Recognizing abuse

Posted by Nurse Linda in Life After Paralysis on February 18, 2020 # Relationships

WheelchairAbuse is a horrible thing. That is something that we all in agreement. However, recognizing it can be a challenge. If someone slaps another person, we can identify that as abuse right away. There are other forms of abuse that are not quite as easy to recognize.

One of the difficulties in identification of abuse is the way that it begins. A significant red flag for abuse is if you are uncomfortable around another person just when meeting them. Some personalities just do not blend well together. Even mild abuse produces a tension in your body and mind. It is easy to pick up on an abusive personality when it is bold and quickly apparent.

Most of the time, abuse is not so rapidly recognized especially at a first meeting when everyone is putting their best foot forward. Abuse usually evolves over time. It sneaks up on people. Abuse might take years for the full spectrum to appear. At first, it might be just a friendly correction or a humorous pointing out of something that you do that bothers the other person. This is not necessarily abuse but continued and increased actions can be.

Often, an abusive relationship generally builds over time, incorporating the abusive behavior into your everyday life.Most people do not even recognize abuse because it has become ‘normal’ behavior to them.

The list below contains some types of abuse and examples. Most likely more types will be defined as time passes and society evolves. This is just a sampling of abusive behaviors. There is not a complete and exhausting list. The examples will help you think about your situation but does not include every type of incident.

Physical abuse is one that people can easily recognize due to the abuser striking, hitting, punching, pulling or any physical contact with your body. Physical abuse can also include grabbing your clothes, holding you down, driving to scare you, locking you in or out of the house, choking, throwing things, breaking items and stalking (physically and online). It can and often starts with physical abuse to animals.

Emotional abuse has received more publicity lately which has helped many recognize it in their own lives. Some examples are name calling, yelling and screaming at you or about you, intimidation, embarrassing you, excessive teasing, telling rumors about you, harassing you, stalking, isolating you from family and friends, making you feel guilty or blaming you for their behavior.

Verbal abuse is closely tied with other forms of abuse especially emotional abuse. It consists of using words and tone to shame you, humiliate you or to make you feel unworthy of a relationship with the abuser or anyone else.

Psychological abuse consists of things such as constantly breaking promises, devaluing you, isolating you, gaslighting or playing mind games, threatening to leave you or threatening suicide if you do not do what is requested, always insisting the abuser is right and you are wrong. Infidelity is considered emotional abuse.

Sexual abuse can range from unwanted kissing or touching, to rape. Included are activities such as unwanted rough sex, being forced to watch pornography or to watch your partner have sex with another person, use of unwanted sexual positions or devices, forcing sex with other people, restricting use of birth control or condoms, insults about your sexuality or recording your sexual encounters without permission and showing them to others.

Power abuse is when the abuser takes over in your decision making. This could be managing your finances without your approval or making healthcare decisions without your input. During a period of crisis, you might welcome help in making these decisions, but you should always be consulted and retain your rights especially as you recover. Abuse of power can pertain to everyday activities such as how to arrange your kitchen, supplies, schedule and who is allowed to talk with you.

Financial abuse is closely related to abuse of power. The abuser may spend your money on things they want, not let you know how much money you have, force you to sign documents, make you ask for money, track what you buy or criticize how you spend your money.

Stalking is a form of abuse. It can be someone watching your movements, invading your privacy, or following you. Stalking can be done physically or through the internet. There are cases where people have tapped into security systems to harass and intimidate.

Neglect is an abuse that can happen to anyone but can be particularly found with individuals with healthcare concerns. Hiding your mobility support or making it inaccessible is a form of neglect. Withholding medications, food, water, refusing to provide care needed such as turning, or other techniques needed to maintain your health or refusing to take you to the doctor are just a few examples.

Abuse of individuals in specific populations has special names such as child abuse or elder abuse. The types of abuse can be as in the above list.

Examining an abusive relationship can be frightening. We become dependent in different ways within our relationships. Some of us do not enjoy paying bills so we let our significant other do that job. That is not abuse but a conscious decision. It becomes abusive when you are not allowed to know about your own finances.

Abuse can go in many directions. What if the person who is abusive is not your caregiver, family member or friend? What if the abuser is you? Self-exploration is critical to your mental health. When evaluating abuse in your life, you need to review your own actions as well.

Become aware of forms of abuse so you can recognize that it is happening. It is not your fault. The fault lies with the abuser. In the event of spinal cord injury, it does not matter how your injury occurred. Perhaps you were drinking and driving, dove into shallow water or inherited a disease. Those things happened. The spinal cord injury is secondary to that. It is an unfortunate event not a consequence.

You should never be punished verbally, physically or in any other way because you have a spinal cord injury. Many people make split second choices or inherit an unusual gene. Spinal cord injury is sometimes associated with choices, but it is not a choice, it just happens.

Dealing with abuse can be quite difficult. First, the abuse must be recognized. Often, I will see or hear people teasing others. Usually, this is written off as just a joke, or this is the way we play around. However, consistent teasing is harmful to a person’s well-being especially over long periods of time. This is probably one of the most common forms of abuse because people do not recognize it.

Second, you will need to decide how you want to handle the situation. Telling someone that their behavior is uncomfortable for you is a good start. Not everyone will see the errors of their behavior or they might not agree with you. Telling you that you are over reacting is an abusive technique used so they can continue their abusive behavior. Your feelings are yours. No one else can judge them.

Third, if the situation does not resolve, you might need to take more serious action. This might include finding a new caregiver. If the person is your spouse, you could investigate alternate sources for care giving. Perhaps another relative can help or, if you are able, hire someone to provide your care so your marital relationship can be just that. Talk to a neutral person such as a counselor or therapist. If the abuse has been ongoing, it will take some time to detangle the abuse from the relationship.

If the abuse is severe, you might want to consider legal action. There are attorneys who will review your case for free and use a sliding scale for payment.

Many times, people are fearful of their abuser and will not speak up. You have opportunity to bring up the subject in your doctor’s visit. In the visit, you have a right to privacy to discuss your concerns without anyone else in the room. The doctor can set up counseling, social work, home health or other arrangements until your situation can be sorted out. This is their job to help you especially if you are in a dangerous environment. Abuse is a dangerous environment.

People become dependent on their abuser because the abuser sets up the situation so that you will not complain and perhaps will be convinced that they know your needs better than you do. Often individuals will miss their abuser. You must maintain your resolve to end the relationship. That can be a challenge especially when you do not know how your situation will turn out. Questions about who will provide care and how will you relate to the new person are frightful. Remember, you always have options. If the replacement situation does not work out, you will find another person who will. Thoughts of being alone or an uncertain future can be scary but leaving an abusive relationship is a reward you deserve.

Pediatric Consideration
Child abuse is a particularly harrowing situation because typically the child does not realize what is happening. They think they are pleasing the adult which is what children do. They sing a song that pleases adults. They learn to read and count that pleases adults. They are cute that pleases adults. Their innocence can be used as a device by abusive adults.

Know the care providers of your children. This can be teachers, caregivers, bus drivers, baby sitters, friends or even family members. Children who are nonverbal cannot tell you something happened. Children with sensation issues might not realize someone has touched them inappropriately.

Watching your child’s behavior will provide indications that something disturbing has occurred. If they display aggressive behavior toward someone, are fearful of being with someone or become quiet and withdrawn, you will know something has happened. It might not be abuse, but something upset your child. Talk with the people of concern to see if any indication can be found. Talk with other parents to find out their feelings about the adults your child spends time with. You may find that the teacher just is not a good fit for your child.

Talking with your child about their day, thoughts and feelings will help gain a solid relationship with them. They will be more likely to tell you something happened if you have an open, safe relationship.

Linda Schultz, Ph.D., CRRN, a leader and provider of rehabilitation nursing for over 30 years, and a friend of the Christopher & Dana Reeve Foundation for close to two decades. Within our online community, she writes about and answers your SCI-related healthcare questions in our Heath & Wellness discussion.