Stemming the Domestic Abuse Epidemic

Early intervention and treatment can be effective.
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A prayer vigil near the home where three women were found in Cleveland, May 8, 2013 (David Duprey/AP)

Ariel Castro pled guilty to 900 counts of kidnapping and rape on Friday and accepted a sentence of life without parole. Although he finally admitted to his crimes, we are left wondering what could have possibly led to this extreme violence against women. One clue is that Castro had a record of domestic violence arrests. But Charles Ramsey, the neighbor who intervened in what he believed was a domestic situation, also had a history of perpetrating violence in the home. What leads one man to break the cycle of violence and another to escalate to kidnapping, rape, and torture? 

We know that neighborhoods with higher levels of poverty, unemployment, and liquor stores have higher rates of domestic violence. Did any of Mr. Castro’s neighbors think it was “just another” instance of domestic violence and figured it “wasn't their place” to intervene? Many neighbors have now reported, in hindsight, screams from Castro’s house. (In contrast, in some South African towns, women stand outside their homes and bang pots when they hear a neighbor being assaulted to create community awareness to stop the perpetrators.)  

In Ariel Castro’s case, the story becomes more complicated. Ariel Castro says he was abused as a child. A U.S. Department of Justice report revealed that abused children begin committing crimes at younger ages and commit nearly twice as many offenses as non-abused children. Was this the root of Mr. Castro’s violent nature?  His own daughter, Emily Castro, witnessed domestic violence in the home. She developed severe mental health issues and attempted to kill her own infant. However, most abused children or those who witness violence do not go onto perpetrate violence.

Castro is a particularly monstrous perpetrator, but it's also important to put this story of violence against women in context.  

Each day in the United States, three women are killed by a partner and 24 people per minute are victims of rape, physical violence, or stalking by an intimate partner. 

I’ve been an emergency room doctor for over a decade at one of our nation’s largest inner city hospitals, Grady Memorial Hospital in Atlanta, and I’ve witnessed firsthand the injuries from domestic violence as well as the long term mental health consequences of abuse. I know these injuries are preventable. Further, as part of my team’s research funded by the Centers for Disease Control and Prevention, we surveyed over 3,000 patients and found that nearly one in five men disclosed recent domestic violence towards a partner. 

Unfortunately, there are not many effective resources for us to intervene early when we identify perpetrators. Mandated batterer intervention programs disproportionately enroll minorities and lower socioeconomic groups and have not shown long term success. Perpetrators are charged to take personal responsibility for their actions and actively engage in changing  how do we best support that commitment?  

Congress did finally pass the Violence Against Women Act after a brief lapse this year to maintain funding for domestic violence services. However, funding to study new programs to prevent or treat domestic violence is limited.  The National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention receives less than two percent of the CDC budget, despite the magnitude of injury and violence in our country.

Given that one in four women have experienced abuse by a partner, someone in your life — a neighbor, a parent at your child’s school, or your family — is experiencing domestic violence. Although we may never know what led to Mr. Castro’s violent nature, we can take this as an opportunity to highlight that more effective treatment programs for batterers may help stop violence from escalating or continuing to batter.

A Florida program developed three different domestic violence programs differing by first time offenders, those with substance abuse or mental health issues, and those with a violent criminal history or who used a weapon during the domestic violence. Among the 18,000 perpetrators enrolled, those who did not complete the program were two to three times more likely to be re-arrested for domestic violence. And, as Charles Ramsey’s example and studies have confirmed, perpetrators who take responsibility for past behavior and learning new communication skills can change. 

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Debra Houry, MD, is an emergency physician at Grady Memorial Hospital, director of the Emory Center for Injury Control, and president-elect of the Society for Advancement of Violence and Injury Research. She is also part of the Public Voices Fellowship at Emory University.

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