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Melissa Harris-Perry: I'm Melissa Harris-Perry. You're listening to The Takeaway. We're about to talk about head trauma, which means you probably think we're going to talk about football, but recent research finds that domestic violence survivors may experience head trauma at even higher rates than football players. According to some estimates, 1.6 million survivors of domestic abuse will experience brain injuries every year. Davine Manson is one of those survivors.

Davine Manson: It was my children's father who I decided that I no longer wanted to be with at the time. I left him, moved on to someone else after being with him for several years. It was over nine years of me being with him. Many years of me dealing with abuse, many years of me dealing with him cheating. I decided I had had enough. I moved on. He got upset. On this particular night, he broke into my home and he found me and my new partner in my bedroom. He came in, caught us off guard. This is when he began a vicious attack to which led him being incarcerated for 28 years.

Melissa Harris-Perry: The head trauma that Davine experienced that night has had both immediate and longer-term effects.

Davine Manson: I suffer from seizures because of him, or what he did. Traumatic brain injury, I have long-term and short-term memory loss.

Melissa Harris-Perry: The trauma also contributed to a speech impediment, and the attack led to her having severe depression, anxiety, and PTSD. Today, Davine is a volunteer with the nonprofit Pink Concussions and is also starting her own organization to help women who've experienced domestic violence. After hearing Davine's story, I wanted to understand more about head trauma and domestic violence, so we spoke with two experts.

Rachel Ramirez: My name is Rachel Ramirez, and I am the founder and director of the Center on Partner-Inflicted Brain Injury which is a project of the Ohio Domestic Violence Network.

Eve Valera: Hi. I'm Eve Valera, associate professor of psychiatry at Harvard Medical School.

Melissa Harris-Perry: I asked Rachel to walk us through what kind of head trauma domestic violence survivors experience.

Rachel Ramirez: Their heads are hurt in lots of different ways. When we think about two buckets of head trauma, there's trauma from external force to the head where somebody's hitting the head with hands, hitting the head with an object, hitting the head with something else. There are ways in which domestic violence victims fall or are pushed to the ground. Then there's a whole 'nother type of head injuries that occurs when a survivor has some type of violence that's done to them that makes it hard to breathe, such as strangulation or choking, or suffocation.

I think that that's one of the real differences when looking at studying head injuries with domestic violence, and understanding in a domestic violence and in other areas, it can be very widespread. There's a lot of different ways in which it happens.

Melissa Harris-Perry: It's difficult to hear and think about that, but helpful to do so. Eve, I'm wondering how the kinds of head traumas that Rachel has just described compares to say football players or soldiers, lacrosse players. We certainly talk about traumatic head injuries, but we typically talk about them either in the context of sport, battle, or accidents. For example, a vehicle accident

Eve Valera: For many, many years, it's been associated if you have-- If somebody says, "Oh, there's a concussion or a brain injury," people think of an athlete, or maybe someone who's served in the military might think of the military. Those are really common associations, but what people haven't thought of for the most part is women who have experienced partner violence and who are being hit in the head.

That leads into your answer in that we don't know a lot about what's different between mostly what's been studied in the literature to date, is that we've studied mostly males, mostly healthy males because people who are athletes or in the military tend to be healthier. They're sustaining brain injuries in ways that some are similar, but some are very different from what women who are experiencing partner violence are experiencing. In terms of how they're the same or different, we don't really have the data to know how they're different, and that's why we really, really need to be studying these women.

Melissa Harris-Perry: Rachel, I'm also wondering about diagnosis. I'm thinking, I don't have one, but if I had a son and he was playing lacrosse or he was playing football and had a concussion or even came in for any other series of sets of injuries, he'd be tested for concussions. I'd sign something around concussions, we'd take certain kinds of precautions. I'm wondering for domestic violence survivors who so often we know don't report at all, and then when they report may not report immediately or may not get immediate medical treatment, I'm wondering about diagnosis. When do we even find out when these women have, or if these women have traumatic brain injuries?

Rachel Ramirez: I work at the statewide colosseum on domestic violence, and we have 75 member programs. As a part of our work, we had the opportunity to go out and talk to survivors who are accessing domestic violence services. When we ask them about their history of being hit in the head, their history of strangulation, it was very, very high with over 8 of 10 survivors and programs reporting pretty extensive head trauma. When we asked how many survivors had been to the hospital, very, very few of the few that had almost none had been diagnosed with any type of brain injury.

I think one of the challenges we have and particularly some of the work that we're trying to do on our end in domestic violence is creating linkages with those concussion clinics and organizations that have served individuals who work with brain injuries. They're not showing up in any of their services because it's not even something that I would think to access. Domestic violence victims also experience their violence in private, which is one of the very, very different just realities and situations where a lot of our response to concussions in sports, to concussions in the military, to concussions in other places, there are things that are happening in front of other people.

I'm sure in Ohio one of the things that we do, I do have kids that play sports, and every time we register them for a sport, we get a concussion fact sheet that we have to sign up for. You don't get a brain injury fact sheet when you get into a relationship. Again, because there's so little knowledge around domestic violence in a brain injury, there's also not that coach, not that teacher, not that parent that's watching that can say, "Time out, something happened, this is what I should be looking for," and then facilitating them to proper medical care.

I think also our survivors have also expressed really concerns about what a brain injury diagnosis could mean if they're in situations where they might be separating or escaping a relationship and are in custody situations or hearings, and how that could potentially be used against them. Again, it's like you're stuck between a rock and a hard place where it's very hard to treat something that hasn't been identified.

I think both from the perspective of service providers and domestic violence, and even domestic violence victims themselves, when they're hit or hurt in the head or choked or strangled, they don't think that might have been a brain injury and that might have impacted your brain, or might have impacted my brain, and it could have these impacts on my life.

Melissa Harris-Perry: Eve, again, I know in certain ways it's the initiation of a field of study, but what do we know so far about the effects that head trauma has in the lives of those who are domestic violence survivors and have survived either being hit or hurt in the head or strangulation?

Eve Valera: As you said, we really don't know a lot. What we do know is based on smaller studies. We like to have lots of studies and replications and larger numbers. From my studies, I can't say anything about the immediate after effect, but if we talk about in general, when folks, anybody regardless of who we are, if you sustain a concussion or a mild traumatic brain injury, you often have a host of what someone might call post-concussive symptoms which could include sleep problems, emotional problems, difficulties thinking or paying attention, et cetera, and things that could really interfere with your daily life. That's something that you might expect.

When I interview my women in my studies, I'm not usually getting them right away. I'm usually getting them at least some time way down the road. Maybe 3 months, 4 months, 5 years, 20 years. What I've been able to show is that there is a relationship. I found a relationship between the number of brain injuries as I've characterized them because there's different definitions of brain injuries, and the number of recency and severity of brain injuries and women's ability to learn a list of words that are read to them and remember that list of words later. Also, their ability to perform what we call cognitive flexibility tasks, so switching rapidly from one thing to another successfully and easily.

Then there's also increased rates or a positive association of people who have more brain injuries, more recent and more severe with higher rates of depression, anxiety, PTSD symptomatology, and worry. In that study, we really did see an association showing that if you have one or two brain injuries, I might not worry at all. If you have three, maybe still not worry. Once you start getting up there, I'll be much more concerned that you're going to be having these types of problems that may be more persistent.

In terms of later on in life, and I think that's part of what your question is asking here, we have no, zero, good systematic data to try to determine if I've had X number of brain injuries now, now I'm 60 years old or something, am I going to be more likely to dement earlier or have some type of neurological disease and increased rate of that? We haven't been able to study that yet.

Anecdotally, I could tell you that there are stories of women who basically are in a safe relationship now. They haven't been getting head injuries or abused, and they say, "Wow, I still have a host of problems. I have these problems that I just feel like I shouldn't be having. I feel like I'm dementing." Then you look back and they have a history of repetitive brain trauma from their partners. Can we defend and link that? No, but I definitely think there's a possibility, a strong possibility in my opinion, that those are linked.

Melissa Harris-Perry: Rachel, as I'm listening to Eve talk about we don't know exactly what it is, but at least relative to some antidotes, she can say, okay, someone might be in a safe relationship later and still seeing these lingering effects. I'm tying that back to your point about you can't pass out the handout the way you do to parents about the possibility of head injuries at the start of a relationship.

There are folks who end up seeing people over time who have experienced domestic violence. I'm wondering about educational interventions for emergency room providers, for first responders, for shelter volunteers and staff to put head injuries on the list of things to be aware of, to be asking about, and to be moving towards trying to manage, or at least have awareness of even while the data collection is still growing.

Rachel Ramirez: Thank you so much for bringing that up because I think that's actually how we at the Ohio Domestic Violence Network got into this head injury work was with a grant to help domestic violence programs or 75 member programs across the state increase access to their services for survivors who had disabilities. We wrote brain injury into that grant because we as an organization didn't know much about it, had never provided training on it. Didn't really see that or understand that as an area of knowledge that we had to have, so we partnered with five agencies across the state just to learn a little more about that.

Very important, I think one of the other opportunities with this work is really thinking about how we have to have people talking to each other who haven't traditionally talked to each other. People from brain injury and domestic violence, people who do traumatic brain injury work and people who do strangulation work, people who work in research, and people who are in direct service.

In our project, we partnered with the Ohio State University's College of Public Health and Dr. Julianna Nemeth. We're able to really have an understanding and think through and develop a framework for ways in which domestic programs could increase access to services for survivors. On our website at www.odvn.org, there is information about a evidence-based framework that has been evaluated by Ohio state called CARE, which stands for connecting, acknowledging, responding, and evaluating, as well as a set of tools. They're called the CARE brain injury tools that are available for both domestic violence victims.

Some of them are written directly for domestic violence survivors because that's something that we learned from programs that while programs and survivors really weren't thinking about this, they also said, "We don't have the training, we don't have resources. I don't want to print out the Ohio Department of Health's sports concussion fact sheet and give that to survivors because that doesn't seem to be what they need. We need something that explains the complexity of domestic violence."

We ended up developing those tools and have provided extensive training on that across the state of Ohio. I do training for different domestic violence organizations across the country on a regular basis. I think that that's a big step is helping first responders or people who are seeing domestic violence victims just getting brain injury on their radar that brain injury could be one of the impacts of domestic violence. I think one of the other real differences we have with domestic violence victims and brain injury, it's such a traumatic situation in which someone obtains a brain injury for domestic violence when someone is experiencing an interpersonal assault by someone that they love.

That, again, is very, very different than a car accident or a fall or something like that. Having first responders even say something like, "Do you know that your brain can be impacted when your head is hurt? If you notice yourself feeling differently, things are changing, things are not feeling clear, that might be something that could be connected to your head trauma."

Melissa Harris-Perry: Eve, a last question for you. I know that we don't always talk about this, but research requires resources. I'm wondering about the availability of resources for doing this research.

Eve Valera: The availability for doing this type of work has been pretty low. Basically, I did my first study and it was published in 2003. I wanted to continue doing this research, but because there were no labs to go into that were looking at the intersection of domestic violence and brain injury and there weren't funding opportunities, I had to do something else for a while. Then I got a Center of Excellence grant from Harvard, which allowed me to collect data in the background.

That was this little grant that really then through blood, sweat, and tears, I managed to eke out a couple of imaging studies, which then allowed me to apply for funding because it's a catch 22 in this research world where unless you demonstrate that you can do it and do part of it, you can't get the funding to do it. It's been challenging. I'm hoping the tide is turning a little bit now, but there's definitely not the resources available to look at IPV or domestic violence-related TBI that are available for athletes or military folks. There's just tons and tons of data out there on mostly men in those other fields. Really, we're still very limited in the funding that we have gotten.

I have no idea if it's going to change, but it has to change in my opinion, and then we're going to keep pushing it, but we really do need people who are in control of funds and the National Institutes of Health, et cetera, to really recognize this and say, "Yes, we need more people doing this work," maybe putting out a call for proposals or something like that. The fields have definitely been thwarted at least from my perspective because I would have been able to do much more if I had more funding more quickly. Basically, there's not a lot of resources right now.

One of the things that Rachel was talking about is just when you're talking research aside, just an example of how the men and the athletes tend to get all of the resources, if you look at a domestic violence shelter, there are certain things that are provided. Rachel could tell you even better exactly. There're different counselors, there's somebody who may help guide you to get an order of protection, et cetera.

Then if you look at it seems like a lot of women may be sustaining brain injuries, but there isn't any newer rehabilitation unit associated with the shelter, which in my view makes no sense at all, but that's where we are. We need to demonstrate through good epidemiological data or data collected in shelters that the rates of women with brain injuries in these shelters is X, Y, or Z. There's no reason we shouldn't have funding to support neuro-rehabilitation for women who may have sustained a brain injury and are showing up in the shelter.

Melissa Harris-Perry: Eve Valera is an associate professor of psychiatry at Harvard Medical School. Rachel Ramirez is the founder and director of the Center on Partner-Inflicted Brain Injury. Eve, Rachel, thank you both for joining us.

Rachel Ramirez: We really appreciate it. Thank you for spreading this word to people.

Eve Valera: Yes. Thanks so much for having me. I really appreciate it.

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