Who is really in the ER?

posted in: Editorials & Essays | 0

By Philip W. Cook
Copyright 1998

The Journal of the American Medical Association has published a report which was recently picked up by the Associated Press and printed in a few newspapers, but it deserves more detailed attention primarily because it challenges common assumptions about a serious health and social issue. The study examined 516 patients seeking services in the emergency room of Charity Hospital in New Orleans, Louisiana. Out of these numbers, a slightly greater number of men were victims of physical domestic violence than were women (20% vs. 19%). The doctors also said, “We determined that women experienced significantly more past and present nonphysical violence, but not physical violence than men.”

It should be understood however, that this hospital serves a primarily poor population and another more nationally representative sample of hospital emergency rooms by the U.S. Justice Department shows a lower rate of patients seeking treatment for domestic violence, 14% of women and 3% of men. It is significant however, to note that the rate for intimate partner domestic violence may be greater than what this survey shows. This is because the relationship between victim and assailant was unknown fully a third of the time for men, and a fifth of the time for women. Also, male victims of partner violence may be even more likely than women victims to attribute such injuries to strangers or others.

Males also seek medical attention for all types of ailments at a lower rate than women.

These emergency room admissions studies do not of course, represent the totality of domestic violence, nor do law enforcement reports or even the Justice Departments own National Crime Victimization Survey, which surveys crime victims who may not have reported anything to police. There are many domestic violence victims who do not go to the emergency room, report to police, or answer honestly when asked to list intimate violence by a current partner or former partner in a survey asking about all types of crime especially when their current partner may be present when filling out the Justice Department survey. This is why domestic violence advocates frequently point to work funded by the National Institute of Mental Health and conducted by the Family Research Laboratory at the University of New Hampshire. These surveys show that nearly two million women are victims of severe domestic violence each year. This is twice the number reported by the Justice Department National Crime Victimization Survey and much more than the 204,400 women injured in the Justice Department emergency room study. The Family Research Laboratory is the source of the often-quoted statistic that a woman is battered by her intimate partner every 15 seconds. The trouble with quoting this source however, is that most advocates have taken to ignoring the complete and most recent result: 1.8 million women victims of severe violence and two million male victims. Or to put in another way, a man is severely assaulted by his mate every 15 seconds, a woman is similarly assaulted every 18 seconds.

These reports have been upheld by thirty other independent studies. Such reports even when limited to just what women respondents say, show that women hit first 53 percent of the time. The women also report that a quarter of the time only they were violent , a quarter of the time it was only the man who was, and the remainder of the incidents involved mutual violence.

These results are part of the hidden side of domestic violence. The new emergency room reports add to our understanding of this criminal and social tragedy, but it is only one part of the picture. It will for example, be news to most, that men made up any significant percentage at all of those injured by domestic violence in emergency rooms. Unfortunately, the lack of what the JAMA article doctors call, “the recognition of the global nature of domestic violence” hurts the victims but also everyone’s efforts to stop it. Government at all levels, medical personnel, social service workers, law enforcement, corporations, psychologists, counselors, shelters and crisis lines, have ignored or even directly discriminated against the male heterosexual victim, the heterosexual female perpetrator, as well as gay men having violence problems in their relationships.

Given the historical background of the fight to win for domestic violence a place as a significant social problem there was a need to concentrate primarily on services and recognition solely for women victims. To move forward today towards more effective help for people caught in the domestic violence trap however, we need to recognize that domestic violence is a human problem, not a gender problem.


Philip W. Cook is the author of Abused Men-The Hidden Side of Domestic Violence (Praeger).

Note: JAMA article is 1997; 278;620 from an original article in Annals of Emergency Medicine, Official Journal of the American College of Emergency Physicians Vol. 30 number 2.

Copyright © 1998, Philip W. Cook