By: Fatima Asim
Rape is one of the most severe of all traumas, causing multiple, long-term negative outcomes, such as posttraumatic stress disorder (PTSD), depression, substance abuse, suicidality, repeated sexual victimization, and chronic physical health problems. This article examines rape victims’ experiences seeking postassault assistance from the legal, medical, and mental health systems and how those interactions impact their psychological well-being.
THE LEGAL SYSTEM: Rape prosecution is a complex, multistage process. Most victims’ first contact will be with a patrol officer, which will be the first of numerous times victims will be asked to describe the assault. Typically, a detective is then assigned to investigate and decide whether the case should be referred to the prosecutor. Detectives have considerable discretion in conducting investigations, and what happens during this process can be quite upsetting for victims. Victims are questioned about elements of the crime (e.g., use of force, or other control tactics) over and over again to check for consistency in their accounts, which can be emotionally unsettling and, given that trauma can impede concentration and memory. Many victims report that this questioning strays into issues such as what they were wearing, their prior sexual history, and whether they responded sexually to the assault. If a case progresses past the investigation stage, prosecutors often conduct their own interviews with the victims prior to deciding whether to file criminal charges. Either way, victims go through a punishing. For the cases that are accepted for prosecution, victims must prepare for a series of court hearings (e.g., preliminary hearings, trials, plea hearings, sentencing). Even victims who had the opportunity to go to trial described the experience as frustrating, embarrassing, and distressing, but they also took tremendous pride in their ability to exert some control in the process and to tell what happened to them. However, not all communities have rape crisis centres, so many victims do not have the option of working with an advocate. Although rape crisis centers have been instrumental in changing the legal culture of rape prosecution, many victims have little faith that justice is possible.
THE MENTAL HEALTH SYSTEM: The mental health effects of rape have been extensively studied, yet it is still difficult to convey just how devastating rape is to victims’ emotional well-being. Many women experience this trauma as a fundamental betrayal of their sense of self, identity, judgment, and safety. Between 31% and 65% of rape survivors develop PTSD, and 38% to 43% meet diagnostic criteria for major depression. Clearly, victims may need mental health services, but there has been comparatively less research on what services they actually receive and whether that care improved their psychological health. First, some victims receive mental health services by participating as research subjects in randomized control trial (RCT) treatment outcome studies. This option is available only to rape survivors who live in communities where such research is being conducted and who fit eligibility criteria. A second, and more typical, way victims receive postassault mental health services is through community-based care provided by psychologists, psychiatrists, or social workers in private or public clinic settings. More victims receive mental health services in these settings than in treatment outcome studies, but these settings are still highly underutilized and have serious accessibility limitations. A third setting in which victims may obtain mental health services is specialized violence against women agencies, such as rape crisis centers and domestic violence shelter programs. Rape crisis centers help victims negotiate their contact with the legal and medical systems, and they also provide individual and group counselling. These agencies are perhaps the most visible and accessible source for mental health services for rape victims as they provide counseling free of charge and do not require health insurance. The goal of psychological first aid is to accelerate recovery and promote mental health through eight core goals and actions: (1) initiate contact in a nonintrusive, compassionate, helpful manner; (2) enhance safety and provide physical and emotional comfort; (3) calm and orient emotionally distraught survivors; (4) identify immediate needs and concerns and gather information; (5) offer practical help to address immediate needs and concerns; (6) reduce distress by connecting to primary support persons; (7) provide individuals with information about stress reactions and coping; and (8) link individuals to services and inform them about services they may need in the future. Mental health professionals could work with hospital emergency departments, programs, and police departments—either as providers of psychological first aid or as training consultants.
Rape victims encounter significant difficulties obtaining help from the legal, medical, and mental health systems, and what help they do receive can leave them feeling blamed, doubted, and revictimized. As a result, survivors’ postrape distress may be due not only to the rape itself but also to how they are treated by social systems after the assault.
The community response to rape is not haphazard: Certain victims and certain kinds of assaults are more likely to receive systemic attention. But one must remember that many victims, indeed most, do not seek help from the legal, medical, and mental health systems. When these survivors are asked why they do not, they say that they are concerned about whether they would even get help and that they are worried about being treated poorly.
The trauma associated with negative postassault help seeking can be prevented, and our communities can be more effective in helping survivors heal from rape. We need programs that victims will trust and that will help them through the healing process.