Violence Against Women
Speaker: Dr. Mark Rosenberg (click here for biography)
Primetime Summit 1

Transcript of Proceedings
June 4, 1999

ROSENBERG: Thanks, Sonny. What I would like to do is give to you a couple of things to take away from here, and then engage you in a discussion with us. I think one of the ideas that I want to give you is that our children, in the area of violence, are the people who are suffering the most.

When you think about what our legacy is, it is our children. That is what we will leave here. That is how we create our future. If we went around the room and asked people what are they proudest of, most people would say their children, or their grandchildren. It follows for granted. On a larger scale, we need to take better care of our children, and the impact of violence against women, the impact of domestic violence, the impact of rape on our children has been totally, completely, and absolutely neglected.

And we can change that. We can change that. There's the message. That's what I'd like to engage you on. Let me start with some slides. What I want to show you is violence in the United States. And let me start with this first slide. What this slide shows you, it's the rate at which young people in this country are murdered. And it compares to the rate in this country, the red lines, to the rate in 22 other comparably developed countries. It starts with Japan, with a rate that's less than one half per hundred thousand. One half per hundred thousand. And it goes all the way up to Scotland, where the rate is seven and a half per hundred thousand. And if you look at the overall U.S. rate, you can see, it's not twice the next country, which would land you here. And it's not three times the next highest country, which would land you here.

But it is off the charts, as Dr. Satcher said last night. Off the charts. And what we have done on this graph is listed the rate for young white men in this country. Again, you can see it's more than double the next highest country. And we've listed separately the rate for young black men in this country. And this is the rate at which we kill young black men in this country. Watch what happens on this slide.

I don't think you can see the number in the lower right hand corner, but I'll read it to you as we go. Watch what happens to the U.S. rates as we go forward here. These rates are now at 25, and the rates go on. The U.S. rate goes all the way, almost to 40, compared to Japan, which stopped at one half. So you're now 80 times as high as a comparable country. But look at the rate for young black men, because that rate, we're now at 50. That rate goes on, and on, 75. And on, 100. And on, 125. And on, 150. And on.

That is an epidemic. That is clearly an epidemic by any definition. Let's talk about this impact. Some of where it might come from, an area that we need to pay more attention to. A connection here that we want to make is violence against women. That's enough statistics. Sonny warned me against too many slides that showed statistics. I have a lot more slides. And none shows statistics.

This is a quote from my hero, my mentor in public health, Bill Foege, a former director of CDC, the man responsible for eradicating smallpox in the world, for immunizing children in the world. And what he said was, "If CDC is to maintain the reputation it now enjoys, it will be because in everything we do, behind everything we say, as the basis for every program decision, we're willing to see faces. This we have in common with you." So let me show you a face.

This is the face of Vi Harwell. Vi Harwell is a woman that I met after she was injured. I put her story together by taking newspaper accounts from her home town, slides from her family album, and photographs that I took after I met Vi. I put them together with interviews and conversations with Vi, with her family, with her caretakers, with her friends. Let me share Vi's story with you. Vi was 36 years old when I met her. This is the actual cover of her family album. And what it says is "The family, where love abides and happiness abounds I spoke to Vi's mother. She said Vi was really the life of the family. This is Vi, the shorter one, with her sister Lanita. She said, "She was the joyful one of my kids. She kept the family alive. She was just really lively. She was the one, the only one that was close to me."

I spoke to her sister, Lanita. She said, "My brother, Bobby," the tallest one in this picture, standing in back of Vi, "my brother Bobby was a very physical person. He believed in an eye for an eye. If someone did something, he had to do it right back. He and this guy had some words in a local tavern. The guy was in the bathroom, and a lady, who was a distant cousin of my family's opened the door, not knowing this guy was there. The guy started pushing the lady around, because she had opened the door."

"My brother stopped the fight, stopped him from jumping on this lady, and whipped him over right there, for jumping on this woman. He thought my brother embarrassed him in front of everybody in the tavern. All that week, they had words, and the guy vowed to get Bobby back. As Bobby was leaving this tavern on a Saturday night, the other guy across the street crouched between two cars. He shot him with a rifle with a scope on it. He had a gunshot wound to his head, so Bobby's death was instant." "It was an assassination. That's what it was. The guy showed people that he could be bad. He even went to the neighboring city and bragged about it. The police just came to the tavern and said, 'You've been bragging all night, let's go to jail.' And that was the end of that. He was sentenced to 35 years." I said, "So there are the same ingredients of alcohol, and argument, and a gun." Lanita said, "Right. The same thing. "I just look at most of the shootings that have occurred in that region. It's the same thing. You're looking at people who were shot because someone was drinking. Nothing was a hunting accident. It's always a drunk with a gun. Just what a waste, when will this stop. It's just maddening and sickening."

Vi got married, and Lanita helped her. Vi married Alex, a state trooper, and their first years were very happy. Vi and Alex had a son, little Alex, and they actually took him to a carnival, where this picture was taken.

Vi ran for the school board in her hometown of Pulaski, Tennessee. No black person ever had served on that school board. Vi ran, and Vi won. Vi said, "I was selected as an Outstanding Young Woman of America for 1988. And the Giles County Woman of the Year for 1989. I had my own weekly radio show, where I discussed current events. When I went to work, when I got more active, he was no longer in the spotlight. He was no longer shining, and we went downhill."

You see, in Giles County, he was the first and only black state trooper, for which a lot of people looked up to him. But then came along a little country wife that he thinks has gotten beyond her means. She takes the light off of him. "I no longer depended on him. He told Lanita I'd forgotten my raising. I got too big for my britches." Vi said, "But everything I did was to help someone less fortunate than me. When I got on the school board, I averaged four or five calls a night, and of course it interfered with us. The people would ask him, and, you know, he'd make slurred remarks when they'd ask him, not, 'are you Alex,' but 'are you Vi's husband?' He'd say no. Or he'd say that I was his cousin. Things got so bad that on May 24th, I sent him a letter asking him to move out of the house."

Lanita said, "My mother was crying over the phone, and told me what had happened. I was utterly shocked, and the first thing I did was scream. I was just frightened, and shocked, and just a basket case, more or less." I couldn't sit and wait until the next morning, so we drove all the way to Nashville that night. When they told me that her pupils were fixed and dilated, that she was not responding and all, and not breathing on her own, I just felt worse. I just knew I was coming to Tennessee to probably tell them to discontinue life support. When I got to her bedside, it was like they were telling me that they were waiting for her ventricles to fill up with blood, and she was going to die."

"I just went to the hospital chapel and prayed out loud. The neighborhood news noted that she was shot by her husband with a .357 magnum hand gun." Violetta Harwell remained in critical condition with a severed spine. Family members are hopeful that Harwell will one day be able to breathe without the aid of a ventilator, although at present, she's a quadriplegic, and is only able to blink her eyes in response to questions. Investigators for the Tennessee Bureau Of Investigation have said they were looking into reports of domestic disputes the couple were having as a possible motive for the shooting. Harwell had given investigators varying accounts of the incident, including an initial statement that the gun discharged accidentally while he was cleaning it. I spoke to Vi's doctor, Don Leslie, and she, he said, "Vi was shot by her husband with a .357 magnum in May, and sustained, as a result of that, a ventilator-dependent, quadriplegic state." She can't use her upper or lower extremities, and does not have spontaneous use of her diaphragm. She can't breathe on her own, and requires mechanical ventilation at all times. Vi can use her head. She can blink her eyes. She can open her mouth, chew, and swallow. And she can talk, if her tracheal cuff is deflated to allow air to go across her vocal chords. She can talk if she times her talking with the exhalation of the ventilator".

Dr. Leslie said she's had a very difficult course. She initially had a cerebral spinal fluid leak. She's had multiple problems with pulmonary infection, urinary tract infections, some skin problems, and very severe problems with her psychiatric well being as a result of the adjustment to this trauma. Vi has been very frightened with this. She's had severe nightmare states. She's had total shut downs at times, when she wouldn't talk to any of the staff, me, family members, or her only child, her eight year old son, little Alex.

Dr. Leslie said she's had problems dealing with her husband, who shot her. She doesn't remember what happened. He wanted to come down and see her. She didn't want to see him initially, then she decided she did want to see him. This was overwhelming to her.

And when they had their talks together, she states that she's lonesome. She's lived with this man for 15 years, and she missed him, despite the fact that he did shoot her. I asked her why she wanted to see him when it was so upsetting to her and her family, and all of the staff. And she looked at me and said, "Dr. Leslie, when was the last time someone held you in their arms and told you they loved you. Sometimes I just need that." Vi said, "Dr. Leslie told me to stop feeling sorry for myself. He said you're going to die. You're going to die unless you decide that you're going to get out of here. He said there's nothing else he could do for me." He said, "I can't order it like a prescription for make-up, and a manicure, and a hair stylist." He said, "You've got to get up and do it for yourself. You're going to die if you don't." "I've loved him," Vi said, "ever since." Dr. Leslie said, "We've set a discharge date of next Wednesday. She's been here a number of months, and she's having separation anxiety. She says that she feels she's going to die. She's scared to death, afraid that something is going to happen to keep her from going home.

She cannot verbalize what that is, but she's afraid. It's like fear itself. She's afraid of the fear. She said that last night her respirator become unhooked from her trachea. It frightened her, because she was without ventilation assistance for a moment. Of course, the alarms went off, and the nurses came. But she's very concerned that something like that could happen in transit, or God forbid, at home. That would be the end of her life."

She's tethered to the ventilator. If it comes undone, and alarms don't go off, and she doesn't get help immediately, she would die. In November, Vi and little Alex moved to Lanita's house in Chicago to live with Lanita, her husband, and their two children. Vi said, "I used to have a full time job, mother, housewife, a talk show, member of the school board. And now I'm here. It's all been taken away. But what I lost," she said, "were material things. And I'm not into material things so much any more."

Lanita said, "In her mind, she wants to think she had an Ozzie and Harriet type life, but in reality, it probably wasn't. With her private life, she doesn't want people to know how bad things were. I think it was normal, everyday stuff, but with her husband drinking, I think things got worse. You know you can cope with financial problems. You can cope with not having enough time for yourself. But when you've got other factors like alcohol interfering, it may add a little bit more to it than you can stand. I think there were problems just building up and building up in their lives, and she didn't want to face them, and he probably didn't, either. How it got to a gun in his hand the night she was shot, I don't know."

I was with Vi on the night of the trial, and Vi said, "Lanita and Henry are down at the trial today. It would be good news if he's found guilty of second degree murder, and that he receives 15 to 30 years." She said, "I've thought it about a lot. I've had from May 29th to think about it." She said, "After reading the investigator's report, I believe that he planned it. The Tennessee Bureau of Investigation hired a ballistics expert, who testified that a .357 magnum required too much pressure on the trigger to go off accidentally. He said there had never been a case of this happening. Alex said he was getting ready for target practice. Yet at the time, it was already pitch dark outside. They found a .357 pistol hidden under the pillows on the couch. "Now nobody keeps their guns in the couch."

There was a neurosurgeon's report that the bullet entered from behind, yet Alex had said he was standing in front of me. He was a coward. He shot me in the back of the head, in the very back of the head." She said, "Reading that report was devastating. I was scared. For the first time I read it, I cried. The second time, I got mad as hell. Knowing you can live with somebody for "And knowing you have a son to take care of. I mean nothing, nothing should make you want to take somebody's life." Vi said, "Before my injury, I was too busy to have time for my son. Now, I live to love him." Lanita said, "Little Alex had been a wonderful student before he moved here to Chicago with us. But during the winter, he started having a lot of problems. His teachers let us know that he was not doing his schoolwork, or turning in his homework. And worse than that, he was lying about it. When we found out, I started going with him to a child therapist. That worked great. It really turned him around, and he went from being a real problem to where he was selected as a star student of the week. He invited me to come to his class on the day he was supposed to get the award. It was a surprise. I was delighted," she said, "and he was surprised and very happy. After he got the award, he introduced me to his class. He said, this is Lanita, my mother."

I spoke to Vi, and I said there's a lot of long hard work in rehabilitation. She said, "Before I was injured, I had everything. Wonderful jobs, a new car, a new house, the best clothes. Everybody knew me, and I took my life for granted. And now, each day means much more. Each day is worth much more." Let me stop the story here, and talk a little bit about what goes on, what went on.

Vi's case is a case of domestic violence. It is a prototypical case of domestic violence. We're including what we refer to as domestic violence, violence with partners, and sexual assault or rape, physical assault, a wide range of behaviors that can from slapping and hitting, pushing, shoving, grabbing, hitting with an object, holding a knife to one's throat.

Ultimately, in Vi's case, putting a gun to someone's head and pulling the trigger. I showed the case to someone two days ago. He looked at the story and he heard Vi's account of how she had been shot, and he said, "That's not a shooting." He said, "That's an execution." We're talking about physical assault against women. We're also talking about rape, which is forced vaginal sex, oral sex, and anal intercourse. These are things we can talk about now. These are things we have got to talk about now. We also include partner violence. Violence between people who know each other, perpetrated by a current spouse or a former spouse. This is a time, during separation or divorce, when women are at higher risk than when they're married. And we're also talking about emotional abuse. Threats. Intimidation, that can be subtle, or that can be veiled, but that invokes fear, paralyzing fear in a person. So this is what we're talking about when we talk about violence against women.

What do we know about it from our research? First, we know that it's very wide spread among American women. Very widespread. We work now, hand in hand. The Department Of Health And Human Services, CDC, and the Department Of Justice. It's a wonderful partnership. For the first time ever, Health And Human Services and Justice are talking the same language, using the stone definitions, measuring the same thing, and working together to prevent the same problems. What we found in a survey that we did together is that 25 percent of women were raped or physically assaulted by an intimate partner in their lifetime. 25 percent of women. This is a big problem. It translates into one and a half, one and a half million women a year. One and a half million a year who are raped or physically assaulted by an intimate partner. So it's widespread. It's also primarily partner violence. Violence against women comes from your partners. Not from strangers, but from your partners, your intimate partners. 76 percent of the women who were raped or physically assaulted were raped or physically assaulted by a partner. Three quarters of them, by partners. Rape, the third point here, is primarily a problem of our youth. Of our children. Rape is a problem for our children. The same survey found that 18% of women said that in their life, they had experienced an attempted or completed rape at some time in their life. Eighteen percent of all women. Of these, and this is a striking thing, of all women who had been raped or had a serious attempted rape, more than half occurred when they were under 18 years old. Under 18. And of these, 22% happen to women who weren't women at all. It happens to girls who are

What do you see when you put together the young age at which women are attacked, and that they're attacked by an intimate partner, under 12? These happen in family situations. As Donna Shalala said, this is a story about incest, and we have got to start talking about it. These are our charges, the people we have to protect. It's becoming very clear as well that violence against women does not occur in a vacuum. It is closely linked, very closely linked to the other forms of violence that we face in our society.

First, children who witness violence. Remember Alex, little Alex? You remember what happened to him? He was very smart. He's exactly the same age as my son, but a little better organized, and a little better a student. He was very smart. But when he moved to Chicago with his mother, he really started having problems. His grades fell. He started lying about his grades. They didn't know what to do, so Lanita brought him to therapy. And she said that therapy really turned him around, remember? He went from being a problem student to being the star student of the week. It was a cure. It wasn't a cure. Remember how he introduced Lanita when he went on stage there? He said, "This is Lanita, my

How long does this last? How big an impact does it have? Big. Big. We know that the impact on children who witness violence, and who live with violence in the home has a tremendous impact on children. If you witness violence at home, or in many cases, if you're abused as a child, you grow up and replicate the violence. You are much more likely to perpetrate violence when you grow up, if you see it in your family. You are more likely, if you're a girl, to end up in a violent relationship if you witness it, or if you're exposed to violence as a child. This relationship is powerful. This relationship is strong. What are the findings that people talk about from watching violence in the media and violence in TV, that basically say, "Yes, it can have some anti-social effects," and they put them into three categories.

They say the first effect comes from learning and imitating what you see on the big screen and on the small screen. Learning and imitating. The second type of effect is from desensitization. You get numb to the violence on the screen. It doesn't have an impact. You lose your normal ability to react. And the third way that screen violence has an impact is by creating a sense of fearfulness in people who grow up with it, the children. They come to see that this is a frightening world, a world in maybe you must use violence to defend yourself. So, learning and imitation, desensitization, and this notion of fearfulness apply to the screen media.

They apply to kids like Alex, much, much, much more strongly. And we're talking about exposures in the home at the rate of millions. So there is a connection between violence against women and children who witness it. Youth violence, there is a connection between kids who grow up with violence, and the kids who take it out on the street. We commissioned Ivan Yusay, a young black film maker with an MBA to go out and do a study of dating violence in the inner city, and he came back to us and he said, "Man, this was an incredible experience. He said it is so widespread, almost universal where he went to talk about it. But he asked everyone, "Where were you first exposed to violence? Was it rap music? Was it videos? Was it movies?" And they said, to a person, and this stunned him, "It was in my home. In my home." This blew him away. This blew him away, this finding.

What's the connection with school violence? School violence has changed, as you know. It's changed from being one-on-one, taking grudges into school, something that's happened at a relatively low level of maybe 40 to 50 a year, to fatal school violence incidents. It has changed so that the focus, now, is on these multiple episodes, multiple killing episodes of violence.

Let me just paint some possible connection in front of you. If you look at Jonesboro, Pearl, and Paducah, and you take those there episodes that happened a year ago to a year and a half ago, in those, the average age of the victims was thirteen and a half years old. The average age of the perpetrators was eleven and a half. Every single perpetrator was a boy. And every single victim in those three cases was a girl. Is there a connection between violence against women? Oh, yeah. This is violence against women. Perpetrated by men. We looked closely at every single episode of multiple victim school homicides, from '92 to '94. In that big series, every single perpetrator was a boy. This is male violence. Is there a connection? We think there is. It's something we certainly need to look more closely at.

There is this cycle of violence, and let me just put it front of you here. It's a cycle of violence that goes from children witnessing violence as a child, or witnessing abuse, or actually being abused. It starts here. Alex is witnessing it. It goes to dating violence, it goes to youth violence, the violence in the schools, and the it's replicated in adult partner violence, and they have children, and their children witness it, and it's a cycle that goes on and on.

We're learning. We used to think that, "Oh, my gosh, there are so many different types of violence. There's child abuse, there's youth violence, there's dating violence, there's violence against women, there's rape, there's elderly abuse. How do we ever approach so many things?" And what we understand now is that they're tied together, and you can approach the whole cycle. It gives us great power. Let me close and say that we're starting to focus on prevention. How do you prevent this? Where do you get a handle? How do you have a start on this ?

What we really need to do is go upstream. This movement to stop domestic violence, and help the woman who is treated for sexual assault, these movements have been started by advocates. And they did an incredible job. They focused resources on treating people who needed the help at the time. What we need to do is go back earlier in the cycle, to prevent it from happening, to break the cycle, to step in here. What we need to do is to change the norms that exist in society. Let me mention to you just three things, three points that we think you can address, or you can have a powerful influence on. The first norm is the notion that men have the right to dominate women. It's the men who can decide, it's the men who should decide. What happened to Alex? Do you remember big Alex? He said that people would come up to him and say, "Are you Vi's husband?" And he'd say, "No." Why did he say no? He was ashamed. He's supposed to be the dominant one. He's supposed to be in charge. And he was ashamed and disgraced, and he said, "No, I'm not married to her." Unfortunately, the shame and the disgrace built up so much, so much, it led to violence on his part, and that's the second norm that's out there that we have got to change. So the first is dominance by men. The second is force by men; that when men are challenged and are threatened, they have the right to use force.

Threaten, intimidate, put a gun to someone's head, put a knife to someone's neck, this is how men react. Not only is there this sense that they have the right to use force, they don't know how to do anything else. Alex didn't know how to talk to Vi, and tell her, "Vi, I feel so bad. Do you understand how ashamed I am? I'm supposed to be a state trooper. People used to look up to me, and now, I'm hanging on to your skirt. Do you know how bad that feels, Vi? Help me."

We don't equip men to say that. That's not a skill we give them. It's force. That's the second social norm. So domination, the use of force, and the third norm is isolation. It's the sense that what happens in the family stays in the family. You can't talk about it outside. I asked Vi, "Why didn't you go for help? Why didn't you ask someone?" She said, "Who could I turn to? Who could I turn to? I couldn't go to the police. They'd tell Alex." I said, "Why didn't you go to your doctor?" She said, "Alex and I had the same doctor. He would tell Alex." Even when women try to find someone outside the family, they are isolated. Rural women are physically isolated. There may be no one around for miles and miles. So these three social norms, men can dominate, men can use force, and men can keep it in the family and isolate the women, we have got to think about changing those social norms.

And I think the good thing is that you have the power. You have the power. We can start to tell these stories. We can address the norms, and start to change them. You have tremendous power to affect good. Tremendous. And we can harness it to make a change. We can change from presenting this as a problem by itself to a problem with a solution. My hero, Bill Foege, said, "The greatest threat facing public health today is not AIDS. It's not drug abuse. It's not even Ebola virus. And it's not violence". He says, "The greatest threat to our health, and our collective well being is fatalism. It's this notion that we just have to live with this problem. That's the way it is. We can't change it, and we may as well just shut our doors, and lock ourselves inside." We can give the message that this is a problem, and it's a problem we can change. I'm convinced if we work together, we can change the world, and we can change this legacy that we give to our children. We're very excited about working with you, and I thank you for your time.