he first time I saw a demonstration of domestic violence (violence among family members including parents and children, or siblings) and its close cousin intimate partner violence (between spouses or romantic partners) in Lahore, I was taken aback. I was visiting from the US and had gone to a prominent girls’ college to give a talk on mental health. On the way out, I saw a young couple arguing and as I walked past them, I saw him raise his hand and slap her full across the face. This was in the afternoon, in full view of dozens of people standing around. As I watched, too shocked to respond, he barked something at her, turned around and strode off towards a waiting car. She bowed her head and meekly followed him into the car and they roared off. I have no idea who they were or what their relationship was but the incident is still etched in my mind as a demonstration of what millions of women go through every day.

Studies indicate that a staggering number of women experience intimate partner violence in Pakistan during their lifetime. Surveys have revealed that around 39 percent of married women have encountered physical violence, while 25 percent have suffered sexual violence at the hands of their intimate partners. Such behaviour, though distressing, often remains underreported due to fear of repercussions and societal pressures that discourage victims from seeking help or reporting abuse. Similar figures have been reported for domestic violence and are comparable across the SAARC region. Globally, intimate partner violence is a pervasive issue affecting millions. According to the World Health Organisation, approximately one in three women worldwide have experienced physical and/ or sexual violence by an intimate partner or sexual violence by a non-partner in their lifetime.

While a lot of attention has been paid to helping and rehabilitating victims of violence who are disproportionately women, less has been said about what can be done about the perpetrators who are usually (although not always) men.

An American couple comes to mind. She was our office manager and he worked in the IT department at the same clinic. I worked in a supervisory position at the clinic and was on cordial terms with both of them. They had met, fallen in love and married at the same job so we were all familiar with their ‘story’ and were happy for them. Until one day he confided to me tearfully how unhappy he was because she constantly berated and belittled him at home, refused to do anything around the house, made him do everything for their children (they had had twin babies soon after marriage) and sometimes slapped or otherwise physically abused him. He felt trapped, miserable and unhappy but did not want to lose his children. It was an eye opening experience for me since I had never before heard a story where a woman was the abuser. While domestic violence affects both genders, women disproportionately bear its brunt in Pakistan. However, instances of violence against men, though under reported due to social stigma, also exist and demand attention.

The usual pattern after a heinous incident comes to light, such as the Noor Mukaddam case or the Zainab Ansari case in Kasur, is outraged cries for barbaric vigilante justice, an outcry on media and social media for a few days and then silence.

While continuous evaluation and strengthening of the legal framework is necessary, more needs to be done. Providing shelters, legal aid, counselling and financial assistance to victims of violence is imperative but the rehabilitation of perpetrators is equally important. Intervention programmes aimed at addressing abusive behaviour, counselling for anger management and substance abuse treatment if applicable, are integral in breaking the cycle of violence. Programmes that engage men and boys in discussions about masculinity, healthy relationships, and non-violent conflict resolution are vital in preventing future occurrences of domestic violence.

These programmes should encourage accountability, promote healthy relationships and encourage the integration of perpetrators back into society as non-violent individuals. Mental health conditions in perpetrators like depression, unresolved trauma from the perpetrators’ past and personality issues need to be addressed by counselling and, if needed, psychiatric treatment and medications. Substance abuse, a common cause of aggressive behaviour, needs to be forcefully addressed. Access to mental health services, including substance abuse services is severely constrained in Pakistan because of economic reasons and, as pointed out in these pages many times before, needs to be made available to everyone who needs it. The role of government cannot be overlooked. Our national healthcare budget still does not allocate separate resources for mental health services and this must be addressed urgently.

Community involvement and awareness campaigns are instrumental in combating intimate-partner and domestic violence. Engaging religious and community leaders to advocate for gender equality and denounce violence is pivotal in shifting cultural attitudes. Media campaigns, workshops and school curricula promoting healthy relationships and non-violent conflict resolution can help reshape societal norms.

Last night, my 17-year-old daughter came home from a debating competition and regaled us with stories of her exploits. As she has begun to mature into a confident young woman, her two older brothers and I have learnt to temper our natural aggressive impulses and watch our words very carefully around her since any suggestion of male dominance is met with an immediate and forceful rebuke. Having grown up with no sisters, the transition has been interesting for me. My women co-workers at our hospital tell me that they like the new, ‘softer’ me. But it is not enough to wait for men to realise these things on their own, especially not while so many are suffering in our country. We must do more.

The writer is a psychiatrist and faculty member at King Edward Medical University. He is the author of Faiz Ahmed Faiz: A Biography, Sang-e Meel Publications, 2022. His X handle: @Ali_Madeeh