Alexander Krivitskiy
why coercive control
is so often misread
The person who looks less credible
Years ago, a woman came to see me after something had happened at home that she could barely tell me without crying. I have changed identifying details, as I always do when I write about patients, but I remember the clinical encounter because of what she kept saying to me: “The woman was real.”
She was living in her fiancé’s house and was financially dependent on him at the time. Their work schedules were different, and one day she unexpectedly came home and found him in bed with another woman.
By the time she took a seat in front of me, she already knew what she had witnessed. The fact that she had started to question it was what scared her the most. She did not have a photograph. Of course she didn’t. Most people don’t think of taking photographs when they catch their partner in the act of infidelity. Photographs aren’t relevant in that situation. They tend to think of other things.
“The woman was real,” she repeated.
I was fairly certain that she believed what she was telling me. However, in my role as a psychiatrist, I had to consider something disturbing. If I had joined the story at a later point, with no prior knowledge of the relationship, the clinical scenario could have looked dramatically different. This was a clearly distressed woman. She was convinced she had seen someone that her partner denied had ever existed. She was upset and frightened. She was beginning to wonder whether she could trust her own mind. Her partner, according to what she told me, had remained calm.
This example is definitely different from the others. The way coercive control shows itself is usually more subtle than making a woman disappear and leaving an unmade bed. I come in after the first events have occurred. By the time I see the patient, I am usually seeing the person who has already lived through what happened.
That person may even appear less deserving of belief than the person who caused the reaction in the first place.
What chronic coercion does to the brain and body
By the time someone has lived with coercive control for months or years, I am not just focused on what a person thinks when they have been subjected to coercive control. I am interested in what their brain has learned to understand and expect about the relationship.
The brain is constantly making predictions about where to direct our attention. Often we don’t even notice these predictions. I can sit in my office while the ventilation system hums above me and eventually stop hearing it, but immediately notice a change in someone’s voice tone. We can’t pay attention to everything around us at the same time. Some things get our attention while other things are ignored. If every sound, movement, or sensation required the same amount of attention, it would be very difficult to do anything else.
In a relationship even small changes in someone’s behavior, like the way they speak or interact, sometimes signal that something bad is going to happen. We start paying attention to little things, like where a person puts their keys or how they enter a room, because it can help us determine what is going to happen next. This is something people are typically really good at. The brain can learn changes that carry information, and over time it remembers small details that others may not find relevant. Silence may usually feel pleasant, but in some relationships it can foretell an argument. There may have been too many arguments to count, and after a while even silence may begin to sound different. Unpleasant changes can happen repeatedly, and small details may carry information that is not noticeable to others.
The principle involved in most forms of learning is as old as the experiment with Pavlov’s dogs. Basically, the idea is to link something that is neutral or irrelevant to the learning process to something that is important enough to be worth learning. In the case of Pavlov’s dogs, it was the sound of the bell that was used to signal the dogs to expect food, and eventually, the sound of the bell, by itself, caused the dogs to salivate. Of course, the learning process with people is considerably more complicated than with Pavlov’s dogs. However, like dogs, people can learn by association. People can learn to react in a certain way to other people by what they have previously learned to expect from that person.
These habits are learned subconsciously, and the body can begin responding to a cue without the person consciously realizing what it means to feel differently. My patient may describe, “I knew from the way he walked into the kitchen,” and be unable to explain what they noticed. I hear these sorts of things all the time, and they’re really not that surprising to me. People learn, often subconsciously, what sequences of events happen and the relations among them.
We have to look at how predictions are made. The brain can become very sensitive to a particular stimulus and still occasionally be wrong. With unpredictable threats, the unknown becomes something that is difficult to ignore. The person may keep looking at someone’s face or around the room, trying to figure out whether something is about to happen.
We also have limits to the amount of information we can hold in mind at one time.
Information is only briefly held in what is referred to as working memory. Working memory is used during a conversation to hold the beginning of a question while formulating an answer. When part of our attention is focused on a possible threat, we have less attention available for anything else. Similarly, if we are extremely emotional, that also takes up some of our working memory and our attention, and we can’t give it to something else.
I see the consequences of this in clinical interviews all the time.
A person may know perfectly well what happened and still tell it badly.
For example, the patient begins by stating that something happened on Tuesday. But then they jump back to three months prior because the patient believes they have to explain Tuesday. Then they realize they’ve forgotten to mention something that was important, and lose the original question in the process. Finally, the patient becomes embarrassed because they realize they’re not giving a coherent story. Ultimately, if I interrupt them too much, they become even more confused and lost about how to give their story.
When someone tells a story this way, it can look like dishonesty or unreliability. Sometimes it is. But I also see people become much more disorganized when they are extremely emotional. They have trouble keeping track of what they are trying to explain, especially when part of their attention is focused on something they believe is important or threatening. Stress does not turn off the prefrontal cortex. It is more accurate to say that stress impairs its functioning. As a result, individuals may have difficulty properly organizing their thoughts and ideas.
Stress can affect memory too. Memory is not a perfect copy of what happened.
Many factors can affect long-term memory, including what is going on around a person and how they are feeling at the time. Something a person can remember in a calm state may be much harder to remember when they are frightened, intimidated, or extremely emotional. The opposite can happen too. For example, something in the environment may bring a memory back that the person had been struggling to recall.
I am aware of how I interpret inconsistency.
When a patient says much more on Thursday than on Monday, I look for what was going on for them between those two days before assuming the inconsistency means something. It may be that they remembered something that aided their recollection, or that by Thursday they had sufficient reason to trust me to say the things they left out on Monday. I’ve also found that the presence of particular people in the room can affect a patient’s ability to think and speak. For example, if the person a patient is afraid of is no longer in the room, the patient may be able to talk about things that were too difficult to discuss in their presence. Inconsistencies do not necessarily mean a patient is being deceitful, but they still require an explanation.
The body remembers learned predictions very well. I know people who understood their relationship was over. However, a ring tone associated with their partner would still make their stomach drop. A separate person might feel anxiety associated with footsteps approaching their bedroom. They may also notice their heart begin to race when they hear a certain phrase, especially if that phrase used to come before a long and hostile verbal attack. The thing that triggers the reaction may be harmless by itself. However, because of what happened before, they may have learned to associate it with fear or anxiety.
Why survival behavior looks contradictory
I’ve evaluated individuals who could describe disturbing behaviors of a partner and then twenty minutes later, ask if they should call that partner because they were worried about them. People tell me they want to leave and then go home to that partner. Patients minimize situations that sound concerning and then become annoyed when a family member calls it abuse. Sometimes, they disclose something even more concerning to me when that person leaves the room. These situations can seem almost incomprehensible if you look at them as separate occurrences.
Freezing is not always just doing nothing.
Sometimes people are completely capable of speaking but unable to express what they want to say at that moment. They may even agree to something they oppose. Later, when they are no longer in that situation, they may be able to explain what they wanted to say or how they really felt. I’ve had patients become very frustrated with themselves because they think that if they can explain themselves clearly now, they should have been able to do the same thing then.
Appeasement usually occurs when someone is trying to keep the peace.
They may compromise or give in to a demand in an attempt to avoid an even bigger confrontation. Sometimes they may agree with something they don’t actually believe. People are typically aware of what they are doing to calm the situation. I have seen people show affection while still being angry, or stop trying to make a point because they already know where the conversation is going. Over time, people can become very good at figuring out what will calm the other person down. The difficult part is determining how free those choices really are.
I once met a patient who told me they had learned the art of apologizing to their partner. With a kind of dark amusement, they explained which kinds of apologies worked fastest. They had learned how much explanation to include without sounding dismissive or being accused of “making excuses.” They also learned how much responsibility to take to resolve the argument. They described learning to apologize in a way that allowed them to settle the argument without agreeing to things they didn’t actually believe.
They knew it too. What embarrassed them most was how automatic the apology had become.
Going back to the relationship often causes even more confusion for the people around them. Often, people assume that leaving helps answer the questions about the relationship.
Then they ask: Why return to a relationship if it’s intolerable?
The question has a lot of intuitive appeal, but it is important to note that people do not necessarily leave because they are no longer attached. People leave for a variety of reasons.
- People can leave and still go back to the abusive relationship when the person who hurt them shows kindness.
- People who leave may start to worry about how the person they left will survive without them, feel they owe it to the person to stay, feel afraid of finances, feel guilty about the children, or worry about what will happen to them.
- People may leave abusive situations and discover later that life outside the relationship is harder to manage and more difficult to access than they previously imagined.
People leaving abusive situations may still carry all of these fears and feelings with them. However, these feelings do not make the situation any less abusive.
I’ve had patients describe situations that are deeply disturbing and then almost immediately give a long explanation of the person who committed the disturbing act.
People focus on the external factors: the pressures that the person was under.
They give a history of the person, what happened to them as a child, and how nice they are to other people. As a result, I have had patients come to me, frightened by their partner, and then spend the rest of the appointment telling me how I can’t judge their partner.
This is not necessarily denial. Sometimes that is genuinely how the person experiences the relationship. Love does not always disappear when a relationship becomes harmful. People can and do behave abysmally, but often love just doesn’t disappear. Sometimes a patient can accurately recognize that an event happened, and still be unable to agree with what that event means about the person they love.
Not all contradictions indicate that someone is being coerced. People may contradict themselves for several different reasons. Those reasons might have nothing to do with abuse or trauma. It is not my responsibility to conclude that all inconsistency in people is pathological, or to assume that all of them are innocent. It is to refrain from drawing conclusions about behavior before understanding the context in which that behavior may have been helpful to the person.
Some behaviors can seem irrational or inconsistent once we see them outside the environment where they were learned, even though they may have made sense to the person at the time.
The credibility trap
I spend more time in courtrooms than I ever expected when I became a psychiatrist. Several times a week, I may be involved in commitment or guardianship hearings, often sitting on the side arguing for something my patient does not want. I know these patients outside the courtroom. I have spoken with them when they were calm, watched them reason through complicated decisions, and heard them explain exactly why they disagree with me.
Then I watch my patient testify and barely recognize the person speaking.
A patient who was perfectly articulate with me that morning before going to court may stumble over a simple question, lose the thread of an answer or become so overwhelmed that the judge is left listening to something almost impossible to follow. Sometimes they start answering a different question because they are desperately trying to explain the context. Sometimes their speech becomes halting in a way I have never heard in my office. And I can see the problem developing in real time: the harder they try to persuade the court that they are capable of speaking for themselves, the less capable they may appear.
I have seen this with individuals representing themselves during custody or disability cases. There have been cases I knew well enough to agree with the patient’s position. However, once they enter the courtroom and begin answering questions before the judge, they may not be able to give the same history with the same clarity they had when they told it to me. The other side often presents the case calmly and deliberately, using the language of the case and answering questions in a very exact way. By that point, the two sides may be telling the same history in completely different ways.
I have learned not to give too much weight to how calm someone appears.
There’s a great example of this in the movie Promising Young Woman, written and directed by Emerald Fennell. The main character, Cassie, changes the way people understand what is happening once they realize they were wrong about her. In one scene, Cassie appears to be very intoxicated. Because of this, people around her make assumptions about her and about what is acceptable to do around her. Then Cassie suddenly becomes completely lucid, and everyone has to understand the situation differently. Only about 30 seconds have passed. Nothing that happened before has changed, but the person everyone thinks Cassie is has changed completely.
There can be a particular kind of mismatch in coercive situations. One person may be fully prepared to give their account and completely at ease saying what they will say. The other person may understand that this is the moment when somebody is going to decide what happened to them. Being believed may be so important that they have more difficulty explaining it.
I have seen this happen many times and have learned not to confuse the better performance with the better evidence.
Watching this happen from both sides of the courtroom has made me think for years about writing something specifically for people who have to testify about coercive control. Not a book about how to sound more believable, because I dislike the premise already. I want to write about what happens to people when they have to describe some of the most frightening and humiliating experiences of their lives in a room where hesitation can be interpreted as uncertainty, emotion can work against them, and the person across from them may appear far more comfortable. I know there is a difference between telling the truth and being able to present it well under pressure. Those are not the same skill. The second one can be learned, and I would like to help survivors learn it without asking them to become less human in order to be believed.
The problem is that institutions make judgments about credibility all the time.
When the evaluator becomes part of the problem
I often think of The Yellow Wallpaper when I encounter questions related to situations like this. The narrator’s husband is her physician, and so when they disagree about her situation, the final word always lies with the husband. Once he decides what is wrong with her, almost everything she does can be absorbed into that explanation.
Her distress does not challenge his authority. It can be used to confirm it.
Similar things happen with medical records. I may write a note about a patient, and the next physician may read it before they ever meet that patient. It is hard not to let that affect the way they see the patient when they finally meet them. Usually a physician goes into an encounter to assess a patient, but once something is already written in the chart, it can be easier to notice the things that seem to support it.
When a patient is described as paranoid, another clinician may interpret an ordinary concern as part of the paranoia. Or when someone is described as difficult, people may expect them to be difficult before they even meet them. What is already written in the record can affect how their behavior is understood later.
I have seen this problem in the way concerns are raised outside of medicine as well. Quiet concerns are ignored. Often, they are raised with more and more urgency and sometimes even with an accompanying paper trail. Eventually, the institution in question ticks a box showing an internal record of the concern being raised. The record may show a paper trail, but it may not show what happened before the concerns were raised.
Words like labile, fixated, noncompliant, paranoid, or intense can be useful when they accurately describe what I am seeing in a patient. Are these words unfair? I don’t think so. I will use these words if I think they are warranted. However, these words are often used to explain a patient’s behavior rather than describe it. The result is that no one looks at what happened before that behavior appeared. Also, no one asks what the patient is actually responding to.
Even with experience, it can be difficult to know what is happening. The patient may be misperceiving a threat, but it is also possible that something is happening that I have not seen. Just because I have not seen what is happening does not mean that the patient is not perceiving what they say they are perceiving. I have to consider all of the possibilities and decide which one is most likely. I also have to be careful not to jump to conclusions and assume that what other clinicians have already written explains the situation.
The way a patient is initially documented can influence how that patient is perceived and understood by others. Patients sometimes believe that these descriptions are wrong and try to correct them. However, trying to correct that information can sometimes be interpreted as another example of the same problem.
At this point, the description can start becoming part of the case itself. The clinician is observing the patient, but the patient is also reacting to the way the clinician understands them. The description is not meant to represent what the clinician expects to see. However, by this point, those expectations may already be affecting what happens during the interaction.
What I actually want to know
When dealing with people who behave in ways that prompt others to give them extreme labels (i.e. frightened, suspicious, disorganized, etc.), I try to be thorough and find out what it was that caused the latest dramatic shift in their behavior, instead of making use of the easiest label.
- Has this person always been this way? If not, when did the change happen?
- What’s happened to them? Are they scared of something? Has that thing actually happened?
- Are there things that happen in some places but not others that help them piece their story together?
- Who is in those different places?
What happens when a person resists? I am equally curious to find out.
I have theories about why situations occur the way they do.
For example,
Why does the presence of certain people cause symptoms to almost disappear or feel more controlled?
Why is it that when someone leaves the room, symptoms often predictably and significantly improve?
I don’t assume allegations are true. This person’s behavior could certainly be affected by coercion from someone else. I still need more information before I can make that judgment. What bothers me is diagnosing a patient before there is enough evidence to really know what is going on.
I have found it useful to ask what happened to this person’s behavior when I am trying to understand a confusing history.
Often, this tells me more than simply asking what kind of person they are now.
I still think about what my patient said that day: “The woman was real.”
She wanted me to understand that she had seen something that I had not seen. What stayed with me was how frightened she had become of her own certainty. She had walked into that bedroom certain of what she had seen. By the time she was sitting in my office, she needed somebody else to help her decide whether she could trust herself.
I have spent most of my career trying to understand what symptoms mean.
Coercive control has made me more interested in what happened before those symptoms appeared.
I find myself asking that question more often now, especially when something about the presentation does not quite add up.
What happened to this person that made them become this way?
Vera Hart
