Written by Jessica Eaton
17th January 2019
Aye. Not shy of a controversial topic or two on this blog, are we?
It’s true. Over the years, I stopped encouraging women to talk to their doctor or to the police if they had been raped. When women asked me what to do, I stopped advising them to report to the police and I stopped advising them to go to their GP for support. I want to talk about why I made this decision and why I still do not encourage women to report to police or disclose to doctors that they have been raped or sexually assaulted.
Some people might be surprised to read this. Others who know me well, know what’s coming in this blog:
We have to talk about the way disclosure and reporting sexual violence can make the situation much worse for women.
This year, I have been working in sexual and domestic abuse for nine years. That includes years spent managing vulnerable and intimidated witness programmes for sexual, domestic and physical violence trials, manslaughter, trafficking and homicide cases. In addition to another few years managing rape centre services for women and men. And a few more years working in child sexual exploitation.
Over the years, I noticed the same pattern emerging everywhere: we were advising women to disclose and to tell people what had happened to them, but they were not benefiting from that disclosure. In fact, lots of women I worked with were negatively impacted by disclosing or reporting rape.
Those of you who work in these services will know what I mean:
– Women who report to the police only to be questioned for hours about what they were wearing, why they were drinking and whether they were telling the truth
– Women who report to the police to be asked why the didn’t report sooner
– Women who report to the police, initially believing they were not to blame, leaving the station convinced it was her own fault
– Women who try to report to the police but are told their evidence was not good enough or that their complaint would go nowhere
– Women who reported to the police but had their case NFA’d (no further action) because she was not ‘credible’ enough
– Women who reported to the police but were told they were not reliable enough because they have autism, mental health issues or addictions
– Women who go to their doctor to disclose abuse or rape and are met with a GP who has absolutely no idea what to say to them because no one has trained them in how to support a disclosure
– Women who go to their doctor about trauma responses to abuse or rape and get told they have mental health issues and are prescribed anti-depressants with no other assessment
– Women who tell their doctor that they were raped or abused and are asked intrusive and judgemental questions
– Women who disclose to their doctor that they are having flashbacks or trauma responses to abuse and are told they need to ‘get over it’
The reality is, in the UK, when a woman is raped or abused, we hear the same two ‘routes’ to care advised over and over again: “You must report it to the police” and “I’m sorry you feel that way, have you spoken to your GP?”
But what if those two routes are causing further harm? What if the people in those routes don’t have the right training to be the first response to rape and abuse disclosures? What if our systems are not set up for women and are instead penalising them for disclosure?
What if women were better off not reporting the rape at all? What if women were better off not speaking to a GP about sexual trauma?
Case Study 1: Dina
Dina was sexually abused by her parents for many years but has only recently come to understand what happened to her. She is a 36 year old female with two kids and a husband. She has been feeling low, distant, erratic and having a number of physical and psychological symptoms of trauma. She talks to her friends who tell her to go to her GP for help. She goes to the GP after weeks of building up the courage. When she gets to see her GP, she uncomfortably tells them how she is feeling and some of the thoughts she has been having. The GP looks disturbed and asks her why she has only just remembered. The GP asks Dina why she has never told anyone before. Dina doesn’t know what to say. The GP asks her some standard questions about her low mood and suggests that she is suffering from anxiety and depression and prescribes 25mg Sertraline. Dina leaves the surgery to get the prescription and goes home.
Do not be fooled. This case study is so common, people reading this blog will identify with it straight away. This is an example of the way trauma is medicalised and trivialised by untrained and unsupported medical practitioners who have not had decent, trauma-informed training. Women are often labelled, medicated and sent on their way. Sometimes, if severe, they will be referred to a mental health team who will further label and medicate them. True trauma-informed approaches that would look deeply at the sexual trauma, the memories and the context of her symptoms is lacking in the UK, so thousands of victims of sexual trauma will simply be told they are mentally ill and medicated for many years with no access to decent support or therapy.
In this case, was this really the best outcome we could have provided for Dina? No.
There was no discussion of the memories, the trauma, the responses, the fact that her feelings are normal. There was no explanation of the psychosomatic and physiological manifestations of trauma that would have helped her understand why her body and brain are feeling different now she has remembered the abuse. Instead, she is labelled and medicated with a standard dosage of a massively over prescribed anti-depressant and sent on her way.
Case Study 2: Rachel
Rachel was told to seek support from the local mental health team for her feelings and thoughts after she was raped. She spoke to a Community Psychiatric Nurse (CPN) a few times over a period of weeks. This week she has been told they think she has borderline personality disorder. Rachel was sure that her feelings were because she was raped by her ex-partner, but this professional has just explained to her that she actually has a personality disorder that is making her think and feel differently about herself and others. Rachel is now flagged at her GP surgery, by the police and by the A&E department as having a personality disorder which means people are less likely to believe her and more likely to assume her reports or behaviours are due to, or affected by, a personality disorder. She is likely to struggle to ever get the incorrect diagnosis removed and it may affect her employment, education and opportunities in the future as it is so stigmatising.
Again, extremely common. Women and girls are 7 times more likely to be diagnosed with BPD than boys and men (Ussher, 2013). Also, it is a very common catch-all diagnosis for women with histories of abuse and trauma. Borderline personality disorder and the newer ’emotionally unstable personality disorder’ are well known to practitioners working with women and girls who have been abused or raped, because they often have been diagnosed with these terms instead of trauma. In fact, you may be interested to know that the criteria for BPD and EUPD is very similar to the old criteria from DSM II for ‘hysteria’ (Ussher, 2013). That’s right. Personality disorder in women has the same criteria as a sexist old diagnosis of ‘hysteria’. Hysterical women. Crazy, mad, angry women with mental health illnesses caused by their crazy wombs.
With Rachel, our professional or personal advice was for her to speak to the mental health team in her locality – but was that really in her best interests? Did Rachel need support or a psychiatric diagnosis? Why did we tell her to go to the mental health team in the first place? Isn’t trauma after rape normal?
Case Study 3: Lisa
Lisa was raped on her way home from drinks with work colleagues. It was around 7:45pm and she was in familiar streets walking home. She says that a man came out of nowhere and attacked her, dragging her up the street before pushing her over. She says there must have been witnesses because the street was full of people walking home in the light summer evening. After she was raped and the man ran away, she rang 999 and waited for the officers. She was feeling hopeful, because she had been raped before when she was a teenager and because that happened in a relationship with no witnesses and no evidence, the case was closed. She thought, this time, she would definitely be taken seriously and she knew it was not her fault. The police arrived and took her to the station and to the SARC for examination. It was when she was giving her interview that the officers asked her questions that made her question herself. They asked her if she had been drinking because she smelled of wine. They asked her why she was walking home alone after drinking. They told her they knew she had reported rape before and ‘it had come to nothing’. They asked her why she couldn’t remember what he was wearing. They asked her why she didn’t fight him off or scream for help. Lisa explained she had mental health issues she was currently seeking help for and then realised that was making her sound even less credible. Lisa started to cry and realised, she was not the ‘credible’ victim she thought she was. The case was NFA’d three weeks later and nothing was done to apprehend the offender.
As much as this might read like a ‘worse case scenario’ for women reporting rape, it really isn’t. It’s common. It’s happening everywhere. Women are scrutinised from the moment they report. Everything is considered: their behaviour, their character, their mental health, their background, their criminal history, their sexual activity, their story, their intoxication, their appearance and their body language. We know this to be true. We know the research has been telling us consistently for the past 40 years that women who report rape to the police blame themselves more and wish they hadn’t reported at all (Campbell et al, 2009; Ullman, 2004; Eaton, forthcoming). We also know that only around 13% of people (men and women) who are raped ever report to police (CSEW, 2017).
We know that the research explains this trend clearly: victims are measuring themselves against rape myths and stereotypes to consider whether they will be believed or not (Campbell et al., 2009; Sleath, 2011). Even research from University of Bedfordshire (2015) showed that girls who had been sexually exploited in childhood who were encouraged to report and then go through a criminal prosecution process in court had worse outcomes, worse mental health and much higher rates of trauma. So why do we keep telling women to report to police?
When the CSEW is reporting that 510,000 women were sexually assaulted or raped in 2017 but only 2991 offenders were convicted – that gives women a 0.5% prospect of conviction of the person who sexually assaulted or raped them. So why do we keep putting women and girls through the process of questioning, interviews, evidence collection, trial, waiting and agonising for sometimes 12-18 months? Is this in their best interests? Is reporting to the police really the best thing for them as a victim? No. It isn’t. Is it good for society? Supposedly, but if the conviction rate is anything to go by, then no. Will it protect others from being raped? Probably not.
So I got to the point after working with hundreds, maybe thousands of women and girls who have been raped (and the thousands of women and girls who write to me about their experiences of this too) – where I just stopped encouraging women to report to police or disclose to the GP. And trust me when I say, I know I am going to get backlash for coming out and publicly saying this. I know people are going to argue that I am being irresponsible.
But riddle me this, if women disclosing to their GP is resulting in them being stigmatised, labelled and medicated instead of being supported – and reporting to the police is causing women to blame themselves or become more traumatised than before – in whose interest is this advice?
What if we started being honest with women when they were raped?
What if we told them that if they went to their GP and disclosed rape, exploitation or abuse, there is a high chance they will be met by someone who has no training in how to support them, has no idea how to explain sexual trauma to them and is likely to either medicate them or refer them to a mental health team who will medicate them too?
What if we told women the truth about what happens when they report a rape, how it might make them feel, how waiting 12 months for a trial date might impact their lives, how being made to relive their experiences 18 months later in a courtroom when they were just starting to feel okay again, might affect them? What if we told them about the conviction rate? What if we told them about the way justice actually feels when an offender gets a suspended sentence but you live with the memories of the rape forever?
What if we suggested something else entirely? What if we actually advised women and girls based on what was in their best interests?
Not our best interests. Not the state’s. Not the professional’s. Their best interests. The interests of the woman.
I no longer advise women to report to the police and I no longer advise women to go to their doctor. Neither are supporting female victims in the way they should, and the evidence is consistently showing us that these routes cause further trauma.
So what do I advise them?
Well, it’s simple really:
– Seek out women’s centres and specialist, third sector rape and sexual violence services
– Use helplines to talk anonymously and confidentially about how you feel without having to commit to a service
– Seek free mental health support from third sector organisations and research them to check they use approaches you agree with
– Report anonymously to Crimestoppers if you would like to
– Read lots of reports and research to inform yourself before making a decision to report to the police about abuse or rape
– Seek advice from experienced women’s centres and sexual violence services about reporting without any pressure or bias
– Make a decision based on what is best for you, and do not think about anyone else. Be selfish. Do what you want to do.
– You are not responsible for the offender’s actions or next victims, reporting them is highly unlikely to stop them from abusing others long term
– Decide whether you are ready to disclose at all, there is no pressure and no rush. Talk to people you trust and who love you and care about you
– Seek trauma-informed advice and therapy to learn about your body and brain after sexual trauma without being diagnosed as mentally ill
– Talk to other survivors and victims if you would like to, to learn and to find some common ground with others
– Use reflective techniques to process your memories and feelings such as writing, art, singing, reading and learning
– Look after yourself and do something nice for yourself every day
– If you do want to report, seek support and don’t go alone
– If you do want to go to your Doctor about concerning health symptoms you need advice with, take someone with you and prepare what you are going to say and what answers you want and don’t want. You are in control of your health. If you do not want a medical response (medication and diagnosis), tell your GP you are looking for therapy or support and ask for referrals or signposting.
In reality, there are many more routes to recovery and support than two systems that are failing women right now. Until the services are staffed by people who are fully trained and until responses to women with sexual traumas are reformed and redesigned to stop scrutinising, medicating and blaming women for rape, women are better off avoiding them all together.
There are better, more woman-centred, trauma-informed, strengths based approaches out there.
Let’s put victims first, not systems. What’s in their best interests? Can we do better?
*Short, tongue in cheek disclosure: Yes, I know this happens to men too. Yes, I know there are some great police officers. Yes, I know you might have a great GP. No, your anecdote does not trump years of research and real experiences of women and girls.