongoing thing that can't be solved. We just help them make it easier to deal with. We help them build resiliency.'

That's because the effect of the trauma seeps into the survivor's everyday life, Hill said, manifesting itself in many different ways.

'Often, they can't sleep at night, they'll be hyper vigilant, they can't go to work, they're isolated from their families or children, they're alone or depressed.'

Triggers can also continually haunt women, Hill said, like the smell of certain cologne, a particular word or loud, dominant voices can remind them of their partner or a traumatic event. 'I had one client whose abuser rode a Harley-Davidson,' Hill said. 'Every time she heard a motorcycle, her heart rate went up.'

Coping

When working through the aftermath of an abusive relationship or sexual violence, each woman has to find what works for her, Hill said. Some choose to journal, others meditate and some learn breathing techniques to help calm them when a trigger presents itself.

But self-medicating with alcohol or drugs is not uncommon either, she said.

'We don't identify good or bad coping,' she said. 'We just ask is this helpful? How can we build on it?'

Therapy, group counseling and substance abuse help can be a powerful combination to deal with the emotional trauma, Hill added. Waypoint Services has a variety of support groups — groups for women who are also struggling with substance abuse, groups for mothers dealing with Department of Human Services and groups for women seeking support — that offer education as well as validation for the choices they've made.

During the support groups, lead by counselors or certified volunteers, women share their experiences, the tactics used against them and how they cope, Hill said.

'A great group is lead by the group rather than the facilitator,' she said. 'The facilitator is really there to avoid shaming and victim blaming.'

Hill said women who have left an abusive relationship often blame themselves for not leaving sooner and for what happened to them.

'We tell them they did the best they could at the time,' she said. 'Whatever they did to stay safe is great.'

Maxine said the peer groups helped her realize she wasn't alone and rebuild her self-esteem. She's also worked with her therapist to finally forgive herself.

'I'm really enthusiastic about recovery now,' she said. 'I wasn't before. I thought I wasn't worth it. I took the blame for what happened to me.'

The session when she finally realized her attack wasn't her fault significantly altered the course of her recovery, she said.

'I went back to my room and showered,' she said. 'I felt all of the filth fall off me.'

These days, Maxine is proud to be sober. She has a new job. And she has regained her self-confidence, saying she is happier than ever before. Hill said Maxine has become a leader, helping other women deal with their situations.

'I like to say that I was this old rusty car,' Maxine said. 'Slowly, people came into my life and pulled me out of an old, dirty barn. They worked on me and eventually polished me into this beaming sports car.'