NR: Hello, everyone. Welcome to our show ‘Between Friends’ and on today's episode, I am your host Nandini Ray and we will be discussing the effects of domestic violence or dating violence on children and teens. I'm so glad that today we have Dr. Tasneem Ismailji as our guest. Welcome, Tasneem!

TI: Thank you so much, Nandini. I'm very pleased to be here. Hello, everybody.

NR: Dr. Tasneem Ismailji is a pediatrician. She's also the co-founder, current board member, past board chair, and past president of the Academy on Violence and Abuse, a nonprofit organization that works to advance health, education, and research on the prevention, recognition, and treatment of the health effects of violence and abuse across the lifespan. Tasneem also serves on the medical committee of the Santa Clara Domestic Violence Council. Dr. Ismailji has conducted several trainings on health effects of violence and abuse. For over past 25 years, she was honored by family children's services of Silicon Valley for her work on domestic violence, and by the Santa Clara Domestic Violence Council with the champion of peace award. Tasneem, I'm so glad that you were here today to discuss this very important community issue. Sometimes we think that domestic violence, intimate partner violence, everybody knows about it. But, no. And even if they know, they don't want to talk about it. This is a devastating social problem. Sometimes people think ‘this is someone's personal problem. I am happy I don't have any problem in this moment in my life. So why should I even discuss domestic violence,’ but we must understand that it is a social problem and it is affecting all of us directly and indirectly. And especially children! I mean, when children are seeing domestic violence and abuse at their home- and I think that home should be the safest place for all children- and if they're seeing that parents are abusive to each other, or one parent is controlling and abusive to another parent or children- that is devastating. And as a medical practitioner you see this, and as a researcher you do work in this field. So, I would like to know that... can you please discuss what are the short term and long term effects of domestic violence or abuse on children when they see violence at home?

TI: So then these are very good thoughts, and what I would like to say is that in addition to its being a social problem, the reason why I devote so much of my time and energy is because it is a health problem. It affects the health of all of us. And so it affects the health of the woman who's in an abusive situation, it affects the health of the person who's doing the abusing, and it dramatically affects the health of the children. Just imagine a newborn baby, just born, and if you were to take this newborn baby, and there was shouting, and there was screaming, and there was hitting around this one-day old, precious new life, what do you think the effect would be on this baby? This baby will start to cry, and it will cry and cry, and you cannot console a baby, even though it's brand new. That is the effect of abuse in a household. This is a fact. So we want the children, we want the babies, to be in a household that is safe, that is stable, and that is nurturing. And children thrive in that. But what we are talking about is abuse. And this is the effect of abuse on the children's development. And how it is that if you take this newborn baby, and the baby stays in a home in which there is demeaning, there's humiliation, the woman is being degraded, is being hit, is being injured, and perhaps in the worst situations, the danger may be so high that the woman may actually be killed, and the children may be also killed. So this is a very, very serious health issue and a health problem.

NR: So, what are the short term and long term effects on children? I mean, if they're seeing something do you think that they will forget within two years, or they will start coping and start normalizing the views, or it will have it will have any impact on their brain and their well-being?

TI: We know that, studies show, there is a huge impact on the brain and neuro development. So if you were to go to the Harvard site on developing children, you will see all of the studies and the evidence over there. So as you take this newborn baby, living in this household, you will see that this baby will have development issues and the baby will not develop normally. It will have certain effects in which this baby will now be very hard to regulate emotionally. They will have anxiety; they will develop depression. As the child gets older, they will have contact disorders, low self-esteem, attention difficulties, reduced problem solving skills, and do poorly in school, have difficulty making friends. So these are all the domains of normal childhood that are affected very seriously by the abuse.

NR: I was reading an article where they were talking about a couple of children who are facing domestic violence, have seen domestic violence, very closely. They said that when some children don't get attention from their parents, who are always in conflict, they seek out attention from outsiders. When they go out they seek attention from strangers, in that case, they can put themselves in a dangerous situation right? So anybody can take advantage of those children, don't you think so?

TI: That is a good thought. So what happens is that the children really are not able to regulate themselves emotionally. So they really don't know who are the good guys, and not such good guys, they are not able to tell that. So neurologically, they have been damaged, and they're not able to make this differentiation. So they may go out, you know, they will go out looking for friends outside, and they're not able to tell, who are the people that have the best interest, and who are the people that don't have the best interest, and so they put themselves in danger that way.

NR: And also, do you think that they learn to be abusive to others by seeing abuse all the time? That may be they think that violence or anger can be the solution to everything. I mean, if I want to get it, get things done, I can be angry or I can be abusive. I can use force to get it, get things done. And then they start bullying their friends or their classmates. Is it possible, too?

TI: Yes. So what we know is that when children are raised in a home in which there is abuse, they're much more likely to either be the abusers (that's generally for boys,) or they're more likely to be abused (that's generally for girls.) So what is happening is that the children, most children, all of us as humans, learn from our parents. It's not just humans, if you take birds, or animals, that's what they do. The parents teach the children or the babies with a little bird or little animal on how it is that they are supposed to live. And the same thing is for humans, so the children are learning from the humans and these parents are teaching them: well, this is the way you get things done in this life. If you are not happy with what's going on, you yell and scream and you hit and you injure the person. There is a dynamic in domestic abuse that I think everybody should know about, and that is: one person is controlling the actions of the other. So this is where this happens. So one person is in control, and the other person doesn't have much that they can do or say- this is very important dynamic to understand, because a lot of victim blaming goes on. So what happens is that people think, oh, there's something wrong with a woman. There's something that she's not doing right. If only she could do something and keep her husband happy, there would be no domestic abuse. This is a key concept to understand that this is not how it happens; it happens because it's usually the male, it's usually the husband, who then uses control and abuse on the woman, and that's the person who we need as a society to hold accountable; that's the person that we, as family and friends need to go and say, “hey, what you are doing is not the best for your wife, it's not the best for your family, it's certainly not best for your children.” This person, if they are listening may indeed, change their behavior may indeed say, “oh, what are you saying? I have to think about it.” They might have been brought up in an abusive home, and so they don't know anything better- that's one thing. The other thing is that it's our society and our media- if you look around, we are constantly bombarded by messages in the media about violence, about control. Power and control is something that people want. They want it in the society, they want it in their business. “Who's that big CEO? Oh, he's powerful, he's controlling.” People admire that. But when it comes to family, it's absolutely the opposite. It's very, very harmful.

NR: Here, I want to make one point that yes, we all know as domestic violence advocates who are working in this field, that statistics-wise mostly men are abusers, but it's also possible that men are abused by their partners, female partners. And so if somebody is listening, and if that person is a male, and thinking that “oh, you know, they believe that all the time, men are bad, men are doing abuse, so I shouldn't be even reaching out to anybody to get help, and they won't believe me,” I just want to point out that that is not the case. Anybody who is abused and who is suffering, they have every right to get help and seek out help, and everyone has a right to have a safe and healthy intimate partner life or family life. And whoever is abusing, whether it is male or female, they should be accountable, it's not victim's fault; abuse cannot be victims fault, and whoever is suffering from domestic violence, intimate partner violence, there are resources out there. Five agencies in Santa Clara County are providing free and confidential help, they should reach out to them and know their rights and options. Maitri is one of them. Next door solutions, Community Solutions, and AACI. And another one is YWCA Silicon Valley. Of course, Maitri is there, please call them to find out your rights and options.

TI: I would like to make another point there. You're absolutely correct, and I usually think about this as beyond a gender issue. Unfortunately, the statistics show that it's more men than women. But if you look at the minority populations, if you look at gay, lesbian, bisexual, trans or questioning, we see perhaps a little more domestic abuse in those relationships. So we know it's a little more than just a gender issue. Yes, women are also abusers sometimes, but most of the statistics show that it's predominantly the men. And so, you know reaching out to Maitri and to discuss these issues is very, very important. Doesn't matter if you are man or a woman or a questioning or gay or lesbian or trans- it's very important to reach out to the experts who see this every day and can help them.

NR: And Tasneem, another thing I have seen in our community is that divorce is absolutely a stigma. No one wants to talk about divorce and many community members think that it is better to stay in an abusive relationship rather than raising children alone as a single parent. And sometimes they think that they are staying in this relationship, though they know it is harmful for them, because it is good for their children. And sometimes it is possible that they're not realizing that children are noticing, children are observing abuse. And children are, as you say it’s a learned behavior, learning how to be abusive or how to suffer in silence. So what do you think of people when they think that it is better to be in a broken relationship, a broken home for children, but where the children are exposed to domestic violence, or intimate partner violence? Is this the right decision? What do you think as a doctor?

TI: So one of the things that I as a doctor do, one of the first things when I identify a family that has domestic abuse, I do what is called a danger assessment, a tool developed by Dr. Jackie Campbell, and there are many questions that I have the family go through the woman go through, and that's the first thing that I identify, to see how much danger this family and this woman may be in. It’s a safety issue, and we know this using this instrument if there are signs that a woman may be in very high danger, then I have to as a doctor, do something immediately, and that may be in consultation with the woman. The woman also recognizes when she does a danger assessment that she being abused, because there's a lot of denial in people. And, if you do the danger assessment, you find the danger is very high, then you cannot wait. You have to do something to save the life of the children and have the woman. So this instrument is available at Maitri? Is Maitri doing the danger assessment? Yes, yes, we are doing that. Right. So if there is a family, there's a woman who is concerned about it, that's the first thing is to do that danger assessment. I myself start over there. And if the danger assessment is positive, then we immediately reach out to Maitri to take the case and do something in an urgent fashion. If you take most of the other situations that you talked about, in which there is emotional abuse, maybe it's not to the level of a danger, but there is constant emotional abuse, physical abuse, financial abuse, sexual abuse, then then we have to do something as a society then we have to do something as a physician, because it has profound health effects. And so at that point in time, we sit down and we do some education with the woman about what is domestic abuse, we talk about how it is the abuser who needs to be accountable. And the first most important thing is say, is this is not your fault, and when you describe the effect on the children, then the woman understands how serious this is- that, many times, makes her mind up that she wants to do something about it.

NR: So do you think that children who are seeing domestic violence can recover from witnessing or experiencing this abuse? I think you did a lot of work in a CAE area: Adverse Childhood Experiences, right?

TI: Yes, right. So this is a very exciting time, because since January 2020, the whole state of California is introducing an option for primary health care doctors to do what is called ACE screening. So, ACE stands for adverse childhood experiences and that is 10 categories of child maltreatment, child abuse, physical, emotional, sexual, two categories of childhood neglect, and emotional and physical neglect. And then there are categories of household dysfunction that includes domestic violence, substance abuse, if a parent is in jail, there’s separation, single parent- all of those categories show that when you see if there are four or more of these categories, then they are related to the 10 leading causes of death in, in the healthcare. So this is a very, very important thing because it has such profound effects on really complicated health issues. You think about heart disease, you think about diabetes, asthma, cancer, these are the kinds of conditions that are related to having adverse experiences in your life.

NR: Oh, God! Sometimes, you know, people like me, we don't have medical background or medical knowledge, and we may not understand that on a regular basis that this kind of adverse childhood experience can have an enormous effect on someone's life. I mean, it’s lifelong effect, right?

TI: It is a lifelong, you experience it through your life course. And then if you think about it, you also know that if you have six or more of these abusive categories, then you actually lose two decades of your life. So you actually live less, than if you did not have these.

NR: That's a very serious issue that we need to, community members need to, know about- sometimes we are not getting enough information about this medical world, what kind of research is happening in that area, and it's always good to do this kind of show to let people know that the adverse experience in your life can have enormous effects on your well-being or on your health so that people understand and do something about it. And especially, sometimes it's possible that parents are involved in is engaged in any kind of conflict, any kind of whether it is physical abuse or other abuses, and they may forget that someone is watching, and they keep doing that abuse or that violent behavior without understanding that they're ruining someone's life, right? They are ruining their children's life.

TI: Yeah. So some parents will tell me, “No, no, the children don't know, when we have these arguments or when there is hitting the children don't know because they are in a different room.” I can tell you the research shows that children know- we call this ‘children exposed to domestic abuse.’ We know, as I said before- you take that newborn baby, you take a five-year-old, you take a 10-year-old, you take an 18-year-old- all of these children know what is going on in the house and their health and well-being is profoundly affected by this.

NR: Thank you for Tasneem for sharing this insightful resource and information with us. Listeners, we are discussing the damaging effects of domestic violence and abuse on children and teens, and today we have Dr. Tasneem with us. Now it's time to take a break and then we will come back soon. Don't go anywhere. [BREAK]

Hello everyone, as I said that we are discussing the damaging effects of domestic violence and abuse with Dr. Tasneem Ismailji. And we are back again in the conversation after a short break. So Dr. Tasneem, we so far we are talking about effects of Domestic violence on children. Now, I would like to know about the effects on teens, because I have seen that South Asian parents, in my family or friends we have seen that many parents, they have high school or teenage children, and they say that, “oh, my children, they don't know anything about dating or they are not in any dating relationship. Or what are you talking about? Why would we even think that? We shouldn't be talking about dating relationships or something like that with our children, they're only in ninth grade 10th grade 11th grade.” But personally, I believe that sometimes we don't understand that maybe our children, our teen children, they are in some relationship and my concern is if they didn't know how to be safe in their dating relationship that is more important, rather than pushing our children to not have that in relationship. So, what do you think? Have you have seen in your career that teens are facing dating violence and abuse in their own life, and they're not talking about that feeling or if they're abused by their dating partners, and they're not comfortable talking about their feelings with their parents or their family? Anything you want to share?

NR: Sometimes I've seen that, especially in our South Asian community, there is a barrier between parents and children about what we can talk or cannot talk. And I'm not generalizing; I'm not saying that all South Asian parents and children have a barrier between them. But many times I have noticed that on many topics, we are not very open or very comfortable talking to our teen children. And I remember one doctor once told me that she had a 15-year-old come in because of some shoulder dislocation. But when the doctor was examining the girl, she found out that the girl is actually pregnant. And then she started questioning, and came to know that the 15-year-old girl actually is having a dating relationship and her boyfriend is very abusive. And the shoulder dislocation, the reason she came to see a doctor, was actually caused by the boyfriend. On top of that, she is pregnant. And when that doctor wanted to have discussion with the parents because of a serious issue like this shoulder dislocation, but also the pregnancy of a 15-year-old, that girl got really upset that she started crying and she said, “my parents don't know anything. I told my parents that I had an accident. So, that's why I have shoulder dislocation. I didn't talk about my boyfriend, forget about abusive boyfriend.” When I was listening to this story, I felt so sad. I was thinking about that 15-year-old that she's so helpless. She is abused by her boyfriend, going through enormous pain, and now she's so scared that what will happen if her parents come to know about this situation. I don't know what to do, how to remove this barrier. I have a teenage son, who is a 15-year-old boy, and sometimes I wonder if we are communicating enough, so he knows that whenever he is facing are any abuse or any problem in his life, he can come to us, he can talk to us without any fear. Why do you think that in our community we see this kind of barrier between parents and children? Anything you want to share as a doctor, as a community member, as a woman as a mother, South Asian mother?

TI: of course, I have raised two adult of my children (they are adults now,) and two grandchildren as well. So this is something that we as parents have to be very thoughtful about. You know, we live in a very rapidly changing society, we have so much information and knowledge available to us because of the internet. I know that most parents have the best for their children in their heart, but they sometimes don't know how to go about doing that. So I think what we need to do is start the conversation. Because when I listen to many, many conversations within my family, we talk about all kinds of issues but we don't talk about healthy relationships, and that's the conversation that we need to start. So we need to really reach out to all of our friends, family, and start this conversation so that each one is starting to learn from it. It's the secrecy, it's the shame, it's the fear- these are the harmful things, and the child that you just told me about, the 15-year-old, is probably more scared of the boyfriend than of the parents, and will not tell the parents because the boyfriend is keeping her very scared- that's part of the abuse. And another part of the abuse that you have to understand is that the 15-year-old’s pregnant, she probably was raped by the boyfriend. And so it's not that the children are out there just wanting to have sex, that's not what it is. It's far more complicated than that. And we must not be afraid of normal sexual development. We must reach out to our children and say, “Yes, I don't know about these things but I'm willing to learn.” We must be open. We must have these conversations. We must openly discuss because the more we discuss, the more comfortable we feel about these issues. We learn more, and we open more and the children are watching us. “Wow, my mother is willing to learn. My father who never ever gave me a hug is now willing to learn and give me a hug as a parent.” So these are new experiences, and we need to be open to that. Because if you don't, the effects on the health and well-being of your children are very, very serious. This particular child who's pregnant with a shoulder dislocation is at very, very high risk. That is a very urgent situation. And as a doctor, what I need to do is get permission from the teenager by expressing to her how much danger she is in, and then reach out to her and say, we really need to get your parents involved in this because we need to make sure that you are safe. We need to talk to Maitri and get them involved. We need the advocates here. We need to have everybody who can assure that this child’s safety and health is taken care of.

NR: Yeah, sometimes it is sad to see this kind of news. I remember a couple of months back, there was a case on the newspaper about Punjabi family, I think in Bakersfield, and it was big news in the media. Their teenage daughter delivered a baby and the family killed that baby because they were thinking about family shame, family name, reputation, and then they killed that baby after their teenage girl delivered the baby boy and it's so sad to read this kind of news. And I don't know… sometimes I feel this should be a lesson for our community members to know, to understand our children, to be supportive to our children, and not to think about what people will say and what the community will say. Instead, think “how can I support my own children”, right?

TI: Oh, absolutely. So you know, we have some of these ideas back from where we were born and raised. And we have to understand if we are going to be living in the US, we cannot kill a child. That is a crime. That's a murder, and that will not go without being detected, not in this country, it will be detected, and you will have to go through prosecution for that. You will have to go and be accountable for murdering a child. So this is not a simple thing. This cannot be hidden. People who have this kind of mindset, who have these kinds of ideas, I'm sorry to say these are old ideas. These are not ideas by which one can live and thrive. These are harmful ideas, and they should be immediately given up.

NR: Raising kids, raising children, it's not only a parent's responsibility. It takes a village to raise Yes. Right. All teachers, schools, policymakers, doctors, community members, families, parents, all of us need to support our children when they are in any kind of abusive situation or they're facing any problem in their lives. For example, our teen suicide rate is really high. If you see the research, if you see the statistics, it is increasing. And why it is increasing? Because many times I think that they don't have enough support from their families, from their school systems, and mental health is a big stigma in our country. No one wants to talk about mental health problems, right? You're a doctor, you know better. If they're facing any problem, they don't want to admit a mental health problem. So, is there any advice for parents? For families?

TI: Yes, the most important thing is to stay connected and communicative with your child. And as I talked about the adverse childhood experiences before, we know there's a very high correlation and association between how many adversities you have and the suicide risk. We also know that people who have adversities also abuse substances like alcohol or marijuana or other drugs, and that may well be related to the suicide rate as well. So again, coming back, it takes all of us you know, it's the doctors, it's the school, it's the friends, it's the parents, all of us together need to look after this child. And we do teach the doctors, because suicide is so common in teenagers now, that they should be screening for suicide risk. So that's one of the very strong recommendations that we are making, that all healthcare professionals should be asking about suicide in teens.

NR: So as a mother of a teenage son, I would like to know what are some tangible tips when approaching a conversation on relationships with my children.

TI: You have everyday opportunities, not only to talk about healthy relationships. If you go to an event that you will have with your community members, you can just start the conversation about, “oh, did you notice this one was having such a good time conversation with a child with the teenager” “This father was speaking so nicely and gently and having fun and making jokes. And look at that other father, he was not at all, either not even noticing the child, the teenager or not even having any conversation.” So if you take those small kinds of observations, those are good starting places to start this conversation about what is a healthy relationship? What is an unhealthy relationship? And, we need to talk respectfully with our teens; that's the first place, whether it's our teens or with any of our children. We need to start speaking using respectful language. We need to start showing our love and our caring. And when it doesn't happen, that's a good starting place again to say “Oh, did you notice that” and then open that conversation with your teenage son and open that conversation with your family members, with your husband, with their friends, when the friends come over. That's one of the things I used to do when my daughter was a teenager. She used to go to school over here. I have all of the school friends come to our house. And, and this is a long time ago, so I used TV programs like Gilmore Girls- Gilmore Girls was a very good TV program to talk about healthy relationships. Because when you slow that TV show down, I could show where there was abuse going on. And so TV media is another really good- if you're sitting down and watching a TV program with your child, or you're watching a game or you're watching anything, you can make these observations. “So what do you think about that? That doesn't sound right to me.” and then you build your case, little by little, and then you start talking about that, you know, talking is one thing you know, children learn from what you do, so you need to be very respectful with your spouse, you need to be respectful with your children, you need to be respectful with all of your family members. And then, you know, give them opportunity, give them space to talk about different people who have different views. That starts the conversation.

NR: So having good role models in our community and in our families are very important. Right? And as you were saying that communication is the key. So, we must have good communication with our children, and to talk about learning, you know, we must know what they are thinking about, anything happening around them and how we can chime in or how we can get into any type of conversation on any topic with them.

TI: Yes. So one of the things is teens, you know, because you have a teenage son- as soon as they come home from school, they go to their room and they shut the door. So they don't really want to talk to you. You have to try not five times harder, not 10 times, you have to try 1000 times harder to make that space that feels loving and comfortable. The teenager will come out from the room. I used to have a little smoothie for my daughter, that sure got her out of her room and we'd sit down and then I'd have a cup of tea and she would have a smoothie and we start talking about her day.

NR: Wonderful, wonderful Tasneem. We are really thankful that you are here and sharing your personal experience, your knowledge, your expertise with our listeners, and I hope we will be doing this kind of short again and again. And you will come again and again to talk about this issue. So that we together we can mobilize our community in ending victim blaming, in raising good, healthy relationships, healthy kids. And thank you! Thank you listeners for being with us.

TI: You're very welcome Nandini.