By Judy Foreman, Globe Staff, 03/21/00

The rice was the tip-off.
When the young woman's mother came to visit her in New York, she was astounded at all the rice her daughter kept in the cupboard. When the mother asked why, the daughter shrugged. Her husband, she explained, always complained that she ``didn't make rice as fluffy as his mother did.'' So she'd keep trying over and over.
``There's nothing wrong with the way you make rice,'' gasped the mother. What was wrong, both women realized, was that the daughter was caught in an abusive relationship. Her husband's constant criticism about her cooking was part of a larger pattern of psychological humiliation and beatings.
Since that incident 22 years ago, the story has become legendary in the domestic violence field, not least because the daughter was Sarah Buel, who left her husband and went on to Harvard Law School, and now runs the domestic violence clinic at the University of Texas Law School in Austin.
Domestic violence - overwhelmingly a male-against-female problem but a major issue in same-sex relationships as well - is a public health dilemma of staggering proportions that crosses boundaries of wealth, race and class.

As researchers probe the enormity - and complexity - of domestic abuse, they are becoming more sophisticated at helping victims fight back with "safety plans" and other long-term strategies for physical, and psychological, survival.

A decade ago, the standard question for a woman in an abusive relationship was: "Why don't you just leave?"

But evidence is mounting that "just leaving" can be dangerous; some men become vengeful when a woman stands her ground. This is complicated by the fact that women often feel ambivalent toward their abusers, and want legal intervention one day and not the next.

Leaving an abusive relationship is no small task - anywhere.

Between 10 and 50 percent of women worldwide are hit or otherwise physically attacked by an intimate male partner at some point in their lives, according to researchers from the Johns Hopkins School of Public Health and the Center for Health and Gender Equity in Takoma Park, Md., in a recent report based on 500 studies.

Often this leads to physical injury. Sometimes it leads to murder. Worldwide, 40 to 70 percent of homicides of women are committed by intimate partners, the Hopkins team found. By contrast, only a small percentage of men who are murdered are killed by their female partners and, in those cases, the women are often acting in self-defense or retaliation.

"Around the world, at least one woman in every three has been beaten, coerced into sex, or otherwise abused in her lifetime," said the researchers in their report.

Abuse can run the gamut from hitting, slapping and kicking to sexual coercion to psychological control by intimidation and humiliation.

Sometimes the physical symptoms last long beyond the wounds have healed; some women live with irritable bowel syndrome and chronic pain syndrome. Others suffer with psychological problems such as depression, anxiety or abuse alcohol and drugs. And because abuse and intimidation mean that a woman often can't negotiate the terms of sex, she's also at risk of sexually transmitted diseases such as AIDS and unwanted pregnancy.

While heterosexual women are the main victims, researchers now know that violence is just as common in relationships between gay men and lesbian women.

Studies suggest battering occurs in 25 to 46 percent of same-sex relationships, said Beth Leventhal, executive director of the Boston-based Network for Battered Lesbians and Bisexual Women, a nonprofit group.

Emily Pitt, a domestic violence worker at the Fenway Community Health Center in Boston, said the "cycle of violence" can be similar in heterosexual and homosexual relationships.

It often begins with psychological abuse - threats of violence like walking around the bed with a knife, humiliating comments such as "you're getting fat" or surrogate violence such as attacking pets, said Lois Haggerty, an associate professor at Boston College School of Nursing who, with colleagues, is studying abuse in women who visit prenatal clinics.

Emotional abuse often escalates into physical abuse, which in turn is often followed by a "honeymoon" period in which the abuser apologizes and the victim takes responsibility for helping him change. Then the cycle begins again.

That abuse is similar in heterosexual and homosexual relationships suggests that, while the basic pattern fits into cultural definitions of masculinity and feminity, abuse is really about power and control, said Sally Engle Merry, a legal anthropologist at Wellesley College. It's "the opportunity, and the entitlement, for the powerful to use force to control the less powerful."

How can such a complex dynamic ever be changed?

"What seems most effective," Merry said, "is a three-layered approach." First, there must be "some kind of punishment for the batterer. In the absence of punishment, other approaches don't have much impact. . . . Second, there has to be some effort at reform - treatment programs." Over time, educating batterers that their behavior is not acceptable can change cultural norms. Data suggest that, although many batterers drop out of treatment programs, 80 percent of those who stay stop battering, at least for a year.

"Third, there must be mechanisms that focus on the woman's safety." Shelters help, but so do the much-maligned temporary restraining orders - civil court orders aimed at keeping the batterer away from his victim.

Over time, Merry said, "the law acts not just by imposing sanctions but also by creating normative standards for how people ought to treat each other." In recent years, the number of restraining orders has soared in many states, including Massachusetts.

Restraining orders may not deter someone who is homicidal but they can work with a "relatively new batterer who has not had a lot of experience with the courts."

Daria Niewenhous, a health care lawyer at the Lahey Clinic who for years headed the pro bono domestic violence project at the law firm, Mintz Levin, agreed. "Restraining orders can and do work when the batterer has something to lose if the order is violated," she said. But they "should always be part of a safety plan."

Such safety plans - specific steps developed over the years from hard-won experience - don't give blanket advice to women to leave an abuser immediately. For one thing, it's when a woman leaves that an abuser is most likely to feel he's losing control, and to attack. For another, it usually takes four to five attempts - and a good long-term plan - before a woman manages to leave for good.

Rather, today's safety plans read like survival manuals for living in a war zone. They advise, for instance, that a battered woman tell one or more neighbors about the violence so they can call 911 if they hear or see a disturbance in the woman's home.

During an argument, a woman should walk into a room that she can leave easily. Staying away from rooms, such as the kitchen, where there are items that could be used as weapons, is also a good idea. Having a bag packed with spare keys, money, documents and clothes and keeping it at the home of a friend or relative also makes sense.

If your abuser is stalking you, you can "tell your employer if you need to be walked to your car," said Kristie Wang, spokeswoman for the San Francisco-based Family Violence Prevention Fund, a national policy and advocacy group. Your employer may also be able to help if your abuser makes harassing calls at work or if you need to have a desk away from a window.

It also helps to tell health professionals about the violence. They can suggest resources to turn to, offer emotional support and keep records of the injuries.

In fact, asking about domestic abuse is now the standard of care for health care providers. "All health care providers should ask every patient, every visit," said Buel of Texas.

The key is not to keep the abuse secret. Ask friends and family members, especially men, to confront the abuser if they see or hear him being threatening or humiliating. If a man knows others are watching, he may think twice about his behavior or become embarrassed by it.

No one deserves to be hit or threatened. Even if she overcooks the rice.

Judy Foreman is a member of the Globe staff. Her e-mail address is: foreman@globe.com.Previous "Health Sense" columns are available through the Globe Online searchable archives at http://www.boston.com. Use the keyword columnists and then click on Judy Foreman's name.

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