Marilyn Merritt-Gray

Counteracting abuse and breaking free: The process of leaving revealed through women's voices

In a feminist, grounded-theory study, we interviewed rural survivors of abusive relationships to discover a substantive theory to explain the process of leaving. The central process for survivors was reclaiming self. In this article, we discuss the initial stages of reclaiming self: counteracting abuse and breaking free. Our findings reveal that the abused women were not passive victims. From the beginning, they counteracted abuse by relinquishing parts of self, minimizing abuse, and fortifying their defenses. The work of counteracting abuse prepared the survivor for testing the exits in the process of breaking free. These findings support the view of abused women as survivors and clearly demonstrate the societal infrastructure required to support womens efforts to counteract abuse until they have acquired the strength and resources to leave. In addition, questions are raised about the roles of lay and professional helpers in facilitating and inhibiting the process of reclaiming self.

Not Going Back Sustaining the Separation in the Process of Leaving Abusive Relationships

In a feminist grounded theory study of rural survivors, the authors discovered reclaiming self as the four-stage, social psychological process for women leaving and not returning to abusive conjugal relationships. Not going back, the third stage, is a process of sustaining the separation over time by claiming and maintaining territory and relentless justifying. Much of the current research has focused on the intra- and interpersonal processes of surviving in the relationship, preparing to leave, and managing the initial crises of leaving. This article contributes to existing literature by explaining the complex social processes involved in not going back and may provide guidance for professional and lay helper interventions during this critical period.

Modelling the effects of intimate partner violence and access to resources on women's health in the early years after leaving an abusive partner ☆

Although the negative health effects of intimate partner violence (IPV) are well documented, little is known about the mechanisms or determinants of health outcomes for women who had left their abusive partners. Using data collected from a community sample of 309 Canadian women who left an abusive partner, we examined whether womens personal, social and economic resources mediate the relationships between the severity of past IPV and current health using structural equation modelling. A good fit was found between the model and data for hypothesized models of mental and physical health. In the mental health model, both the direct and total indirect effects of IPV were significant. In the physical health model, the direct effect of IPV on physical health was about four times as large as the total indirect effects. In both models, more severe past IPV was associated with lower health and womens personal, social, and economic resources, when combined, mediated the relationship between IPV and health. These findings demonstrate that the health outcomes of IPV for women who have left an abusive partner must be understood in context of womens resources.

Intrusion: The Central Problem for Family Health Promotion among Children and Single Mothers after Leaving an Abusive Partner

Like other single-parent families, those consisting of mothers and their children who leave abusive partners/fathers are broadly viewed as deficient, high-risk structures in which children are susceptible to multiple problems. The mechanisms of strength and vulnerability in these families are poorly understood, and, consequently, their health promotion processes remain virtually unexplored. In a feminist grounded theory study of health promotion processes of single-parent families after leaving abusive partners/fathers, the authors discovered intrusion to be the basic social problem as families strive to promote health in the aftermath of abuse. The authors discuss the complex nature of intrusion, demonstrating how health is socially determined, and the challenges of health promotion in terms of the issues and dilemmas faced by study families and consider implications for health promotion knowledge and practice.

ILLUMINATING SOCIAL DETERMINANTS OF WOMEN'S HEALTH USING GROUNDED THEORY

Emphasis in health policy has shifted from curative intervention to prevention and health promotion through personal responsibility for lifestyle choices and, most recently, to the social determination of health. These shifts draw attention to and legitimize womens health research that moves beyond biomedical, epidemiological, and subjective knowledge to question previously unquestioned societal norms and structures that influence womens health. The challenge is to avoid relying solely on population-based studies that support relationships between social determinants and indicators of womens health and to find ways to illuminate the processes by which social determinants interact with the health of specific groups of women. Without such research, our knowledge of how social factors that underpin womens health interact will be faceless and will not address the interplay of health and social policy within womens lives. One research method that may be useful for exploring the interplay between such policies and womens health is grounded theory. Grounded theory is a widely used approach in womens health research. The goal of grounded theory is the discovery of dominant social and structural processes that account for most of the variation in behavior in a particular situation. Despite the usefulness of this method for capturing the interaction between social conditions and womens health experiences, many grounded theory researchers restrict themselves to womens subjective experiences as a source of data for theory development. Consequently, the resultant theorys capacity to illuminate the effects of the social determinants of health is limited. The purpose of this article is to discuss how the grounded theory method can be used in a participatory way to theoretically sample structural conditions at many levels. Using examples from completed and ongoing womens health research where data have and have not been collected primarily from women themselves, we outline the benefits and process for using grounded theory to influence health and public policy in womens health.

Strengthening Capacity to Limit Intrusion: Theorizing Family Health Promotion in the Aftermath of Woman Abuse

Children’s health is a key factor in women’s decisions to leave abusive partners, yet how these families promote their health after leaving is poorly understood. In this feminist grounded theory study, the authors conducted repeat interviews with 40 single-parent families that had left abusive partners/fathers and analyzed the data using constant comparative methods. Findings reveal the central problem faced by families is intrusion, unwanted interference in everyday life that stems from abuse and its fallout. Over time, families promote their health through the basic social process of strengthening capacity to limit intrusion via four subprocesses: providing, regenerating family, renewing self, and rebuilding security. Depending on the degree of intrusion, the focus strengthening capacity shifts between practical goals of surviving and more proactive efforts directed toward positioning for the future. This theory adds to our knowledge of the long-term consequences of IPV for families and provides direction for practice and policy.

Abuse‐Related Injury and Symptoms of Posttraumatic Stress Disorder as Mechanisms of Chronic Pain in Survivors of Intimate Partner Violence

OBJECTIVE To examine the role of abuse-related injury and posttraumatic stress disorder (PTSD) symptom severity in mediating the effects of assaultive intimate partner violence (IPV) severity, psychological IPV severity, and child abuse severity on chronic pain severity in women survivors of IPV. METHODS Using data collected from a community sample of 309 women survivors of IPV, structural equation modeling was used to test a theoretical model of the relationships among the key variables. RESULTS The theoretical model accounted for almost 38% of the variance in chronic pain severity. PTSD symptom severity was a significant mediator of the relationships of both child abuse severity (beta = 0.13) and assaultive IPV severity (beta = 0.06) with chronic pain severity. Lifetime abuse-related injury was also a significant mediator of the relationships between both child abuse severity (beta = 0.05) and assaultive IPV severity (beta = 0.06) and chronic pain severity. Child abuse severity made the largest significant contribution to the model (beta = 0.35). Assaultive IPV severity had a significant indirect effect (beta = 0.12) on chronic pain severity while psychological IPV severity had a significant direct effect (beta = 0.20). CONCLUSIONS Management of chronic pain in IPV survivors requires attention to symptoms of PTSD, abuse-related injury, and lifetime experiences of violence. Ensuring that acute pain from injury is adequately treated and followed over time may reduce the extent of chronic pain in abused women. The results also support the importance of routine assessment for IPV and child abuse.

Pathways of Chronic Pain in Survivors of Intimate Partner Violence

OBJECTIVE To examine the roles of lifetime abuse-related injury, posttraumatic stress disorder (PTSD) symptom severity, and depressive symptom severity in mediating the effects of severity of assaultive intimate partner violence (IPV), psychological IPV, and child abuse on chronic pain severity in women survivors of IPV. METHODS Structural equation modeling of data from a community sample of 309 women survivors of IPV was used to test partial and full theoretical models of the relationships among the variables of interest. RESULTS The full model had good fit and accounted for 40.2% of the variance in chronic pain severity. Abuse-related injury, PTSD symptom severity, and depressive symptom severity significantly mediated the relationship between child abuse severity and chronic pain severity, but only abuse-related injury significantly mediated the relationship between assaultive IPV severity and chronic pain severity. Psychological IPV severity was the only abuse variable with significant direct effects on chronic pain severity but had no significant indirect effects. CONCLUSIONS These findings can inform clinical care of women with chronic pain in all areas of healthcare delivery by reinforcing the importance of assessing for a history of child abuse and IPV. Moreover, they highlight the relevance of routinely assessing for abuse-related injury and PTSD and depressive symptom severity when working with women who report chronic pain.

Voices from practice: Mental health nurses identify research priorities

Through a collaborative research project, nurse clinicians and nurse academics identified and prioritized the most important research questions arising from the current and future practice of mental health nurses in an eastern Canadian region. Study methods included the Delphi technique and a nominal group survey approach. Nine categories of research questions emerged. The top four categories are discussed under the headings: Preparation of Helpers, the Service System, Caregiver Needs, and Clients With Major Behavior Problems. This timely study offers explicit direction for psychiatric and mental health nursing practice and research, and for the development of social policy.

A Theoretical Understanding of Abusive Intimate Partner Relationships that Become Non-violent: Shifting the Pattern of Abusive Control

Our theoretical understanding of abusive intimate partner relationships has ignored relationships that have become non-violent. We interviewed a community convenience sample of 27 women whose relationships had become non-violent. Using the constant comparative analysis of grounded theory, we generated a substantive theory, shifting the pattern of abusive control with three sub-processes, counteracting abuse, taking control, and living differently. Women’s acquisition of personal capacity and autonomy was foundational to countering the insidious oppression of abuse. Partners in these relationships that became non-violent, paid attention, gradually backing off and ceasing violent acts. For some women, coexisting in a violence-free relationship was satisfactory; for others, investing in an improved intimate partner relationship was essential for sustaining living differently. This theory provides direction for women who are working toward living differently with partners who are no longer violent, and for their helpers. Further, our findings contribute to our theoretical understanding of how abusive couple relationships may evolve over time.