How much damage does the rapist do? As long as we are talking physical injuries, these are usually the consequence of the assault, not of the rape per se. Accounts of the psychological consequences of rape attribute the woman’s suffering to the rape itself, which has the effect of making it sound catastrophic. Raped women will be told not only that they are irrevocably damaged in soul and body but that if they do not acknowledge this they are in denial. When we encounter a system in which women reporting rape are, besides providing sperm samples and blood tests and an extended narrative of events, to be examined by a psychiatrist and a diagnosis arrived at, we might wonder if they will ever be allowed to get over it. Getting over it becomes a suspect activity in itself.
In 1974 Ann Wolbert Burgess, founder of the rape crisis counselling service at Boston City Hospital, and Lynda Lytle Holmström of Boston College published their account of what they called Rape Trauma Syndrome in the American Journal of Psychiatry.21
They interviewed and followed up 146 patients admitted during a one-year period to the emergency ward of a city hospital who complained of having been raped. Using their analysis of the ninety-two adult women rape victims in the sample, they identified a rape trauma syndrome which came in three forms: a typical form, compounded reaction and silent reaction.
It seemed to more than one observer that the authors of the article in the American Journal of Psychiatry had assumed what they needed to prove.
Criticisms of the scientific validity of the RTS construct are that it is vague in important details; it is unclear what its boundary conditions are; it uses unclear terms that do not have a basis in psychological science; it fails to specify key quantitative relationships; it has not undergone subsequent scientific evaluation since the 1974 Burgess and Holmström study; there are theoretical allegiance effects; it has not achieved a consensus in the field; it is not falsifiable; it ignores possible mediators; it is not culturally sensitive; and it is not suitable for being used to infer that rape has or has not occurred.22
Ann Burgess is now principally known as the original of Wendy Carr in the Mindhunter TV series.
According to the US Rape, Abuse and Incest National Network 33 per cent of rape victims contemplate suicide and 13 per cent attempt it. A now famous victim impact statement from 2016 reads in part ‘you [the assailant] took away my worth, my privacy, my energy, my time, my intimacy, my confidence, my own voice, until today’.23 Why should a sexual assault take away these precious, intangible things? There is a clue to how to reclaim them in the last two words. The victim who takes over her narrative becomes a survivor.
Diagnosis of RTS gradually gave way before an identification of the distress caused by rape as a form of Post-Traumatic Stress Disorder. In the case of PTSD more rigorous assessment had been carried out and clear criteria had been established. Now we learn that whereas only 10 to 20 per cent of veterans will suffer PTSD, 70 per cent of rape victims will suffer moderate to severe distress, ‘a larger percentage than for any other violent crime’. As usual we are here confronted with unanswerable questions. Most rape is not accompanied by physical injury or carried out by men unknown to the victim, nor is it followed by flashbacks or is it ever identified as a crime. In the case of a woman who chooses to report the event, we have no idea how much of her distress is caused by the work-up itself, by the compilation of the forensic evidence, by her having to tell her story over and over and in public and then to defend it both in the committal stage and later in the courtroom. The most catastrophic shock must surely come when, as far too often happens, the jury does not convict. Nothing in the literature of PTSD after rape deals with these experiences. For all the intellectual effort and energy that has gone into getting the law of rape to make sense, conviction rates are falling. Meanwhile the true extent of non-consensual sex remains unimaginable.