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He hit me; but it’s okay! Female submissiveness in marital abuse: A review in Indian context

India, a country with manifold multicultural bonds and relationships often witnesses a gross number of conflicted marital relationships. The plight in the frequency of marital abuse reporting in India has called gross public health attention globally. Multiple factors contribute to this arena in which, when we analyse can find out females submissiveness to report and or react to such kind of abusive incidences. The objective of this article is to review recent literature on female submissiveness in marital abuse. This narrative review is carried out to depict various perspectives that initiate abusive relationships and certain factors that prevent women from being subjected to rapid response. Literature relevant to the topic which was published within twenty years in prominent journals, newspapers, and websites has been reviewed thoroughly while writing this paper. Keywords for literature search included terms such as domestic violence, intimate partner violence/abuse, spouse abuse, married woman/female submissiveness, abusive marital relationships, and marital abuse. There is a paucity of studies analysing psychological and socio-demographic determinants of this submissiveness within such relationships in India. Several factors such as cultural, psycho-social, environmental attributes may prompt submissiveness among females in abusive marital relationships, which often leads to psychopathology and physical ailments. It is important to understand the need for a multidisciplinary approach to preventing marital abuse as a public health issue. By preventing and modulating such factors public health and women’s well-being can be preserved in various domains.


Introduction
Marriage is considered to be one among the prominent social institution among human beings. Discussions on women equality and empowerment are on rise; however, the basic mindset in society about women is quite different since decades. Globally in every society there are proverbs, jokes, and certain unwritten rules pointing traditional acceptance of wives beating by their partners e.g., "A wife is not a jug…she won't crack if you hit her 10 times' (Russian proverb) and 'A spaniel, a woman, and a walnut tree -the more they're beaten, the better they be' (English proverb)." In India also the scene is not that different, as portrayed in movies, Medias and cartoons. In India, on comparison with developed countries women perceive more hardships in marital life. Factors like economic dependence on men, cultural and religious practices in India and traditional patriarchal organisation in families owe to marriage-related disharmonies. [1] A report by The National Crime Records Bureau (NCRB) 2019 portrays a majority (30.9%) of all the 4.05 lakh cases under crimes against women are registered under Section 498A (deals with 'cruelty by husband or his relatives') of the Indian Penal Code. However as per the available data and upcoming incidences in society gives an outlook that far more than the reported cases, He hit me; but it's okay! Female submissiveness in marital abuse: A review in Indian context unreported cases are significantly high. Under reporting of cases often comes out in media when someone in the relationship commits suicide or gets murdered. [2] The effects of abuse in a female partner are enormous which can restrict freedom, mental ill-health, drastic narrowing in self-esteem, and giving rise to depressive cognitions and so on.
The National Commission for Women (NCW) registered significant hype in rate of marital abuses during the Covid 19 related lockdown. [3] In Kerala, two incidents (one culpable homicide committed by husband and a suicide case) [4,5] in 2021 reported related to marital abuse draw attention of the state recently due to dowry issues and both victims didn't reported legally before the tragedy.
The astonishing fact is that projected number of crimes reported is just tip of an iceberg. In reality, gross numbers of cases are buried out due to multiple factors. [1,6] Insufficient dowry, disobedience to commands, intoxicated male partner due to substance abuse, for not having male children, assuming infidelity, unemployment, refusal to have sex and arguing back are pointed out as reasons in marital abuses. [7] Identifying female survivors and assisting them on such a way to recovery could mitigate the long-term effects of violence and prevent future abuse. [8] The clinician's responsibility is to look for signs of abuse, assess the patient's and her family's safety, and provide ongoing medical care and nonjudgmental support. The basic concepts of confidentiality and safety of women and children need to be better understood and applied by general practitioners dealing with partner violence. [9] Physicians should be taught objective assessment models and the implications of using those models in practice; however, the first step is to appreciate what it's like to be submissive in an abusive household. [10] Doctors and nurses who work in primary care have expressed a commitment to combating DVA (domestic violence and abuse) based on personal experience. Personal experience with DVA makes healthcare providers more prepared to deal with the issue. As a result, a basic understanding of the factors that keep women submissive in abusive relationships will benefit the medical community. [11] This review is spearheaded for portraying psychosocial, cultural and demographic factors that may lead to submissiveness in tolerating abuse within marital bond.

Materials and Methods
We searched Pub Med, Google Scholar, Science Direct, JSTOR, and prominent online newspapers (Indian and Global) for articles published in English language. Electronic search was done using terms such as "Abuse", "Spousal Abuse", "Intimate Partner Abuse", "Wife Abuse", "Spouse Abuse, "domestic violence", "intimate partner violence" and "women/female submissiveness". For this review, we considered original quantitative research articles, qualitative studies, narrative review papers, relevant systematic reviews, book chapters, and important news articles published in the last 10 years (2011-2021) which are available as free and full text. We selected relevant articles for this narrative review after manually appraising abstract and results. The inclusion criteria of study involved are; (1) full text articles published in indexed journals, (2) articles involving background and data of abusive marital relationships, (3) articles with literate of female submissiveness and (4) pertinent news articles published online.

Female submissiveness among abusive marital relationships
Marital violence and abusive family relationships have been identified globally as a cardinal public health concern. It does have dooming consequences affecting physical, reproductive, sexual and psychological health of women irrespective of socio-cultural and economic context of families. Several reports in Indian NCRB denote high rates of cases, especially in the last two years. Incidences in which females respond to such abusive reactions from partner are few and opting to move on for filing a case or other legal proceedings are also scarce. There is a dearth in literature which specifies determinants of female submissiveness. However, the following factors are pointed out in literature as factors that leash women within marital abuses submissively.

Learned helplessness
Testimonial collectives often report stories of Indian women tolerating violence from partners very often. In each stories [12,13] we can see phases in which female partner reaches a stage to get used with it and remains silent in a notion of 'no one can save me from this'. Learned helplessness, a term that is often used in the background of depression, is a behaviour pattern that involves a negative and ill-healthy response. Learned helplessness is portrayed by avoidance of challenges, greater dependence and the lack of or non-employment of problem-solving strategies when manifold obstacles arise in life. [14] As far as marital issues are concerned, female partner may strive to deal with abusive relationship at the outset, but when they don't get any kind of help or support from family, society and or even from legal system she may reach to the mindset of learned helplessness. This can remain life long as they start accepting issues as their fate and may stay helpless. But in some studies employment of women have significantly higher cognitive, physical, and social coping, as well as lower learned helplessness than non-employed women. [15] Physical intimacy and romance acting as intermittent reinforcements A typical mode of instilling love adopted by male partners, who have substance use disorders and psychopathic in nature is by having physical intimacy. By engaging in physical relationship at various intervals create a sense of romance, attachment and belonging in female partner which let them tolerate and compensate for what they suffered in the form of abuse.
When evaluating the neurobiological aspects [16] release of Volume 11 : Issue 2 : February 2022 hormones (Testosterone, oestrogen and increased level of Dopamine) related to sexual activity acts as a reward system [17] which reinforces the twisted relationship. [18] This reinforcement will act for a while or until the next abusive episode to remain female submissive or to repress the effects of violence by male partner.

Theory of cyclic abuse
In Kerala, a suicide of a newbie BAMS student due to dowry harassment reported [5] during 2021 grabbed media attention nationwide. As per the confession of abuser, the victim has been exposed to domestic violence multiple times within the brief period of their family life. After several episodes of abuse she went to back to own house stating that she no longer wish to stay with husband at his home. Strangely, she was convinced each time by the abuser and taken back to in laws house. The series of domestic violence recommenced in a cyclic pattern until the suicide of victim.
Aforementioned incident is in concordance with the theory put forth by Walker, in which women go through three different stages during abuse. Tension building (where issues arises and end up in certain arguments), explosion (anger exploded out on female partner, abusing peaks up and severe rage), honeymoon phase (Phase in which male abuser tries to convince female partner with intimacy, apologies and even demonstrates physical intimacy) and a calm phase. [19] In calm phase the abuser pretends to be taking decision of not abusing female partner again, sometimes even behaves as abuse never happened in between and tries to fulfil promises given during honeymoon period. [20] Gas lighting phenomenon The term was first reported in 1969, [21] coined from the theatre play Gas Light in 1938. This is a psychological phenomenon in which a partner most often a husband gradually turns his unsuspecting wife in order to infer mental illness and provoke admission to a mental health unit. [22] An abusive husband may always point wife as being irrational, forgetful and as having psychopathology which leaves wife into isolation; as time proceeds wife may start accept the concerns rose by husband as true and may get willing for even psychiatric consultations. [23] At the end women may start contemplating that there is some fault or drawbacks in their side and deserve this kind of punishments or violence.

Age related factors and early marriages in India
Abuse of any type; either it is emotional, physical or psychological, ultimate victims are younger in age ranging from 20-30 years. Especially younger women experiences higher rate of isolation and women's overall experience of property damage was also higher than that of men. [24] Multiple studies reported low age among female partners and some studies even ruled out statistical correlation of lower age and domestic violence. Negative health outcomes related to marital abuses in young aged female are also reported in many cross cultural studies. [25,26,27] Age at which females get married is far low especially in North Indian states as reported in various studies and longitudinal surveys [28,29] in last decade, even though child marriage is illegal in India. Literature correlates early marriage and partner violence clearly [30] ; again the question of submissiveness also connects in this regard. Increased age of husband may portray a parental figure among female spouses which may lead them to think abuse as one or other way of punishments for their doings.

Fear of social isolation
In India, social stigma associated with divorced females is at its peak, how people in environment will think about? How will society perceive about a female with or without children? These are concerns common in traditional orthodox families. Females become submissive in this aspect because as if they get divorced or step out of family how society will react, whether family will accept back at own home etc., are queries raised in mind. Hence, probability to tolerate all misdoings by the partner is quite common in Indian settings. Very few studies are pointing to this perspective of female submissiveness [31] ; no authentic study has been published focusing this aspect. To the contrary many studies reports the high rates of social isolation in gray divorces, [32,33] hence it can be reasoned logically to great extend that fear of social isolation related to divorce or separation spearheads in tolerating marital abuses.

Passive role and submissive personality traits in females
Elevated levels of testosterone has been attributed to aggressive traits in males, [34] same way in females submissive traits are prominent. Obviously cross cultural, educational, personality and socio demographic determinants play a vital role. In India females assume a submissive and or passive role [35] in family making (feminine nature which cares and rears more than becoming aggressive) and males lead or dominate; (some neurobiological basis plays a role) [36] in pertinent deals. Socio cultural intersections are having a prominent part to play in a country like India with numerous cultural, traditional and patriarchal stereotypes.

Societal stigma and perceived limitations related to remarriage
Divorce in Indian society has its own stigma which women and family perceives as negative impact in life. [37] Attitude and perception towards remarriage is also significantly associated with scepticism and suspicion. [38] The choices for remarriage were also limited before but there is significant trend in that scene now, as certain websites and groups which promote remarriage. The pertinent caste system in India also embraces this dilemma of women about remarriage. Moreover women are expected to stay tolerating and bearing all type of tortures either physically or emotionally from partner and in-laws in Indian social fabric. [39] Unemployment and educational deprivation Lack of job and basic schooling determines a great role in domestic violence vulnerability in females globally. [40] Studies conducted in Indian context reported high rates of domestic violence and abuses; these are significant in families with unemployed females and those who are deprived of basic school education. The lack of awareness regarding legal infrastructure in the country also leads women to stay passive in under-reporting of abuses within family relationships. Basic illiteracy about one's own rights makes an individual vulnerable to become a victim in these instances, especially male partner may portray as their right or inherited privilege to abuse or punish physically their female counterparts. [6] On the other side married women who are more educated than husband are not much likely to expose to partner abuse. In families where male counterpart if more educated we can rule out a inversely proportional relationship of abuse against female partner; which is reported out in various Indian studies. [41][42][43] Sake of children After all above mentioned factors the query retains is; why females stay in such relationships silently. No cross sectional studies in Indian context tried to address this specifically so far is a matter of fact. A testimonial collective [44] reported in a prominent news paper in India portrayed that female partners tolerate abusive acts of male partner mainly in the concern of their children. What if they get separated and how come will take care of children as a single parent, a common cognition throughout. [45] This; though may get aggravated if the victim is unemployed and financially deprived off.

Fear of retaliation
Victims of marital abuse are embraced with a fear that partners may cause excessive violence in future if they report or try to stay separate from them. [46,47] Specifically it has been reported globally [46] that fear of retaliation as a vital factor to report any type of harassment in and around workplace, within marital leashes and families. A pioneer work [48] done two decades back reported by W.H.O, points fear of retaliation from intimate partner as one among the determinants that keeps women submissive and not leaving male partner permanently. No Indian studies so far reported clearly this as a major predisposed cause though.
This can be worse in families were female spouse is uneducated, unemployed and not in connection with own families. Studies conducted on emotional abuse among marital bond reports retaliation associated unspecific fear in Indian context as a contributing factor which can worsen female submissiveness. This may not be always feared of physical violence but it can be of emotional neglect and or isolation from male partner. [24] If healthy coping measures are not adopted this fear can become morbid [49] and lead to drastic mental health issues in female spouses.
Despite of all above mentioned factors which can be considered as background of female submissiveness there is a rise in percentage of women seeking help as well. But the fact is, it is more in developed cities like Delhi. The crime and abuse against women are surging in an unleashed manner. [50,51] Even in European countries family physicians and health care workers reported the hurdles in addressing such abusive events. [52] The need to develop policies and awareness campaign to know own rights and being assertive to report abusive incidents are inevitable.

Conclusion
In this review some arguments stated are from experiences shared in testimonial collectives in major newspapers and couldn't substantiate it with scientific evidences published elsewhere. Provision of legal awareness, family support and counselling can help in addressing submissiveness and to report issues if any in marriages. Scope of women empowerment in the light of education, life skills training and scientific thinking has also need to be sparked up. Assertive reporting of abuses can prevent potential negative public health outcomes like mental health issues, homicides, self injury, substance use, suicides, problems in children and various physical health complications associated with the same reason.

Key messages
• Sexual assaults and other crimes against women are on the rise. • Psychological, physiological, and socio-cultural variables significantly contribute to women's submissive behaviour in abusive relationships. • Women's empowerment within the ambit of Indian law, as well as assertiveness in pursuing rights, must be ensured. • Primary care physicians and health-care faculty can play a delicate role in determining whether or not an incident of abuse has occurred.

Take home message
Adequate formal education, shattering cultural taboos, assertiveness, financial independence, and understanding of legal services will all aid women in overcoming barriers that may incentivize them to remain submissive in an abusive marriage.