Reasons why they stay.
권지현 2026-10-03
In Korea, there are 6 Veterans Hospitals. They offer health and medical services for veterans, especially who participated in Vietnam war and Korean war. Already many Korean war veterans passed away, so mostly Vietnam war veterans visit these hospitals.
As a psychiatrist, I have a chance to meet patients’ family members, especially their spouses. Sometimes, these spouses also visit psychiatric clinics, but usually I feel they need more psychiatric help. Most of my male patients suffer from various physical problems such as pain, numbness in addition to mental problems. These symptoms usually maintain their whole life with unknown causes. Usually, they are polite to others, but they lose their temper and do harmful actions or comments to their significant others. I think I could call it ‘domestic abuse’ which maintains their whole marital life. Some spouses got divorced, but others have maintained their marriage for a variety of reasons. In my opinion, a big portion of reasons which make them stay as spouses are because of their offspring. Almost all of their kids are already grown-ups; they have their own lives and leave their parents. Just two of them are left and have more time together after retiring. Usually, male patients don’t have any social gatherings except veterans’ assembly. Their spouses have chance to leave these male patients. Sometimes their children encourage them to separate from my male patients. (Even though they-children- respect both of their parents.) Usually, these spouses have already achieved financial independence. They can go away whenever they want. There is no obstacle to preventing them. Why do they stay besides their stressful husbands? That’s my big question.
증례 : 비밀유지
Battered woman syndrome is a pattern of psychological and behavioral symptoms seen in some women who have experienced repeated, severe intimate partner violence (physical, sexual, psychological, and/or financial abuse). It’s coined by Lenore E. Walker in the late 1970s (book: The Battered Woman, 1979). She described how chronic abuse affected cognition, emotion, and behavior, especially: Why some women stayed in abusive relationships, how they perceived danger and options, and why they may respond with learned helplessness, hypervigilance, and trauma symptoms.
Walker originally described BWS as comprising two main components: a cycle of violence and learned helplessness.
There is a similar psychological phenomenon called Stockholm syndrome, in which hostages, captives, or abuse victims develop positive feelings, loyalty, or empathy toward their captors or abusers, and may simultaneously feel distrust or hostility toward authorities or rescuers. It was named after a 1973 bank robbery and hostage situation in Stockholm, Sweden.
During a six-day siege, some hostages became emotionally attached to their captors, defended them, and expressed fear of police more than the robbers.
Swedish psychiatrist and criminologist Nils Bejerot coined the term “Stockholm syndrome” to describe this paradoxical attachment.
The term quickly spread beyond hostage situations to describe similar dynamics in domestic violence, kidnapping and child abuse.
Among domestic violence, between partners violence is called intimate partner violence (IPV).
Intimate partner violence (IPV)
In various psychoanalytic theories, IPV is discussed. I will focus on IPV victims.
Freudian
Repetition compulsion
: Victims may unconsciously re-enact early traumatic relational patterns by entering or staying in abusive relationships.
Death drive (Thanatos) and aggression
Masochism
Identification with the aggressor (Anna Freud)
Later, trauma theory (beyond drive theory)
Kleinian
Paranoid-schizoid position
: Chronic abuse can force the victim into a paranoid-schizoid position. For the victim, it’s difficult to reach the depressive position. The depressive position involves recognizing the other as a whole person (both good and bad) and feeling concern/guilt. In IPV, this is often unsafe seeing the abuser as partially good can increase risk. Thus, the victim may be stuck in paranoid-schizoid position as a survival strategy, not pathology.
Projective identification
: The victim may project her own rage, aggression, or badness into the abuser, then experience him as purely evil, internalized the abuser’s projections (being told she is crazy worthless) and begin to feel those things.
Kohutian (self-psychology)
The victim is subjected to relentless humiliation, devaluation and control which are profound narcissistic injuries. These attacks undermine her self-cohesion, leading to feelings of emptiness and shame. Over time, the victim’s self may become fragmented: difficulty knowing what she feels or wants, loss of agency.
Many victims have histories of inadequate mirroring and protection in childhood. In the abusive relationship, she may serve as a self-object for the perpetrator, absorbing his rage and shame while her own needs are neglected.
Bionian
Many victims have histories where caregivers could not serve as adequate containers for their raw affect (beta elements). As adults, they may have limited alpha function: difficulty thinking about intense emotions, tending instead to endure, dissociate, or act. In the abusive relationship, the victim often becomes the container for the perpetrator’s beta elements (rage, shame, hatred). She is forced to hold what he cannot think, experiencing it as terror, confusion, and somatic distress. Chronic exposure to violence and coercion overwhelms her own alpha function: experiences remain as beta elements (nightmares, flashbacks, somatic symptoms, dissociation), thinking and reflection become nearly impossible in moments of danger. The perpetrator projects his disowned aggression and destructiveness into her; she may feel crazy, bad or responsible for his rage, act in ways that seem to confirm his projections (e.g., becoming angry or desperate).
Winnicottian
In many IPV victims’ histories, there are patterns of chaotic, threatening, or invasive early environments. Their caregivers could not provide reliable holdings. To survive an unpredictable or dangerous environment, the child develops a false self: compliant, pleasing, hyper-vigilant, organized around managing the caregiver’s moods and demands. The true self (spontaneous, authentic, creative) is hidden and protected but cannot fully emerge or be experienced as real. The abusive relationship is experienced as massive, ongoing impingement. The victim’s false self may become rigid. Over time, the victim may feel emotionally numb. In some IPV victims, aggressive or self-destructive behaviors may be understood as desperate attempts to test the environment. Winnicott described the antisocial tendency as a sign of hope: acting out, stealing, aggression, or rule-breaking can be an unconscious attempt to recover what was lost (care, stability, holdings).
Kernbergian
Kernberg’s framework is often applied more explicitly to perpetrators (especially those with Borderline Personality organizations.
Many IPV victims, especially those with complex trauma histories, show features of identity diffusion. IPV victims often carry internalized object relations in which one part of the self identifies with the victim (helpless, shamed, terrified), another part identifies with the aggressor (critical, punitive, controlling). This can manifest as intense self-blame, harsh internal criticism that echoes the abuser’s voice, and difficulty distinguishing her own desires from the abuser’s demands.
In close relationships, IPV victims may split the partner into all-bad (during/after abuse) and occasionally all-good (during honeymoon phases). IPV victims may struggle to hold an integrated view and oscillate between idealization and devaluation. This splitting is both a survival strategy and a source of instability.
Kernberg emphasizes that aggression and hatred are central affects in borderline organizations. In IPV victims, this aggression may be turned inward: self-harm, suicidality, occasionally turned outward: reactive violence, explosive anger. Aggression may be experienced as uncontrollable hatred toward self, abuser, or the world.
Why they stay
Freudian
The abusive relationship repeats early traumatic patterns (e.g., childhood abuse, neglect, chaotic caregiving), which feel familiar and ego-syntonic (“This is how love works”).
Leaving would mean confronting the full impact of the trauma (grief, rage, shame). Also, facing the unknown, which can feel more terrifying than the known danger.
Kleinian
The victim’s internal world is organized around a persecutory object (the abuser) who is experienced as all-powerful and dangerous, the only one who knows her, the center of her emotional universe.
The victim may also identify with the abuser’s projections (“I am bad, I deserve this”), making leaving feel like escaping herself, not just the relationship.
Leaving would mean facing the annihilation anxiety of being without the (bad) object that organizes her world, tolerating ambivalence (“He is cruel and sometimes kind”), which feels impossible in a paranoid–schizoid state.
Kohutian
The abuser, despite being violent, also provides intermittent selfobject functions. Occasional affection, praise, or honeymoon phases that temporarily restore a sense of being seen and valued. A sense of belonging and identity (“I am his partner,” “I hold the family together”).
Leaving would mean facing self-disintegration (“Who am I without him?”), confronting shame and worthlessness (“No one else could want me”), and losing the only source (however toxic) of self-cohesion.
Bionian
The victim’s psyche becomes organized around holding the abuser’s projections. She feels responsible for his emotions (“If I keep him calm, he won’t explode”). Her identity becomes “the one who contains his rage.
Leaving would mean no longer having a defining function in the relationship, facing her own uncontained beta elements (terror, rage, emptiness) without the structure the abuse provides and risking the abuser’s unleashed aggression if she tries to leave (which is often realistic).
Winnicottian
The abusive relationship is a massive, ongoing impingement that disrupts the victim’s going-on-being (sense of continuous existence).
The victim’s false self becomes highly developed hyper-compliance (“I must keep him calm”), hyper-vigilance (monitoring his mood, the environment), and self-sacrifice (putting his needs, the children’s needs, the family’s image ahead of her own safety).
Leaving would mean risking further impingement (stalking, legal battles, economic collapse), facing the emptiness and disorientation of a life no longer organized around managing the abuser, allowing the true self to emerge, which feels dangerous after a lifetime of hiding.
Kernbergian
The victim’s identity is organized around the victim role: “I am the one who is abused,” “This is who I am,”
Leaving threatens this identity, creating existential anxiety (“If I’m not his victim, who am I?”).
Internalized abuser introjects (his voice, criticisms, threats) live inside her: “You are worthless,” “No one else will want you,” “You’ll never survive without me,”
Leaving feels like betraying an internal part of herself, not just an external person.
In cases of borderline personality organization, the victim may oscillate between: Clinging to the abuser as an idealized object (“He’ll change,” “He loves me”), Experiencing him as all-bad but feeling unable to tolerate the emptiness and rage of separation.
Precautions for analysts for IPV victims in different analytic theories
Across psychoanalytic traditions, there is broad agreement that working with IPV victims requires specific precautions to protect the patient, the therapist, and the integrity of the analytic work. While each theory emphasizes different mechanisms (repetition, splitting, narcissistic injury, containment failure, impingement, identity diffusion, projective identification), all converge on several core safety, boundary, and ethical guidelines.
Explain confidentiality clearly, including mandatory reporting laws.
Avoid conjoint couples' therapy when there is ongoing severe violence, coercion, fear.
Maintain a clear consistent frame: session length, frequency, contact between sessions, fees, cancellation policy.
Theory-specific precautions
Freudian
Focus: repetition compulsion, trauma, masochism risk
Precautions:
Avoid interpreting staying in the relationship as masochism or unconscious wish to suffer. This can be experienced as blaming and re-traumatizing.
Be alert to repetition compulsion. A patient may unconsciously re=enact abusive dynamics with the therapist (e.g., testing, provoking, then feeling abandoned).
Kleinian
Focus: splitting, projective identification, paranoid-schizoid dynamics
Precautions:
Expect to be cast as an all-good rescuer or all-bad persecutor; avoid colluding with extreme.
Be careful with interpretations of splitting early on; the patient may experience this as an attack or as you take the abuser’s side.
Kohutian (self-psychology)Focus: narcissistic injury, self-fragmentation, selfobject needs
Precautions:
Avoid interpretations that could be experienced as humiliating or shaming.
Be mindful of your own narcissistic countertransference.
Provide empathic mirroring and validation before any interpretive work.
Support the rebuilding of a cohesive self without pressuring the patient to be stronger.
Bionian
Focus: containment, beta elements, alpha function, toxic projections
Precautions:
Recognize that the patient may evacuate raw, unthinkable affect into you; do not respond with premature interpretation or emotional withdrawal.
Monitor your own alpha function: if you feel overwhelmed, numb, or action-driven, seek supervision.
Prioritize being a container over doing it.
Use supervision to process toxic projections and prevent vicarious traumatization.
Winnicottian
Focus: holding environment, impingement, false self-compliance
Precautions:
Avoid intrusive interventions that replicate impingement.
Respect the patient’s pace; allow silence and not knowing as part of the holding environment.
Provide a reliable, non-intrusive holding environment: consistent sessions, clear boundaries, and attuned presence.
Support the gradual emergence of the true self without demanding immediate change.
Kernbergian
Focus: identity diffusion, splitting, internalized victim=victimizer dyads BPO
Precautions:
Be alert to rapid shifts in self-state (helpless victim – harsh critic – aggressive perpetrator) and corresponding shifts in how you are experienced.
Avoid being pulled into enactments (harsh confrontation, over-rescuing, collusive neutrality).
Maintain a structured, active stance with clear limits, but adapt to trauma and safety.
Gently interpret splitting and internalized dyads only when the patient is sufficiently resourced.
Analyst self-care and systemic precautions
Across all theories:
Regular supervision or consultation is essential to:
Process intense countertransference (Rage, despair, rescue urges)
Check blind spots (collusion, splitting, over-identification)
Maintain ethical and safety boundaries
Attention to vicarious trauma:
Monitor your own sleep, mood, somatic tension, and cynicism.
Seek personal therapy if your own trauma history is activated.
Institutional and professional support:
Follow your professional body guidelines on IPC.
Use risk-management consultation when unsure about confidentiality, reporting, or safety planning.
증례 : 비밀유지
As a psychiatrist, sometimes I try to persuade IPV victims who can make their own life without IPV perpetrators. I think it is more reasonable. However, I think I have to make a choice or give some advice differently case by case.
References
Wikipedia
encyclopeida
Trauma, violence, and abuse
Journal of the American Academy of Psychiatry and the Law
APA dictionary of psychology
Notre Dame Journal of Law, Ethics & Public Policy
Psychodynamic Practice Individual, Groups and Organisations
Frontiers in Psychology
Campbell law review
Psychiatric Clinics of North America
Britannica
APA Dictionary of Psychology
The Journal of Psychotherapy Practice and Research
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