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Our objectives are to describe the pattern of abuse associated with battering and to evaluate the contribution of the medical system and of broader social forces to its emergence. A pilot study of 481 women who used the emergency service of a large metropolitan hospital in the U.S. shows that battering includes a history of self-abuse and psychosocial problems, as well as repeated and escalating physical injury. In addition, although the number of battered women using the service is 10 times higher than medical personnel identify, the pattern of abuse that constitutes battering emerges only after its initial effects are presented and in conjunction with specific medical intervnetions and referrals. Examination of intervention and referral patterns suggests a staging process by which battering is socially constructed. At first, the physical trauma associated with abuse is medicated symptomatically. But the patient's persistence, the failure of the cure, and the incongruity between her problems and available medical explanations lead the provider to label the abused woman in ways that suggest she is personally responsible for her victimization. Although secondary problems such as depression, drug abuse, suicide attempts, or alcoholism derive as much from the intervention strategy adopted as from physical assault or psychopathology, they are treated as the primary problems at psychiatric and social service referral points where family maintenance is often the therapeutic goal. One consequence of this referral strategy is the stabilization of "violent families" in ways that virtually insure women will be abused in systematic and arbitrary ways. The use of patriarchal logic by medical providers ostensibly responding to physical trauma has less to do with individual "sexism" than with the political and economic constraints under which medicine operates as part of an "extended patriarchy." Medicine's role in battering suggests that the services function to reconstitute the "private" world of patriarchal authority, with violence if necessary, against demands to socialize the labors of love.

Viewing child abuse through the prism of woman battering reveals that both problems originate in conflicts over gender identity and male authority. Data indicate that men, not women, typically commit serious child abuse. A study of the mothers of child abuse victims shows that battering is the most common context for child abuse, that the battering male is the typical child abuser, that the battered mothers have no distinctive pathology in their backgrounds, and that clinicians respond punitively to the battered mothers. The child abuse establishment assigns responsibility for abuse to mothers regardless of who assaults the child, and responds punitively to women, withholding vital resources and often removing the child to foster care, if women are battered or otherwise fail to meet expectations of "good mothering." The combination of male control, misleading psychological knowledge about women's propensity for "bonding," and sanctions used to enforce gender stereotypes of motherhood combine to increase the entrapment and inequality from which battering and child abuse originate, a process termed "patriarchal mothering." The best way to prevent child abuse is through "female empowerment."

This article explores the importance of woman battering for female suicidality, with special attention to the link among black women. Suicidality has classically been framed with a distinctly male bias. As a result, suicide attempts (a predominantly female event) have been defined as "failed suicides" and the distinctive social context of suicidality among women has been missed. The authors propose that suicidality among battered women is evoked by the "entrapment" women experience when they are subjected to "coercive control" by abusive men. A literature review highlights the probable importance of male violence as a cause of female suicidality. Pursuing this possibility, we assess the significance of battering in a sample of women who have attempted suicide, the characteristics of battered women who attempt suicide, and the appropriateness of the medical response. The results indicate that battering may be the single most important cause of female suicidality, particularly among black and pregnant women. The implications of this finding for theory and clinical intervention are discussed.

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