1. Brown, Theresa PhD, RN


We all need to take heed and ask questions.


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Rachel Louise Snyder's No Visible Bruises: What We Don't Know About Domestic Violence Can Kill Us (Bloomsbury Publishing, 2019) begins, appropriately, with the force of a gunshot: "An average . . . of 137 women each and every day are killed by intimate partner or familial violence across the globe." Snyder contends that few people understand the scope of this problem. In working with patients, nurses may detect signs of intimate partner violence without fully grasping how serious it is. For me, this book added invaluable knowledge to my nursing work.

Figure. Theresa Brow... - Click to enlarge in new windowFigure. Theresa Brown, PhD, RN

Let's start with some clarifying points. First, although the majority of victims of domestic violence are women, Snyder notes that men can also be victims, as can children. Snyder further breaks down the stereotypic view-male perpetrator, female victim-when she acknowledges "the grim statistics of domestic violence in LGBTQ relationships and communities." She points to the inadequacy of the term "domestic violence," which can imply that violence occurring in the home is somehow less severe than it actually is. Snyder prefers the term "terrorism," but uses "domestic violence" throughout the book because it is the most common.


Snyder presents several shocking statistics. In the United States, domestic violence incidents lead to 8 million missed workdays and $8 billion in health care costs annually. Between 2009 and 2017, more than half of the mass shootings in this country-54%-had some connection with domestic violence. The leading cause of death for young African American women nationwide is homicide; it's also the leading cause of maternal mortality in Chicago, New York City, and the state of Maryland. Although not all of these homicides involve domestic violence, many surely do. Snyder writes that her Google search for "estranged husband" and "killed" yielded more than 15 million results.


The book begins with the story of Michelle Monson Mosure, a woman living in Montana whose husband Rocky killed her, their two children, and then himself in November 2001. Snyder interviewed Michelle's parents, in-laws, and siblings, familiarizing herself with countless details of Michelle's life as she sought to answer this question: Why do victims stay with their abusers? For years, Michelle suffered repeatedly from Rocky's extreme jealousy, escalating threats, and physical beatings. At times Rocky would take the children away without telling her where they were going or when they'd be back, cementing his control over her by indirectly threatening her kids' well-being. Eventually Michelle did go to the police to file a restraining order, but days later she took back the complaints she had made against her husband. This isn't unusual, Snyder tells us. Victims like Michelle may recant their testimony to show solidarity with their abusers, hoping to placate them enough to stay alive. They believe the authorities can't or won't be able to guarantee their safety, and often they're not wrong.


Unbelievably sad and horrific stories fill No Visible Bruises. One of the book's most striking points is that domestic violence complaints are often prosecuted as civil rather than as criminal cases, in keeping with legal traditions regarding family disputes. This classification endangers victims because it elides the severity of the violence they endure, and protects their abusers from appropriate prosecution. Snyder writes,


Imagine a man, a stranger, strangling another man with a phone cord, pushing another man down the stairs, punching another man so hard he breaks an orbital eye socket. Such assaults happen daily with domestic violence, but I have yet to speak with a prosecutor who sees these crimes treated as seriously as when they happen in the context of domestic violence.


Reading this book took me back to my teaching days at Tufts University, more than 20 years ago. One day, at the end of the semester, a student came to class with bruises around her neck. I asked what had happened and she casually explained the bruises away, but her explanation wasn't convincing. The moment has stuck with me: I felt that I was seeing something wrong, but I had no idea what to do. After reading No Visible Bruises, at least I know to ask more questions in such situations, and not accept facile answers. For women under threat, that added knowledge might make all the difference.