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Last Updated Tuesday September 26 2017 04:17 PM IST

Heal Thy Self | A recovery guide for survivors of sexual assault

Nirmala Ferrao
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Heal Thy Self | A recovery guide for survivors of sexual assault

A new year has already hit its stride. But some things, it seems, never change. 2017 was virtually ushered in with incidents of sexual molestation in Bengaluru, once again catapulting India into the international headlines for all the wrong reasons. And sexual atrocities against women just seem to go on and on.

Not that men can’t be raped, or that women don’t commit sexual assault. But, overwhelmingly, the perpetrators of sexual violence are men – whether the victims are women, men or children. In India, the majority of perpetrators are known persons – family members, neighbors, local youth. And, for a variety of reasons, most cases go unreported.

In those that do come to media and public attention, the outrage and condemnation almost predictably run parallel with a fresh sputter of victim-blaming. It is not only fatuous politicians who brandish casual misogyny in their public spouting, blaming the assault on the west, on urban culture, but most of all on the victim. At a less public level, this finger-pointing at the victim also happens over coffee-table tattle and marketplace prattle.

Unfortunately, it is still very common for survivors themselves to buy into the game of victim-blaming. Many survivors question whether they could have caused or prevented the assault. Was it something they did – or did not do?

But, if you are a survivor, the primary truth you should never lose sight of is this: sexual assault is never the victim’s fault. Nothing you did or said or wore (drinking alcohol at the party; accepting a lift; wearing a sleeveless dress) gives anyone the right to assault you. You are not responsible for the assault. The assailant is responsible for the assault. Whatever you did to survive was right and it worked: you survived. And now, though the process is painful, slow and confusing, you can begin to recover.

Also read: Protect your personal space, win at psychological warfare

The survivor's manual

In the immediate aftermath of sexual assault, a turmoil of reactions – shock, numbness, confusion, shame, guilt, anger and severe distress – jockey around in your psyche. At the same time, your conscious mind is trying to work out what you should do now. To decide, in this shattered state of mind, to walk into the cold, clinical environment of a hospital or the forbidding confines of a police station is an act of stupendous courage.

But you may not want to do either of these things, and that, too, is a valid choice. There is no one right way to think or act after a sexual assault. Instead, there are several options on how you can meet your physical safety and emotional needs, how you can obtain medical attention, and how you can pursue legal action should you so decide.

Also read: Heal Thy Self | Hearing Voices?

Your first priority is to get to a place where you are physically safe

Your first priority is to get to a place where you are physically safe. Contact someone who can help you: a family member, relative, friend, room-mate, activist or a trusted lawyer. Having someone supportive with you can also be invaluable if you are deciding to get yourself to medical care and/or to a police station to register a complaint.

Medical care can help you regain a sense of control over your body. The idea of seeing a doctor right after a sexual assault may seem unpleasant. But there are important reasons to do so. You may have external and/or internal injuries or infections that require medical attention. You also need to be assessed for sexually transmitted diseases (STDs). In addition, at a medical facility, you may be offered emergency contraception. Many sexual assault survivors find that receiving medical attention helps them to gain a sense of control over their bodies.

If you are considering legal action… Apart from such medical care, if you plan to take legal action, a medico-legal examination and report, along with an accompanying case history, can serve as evidence in court. Even though you may not feel ready at this time to consider pressing charges against your attacker, the physical evidence can be preserved in case you decide to press charges at a later date. You can choose to have the forensic evidence collected without filing a police report immediately.

The medico-legal exam is actually a legal procedure for collecting evidence. It is done through a precise and detailed exam performed by a medical professional. Your informed consent is required for any exam or collection of evidence – or, if you are a minor, your parent or guardian’s consent. Ask the doctor what s/he will be doing during the exam so that you know what to expect.

One of the things you can expect is to be examined for semen or other bodily fluids, foreign hair samples, dried or wet secretions on the body surface, fibers. Ideally, the collection of specimens for evidence should be done as early as possible after the assault since medical evidence is quickly lost. The best biological evidence is collected within the first 12 hours; by 72 hours, evidence may tend to disappear. To preserve the physical evidence of the assault, it is also important not to change your clothing, wash or shower, urinate, brush your teeth, eat, drink or douche before the exam. These activities can destroy evidence that is highly useful should you decide to seek legal redress.

Under the provisions of the criminal procedure code, any registered medical practitioner can conduct a medico-legal examination in a case of sexual assault. So, you could choose to go to the emergency department of a public or private hospital, or to a private physician. A Supreme Court judgment has also held that a police requisition is not necessary to conduct a medico-legal exam. Refusal to conduct a medico-legal examination and to provide treatment are punishable with imprisonment.

Also read: Heal Thy Self | Make or break… any habit you want!

History-taking – a vital part of evidence collection

History-taking – a vital part of evidence collection. Although the medical evidence is crucial, it is not always available to a substantial degree. For instance, it’s a widespread misconception that injuries are inevitably present in cases of sexual assault. As a matter of fact, for a variety of reasons (e.g., delay in reporting the incident; the natural elasticity of the post-pubertal hymen; the use of a lubricant), less than half of all survivors show injuries to the genital and anal areas. Other kinds of forensic evidence may also not be available: for instance, if a condom was used, vaginal swabs and smears will be negative for sperm or semen.

But, apart from the forensic evidence, there is another kind of evidence that also carries legal weight. This is the 'history-taking' that will also be conducted at the medical facility. This comprises, in your own words, all that you can recall about the incident, covering details such as: the date, time, place of assault; the number of assailants; descriptive/identifying features of the assailant(s); details of the acts of sexual or other violence that were inflicted; the use of physical restraints, if any; injury marks that you may have left on the attacker’s body.

Counseling can make the crucial difference. Counseling, in the aftermath of the sexual assault, begins ideally at the health facility itself. It should be in the nature of what is known as “first contact psychological support” as well as validation (that you are believed; that you are not at fault; that rape is a personal violation no matter what your background and situation). Suicide prevention is the second critical aspect of psychological first aid. The third component is to encourage the survivor to express feelings about the abuse and deal with them.

Studies have found that sensitive and supportive counseling received at the time of first contact and in the first few weeks thereafter, determine to a large extent how the survivor will subsequently cope and can prevent many of the later psychological consequences. Unfortunately, in the majority of Indian healthcare facilities, such counseling is conspicuous mostly by its absence.

Should you file an FIR?

Should you file an FIR? The decision to make a police report can be one of the most difficult decisions for a rape survivor to make. In the first place, survivors do not have the conviction that they will be treated with sensitivity and respect at the police station where a latent bias against women, and damaging stereotypes about sexual assault, thrive. Many police officers blame rape victims, studies have found. Also, it is not uncommon for police to disbelieve rape victims unless they look disheveled and traumatized and show visible bruising. It is not unknown for rape victims to be given the metaphorical third degree when they attempt to report the attack.

Other reasons might also keep you from reporting sexual violence. You might be worried about identifying the perpetrator because of the fear of retaliation. Sometimes victims, particularly youth, are afraid of getting into trouble for doing something they weren’t supposed to be doing when the assault took place, such as drinking alcohol. Many survivors can also feel overwhelmed if they are pressurized by the family not to report the assault. The fear arises from the very strong social stigma and what is known as “secondary victimization” that persists as a leitmotif in India.

On the other hand, some survivors find getting the legal process underway helpful in their recovery, especially if the rapist is found guilty. To maximize the chances of an arrest and successful prosecution, it’s important that you report as soon as possible after the rape while the evidence is still present and your memory is still detailed.

Also check: Heal Thy Self | How to prevent a suicide

Take care of yourself emotionally. There is no “right way” for a survivor to react in the immediate aftermath of a sexual assault. The range of possible reactions include:

Shock and numbness

Shock and numbness. It may seem like your body is shutting down or withdrawing. You may go through the motions, but be unaware of all that is happening. For example, you may know that people are talking, but you do not fully hear what they are saying.

Another reaction to the emotional shock may be to begin distancing yourself from the sexual assault. You may claim to feel nothing or to be “fine.” You may outwardly appear to have “recovered”. Denial is in place so that “functioning as usual” can continue.

What might help: Understand that these are normal reactions right after a trauma. Reassure yourself that these feelings will diminish.

Talking with someone who can listen in an understanding and affirming way -- whether it’s a friend, family member, or significant other -- is a key part of the healing process. If you feel ready, you should allow those who offer their support to help you through this period.

However, the reaction of family and / or friends to your experience may not be what you anticipate or would like it to be. While some may give you their full support, others may express blame. The decision to talk about your experience is a personal choice. You do not have to share your experience with anyone until you feel ready.

Physical concerns. Your body could respond to the continued emotional stress with physical symptoms. You might have sleeping difficulties, headaches, appetite changes, stomach distress or other problems. Changes in sleeping patterns (sleeping too much or too little) are one of the most common after-effects of trauma.

What might help: Again, these reactions are normal and, generally, do not last long. However, some survivors do continue to have nightmares or other physical symptoms that interfere with their ability to function. If these physical symptoms don’t go away, you should seek medical attention.

Disruption of daily life. However resilient you are, the experience of sexual assault may still result in psychological crisis. During the first few weeks or months after the rape, as the shock and numbness wear off, you may feel pre-occupied with thoughts about the assault. It might be hard for you to concentrate. You might find yourself thinking about the sexual assault when you don’t want to think about it.

Some symptoms make their appearance weeks or months later. These might include: mood swings, irritability, crying spells, depressed mood or difficulty making decisions. This delayed response is not uncommon among rape survivors.

One of the ways that your mind takes care of you is to allow you to move on with life (job, family, social interactions). Yet, while you are trying to “move on”, you might come across some reminders of the trauma (situations, smells, familiar sounds). These “triggers” can remind you of the rape and cause you to experience some emotional distress. A common example is the one-year anniversary date of the assault. The extent of the distress can vary from a mild, uncomfortable memory or a flashback, to a physical reaction of anxiety or panic. Most rape survivors learn how to recognize and cope with their triggers over time.

What might help: Although these are normal reactions, they can be very distressing. Be gentle with yourself and do whatever you need to do to try to reclaim your life. For example, it is okay if you need to sleep in a room other than your bedroom (especially if you were raped in your bed). You may want to make some small changes in your life, such as buying new bed linen or taking a different route to work. These small changes can help you to feel that you are taking back control.

However, if the disruptions in your life continue, it may be useful to go to a counsellor. Counselling can help you identify and resolve lingering issues surrounding the assault.

Long-term Post-traumatic Stress

Long-term Post-traumatic Stress. Some rape victims experience more distress months or years after a trauma. Their responses could include: preoccupation with the trauma; unwanted, intrusive, thoughts or feelings about the trauma; flashbacks; repeated nightmares; continued sleeping difficulties; difficulty concentrating; or feeling numb or detached. These are also some of the symptoms of Post Traumatic Stress Disorder (PTSD), which can affect people who have experienced a life-threatening trauma. “Rape Trauma syndrome” is now an accepted medical term used to describe a pattern of responses seen in many sexual assault survivors.

What can help: Counseling and/or medication can be successful in treating these issues.

A sexual assault survivor does not move from stage 1 to stage 2 to stage 3 in a simple manner until “recovery” and then leave it all behind. Instead, it is more common for a survivor to move back and forth through the different stages. For example, a survivor may tap into denial at any time as a way of coping with other life stresses, or a survivor who is well on the path to recovery may suddenly be overwhelmed by an event and find the memory of the rape becomes all-consuming once again. This is completely expected, and is not moving “backwards” in recovery; rather, it often provides an opportunity to work through feelings which may have been too difficult to tackle at an earlier time.

Each survivor recovers at her (or his) own pace and manner. What is important is to stay the course. As the German philosopher, Friedrich Nietzsche, said: “That which does not kill us makes us stronger”.

(The author, a former editor of 'Health & Nutrition' magazine, now works as a counseling therapist)

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