“But Did You Die?”: Intimate Partner Violence as a Social Determinant of Health

Abstract

Many Black women experience worsening abuse; however, there is a significant number of women experiencing non-physical forms of abuse, what I term hidden abuse. In one in five domestic violence cases, the fatal or life-threatening event was the first episode of physical violence the woman experienced from their partner, suggesting that some Black women die before they receive help. Violence against Black women requires a systems approach that redresses resource inequities. I attempt to expand upon fundamental cause theory, a systems theory used by social science researchers, to show that intimate partner violence is a social determinant of health. I apply this theory to an autoethnographic case study of hidden abuse. Implications for social work research, practice, and policy include developing, advocating for, and evaluating programs and policies that increase financial instability, affordable housing, and access to community networks and social support for victims of violence.

Introduction

Intersectional approaches to fundamental cause theory have been used in public health to understand Black women's experiences of structural gendered racism and how it contributes to racial and gender inequities in health, specifically COVID-19 (Pirtle & Wright, 2021). Structural gendered racism is the totality of interconnectedness between structural racism and structural sexism in shaping racial and gender inequities (Pirtle & Wright, 2021). Intersectional approaches have also been applied in social work to understand how structural gendered racism contributes to violence against Black women (Bent-Goodley, 2007).

Crenshaw (1991) identified that violence against Black women is usually the effect of the subordination they experience. Namely, many of the women are underemployed or unemployed, in poverty, and/or homeless. Women of color and women in poverty are forced to rely on underfunded public services that often cannot meet their needs (Bent-Goodley, 2007; Crenshaw, 1991). Because women of color and women in poverty must rely on public institutions, they are exposed to institutional racism and discrimination. For example, because of the “Strong Black Woman” trope, Black women have been denied services because they are thought to be able to “handle” the violence (Bent-Goodley, 2007). Further, because of this trope Black women are expected to withstand abuse because of Black men's disempowerment, what Bent-Goodley (2001) refers to as racial loyalty.

Black women disproportionately experience intimate partner violence (IPV), and IPV is related to gender and racial inequalities in health, particularly those related to income, employment, housing, and social networks. Death is the most extreme outcome. In 2012, Black women in the United States were two and half times more likely to be killed by an intimate partner or stranger than white women (Violence Policy Center, 2014). In 2020, Black women in the United States were three times more likely to be killed by an intimate partner or stranger than white women (Violence Policy Center, 2022).

One possible reason for the increase in the disparity is a lack of focus on non-physical forms of IPV. For example, in one in five IPV cases, the fatal or life-threatening event was the first episode of physical violence the woman had experienced from their partner (Block, 2003). This suggests that there are Black women who experience violence in their relationships; however, because this violence may be non-physical, the support they need comes too late.

Multiple factors shape how Black women experience IPV, including lack of economic resources, racism, discrimination, and sociocultural messages and stereotypes rooted in Black women's sexuality and expectations of Black women's resiliency (Bent-Goodley, 2007; Harris-Perry, 2013). There is a dearth of literature on how these factors contribute to the experience of non-physical IPV, what I term hidden abuse.

In this article I expand upon fundamental cause theory (Link & Phelan, 1995), a well-established systems theory used by social science researchers that understands social conditions as underlying causes of health disparities, to understand IPV as a social condition that is an underlying cause of racial and gender health disparities. In other words, I argue that IPV is a social determinant of health. I apply this theory to an autoethnographic case study of hidden abuse.

Violence against Black women requires a health systems approach that redresses resource inequities to address racial and gender disparities in health. Though fundamental cause approaches have been used to understand IPV among Black women and men in same gender relationships (Bent-Goodley, 2007; Methany, 2019), my article is one of the first to use an autoethnographic case study of hidden abuse to illustrate intersectional approaches to fundamental cause theory. I provide implications for social work research, practice, and policy.

The Domestic Violence Model, Coercive Control Model, and Hidden Abuse

Abusers can control their victims through many tactics including but not limited to emotional and psychological abuse; control of time, space, and movement; monitoring and stalking; sexual abuse; economic abuse; isolation from sources of support; faith-based and spiritual abuse; manipulating and grooming; exploiting systems, institutions, and services to manipulate victims; coercing criminal activity; intimidation and threats; and physical abuse, violence, and homicide (Katz, 2022). Some abusers may choose to physically abuse but others may not. Moreover, victims often experience multiple forms of abuse in a single relationship (Krebs et al., 2011). For example, in a study of 103 victim-survivors, all of them experienced psychological abuse, 99% experienced financial abuse, and 98% experienced physical abuse (Adams et al., 2008). This suggests that both physical and non-physical forms of abuse are common. However, the domestic violence model of abuse primarily frames the violence as physical and episodic (Stark, 2007). But what happens in between those episodes? Coercive control.

Coercive control is the use of force or threats by abusers to compel or dispel a particular response, compelling obedience in the victim indirectly by monopolizing vital resources, dictating preferred choices, microregulating a partner's behavior, limiting the victim's options, and depriving them of supports needed to exercise independent judgment (Stark, 2007). For example, coercive control of space, time, and movement can include coercing the victim into spending more time with the perpetrator than they wish to; coercing them into life- altering actions such as relocating to a new area; controlling what the victim can eat; preventing the victim from engaging in the play/leisure activities that they enjoy; and depriving the victim of resources required for normal daily life (Katz, 2022). IPV is best understood in terms of coercive control because it encapsulates all the physical and non-physical tactics abusers use to control their victim.

Non-physical forms of coercive control, what I term hidden abuse, can have a greater impact than physical acts of coercive control. For example, the strongest predictor of post-traumatic stress disorder (PTSD) in abused women is psychological violence (Pico-Alfonso, 2005), and in many cases emotional abuse can precede physical abuse (Karakurt & Silver, 2013). Additionally, there is an emerging emphasis on understanding emotional abuse as a construct separate other forms of abuse that has its own theories and prevention/intervention strategies (O’Leary & Maiuro, 2001). Although research has established the significance of addressing all forms of coercive control (Fontes, 2015; Katz, 2022; Stark, 2007), hidden abuse remains understudied among Black women.

The resources available to Black women experiencing hidden abuse in the United States are limited. The primary method used to disrupt abuse in relationships is batterer intervention programs (Aldarondo & Mederos, 2002; Pence & Paymar, 1993); but one must call the police to access these programs. This presents several issues. First, Black women cannot rely on the police for help. Many of the police are abusers themselves (Blumenstein et al., 2012; Johnson, 1991; Neidig et al., 1992) and may expose victims to more violence (The Marshall Project, 2020). Second, although batterer intervention programs discuss coercive control, i.e., different types of power and control (Pence & Paymar, 1993), the term ‘batterer’ connotes physical abuse. This suggests that some Black women experiencing hidden abuse may not believe these interventions are for them and therefore may not call the police. Third, and most damning, is that research shows these programs do little to address the cycle of violence against Black women (Feder et al., 2008) and, instead, contribute to the cycle of violence. For example, Black men are 2.5 times more likely to abuse again when they terminate engagement from these programs (Waller, 2016), increasing the risk of them murdering their partner or escalating levels of violence (Campbell et al., 2007).

The response of social work in the United States to address IPV using batterer intervention programs is a health response. Batterer intervention programs are psychoeducation counseling programs or therapy. Therapy is an individual-level intervention and, fundamentally, therapy is insufficient in addressing the social conditions (e.g., racism, sexism, heterosexism) that underlie IPV. Psychoeducation counseling programs require the most individual responsibility and have the least amount of population impact (Frieden, 2010). Further, from a coercive control perspective, batterer intervention programs do little to address the intent of abuse. Awareness and education of abuse are clearly not enough to address gender-based violence.

Fundamental Cause Theory

In their foundational article, Link and Phelan (1995) set out to explain why socioeconomic inequalities in health persist despite changes in the mechanisms (e.g., diet, smoking, exercise) thought to link these inequalities to disease. Social conditions such as classism (SES) are basic, fundamental causes of health disparities because these conditions embody access to important resources, such as knowledge, power, prestige, money, and interpersonal resources embodied in social networks. Because these resources are flexible (i.e., can be transported from one situation to the next), those who command the most resources will be in the best position to reduce their risk of disease no matter how the disease profile changes (i.e., what is known about the disease, risk factors, etc.) (Link & Phelan, 1995). In other words, classism is a fundamental cause of disease because those with more economic resources are better positioned to avoid negative health outcomes or reduce their risk compared to people with fewer resources. Social change lies in addressing the differences in access to these resources, which may be more challenging for some resources (e.g., freedom) than others (e.g., knowledge) (Link & Phelan, 1995).

There is robust literature on fundamental cause theory and its application to understanding racial and socioeconomic inequalities in health (Gengler, 2014; Lutfey & Freese, 2005; Nazione & Silk, 2013; Phelan et al., 2010; Spencer & Grace, 2016; Van ryn & Fu, 2003). Fundamental cause theory has been applied to understand a wide range of social conditions as underlying causes of health disparities including, but not limited to time, stigma, and racism (Gee et al., 2019; Hatzenbuehler et al., 2013; Phelan & Link, 2015). Further, Bird and Rieker (2008) have attempted to understand gender as a fundamental cause of health disparities. They argue the reasons behind gender health differences cannot be fully explained solely by biological (e.g., differences in hormones) or sociological explanations (e.g., differences in social position) and is best understood through constrained choice. Not all the constraints affecting everyday decisions that make health a priority are the same for men and women. For instance, if a place of employment has on-site childcare, this can help parents establish a regular breastfeeding schedule, which in turn can reduce stress levels (Bird & Rieker, 2008).

What social science researchers were trying to explain is not the effects of gender per se but rather cisheteropatriarchy. Cisheteropatriarchy determines if the workplace has on-site childcare, and other things like parental leave—things we know affect some gendered people more than others. IPV is one of many social conditions that stems from the system of cisheteropatriarchy. Coercive control then is a gender strategy deployed by abusers: “a patterned and self-interested way socially identifiable groups [e.g., men] mobilize scarce resources to pursue major life goals in an important area in their existence” (Stark, 2007, pp. 230–231).

White cisheteropatriarchy has and continues to dictate Black women's position in society, making Black women vulnerable to violence. For example, colonial law did not recognize enslaved people as fully human, therefore crimes committed against the enslaved by their owners were not punished, while crimes committed between enslaved peoples were also unpunished (Broussard, 2013). Crimes against victims were only reported in the newspaper if the victim was white (Broussard, 2013), suggesting that for enslaved women, crimes of rape or abuse committed by both slave owners and enslaved men went unrecognized and unpunished. As such, white cisheteropatriarchy undergirds racial and socioeconomic inequalities in health generally and Black women's experiences in particular.

Link and Phelan (1995) argue that a social condition is a basic, fundamental cause if it: (a) influences multiple health outcomes, (b) affects health over time through multiple risk factors, (c) involves access to flexible resources that can be used to minimize both risks and the consequences of negative health outcomes, and (d) is reproduced over time through the continual replacement of intervening mechanisms. Below I explain how IPV is a fundamental cause of racial and gender health disparities by showing the mental and physical health outcomes, risk and protective factors, and flexible resources associated with IPV, and how IPV continues despite changes in awareness and education of IPV.

Intimate Partner Violence as a Fundamental Cause of Racial and Gender Health Disparities

IPV shapes health outcomes in myriad ways. Even resources like time and relationships mitigate or magnify the effects of IPV on health outcomes, which is why Link and Phelan (1995) categorize these resources as flexible given their potential for variation over time. I review several examples, including physical and mental health, financial and housing instability, and flexible resources like time, relationships, and freedom, to illustrate the ways IPV contributes to racial and gender health disparities. Moreover, without interruption or intervention, these disparities continue to be reproduced over time.

The physical and mental health consequences of IPV are significant. Victims of IPV are more likely than non-victims to experience a range of health outcomes, including but not limited to broken bones and other physical injuries; chronic health problems such as chronic pain, fainting and seizures, poor sleep quality and sleep disturbances, cognitive decline, hypertension and chest pain; gastrointestinal issues such as stomach ulcers, loss of appetite, eating disorders, and irritable bowel syndrome; gynecological problems such as sexually transmitted infections, vaginal bleeding or infection, fibroids, decreased sexual desire, genital irritation, pain during intercourse, chronic pelvic pain, and urinary-tract infections and; PTSD, depression, insomnia, anxiety, social dysfunction, and substance use/misuse (Campbell, 2002; Gallegos et al., 2019; Williams et al., 2017). Dealing with these health issues takes time and comes at substantial costs to survivors, only some of which are financial. Given the costs of care, it is concerning that women experiencing IPV have their economic and financial lives sabotaged. The experiences of abuse are both significantly associated with the magnitude of financial strain for survivors of IPV (Lin et al., 2022). Though, disparate financial and economic outcomes can be mitigated: research finds a link between employment and IPV (Bowlus & Seitz, 2006), particularly that decreases in gender wage disparities reduce violence against women (Aizer, 2010).

IPV is also associated with increased housing instability, which leads to homelessness (Pavao et al., 2007). Housing instability may include difficulty paying rent, mortgage, or utility bills, frequent moves, overcrowded living conditions, or doubling up with family or friends (Pavao et al., 2007). Women who experienced IPV in the year prior had higher odds of reporting housing instability than women who did not experience IPV (Pavao et al., 2007). Housing instability is connected to racial and gender health disparities. Homelessness is associated with poor physical and mental health (Bensken et al., 2021; Padgett, 2020). Victims of violence must make the difficult choice of being safe yet unhoused or housed yet unsafe (O’Campo et al., 2015).

Victims experiencing IPV must contend with having their time sapped, social networks and relationships sabotaged, and freedom constricted. Abusers steal from and control the time of victims as a tactic of coercive control. People with access to more time can manage their health better than people with access to less time. People need time to visit the doctor, exercise, and maintain social relationships (Gee et al., 2019). In fact, time is strongly associated with stress and other forms of illness (Gee et al., 2019). By controlling the time of victims, abusers can control how victims spend their time, forcing victims to deprioritize their health and social relationships and contributing to racial and gender health disparities.

Maintaining social relationships is shown to be important to health (Gee et al., 2019). Yet, abusers use isolation as a form of coercive control; this was particularly salient during the COVID-19 pandemic when stay-at-home orders went into effect (Peitzmeier et al., 2021). Abusers isolate their victims from their family and friends, taking control of their social network, their social relationships, and therefore their victims’ health. Moreover, Black women who experience IPV tend to rely on informal networks for tangible support (e.g., money) (Morrison et al., 2006), meaning that abusers can also control their victims’ access to resources through their social networks.

Abusers, through their totalitarian tactics, restrict the freedom of victims. Victims experience this lack of freedom from their abusers and the systems purported to intervene in this violence. In other words, victims can become entrapped in policing and legal systems and incarceration has been shown to have especially severe impacts on racial and gender health disparities (Phelan & Link, 2015). Black women experiencing violence are in particularly vulnerable position because of gender entrapment. The legal system punishes Black women for behaviors that are logical extensions of the violence in their intimate relationships (Richie, 2003) (e.g., fighting back). For instance, Black women are more likely to be arrested for IPV than white women (Plass, 1993). Moreover, incarcerated women can still experience IPV from their partners on the outside, either through general abuse (i.e., verbal, physical) or leveraging the woman's incarceration to intimidate or control (Garthe et al., 2023).

The Intimate is the Political: Autoethnography as a Phenomenological Tool

Autoethnography is the “use of personal experience to examine and/or critique cultural experience” (Jones et al., 2016, p. 22) while phenomenology is the study of lived experiences (Peoples, 2021). I combine the two methods by using autoethnography as a phenomenological tool (Pitard, 2019) to understand Black women's lived experience of hidden abuse. Autoethnography is useful in uncovering deeply concealed oppressions (Lourens, 2018). It is also valuable in that it allows the personal/psychological to illuminate the political, while the political influences the psychological (Maseti, 2018). Autoethnography retrospectively and selectively indicates experiences based on, or made possible by, being part of a culture or owning a specific cultural identity (Pitard, 2019). Because I am a Black women victim-survivor of hidden abuse, I can use my personal experience to promote deeper understanding about the barriers faced by Black women who experience hidden abuse (Ellis & Bochner, 2000). Further, my use of autoethnography and phenomenology is grounded in standpoint feminist theory (Harding, 2004) which challenges the relations between knowledge production and practices of power. To challenge conventional writing practices, I write my autoethnography in the style of creative writing or creative non-fiction (Averett, 2009). I use colloquialisms where I feel most comfortable. Moreover, I apply autoethnography as a form of justice. Black women experiencing interpersonal violence (either intimate or community) have nowhere to turn (Morrow, 2024). I tell my story in autoethnographic form to take control of the narrative. In other words, I derive empowerment from writing about my experiences (Busch & Valentine, 2000; Davis, 1998). This method provides a platform for self-transformation that may bring healing from emotional scars of the past (Chang, 2008). I extend the practice of Black women and genderfluid individuals in academia using autoethnography to write about and make meaning of their lived experiences (Griffin, 2012; Jackson et al., 2022; Keeton, 2021; Maseti, 2018; McCoy, 2021; Morrow, 2024; Osei, 2019).

“But Did You Die?”

Imagine you’ve been kidnapped. Taken from your place of safety and security. You’ve been tied to a chair. You don’t know all that's been done to you. Time is nebulous. The only consistent thing, the thing you know for sure, is that the kidnapper sits across from you with a bat saying, over and over, “I decide when.” ¹ This is what it's like to be in an abusive relationship. Your every decision, movement, and thoughts are dictated by the dictator. They decide the tactics they use to control you. They decide everything.

For most of the PhD program, I was in an abusive relationship. Abusers are slick. Charming. Master manipulators. And Mitchel was no different. ² In the beginning, Mitchel did what any textbook abuser would do and showered me with affection and admiration. A classic control tactic (Strutzenberg et al., 2016) that catches women in the abuser's web without them realizing it's a web (Fontes, 2015). And that's what happened to me.

Mitchel and I would spend a lot of time together. He came off as doting and loving. But there was the explosive, controlling, coercive, and selfish side to him. When we did spend time together, we watched what he wanted, which was mostly, annoyingly, wrestling. He micromanaged my behaviors down to my use of toiletries. For instance, if he wanted me to use something because he liked it (e.g., spray deodorant vs regular deodorant), he would just buy it for me. I usually never protested because the things he wanted me to change weren’t – at the time – serious enough for me to put up a fight.

I would constantly ask Mitchel to do basic things like cook/learn how to cook. Being a student, teaching, and dealing with family problems as they came up, I needed a partner who would support me in cooking because it takes up so much of my time. But it seemed like that duty always fell to me. One day, I asked him to cut vegetables for me. He started hacking away, with a gleeful smile on his face. I told him “Never mind. I’ll do it.” He did this on purpose to ensure that I would never ask him to do it again. And I didn’t. On the rare occasions he cooked, I had to deal with dry chicken breast, undercooked burgers, or whatever else he half attempted to put together. He also controlled what we ate. I personally like foods filled with heavy carbs (e.g., pasta). But when he would ask me what I want for dinner, whenever I suggested something that he felt was “too heavy”, he would reject it. Even though I knew exactly what I wanted. And he asked me. But I always made the compromise, and we would get what he wanted or what he was willing to get.

The duty of buying groceries also fell to me. He would contribute barely enough to cover the expensive snacks that he liked. He would barely contribute financially in general. He would start and stop jobs whenever he felt like it, placing a financial burden onto me. In other words, he knew that because I am “strong Black woman” (Harris-Perry, 2013), I was going to do what I could to make sure that we were financially stable. Even if that meant I put myself into a hole. I started taking out more personal loans than usual to cover expenses. He used my resources to increase his. One day he asked me for gas money – with a puppy dog face. Later, he revealed that he already had 25 dollars in gas money but asked me for 10 dollars more to fill his tank up. To top himself off, so to speak. He restricted my finances to the point that we were sharing a combo meal from a fast-food restaurant. He brought me to my absolute lowest. He was robbing Peter to pay Paul. There may have been multiple Pauls, but I was the only Peter.

I was overwhelmed and my body showed it. I drank every day. Any time I wanted. I tried to drink as much as I could to numb myself. But I didn’t quite know why I was numbing myself. I thought it was because of the COVID-19 pandemic but not the shadow pandemic (UN Women, 2021). I was experiencing suicidal ideation (Kafka et al., 2022). I didn’t have any plans, but I had feelings of not wanting to be in this world. I didn’t want to continue to live in the (mental) state I was in. Mitchel did what many abusers do and encouraged drug and alcohol use (Fontes, 2015; Stark, 2007). It's a tactic used by abusers to keep the mind of their victims hazy so that victims don’t have time or space to themselves to think.

I lost a substantial amount of unintentional weight over the course of the relationship. I hated who I was when I looked in the mirror. I didn’t recognize the face that looked back at me. Or the arms that seemed to have lost muscle mass. Or the chest that now showed the outlines of my ribs *if* I breathed just hard enough. I didn’t see mySelf but anOther. The lack of eating because of the financial abuse was exacerbated by the drinking. I had no appetite. No desire for food. According to medical charts, I wasn’t underweight, but the numbers didn’t represent the body that I used to have; the person I used to be. And Mitchel knew this. But like any abuser he used this to his advantage to psychologically abuse me. He knew that I wanted to increase in weight and was struggling with my body image. After all, I am a Black woman, and I am supposed to have a particular shape and weight (Hughes, 2020). At least, that's what I was used to. One day, unprovoked, he sent me a picture of a Black woman wrestler who is a similar billed weight to what I used to weigh. A Black woman wrestler whom he admires.

Post-traumatic stress disorder. That's the diagnosis I received. I went to therapy to get help leaving Mitchel. I was making plans with friends to ensure my escape, but I couldn’t leave right away. Because though physically I was ready, mentally I wasn’t. I had been abused to the point that I didn’t want to sleep. I would jerk myself awake because I didn’t want to think about the infidelity. Or that he was a sexual abuser/predator. It was too much for me, so I tried my best to keep myself in the waking life. He had captured my psychic space; I was imprisoned in my mind.

We moved where Mitchel wanted to move. I was ok with it because it was my way of exploring new areas or cities but with someone else who is knowledgeable. However, he exploited this, isolating me from my friends and family. Although they were never far, I saw my friends and family very little. He made sure to shrink me (Young, 2005) in more ways than one: not just with the psychological violence to tear down my self-esteem but shrinking my connections to my support system.

When I was ready to leave physically, and mentally, I couldn’t financially. I applied to an apartment but was denied, undoubtedly, because I didn’t make enough; though, in all my years being a student, I had never been denied housing. But this was during COVID. And rent was going up (Laster Pirtle, 2020). And places that claim (on their application) to rent to students don’t do it in practice. I remember sitting on the side of the bed and crying that day after receiving the rejection letter because I thought I would be trapped forever.

When we moved in 2021 to a new house, we entered into a two-year lease agreement. At the time, it was the best decision to be made. We were moving because the landlord of the previous house didn’t want to renew our lease. So, we needed a place to stay and quick. I didn’t want to go back home and live with my mama, because that meant paying for storage for all my things. I bought all the furnishings for the house – Mitchel literally bought nothing. And because rent had been going up, I couldn’t afford to live by myself. That meant securing money for a moving truck, security deposit, first month's rent, and any other fees. Just for us to move into the house cost about $3,000. I knew the same was going to be true for apartments – because I had also been searching for one bedrooms. I just wanted peace. And peace for me was to be stable yet unsafe.

But I didn’t have peace. And to get it, I needed to get out of the lease. Because if I didn’t, I would be financially tied to Mitchel even if we lived separately and weren’t together. My name would still be on the lease, and he knew that I would pay any or all of the rent if I had to, to secure my credit and my ability to rent in the future. And as I sat on the bed, feeling stuck, reading the rejection letter over and over, I felt like peace was no longer attainable. A couple of months later, I decided to talk with a lawyer through student legal services.

I had to talk to a lawyer because I had no access to any additional funding to break the lease. Receiving my fellowship affected the cost of attendance in a way that shrunk the amount of loans I was eligible to receive for the year. Whereas I thought I was eligible for about $20,000 in federal student loans, I was only eligible for $1,800. But I was perfectly fine with adding to my already high burdensome student loan debt; debt that Black women disproportionately owe compared to white women (Friedline et al., 2023). I was running out of options.

I fell to my knees and cried after meeting with the lawyer. In the state of Michigan, if a tenant fears for their life, the landlord must let them out of the lease. This information was conveniently left out of the 50-page rental packet when we moved in. I was so happy. I could finally get out of the lease. Or could I? I panicked. Because it would all come down to how the State of Michigan legally defines abuse. And Mitchel had never physically abused me. I had no “evidence” of the abuse.

When I got home, I feverishly looked online for state-specific laws about abuse. Michigan defines abuse as physical or mental harm. I read it repeatedly to make sure that I had read it correctly. I was going to be free. I called the leasing office to begin the process. I had to provide my landlord with documentation that I had experienced violence. “Do you have any court documents?” the representative for the property management asked me over the phone. I didn’t. But what I did have and what I submitted was a qualified third-party document signed by my therapist to show that I presented symptoms of PTSD, a direct result of experiencing violence. I had my evidence. And therefore, my freedom.

Discussion

My own philosophical understanding of what constitutes IPV changed drastically after the relationship. Being a victim-survivor of adolescent dating violence, where I experienced primarily physical abuse, my understanding of IPV was that of the domestic violence model. I understood IPV to be physical and episodic. It wasn’t until I was in this past relationship in which I experienced hidden abuse that I began to understand IPV as coercive control. In other words, abusers can use a multitude of tactics to control their victims physically or otherwise. This also suggests that there are Black women who are experiencing coercive control but may be unaware; may be aware but unable to do anything because the coercive control tactics are non-physical, and the resources are limited to those experiencing physical violence. In other words, Black women continue to die because we fail to recognize all forms of coercive control, including hidden abuse.

What I am most embarrassed to admit is how much of the “Strong Black Woman” trope was a part of my experience and is a part of who I am. Black women, because of the trope are taught to endure pain. Because of racial loyalty, Black women are taught to endure pain for the sake of Black men's disempowerment. I am someone who does not believe in racial loyalty, but I didn’t realize how much I was race loyal in my actions. I first endured Mitchel's lack of employment because I knew he was a Black man without a college degree and thought that was the reason why he was struggling. But he just didn’t want to work at all and always relied on other peoples’ resources. The “Strong Black Woman” trope is a double-edged sword. Because while I was abused because of it, and endured much of the abuse because of it, I also left because of it. I made the decision to leave six months prior to my leaving. The entire time, I had to hide my intentions for fear that he might kill me. I couldn’t fight back physically – though I really wanted to – because I would more than likely be arrested. I even told one of my friends that “I was going to ‘catch a case.’” If it were not for my resilience, for my not being a “Strong Black woman,” I wouldn’t be alive today. And I wouldn’t have my freedom.

I use an autoethnographic case study to illustrate fundamental cause theory and show how IPV is a social determinant of health. Further, I use the case study to show how social conditions such as housing and financial and economic instability contribute to IPV. For example, people who rent are at the mercy of landlords. If the landlord decides not to put information about IPV in the rental packet, people are not aware of this information unless they know to search for it. I had access to a lawyer, but not everyone does. Or should have to. I happened to live in a state that recognizes hidden abuse. But not everyone does. Or should have to. This suggests that Black women experiencing hidden abuse are in a particularly vulnerable position because what constitutes as “evidence” of abuse is often physical. In other words, physical violence is considered visible violence. But not all violence is visible, rather invisible.

Limitations

It is important to note that this autoethnography is unique to me. In other words, I used a combination of specific theories and conceptualizations of IPV to understand my own unique experience of hidden abuse. Fundamental cause theory alone cannot capture Black women's experiences of violence. But using an intersectional approach to fundamental cause and the theory of coercive control allowed me to create this unique autoethnography. Additional qualitative research needs to be conducted to understand the nuanced differences among Black women's lived experiences of hidden abuse. Moreover, additional research is needed on the different types of abuses experienced by Black women to better understand how to fully address and reduce violence against Black women.

Concluding Implications for Social Work

Time is an important factor when intervening in abusive relationships. For example, a vulnerable time in a victim's life is when they are pregnant. Wallace and colleagues (2021) found that homicide is the leading the cause of death among pregnant women in the United States, and that pregnancy indicated an increased risk of homicide particularly among Black people. It is believed that another dangerous time in a victim's life is when they are about to leave (Tjaden & Thoennes, 2000). Moreover, when victims are ready to leave an abusive relationship, they do so when they believe the abuser will not change or children are now involved (Potter, 2007). The continued deaths of Black women victim-survivors at the hands of police officers highlight that if social workers wait to intervene until there is a physical sign of abuse or until the abuse has gotten worse, then it will always be too late.

Fundamental cause theory has important implications for social work research, practice, and policy. The social work profession's adoption of psychotherapeutic interventions has changed the definition of abuse from a gender strategy intentionally deployed by men to being an effect of mental health illness (Davis, 1987; Edleson, 1991). However, this framework individualizes IPV and further decenters victims. Fundamental cause theory is part of a systems approach and is useful for understanding disparities in health, including IPV. A systems approach is important because it allows for the integration of multiple concepts and sources (Diez Roux, 2012). Fundamental cause theory is flexible and can be expanded to understand how IPV is a fundamental cause of racial and gender disparities in health, important structural factors that clearly affect health and healthcare interactions. Moreover, as part of a systems approach, fundamental cause theory has a direct link to intervention and policy (Diez Roux, 2012). By understanding IPV from a systems approach, researchers and practitioners can develop programs and policies that address the immediate structural needs of victims experiencing violence, including financial instability, affordable housing, and access to community networks and social support, so victims can have safety and stability.