Valentines and roses are tender gestures but some acts of love are not so tender

Ah, February. It`s Cupid`s month, complete with valentines, flowers, and candy. People meet and fall in love. It is exciting, thrilling, fun, and passionate. Love is in the air.

Heidi Emmerling Jones, RDH, BS

Ah, February. It`s Cupid`s month, complete with valentines, flowers, and candy. People meet and fall in love. It is exciting, thrilling, fun, and passionate. Love is in the air.

Or is it? Some statistics show otherwise:

- Approximately 3 to 4 million American women are battered each year by their husbands or partners.

- Research suggests that wife-beating results in more injuries that require medical treatment than rape, auto accidents, and muggings combined.

- The Federal Bureau of Investigation reports that 30 percent of female homicide victims are killed by their husbands or boyfriends.

- Violence will occur at least once in two-thirds of all marriages.

`Red flags` that denote criminal abuse

As hygienists, we may think our middle class patients are immune to this sordid phenomenon. However, we need to bear in mind that domestic abuse crosses all socioeconomic boundaries. Many women reveal few, if any, signs of abuse. When the signs are present, though, we should see them as red flags.

What about the woman who frequently misses appointments? Or whose partner calls and cancels them for her? What about the woman whose partner insists on accompanying her into the operatory? What about the woman who constantly complains about headaches, insomnia, and choking sensations, as well as stomach, chest, pelvic, and back pains? What about the woman who allows her medical disorders, such as diabetes and hypertension, to become aggravated, since frequently the abuser refuses to allow her to take medication? What about the woman who displays poor hygiene? When someone is frequently beaten and raped, it is hard for her to take care of herself. Victims of abuse are often loners, overweight, and not taking care of themselves.

What about the woman who seems shy, frightened, embarrassed, evasive, anxious, or passive? What about the woman who says she fell down the stairs but displays a black eye? Some injuries do not happen accidentally. Accidental bumps to the head usually occur on the forehead or upper occipital area, not on the sides or directly on top. Unintentional bruises are usually seen on outer parts of the extremity; bruises on inner aspects of arms are suggestive of intentional injury.

What about the woman who cries? This is not love. This is criminal abuse that stems from an addictive relationship.

One young woman writes, "He would beat me, then rape me. It was supposed to be a loving gesture. Compared to other men in my life [an abusive step-dad and a father who committed suicide] he was wonderful. When I`d see him cry, I`d remember the softness and gentleness. He`d buy me roses and jewelry to make up for the pain." How romantic! If, as a society we cannot tell the difference between romance and abuse, we`ve got a problem.

Our training to be indifferent

And we do. We should be absolutely appalled at our tolerance of abuse. There is a historical tradition of patriarchal rule over wives and children. There is a legal tradition of "wife chastisement" laws which acknowledge a permissible level of physical abuse. The rule of thumb, for example, comes from the rule that a man could beat his wife with a stick as long as it was no thicker than his thumb.

As a society, we value privacy and reject outside interference. Researchers who surveyed violence in U.S. families concluded that the level was so great and approval of violence against family members was so widespread, they were justified in calling the marriage license a hitting license.

Cultural norms reinforce batterers` beliefs. We hear clergy preaching that wives should be subservient to their husbands. We see judges failing to enforce their own court orders against batterers. We hear reports that 56 percent of adolescent girls agree that, under certain circumstances, it is OK for the man to use force to obtain sex. We hear reports that one out of six women believe that, when a man is sexually aroused, it is impossible to stop him or for him to stop himself. The statistics show that men and women are socialized to believe that satisfaction of a man`s sexual urges is a woman`s responsibility and that violence against female partners will be supported and tolerated.

Abuse is so prevalent and its presentation can be so varied that many experts recommend routine screening, even if the patient shows no signs of having been abused. We can incorporate nonthreatening questions into the written and oral health history and review. Simply state that you know domestic violence is very common, so you are now asking every patient about it. For example:

- Are you in a relationship in which you have been physically hurt?

- If you were experiencing violence in your home, would you know where to get help?

Because women may be terrified of their abusers, these questions need to be asked in private without the partner in the room. One woman writes, "Once when I tried to leave my ex-husband, he took my puppy and threw him against the wall. He told me to remember those cries would haunt me because they would be the cries of my young niece." The dramatic threats sometimes imply potential harm to others if a woman leaves her relationship with an abuser.

Despite our help, she may not leave initially. Everything may be in the partner`s name: house, checking account, car. She needs to worry about finances, how to earn a living, or how to feed and clothe her children. As bad as the battering relationship seems, the alternative could appear worse.

We need to vary our approach, and we need to persevere, just as we vary our approach and persevere to get our patients to quit smoking, eat better, or floss.

We must not chastise or blame the victim. Rather, we need to remember that no one chooses to be in a violent relationship. No one likes to be called names, hit, or raped.

In addition to incorporating a variety of questions designed to detect violence, we can also put in place a reminder system on our charts of suspected cases of abuse, such as when partners call to cancel appointments. We can make time available for a private interview if the partner accompanies her.

We can provide information about abuse such as posters or small business-size cards that are sometimes available from local shelters. These cards can be placed in the waiting room, the operatory, the rest room, or other places where she can pick them up in private and conceal them from her partner.

We can also make an impact outside the walls of our operatories. We can give lectures to PTAs. We can volunteer our time or donate items to shelters. We can network with other professionals. Also, although battering is a crime in all 50 states, not all states have mandatory reporting laws. In states without these reporting laws, we can contact our hygiene association or our legislators with legal remedies.

In this season of romance, I picture two figures huddled on the park bench, obviously in love. Perhaps one of those figures is my son or daughter in a few years. They cling together. There`s a tug at my heart as I see them hug, kiss, and playfully throw snowballs. I can only hope for them that this thrill, this passion that they share does not turn jealous and addictive. I can only hope they both realize that each deserves to be treated lovingly and respectfully and that this romantic love matures into a nurturing relationship. I can only hope, that as a society, we tolerate nothing less.

Heidi Emmerling Jones, RDH, BS, is a consulting editor for RDH, a writer, speaker, and clinician from Sparks, Nevada. Her e-mail address is hej@unr.edu

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