Listening to Bedouin Women Who Were Affected by Intimate Partner Violence and Sought Help From a Doctor

Abstract

The purpose of this study was to examine how Bedouin women perceived and interpreted seeing a doctor for help in the aftermath of intimate partner violence. In the phenomenological study, 38 semi-structured interviews were conducted at two different points in time. The first interview took place before the first appointment with the doctor, and the second took place about 3 months after seeing the doctor. The findings revealed two main themes: an act of resistance against the prevailing social norms and empowerment out of crisis. The study found that doctors and other professionals working in the field of domestic violence in community clinics provide a reliable first source of support for women within a limiting social space. This brings into focus the centrality of the role of the doctor/health care professionals within the framework of the community clinic and is intended to direct, train, and deepen the insights of the medical staff that work with women affected by intimate partner violence and to create uniformity in the interventions for these women.

Keywords

Bedouin women doctor intimate partner violence

Although the Bedouin community of the Negev is similar in some of its sociodemographic and cultural characteristics to other Bedouin-Arab communities in the Middle East (e.g., marriage between relatives, polygamy, and the extended family/hamula as the most basic social unit), it is unique in other aspects. Part of the Bedouin community in the Negev lives in unrecognized settlements, inhabiting structures such as shacks and tents without basic services such as electricity, running water, a sewage system, telephone lines, and paved roads and without access to convenient public transportation, health, and education services. (For a broad overview of the characteristics of the Bedouin community, see Manor-Binyamini, 2013.) Israel’s Bedouin population is nearly 140,000, approximately 45,000 of whom are women aged 18 years and older (Manor-Binyamini, 2013). Traditionally, Bedouin-Arabs who identify as Muslim were nomadic people. However, today they are undergoing a rapid and dramatic process of transition and change caused by sedentarization, urbanization, and the influences of modernization. Bedouin-Arab society is highly gender segregated and patriarchal. Men lead the household and dominate both the polity and the economy. The culture controls women through constructs such as family honor, shame, female virginity and sexuality, and in some instances, female genital mutilation (Al-Sadawi, 1985; Shalhoub-Kevorkian, 1997). The roles and social class of the individual in the tribal Bedouin community vary based on age and gender. From childhood, different social paths are set for men and women and there is a clear division of roles at every organizational level. Although the status of women is considered lower than that of men, it is also subject to change over the course of their lives in conjunction with the different roles they must fulfill. Their sense of identity and their supportive (for the most part) social networks are built on a tribal basis, and the tribe constitutes an affiliation group (Aharoni, 2004). Significantly, Bedouin women benefit neither from the secular and civil rules in their community with regard to their personal status nor from their rights according to Sharia (Islamic law); their lives are generally governed by the laws of the tribal tradition (Sharia law) and a patriarchal judicial system (Gahashan, 2005). That notwithstanding, the Bedouin woman in Israel lives in a world of contradictions in that she is caught between modernization and change, on the one hand, and forces of conservatism and traditionalism, on the other. These forces operate in opposite directions and are influenced by many factors; for example, slow changes are seen in the traditional gender roles (Abu-Rabia-Queder, 2008; Meir & Gekker, 2011). More women are now being allowed to study and attain higher education (Abu-Rabia-Queder, 2011), to work outside the home, and to have some contact with the dominant Jewish culture. Another example of contradictions between the trend of modernization and the changes in the forces of conservatism and traditionalism is the complex combination of traditional and modern medicine within the Bedouin community. The Bedouin are terrified of being hospitalized (Abu-Rabia, 2015, p. 13). There are more and more healers in the Bedouin community who collaborate with practitioners of modern medicine by referring their patients to certain doctors when they think that modern medicine can help the patient (Abu-Rabia, 2015). Abu-Rabia (2015) also pointed out that the perceptions and attitudes of the Bedouin community toward Western doctors is that Western doctors are mediators between the patient and God (Allah). The trust that the people of the Bedouin community put in their healers and the trust of the healers in Western doctors enable the Bedouin women who are victims of violence to be referred to Western doctors.

Based on the situation of women within the Bedouin community, it is particularly important to listen to the women’s own voices in describing and uncovering the experience of Bedouin women who are victims of intimate partner violence and have sought help from their doctors.

Intimate Partner Violence and Its Impact on Women’s Health

Intimate partner violence is defined as a physically aggressive tactic that a man uses against a woman with whom he has an intimate relationship. This violence may be carried out to harm the other person physically (Gelles, 1997), while the most common forms of harms caused include physical, sexual, and psychological violence, along with social and economic control over the woman. Johnson (1995) distinguished between two types of intimate partner violence. The first type is “common couple violence,” which is characterized by irregular and unpredictable violent outbursts on part of the man. This violence is a result of interpersonal relationships in which conflicts and arguments spin out of control. The second type is “patriarchal terrorism,” which stems from a patriarchal view of the right of men to dominate over women. This type of violence is sometimes accompanied by sexual assault, mental abuse, verbal humiliation, economic enslavement, threats, social isolation, and other control tactics. The impact of violence is evident in a wide range of health problems. Violence can result in many types of short- and long-term illnesses. Examples include chronic neck and back pain; migraines and headaches; head, neck, or hand trauma; persistent physical pain; complications in pregnancy; and repeated miscarriages (Cocker, Smith, Bethea, & King, 2000; Weaver, Turner, Schwarze, Thayer, & Carter-Sand, 2007:). Studies indicate that women who have experienced violence that resulted in psychological and physiological harm were at a higher risk of developing depression and stress and attempting suicide (Taryn & Blair, 2011).

Help Seeking in Women Who Are Victims of Intimate Partner Violence in Non-Western Societies

Violence is a universal phenomenon that affects women in diverse population groups regardless of differences in social, economic, and cultural status. Culture shapes attitudes toward domestic violence, and in disclosing domestic violence and seeking help (Bauer, Rodriguez, Quiroga, Flores-Oetiz, 2000). Hamberger and Phelan (2004) noted that women avoid seeking help because of personal, family, and social reasons. They tended to keep the “secret” to avoid being blamed for the violence by those around them in their immediate environments. This dynamic is prominent in traditional societies that exert social pressures. Every step taken toward seeking help is met with a lack of understanding and a lack of acceptance. Culture dictates ways of behaving and coping and emphasizes the expectation that women should be loyal to their families and children, the preservation of the integrity of the family, the sublimation of the shame that accompanies violent incidents, and the social stigma associated with violence, separation, or divorce, and even seeking help in the community (Bauer et al., 2000). In Arab society, violence is a hidden issue, family problems are perceived as sensitive and confidential subjects, and women who expose their “secrets” relating to violence are denigrated by both their families and their societies (Haj-Yahia, 2000). Lee and Hadeed (2009) found that the starting point in understanding the dynamics associated with seeking help lies in understanding both the social-cultural contexts and its limitations, which prevent social support. Women who turn to formal frameworks face socially and culturally unsuitable responses, thus adding to their difficulties in disclosing domestic violence. Concealing such violence and avoiding formal frameworks for help is notable in Israel among Arab women who tend not to ask for help or to disclose information to outsiders, and any discussion of the topic of violence with community support groups is perceived as threatening (Rabin, Markus, & Voghera, 1999). This is particularly noticeable among Bedouin women. In this situation, women who are victims of violence who seek help from different elements in their community are more likely to encounter the types of responses from their cultural environment that may sometimes impair the processes of seeking help and even intensify the stigma accompanying their choice to seek help and reveal their secrets, thus dictating how they cope (Bauer et al., 2000). As a result of the difficulties that women experience in asking for help, they sometimes prefer to turn to an informal social network such as family and avoid any involvement of formal officials on account of personal considerations related to coping with social pressures and with the price of asking for help. Often, women fail at this, and the violence persists and becomes even more severe. At this point, women often arrive at the understanding that formal help is needed (Hamberger & Phelan, 2004). Turning to others for help is related, according to Leon, Johnson, and Cohan (2007), to the type of violence involved. Leon et al. (2007) noted that women who had experienced intimate partner violence often turned to their family networks, whereas women who had experienced physical and sexual violence tended to seek help from formal channels. For example, for women in Asia who lacked family support, the severity of violence and abuse triggered them to turn to formal channels such as the law for help (Kulwicki, Aswad, Carmona, & Ballout, 2010; Lee & Hadeed, 2009). Bauer et al. (2000) investigated the difficulties experienced by Latin American and Asian women in seeking help. They focused on women’s difficulties in two aspects—a social and political aspect and a linguistic aspect, of which the latter implicates the differences in the spoken language between the woman seeking help and the service provider, which leads not only to poor communication but also to helplessness and a lack of awareness of women’s rights and services in the community. These difficulties are compounded for Bedouin women who turn to formal channels for support such as the courts and the law. Women who are victims of intimate partner violence who turn to formal channels for help thus face a variety of impediments: personal, familial, social, and cultural. These women are caught between two opposing forces: social stigma versus their personal needs.

Method

Participants

The study sample is based on purposive sampling of women who have experienced the phenomenon under study (Patton, 2002). The sampling in this study was a criterion sampling (Patton, 2002) of Bedouin women who had turned to their community clinic for the first time to make a doctor’s appointment.

These women go to see doctors following their appointments with the healer in their community, whom the women turn to because of pain, or following hospitalization, on the recommendation of their physician at the hospital. The doctor at the clinic that the women go to see is a family physician and a member of the Bedouin community.

The women were identified by the community nurses, who presented the research and their goals to all the women who came to the family physician’s clinic. Of the 38 women who were asked to participate in the study, 19 agreed. After receiving the women’s initial willingness to participate, the first researcher coordinated the time for their interviews. Table 1 presents the demographic background of the participants.

Table 1.

Demographic Variables of Participant in the Research.

Women	Age	Education	Number of Children	Years Married	Religion
1	35	Below high school	6	15	Secular
2	32	High school	5	12	Secular
3	40	Higher education	9	19	Secular
4	44	High school	11	23	Secular
5	29	High school	4	9	Secular
6	34	High school	7	14	Secular
7	38	Below high school	6	18	Religious
8	31	High school	4	10	Secular
9	43	High school	10	24	Religious
10	45	High school	13	24	Secular
11	39	Below high school	7	19	Secular
12	55	Higher education	12	33	Secular
13	26	High school	3	6	Religious
14	33	High school	5	13	Secular
15	37	Below high school	7	17	Secular
16	50	Higher education	13	28	Secular
17	28	Below high school	3	7	Religious
18	36	High school	5	15	Secular
19	44	Below high school	9	26	Secular

The sample was homogeneous in many ways. The women ranged in age from 26 to 55 years. Most of them had a high school or higher level of education (n = 11). The women in the sample had a total of 128 children. The number of years of marriage ranged from 6 to 33, and most of the women reported being secular (N = 15).

Data Collection Methods

First, ethical approval for the research was received from the ethics committee of the university. All the participants signed informed consent forms before the first interview and the women were assured that the interviews were completely confidential and that their names would be replaced with numbers. Next, in-depth, semi-structured phenomenological interviews were conducted. The first interview that took place before the doctor’s appointment comprised two parts. In the first part, demographic questions were presented. The second part included open-ended questions. Data were collected with a focus on the question of why the women had turned to the doctor for help. The second interview (which was set at the end of the first interview) took place approximately 3 months after the doctor’s appointment, when the women visited the doctor for a follow-up, and included questions that focused on the help provided by the doctor and its significance to the women.

The interviews relied on two main types of questions: descriptive and structured (Spradley, 1979). As a result of the sensitivity and silence that surrounds this issue within the Bedouin community, along with the need to protect the details of the women’s lives, all the interviews were conducted by the first author. The interview guide facilitated the conversation while allowing for flexibility to let the participants raise issues of interest and ask clarifying questions. The interviews took place at the community clinic and lasted for 1 to 3 hr each time. The interviewing phase of the study lasted 14 months.

Data were collected by means of tape-recorded interviews transcribed verbatim (Spradley, 1979). The interviews and preliminary analyses were given to the women, who were then asked to read the description of the interview and the first analysis and to relate to them. All the women were interviewed by the first author.

Data Analysis

Thematic analysis of the interviews was performed by the two authors using familiarization, highlights, and techniques for writing memos or notes (Burnard, 1991). Familiarization involves repeatedly listening to recordings and reading transcripts and documenting impressions. Thematic analysis was applied as a multistage procedure, with the first step involving the interpretation of individual interviews. Themes were then developed based on this analysis and cross-checked and compared with other interviews, enabling a comparison between the individual and the collective understanding. Some categories that were not raised in other interviews were merged with a broader theme as subcategories. This procedure allowed for the comparison of the theme generated in each individual interview with other participants from the group. This process of combining the experiences of individual participants into one group provided an overview of the women’s experiences and perceptions as a whole.

Narralizer software was used for data management and the organization of the transliterations of the interviews. In the process of generalizing the themes and categories, the authors carefully followed coding practices (Burnard, 1991), thus reflecting the main message of the study while maintaining the participants’ original wording to the greatest extent possible. This coding system was then tested using member checking to achieve reliability, and this was done by the double-blind coding of two colleagues who did not take part in the study. Next, apparent validation was performed (Atkinson, Coffey, Delamont, Lofland, & Lofland, 2001).

Findings

Analysis of the interviews revealed two central themes that reflect the significance of the decisions of Bedouin women who were victims of intimate partner violence to turn to their community doctor for help: an act of resistance against the prevailing social norms and empowerment out of crisis.

An Act of Resistance Against the Prevailing Social Norms

Bedouin women who had been affected by violence reported that they had turned to seek help after all their informal and social systems had failed to provide them with help:

I turned to the doctor only after I tried everything, I tried and tried, and I could not change anything . . . I told his mother, she tried to help me, She spoke to him several times, but it did not help . . . I am alone, my family . . . they are not interested in me or my children . . . I told them that he beats me again and again, but they fear the stigma and so they told me to stay with him. (I, 9)

Turning to a doctor in their community was a conscious choice, understanding that they were entrusting the secret of the violence they had experienced to the doctor.

In their appeal to the doctor, the women reported awareness of the fact that their act of seeking medical help was an act of internal and external defiance to the dictates of their society. This perception was based on a number of key arguments that came up during the interviews. All the arguments presented by the interviewees originated in the “violation/opposition” to the existing social norms within the Bedouin community. The first argument is the fact that the issue of violence against women is a silenced topic in the Bedouin community. It is unacceptable to speak about this issue, both within the community itself and to anyone outside of it. Therefore, the mere act of seeking out-of-community elements and support services constitutes, from the perspective of these women, a violation or an act of resistance against the social norm of silencing them from airing out their secrets:

It starts with education, ever since we were born, we were taught that we need to keep our mouths shut . . . When I tried to speak out within my family, they said to me—why am I raising such a subject [the violence] . . . They were not willing to listen. (I, 17)

Turning to others for help was perceived by the interviewees as an act of resistance against their society’s values, and as an act that was necessary to stop the violence because their family forbade them from revealing their secret because of the fear of stigma and shame. This edict deepened both the women’s sense of distress and their sense of loneliness and alienation from society:

With all due respect to Bedouin society, there is an expectation that the woman should bear the burden, know how to remain silent . . . They never give her any support. (I, 16)

Society increases the sense of distress in these women who are already exposed to violence:

Do you know what it is to be silent? to keep quiet is to keep quiet, to go through all this as if nothing is happening . . . You cannot say “help me,” you cannot say “I am leaving,” everything is closed down . . . Our family will not support it . . . (I, 11)

Our community does not accept the battered woman, it will not allow her to seek help, they are against the woman, against her appeal for help . . . They respond very harshly to a woman who initiates a doctor’s appointment . . . you see, I can keep getting beaten for the rest of my life, and no one would support me in seeking help. (I, 15)

We do not speak in my family, we certainly do not express any feelings and we do not deal with our problems outside the family. (I, 10)

The interviewees emphasized that the social value of secrecy was harmful to them, and their distress and violence were not being addressed.

Second, the norm in the Bedouin community is that a woman does not address or converse with a man when she is not accompanied by her husband, brother, or other male relative. Furthermore, a Bedouin woman does not make any decision on her own. A doctor’s appointment is a violation of these norms. These women decided to see the doctor, actually visited and saw the doctor independently without an escort, and spoke, for the first time, with a man who was not their son or relative:

It was a process, when I decided that I was going to look for help and tell the truth, I started looking inwards, because then I started to think and I knew that I had to do something . . . but I was scared, very, very scared, I did not know if it was the right thing . . . I did not know how it would end. (I, 18)

In addition, in their interviews, the women noted their awareness of the fact that opposition to a social norm in a patriarchal and traditional society, like theirs, comes with a “price.” All the women spoke of their fear and apprehension of being punished by banishment or the loss of their children.

The women’s internal discourse ranged between two axes. The first voice expressed fear, insecurity, and the need to examine and approve their own choice to ask for help, in addition to the desire not to undermine the possibility that the family will not continue to exist. The second voice justifies the choice to seek a way to end the violence and to share with others what they have been going through:

I have no control over my own life, I am a battered woman, and that is a feeling of having no control, the only control that I do have is that I get to choose the people who I am going to share this secret with . . . and I chose the doctor . . . this comes from my own decision, but on the other hand I am afraid of losing my children . . . I want to live in a non-violent relationship . . . (I, 16)

The interviewees represented a point of view that perceived turning to the doctor for help as a factor that would enable them to bring an end to domestic violence. The emotional barrier that the interviewees described was fear. The fear that was brought up in the interviews with these women was based on an ongoing experience of violence that from their perspective, had deprived them of their power and their ability to choose to live without violence. The interviews show that the women had turned to their doctors and disclosed the secret of the violence after a process of prolonged deliberation characterized by an ongoing internal dialogue:

It is not enough that my husband is supposed to be the person closest to me, the most loving, and he hurts me, but my own family also blames me for it . . . it is like going from being a victim to being the accused, how can I find my way out of that, I need help. (I, 15)

Most women reported that the point at which the violent situation could no longer continue was marked by a situation that they could no longer tolerate along with their understanding of their need to get help as well as the unavailability of family and social resources to provide that kind of help:

At first it was hard for me to think that I needed help, but I understood that there was nothing else to be done, I had to do something, otherwise I would remain a battered woman . . . He smashed my head against the floor, dragged me out of the house in the middle of the night . . . I do not want to. Besides, no one in the family would help me, I was alone. I had no choice. (I, 14)

Empowerment Out of Crisis

The interviewees explained that their choice to turn to the doctor was made during a moment of crisis. The women’s assessment of the situation as a crisis is influenced, as was made clear during the interviews, by their familial and cultural contexts, their attitudes toward the violence they faced, and their perception of their patriarchal situation:

That day I had a big fight with my husband, we argued about the fact that he did not want to buy groceries for the house, he did not want to give me any money at all. I tried to talk to him several times and he did not care, he did not care about anything. (I, 3)

I turned to the doctor after a day of severe violence, I felt that I was fed up, I could not take it anymore . . . (I, 2)

Another situation that led them to decide to seek help, which is described by the interviewees, is a situation that they defined as “crazy”:

The last time it happened, he was just crazy, I took such a beating, I had pains and bruises all over my body, I couldn’t move for a few days. I turned to the doctor for an examination, the doctor knew it was violence and he offered me help . . . I decided I had had enough. (I, 1)

The interviewees clarified the sense of crisis in which they were trapped, that is, they were caught between social values and cultural constraints, along with their own personal pain in the face of seeking help:

A battered woman reaches a point where she has nothing to lose . . . There is nothing worse than this situation . . . so I was afraid, but I do not want to die, so I turned to the doctor. (I, 14)

The interviewees believed that change begins with adopting a different attitude:

Until recently, I believed what I was told, that a woman should suffer in silence for her family, that it is forbidden to talk about what is going on in the home . . . I got married and I kept doing what I was taught, keeping all the matters of the household a secret . . . I was submissive . . . but doing this has not helped me, the violence continues and it’s only getting worse, continuing to keep quiet will not help me. (I, 13)

The participants noted that seeking an appointment and then meeting with the doctor was a process that strengthened and empowered them.

As a result of seeing the doctor, the interviewees began to either embrace a new understanding or embark on a new approach toward deciding to seek help:

That’s what scared me, I do not want to lose my family or my home . . . Today I know that you can turn to get help and also get to keep everything . . . People here, in the community, do not understand that because they are afraid to even try to turn to anyone for help. They do not know what it means to meet with a professional, they still think that if you turn to a professional, it means that there will be a complaint with the police and the courts. (I, 12)

Most of the interviewees emphasized the awareness that they had gained by meeting the doctor. The health care professional helped most of them uncover their emotional world in such a way that the interviewees emphasized that a space was created for them in which they were able to express their beliefs. These beliefs did not conform to the social values in their society, which required them to stay silent:

He woke me up, made me think about solutions, for myself, made me think where my boundaries are . . . helped me to see myself, the children in our home. (I, 8)

I got support, that was important to me, not to feel alone . . . I feel stronger, I believe more in what I am doing. I finally have someone to talk to, everyone at home stays silent. (I, 7)

In their interviews, most of the women talked about the actions they had taken following the treatment. Some of these actions (e.g., turning to the police) were contrary to their social edicts, and the women discussed the assistance and the power that the treatment had given them:

The treatment has helped me create change for myself; it was hard for me to tell anyone what I went through, today I can. (I, 11)

I understood, through the treatment, that I had power, I filed a complaint, my husband was arrested, I let him, and his family, understand that I am capable, that I will not allow myself to be beaten anymore, I resisted, I broke down and I got up, and I was strong thanks to the help that I got . . . That’s what brought on the change. (I, 10)

From what the interviewees said, it is apparent that the treatment or help that they had turned to had either created a sense of empowerment in them or had given them the ability to act to change the situation in which they were trapped:

At first, when I turned to the doctor, I did not understand what would be helpful to me, in talking about something that hurts, because I was inside my own pain, the conversations helped me see things differently, not out of fear, not out of anger. (I, 10)

The interviewees described a safe space in which they were allowed to speak openly, to think, to consider, and to arrive at a decision regardless of the direction or the significance of that decision:

The doctor is not my father, not my mother, not my family, he is a professional. I can say what I really think and want, and it would be accepted by him without any judgment, without any talk of what I am allowed and not allowed to do . . . (I, 5)

The findings revealed a change in the perceptions of the interviewees between the first interview, which took place before they turned to the doctor for help, and the second one which took place during the follow-up visit to the doctor:

I think every woman in my situation should turn to their doctor for help, without fear, without hesitation, it is the only way that we can say, “Enough!” (I, 17)

The distress of the violence that they are experiencing is not being addressed.

Discussion: Powerful Social Structures, Accounts of the Subjugation of Agency, and Empowerment From Crises

This article offers a description of a phenomenological examination of Bedouin women who had been affected by intimate partner violence and had sought help from a doctor. Through two sets of in-depth interviews with Bedouin women who turned to a doctor for help, this study draws certain conclusions. This phenomenological examination is important not only because it is almost impossible to find studies based on interviews with women survivors of intimate partner violence who sought the help of a doctor, which by itself is an act that contradicts the cultural practices in their community wherein women are usually expected to put up with violence quietly, but also because of their daily accounts that reveal a unique dialectic between structure and agency. This dialectic expresses the voice of personal and social suffering that encourages a complex and normative debate.

As in most other patriarchal and authoritarian societies, the interviewees in this study described how their suffering from violence was a powerful cultural scenario that was expressed by the fact that they saw violence as “natural” in their lives and how this violence was actively used as an increasingly “obvious” control tool. It also asserted the truth that women exercised limited agency within the powerful and stable social order that was in place. All the interviewees described a powerful social structure that fully dominated their lives.

In a patriarchal society, there is a perception that men are superior to women. For example, a man can banish his wife at any moment and for any reason—apparent or covert—whereas the woman does not have the same right. The banishment of a wife by her husband means that she loses all her rights as a result of the marriage and the divorce, such as her rights in the home and her rights over any assets. She loses the custody of her children upon divorce largely because of the perception that it is in the best interests of the children to live with their father’s tribe (Ma’an, 2005). This is in addition to the fact that violence against women is legitimized. It appears that violence is a subjugation mechanism that is used to control the woman and to put her in her place, in which the woman learns to absorb violence as a way of life. Very few women dare to break the cycle of violence, especially, as reported by the women in this study, in the absence of support from their immediate family and on account of the silencing and the price that these women may have to face and pay. Seeking help from outside the community constitutes a challenge to these social norms and is seen as an act of resistance. Their objections to this powerful structure were expressed mainly by searching for help and turning to a doctor.

The findings of the study reveal that seeing a doctor, as described by the interviewees based on the social norms that exist in Bedouin society, was an expression of resistance against the powerful and oppressive social structures in Bedouin society. These explanations highlight the research and clinical similarities regarding structure and agency in a way that other studies do not suggest (for a recent description of this long-standing dialectic, see Pleasants, 2019).

According to the perceptions of the women who participated in this study, their main reason for seeking help was a crisis that caused them both to confront their family and society’s ability to provide them with support and to preserve their rights in the face of their community’s values. The women’s decision to seek help was accompanied by feelings of ambivalence toward receiving help, concerns about the price they may have had to pay for seeking help, and the disclosure of their secret. Horsfal (1991) noted that intimate partner violence toward women exposed the hidden side of patriarchal forcefulness as a social characterization in which the masculine position of power is socially structured. In a traditional patriarchal society, social norms reinforce a forgiving and even accepting attitude toward expressions of violence against women in which the compliance of women to these dictates is self-evident and reduces women’s ability and power to confront violence (Haj-Yahia & Btoush, 2008; Kulwicki et al., 2010). The findings of the current study are supported by other studies, for example, Haj-Yahia (2000), who investigated the attitudes of Arab women regarding optimal ways to cope with violence and found that existing ways of coping are determined by the prevailing sociocultural context and include contacting the family and formal frameworks or law enforcement officials. They also found that confronting the violent husband or expressing a desire to divorce is perceived as undesirable by both the family and the society (Haj-Yahia, 2000). Moe (2007), who investigated Arab women immigrants, found that their lives with violent spouses were reinforced by patriarchal principles that limited their attempts to achieve a secure life and found that these women were abandoned and unsupported by their society, including official frameworks such as law enforcement. The findings of this study were corroborated by Kaukinen (2004), who investigated coping among Arab women immigrants living in the United States. The women in this study used the strategy of seeking help from their families until they finally turned to law enforcement and medical professionals. Each time they moved to another stage in their coping strategy, these women required further emotional investment.

The women in this study perceive the significance of seeking help as a reflection of a crisis, a break from the need to make concessions for the sake of their families, a move toward a willingness to make decisions on their own behalf, and a more active self-perception. Pointed to the concept of ideological dilemmas as placing the individual within social contexts in which self-evident social and cultural values shape the individual’s internal and external choices. Exposing violence to the doctor, according to the interviewees in this study, took place at the point at which they needed help while experiencing pressure from two opposite directions, torn between alternative values (Haj-Yahia, 1995). In this crisis situation, personal power is combined with a sense of weakness that comes from their society and culture. The women described a transition from being passive and subject to the personal and social expectations of others to having an active self that examines the difficulties and consequences of seeking help while remaining in the community. In this situation, the value of freedom of choice is critical for these women because it contains a message that the help they receive is a sign of respect for them and for their choices, along with a recognition of their special social situation, for example, with regard to their children. These women choose their strategies according to their circumstances while calculating the perceptions, values, and attitudes that are influenced by both personal and cultural considerations (Haj-Yahia, 2000).

In the process of seeking help, women facing violence are required to deal with rigid patterns of thought and emotion that have long been perceived as a means of survival in their lives of violence (Haj-Yahia, 2000; Rizo & Macy, 2011). This situation is especially characteristic of battered women living in a collectivist society. In a study of Korean women, the participants were found to prefer cultural values that required modesty and keeping the secret of violence within the family (Kim & Lee, 2010).

Gender relations in Arab society are based on a patriarchal system that reinforces the weakness of women and explains the distress of women while seeking help as caused by their internalization of the values of their society (Eckstein, 2011). A study of Arab women in the United States found that the main reason for these women’s decision not to initiate the cessation of the violence against them was the lack of support from their families of origin (Kulwicki et al., 2010). The essence of the conflict that occurs when these women turn to a doctor for help is the struggle between their individual and their collective identities.

The difficulty experienced by women who are being victimized by violence in obtaining help after facing a crisis is a universal experience for battered women (Fiolet, Tarzia, Hameed, & Hegarty, 2021). Fiolet et al. (2021) explored the views of indigenous peoples in their scoping review and found that they also exhibited help-seeking behaviors to deal with family violence. The main theme they found is to sought help when crisis point is reached.

The present study shows that the experience of women differs significantly between the first and the second appointment with the doctor. The interviewees described a process of empowerment beginning with their disappointment with the reaction of their extended families and the recognition of their cultural limitations. The process continues with a sense of awareness and a belief in their ability to take control over their lives. This is possible through treatment that respects their freedom of choice and their legitimate right to autonomy. The respectful treatment that the women described enabled them to contain their ambivalent feelings while continuing to self-examine and to make a decision that is right for them and their needs, even if this meant maintaining the marriage. The women in the study were aware of the dynamics of their relationship with their culture, but did not expect an immediate reply or an immediate active response. Furthermore, they also feared undermining the delicate balance in their lives. This expectation fits in with the findings that Robinson and Splisbury (2008) shared, which showed that women who are victims of violence need to be listened to, accepted, and be made to feel that there is a legitimacy to their emotions as conditions for creating a change beyond the “concrete thinking” that constitutes the progression from the stage of “reflection” to that of “decision.”

Implications of the Study for Practice

This study adds to the knowledge of the factors that promote and delay the process of women turning to a doctor for help. The findings of this study reveal that doctors and other professionals working in the field of domestic violence in community clinics are a reliable first source of support for women within a limiting social space. This point brings into focus the centrality of the role of doctors and health care professionals within the framework of the community clinic and is intended to direct, train, and deepen the insights of the medical staff with respect to responding to women affected by intimate partner violence and to create uniformity in the interventions for these women. Although these women place the secret of the violence “in the hands of the doctor,” their choice to turn to the doctor is made with great hesitation, insecurity, fear, and even reservations. At this turning point, it becomes very clear how important it is to provide these women with help using an empathetic, accepting, and non-stigmatizing approach within a medical setting.

This study points to social forces that create a trap for women and weaken them. In seeking help in the first step, attention should be paid to the obstacles and barriers that these women perceive on the personal, marital, familial, and social levels. In the next stages of the relationship, it is very important to focus, direct, and emphasize upon the possibility of developing problem-solving strategies.

To encourage women affected by intimate partner violence to seek help, there is a need for a change in attitudes, beliefs, and behaviors toward women who have experienced violence (Olsen & Lovett, 2016). Change should occur at all levels and will also require organizational, community, and government support (including resources) for women, along with appropriate engagement with formal services. Approaches to transformation need to involve acknowledgment of the barriers that women encounter in attempting to seek support, and these obstacles often go above and beyond those faced by women who live in non-conservatism and traditionalism communities.

Limitations of the Study and Implications for Future Research

This study has several limitations. First, although this study examined the perceptions of Bedouin women, there is a need for a comparative perspective that examines the views of the men and other members of the extended family, because of the importance and centrality of the family within the Bedouin community. Furthermore, despite the complexity of the proposed research, the research report of Ma’an (2005) revealed that two of the main factors of the expansion of violence against women in the Bedouin community are early marriage and polygamy. The points of view of early marriage women and women living in polygamous households and that experience violence in this community should be examined.

Second, it is important to understand the perceptions and roles of the doctors, nurses, and social workers working in the community with victims of violence in the Bedouin community.

Finally, building on existing research is necessary. To provide a contextual understanding of what Bedouin women who have been affected by intimate partner violence go through, and to encourage culturally appropriate responses from service providers, more research is necessary. It is important to recognize that women should be encouraged to identify their own support priorities and develop their own solutions. However, it is surprising that these populations are rarely genuinely consulted in research (Fiolet et al., 2021). Even when women who have been affected by intimate partner violence are consulted, there is rarely a woman-centric lens applied to the analysis of the data collected. This suggests that there needs to be further consideration of these factors in determining the methods to study with women who have been affected by intimate partner violence.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Iris Manor-Binyamini

Author Biographies

Iris Manor-Binyamini, PhD, is assistant professor at the University of Haifa in Israel. One of her main academic interests include the Bedouin community (special education, parents/sibling of adults with various disabilities, women).

Michal Schreiber-Divon, PhD, is lecturer at Talpiot College of Education in Israel. One of her main academic interests include sexuality of children/adolescents/adult with and without intellectual disabilities.

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