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LIFE OF A RAPE SURVIVORS IN INDIA: AN ANALYSIS OF THE COPING ON REHABILITATION STRATERGIES



INTRODUCTION

Overview

1It is troubling enough that such a small proportion of reported rapes make it to court, worse still that so few victims come forward in the first place. But most disturbing of all is the reason why so many people keep their suffering to themselves: because they do not think they will be believed. That rape is still a dirty secret, hedged about with so much blame and shame that victims feel they cannot come forward, is testament to how far we still have to go.


There are, of course, great legal difficulties in rape trials. Sexual assault is one of the few crimes where proof lies not in the physical facts of the matter, but in the subjective intentions of those involved. One person's word against another's, with no corroborating witnesses, is highly problematic for a legal system predicated on the concepts of innocent until proven guilty and proof beyond reasonable doubt.


This is no call for the wholesale abandonment of basic tenets of justice. But simply to shrug our collective shoulders, blame intractable issues of principle, and thereby leave a swathe of victims of violent assault with insufficient legal protection cannot be acceptable in what purports to be a civilised society.


The latest statistics make gruelling reading. More than a third of British women have been subjected to some kind of sexual assault, and one in 10 has been raped, according to the Mums net social networking site. Barely a third of victims go to the police, and another third tell no one at all, not even close friends.


In fairness, there has been significant progress in terms of institutional procedures. In many areas of the country, for example, there are now specially trained police officers and court prosecutors for cases of sexual assault. But uneven regional conviction rates only underline the extent to which such practices remain an optional extra rather than standard.


Equally, although victims no longer face the prospect of being cross-questioned by their attacker in court, pursuing a case to trial remains a horrifying ordeal. As a witness for the prosecution, the victim has no legal support, and faces intensely personal questioning from defence lawyers, often while face-to-face with their rapist for the first time since the assault. Even within the framework of innocent until proven guilty, there is more that can be done to ease the burden on victims, not least allowing them legal representation in court.


But the shortcomings of our institutions are merely part and parcel of a wider cultural understanding of rape that still militates against justice. It is that culture that must change if victims are to be encouraged to speak up. Comments from the Justice Secretary last year that appeared to imply that some rapes are more "serious" than others have hardly helped, adding to the persistent fallacy – often stoked by the media – that a person being either drunk or dressed in a certain way must take some responsibility for the actions of their attacker.


Part of the problem is the myth that rape is primarily a threat on the streets at night. Far from it. In fact, rape rarely occurs in the proverbial dark alley. The truth is both more banal, and more appalling: two-thirds of victims know their attacker, and assaults commonly take place in the home of either the victim or the rapist. Perpetrators rely on shame to keep their crime secret. Too often they are proved right. And if the conspiracy of silence is a problem for women who are raped, it is even worse for men.


Mumsnet is, therefore, to be applauded for its efforts to create a climate where victims feel they can come forward. The current Survivors UK ad campaign encouraging male victims to seek help is also welcome. But each is just one small step. Rape is one of the more appalling things that one human being can do to another, and yet there is no other crime about which our society is so ambivalent. That must change.


RAPE PERVASIVE SOCIAL PROBLEM THAT TRANSCENDS SOCIO- CULTUTRAL BOUNDS

Rape is a major public health and pervasive social problem that transcends socio-cultural bounds; with myriad bio-psychosocial effects on victims/survivors and the wider community. Indeed, survivors of SA suffer the effects of assault for a lifetime. A key aspect for practitioners working with individuals, families and communities affected by SA is to understand the background, nature and extent of the problem; as well as important medicolegal considerations and support services.


Typically, rape is an expression of aggression, anger, or need for power; psychologically, it is more violent than sexual. Nongenital or genital injury occurs in about 50% of rapes of females.


Sexual assault is rape or any other sexual contact that results from coercion, including seduction of a child through offers of affection or bribes; it also includes being touched, grabbed, kissed, or shown genitals.


Rape and sexual assault, including childhood sexual assault, are common; the lifetime prevalence estimates for both ranges from 2 to 30% but tends to be about 15 to 20%. However, actual prevalence may be higher because rape and sexual assault tend to be underreported.


Females are raped and sexually assaulted more often than males. Male rape is often committed by another man, often in prison. Males who are raped are more likely than females to be physically injured, to be unwilling to report the crime, and to have multiple assailants.


  1. Symptoms and Signs

Rape may result in the following:


  • Extragenital injury

  • Genital injury

  • Psychologic symptoms

  • Sexually transmitted diseases (STDs—eg, hepatitis, syphilis, gonorrhea, chlamydial infection, trichomoniasis, HIV infection)

  • Pregnancy


Most physical injuries are relatively minor, but some lacerations of the upper vagina are severe. Additional injuries may result from being struck, pushed, stabbed, or shot.


Psychologic symptoms of rape are potentially the most prominent. In the short term, most patients experience fear, nightmares, sleep problems, anger, embarrassment, shame, guilt, or a combination. Immediately after an assault, patient behavior can range from talkativeness, tenseness, crying, and trembling to shock and disbelief with dispassion, quiescence, and smiling. The latter responses rarely indicate lack of concern; rather, they reflect avoidance reactions, physical exhaustion, or coping mechanisms that require control of emotion. Anger may be displaced onto hospital staff or family members.


Friends, family members, and officials often react judgmentally, derisively, or in another negative way. Such reactions can impede recovery after an assault.


Eventually, most patients recover; however, long-range effects of rape may include posttraumatic stress disorder (PTSD), particularly among women. PTSD is a trauma-related disorder; symptoms of PTSD include

  • Re-experiencing the trauma (eg, flashbacks, intrusive upsetting thoughts or images)

  • Avoidance (eg, of trauma-related situations, thoughts, and feelings

  • Negative effects on cognition and mood (eg, persistent distorted blame of self or others, inability to experience positive emotions)

  • Altered arousal and reactivity (eg, sleep difficulties, irritability, concentration problems)

For PTSD to be diagnosed, symptoms must last for > 1 mo, must not be attributable to the physiologic effects of a substance or a medical disorder, and must significantly impair social and occupational functioning. Patients with PTSD often also have depression or other psychologic disorders (eg, substance use disorder).


Male Rape: The Silent Victim and the Gender of the listener

Although the long-term effects of sexual abuse of women by men have been studied extensively, there has been minimal research exploring the effects of sexual assault by men on other men. Until recently, very little attention has been paid to male victims of rape and sexual assault in adulthood; even less attention has been paid to male rape in the military. In fact, there are few studies on even the prevalence of sexual assaults of men in the US Army. Similar to female rape victims, adult male rape victims rarely turn to the legal, medical, or mental health systems for assistance. Personal stories of male rape mirror female rape in terms of a sense of shame, humiliation, and self-blame, but males are even less likely than females to report an assault.


Four male veterans—all victims of male rape—recently presented to a Veterans Affairs (VA) outpatient clinic, providing further insight into this seldom-studied phenomenon.

A common theme emerging in treating male rape victims is a lost sense of manliness. Male victims voice their concern in reconciling their masculine identity with their experience of being raped. One patient reported that he never disclosed it to his wife of 30 years; the sense of stigma from the rape was felt as huge and devastating.


The veterans treated in this VA outpatient setting all reported a preference for a female psychiatrist and difficulty in discussing rape with a male psychiatrist. It is possible that male rape victims experience more negative counter-transference reactions from male psychiatrists. Male psychiatrists may not be free of homophobic reaction, which further hinders patients from articulating the history of the abuse.


None of the 4 victims examined disclosed his rape to any male psychiatrist by whom he was examined. One of the male victims was labeled as “malingering” in spite of 2 severe suicide

attempts. The physician became frustrated by the perceived “secretiveness” of the patient and interpreted it as malingering. While patients dread the idea of disclosing the rape to a man and fear how telling would affect them, they also complained that no male psychiatrist had asked them about a possible abuse history. Treatment of rape victims should start with an exploration of our own beliefs about male rape.


Training in this specific area is needed for psychiatric residents as well as for military personnel, the police, emergency department staff, nurses, and general practitioners. The research on sexual assault of women may not be appropriate for men who have been sexually assaulted. Applying research findings from female victims to male victims may lead to damaging behaviors that are harmful to male rape survivors following the assault and in the long term.


Furthermore, it should be explored further if the gender of the listener has a role in the underreporting of male sexual violence. This can help identify the number of male victims of sexual assault, which may allow planning of appropriate clinical services and counseling strategies that may support recovery.


Stressing how men and transgenders are sequestered from the point of view of victims of rape under the existing Penal Laws, a petition was moved in the Supreme Court praying that Section 375 IPC which defines rape as an offence by man against a woman as discriminatory and make it gender neutral.


The petition moved by ‘Criminal Justice Society of India’ through advocate Fuzail Ahmad Ayubbi said Section 375 IPC be declared violative of Articles 14, 15 and 21 of Constitution of India insofar the definition of rape does not account for gender-neutrality.


Noted Criminal Lawyer Senior Advocate KTS Tulsi was the President of the petitioner Organisation.


The petition relied heavily on the three recent landmark judgments on the apex court in National Legal Services Authority v. Union of India & Ors5; Justice K.S. Puttaswamy v. Union of India & Ors and Navtej Singh Johar v. Union of India & Ors6 to seek gender- neutral rape laws.


Rape and Posttraumatic stress disorder: A review

One woman is sexually assaulted in Canada every minute. At the University of Alberta, 21% of students have reported at least one unwanted sexual experience. Recovery from sexual- assault- related Posttraumatic Stress Disorder is not solely measured by eliminating symptoms or achieving specific outcomes. There are many factors involved in successful recovery, including the degree of support received, previous self-concept, personal strength, and professional treatment provided by the medical and justice systems. PTSD is one of the problems that may result from failure of the recovery process.


PTSD is caused by exposure to a traumatic event and intense psychological distress occurs as a result of re-experiencing the event. PTSD is diagnosed when symptoms last longer than one month. To prevent the distressing reactions, survivors will avoid stimuli that provoke these feelings and this avoidance behaviour can be severe enough to significantly impair daily life.


The consequences of a sexual assault may be manifested biologically, psychologically, and sociologically. By gaining a better appreciation of the repercussions of sexual assault, a holistic and individualized therapy can be developed to ameliorate the physical and emotional pain following the trauma. The issues facing individuals who have experienced sexual assault will be discussed and improvements in current treatments will be suggested, with hopes to develop more effective and holistic therapies in the future.

The alarmingly high rate of PTSD in survivors of sexual assault is a strong indication that the current therapies for rape victims are inadequate and in need of improvement. There is no 'cookie cutter' treatment for every victim suffering with PTSD, as the disorder can manifest itself in many ways. It is important to consider the biological, psychological, and sociological impacts when developing effective treatment and intervention methods for sexual-assault-related PTSD.


After an assault, survivors experience The Rape Trauma Syndrome (RTS), which affects not only victims of rape, but also victims of all types of sexual violence and would perhaps be better labelled as Sexual Assault Trauma Syndrome. RTS is characterized by three phases.16 The Acute Phase occurs immediately following the assault when the survivor is in crisis and experiences a wide range of emotional reactions. These reactions may be categorized as Expressive, such as shaking, crying or yelling; or Controlled such as flattened affect, appearing outwardly calm and subdued. The second phase is Outward Adjustment, when the survivor focuses less on the assault, often with a high level of denial, and involves themselves in normal daily activities. The final phase is Long Term Reorganization, in which the survivor integrates the assault into their view of themselves and resolves their feelings about the assailant. There are many psychological effects to consider following a sexual assault such as feelings of shame, guilt, anxiety or depression. These feelings may be even stronger and more harmful if the survivor does not receive support from their family, friends or authorities.


Cognitive factors play a large role in the onset, severity, and outcome of PTSD after sexual assaul19. These factors include mental defeat and confusion, negative appraisal of emotions and symptoms, avoidance and perceived negative responses from others. If the survivor of sexual assault believes that others have failed to react in a positive and supportive manner,

there is a greater risk of PTSD. It has been suggested that trauma recovery is characterized by a reprogramming, integration, and habituation to the traumatic images, leading to a restoration of a sense of safety. Over time, PTSD symptoms will decrease, the survivor will be less preoccupied with blame towards self and others, and a will achieve a regained sense of control.


Events perceived as uncontrollable are much more distressing than controllable events, therefore with uncontrollable events such as sexual assault, survivors will attempt to attribute blame to behavioural, dispositional or vicarious causes. Behavioural self-blame has the potential to be adaptive as it promotes the belief that negative outcomes can be avoided in the future; whereas dispositional self-blame attributes the traumatic event to one's personality and this thinking does not give a sense of future control. Vicarious control refers to the perception that some other person or entity had control over the occurrence of that event. Attributing blame in any of these ways focuses on the past and is associated with poorer outcomes in PTSD. To improve PTSD, treatment outcomes emphasis should be on controlling the present situation and what can be done about the impact of the event, rather than how it could have been avoided or can be avoided in the future . In view of the fact that control over the recovery process results in lowered distress levels, fostering this form of control could be an important component of interventions for sexual assault survivors.


Early intervention is critical for sexual assault victims because the level of distress immediately following the assault is strongly correlated to future pathologies and PTSD. In a study collecting self-reports from survivors of assault that assessed their degree of support and psychological distress during and immediately following the rape, it was found that high distress levels significantly predicted increased levels of fear and anxiety in the months following the assault. As the level of distress is strongly correlated to PTSD symptoms, an attempt to decrease levels of distress immediately following sexual assault may result in a

more positive treatment outcome. When survivors seek medical assistance, the forensic rape exam can be very traumatizing. Resnick et al., demonstrated that meeting with a rape crisis counsellor or viewing a video before a forensic rape exam depicting in detail what to expect during the exam, resulted in decreased levels of stress after the exam in test groups compared to the non-video control group. Of all the eligible women, 81% agreed to participate in this video study, indicating that this is a feasible way to decrease distress and reduce future PTSD development following the physical examination.


SOCIOLOGICAL ISSUES CONTRIBUTING TO PTSD


Recovery from psychological issues due to sexual assault related PTSD is not solely an individual challenge, but also a challenge for those close to the affected individual. The recovery process is also a sociological issue and societal aspects should not be ignored. Research indicates that initial levels of distress and perceived control are key factors in the onset and severity of PTSD. Perceived positive regard and support has also been shown to be important to recovery. Less than half of individuals who have been sexually assaulted disclose the assault to others and it is clear that many are not getting the support they require. As a large part of the recovery process is related to a solid support network, part of the discussion of treatment and prevention of PTSD should be sociologically directed by targeting attitudes towards and origins of sexual assault with considerations of how these attitudes may create a rape-prone society and allow for such a high frequency of sexual assault.


There are many rape myths in our society, for example, beliefs that individuals lie about being assaulted, perpetrators are easily identifiable, or that men cannot be sexually assaulted. These myths promote negative attitudes and victim-blaming philosophies. Education is the first step in preventing PTSD associated with assault. The number of sexual assault victims willing to tell someone about their experience is increasing, potentially because there is less of a stigma attached to it today and there are more voluntary and professional support agencies. Although this shows some improvement, many individuals still have attitudes that sex role stereotyping, adversarial sexual beliefs, and acceptance of interpersonal violence, all of which lead to greater acceptance of rape myths. Although sexual assault programs are becoming more pervasive across college campuses, these programs are not always effective in implementing meaningful changes in cognition and behaviour . By understanding the failures of education programs, directions for improvement are found. Increasing program length may allow for more meaningful changes in cognition and behaviours to occur . Targeting the attitudes that lead to greater acceptance of rape myths may lead to a more supportive community for victims of sexual assault. Education is vital in rape prevention and to foster a supportive environment for survivors of this crime, but it is clear that more research is needed to improve the efficacy of these programs.


Many survivors who disclose their assault to others experience secondary victimization. Secondary trauma occurs when survivors seek assistance from medical, legal or healthcare professionals, but these professionals often exhibit and use victim-blaming behaviours. Contact with many services especially those which do not specialize in sexual assault traumatization, can increase survivors' psychological and physical distress.


Society contributes to the acceptance of rape myths through individuals the survivor solicits for help as well as by contributing to the negative cognitions of the survivors themselves. Negative cognitions foster self-blame and increase the risk of post-assault psychopathologies, likely contributing to the low disclosure rates.



CONCLUSION

Sexual Assault is acknowledged as a crime stemming from social injustice and inequality, whose recognition has broadened the scope of the crime over the past few decades. A broader understanding of the nature of SA can assist health practitioners to more effectively recognise and respond to the presenting needs of survivors and their loved ones.


Moreover, with various psychological and physical health consequences following SA, counselling can help survivors experiencing trauma in regaining a sense of control, independence and trust following their experiences; while reducing self-blame, guilt and various related psychological symptoms. The survivor's recovery may be further facilitated when the counsellor utilises cognitive and feminist approaches, psychoeducation and referral to self-help groups during therapy; as well as working closely with related community services aimed at providing specialised support for survivors of this crime.


In conclusion, I would like emphasize that sexual violence poses an obstacle to peace and security. It impedes women from participating in peace and democratic processes and in post- conflict reconstruction and reconciliation. As a tool of war it can become a way of life: once entrenched in the fabric of society, it lingers long after the guns have fallen silent. Many women lose their health, livelihoods, husbands, families and support networks as a result of rape. This, in turn, can shatter the structures that anchor community values, and with that disrupt their transmission to future generations. Children accustomed to acts of rape can grow into adults who accept such acts as the norm. This vicious cycle must stop, as we cannot accept a selective zero-tolerance policy. Today's adoption of resolution 1960 (2010), on sexual violence, is an important step in that direction. It is for that reason that Slovenia joined in co-sponsoring it.

BIBLIOGRAPHY

Primary Sources

  1. Frazier PA. Perceived Control and Distress Following Sexual Assault: A Longitudinal Test of a New Model. Journal of Personality and Social Psychology. 2003;84(6):1257–1269.

  2. Volunteer Training Manual. Sexual Assault Centre of Edmonton. Edmonton, AB; 1999.

  3. British Crime Survey. Rape and Sexual Assault of Women: Findings from the British Crime Survey. Home Office Research Study 159:1–6 from http://www.homeoffice.gov.uk/rds/pdfs2/r159.pdf; 2002.


Secondary Sources


  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th ed., rev.). Washington, DC: American Psychiatric Association; 2000

  2. The challenge of definition of rape, Lan urbina( The New York Times)Oct.11,2014

  3. Girelli SA, Resick PA, Marhoefer-Dvorak S, Hutter CK. Subjective Distress and Violence During Rape: Their Effects on Long-Term Fear. Violence and Victims. 1986;1:35–45

  4. National Center for Post Traumatic Stress Disorder. Epidemiological Facts About PTSD - A National Center for PTSD Fact Sheet. Retrieved April 1, 2005

  5. Stephen Gold's review of: Sex, Power, Conflict: Evolutionary and Feminist Perspectives, Edited by David M. Buss and Neil M. Malamuth. Oxford University, Press, New York, 1996

  6. From N.M. Malamuth & M.F. Heilmann, Evolutionary Psychology and Sexual Aggression, in HANDBOOK OF EVOLUTIONARY PSYCHOLOGY 515-42 (C. Crawford & D. L. Krebs eds., 1998)

  7. Acierno R, Resnick H, Kilpatrick DG, Saunders B, Best CL. Risk factors for rape, physical assault, and post-traumatic stress disorder in women: examination of differential multivariate relationships. J Anx Dis. 1999;13:541–63

  8. Dunmore E, Clark DM, Ehlers A. Cognitive Factors Involved in the Onset and Maintenance of Post Traumatic Stress Disorder (PTSD) after Physical or Sexual Assault. Behaviour Research and Therapy. 1999;37:809–829


Articles or Journals.


  1. The role of self-objectification and women’s blame, sympathy, and support for a rape victim, Casey L. Bevens ,Amy L. Brown,Steve Loughnan


Published: June 28, 2018,https://doi.org/10.1371/journal.pone.0199808


  1. Sexual assault: An overview and implications for counselling support


Pablo A. Fernandez, Published online 2011 Nov 30. doi: 10.4066/AMJ.2011858


  1. Koss MP, Figuerdo AJ. Change in Cognitive Mediators of Rape's Impact on Psychosocial Health Across 2 Years of Recovery. Journal of Consulting and Clinical Psychology. 2004;72(6):1063–1072.

  2. Campbell R, Barnes HE, Ahrens CE, Wasco SM, Zaragoza-Diesfeld Y, Sefl T. Community Services for Rape Survivors Enhancing Psychological Well-Being or Increasing Trauma? Journal of Consulting and Clinical Psychology. 1999;67(6):847– 858

  3. Breitenbecher KH, Scarce M. An Evaluation of the Effectiveness of a Sexual Assault Education Program Focusing on Psychological Barriers to Resistance. Journal of Interpersonal Violence. 2001;16(5):387–407.


  1. Dunmore E, Clark DM, Ehlers A. Cognitive Factors Involved in the Onset and Maintenance of Post Traumatic Stress Disorder (PTSD) after Physical or Sexual Assault. Behaviour Research and Therapy. 1999;37:809–829


  1. J. M. Goodwin and R. Attias, “Eating Disorders in Survivors of Multimodal Childhood Abuse,” in Clinical Perspectives on MPD, ed. R. Kluft ( Washington, 1993), pp. 327-341


Literature Review


  1. Kaitlin A. Chivers-Wilson*, Sexual assault and posttraumatic stress disorder: A review of the biological, psychological and sociological factors and treatments, Mcgill J Medv.9(2); 2006 Jul, PMC2323517: This article provides information about posttraumatic stress disorder, PTSD Pathophysiology, Psychology of PTSD and cognitive factor, Psychotherapy treatment option for PTSD. It also describes how sociological issues contribute to posttraumatic disorder which results after rape.

  2. Social Reactions to Sexual Assault Disclosure, Coping, Perceived Control and PTSD Symptoms in Sexual Assault Victims, Sarah E. Ullman, Ph.D. and Liana Peter-Hagene, M.A Author manuscript; available in PMC 2015 May 1: This article gives us detailed information about sexual assault, social reaction, how society reacts when a victim discloses his/her sexual assault. This article also provides coping mechanisms which can be exercised by a victim to overcome aftereffects of rape.

  3. The role of self-objectification and women’s blame, sympathy, and support for a rape victim, Casey L. Bevens ,Amy L. Brown,Steve Loughnan, Published: June 28, 2018: This article gives a study conducted and has analysed the results, it has given in detail the method, results conducted during the study. It also describes the role of self-objectification and how women blame themselves for the crime and also how society sympathises with the victim rather then providing help to them.

  4. The challenge of definition of rape, Lan urbina( The New York Times)Oct.11,2014: This article shows how there are chellenges to the definition of rape and shows how there is no specific definition of rape and we tend to confuse when sexual assault turns into rape, and therefore distinguishing between the latter and the former becomes difficult, It also defines consent, it’s relation to rape and when can an assault turn into rape.


Submitted by- Vitthal Dixit

NATIONAL LAW UNIVERSITY AND JUDICIAL ACADEMY, ASSAM


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