Social Science & Medicine 122 (2014) 44e52

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Social Science & Medicine

journal homepage: www.elsevier.com/locate/socscimed

‘Every bone of my body:’ Domestic violence and the diagnostic body

Paige L. Sweet
Sociology, University of Illinois at Chicago, 1007 West Harrison Street (MC 312), Chicago, IL 60607-7140, United States

a r t i c l e i n f o a b s t r a c t

Article history: Diagnostic categories for domestic violence have shifted over time, transforming from a disorder of
Received 9 January 2014 psychological passivity and acute injury into a chronic and somatically invasive condition. This paper
Received in revised form links these changing diagnoses to constructions of the abused body and to victim-blaming narratives.
3 October 2014
Based on an analysis of medical journal articles, this research identifies two logics that undergird do-
Accepted 6 October 2014
mestic violence diagnoses, the body, and victim-blaming: 1) the logic of injury (1970se1980s); and 2) the
Available online 7 October 2014
logic of health (late 1980sepresent). The logic of injury is associated with overt victim-blaming, a
temporally bounded and injured body, and psychological passivity. Once the feminist anti-violence
Keywords:
Diagnosis
movement gained mainstream credibility, however, the logic of injury fell out of favor as an explana-
Domestic violence tion for domestic violence. What surfaced next was the logic of health, which is associated with chronic
Body diagnoses and what the author calls a temporally extended body. The temporally extended body is
Chronic flexible and layered, linking up past, present, and future states of disordered embodiment. The author
Biomedicalization suggests that, rather than ushering in hope and possibility via the logic of health's somatic flexibility, this
Temporality abused body creates spaces into which new forms of blame and self-responsibility can take shape.
© 2014 Elsevier Ltd. All rights reserved.

1. Introduction
That preoccupation with the future increasingly pervades our
experiences of the present is a central claim of many theorists
dealing with biomedicalization. We are made up of potentialities,
constituted by our engagement with what is novel about the future.
As Adams et al. (2009) point out, this temporal combustion pulls us
in two directions at once: to know oneself is to know about one's
future, and yet the future is quintessentially unknowable. Reflect-
ing this dual orientation, one of the central features of bio-
medicalization literature is a tension between both the expansion
of hope and of governance, between novel modes of flexibility and
increasing self-responsibilization (Galvin, 2002; Orr, 2010; Pitts-
Taylor, 2010; Rose, 2007). The expansion of possible futures via
technologies and biomedicine may yield unexpected configura-
tions, transforming what is normative. Or, we may become subject
to further regulation, investing normative standards with new
power.
The aim of this paper is to explore this tension at the level of the
body, using the case of changing biomedical constructions of do-
mestic violence. I will explore how diagnosis is used to capture
domestic violence in particular ways, to label and make sense of the
abused bodies that biomedicine must diagnose. I will also show
E-mail address: psweet2@uic.edu.
how diagnoses shape the possibilities of the abused body, its pre-
sent and future “health,” its temporal movements through
biomedical pathologies. Tracking constructions of the abused body
through biomedical literature from the 1970s (the early years of
medical attention to domestic violence) through the present, I
attend to the ways in which the boundaries of the abused body are
reconfigured in line with cultural shifts in victim-blaming narra-
tives and in diagnostic categories. Here, I define victim-blaming as
the widespread cultural discourse and practice that holds victims of
violence and oppression responsible for their own victimization. In
this analysis, I will link together: modes of victim-blaming, the
construction of bodies, and shifts in diagnoses. The construction of
the abused body here is not just reliant on biomedicine; rather,
biomedical diagnoses and victim-blaming tropes are entangled
(Murphy, 2012).
First, I will review literature on diagnosis and the biomedical
body, in which I take up this tension between increasing flexibility
(Clarke et al., 2010; Rose, 2007) and the ushering in of new forms of
blame (Pitts-Taylor, 2010). Next, using data from peer-reviewed
health journals, I will demonstrate the important role that diag-
nosis plays in defining domestic violence. Variably diagnosed as a
disorder of pathological passivity, as a set of acute injuries, and as a
chronic disease, I will argue that a profound transformation in
diagnostic categories has taken place since the 1980s. I follow these
diagnoses through health literature to reveal how they construct
the abused body, both relying on and reinventing victim-blaming

http://dx.doi.org/10.1016/j.socscimed.2014.10.014
0277-9536/© 2014 Elsevier Ltd. All rights reserved.
 P.L. Sweet / Social Science & Medicine 122 (2014) 44e52
narratives. Ultimately, I argue that the chronic framework amplifies
victim pathologies via temporal extensions of the body, which locate
abuse inside the body, making the victim's future increasingly
subject to her past abuse.
2. Theoretical background
While medicalization is concerned with a broad process of
redefinition from social to medical problems (Conrad, 2007),
studies of diagnosis focus on the construction of medical knowledge
(Brown, 1995). Analyses of diagnoses call attention to biomedical
epistemologies and the reification of particular cultural dynamics
(Jutel, 2011b). For example, Jackie Orr tells the story of how panic
disorder filled the gap left by hysteria in twentieth century diag-
nostic classifications (2006). Doctors did not deem women less
“hysterical,” but rather, the diagnostic language that captured this
pathology changed. The sociology of diagnosis gives us the tools to
examine how problems are “captured” by biomedical discourse,
how they are made to “speak” about pathologies and treatments
(Orr, 2006, p. 21). Because biomedicine has a great deal of cultural
legitimacy to define what bodies are and do (Rose, 2013; Turner,
1996), diagnostic categories act as pronouncements of what is
“real,” making it appear that diagnoses describe nature itself (Jutel,
2011a).
The terms of diagnosis, however, do not remain stable over time.
Notably, scholars have documented a shift from processes of
medicalization to those of biomedicalization. Biomedicalization
does not exert control over something, but rather, fundamentally
transforms the way we understand our lives (Clarke et al., 2010).
“Life itself” (Rose, 2007) is to be intervened upon with medical tools
and promises of a “better self.” Biomedicine's authority to define
life is not limited to discrete control over diseases; instead,
biomedical discourse reshapes the way we envision our bodies and
our selves, always open to “enhancement.”
With the rise of biomedicalization over the past fifty years
(Clarke et al., 2003) comes the increasing equation of personhood
with “good health” and proper embodiment. According to Nikolas
Rose, “Personhood itself becomes increasingly somatic … To live
well today is to live in the light of biomedicine” (2013, p. 7). Our
bodies are diffusely regulated through regimes of “good health” via
the normalizing discourses of biomedicine (Decoteau, 2013). Under
conditions of biomedicalization, “The body is no longer viewed as
relatively static, immutable, and the focus of control, but instead as
flexible, capable of being reconfigured and transformed” (Clarke
et al., 2010, p. 78). Rather than fixed objects of biomedical knowl-
edge, bodies become actors that play malleable roles in patients'
futures.
While some scholars view this biomedicalization of possible
futures as opening up a field of hope (e.g. Rose, 2007), other
scholars question the neoliberal mandates to self-monitor that are
contained within biomedicalization discourses (e.g. Pitts-Taylor,
2010; Galvin, 2002; Mamo and Fosket, 2009). For example, in her
discussion of neuronal plasticity, Victoria Pitts-Taylor argues that
scholars have exaggerated the postmodern potential of plasticity
(2010). Though plasticity does free the brain from biological
determinism, plasticity also invests the subject with unparalleled
responsibility to live his or her brain “correctly.” According to Pitts-
Taylor, “… popular discourse on plasticity firmly situates the sub-
ject in a normative, neoliberal ethic of personal self-care and re-
sponsibility linked to modifying the body” (2010, p. 639). With
flexibility comes a mandate to be a “better” self, a more productive
citizen, and a more rigorous health consumer. According to Rose
Galvin, neoliberal risk discourses amplify concern about the health
of the body while also amplifying the blame attributed to people “at
risk” (2002). As health risk is increasingly inscribed in somatic
45
selves, it becomes nearly impossible to delink biomedical discourse
from the pervasive cultural blame doled out for “bad” embodiment.
Other scholars view the uncertainty that comes with bio-
medicalization in more optimistic terms. As Rose suggests, “… risk
calculations offer no clear-cut algorithm … Contemporary bio-
politics thus operates in practices of uncertainty and possibility”
(2007, p. 52, emphasis added). One's future health is always subject
to change; thus, future modes of embodiment are uncertain and
perhaps open to, “… tactics for contestation, or new forms of cu-
riosity” (Adams et al., 2009, p. 250). It is as if the boundaries of the
body are opened up by their unpredictability. Indeed, Jasbir Puar
has argued that this type of dispersion of bodily boundaries may
yield challenges to normative conventions (2007, p. 221). The
implication here is that when the boundaries of the body become
unhinged from here-and-now certainty, unforeseeable (and often
progressive) possibilities abound.
On the one hand, flexible bodies usher in neoliberal forms of
blame. The risk that is part of this flexibility provokes dis-ease and
uncertainty among patients, many of whom are constantly in a
state of being almost-ill (Fosket, 2004; Shostak, 2010), or as Tim-
mermans and Buchbinder call them, “patients-in-waiting” (2010).
On the other hand, many scholars argue that flexibility will open up
novel possibilities for bodies and selves. These analyses, however,
often fail to identify the flexible biomedical body as a normative
body. If we consider inequalities across race, gender, and sexuality,
it becomes less clear for whose futures the biomedical body, in all its
pliability, can really provide hope. For example, in her work on HIV,
Claire Decoteau shows how the flexible futures opened up by bio-
politics depend on one's ability to embody norms, to sync oneself
with Western ontologies of the body (2013). When the biomedical
body is unattainable, insecurity is ramped up in patient's lives
(Decoteau, 2013). This point is critical for understanding the bio-
medicalization of domestic violence victims, who carry a heavily
gendered stigma with them, typified in victim-blaming narratives.
What is clear is that temporality has become a central feature of
biomedicalized bodies, especially since the expansion of chronic
illness after World War II (Armstrong, 1988; Clarke et al., 2003,
2010). Adams et al. (2009) suggest that we are living in a state of
“anticipatory modes” in which, “… the future is inhabited in the
present” (p. 249). This constant anxiety about the future actually
reconstitutes who we are in the present. And as Armstrong con-
tends, “… emphasis on a population constantly ‘at risk,’ chronic
illness, prevention, health promotion, anticipatory care, early
diagnosis, and so on, have functioned to celebrate the existence of a
temporal trajectory to almost all illness” (1988, p. 219, emphasis
added). Temporality pervades the epistemology and practice of
biomedicine. But as Armstrong goes on to explain, the rise of risk
frames is generally meant to “protect the future” of patients (1988).
Therefore, biomedical extension into the future of health implies
optimization. However, in the case of domestic violence, I will argue
that, rather than functioning to optimize health, the temporal ex-
tensions of the abused body function to extend and deepen pa-
thology. For battered women, the future is already jeopardized,
already in a state of perpetual and yawning disaster.
Using this frame of temporality, I will make two claims on this
set of literature. First, I will argue for an understanding of the ways
in which diagnosis compels particular forms of embodiment.
Following Berg and Harterink, I understand the embodiment of the
patient as a discursive biomedical production (2004, p. 14). Shifting
diagnoses construct the modes of embodiment available to pa-
tients. Second, I will argue for a reconceptualization of the bio-
medicalized body as what I call a temporally extended body, a body
that is extended into the future while remaining suffused with the
past. The body here is “splayed” (Puar, 2007) across multiple reg-
isters: past abuse, current presentation in a biomedical setting, and
46 P.L. Sweet / Social Science & Medicine 122 (2014) 44e52
future chronic pathologies. My argument is that, far from producing
exciting possibilities for novel forms of embodiment, this tempo-
rally extended body enrolls victims in a perpetual process of
incorrect embodiment. Though the biomedicalization of abuse is
intended to legitimate domestic violence as a “real” problem, it
ends up pushing abuse deeper into victims' bodies, making abuse
increasingly constitutive of their selves.
3. Methods
In this article, I examine medical and public health peer-
reviewed journal articles dealing with domestic violence. This
study is part of a larger project about the evolving relationship
between the feminist anti-violence movement and biomedicine,
for which I interviewed doctors, nurses, and domestic violence
medical advocates. For this smaller study, I focus on the biomedical
perspective in order to highlight the diagnostic shift that has been
central to the inclusion of domestic violence in hospital procedures.
By honing in on biomedical literature, I am able to reveal the pro-
found reshaping of domestic violence diagnostic frameworks since
the 1970s. At the same time, this study is limited by its small sample
size and a narrow focus on health literature alone.
To find articles appropriate for analysis, I used Google Scholar
and PubMed, applying the key words “domestic violence,” “intimate
partner violence,” “abuse,” and “spouse abuse.” I omitted articles
that focused on children, those that were prevalence studies only,
those that tested screening instruments, and those outside the
United States. I also excluded articles from therapy and social work
journals. Because the number of articles published after 2000 was
still overwhelming, I further narrowed the number of articles
analyzed by choosing those that: 1) were either review articles or
were focused on the general relationship between domestic
violence and health (i.e. articles that were not about specific con-
ditions, such as preterm birth); and/or 2) had been frequently cited
in other literature on health and domestic violence and therefore
have a type of “landmark status” in the field (Kempner, 2006).
These criteria allowed me to filter through the thousands of articles
published (e.g. there were 3439 articles from 2000 to 2013 alone),
while retaining an expansive view of the field. I searched for articles
published between 1970e1989 (four articles), 1990e1999 (17 arti-
cles), and 2000epresent (32 articles). In the end, I analyzed 53
articles, using a system of open coding in which I read through the
articles multiple times, looking for relevant themes of diagnosis
and the body.
The exclusion and inclusion criteria laid out above privileged
review articles on the health effects of domestic violence. This
method has drawbacks. By focusing on reviews and “landmark
status” articles, I prioritize a “mainstream” medical perspective on
domestic violence, thereby silencing alternative frameworks that
may exist in non-biomedical literature. Second, by excluding arti-
cles that focus on specific conditions, my analysis may focus too
much on emergency medicine. For example, I excluded articles
specifically about the relationship between HIV and domestic
violence, even though this burgeoning research area makes inno-
vative claims. However, an article that I did include in the analysis, a
review of physical and mental health research on domestic violence
(Dillon et al., 2013), does include several articles about and a dis-
cussion of HIV. Therefore, while my method of article selection is
not exhaustive, it does provide a snapshot of the central medical
paradigms in a given time (Hasson, 2012). Additionally, I found a
great deal of consistency between the outcomes of this analysis and
that of my larger interview project, suggesting the validity of these
findings.
To capture the shift in biomedical constructions of domestic
violence victims across historical periods, I divide my analysis into
two separate “logics” that underlie diagnosis, constructions of the
abused body, and victim-blaming. During the 1970s and early
1980s, I argue that the “logic of injury” undergirds domestic
violence diagnosis, the body, and dominant modes of victim-
blaming. The logic of injury is premised on the idea that abused
women are masochistic and unable to act on their own behalf.
However, as the anti-violence movement gained mainstream
legitimacy in the 1970s and 1980s (Schechter, 1982), the logic of
injury fell out of favor in biomedicine. I argue that it is the cultural
shifts propelled by the legitimation of the anti-violence movement
that cause biomedical representations of the abused body to
transform in the 1980s. What I call the “logic of health” then comes
to define diagnosis, the body, and new modes of victim-blaming.
The logic of health is characterized by chronic symptoms, indis-
tinct and temporally stretched boundaries of pathology, and sug-
gestions for victims to improve their health and “productivity.”
Though this shift from a focus on acute injury to a focus on the
“pathways” between abuse and chronic health problems is perva-
sive, it is not absolute (e.g. Brownridge et al., 2011 includes an
extensive discussion of the acute effects of violence). These logics
capture broad epistemic trends rather providing pure and tidy
categories.
4. The logic of injury
In 1979, Lenore Walker proposed Battered Women's Syndrome
as a psychological explanation for domestic violence victims'
“compliant, passive, and submissive” behavior (p. 46). Walker's
model suggested that women victims of male violence developed
“learned helplessness” over time, producing a “negative cognitive
set” that made them incapable of defending themselves or leaving
the relationship (1979, p. 53). Battered Women's Syndrome has had
a great deal of cultural legitimacy since Walker coined the term,
enjoying widespread use in courtrooms, clinics, and the popular
imagination (Ferraro, 2003; Rothenberg, 2003). According to Bess
Rothenberg, “… the battered woman syndrome [was] the most
recognized explanation for domestic violence through the mid-
1990s” (2003, p. 778). Indeed, many early medicalized conceptu-
alizations of domestic violence emphasized women's “passivity,”
“masochism,” or personality deficits. As evidenced in the 1985
debate over including “Self-Defeating Personality Disorder” in the
DSM (Mitchell and James, 2009; U.S. Department of Justice, 1985),
women victims were pathologized for having an excess of feminine
weakness. The medical “problem” was focused on constructing a
pathology out of victims' “staying” behavior. However, in the
advocacy and medical realms, Battered Women's Syndrome fell out
of favor over the next 20 years (Rothenberg, 2003). In 1996, the U.S.
Department of Justice and the U.S. Department of Health and Hu-
man Services issued a report that formally rejected the use of
Battered Women's Syndrome terminology due to lack of “validity”
(Ferraro, 2003; Rothenberg, 2003; DOJ, NIJ, USDHHS, NIMH, 1996).
Here, I argue that the use of Battered Women's Syndrome and its
accompanying acute injury model mark a distinct phase in the
biomedical construction of domestic violence. The “diagnosis” of
Battered Women's Syndrome carries with it a specific mode of
embodiment for domestic violence victims. This mode of embodi-
ment is characterized by a bounded body made up of discrete parts,
which are prone to injury. As I will show, not only does the logic of
injury undergird domestic violence diagnosis and embodiment
during this time, but it also compels a form of victim-blaming that
marks women as “crazy” and weak.
In Walker's model, psychological passivity is clearly linked to
acute injury: women allow themselves to be injured because of their
pathological passivity. In turn, injuries are an important component
 P.L. Sweet / Social Science & Medicine 122 (2014) 44e52
of Walker's evidence for the existence of Battered Women's
Syndrome:
If there has been physical violence, the battered woman will
often minimize her injuries. For example, a woman whose
husband tried to choke her with a metal chain reported that she
was grateful that she only had marks around her neck, rather
than cuts from the chain breaking the skin. The fact that she
could have been choked to death was skirted by her saying, ‘Gee,
it didn't even break the skin.’ (1979, p. 63)
Here, Walker suggests that the victim's focus on injuries is itself
a sign of pathology. The victim is pathological in part because she
incurs and then “minimizes” her physical injuries. The era of Bat-
tered Women's Syndrome is linked to an acute injury model of
abuse in the biomedical literature. For example, in a 1980 piece
entitled “Battered Woman Syndrome,” Dr. Warren Appleton sur-
veyed women in the Emergency Department and reported finding
“sprained ankles,” “contusions to face,” and “contusions to neck” (p.
87). The medical gaze is directed exclusively at discrete bodily
parts. Additionally, in a 1987 study, the authors characterize do-
mestic violence health consequences as, “… blows to the pregnant
abdomen, injuries to the breast and genitals, and sexual assault”
(Helton et al., 1987, p. 1337). The following diagram (Fig. 1) from the
same article depicts the abused body as marked up by bounded
locations of injury.
Fig. 1. Frequencies of sites of abuse (n ¼ 54) of 24 women battered during current pregnancy.
From Helton et al., 1987, p. 1338.
47
Here, the victim's body is made up of distinct spaces that are
prone to bruises and gashes. The borders of this body are well-
bounded. She suffers injury but can escape that injury if she
leaves the relationship. For example, Walker writes that, “women
can reverse being battered” by being “dragged” outside of the
relationship (1979, p. 53). In this sense, both pathological passivity
and its accompanying acute injuries are temporally bounded. There
is a definite end-point at which the victim's negative heath effects
will cease. The victim's body is made up of an array of immediate
injuries. Because the victim can leave behind injuries and psycho-
logical deficiencies, the source of abuse here is detached from the
victim's self, external to her and capable of being cast off. Abuse
makes her weak, but it is more definitive of her past and immediate
present than of her future.
Based on Battered Women's Syndrome, the acute injury model,
and their bounded and static modes of embodiment, we can see
how closely medicalization and embodiment are tied to victim-
blaming. Because the 1970s and 1980s witnessed the very early
years of the anti-violence movement, domestic violence was not
yet widely politicized, nor were victims considered sympathetic
figures (Richie, 2012; Schechter, 1982). The logic of injury, then, is
an outgrowth of this early form of victim-blaming, which is overt
and insistent on victims' mental deficiencies. In this narrative,
abuse continues because women have too much passivity, making
them act badly, becoming subject to more and more injuries.
Indeed, a distinctive feature of articles published under the logic of
48 P.L. Sweet / Social Science & Medicine 122 (2014) 44e52
injury is that they only survey women patients (without explaining
why), further demonstrating the institutionalization of the femi-
nized Battered Women's Syndrome concept in the medical model
during this time.
This focus on injuries does not completely disappear after the
1980s. For example, one medical study in 1999 focuses on soft-
tissue injuries (Kyriacou et al., 1999). However, the vast majority
of studies published after the late 1980s focus on chronic symptoms
after abuse. In the passive/injury model, the abused body is static;
the body's pathologies are fixed in the moments, days, and weeks
after abuse. Contrarily, after the logic of health ascends, the
embodied reverberations of abuse continue for years, extending the
abused body's pathologies through time. Underlying this extension
is the logic of health, which is characterized by diffuse medical
problems and pathologized futurity.
5. The logic of health
While the logic of injury was rooted in an injured and bounded
body, the abused body under the logic of health constantly moves
toward more illness. This newer logic also compels a new style of
victim-blaming that is based on “health” as a moral mandate to take
care of oneself in a biomedically defined way. While the cause of this
shift from the logic of injury to the logic of health is entangled in
both anti-violence and biomedical histories, I want to suggest that
the “acceptability” of particular modes of victim-blaming has
played a causal role in the shift. Once the anti-violence movement
gained legitimacy, it was no longer acceptable to pathologize
abused women based on claims of “passivity,” to mark them with
overt psychological deficiencies. Tired images of battered women
as Stockholm Syndrome-like lost most of their influence in pro-
fessional circles during the 1980s and 1990s (Ferraro, 2003).
These types of shifts also occurred in the legal system; for
example, Beth Richie argues that the anti-violence movement “won
the mainstream but lost the movement” by allying with legal and
criminal systems (2012). Feminist language is incorporated but
movement goals are diluted. Feminist-influenced language is
similarly evident the medical articles analyzed here. For example,
Stacey Plichta's (1993) review article warns physicians against
focusing on victims' deficiencies. Many articles call on doctors to
screen patients in a non-judgmental way and to treat domestic
violence as a serious problem (e.g. Alpert, 1995), suggesting that
anti-victim-blaming logics have impacted medical discourse
significantly. This shift away from overt victim-blaming may also be
partly attributable to the increase in feminist physicians over the
course of the 1980s and 1990s (Riska, 2001), especially considering
the disproportionate number of women physicians who authored
the papers included in this study. This use of anti-violence move-
ment language in medical discourse is also evident in the articles'
discussions of victims' gender e while in the 1980s, victims were
simply assumed to be women, the 1990s reveal a shift toward the
politicized language of “violence against women,” intentionally
focused on male violence as a gendered problem (e.g. Goodman
et al., 1993). Thus, subtle anti-violence movement influences push
the medical field away from the logic of injury's blatant victim-
blaming modes. However, my argument is that rather than dis-
appearing, the overt victim-blaming narratives of the 1970s and
1980s were later reinvented within to the “neutral” language of
biomedicine.
This shift to the logic of health occurred primarily in the late
1980s and early 1990s, but it is an ongoing transformation. A 1992
article in Archives of Family Medicine gives a snapshot of this shift:
Until recently, the medical literature had focused exclusively on
forensic issues and acute treatment. Consideration of somatic
consequences that extended beyond the emergency period was
limited to the psychological aftereffects. Now, a rapidly growing
body of research associates victimization by violence to physical
illnesses … somatic outcomes, including acute conditions,
delayed consequences, and related changes in longitudinal
medical care usage. (Koss and Heslet, 1992, p. 53)
This is a shift from domestic violence as injury and psychological
suffering to domestic violence as somatic disease. The problems of
the abused body are not limited to the moments after abuse, but
rather, they are “delayed” and have “longitudinal” outcomes.
In terms of medicalization, the logic of health is deployed as a
“chronic” diagnosis. Medical research increasingly identifies do-
mestic violence victims through the language and classification
tools of “chronic” conditions. In general, medical interest in the
“long-term” rather than immediate effects of abuse exploded after
the late 1980s. Consider this diagram (Fig. 2) from a 1997 Behavioral
Medicine article:
In this diagram, violent assault is followed by acute injuries and
immediate stress, but the bulk of the arrows point to chronic in-
juries, long-term biological dysfunctions, and poor health behav-
iors. Rather than ending with acute injury, as was in the case in
Fig. 1, this diagram culminates with a generalized and long-term
“increased risk of health problems,” extending the victim's pa-
thologies through time. In another example, a Lancet article cau-
tions that, “… injury is not the most common physical health
outcome of abuse” (Ellsberg et al., 2008, p. 1165). Another article
suggests that although abused women may present in the emer-
gency room, abuse should be treated in the “chronic illness” model
rather than the “physical emergency” model (Kramer et al., 2004).
This new diagnostic categorization of domestic violence, then,
comes with a new conceptualization of the abused body. The
chronic nature of domestic violence reverberates throughout vic-
tims' bodies and minds, plaguing them even after the abuse has
ended. Indeed, under the logic of health, a focus on acute injuries is
considered regressive. In a 1995 Annals of Internal Medicine article,
doctors were encouraged to put aside the acute injury model
because victims tend to present with, “… chronic symptoms that
are not accompanied by discernible physical findings” (Alpert, p.
777). In this sense, the abused body does not even present itself as
being obviously abused e doctors have to be knowledgeable about
domestic violence in order to address its covert effects.
Additionally, the list of possible conditions that result from
domestic violence under the logic of health is seemingly endless.
Once abuse is installed in the victim's body, no part of her is left
untouched by its shockwaves. For example, researchers list “heart
attack,” “stroke,” “loss of dexterity,” “impaired function of immune
and endocrine systems,” and “infectious diseases” as possible
health outcomes of abuse (Resnick et al., 1997, p. 66). Other articles
mention “joint pain,” “back pain,” “insomnia,” and “shortness of
breath” (Bonomi et al., 2006). Fainting, seizures, central nervous
system damage, and gastrointestinal dysfunction are also listed
(Campbell, 2002; Ellsberg et al., 2008; Wuest et al., 2009). Another
article catalogs “insomnia,” “choking sensations,” and “hyperven-
tilation” as somatic outcomes of abuse (Dutton et al., 2006). What
becomes clear from these lists of symptoms is that the abused body
is no longer made up of discrete points of injury. Rather, the abused
body under the logic of health is made up of diffuse and reiterative
pathologies that unbound the fixed borders of the body. The borders
of this abused body are fuzzy and constituted by layered possibil-
ities of illness.
For example, in a 2013 article, the authors state that abused
women report, “… pains in ‘every bone of my body’” (Dillon et al.,
2013, p. 9). Here, abuse is everywhere inside the body. According to
 P.L. Sweet / Social Science & Medicine 122 (2014) 44e52
Fig. 2. Hypothetical model explaining development of violence-related health problems.
From Resnick et al., 1997, p. 66
David Armstrong, clinical biomedicine has undergone a shift in
which, “Clinical problems were not simply located in a specific and
immediate lesion but in a biography in which the past informed
and pervaded the present” (1988, p. 217). Injury recedes in
importance to make way for embodied collisions between past and
present, the production of a body rife with chronic symptoms.
What I contend, however, is that domestic violence pervades the
future of the abused body even more powerfully than the present.
This collision works by linking past, present, and future, extending
the boundaries of the body's pathologies through time. It is as if the
abused body itself is multiplied (Mol, 2002), transforming into a set
of overlapping disordered bodies that combine to produce the
manifold possibilities of the victim's health future. There is a
“multi-temporality” (Twine, 2002, p. 84) here, in which the past
abuse is linked to the victim's current presentation in a medical
setting which is linked to a future of chronic pathologies.
I would like to expand more on the idea of the abused body as
fuzzy and nonspecific. By this I mean that not only are the possi-
bilities of current and future illness varied and unknown, but also
that the abused body is not definable thing; rather, the abused body
is a set of potentialities constantly realized throughout the victim's
future in the form of disordered health. Abused women cannot
actually inhabit a healthy body at all because that body does not
exist. Rather, victims' futures are splayed across various degrees of
un-wellness. For example, an Annals of Emergency Medicine article
argues that, “… all female patients with non-motor vehicle accident
trauma … should be questioned about the possibility of injury by a
known partner” (Abbott, 1997, p. 784). Here, women patients are
suffused with the potential for victimization; any injury without a
known source could be attributed to domestic violence. Addition-
ally, a review article suggests that abused women's injuries are
characterized by “low positive predictive value” and “low speci-
ficity” (Plichta, 2004, p. 1301). In this sense, the abused body is
49
biomedically identifiable precisely by its imprecision, its vague
symptoms.
Indeed, medical articles refer to abused women's “nonspecific
medical complaints” (Abbott, 1997, p. 784) and the “indirect”
relationship between abuse and physical health symptoms (Coker
et al., 2000, p. 266). Another article relates that, “battered women
suffer numerous health symptoms that do not necessarily relate to
any specific injury” (Sutherland et al., 2002, p. 610). In stark
contrast to Fig. 1, which shows the 1980s abused body as consti-
tuted by discrete injury points, this abused body is made up of
reverberating symptoms that are unrepresentable in two-
dimensional space. The abused body under the logic of health is
layered, loose, and proliferating. While some scholars have pointed
to the possibilities of these types of biomedically flexible bodies, I
would suggest that, in the case of domestic violence, this “flexi-
bility” actually allows for new spaces into which victim-blaming
can seep.
6. Bodily extensions
The biomedical literature analyzed here reveals that the chronic
model under the logic of health is a rearrangement of stigmatizing
lessons about abused women, suggesting that we need to be
watchful for veiled manifestations of victim-blaming. Rather than
tapping into anxieties about women's passivity and dependence,
this new style of victim-blaming taps into anxieties about women's
ability to manage their lives in the long-term, to lead normatively
“healthy” and “productive” lives. This style of victim-blaming, then,
projects women's pathologies deep into their bodies and their
futures.
Rather than singular and injured, the abused body is now
dispersed, multiplied, and non-specific, constituted by precarity
and fuzzy boundaries between present and future (Berg and
Harterink, 2004). Temporality becomes increasingly important
50 P.L. Sweet / Social Science & Medicine 122 (2014) 44e52
under the logic of health. For example, several articles mention the
importance of the “temporal associations” between domestic
violence and poor health (Ellsberg et al., 2008, p. 1171; Gazmararian
et al., 2000). Indeed, a focus on the “temporal pathways” that link
abuse to future chronic symptoms has emerged in the literature
more recently (Ford-Gilboe et al., 2009; Montero et al., 2011). This
interest in “pathways” suggests that the links between abuse and
medical problems are becoming increasingly indiscernible and
distant. We are witnessing the boundaries of the abused body's
pathologies becoming less fixed, leaking into the future while
reanimating the past.
For example, in a 1995 article, Plichta and Weisman suggest that,
“The effect of spouse abuse on physical health has been shown to
extend beyond the immediate injury. It has been linked to having
poorer health in general …” (p. 46). The abused body will not return
to a normal, pre-abuse state at any point in the future; rather, the
consequences of abuse become thoroughly diffused throughout the
victim's future wellbeing. In an Annals of Epidemiology article, this
diffusion of abuse is reiterated: “… recent [intimate partner
violence] is associated with an increased risk of poor health beyond
the risk associated with past abuse” (McNutt et al., 2002, p. 127).
Here, we see how the logic of health is future-oriented. The medical
gaze is no longer directed toward past abuse; rather, risks for
ongoing pathologies proliferate into the future. The boundaries of
the body, their ability to contain abuse within the past or the pre-
sent, are increasingly unmoored.
These descriptions of the mechanisms linking past abuse to
future poor health are particularly revealing when it comes to
victim-blaming. Because health problems are regarded as “intru-
sive” for a long period of time following abuse, the victim's entire
future is at stake. In a Journal of Women's Health article, the authors
note that, “In addition to the impact on individual health and well-
being, violence against women takes an enormous social toll in
terms of medical costs, decreased work productivity and an
increased burden on the justice, social, and health systems”
(Montero et al., 2011, p. 295). Here, the biomedical identification of
domestic violence as a chronic diagnosis jeopardizes victim's fu-
tures in all sorts of ways, making them a “burden” on the system.
In another article, a different set of authors argue that, “Women
who have left abusive partners need to be healthy and functional
for their own well-being and so that they can fulfill their social roles
as parents, be economically self-sufficient, and contribute fully to
society” (Ford-Gilboe et al., 2009, p. 1021). Under the logic of health,
those who cannot properly manage themselves as healthy subjects
are called out for being expensive and detrimental to the system. In
the case of domestic violence, the body's ongoing disorders cause
ongoing financial drainages. The abused body's unbounded-ness,
then, allows for self-responsibilizing blame to bleed in, especially
in the neoliberal language of productivity.
It is not just that victims cause the system to sustain more costs,
but that blame becomes further installed in their bodies and selves.
It is as if domestic violence installs a vulnerability inside victims,
forcing their bodies to constantly reproduce negative outcomes. For
example, in a 1997 article, the authors suggest that domestic
violence exposure increases the risk of “poor health behaviors”
such bad diet and drug use (Resnick et al., 1997). Other articles refer
to victim's post-abuse health behaviors as “risky” (Taft et al., 2007)
or “avoidant” (Krause et al., 2008). One article even suggests that
abused women's “anger/hostility” following abuse may diminish
good health outcomes (Taft et al., 2007, p. 2). Here, abuse is the
clearly demarcated source of victims' “bad” behavior. Indeed, this
type of biomedical language, which indicates an installation of
ongoing abuse vulnerability, is often found alongside discourses of
trauma: “… once exposed to a traumatic event, the risk of experi-
encing a subsequent trauma is substantially increased” (Mezey
et al., 2005, 197). Here, women's re-victimization is bio-
medicalized: she is victimized again because the health conse-
quences of her first victimization were not addressed. The past
haunts the future; the temporal chains linking abuse to all aspects
of victims' lives are extended. Vulnerability to abuse is situated so
deeply here that victims continue to feel its effects and act on its
behalf without knowing it. Abuse becomes incorporated.
By focusing on temporality and the behavioral “pathways”
linking past abuse to future chronic conditions, I have attempted to
show how the logic of health extends the boundaries of the abused
body into the future, locating abuse deep inside the victim. Under
the logic of injury, the source of abuse (the perpetrator) remained
external to the victim, causing acute injuries and making her
dependent on him. Of course, the victim was blamed for “staying”
with her abuser, for “letting” herself incur injuries. Under the logic
of health, however, blame operates more perniciously. When abuse
is subsumed into the biomedical language of “health,” the source of
the problem becomes internal to the victim, pervading her body,
blurring the boundaries between health and illness, between past
and future.
7. Conclusion
After following biomedical constructions of domestic violence
over time, it becomes clear that the boundaries of the abused body
have been extended. But, what does it mean that biomedicine has
developed this temporally extended body? What are the conse-
quences for victims' lived embodiment, for their interactions with
medical systems? Put simply, the temporally extended body is one
example of the power of biomedicine to define past, present, and
future somatic experiences. Like “patients-in-waiting” or patients
marked “at-risk” (Fosket, 2004; Shostak, 2010; Timmermans and
Buchbinder, 2010), abuse victims are strung up between health
and sickness. All of victims' current and future ailments are linked
up to their abuse, making them permanently mired in that rela-
tionship even if they have left it. The liminal space between health
and illness carved out by the logic of health is less a zone of pos-
sibility than it is a marker of bad embodiment, a web of potenti-
alities for pathology.
While the hope is that this heightened biomedical attention will
result in more and better resources for domestic violence victims,
women may also be subject to unwanted biomedical surveillance
under the logic of health. Women who have experienced domestic
violence are increasingly defined in relation to those events, around
and beyond their health status. In this sense, because the logic of
health focuses on behavioral “pathways” between abuse and health
problems, victims may come to blame themselves for their health
problems. On the other hand, however, the logic of health also
constructs the abuse victim as an active rather than a passive pa-
tient, recognizing her as a health decision-maker. While it is diffi-
cult to offer correctives based on these limited data, I would suggest
that the focus in the biomedical literature on “screening” for do-
mestic violence should heed the victim-blaming warnings of
extensive surveillance and diagnosis. Furthermore, the current
medical literature's focus on the category “female patients” with
little distinction between race/ethnicity, sexuality, immigrant sta-
tus, or class suggests that this paradigm is dangerously blind to the
multiple marginalities at play in victims' lives (Richie, 2000).
Biomedical screening and diagnosis involves risks to victims, not
only in terms how they are represented within biomedicine, but
also for their understandings of themselves as healthy or imperiled
subjects.
As literature on neoliberalism and biomedicalization would
suggest, hope for better futures and amplified self-management
mandates are suspended together here. By excavating this tension
 P.L. Sweet / Social Science & Medicine 122 (2014) 44e52
at the level of bodies and blame, I have demonstrated that the in-
vasion of the present with future possibilities does not yield
hopeful configurations so much as it rearranges and fortifies past
pathologies, making them appear both novel and benign. Nikolas
Rose argues that as “life” and its management via biomedicine
come to define us more extensively, our personhood is defined by the
limits of our corporeality (2007). What I am suggesting is that the
limits of corporeality are not always a given, not always definable
and constant. Rather, the limits of corporeality can be pushed
backwards and forwards, temporally extended. The implications for
these temporal extensions of the body do not only involve the
power of biomedicine or the postmodern possibilities of flexible
boundaries; rather, the construction of this temporally extended
body changes the form and character of abused women's in-
teractions with health systems and makes more aspects of their
lives definable according to diagnostic categories. Blaming women
for the abuse they suffer is by no means a new phenomenon, but
under the logic of health, it has a powerful biomedical veneer,
giving it fuel to travel to new regions of the body, to deep features of
the future self.
Acknowledgments
I am grateful to Claire Decoteau and Beth Richie for their
generous guidance throughout this research. I greatly appreciate
the helpful comments I received from Annemarie Jutel, Kelly
Underman, Danielle Giffort, Jody Ahlm, and the anonymous
reviewers.
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