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An 'invisible epidemic': Survivors of domestic violence on living with traumatic brain injury

(In Pictures Ltd./Corbis via Getty Images)
(In Pictures Ltd./Corbis via Getty Images)

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This rebroadcast originally aired on January 20, 2022. 

Editor’s Note: If you or someone you know is experiencing domestic abuse, use a safe computer and contact help. Call the National Domestic Violence Hotline at 800.799.SAFE (7233), or visit https://www.thehotline.org.

The suffering caused by domestic violence is emotional, spiritual and physical.

But there’s one aspect of that suffering that is almost invisible.

“When you think about domestic violence and brain injury, almost everyone I talked to was like, ‘Oh my gosh, that totally makes sense. How had we not thought about that before?’ But we really have not made that connection,” licensed social worker Rachel Ramirez says.

And yet millions of survivors have been living with the impacts of these brain injuries, sometimes for decades.

Listen: A survivor discovers her brain injury, and takes her power back. Find the web extra here.

“Problems with balance, problems with vision, sensory problems, seizures, headaches,” Ramirez says.

So why is there so little research, and awareness?

“There is no surge here. This has been here forever. It was here in the past. It’s here now, and it’s going to be here in the future,” neuroscientist Eve Valera says. “It’s not going to go away.”

Today, On Point: Survivors of domestic violence on living with traumatic brain injury.


Eve Valera, PhD, neuroscientist with more than 20 years of experience researching traumatic brain injury resulting from intimate partner violence. Associate professor at Harvard Medical School and research scientist at Massachusetts General Hospital. (@EveValera2)

Rachel Ramirez, licensed social worker. Founder and director of the Center on Partner-Inflicted Brain Injury, a project run by the Ohio Domestic Violence Network. Co-author of “Trauma-Informed Approaches.” (@OhioDVN)

Also Featured

Freya Doe, a domestic violence survivor.

LISTEN: A ‘First Person’ diary featuring Freya Doe. ‘The shame did not belong to me. The shame belonged on him.’

Show Transcript

MEGHNA CHAKRABARTI: Today, we’re going to talk about a hidden long-term consequence of domestic violence. As such, we will be hearing stories from survivors. So, a warning to listeners. Some of these stories contain explicit details of physical abuse. Freya Doe shared her story with us and the abuse she suffered from the very beginning of her first marriage when she was just 18 years old.

FREYA DOE: In the very beginning, I thought I was happy. I thought I was getting the things that I wanted and needed emotionally. Looking back, I wasn’t happy. I was always in emotional turmoil, to be quite honest. There was a lot of tears. There was a lot of crying. But he was very good at convincing me that I was happy. And that he was the one for me. And again, it wasn’t until I was much older that I looked back and realized that I was not content. And what was happening was not love. It was obsession. It was manipulation. And in a lot of ways, it was torture.

I was not allowed to leave the house. I had one friend that was his friend’s wife, who I was allowed to hang out with. I wasn’t allowed to get a job. And as time progressed, he got more and more frustrated with things at work. He was in the military, so he couldn’t get upset with his sergeant. So he would bring that anger home with him, and lash out at me. Anywhere from walking in the door and flinging his keys at my head, to grabbing me and slamming my head against the wall. If I said, how was your day? I might get punched. It was a constant situation of not necessarily knowing who was going to walk through that door. If he had a good day, things would be OK. If he had a bad day … anything goes.

There was a day when he had been drinking in the morning, and I had gone out and done laundry and I brought it home. And he was upset about something that someone had said to him, and got into a fight with me. And punched me in the face first and then picked me up and threw me off a porch. And then proceeded to jump on top of me, and repeatedly slammed my head into the ground and punched me in the face. Eventually, I woke up on the floor. And then he just stopped dead and looked at me and said, ‘What’s wrong with you?’ And I said, ‘What do you mean?’ And he said, ‘Your eyes.’ And he stood me up, and I went over to the dresser and I looked and the blood vessels in my eyes were starting to burst.

That convinced him to allow me to call 9-1-1. But he kept saying, ‘I don’t want to get in trouble.’ ‘I don’t want to get in trouble. If you call 9-1-1, they’ll find out what I did.’ And I said, ‘Listen, I will just tell them that I fell off the porch, that I was dizzy and slammed the door into my face. It’ll be OK. Just just let me call them, I need to go to the hospital.’

And they came. They got me under the backboard. They put the neck brace on. They got me in the stretcher. I’m completely tied down. And the guy in the ambulance gets in and he’s sitting next to me, and my husband is standing on the end of the ambulance, looking down at me, as this guy says, ‘Did your husband do this to you?’ And I just shook my head as much as I could, which was not much. And, ‘No, no. Of course not. He would never do something like that to me. He loves me. He would never. He would never hurt me.’

They did 22 X-rays of my head, neck, back and chest. And I was in the hospital for five days. And a neurologist came in to see me, and he said, ‘Well, looks like, you know, you’ve got a concussion.’ And he said, ‘You know, you’re probably going to have some light sensitivity for a while and you’ll have some migraines, maybe. But the blood will drain out of your eyes and you know, everything will go back to normal.’

I just thought, ‘OK, well, you know, by the time the blood drains out of my eyes, the migraine should probably go away and light sensitivity will probably go away.’ And the funny thing is, is that neither has ever gone away.

And it wasn’t until about 15 years later that I started having some cognitive issues where I would be talking to somebody and all of a sudden in the middle of conversation, I would just kind of stop dead and my eyes would look around. Because I could not for the life of me, remember what it was that I was talking about. I could be in mid-sentence and just all of a sudden, it’s gone. Everything I was just thinking is just out of my head, and I started thinking that I was getting early onset Alzheimer’s, or some kind of dementia or something to that effect. I chose at that point in time, from fear, to basically ignore that and just put it out of my head. Tell myself, it’s just something that happens to people. And then I started forgetting words. Like I knew what I wanted to say, and I could describe what I wanted to say, but the actual word that I wanted to use, I could not find.

And every time that I would forget a word or I’d forget what I was talking about, or I wouldn’t remember somebody’s name that I had known for forever. That stress would like spike. And I had also developed a lot of anxiety. I started having panic attacks and things like that, that’s how stressed this whole thing had gotten me.

It didn’t really dawn on me that I was still having these symptoms from that particular event. It never went through my mind.

CHAKRABARTI: Freya is a pseudonym. We are not disclosing her name or location in order to protect her safety. There is much more to her story, which we will hear later in the show. As you heard Freya describe, though, she was clearly suffering from repeated traumatic brain injury due to the violence she suffered by the hand of her first husband.

Well, Eve Valera joins us now. She’s an associate professor at Harvard Medical School and a neuroscientist who spent more than 20 years researching the prevalence of traumatic brain injury resulting from, excuse me, intimate partner violence. Professor Valera, welcome to On Point.

EVE VALERA: Thank you, Meghna. So nice to be here. And I’m very appreciative of the opportunity to talk about this issue.

CHAKRABARTI: Can I just first ask you, can you briefly describe to us how many women survivors there may be in the United States like Freya?

VALERA: Well in my work, if you want to extrapolate from that, in the study found that about 74% women sustained at least one traumatic brain injury from the partner, and just over 50% sustained repetitive brain injuries from their partners. And so to put that in perspective, that could be, potentially, if this is extrapolating from my data, which is not epidemiological, but nonetheless an extrapolation. Over 31 million women might be walking around with brain injury from their partners.

And 24 million women, and this is in the U.S. alone, walking around with repetitive brain injuries from their partners. If we want to compare that to sports, so you say, what does that really mean? Or other situations in which we know that there’s recognized, let’s just say, brain injuries. Annual estimates for servicemen and women might be around 18,000. And for the National Football League of the United States, that would be around 300 or 400 a year. Annual estimates for women could be as high as 1.6 million.

So from my estimates, and again, these could be high because we don’t have great epidemiological data. But even if you were to slash that considerably, there’s really no comparison in terms of the number of women who I think have repetitive brain injuries and the number of men, largely, who are being studied in athletics or the military.

CHAKRABARTI: Can you tell us the story of where you were when you first started trying to put two and two together about TBI and survivors of domestic violence.

VALERA: Absolutely. I was actually in graduate school and I was doing volunteer work in a women’s shelter. That was part of my interest. And I was also learning about neuropsychology, which looks at the effects of things like brain injuries in people. And so as I’m doing the work in the shelter, I hear these stories … about women having their heads slammed against floors and walls, being thrown down stairs, having heads smashed against the car window. And I said, my gosh, these women are certainly sustaining brain injuries.

And from what I was learning in my graduate work, it was clear that brain injuries are related to cognitive functioning, emotional functioning, behavioral problems like headaches, etc. And the women at the shelter were also reporting symptoms like that. So I looked and I said, okay, what do we know about this? This is crazy. We have to figure this out. And I do a search. I go to the library. It wasn’t a single article. Absolutely nothing. And this is in the ’90s. There was not one article that came up … no matter what type of search words I used.


VALERA: Exactly.

From The Reading List

Harvard Health Blog: “Intimate partner violence and traumatic brain injury: An ‘invisible’ public health epidemic” — “While studying brain injuries in the mid-1990s, I began volunteering in a domestic violence shelter. I noticed that the abuse and problems many women reported were consistent with possibly experiencing concussions.”

The Journal of Head Trauma Rehabilitation: “Understanding Traumatic Brain Injury in Females: A State-of-the-Art Summary and Future Directions” — “In this report, we identify existing issues and challenges related to research on traumatic brain injury (TBI) in females and provide future directions for research.”

More Resources

  • Pink Concussions: A nonprofit for survivors of female brain injury from sports, violence or military service. 
  • The Center on Partner Inflicted Brain Injury: This project of the Ohio Domestic Violence Network provides statewide, national and international leadership to raise awareness of brain injury caused by domestic violence.
  • Abused & Brain Injured: Toolkits for survivors of intimate partner violence and traumatic brain injury.
  • Concussion Awareness Training Tool: Online training resources addressing concussion recognition, diagnosis, treatment and management. 
  • BrainLine: Information and resources about treating and living with traumatic brain injury (TBI) and PTSD.

This article was originally published on WBUR.org.

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