The psychological adjustment of the rape victim
This article is written for women and assumes a male offender, however SECASA acknowledges that both men and women can be survivors of sexual abuse and that offenders can be male and female.
Delivered at the Psychiatry, Psychology and the Law Congress, Royal Women's Hospital, Melbourne, November, 1980
Lesley Hewitt, Social Worker, Sexual Assault Clinic, Queen Victoria Medical Centre, MELBOURNE.
Reproduced here with the Authors kind permission.
No part of this article may be reproduced in any way without the express permission of the author.
Note to readers; Although this article is over 20 years old, it contains information that some may find relevant which is why we have included it.
Sexual assault is an act of violence that is by definition against the victim's will. The victim is forced to submit to genital, oral and/or anal sexual acts and often to other aggression, abuse and degradation. The attacker controls the situation by the use of physical force, threats of harm and intimidation. The victim fears she is going to be killed or injured. In our experience most victims have perceived that their survival is dependent on compliance and submission to the offender's demands.
Sexual assault is an arbitrary event in the victim's lifestyle. It is sudden, unexpected and unpredictable. She is faced with a life threatening situation that she is unable to effectively resolve. Her usual methods of coping with threats and conducting interpersonal relationships fail her. It is a violation of her physical self and her basic beliefs and assumptions about her environment, about other people and relationships and about herself.
As a result women may experience severe psychological effects. The way the victim copes with the trauma of rape is dependent on several factors. These include her ego strength her social network support, her life cycle stage and the way she is treated as a victim. On 20th May, 1978, the National Times noted that "The Honolulu Star Bulletin" recently reported that Judge Robert V. Richardson had dismissed a rape charge against a motorist who had allegedly knocked down a woman jogger and raped her. The Judge dismissed the rape action because he believed that the woman who was dazed after the accident "did not put up enough resistance."
This statement illustrates the degree to which women are still held to be responsible for or in some way complicit with the act of rape. Despite many changes that have occurred in the treatment of rape victims, there still exists in our society ignorance about, and ambivalence towards the rape victim, causing for many an additional stress.
To date, there has been little well controlled research on the psychological adjustment of the victim. Most sexual assault clinics have been concerned with providing support and treatment to the victim rather than systematic evaluation. Professionals have been reluctant to subject rape victims to intrusive evaluation procedures. Their treatment needs have been the primary focus of such clinics.
Sexual Assault Clinic - Queen Victoria Medical Centre
The Queen Victoria Medical Centre operates a 24 hour Sexual Assault Clinic for male and female victims. 7 Social workers provide the counselling component of the service which has been operating since May 1979. Prior to this, counselling was offered on a referral basis. The main source of referral was and still is the police. Consequently the medical examination is usually performed by one of the police surgeons who treat any injuries and collect evidence for legal proceedings. Follow-up routine testing for possible venereal disease and pregnancy is also provided. Counselling and medical services are also available to those who choose not to report to police.
In the first year of operation of the 24 hour service, social workers saw 279 victims. Of these 204 were victims of rape/attempted rape, 32 were victims of indecent assault, 18 were of incest, 9 were carnally known, and 16 were classified as other.
Rape trauma syndrome
Burgess and Holmstrem studied 109 women who attended the Boston City Hospital in 1974 complaining of rape. They collected their data at the time of initial presentation at the hospital and again 3 months later. They documented the "rape trauma syndrome". They found two phases of adjustment following rape or attempted rape. They call these the acute phase and the long term reorganisation phase, both of which are stress reactions to a life threatening situation.
Immediately following the rape they found that an equal number of women had an "expressed" style where they showed feelings of fear by crying, smiling, sobbing or a "controlled" style where the woman was calm and subdued. The primary emotion expressed by victims is one of fear. Most any say that they felt they were going to be killed or badly injured.
When an individual is subjected to extreme stress, psychological mechanisms are evoked in an attempt to cope with this stress. If the stress is powerful then the defence mechanisms she uses, must be equally powerful. Thus the rape victim may experience emotional shock where she has an exaggerated sense of unreality and disassociation. Things seem unreal to her, and she may have difficulty attending to environmental stimuli. As well, women who have reported to police, have a number of immediate tasks to perform: the making of a statement, identifying the alleged offender either from photos or with an identikit, repeatedly recalling details of the assault, under-taking a medical examination and so on. Most victims try to remain in control of themselves so that they can adequately perform these tasks. It is our experience that women who react in a controlled way are equally as traumatized as those who act in an expressed manner. Unfortunately the extent of the trauma experienced by these women may go unrecognised by their family/friends or professionals and they may receive less support and treatment. In addition, these women may not be believed by family and others who subscribe to the myth that rape victims to be genuine must exhibit histrionic behaviour.
Somatic reactions developed included physical trauma, skeletal muscle tension, gastrointestinal irritability, genitourinary complaints and sleep pattern changes.
Emotional reactions include fear, humiliation, anger, guilt/shame and feelings of degradation and powerlessness. Mood swings and enhanced emotional liability may occur. Increased irritability with, and suspiciousness of other people may also be present. The issue of trust may be important in the counselling process. Given that the victim's trust in people has been betrayed by the rapist, it may make it more difficult for her to trust others. The counsellor needs to indicate that she can empathaize with the victim's feelings, that she can listen and acknowledge the intense emotions the victim has, and encourage rather than suppress discussions of these. The victim may displace her anger onto the counsellor, police, hospital or family. She may be dominated by feelings of helplessness and powerlessness. She needs to be encouraged to make decisions for herself in order to learn to feel some control over her life again. Crisis counselling which is issues orientated is an effective management procedure, and the counselling needs of the victim include ventilation and clarification of issues. Only 15% of victims at the hospital continue in counselling after 6 interviews. The situation is a crisis, most victims are psychologically healthy people, and the treatment of choice is crisis intervention so this is appropriate.
Burgess and Holmstrom report that in the reorganisation phase women develop increased motor activity, changing their jobs, home or lifestyle as a defensive reaction to the assault. Nightmares relating to the life threatening nature of the assault and the powerlessness and alienation are common. The development of phobic reactions to situations reminiscent of the rape also occur. Some mistrust of men with subsequent avoidance and hesitation, along with a variety of sexual difficulties may develop. Victims are often concerned about the effects of the rape on their close interpersonal relationships wondering how this will affect them.
It is important to discuss with the victim the types of problems, feelings and areas of difficulty that she could experience in the weeks and months following the assault. Most victims, have no point of reference upon which to evaluate the normality of their response. Provision of this information enables the victim to place her rape related reactions into perspective.
Factors influencing victims coping capacity
1. The woman's personality and her previous coping mechanisms influence her ability to cope with the rape.
Women with a past or current history of physical, psychiatric or social problems appear to be more likely to develop severe depression, psychotic behaviour, psychosomatic disorders, suicidal behaviour and acting out behaviour associated with alcoholism, drug abuse and/or sexual activity.
Social network support is a factor affecting the woman's coping capacity. Firstly that the woman has significant others in her social network. A number of women, particularly elderly widows who live alone, and whose friends have died, and family moved away, are socially isolated. This can intensify their feelings of alienation and powerlessness, and one of the tasks of the counsellor would be to build up social networks for these victims.
2. Secondly, these people need to be supportive. They need to allow the woman the opportunity to discuss the assault if she wants to and to listen to her. Some families and partners tell the woman "to forget it" refusing to accept the extent of the trauma. Other families become over protective, which may foster regression and dependency in the woman. This seems to occur particularly with adolescents who are in the process of separating from their parents. Some families respond by rejecting the woman. Others are judgemental particularly when they do not approve of the victim's behaviour, and the rape may exacerbate existing conflicts over this. Some families respond with anger.
Other members can over-identify with the victim particularly when they have experienced a similar situation, and are unable to recognise the victim's needs.
3. Life cycle stage may also affect the victim's coping capacity. The rape means different things to women at different stages of their life. The younger adolescent for whom the rape is her first sexual experience may become concerned about her sexual behaviour in the future. She may become afraid of entering into relationship with her adolescent peers.
The middle adolescent who is beginning to develop relationships with males may find that the rape may compound her existing confusion about what is appropriate, affectionate and sexual behaviours.
Middle aged women who may be reassessing their lives and roles, and concerned with independence and autonomy may find the rape reinforcing feelings of inadequacy.
4. The way the woman is treated as a victim may also influence her ability to cope.
This includes treatment by:
1) The police. Of necessity the police are required to question the victim thoroughly. If this is not explained to her she may perceive that she is not believed and this can reinforce feelings of guilt and self blame.
If she is unable to accurately describe her assailant or recall details of the attack, this may reinforce feelings of low self worth and inadequacy.
2) Hospital service. If the victim is treated in an impersonal manner then the feelings of depersonalization are reinforced. If hospital staff offer judgement comments on her behaviour then feelings of guilt can be produced.
3) The courts. The above comments apply here as well. The cross examination can seem like a repeat of the rape experience.
4) The circumstances of the assault can affect the victim's coping capacity.
If the victim is acquainted with her assailant then she is less likely to report the rape to the police.
If she knows the rapist then she may feel more guilt wondering what she has done to provoke the attack. She may question her ability to judge other people. She is unable to use rationalization as a defence to cope with the attack. She seems to feel a greater sense of betrayal and is more confused about the meaning of the act.
If the attack occurs in the victim's home, she may be more fearful. She, as an individual has been invaded as well as her own environmental space.
Whilst women's response to rape may follow a predictable pattern, each individual's circumstances provide differences that will affect her coping capacity and reaction.
The fact that a woman's psychological adjustment to rape, is in part determined by the social systems that impinge upon her, indicates a need for a widespread community response to ensure that those systems are both responsive to her needs, and used to their maximum therapeutic capacity.