Revisiting "The Rape Victim in the Emergency Ward": A Conversation With Dr Ann Wolbert Burgess.

The Rape Victim in the Emergency Ward

The Rape Victim in the Emergency Ward

Having just completed a lecture on posttraumatic stress disorder to junion medical students, I found myself temporarily stunned. One ofthe students had difficulty understanding how a single episode of rape could lead to clinical symptomatology similar to that experienced by a war veteran. Those of us in the trenches of treating traumatized patients are well aware of the psychological and physiological aftermath of such events. However, as illustrated by my teaching experience, many professionals in training (and, I suspect, many ofthose in practice) are not. Solveig Dahi’s monograph on rape is a solid introduction to the impact ofsexual trauma. It is a brief, well-written guide to various aspects ofthe rape experience. The table of contents provides a detailed index for readers looking for specific information. The primary purpose of the book is to report the results of a Norwegian emergency ward program’s longitudinal study of 5 5 rape victims. From a research perspective, one could cite problems with sample size, control groups, and similar fictons, but that approach would miss the value of the work. The author acknowledges the difficulties with this type ofstudy and illustrates the level ofpersonal involvement as well as the impact of the material on the researcher. It is important for any professional providing clinical care for rape victims to recognize the concept ofvicarious traumatization (1). DaM reviews previous research on rape epidemiology, citing the results of studies documenting lifetime prevalences of rape and attempted rape as ranging from 9 to 44 per-

Because rape represents a sexualized form of aggression directed most frequently against women, it is not surprising that female mental health professionals have assumed leadership both in studying the phenomena and in developing methods to assist victims in the posttraumatic period (Bassuk, Savitz, McCombie, & Pell, 1975). Clinical experience indicates that female rape victims may prefer to relate to women counselors during the acute phases of the crisis, perhaps because the victims assume that a woman can offer them empathy and understanding in this situation. However, the reality of crisis intervention work, whether carried out in the setting of the general hospital emergency ward, an acute psychiatric service unit, the local mental health center, or similar facilities, often dictates that male counselors, mental health workers, psychiatric residents, or physicians may be the first or only persons available to the female victims of rape. It is the purpose of this chapter to consider some of the possible difficulties inherent in being a male helping person assisting women in crisis following rape. It is hoped that these speculations will encourage others to share their impressions and experiences in this clinical area and that increased awareness of these problems may reduce the likelihood that they will interfere with potentially helpful intervention efforts.

The authors interviewed and followed 146 patients admitted during a one-year period to the emergency ward of a city hospital with a presenting complaint of having been raped. Based upon an analysis of the 92 adult women rape victims in the sample, they document the existence of a rape trauma syndrome and delineate its symptomatology as well as that of two variations, compounded reaction and silent reaction. Specific therapeutic techniques are required for each of these three reactions. Crisis intervention counseling is effective with typical rape trauma syndrome; additional professional help is needed in the case of compounded reaction; and the silent rape reaction means that the clinician must be alert to indications of the possibility of rape having occurred even when the patient never mentions such an attack.

The present study reports on the forced sexual, excretory, and sadistic acts that occur during rape. The main sample consisted of 115 adult, adolescent, and child rape victims that were admitted during a 1-year period to the emergency wards of a large municipal hospital. Forced vaginal intercourse was the most frequent act reported, but many other acts also occurred, ranging from fellatio and cunnilingus to urinating on the victim. It is argued that various social-psychological meanings are attached to forced sexual acts, most notably power, anger, and male camaraderie. Pair/group rape differs from single-assailant rape in the emphasis placed on watching and taking turns. Analyzing the social meanings attached to forced sex makes a contribution to our knowledge about the use of sex to express nonsexual issues.