Decades of research into traumatic brain injuries (TBI) initially focused on athletes and veterans, examining the immediate and long-term effects of violent blows or jolts to the head, such as headaches, nausea, fatigue, mood swings, depression, seizures, migraines, and memory problems.
However, there’s a less explored aspect of TBI – its impact on survivors of domestic violence. While studying brain injuries in the mid-1990s, Dr. Eve Valera, an associate professor in psychiatry at Harvard Medical School, and a research scientist at Massachusetts General Hospital, began volunteering at a domestic violence shelter. She noticed that the abuse and problems many women reported were consistent with possibly experiencing concussions. Women reported many acts of violence that could cause trauma to the brain, as well as many post-concussive symptoms.
Of the 99 women she interviewed, approximately 75% reported at least one traumatic brain injury (TBI) sustained from their partners, and about half reported more than one — oftentimes many more than one.
Unfortunately, nearly 20 years later — concussion-related research within the domain of intimate partner violence continues to be scarce, signifying a largely unacknowledged and significantly under-researched public health crisis.
The Brain Injury Association of America highlights that undetected and untreated TBI can result in enduring behavioral, emotional, and cognitive struggles, potentially causing issues like homelessness, unemployment, substance abuse, or even loss of life.
The Pathways Program at Swedish Hospital, led by Director Mariá Balata, has been working to address this intersection since 2015. This initiative focuses on equipping healthcare professionals with the knowledge to recognize signs of abuse, including TBI symptoms, in survivors. Balata emphasizes the importance of understanding the impact of gender-based violence on health and empowering survivors.
“The survivors we work with often have a hard time keeping track of appointments or commitments. What doctors would call noncompliance we now understand might actually be the brain struggling with executive function. What we used to think of as emotional trauma, we are now understanding may be a biological response.”
While there’s no cure for TBI, our brains can heal, and brain injuries can get better, especially when they get identified early.
Providing survivors with tools to comprehend their situation and its effects on their functioning is crucial. By understanding what’s happening to them, survivors can liberate themselves from the emotional burden imposed by people who cause harm.
“And while they still have to continue to struggle with what happened, they know they can take steps to live with it. So maybe it’s using a cane, maybe it’s knowing you’re going to need lists for everything, maybe it’s knowing you’re going to need alarms on your phone for reminders. That’s better than walking through the world thinking you’re stupid or incapable, as the abuser might like you to believe.”
“My hope is that by providing this kind of support people learn to walk with their trauma in a way that doesn’t weigh them down in the way that it did before.”
“If we can help people understand what is happening, it can provide an important release of an emotional burden that helps them regain a sense of self. Their sense of self is no longer defined by what the abuser did or the narrative that that person created. There’s a new narrative where they get to take back control.”
Michael Reese has been a partner of the Pathways Program since 2016 and is currently convening providers of domestic violence services and experts in head injury to consider how best to deepen our investment in this critical area. Our mission to ensure all Chicagoans can live healthy lives includes a focus on domestic violence. This priority area focuses on three key strategies to support both survivors and those who cause harm to break the cycle of violence:
Create a service-delivery system that ensures survivors of domestic violence-related head injury are identified, screened and treated;
Increase and strengthen services for People Who Cause Harm (PWCH);
Support select innovative models that expand existing domestic violence services.