*Patient name has been changed to protect privacy
“It makes me want to run far away from him,” said Jane*, shrinking into herself as though she had no right to take up space.
This was her heartbreaking answer to my question: “When you think about how your husband treats you, what goes through your mind?” For a week, Jane had been obliquely dropping pieces of a very disturbing puzzle that indicated a controlling husband who felt entitled to abuse her.
This particular case hit very close to home for me, a woman in medicine hiding my own dirty little secret of domestic abuse from colleagues and patients alike. I struggled with moral distress for months. As a provider, I wished that patients like Jane would realize their self-worth and fight for themselves. But outside medicine, I internalized the abuses that a former partner regularly inflicted upon me, believing myself to be fundamentally unlovable and undesirable. I took a long time to leave, and sometimes I am ashamed of how long I stayed. Today, I openly share my experience as a physician who has known domestic abuse. Since this awful thing had to happen to me, I now use it to advocate for other women. This way, I figure, my pain is not totally senseless.
Domestic violence is a serious problem in the U.S., generating a lifetime population economic burden of $3.6 trillion and an estimated lifetime cost of approximately $104,000 per female victim and $23,000 per male victim. To put these numbers into perspective, the estimated lifetime cost of heart failure is around $110,000 per person. You read that correctly: the cost of domestic violence to American women rivals the cost of heart failure.
Say I have a female patient, and I am concerned she might be unsafe at home. I ask certain questions immediately. Does she feel safe at home? The initial answer to this question has dubious utility; it may take a long time for a victim to acknowledge feeling unsafe and, on average, seven attempts to leave before separating from an abusive partner for good. Thus, I also screen for vulnerabilities: is she pregnant? Is she financially dependent on her partner? Does she have a supportive network of family and friends, or is she isolated from social contacts? Does she have an ongoing mental health issue? Did she experience violence as a child?
Then I ask about relationship factors that could increase the risk to her safety: does her partner have an active substance use issue? Is her partner’s employment unstable? Is her partner unusually jealous or dangerously possessive?
Finally, I ask: does her partner have access to guns?
If the answer is yes, it is an immediate red flag.
(For the record, I would go through the same routine for a male patient.)
Public awareness of firearms as a risk factor for femicide in the setting of domestic abuse is essential right now, given the outcome of U.S. v. Rahimi in the Fifth Circuit Court of Appeals. The Supreme Court plans to review this decision during its current term, which just began this month.
Zackey Rahimi, a Texan with an alleged history of perpetrating domestic abuse, drug dealing, and gun violence, was convicted of owning firearms while subject to a restraining order (which he then violated at least twice) filed in 2020 by his former girlfriend after he assaulted her. Rahimi was involved in further episodes of gun violence after the order of protection was in place, but still appealed his conviction.
The U.S. Fifth Circuit Court of Appeals overturned Rahimi’s conviction when Rahimi’s lawyer argued that the federal law under which his client was convicted — banning people subject to restraining orders for domestic violence from owning firearms — was unconstitutional because it does not fit our “nation’s historical tradition of firearm regulation.” The Supreme Court’s decision in New York State Rifle & Pistol Association v. Bruen last year also played an important role in the Fifth Circuit ruling.
It is appalling that we’re even debating whether a violent man with a documented history of perpetrating abuse, and who is under a restraining order for his victim’s safety, has the right to own a gun. As a physician, I’m terrified for my patients who have survived domestic violence. As a woman who has experienced abuse, I’m equally dismayed and furious.
I’m not fearmongering to push a radical liberal agenda: the data on the issue of gun violence in the setting of domestic abuse are chilling. Most intimate partner homicides are committed with a gun, and these homicides increased in frequency by 26% within the last decade. Possession of a gun by an abuser increases the risk of femicide by 1,000%. Let me reiterate that: direct access to guns by male perpetrators is the single biggest risk factor for femicide in an abusive relationship.
And before someone suggests that we arm victims for their protection, let me add that doing so would be a wholly useless intervention and, in fact, increases the victim’s risk of homicide by the abusive partner. Furthermore, state laws that require abusers to relinquish their firearms reduce intimate partner homicides by 12%. These laws are effective at keeping survivors safe. Now, their continued existence hangs in the balance.
Anyone can be an abuse victim. Domestic violence affects all genders; this fact is undeniable. However, it is also undeniable that women are disproportionately affected by gender-based violence. And so, the upcoming Supreme Court review has paramount implications for the safety of women.
To critics who would dismiss me with a supercilious, “Stay in your lane”: if I have to handle the devastating physical and mental consequences of gun violence in the form of abuse victims presenting to my emergency department or to my clinic, this is definitely my lane.
The outpouring of grief, terror, and trauma whenever a patient tells me about their abuse never fails to break my heart. I do my absolute best to triage and to keep them safe. But I am one physician. I need more societal support to keep my patients safe, and the prospect of losing this federal protection is utterly horrifying.
It is wholly irresponsible and callous to even consider removing this essential protection for domestic abuse survivors for the sake of an obstinately rigid interpretation of “constitutionality” and our nation’s longstanding commitment to gun ownership. The fact that this is up for debate speaks volumes to our society’s attitude towards women and sends a very strong message: that my life and the lives of other women hold less value than an abusive and violent person’s right to own a firearm. It strikes me as logically incoherent; we cannot, as a nation, claim to defend our most vulnerable and simultaneously permit this kind of obtuse, dangerous, and scientifically unsound nonsense.
Women deserve much better than this. It should not be controversial to want to keep firearms out of the hands of their abusers.
Chloe Nazra Lee, MD, MPH, is a resident physician in the Department of Psychiatry at the University of Rochester Medical Center in New York.