I have heard that question more times than I could ever count. I have heard it in healthcare. I have heard it in EMS. I have heard it in conversations about domestic violence. I have heard good people ask it because, from the outside, leaving seems like the obvious answer. If someone is hurting you, leave. If someone is abusing you, get out. If someone puts their hands around your neck, hits you, threatens you, controls you, or makes you afraid in your own home, why would you stay? Today, with everything I know about trauma, the brain, survival, attachment, and my own life, I understand why that question is so much more complicated than it sounds. I also understand something I couldn’t understand about myself for a very long time: sometimes familiar harm can feel safer to a nervous system than unfamiliar safety.

Last week, I spent a lot of time talking about behavior. I talked about the labels we put on people: difficult, attention-seeking, manipulative, noncompliant, lazy, angry, aggressive, self-sabotaging. I talked about how behavior is information and how sometimes what looks like a character problem is actually telling us something about what happened to a person. This week, I want to take that conversation somewhere even more personal because I think we have to understand what happens underneath behavior if we are ever going to understand why someone stays in an abusive relationship. I can look back at my own life now and see things that I simply couldn’t see when I was living them. I wasn’t making decisions from the perspective I have today. I was making them with the brain, nervous system, relationships, resources, coping skills, and understanding I had then.

My ACE score is nine. Abuse didn’t enter my life when I entered an abusive adult relationship. Long before I knew anything about domestic violence, trauma responses, attachment, or nervous-system regulation, my developing brain was learning what relationships were supposed to feel like. There was yelling in my childhood. There was fear. There was chaos. I remember a time when my mom was going to leave my dad, and he threw paint all over her clothes hanging in the closet and poured paint into her dresser drawers. As a child, I didn’t have language for what I was witnessing. I wasn’t sitting there analyzing unhealthy relationship dynamics or thinking about how these experiences were shaping my developing nervous system. I was simply living in my normal. Children don’t get to stand outside their families and compare what happens in their homes with a healthy model they have never experienced. We learn relationships from the relationships surrounding us.

There is something else I remember now that tells me just how much my body understood before my conscious mind ever did. When I was a little girl, I would flinch when my dad sneezed or coughed. Just a sneeze. Just a cough. My body reacted before I could think about it. As I got older, that reaction slowly disappeared, and for years I probably would have considered that evidence that I wasn’t afraid anymore. Now I see it differently. I don’t think my nervous system necessarily stopped responding because everything became safe. I think, in part, my system adapted to what was familiar. The yelling, volatility, hitting, fear, and chaos became woven into my understanding of normal. That distinction matters. Human beings are incredibly adaptive. We can become accustomed to environments we should never have had to adapt to in the first place.

So when people ask why I later remained in unhealthy and abusive relationships, I have to look at the girl who entered them. What did she know about love? What did she know about safety? What did her body recognize as familiar? She had spent years learning to monitor the environment, protect herself, react, survive, and keep going. I often describe it now by saying that I wired for protection instead of connection. That wiring served a purpose when I needed it, but it followed me into adulthood. I didn’t have deep, healthy friendships and a strong circle of safe people around me. Most of my friendships were superficial. Many of the people I spent time with were struggling with their own unhealthy patterns. I could be surrounded by people and still have nobody I felt safe enough to call and say, “I need help. Can I come stay with you?” That is something we don’t talk about enough when we ask survivors why they didn’t leave. Leave and go where?

For me, going home wasn’t an option either. When the men who hurt me faced domestic violence charges, my father didn’t stand beside me. This didn’t happen just once. It happened twice. He sided with the men accused of hurting me. He even provided money toward legal expenses. I was the problem. At one point, I was told that I got what I deserved. Imagine what that reinforces in someone whose brain has already spent a lifetime learning that relationships can include fear, pain, chaos, and rejection. Imagine being physically injured and still somehow becoming the person everyone is talking about as though you are the problem. There were bruises. There was petechiae after the near-fatal strangulation. There were injuries that could be seen, and there were injuries inside my brain and body that nobody understood yet. But my behavior was easier to see than what had happened underneath it.

And my behavior wasn’t always healthy. That is important for me to say because healing has required me to stop telling my story as though every unhealthy thing I ever did was someone else’s fault. I was angry. I was reactive. I could yell. I could push people away. I made unhealthy choices. I hurt people while I was hurting. I had coping behaviors and trauma responses that made relationships difficult. From the outside, those behaviors made it very easy to point at me and say, “See? She’s the problem.” What nobody was asking was what we talked about last week: What is this behavior telling us? What happened before the behavior? What is happening inside her? What has her brain learned? What is she protecting herself from? What injuries might we be missing? Accountability for my behavior eventually became an important part of my healing, but accountability and understanding can exist at the same time. Understanding why someone developed a behavior doesn’t excuse harmful behavior, and recognizing a survivor’s unhealthy coping behaviors doesn’t make that person responsible for someone else’s decision to abuse them.

Interestingly, healing has changed the way I think about behavior far beyond the way I understand my own story. After more than 25 years as a paramedic, I have been on plenty of 911 calls where, from a clinical perspective, the person probably didn’t need an ambulance. Some didn’t need an emergency department at all. They may have been better served by an urgent care or a call to their primary care provider. And if I am transparent, there was a time when I participated in the conversations many providers have had after those calls: Why would they call 911 for this? Why didn’t they just call their doctor? Why couldn’t someone drive them? As I have healed, I don’t see those patients the same way anymore. Maybe they were scared. Maybe they didn’t have transportation. Maybe they couldn’t get an appointment. Maybe they lived alone. Maybe something that seems minor to me after decades of seeing emergencies felt terrifying to them. Or maybe there was something happening in their life that I knew absolutely nothing about.

I no longer believe it is my job to judge whether someone’s reason for calling 911 is worthy of my compassion. My job is to assess them and provide prompt, compassionate, clinically excellent care. I can determine clinically that someone doesn’t appear to be experiencing an emergency without deciding something negative about them as a human being. That realization has made me wonder how often we do the same thing in other areas of life. We see someone repeatedly visiting an emergency department, missing appointments, reacting strongly at a restaurant, not following a treatment plan, returning to an unhealthy relationship, or making a decision that doesn’t make sense to us, and we assume we have enough information to explain their behavior. But maybe we don’t. Sometimes we are evaluating a behavior while possessing only a fraction of the information that produced it. If I can recognize that I don’t know the whole story behind someone’s decision to call 911, shouldn’t I be even more careful before judging one of the most complicated decisions a survivor may ever have to make?

That is why I struggle so much with the simplicity of “Why don’t they just leave?” Leaving wasn’t simply walking through a door for me. Where was I supposed to go? My parents’ home wasn’t safe for me emotionally. I didn’t have the kind of close friendships where someone’s spare bedroom automatically became an option. My survival behaviors had helped keep people at a distance, which meant that when I desperately needed connection, I hadn’t built much of it. My nervous system knew chaos better than it knew peace. And some of the very people who could have reinforced the message that I deserved safety instead reinforced the idea that I was the problem. That doesn’t mean I wanted to be abused. It doesn’t mean abuse actually felt safe. It means the familiar patterns of fear, volatility, rejection, reconciliation, hypervigilance, and survival were patterns my brain and body already knew.

There are also realities beyond nervous-system wiring that we cannot ignore. Survivors may face threats, financial dependence, children, housing insecurity, isolation, fear of retaliation, shame, religious or cultural pressures, lack of transportation, concern about pets, and the very real possibility that leaving may increase danger. There can also be love, hope, attachment, promises of change, and memories of the person the relationship once seemed to be. We sometimes talk about survivors as though they are standing outside the relationship with all the information, resources, support, and emotional distance that we have while judging their decisions. They aren’t. They are making decisions from inside the situation, often while their bodies are operating in survival mode.

And sometimes the family system itself helps keep the pattern alive. We don’t talk about that enough either. What happens when a survivor finally begins recognizing abuse, but the people who should be supporting them minimize it? What happens when the person who caused harm receives sympathy while the survivor receives blame? What happens when everyone can see the survivor’s anger, emotional reactions, unhealthy relationships, or other coping behaviors but nobody wants to look underneath them? Eventually, a person can begin believing the labels. Maybe I really am the problem. Maybe I’m overreacting. Maybe I caused this. Maybe I’m too difficult. Maybe nobody will believe me. Maybe this is simply what relationships are like. Maybe I really did deserve it.

I spent years trying to understand what was wrong with me. Today, I ask a different question. I ask what happened inside me because of what happened to me. That question has changed almost everything. It has allowed me to look back at the little girl who flinched at a cough, the young woman trying desperately to find love and belonging, the survivor whose body and brain were operating from survival, and even the unhealthy versions of myself who hurt other people, with both accountability and compassion. I can acknowledge what I did without ignoring what happened to me. I can understand why my brain adapted the way it did without allowing those adaptations to control the rest of my life.

Perhaps that is one of the biggest things I wish people understood about leaving. Sometimes leaving an abusive relationship isn’t only about leaving a person. Sometimes you are beginning to leave an entire definition of normal. You are challenging what your childhood taught you about love. You are challenging what your nervous system learned about danger. You are challenging family patterns, coping mechanisms, beliefs about yourself, and relationships that may have existed for decades. And after you physically leave, there may still be an enormous amount of work involved in teaching your brain and body that safety doesn’t have to be followed by danger.

I know that now because I am living it. I am learning what connection feels like instead of simply protection. I am learning to recognize what my body is telling me. I am learning that peace doesn’t mean I need to start looking around for the next disaster. I am learning that boundaries are not cruelty. I am learning that I can take responsibility for the ways I have hurt people without accepting responsibility for the abuse committed against me. Most importantly, I am learning that the patterns my brain developed to survive do not have to be the patterns I live in forever.

So perhaps we need to stop beginning with, “Why didn’t you leave?” Maybe we need to ask, “What made leaving so difficult?” What did you learn about love before this relationship ever began? What did your body learn about danger? What happened when you asked for help? Who believed you? Who blamed you? Where could you safely go? What resources did you actually have? What were you afraid would happen if you left? What had happened the other times you tried? And what would you need in order for safety to become something you could not only reach, but eventually recognize?

Those questions don’t remove personal responsibility. They give us information. They replace the assumption that we already understand someone’s behavior with enough curiosity to admit that perhaps we don’t know the whole story.

And maybe that is where compassion begins.

Healing begins with understanding.