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Preface
Peace, Love and Equality
Nurses, interpersonal violence and social justice
Anne McMurray
Peel Health Campus, Murdoch University, Perth WA
Article Text
We live in a violent world; perhaps not more so than in ancient times riddled by wars and crusades, but one in which violence is pervasive and seemingly intractable in our daily lives. The insidious nature of violence challenges nursing as a caring profession; at times, overwhelming our private and professional lives, distracting our pursuit of gender equality, and violating the very notion of a civil and just society. When any segment of society is bullied, subjected to terrorism, or dealt with inequitably, the boundaries of humanity and citizenship are dishonoured. Victims become stigmatized, subordinated to the views of others, culturally dispossessed or rendered invisible (Reid 2004). The question is not just how and why violence occurs, but how and why, in this age when we seem to have such deep understanding of social conditions, have we allowed violence such a pre-eminent place in society.
It is discriminatory to allow one group privilege over another, yet even in the settings of nursing work, we see inequitable and discriminatory processes and practices that divide us and drive our young to seek alternatives to nursing work. As the opinion pieces of Fiona Armstrong and Cubitt and Farrell contend, violence in the workplace is an affront to the profession and to the general public who hold nurses in such high public esteem. Violence against women in their home is equally contemptuous, exacting a toll on women, men, children and society (Krantz & Garcia-Moreno 2005; Moss 2002). Violence sanctioned by marriage and cultural determinants is perhaps the most harmful, given that it desecrates a deep seated relationship of trust (WHO 2002). Intimate partner violence (IPV), sexual coercion and rape occur in a microcosm of societal conditions fuelled by economic exclusion and patriarchal attitudes of entitlement. Economic exclusion denies women access to adequate financial support, preventing them from disentangling themselves from abusive and difficult conditions, especially if they are disabled, recent migrants, Indigenous, members of visible minorities, single heads of households, and/or of older age (AIHW 2003; Woolhouse, Brown & Lent 2004). Patriarchal attitudes entrenched in society have a number of different expressions, but all create the impression that men are entitled to dominance over women, and, like economic exclusion, signal that women are not worthy of inclusion in certain aspects of social life.
The most harmful impacts of violence in the home are visited on the children, and they have no way of making sense of this. Their lives and sensibilities are destroyed by the very people who are entrusted to care for them, to harbour them from harm, and preserve their human dignity (WHO 2002). As nurses, we cannot make sense of this either, and we are left to ponder whether terrorism at home is some inherent, perverse characteristic of the human spirit or a cruel test of resilience: survival of the fittest. Violence distorts gender relationships; the male tyrant abusing his power, with the female masochist colluding in her own victimization by not leaving (Goldner, Penn, Sheinberg & Walker 1990). But this oversimplifies a complex set of relations. In some societies, men can control their wives through economic dependence, without reverting to violence. Violence is higher in societies where there is greater economic equality, but where sex role stereotypes prevent women from being decision-makers. Campbell's (2001) research around the world shows that the greatest danger lies in situations where women's status is changing and in contention with men's status. This often occurs in situations where, after many years of domestic life, a woman chooses to develop her educational and economic capacity by undertaking formal studies, or securing a job that may be beyond her partner's expectation of her.
This strikes a chord with many nurses, especially those who have returned to study. As educators, we often see bright, young women embrace their studies with a thirst for knowledge, a sense of mission, a curiosity about their profession, and a recommitment to it. Tragically, some of these people find themselves as unwitting partners in a power struggle, their new-found sense of self threatening the foundations of their family. We take it personally. These are our people; members of our noble, caring profession. If they were students in the developing world, we would clench our fists in outrage, knowing that their education would be one of the first steps to help them become empowered. We would join our voices with the Millennium Task Force on Gender Equality is bringing issues of education, health and work together to strengthen opportunities for them, to develop anti-violence strategies and increase their representation in political bodies (UNIFEM 2005). There is no equivalent international movement in the wealthy countries of the west. We have the policies, the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW 1978) and the Beijing Declaration and Platform for Action, yet few women actively campaign for the implementation of these policies in their own electorates or their own regions (Social Watch 2005). In reality, we witness the erosion of so called 'developed' societies by retaining the status quo, tolerating terrorism in the home, even when it is against one of our colleagues. Worse, it may be against a colleague who is also subjected to violence at work, through legalised and tacit forms of bullying.
The gender wars of everyday life have the power to affect successive generations, either directly, or indirectly, as some of the children witnessing violence in the home will replicate their dysfunctional upbringing with their own children (McMurray 2005). In a violent upbringing, many young children develop no sense of a woman's experience of self-esteem. They see their mother as a whipping post, and they feel her frustration and defeat as she slides downward along the fragile continuum described by Tower et al (2006) in their paper in this collection. How, then can a child of such a household develop effective ways of relating to others, in relationships of equal power, respect, support, and a sense of the future? At a societal level, the politics of terrorism is rife. We have a right to be angry when one culture impinges on the safety of another. But should we spend billions of dollars to improve beach and border patrols and intelligence, and to amass defensive weapons while our children continue to be victimized by the worst type of terrorism on the planet? Does this occur because society labels domestic violence a woman's problem, instead of a problem of civilization itself? If this is society's approach, we pay only lip service to social justice, and the world continues to privilege one gender over another.
One of the most significant findings of a report on Australia's Welfare indicates that in 2003-4, one third of all clients accessing accommodation assistance were women escaping domestic violence (AIHW 2003). Our health and welfare systems should be the key vehicles for empowerment (UNIFEM 2005). Yet, the 'inverse care law' prevails in many places; that is, those who most need services are least likely to get them (Spencer 2003). When they do access services the health care system should be sensitive to how they construct their experiences (Tower et al. 2006). Our interventions should help women develop a core sense of self, the ability to take action based on self-determination, a sense of control over their life, and a feeling of being connected with others. This occurs only infrequently, and the point is made by several authors in this special issue, Davis and Taylor in writing about Australian women, and Inoue and Armitage describing the plight of Japanese women, that our nursing care must include timely, appropriate and structured referrals.
What can we do about this situation before it worsens? As Webster's opinion piece argues, we are uncertain whether screening for violence works or doesn't work. We know there are different policies throughout the world and throughout this country aimed at reducing violence. But we don't know what works, in what social and cultural context. Clearly, there is a need for further research. In the policy arena we argue the merits of zero tolerance policies that are excessively focused on punitive measures for perpetrators of violence, or taking too lenient an approach so there are few deterrents to committing acts of violence. A balanced, long-term solution involves government legislation designed to enforce punishment with mandatory re-training for those committing violent offences against intimate partners, children or members of the public. At a fundamental level, we know there is a need to actively promote gender equality (UNIFEM 2005). Edgecombe and Ploeger argue in their article that this begins in childhood.
Some of the major challenges involve questions of gender in social life. This can begin with issues of intimacy. Intimacy seems to come easier to girls' lives, especially in the closeness of female friendships that have no parallel in the lives of young boys. For many young boys, life without access to a father figure, or one who has not developed the art of closeness, develop a tenuous distancing from their mothers through a combination of rage, misogyny and homophobia. At this time, young boys are in danger of developing life long antipathy towards women. They need positive male role models who can help them show a more respectful, sensitive side (Fuller 2002). Young girls also need positive role models. In today's world, most young girls follow their TV role models by flaunting blatant expressions of sexuality, implying self-confidence, self-control; yet researchers have found that they still see themselves as passive objects of male sexual desire (Jackson & Cram 2003). This underlines the need to encourage women from a young age to overcome the vulnerability that results from being brought up to depend on males for social and personal esteem, and, as Power et al suggest in their article, to re-think what romantic love really means for them personally. There is indeed, as Dietsch's 'shared stories of private hell' reveal, a need for young girls to develop authentic and multidimensional understandings of self.
Men also need to recognize a woman's right to develop her personal capacity in a way that may differ from theirs. As stated by Power et al., women of all ages need to be encouraged to learn how decisions are made so they can participate in securing their preferred future. This requires societal commitment. It also requires community level sanctions against abuse of anyone. Young people should be able to grow up in a society that nurtures them in developing personal coping strategies and self-esteem; the harmony of mind, body and spirit as it is described by Davis and Taylor. Both women and men need to accept ownership and direction for their own lives, substituting empowerment for entitlement. Only when all people have a right to speak for themselves, a right to dignity, a right to work safely, in equitable conditions will we be able to declare ours a socially just society.
References
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