Domestic Violence and Health Care: Opening Pandora¿s Box ¿ Challenges and Dilemmas

In this article we take a critical stance toward the rational progressive narrative surrounding the integration of domestic violence within health care. Whilst changes in recent UK policy and practice have resulted in several tangible benefits, it is argued that there may be hidden dilemmas and challenges. We suggest that the medical model of care and its discursive practices position women as individually accountable for domestic violence-related symptoms and injuries. This may not only be ineffective in terms of service provision but could also have the potential to reduce the political significance of domestic violence as an issue of concern for all women. Furthermore, it is argued that the use of specific metaphors enables practitioners to distance themselves from interactions that may prove to be less comfortable and provide less than certain outcomes. Our analysis explores the possibilities for change that might currently be available. This would appear to involve a consideration of alternative discourses and the reformulation of power relations and subject positions in health care

Gender and the politics of service provision for adults with a history of childhood sexual abuse

This paper reviews the evidence on the relevance of gender to the prevalence and impacts of sexual abuse in childhood, and to the interaction between adults with a history of child sexual abuse (‘survivors’) and services. It is widely acknowledged now that child sexual abuse increases the risk of a range of problems in adult life, that a wide range of services can offer reparative experiences, and that there is also a risk of retraumatization if the dynamics of abuse are replicated. Points where gender may affect whether experiences of service provision are reparative or retraumatizing include disclosure, allocation of workers and group work. In a context in which the voluntary sector plays a significant role in provision, the potential gains and losses in the current trend for formerly single-sex specialist voluntary organizations to ‘go mixed’ are discussed. The paper suggests that the politics of recognition adds a useful frame for considering survivors’ needs and the relevance of gender to their experience