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The Lifelong Consequences of Rape - Pacific Standard

The Lifelong Consequences of Rape

The long-term psychological and physical effects of the experience are devastating. And they're likely exacerbated by the shame our culture insists on perpetuating.
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(Photo: chasecarter/Flickr)

(Photo: chasecarter/Flickr)

This year will be remembered for plenty of major news events: In the U.S., there was the dismal voter turnout for the mid-term elections; the Ebola scare; and the intense discussions about race relations, police power, and the legal system that Michael Brown’s shooting and the subsequent case against Darren Wilson wrought.

It’ll also be remembered as the year rape was everywhere, the subject almost constantly covered. On college campuses, there was Emma Sulkowitz’s semester-long, mattress-hauling senior thesis and rape protest (which inspired more than 130 student demonstrations challenging how colleges handle rape allegations). And whatever the truth behind the now in-question Rolling Stone story, rapes at fraternities are common enough that there are several studies (and a book) looking into the phenomena. Celebrities like Lady Gaga and Shia LaBeouf spoke openly about their ownsexual assaults. Allegations by models against Terry Richardson flatlined his photography career. The FBI even updated its own definition of rape to be more specific and inclusive, and it looks like the number of crimes that will fall under the new categorization could increase by 40 percent (that’s not even including statutory rape or rapes reported only on college campuses).

"No other physical encounter between human beings carries such a disparate potential for good or evil."

And then there’s Bill Cosby. Allegations that he raped more than 20 women are not only notable for the similarities and specificities the women’s stories share, but also for how many decades they cover. From Joanne Tarshis in 1969 to Tamara Green in the '70s to Janice Dickinson in the '80s, the women who have come forward about the comedian’s alleged crimes are talking about incidents that span 50 years. Some of those women are in their 50s and 60s—yet the details of their stories remain sharp.

That may be because, even decades later, some of them are still suffering from PTSD and other long-term effects generated by their sexual assault. About half of all women who have been raped experience these same effects. Several studies have shown that rape trauma victims have one of the highest risks of developing PTSD and related conditions.

While it's normal to have trouble coping in the days or weeks following any type of violence, PTSD is, by its very definition, a long-term problem, which often includes issues with sleeping, nightmares, severe anxiety, numbness, and depression that can last longer than a month. In fact, these symptoms sometimes last for many months or even years and, without treatment, can get worse over time.

FOR REASONS THAT AREN'T entirely clear to researchers, rape is different from other forms of physical violence and trauma. Even though people may suffer from PTSD following a variety of terrible events, including combat exposure, assault, or a life-threatening accident, rape victims are more likely to experience long-lasting mental and physical problems—and here, long-term can mean a lifetime of torment.

A study earlier this year by a team of German researchers compared 27 rape survivors from World War II with women who had experienced other types of trauma during the war. Among the elderly sample, which was found via extensive media outreach, the authors wrote: “Women exposed to conflict-related sexual violence reported greater severity of PTSD-related avoidance and hyperarousal symptoms, as well as anxiety, compared with female long-term survivors of non-sexual WWII trauma.”

"Social acknowledgement is one of the most important healing effects—a society has to acknowledge that this suffering happened, and has to give the people some kind of symbol of that."

The average age of the women in the study was 80, and these crimes had been committed more than 60 years ago. It wasn’t easy to find these women, who came forward to offer their stories and were thus self-selected—perhaps only because they were still affected so many decades later. This is adefinite limitation in studies of long-term trauma. Nevertheless, even in this sample population,“We were quite astonished that the elderly women had such significant PTSD symptoms,” says lead author Philipp Kuwert, of University Medicine Greifswald at the HELIOS Hansehospital Stralsund in Germany.

Not only does this study point to the different (and more severe) mental health outcomes of those who have been raped, but it emphasizes the possible longevity of these untreated traumas.

Similar results have been found in studies that have looked at Croatian women who were raped in the 1991-1995 war, and ongoing studies are tracking East Congolese women who have experienced rape in conflicts there.

Besides increased likelihood of PTSD, anxiety, and depression, women who are raped also suffer from much higher levels of sexual dysfunction. The most common symptom is dyspareunia, which is pain during intercourse. But other issues, including menstrual issues, chronic pelvic pain, and inhibited arousal and desire can be lifelong issues.

Unlike other types of physical assault, or even traumatic accidents, rape—even if it is ultimately about power—is connected to sex: an act intimately allied with pleasure, relationships, and, sometimes, procreation. This makes its propensity for long-term damage unique. As psychotherapist Laurence Miller writes in his 2013 survey of rape causality: “No other physical encounter between human beings carries such a disparate potential for good or evil.”

BUT BEYOND PERSONAL PSYCHOLOGY, why are the effects of rape so significant and potentially chronic? The answer likely involves both brain chemistry and society's treatment of its victims.

A 2011 study found cortisol levels in rape victims were elevated in comparison to those of other traumatized people. “Whereas salivary cortisol levels decreased in the course of the interview for the group with no past experience of rape, those PTSD patients who had been raped showed a significant cortisol increase when reminded of their traumatic events,” the authors wrote. The hormone is released in times of stress; while it’s useful in a moment of conflict or fear, it contributes to a panoply of health problems in people who have elevated levels on a regular basis—and can even have permanent effects on the brain.

Why the disparity? Researchers aren’t sure—it could be due to the physical closeness involved in most rapes, which sets off a different response when remembered, or it could be due to the shame most rape victims feel. In several studies, researchers have found a link between shame and elevated cortisol. If it is the latter, this connection points to how important the societal response to rape really is; most hit-and-run or robbery victims don’t feel shame.

Blaming victims of rape is so normal and acceptable that when Tarshis appeared on CNN recently to talk about her rape allegations against Cosby, anchor Don Lemon asked her why she didn’t bite his penis off when he forced her to perform oral sex.

We do know that the cultural reaction to rape—from communities, police departments, medical personnel, and the aggressors themselves—can significantly affect how well a victim recovers, the length of the recovery period, and if he or she develops PTSD. A 2004 study looked at the effects of secondary victimization (defined as "victim-blaming behaviors and practices engaged in by legal and medical personnel, which exacerbates victims' trauma"). Most women in the study said that they felt guilty, ashamed, depressed, anxious, distrustful, and, most disturbingly, "reluctant to seek further help" after reporting their rapes. Not surprisingly, the authors concluded that these experiences were "significantly positively correlated with posttraumatic stress symptomatology."

Kuwert, of the World War II study, has been studying rape and war since 2006 and advocates for psychological support, both culturally and individually, for rape victims. “Social acknowledgement is one of the most important healing effects—a society has to acknowledge that this suffering happened, and has to give the people some kind of symbol of that,” he says. “In Bosnia it was important that an Imam gave a speech that addressed the suffering of rape victims there; it had a strong healing effect.”

THE MORE RAPES THAT are brought into the light, the less taboo they are (which can do a lot to reduce shame and guilt), the less likely secondary victimization will occur, and the less likely PTSD will develop or persist.

Currently, only eight percent of rapes are brought to trial, and perpetrators are found guilty about four percent of the time, according to statistics from the Rape, Abuse & Incest National Network. To both reduce rape and bring more rapists to justice, an ongoing cultural conversation is needed—which is why 2014 may turn out to be a good year after all.

The Roman lawyer Cicero is the first person credited with promulgating the idea of “getting what you deserve.” He wrote, in Book 3 of his De Legibus: “Let the punishment be equal with the offence.” And while that concept surely predates him, Cicero influenced none other than the Founding Fathers—Adams and Jefferson were fans—so he gets the credit.

In the cases of sexual assault, the targets are both victims of an in-the-moment crime and a sometimes-lifelong medical and psychological punishment. Their perpetrators, meanwhile, often walk free, due to cultural taboos, shame, and guilt. Blaming victims of rape is so normal and acceptable that when Tarshis appeared on CNN recently to talk about her rape allegations against Cosby, anchor Don Lemon asked her why she didn’t bite his penis off when he forced her to perform oral sex. The cultural response to rape is entirely in our control, even if individual perpetrators are not.

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