Can't Catch a Break

Chapter 1

"Joey Spit on Me"

How Gender Inequality and Sexual Violence Make Women Sick

We have an abundance of rape and violence against women in this country and on this Earth, though it's almost never treated as a civil rights or human rights issue, or a crisis, or even a pattern.

Rebecca Solnit, "The Longest War Is the One against Women"

Men-they don't want to leave me . . . they want to control me.

Robin

Francesca's father came to the United States to live the American dream. An Italian sailor, he jumped ship and swam to shore in Massachusetts, where he married a woman from a well-established Italian American family. Francesca describes her father as "a typical macho Italian man." From the outside, they were a stable and successful blue-collar family. Her parents owned their home; Dad worked at the same job his entire adult life, and Mom stayed home with the children. Francesca's early memories are of festivals at the local church, her mother's traditional recipes for Easter lamb and Italian meatballs, and her father's stories from the Italian American social club. But below the surface her family was sliding into a spiral of illness and affliction. From as early as Francesca can remember, her mother was sick: throat cancer, eye disease, and congestive heart failure, trips to the psychiatric hospital and suicide attempts. It was up to Francesca, as the only daughter still living at home, to clean up the blood and bandage her mother's wrists.

By the time Francesca was thirteen, things were going very wrong. Her "scumbag" older brother began molesting her. Her parents learned of the sexual abuse from the pediatrician who discovered anal warts (a symptom of human papillomavirus [HPV] infection). In response to the abuse, Francesca was put on psychiatric medication; her brother was not held to account for his behavior. Thirty years later Francesca still shakes when recalling how her parents instructed her to tell Child Welfare Services that it was her late grandfather-not her brother-who had molested her. Before her fourteenth birthday she ran away from home to escape the abuse. By the age of fifteen she had met an older man, and as soon as she turned eighteen, she married him. Together they had two sons; a third pregnancy was aborted at her husband's insistence. Francesca recalls the years when the boys were young as the happiest in her life. She loved, and still loves, being a mother. For ten years or so Francesca supported the family, working as a waitress while her husband used the family funds to support his drug habit. An abusive man, he beat her up badly and often, kicking out her teeth, breaking her ribs, and stabbing her in the stomach, as a result of which she had a hysterectomy. Just as bad, according to Francesca, he "destroyed my self-esteem," repeatedly telling her that she was fat and that no other man would ever want her. Despite it all, Francesca managed to work at a series of low-paying, physically strenuous waitressing jobs through her late twenties. When her father became terminally ill with cancer, she quit her job to nurse him. At his death, he left the family home to her to live in and pay the mortgage on. Several years later, "out of the blue someone from the bank showed up," and she and her children were told that they had to move out immediately. It turned out that her husband had fed his drug habit with the money she had given him to pay the mortgage.

By the time Francesca's marriage ended, she was living with multiple, painful chronic conditions, some the direct legacy of her husband's violence: osteoarthritis (a consequence of his beatings), degenerative disk disease with chronic pain and swelling in her back, a broken nose that interfered with her sleep, broken teeth, and panic attacks. She also was diagnosed with hepatitis C and rheumatoid arthritis. Although the hepatitis C is destroying her liver, Francesca is more worried about the visible conditions, especially the rotten teeth and the scarred skin that make it difficult for her to find a job or, in her words, a "good man." Doctors prescribed Percocet for the chronic pain that she developed from the beatings, as well as a pharmacopeia of psychotropic drugs for "my anxiety and bi-polar." It did not take long for her use of Percocet and anti-anxiety medication to escalate into addiction. When the doctors wouldn't write any more prescriptions, she turned to heroin. The intense heroin use lasted for about a year. Percocet remains her drug of choice.

In 2001 Francesca served her first prison sentence for larceny. While she certainly was willing to shoplift or sell an occasional prescription pill in order to scrape by, this charge was tied to her husband having passed bad checks in her name. During the year in jail, her brother (the same one who had molested Francesca) requested and received custody of her children. The state paid him $1,000 a month for each child, and to this day Francesca believes that he wanted the children only for the money. Upon leaving prison, she found that she had lost her Section VIII (federally subsidized) housing eligibility "because I didn't tell them I was in jail." She is indignant about that regulation. "What did they want-that I call collect from jail?" she asked, dripping sarcasm.

Cycles of Violence

When Francesca first told us about her life, we couldn't understand why she left an abusive father and brother only to marry an abusive husband. Nearly all of the Boston women in the project have suffered multiple sexual assaults. With very few exceptions they spent their childhood years in households where male violence against girls and women was commonplace. Nearly all witnessed fathers, step-fathers, or mother's boyfriends physically hurt and psychologically humiliate and control their mothers. Almost all have been raped as adults or been involved in relationships with battering men, or both.

In their encounters with gendered violence the Boston women are not unique. According to the 2010 National Intimate Partner and Sexual Violence Survey (Black et al. 2011), in the United States, on average, 24 people per minute are victims of rape, physical violence, or stalking by an intimate partner; more than 1 million women are raped yearly. Nearly 1 in 5 women has been raped at some time in her life; 1 in 4 women has been a victim of severe physical violence by an intimate partner in her lifetime; 1 in 6 women has experienced stalking victimization during her lifetime; and almost 70 percent of female victims experienced some form of intimate partner violence for the first time before the age of twenty-five (Black et al. 2011). Across the United States an estimated 30 percent of women have been targets of sexual or physical abuse, and nearly 1 in 5 girls ages fourteen to seventeen has been the victim of a sexual assault or attempted sexual assault. A history of sexual assault increases the likelihood of further sexual assault (Finkelhor et al. 2009).

Sexual assault is not a deviant act by a deviant man against an exceptionally unfortunate woman. Rather, it is part of a social cycle in which systemic gender inequality produces gendered violence that then reinforces gender inequality. Together with other structures of dominance, rape is a forceful weapon in the wider arsenal of tools used to generate and preserve gender inequality (Brownmiller 1975; see also A. Davis 1981, esp. p. 178; Hunnicutt 2009). As a "cultural mechanism for inducing a significant transformation of consciousness" (Morris 1991, p. 181), rape reinforces gender stereotypes of masculinity and of femininity.

Gendered violence is always embedded in wider landscapes of inequality. Examining a wide range of cultures around the world, anthropologist Peggy Sanday (2003) found that the incidence of rape is lower in societies in which men are raised in peaceful, stable environments with an ethos of mutual respect and cooperation between men and women. Conversely, societies that promote gender inequality have more cases of domestic abuse and violence overall (Tracy 2007). Turning to the United States, we observe that American women have the same responsibilities of citizenship as men do (women and men are held to the same set of laws and pay the same taxes), yet women earn 77 cents on each dollar earned by men (White House Council on Women and Girls 2012). For American women, the power to make their own reproductive decisions is limited and in some cases outright denied. While women have made strides in the public sphere, they remain grossly underrepresented in the highest levels of government where the most consequential decisions are made. The United States currently ranks 81st among nations worldwide in the inclusion of women in government, and 22nd in the economic, political, health, and education status of American women (Hausmann, Tyson, &amp Zahidi 2012).

Gendered violence begets more gendered violence. For the perpetrator, carrying out an act of aggression with impunity feeds a sense of entitlement or, at the very least, a sense that one can get away with it. The majority of rapists and batterers are serial offenders who abuse more than one woman over their lives (Tracy 2007). Donna, a high-energy white woman in her forties, grew up in a home in which her father and brothers were physically and sexually abusive to her and her sister. "My mother was too afraid to say anything," she told us. "My mother would send one of the girls into the bathroom with toilet paper for my father. We all knew what was going on." Although she left home to escape her father's abuse, she quickly found herself married to a controlling and violent man. Donna explains, "I think the reason he hits me is because his father always hit his mom."

As one might expect in light of Francesca's childhood experiences, battering fathers tend to be authoritarian, controlling, self-centered, and undermining of the mothers. They are also many times more likely than nonbatterers to sexually abuse their children, especially their daughters (Bancroft, Silverman, &amp Ritchie 2012). Thus Francesca's "typical macho Italian father" ruled over her timid, ill, and eventually suicidal mother at the same time that her "scumbag" older brother was raping her. Like many abused girls, Francesca criticizes her mother rather than her father for allowing the abuse to happen. Although it sounds to us as if her father held all of the power in the house, Francesca has elevated him to the realm of sainthood-especially now that he is dead. In blaming her mother more than her father, Francesca follows the public tendency to hold mothers more responsible than fathers for protecting their children from a cruel world over which parents have little control. Still today, when Francesca considers the misery in her life and the lack of adequate assistance with money, housing, and personal safety, she, like most of the other women, tends to blame (female) caseworkers, nurses, and parole officers far more than she blames the (male) politicians and power brokers who make the policies and control the national purse strings.

The physical and psychic scars of sexual violence direct the attention of the women who bear them to their gender, setting them up for lives in which they are never simply "human" but always "woman," an identity largely defined in terms of sexual victimization and gynecological suffering. What we are describing here is gender overdetermination: a social process in which cultural categories of gender supersede individual experience and identity (Boddy 1988; Sered and Norton-Hawk 2013). Gender overdetermination intersects in complex ways with other statuses and identities. In a multicity study, Stephanie Riger and Margaret Gordon (2010) found that women with the fewest resources-the elderly, members of ethnic minorities, and those with low incomes-carry the heaviest burden of fear of victimization and a heightened sense of powerlessness. While for some women, abuse and its aftermath can lead to new kinds of resilience or to meaningful advocacy and activism, few of the Boston women we have come to know see possibilities for jobs, happiness, or self-fulfillment that are not constrained by gender. Their gendered pain becomes the veil through which they experience their own bodies and lives.

Sexual abuse has broad and long-term consequences that function to perpetuate social inequalities. Childhood abuse is correlated with bruises, fractures, urinary tract infections, delayed physical growth, neurological damage, chronic fatigue, altered immune function, hypertension, obesity, depression, suicidal thoughts and attempts, risky behaviors, substance abuse, and in extreme cases, death (Herrera &amp McCloskey 2001; White, Koss, &amp Kazdin 2011). Women who have been abused by intimate partners or who have been sexually assaulted are more likely than other women to suffer from chronic pelvic pain, fertility problems, high rates of pregnancy complications and perinatal death, gastrointestinal disorders, arthritis, invasive cervical cancer, hypertension, urinary tract infections, anxiety, and sexually transmitted infections (Martin, Macy, &amp Young 2011).

A history of having been abused is correlated with a lifetime of earning less money, missing more days of work, and a greater likelihood of becoming homeless (Dáil 2012, p. 17). A twenty-three-city report by the U.S. Conference of Mayors (2007) confirmed that domestic violence is the primary cause of homelessness for women. For Francesca, poor health clearly renders her unemployable, which makes her more dependent on men and thus more vulnerable to additional sexual violence. For Francesca, as for many women, the physical and emotional suffering resulting from rape, abuse, and sexual coercion led to use of drugs and alcohol. Women who have been raped or abused are more likely than other women to live with multiple chronic illnesses, to be charged with a crime, and to be incarcerated (McDaniels-Wilson &amp Belknap 2008; Pelissier &amp Jones 2006). The impact of violence is cumulative: women who have experienced or witnessed greater numbers of abusive events report higher rates of eating-related problems, greater incidence of STDs and hepatitis, overall poorer self-rated health status, earlier involvement in crime, and more arrests.

Criminalized women are twice as likely as other American women to report childhood sexual abuse (24% versus 45%) and more than three times more likely to report family violence while growing up (14% versus 48%) (Messina &amp Grella 2006). Like Francesca, nearly all criminalized women have experienced poverty, abuse, insecure housing, chronic physical and mental distress, separation from their children, and a host of day-to-day degradations and misfortunes. Nationally, at least 70 percent of incarcerated women report having been raped at some point in their lives, typically more than once and often by multiple abusers; more than 10 percent report gang rape; and 22 percent report anal rape (McDaniels-Wilson &amp Belknap 2008).

As Francesca learned from her first experience with the institutional circuit, the dominant model for explaining these connections singles out childhood abuse as causing lasting psychological damage that in turn leads to drug use and victimization. While this causal chain fits the American narrative of individual responsibility, connections between gender violence and incarceration are far more structural. Running away from home in the wake of sexual abuse launches girls into environments permeated with gendered violence, both on the street and in juvenile facilities. Children who suffer sexual assault are less likely to succeed in school, less likely ever to earn a living wage, and more likely to be incarcerated (Child Welfare Information Services 2008). In fact, running away from home-often to escape abuse in households dominated by violent men-is the charge in the first arrest for nearly a quarter of girls in the juvenile justice system. According to Meda Chesney-Lynn and Lisa Pasko (2004, p. 28), "Young women, a large number of whom are on the run from sexual abuse and parental neglect, are forced by the very statutes designed to protect them [statutes disallowing juveniles from leaving custodial parents] into the lives of escaped convicts. Unable to enroll in school or take a job to support themselves because they fear detection [which may result in their being returned to the abusive household], young female runaways often turn to or are forced onto the streets. Here they engage in panhandling, petty theft, and occasional prostitution to survive." On the streets, women are vulnerable to harassment, violence, exploitation, and drug use, all of which drag them into the correctional circuit, where, far too frequently, they experience further abuse.

Girls and women who have experienced abuse are also more likely to be drawn into prostitution (Martin, Hearst, &amp Widome 2010). Estimates suggest that among women working in prostitution, as many as 75 percent were sexually abused as girls (Nixon et al. 2002). In Francesca's case, the constellation of aborted education, meager employment prospects, emotional exhaustion, and immersion in a cultural setting in which sex has more to do with power than with love set her up for sex work. And while paid sex work is not infrequently portrayed as romantic (think of the film Pretty Woman), lucrative (though this is true only in the rare cases of famous madams who supply prostitutes to politicians and celebrities), empowering (think Breakfast at Tiffany's), or funny (as in, for example, Deuce Bigalow: Male Gigolo), in our many conversations and interactions with women who have worked in prostitution, we have never glimpsed a hint of romance, humor, resistance against social norms, big bucks, or pride. The women we know make it clear that sex is not in any way equivalent to other paid or unpaid labor; to work in prostitution, a prostitute must disengage the self or "go numb." While "viccing" (cheating or victimizing) male customers sometimes may be seen as a form of resistance against male power: "Ironically, it is this very resistance which serves to (re)produce them as 'criminal' women at risk for violent retaliation" (Maher 2000, p. 130). The death rate among women in prostitution has been estimated at forty times higher than that of the general population, and a mortality survey of more than 1,600 women in prostitution found that no other population of American women has a death rate even approaching that of prostitutes (Farley 2004).

Francesca

After the strip club gig ended, Francesca picked up a series of day jobs giving out free samples of juice "from an Amazonian rainforest fruit known since the dawn of time for its rejuvenating properties," selling beauty supplies from a table outside a tourist information center, and loading the truck for a one-man moving company run by a Christian pastor she dated for a few months. Homeless, Francesca couldn't provide a place to live for her kids (one in his late teens, the other in his early twenties), but she did her level best to help them network with potential employers and to arrange for them to stay with friends and pay for their cell phones so that they could stay in touch with her. When her younger son was arrested for assault and battery (with a great deal of pride she told us that he had beaten up a man who was trying to hurt a girl), she met him at the police station and put money in his canteen so that he could buy coffee and snacks in jail.

Within a year she met Chris. His blond hair, blue eyes, and wiry build made it easy for Francesca to fall in love with him. In a whirlwind of dress shopping and flower arranging, she married him in a small ceremony on the beach followed by a party at a local karaoke bar. In the first months of their life together, she was delighted with what seemed a Christmas-card home life: he lived with his extended family in a small town two hours away from the drugs and temptations of Boston. Francesca moved in, hoping that her children would join the household and that they could live like "a real family" again.

But things soon turned sour. Because their house was not within walking distance from any town, Francesca depended on Chris's family for rides to the store, to work, or to Boston to see her children. Chris wanted to be with her "every minute," carrying on if she went out without him for even a few minutes. As things deteriorated, Chris began insulting her, pushing her buttons by calling her "fat ass" and "ugly," and accusing her of cheating on him. One morning he broke her cell phone and removed the chip (SIM card) with her phone numbers, making it nearly impossible for her to call on friends for help in finding another place to live. Hitchhiking and begging rides, she returned to Boston and moved in with an acquaintance. That arrangement seemed to be working out until Chris called the police with a "tip" that there were drugs in that apartment. There were no drugs, but the police checked everyone's identification, and Francesca was locked up on an outstanding warrant-she had not been able to pay restitution on a breaking-and-entering conviction ten years earlier. While she was in prison, the friend she was staying with was evicted, and all of Francesca's possessions, including her ID and her dentures, were thrown out.

After serving a brief jail sentence she tried to look for a job, but with no teeth or decent clothes she was unemployable. Out of desperation she reunited with Chris, who by that time had moved out of his sister's house. The two stayed for a few days at a time with various relatives and then settled in for several weeks with her younger son's friend. That worked reasonably well until Chris tried to knock down the door of a neighbor. As had become our routine, Francesca called us and asked us to pick her up. With all of her earthly possessions in one small plastic bag, she next stayed for a few days each at the homes of various friends, moving on when Chris stalked and found her. During this time she contracted pneumonia and her hepatitis C began to flare up. Her stomach became visibly distended; she had pain in her side and several episodes of vomiting. By early winter her feet and legs had swollen up, and she was making frequent trips to her doctor and the hospital. At one visit she was told that she might have a blood clot in her heart, and an appointment was scheduled for her to see a cardiologist two weeks later. Francesca's posture changed-she no longer stood up straight. Even her hair lost its luster. With none of the bravado she had displayed just two years, Francesca sighed, "I'm just tired of everything."

Frequent trips to doctors and hospitals became routine for Francesca. Her need for medical treatment was driven both by the violence and poverty in her life and by her sense that she needed a doctor's validation in order to receive recognition as well as medication for her pain. Over the next few months Francesca lost close to thirty pounds, her stomach became bloated, and she developed rectal bleeding. The doctor told her that she had "a mass the size of a small apple and probably colon cancer," and scheduled her for a colonoscopy. The afternoon of the colonoscopy Francesca called us from the hospital in a panic. She had spent the previous night trying to sleep on an air mattress on the floor of her son's girlfriend's parents' apartment, where she had carried out her colonoscopy preparation according to the instructions she received (instructions that did not take into account that she would be sharing a bathroom with six other adults and a baby). The apartment was located a good thirty minutes by car and ninety minutes by public transportation from the Boston hospital, so she had arranged with a friend of her son (one of the only people she knew who had a car) to drive her to and from the appointment. However, when it was time for her to be picked up at the hospital, he didn't show, and the hospital would not allow her to leave without an adult escort (which is the typical protocol for procedures that involve sedation). "Please," she asked us, "could you come pick me up?"

Knowing firsthand how miserable the whole colonoscopy experience is even in the best of circumstances, we drove posthaste to the hospital, where a forlorn Francesca was sitting on a bench waiting for us to pick her up and walk with her to her primary care doctor's office in another wing of the hospital complex. Earlier in the day she had spoken to a nurse in his office and had arranged for her doctor to leave a prescription for Percocet at the desk. The envelope with her name on it, however, contained only a form for blood tests, and no prescriptions for pain medication. We sat, and sat, and sat while the receptionist looked around the office for the prescription. After an hour during which Francesca looked as if she would melt in her chair (she had not yet eaten that day), the nurse came out and called us into an examining room. Francesca explained what had happened, the nurse went out to speak to the doctor, and after another hour of waiting, the doctor came in, barely glanced at Francesca, and told her that he was not comfortable giving her Percocet, that she should take 800 milligrams of Motrin instead. Half in tears with postcolonoscopy exhaustion, she reminded him that when she was in his office the week before, she had told him that she had been taking Motrin for her arthritis and that he had told her to stop because she had taken far too much. Barely listening to her recounting (his attention was on the computer screen), he wrote a prescription for Motrin and told her she would need to go to the pain clinic. He left the room, and we sat and waited for another half hour, thinking he would return with a referral. Deflated, Francesca (more sensible than I) realized he would not be coming back; the medical assistant soon confirmed that "he was finished" with us. Not only did Francesca not receive a referral that day, but six months later the doctor still had not met with her to go over the colonoscopy results. We still do not know why.

At the time, less than half a year into our project, we could not comprehend what happened at the doctor's office. In retrospect, we understand that the doctor assumed that Francesca was "pill-seeking." Though young, the doctor must have known that by turning her away, there were two possible outcomes: she'd go to an emergency room (at great cost to the health care system), or she'd buy pain pills illegally on the street, putting herself into the dangerous hands of drug dealers and setting herself up for another prison sentence.

Francesca prides herself on being a "survivor." Finished with Chris, she moved in with a friend whom she had met in prison. Known as "Mama Fran" to the women of MCI-Framingham, Francesca embraced the opportunity to help out a former associate who was suffering from debilitating depression. In return for a place to stay, Francesca took over care of her friend's household and children. Francesca's younger son, now twenty and the father of an infant, moved in with them as well. Delighted to be a grandmother, Francesca regained much of her old bravado, revamped her wardrobe, and cut down on her Percocet use during her grandchild's visits.

In the summer of 2011 she met Joey, and the Francesca's old exuberant persona returned in full force. "Joey is the love of my life!" she gushed. "He knows how to treat women. He buys me things and kisses me on the forehead and tells me that I am beautiful and deserve good things." A short, bald ex-con who had been out of prison for almost three years, Joey had a steady job and lived in a two-bedroom apartment furnished with an air mattress, an enormous television, and little else. Within a month of their meeting she moved in with him. Joey was generous to Francesca's children, warmly welcoming them for weekend visits. In Francesca's words, Joey was "a family man," and from the start she looked forward to celebrating a "real Christmas"-her first in a long time-with "my man and my kids."

High on the list of Joey's good qualities was his promise to support her so that she could take care of her health problems. Within a few months of meeting Joey, she planned to have surgery to fix her teeth, nose, throat, back, and hip (all injuries caused by her ex-husband). Before she could get to these surgeries, however, she had to take care of an immediately pressing health issue: flying debris during a storm scratched her cornea. Once her eye healed, she had surgery to remove all of her teeth and grind down and fix the bones in her upper mouth.

Christmas 2011 was a big day for Francesca. The living room-still empty of furniture-had plenty of room for the elaborately decorated tree and the piles of Christmas gifts Francesca had obtained through a local charity. We arrived just in time to see her son charge into the living room to peer inside his Christmas stocking (Francesca had filled it with candy and cigarettes). Beaming with pride, Francesca unwrapped the Chanukah cookies she had bought especially for Susan. Her e-mail message on Christmas proclaimed: "♥ IM TRULY BLESSED AND I GET TO SPEND TIME WITH BOTH MY KIDS TONIGHT AND MY MAN. . . . FAMILY IS WERE ITS @. . . . CANT PUT A PRICE TAG ON THAT . . . (PRICELESS) ♥"

Like nearly all of the other Boston women, Francesca craves a life that matches her idealized vision of middle-class gender normativity. When she and her friends speculate about what their lives will be like in five years or ten years, they offer one of only two scenarios: either things will stay as bad as they are now and they likely will be dead; or they will live with their children in a Leave It to Beaver-style, 1950s house with a white picket fence and a friendly family pet. Francesca on occasion allows herself to dream aloud: "I will own a house, have a dog and my two boys with me." As both of her boys became fathers over study's five years, her dream home evolved to include cooking and baking for her grandchildren when they come for frequent and lengthy sleepovers.

Once her mouth, eye, and various other body parts healed, Francesca felt healthier than she had in a long time. She worked for a while at a diner owned by an Italian family. Thrilled to be serving up authentic Italian food, Francesca treated us to a platter of spaghetti and sauce. But the job was very part-time with no real schedule: the boss would call her in only when the restaurant needed her and paid her under the table. When that job petered out, she was hired at a Dunkin Donuts where she worked erratic, long shifts at the whim of the manager. Standing at work exacerbated bone spurs in her foot. Her doctor gave her an orthopedic boot to wear, but the boot caused her to trip at work. She was not called back in. Without a job she was dependent on Joey for food, shelter, and pocket money. While he sometimes spontaneously gave her twenty dollars for a "mani-pedi" (Francesca loves bright patterned nails), at other times he would "call me a fat cunt" or "say my cooking is bad and throw it out the window" and "throw it [the new pocketbook, manicure, shoes, etc.] back in my face." On one occasion, "Joey spit on me. He doesn't trust women."

Living with Joey did allow her to arrange surgery for her foot. But in late April 2012, when Joey kicked her out and we came to pick her up, she was standing on the curb with her possessions in a few bags and her foot still in a cast. After a few half-hearted declarations of "Joey doesn't deserve a woman like me," Francesca fell into an uncharacteristic silence. Per doctor's orders, she kept her foot elevated-propped up on the dashboard of the car as we drove her back to the apartment of the friend she had been staying with before she moved in with Joey.

Victims, Perpetrators, and the Social Foundations of Sexual Violence

Why-despite our society's efforts to help victims of violence-do Francesca and so many other women continue to suffer assaults, abuse, sexual exploitation, and rape? The federal Violence against Women Act, signed into law by President Bill Clinton on September 13, 1994, increased penalties for repeat sex offenders, trained law enforcement officers to deal with victims of sexual offenses, and established the National Domestic Violence Hotline. Most cities like Boston have police, social workers, psychologists, battered women's shelters, rape crisis hotlines, mandatory reporting requirements-surely these have solved the problem of violence against women. Yet notwithstanding public proclamations that raise awareness of childhood sexual abuse, date rape, and domestic battering, mainstream social responses to sexual violence have not been particularly helpful; they have not changed the culture of violence that endangers women, children, and many men; and rates of gender violence have not declined.

Despite strong evidence linking gender inequality to higher levels of violence, contemporary American law and culture continue to address gender violence as an individual tragedy rather than a product of inequalities or structural violence. During the years Francesca lived with her ex-husband, she was a "frequent flyer" at her local emergency room. "They [the hospital staff] knew what was going on," she told us. Often, they would admit her for a day or two "to give me a break." For the most part, the staff treated her well, but hospitals do not have the resources to provide financial independence or stable housing for the millions of American women who suffer abuse. When we asked Francesca if she had ever gone to a battered women's shelter during the years that her ex-husband regularly beat her, she shrugged, "What was the point? They couldn't do anything." Battered women's shelters provide a temporary escape from a battering man, but are not positioned to solve the underlying problems of poverty and violence. "How about reporting him to the police?" we asked. That was not even a possibility, Francesca explained, because Child Welfare Services could have used domestic violence as a reason to take her children away.

The dominant American paradigm according to which sexual violence is understood to be the aberrant actions of a single perpetrator against one or more specific victims cannot eliminate violence against women. Indeed, certain public policies, inadvertently or not, exacerbate the potential for violence. In response to police inaction regarding domestic violence, many states have passed mandatory arrest laws that require the police to arrest abusers when a domestic violence incident is reported. While this is a good idea in principle, women who report abuse risk further harm when violent men get a day or two in jail and come out even angrier and more likely to batter the women or their children (Davis, Weisburd, &amp Hamilton 2010; Iyengar 2007). Pouring salt on the wound, women who report abuse may find that they themselves are evicted from their homes. Vanessa, for instance, lost her government-subsidized housing because her violent and psychopathic former boyfriend stalked her. In the private housing sector, "nuisance" ordinances that sanction landlords for their tenants' behavior have been used to punish women for reaching out to the police for assistance. In Milwaukee, over a two-year period, nearly one-third of all nuisance citations were generated by domestic violence, and "most property owners 'abated' this nuisance by evicting battered women" (Desmond and Valdez 2012, p. 117). At least some, and possibly many, of these women end up homeless and thus even more vulnerable to violence and abuse.

Although the United States has the highest incarceration rate in the world, the majority of those accused of rape are not arrested, and even when a rape charge is brought to court, the accused is often acquitted or pleads out for no jail time (Koss 2006). Of those accused, only an estimated 5 percent are convicted of rape, and only 3 percent spend any time in jail (cf. RAINN 2009). The National Violence against Women Survey (Tjaden &amp Thoennes1998) analyzed 2,594 separate rape incidents among 8,000 female respondents. Of these 2,594 rape incidents, only 441 were reported to police, 33 were prosecuted, 13 were convicted, and 9 were jailed. Data are scarce, but studies show that even in rape cases with biological evidence, such as matching semen or documentation of anogenital injury, less than a third of such cases made it to trial (Koss 2006).

When women are frightened, bullied, or simply strung along into agreeing to lesser charges, and when the majority of rapists serve no jail time, there are spillover consequences for society as a whole. Every rapist who is exonerated (whether by the victim, her family, or the criminal justice system) fuels men and women's acceptance of the classic rape myths-that women often falsely accuse men of rape for revenge ("Hell hath no fury like a woman scorned") or to cover up their own promiscuous sexual activity. As a consequence of treating violence against women as individual acts of criminality, the character of the particular victim becomes relevant to the outcome of the case. Rape is one of the few crimes in which the victim is scrutinized for ulterior motives, false accusations, or signs of moral deviance. Victims least likely to see offenders convicted are older, are poorer, are deemed promiscuous or prostitutes, have a history of psychiatric diagnosis or drug abuse or a criminal record, did not overtly resist or were acquainted with the offender, or had a history of previous rape or abuse (Koss 2006).

Joy, a woman in her mid-thirties whom Francesca has tried to help, has bounced among the street, rehab facilities, and prison for more than a decade. Far less assertive and self-reliant than Francesca, Joy has not had a safe and stable place to live since she ran away from home as a teenager in the wake of sexual abuse. A few years after we met, she was brutally raped in her room in a "sober house" (housing for recovering addicts; we present more on Joy and on sober houses in chapter 6). When Joy went to court to testify against the rapist, the case against the perpetrator seemed ironclad. DNA evidence had led to his arrest originally-his DNA from a previous rape charge was found in the police computer system; police offers and crime scene officers testified; other witnesses from Joy's building testified; the emergency room nurse who examined her after the rape testified in court. However, the accused was found not guilty. Joy couldn't understand why. "The last three questions the defense attorney asked me are: Isn't it true that you were in prison? Isn't it true that you are an addict? Isn't it true that you used to work in prostitution?"

While the notion that women who are victims of sexual or domestic violence bring their suffering on themselves is rarely declared aloud in twenty-first-century America, its currency is manifested through programs aimed at trying to reform or modify the victim's behaviors or attitudes. All of the Boston women, including Francesca, have been sent to therapeutic programs and spend many hours each week watching television shows that feature pop psychologists who explain the high rate of adult victimization of girls who grew up in abusive homes in terms of trauma that leads to poor self-esteem, emotional distress, and an unhealthy desire to harm oneself. Psychologically damaged by childhood sexual abuse, these poor, unhappy women are said to lack the sense of personal self-worth and autonomy believed necessary to avoid abusive relationships later in life (Van Bruggen, Runtz, &amp Kadlec 2006). This common wisdom, while kinder than older theories that saw abused women as liars, temptresses, or moral failures, still falls into the trap of stressing the character of the victim instead of the social forces that create situations of violence (cf. McKim 2008). In fact, psychologists have come up with no consistent profile for women susceptible to domestic violence (Herman 1997).

The messages conveyed by correctional, welfare, and therapeutic institutions all link women's criminalization to their sexual victimhood; they are told that the same character flaws are the cause of both and that if they continue making bad choices they will continue being victims and they will continue being locked up. While victimhood may sometimes elicit sympathy, in much of mainstream American culture being a "victim" is denigrated as an indulgent choice, and "claims of victimization are scrutinized through a diagnostic lens as symptoms of impaired character rather than as matters of verifiable fact" (Cole 1999, p. 7). Victim blaming is made explicit when the victim is accused of having brought her suffering on herself by hanging out with the wrong crowd, wearing the wrong clothes, or going to the wrong places. Victim blaming takes a more subtle form when we publicly celebrate cancer "survivors" for fighting the disease, which may imply that those who do not survive-and who tend to be erased from public view-"gave up" or "fell victim to cancer." A corollary of victim blaming is the notion that one can refuse to be a victim, a claim suggesting that individuals have a choice in the matter. Indeed, blaming others for one's misfortunes is often seen as "an expression of weakness, moral or psychological, and a dangerous abdication of personal responsibility" (Cole 2007, p. 109).

The focus on the character flaws of individual perpetrators and victims obscures the structural inequalities that foster a great deal of the violence and suffering experienced by so many women and men. When hate-based violence is interpreted as idiosyncratic or aberrant rather than consistent with societal norms, resources are often poured into "correcting" victims through psychological treatment and into "correcting" perpetrators through penal treatment "rather than on dismantling the systemic forces that promote, condone, and facilitate . . . violence" (Mogul et al. 2011, p. 126).

Although only a small percentage of rapists and abusers serve substantial prison time, throughout the current age of mass incarceration millions of men have been thrown into the hypermasculinizing pressure cookers known as jails and prisons that exaggerate the gender inequalities that underpin violence against women. In overcrowded jails, men and boys learn that in order to survive, they have to become "tough" and "numb to the pain of others" (Sabo, Kupers, &amp London 2001, p. 15; cf. Courtenay 2011, esp. p. 218). "Rape-based relationships between prisoners are often described as relationships between 'men' and 'girls' who are, in effect, thought of as 'master' and 'slave,' victor and vanquished" (Sabo 2001, p. 64). When men are released from prison, women easily become the targets of the rage, confusion, and exaggerated machismo that build up during incarceration. As Francesca told us one evening after Joey had spit on her, thrown the food she cooked out the window, and accused her of having sex with other men: "He has this man shit about him. Prison messed up his head. In jail people respected him-didn't mess with him. . . . He doesn't trust women."

Francesca

After the surgery on her foot Francesca rested at her friend's apartment for a few weeks. Before her foot had fully healed, she decided she needed to start over with a clean slate: she would move to Florida to live with a man she had known years earlier. He sent her a bus ticket and picked her up at the station in Miami. Things were wonderful for a month or so while Francesca was passionately in love (according to posts she made several times each day on Facebook), but then "he told me he's not feeling it." Determined to stay off Percocet, she moved in with new friends she had made in the local Narcotics Anonymous community in Florida. These friends helped her find short-term jobs cleaning houses, painting, and waitressing. But after a few weeks her surgically treated foot began to throb. Not eligible for health insurance in Florida, she got on the bus and returned to Boston.

At the bus station we had trouble spotting her. No longer able to walk, we found her sitting on top of her suitcase, hunched over. By the time we arrived at the emergency room, her foot had swollen to twice its normal size and was bright red and oozing pus. Within ten minutes she was whisked back to surgery; the doctor later told us that she had come within hours of losing her foot. A week in the hospital provided Francesca rest, a respite from pain and homelessness, and a nice supply of her beloved Percocet. The day before she was to be released, she invited Joey to visit her. He seemed sullen, barely greeting us. But after we left, "I gave Joey a blow job," Francesca told us later. The next day she moved back in with him. A few days later her younger son joined them, and then a few months later her eldest son moved in as well. No longer in love with Joey but needing a place to stay, she sighed, "It is what it is. You do what you gotta do." A sentiment expressed by women around the world.