RAPE
VICTIM
counterattacking.
Here,
the contradiction
The
Rape
BY MALKAH
Victim: T. NOTMAN,
Psychodynamic M.D.,
AND
The
of nonbeing
creates panic. In a society such as ours, where the fantasy of power is a constant stimulus and Superman, John Wayne, James Bond, and Kissinger are cultural heroes, while powerlessness and alienation are the reality, it is inevitable that rape occurs frequently. Males denied power in their daily lives find means to act as if they had it. Women are the obvious victims because male society still defines them as powerless, functional nonpersons. Providing men with the feeling of power has been considered to be one of woman’s duties. In 1968 I was raped at gunpoint. Later, lying naked on the floor, I could only whisper over and over again, “One doesn’t treat people like this.” I had had only a momentary glimpse of the rapist, a stranger. From my brief description, a police artist drew a face identical to a photo I later identified in police records. This man, who was on parole, had been incarcerated for rape. His parole officer called him in for questioning but concluded on the basis of an alibi that he had been too far from the scene of the crime.
CAROL
C. NADELSON,
The authors are with Beth Israel Hospital. 330 Brookline Ave., Boston, Mass. 02215. where Dr. Notman is Psychiatrist and Dr. Nadel-
Am J Psychiatry
/33:4,
April
1976
account
I wrote
of the rape
(in an
REFERENCES I.
Paz 0: The Labyrinth of Solitude. 1961 2. Metzger D: Skin: Shadows/SILENCE: Form of a Novel. West Coast Poetry
New
York, A
Grove
Review
Love Letter (in press)
rape
range
Press, in the
M.D.
THE
408
fictional
Considerations
Rape challenges a woman ‘s ability to maintain her defenses and thus arousesfeelings ofguilt, anxiety, and inadequacy. Women ‘s individual responses are determined by life stage considerations as well as their defensive structures: concerns about separationindividuation may be aroused in the young woman; a divorced or separated woman may find her credibility questioned; older women ‘sfears of sexual inadequacy may be compounded. In counseling, the victim’s previous adjustment should be assessed, she should be given support and reassurance, and specific considerations related to her life circumstances should be acknowledged and dealt with.
son is Associate Psychiatrist and Director, Medical tion. They are also with Harvard Medical School, where Dr. Notman is Assistant Clinical Professor Dr. Nadelson is Assistant Professor of Psychiatry.
first
unpublished novel titled “Flying With a Rock”) was couched in fantasy. I described the nape of a madwoman. I was still maddened by the assault and could only develop a character who had lost all sense of herself. Four years later I wrote a more accurate version, which describes a woman both overpowered and divested of her power (2). Her last words are “I cannot.” She is emptied out. I decided to make this public in order to break some of the silence and isolation which reinforces the personlessness of women. The private voice in the public sphere confirms our common experience through which we begin to assert ourselves. Unlike my character, now, I can.
Student EducaBoston, Mass., of Psychiatry and
EXPERIENCES
that
we
call
from
sur-
prise attacks with threats of death or multilation to insistence on sexual intercourse in a social encounter where sexual contact is unexpected or not agreed upon. Consent is crucial to the definition ofrape. The importance of mutual consent is often overlooked and misinterpreted; many people assume that certain social communications imply willingness for a sexual relationship. Although men, women, and children are raped, the majority of rape victims are women; this paper will focus on understanding rape as a psychological stress for the woman victim. Burgess and Holmstrom (1) divided the nape victims they studied into three groups: 1) victims of forcible completed or attempted rape, 2) victims who were “accessories” because of inability to consent, and 3) victims of sexually stressful situations where the encounter went beyond the woman’s expectations and ability to exercise control. Despite the different circumstances, the intrapsychic experiences of rape victims in all categories have much in common.
MALKAH
The rape victim usually has had an overwhelmingly frightening experience in which she fears for her life and pays for her freedom in the sexual act. Generally. this experience heightens a woman’s sense of helplessness. intensifies conflicts about dependence and independence. and generates self-criticism and guilt that devalue her as a person and interfere with trusting relationships. particularly with men. Other important consequences of the situation are difficulty handling anger and aggression and persistent feelings of vulnerability. Each rape victim responds to and integrates the experience differently depending on her age. life situation, the circumstances of the rape. hen specific personality style, and the responses of those from whom she seeks support.
RAPE
AS A STRESS
Rape can be viewed as a crisis situation in which a traumatic external event breaks the balance between internal ego adaptation and the environment. Since it is an interaction between an extreme environmental stimulus and the adaptive capacity of the victim. rape is similar to other situations described in the literature on stress. including community disasters (2, 3), war (4-7), surgical procedures (8, 9), etc. The unexpectedness ofthe catastrophe and the variability of victims’ resources for coping with an experience that may be viewed as life-threatening are critical factors in rape, as in other crisis situations. Although there are cultural and personality style differences, descriptions of stress reactions generally define four stages, which vary in intensity and duration (10). These responses, listed below, are also found in rape victims. I. Anticipatori’ or threat phase. In this stage. anxiety facilitates perception ofpotentially dangerous situations so that they can be avoided. Most people protect themselves with a combination of defenses that maintain an illusion of invulnerability. with enough reality perception to allow them to protect themselves from real danger. When a potential stress is planned (i.e. elective surgery), an individual can protect his/her ego integrity by strengthening those defenses which will ward off feelings of helplessness. 2. Imnpact phase. Varying degrees of disintegration may occur in a previously well-adapted person during this second phase. depending on the degree of trauma and the adaptive capacity of the individual. There may be major physiological reactions, including vasomotor and sensorial shifts. Tyhurst (2) reported on the extremes of fire and flood victims’ reactions, which ranged from “cool and collected” to “inappropriate” responses. with “states of confusion, paralyzing anxiety, inability to move out of bed, hysterical crying, on screaming.” The majority of these victims showed variable but less extreme responses-they were “stunned and bewildered” and demonstrated restricted attention and other fear responses, such as automat,
T.
NOTMAN
AND
CAROL
C.
NADELSON
ic on stereotypical behavior. This picture is also seen in rape victims. 3. Posttraumatic or ‘recoil’ phase. Emotional cxpncssion, self-awareness, memory, and behavioral control are gradually regained in the recoil phase. Howeven, perspective may continue to be limited and dependency feelings are increased. The individual perceives adaptive and maladaptive responses in him/herselfand may question his/her reactions. A positive on negative view of one’s ability to cope may affect the course of resolution of the trauma and future capacity to respond to stress, and self-esteem may be enhanced or damaged. Group support during this phase enables the victim to feel less isolated and helpless. Obviously, the rape victim, who is usually alone during the attack, can only hope for support later. Women are often disappointed by the failure offamily, friends. and the community to validate their experience. Janis (9), in his study of surgical trauma patients, noted that any threat that cannot be influenced by the individual’s own behavior may be unconsciously perceived in the same way as were childhood threats of parental punishment for bad behavior. This results in attempts to control anger and aggression in order to avoid provoking punishment. The absence of overt anger is also a very prominent finding in rape victims. 4. Posttremumnatic reconstitutiomi phase A process occurs during this phase that may alter future life adjustment. The loss of self-reassuring mechanisms that had fostered a sense of invulnerability may result in a decrease in self-esteem. The victim then blames him/hense+f for back of perception or attention to danger. Kardiner and Spiegel (I I) studied war stress and stated, As soon as fear is directed inward in the form ofquestioning the individual resources to cope with cxtennal danger. or toward the group in the form of questioning its ability to be a protective extension ofthe individual, then a new and more serious danger situation is created. Maladaptive responses have been reported in the war neuroses ofWorld War II (12), in which the individual develops mechanisms that are protective against further exposure to trauma but are psychologically costly and may involve loss of pnide and selfesteem (13). The rape trauma syndrome described by Burgess and Holmstrom ( I ) can be considered a form of stress reaction that can lead to traumatic neurosis. They reported an acute disorganizational phase with behavioral, somatic, and psychological manifestations and a long-term reorganizational phase with variable components depending on the ego strength. social networks, and specific experiences of the victim. They focused on the violent life-threatening aspects of the crime. Two types of response they noted are: “the expressed style,” in which the victim is emotional and visibly upset. and the “controlled style.” in which denial and reaction-formation seem to be the most prominent defenses. They also described feelings of shock and disbelief in many victims and the prevalence of ‘
‘ ‘
‘
‘ ‘
.
‘ ‘
‘ ‘
Am J Psychiatry
133:4,
April
/976
409
RAPE
VICTIM
guilt and self-blame in the initial phase. The reconstitution phase varies considerably with each individual; however, the patterns of response appear to be similar to those reported in the other types of stress reactions we have discussed.
THE
DYNAMICS
OF
THE
RESPONSE
The important considerations dynamics ofwomen’s responses 2) unconscious fantasies, and sive ego styles.
TO
RAPE
in understanding the to nape are I) affects, 3) adaptive and defen-
vented the attack on the rape are frequent. The assumption is that the woman should on could have handled the situation better, that her unconscious wishes perhaps prevented more appropriate assessment and more adaptive behavior. The guilt of the victim is further increased by focusing on the sexual rather than the violent aspect of the expenience. Although aggression is most prominent in the victim’s perception, society regards nape as sexual. Since long-standing sexual taboos still persist for many people. even an unwilling participant in a sexual act is accused and depreciated. The popular adage that advises the woman who cannot avoid rape to relax and enjoy it’ misconstrues the attack as a sexual experience. In reality, the rape experience is depensonalizing and dehumanizing. The woman is often a faceless object for the rapist’s expression of hostility, and the victim feels degraded and used. Furthermore, since women are expected to exert impulse control in sexual encounters, the nape victim’s sense offailure in setting limits. impossible though this may have been, contributes to hen guilt. ‘ ‘
‘
Anger A striking phenomenon in rape victims is the initial display offean, anxiety, guilt, and shame-but little direct anger. There are several probable reasons for this. I. Since rape may evoke memories of childhood threats ofpunishment for misdeeds (9). the victim may feel that she is being punished on is in some way responsibbe. Her anger may be repressed and experienced as guilt and shame, despite her concomitant feelings of helplessness and vulnerability. Most of the angry feelings appear later in recurrent nightmares, explosive outbursts, and displacement of anger as the woman attempts to master the assault. 2. Expression of aggression in women has been highly conflictual because of cultural restrictions and expectations of passivity and greaten compliance for women. Women have often tended toward a masochistic orientation, in which anger is transformed into cubturally supported patterns of self-blame. Identification with the aggressor. a mechanism that serves as an attempt to gain mastery. may also make it difficult to acknowledge anger toward the rapist. 3. The socially reinforced suppression of aggression in women has a possible adaptive function, since women are usually smaller and physically weaken than men. Therefore, not responding with a counterattack may prove beneficial. This is an important consideration in understanding the concept of consent. In the past. legal expectations included evidence of force on a struggle in order to establish rape. Current laws accept threat of force as sufficient, recognizing that a woman may submit in fear rather than risk fighting and being overcome. Guilt
and
Shame
Despite the varying circumstances of nape and the different degrees of violence, surprise, and degradation involved, guilt and shame are virtually universal. The tendency to blame the victim, thereby assigning responsibility to hen, fosters guilt and prevents her from adequately working through the crisis. It is common for a nape victim to feel that she should have handled the situation differently, regardless of the appropriateness of her actual response. Concerns about the amount of activity or passivity that might have pre410
Amn J P.s ychiatm-y
/33:4,
April
/976
(Jncomiscious
Famitasies
The question of unconscious wishes translated into provocation of a rape must be seriously considered. While undoubtedly there are unconscious fantasies in which rape plays a pant. and some women do have fantasies in which submission to a stronger man may be linked with forbidden oedipal wishes, on the conscious level the women knows she is submitting because any other behavior would result in real danger to hen life. However, this is not so cleanly differentiated in the unconscious. The universality of nape fantasies certainly does not make every woman a willing victim-on cvcry man a rapist. The unconscious fantasy does not picture the actual violence of the experience. An individual’s defensive organization usually protects him/her from acting out such fantasies. However, if the defensive barrier breaks down and unconscious destructive. aggressive, on masochistic wishes gain cxpression, anxiety oven the boss of control combines with guilt regarding the impulses. Rape involves an overwhelming confrontation with another individual’s sadism and aggression and one’s own vulnerability. This challenges the woman’s confidence in her ability to maintain her defenses and controls. Many women feel some ambivalence toward men as a result of past developmental experiences. Women expect men to be their protectors and providers, as well as relating to them sexually. Men may also be seen as potential aggressors and exploiters, and the experience of nape confronts the woman with this violent potential. The betrayal by the supposed protector who turns aggressor has a profound effect. Almost all nape victims say they trust men less after the nape. All men may be suspect, and all are potentially on trial. Uncertainty about one’s ability to control the environment neverbenates with concerns about the ability to control and cane for oneself.
MALKAH
Men’s
Responses
to Rape
It is important to consider the responses of men who participate in discussions about rape. They often feel indignation and sometimes identify with both the victim and aggressor. They may feel their masculinity is violated by both the attack on a woman who is felt to “belong’ to them and by their own helplessness denying in part from early feminine identification as well as from their actual failure to have prevented the attack. This may be particularly threatening to men who need to reject any latent feminine components of their own personalities and may lead to a defensive identification with the rapist in an attempt to escape the anxiety of their own sense of vulnerability. Some men have difficulty coping with the impulse for revenge. which would reestablish their sense of control and the ability to protect “their’ women. A man whose daughter, girlfriend. or wife has been raped may react by becoming overprotective. partly as a result ofhis sense ofguilt for not having been protective enough. However, it may also evolve as a defensive means of handling his anger at the attacker of “his” woman and at the woman for having allowed herself to get in this position. A complex series of feelings about his own sexual impulses may be evoked. and a man may find himself unable to be supportive or helpful to the woman after the rape, despite a previously close relationship. He may have difficulty with his own rape fantasies, his concerns about “used merchandise,” and even the breakthrough of homosexual impulses. He may withdraw from the woman as a result of this anxiety. The woman who is deprived of support from a man who is important to her is particularly vulnerable to adverse reactions after a rape. The man may be unaware that he is not supportive, since denial operates to minimize the experience so it can be forgotten. ‘
‘
LIFE
STAGE
CONSIDERATIONS
It is difficult for anyone to predict how he/she will actually behave in a crisis. In the state ofpanic evoked during a rape, most women think about how to behave to avoid being physically injured on killed. Some talk. some resist, and others become passive, depending on their assessment of what is going on and their past styles of managing stress (14). There are, however, some specific issues related to age and life stage. The
Young
Simigle
Womnami
The single woman between the ages of 17 and 24 is the most frequently reported rape victim. She is vulnerable often by virtue of being alone and inexperienced. Hen relations with men have frequently been limited to the trusted, caring figures of her childhood or the young men she dated in high schoOl. She enters the adult world with little sophistication in some of the nuances of human interaction, and she may easily be-
T.
NOTMAN
AND
CAROL
C.
NADELSON
come involved in an unwelcome sexual encounter. In this age group. the frequency with which nape victims report prior knowledge of the rapist is striking. and this is often the reason for a victim’s refusal to prosecute. A young woman may have been raped by a date, an old friend. or even an ex-husband. and she oftens reproaches herself because she should have known better’ or been more active in preventing the rape. As was discussed earlier. feelings of shame and guilt are prevalent regardless of the circumstances of the rape; coupled with the victim’s sense of vulnerability, these feelings color the victim’s future relationships with men. This is especially tnue for the very young woman who may have had her first sexual experience in the context of violence and degradation. The experience of rape may revive concerns about separation and independence. A young woman’s sense ofadequacy is challenged when she asks. “Can I really take cane ofmyself?” Parents. friends, and relatives often respond with an offer to involve themselves in taking care of her again. Although the offers may be supportive and reassuring. they may also foster regression and prevent mastery of the stress and conflict evoked by the experience. Problems for the younger rape victim also affect her perception of and tolerance for gynecological examination. She may have suffered physical trauma. she is susceptible to venereal disease. and she may become pregnant. An examination is indicated, but it may be perceived, especially by an inexpenienced or severely traumatized woman. as another rape. She is concerned about the intactness and integnity of her body and wants reassurance. However. she may have difficulty dealing with the necessary procedures ifthey stimulate memories of the original rape experience. ‘ ‘
‘
Time Divorced
or Separated
Womnami
The divorced or separated woman is in a particularly difficult position because she is more likely to be blamed and have her credibility questioned. Her lifestyle. morality, and character are frequently questioned. Hen apparent sexual availability makes her seem more approachable sexually. She may expenience the rape as a confirmation of hen feelings of inadequacy, and she is especially likely to feel enormous guilt that can lead to failure to obtain aid on to report the crime. Her ability to function independently is challenged. If she has children, she may worry about her ability to protect and cane for them, and others will probably raise questions about her adequacy as a mother. The woman with children must deal with the problem of what, how, and when to tell them about the rape. If the event is known in the community. its implications for hen and her children may be difficult to manage. The Middle-Aged For ability dence
Womnan
the middle-aged to have control are particularly
married woman, issues of her and her concerns about indepenimportant. She is often in a pen-
Amn J Psychiatry
/33:4,
April
1976
411
RAPE
VICTIM
od of critical reassessment of her life role, particularly in the face of changed relationships to her grown-up children. Husbands in their own midlife crises are often less responsive and supportive to their wives’ sexual and emotional needs. There is a common misconception that a woman, married or single, who is past her most sexually active period has less to lose than a younger woman. One cannot quantify the self-devaluation, feelings of worthlessness, and shame in any woman-especially a woman who may already be concerned about her sexual adequacy.
ATTITUDES
OF
PROFESSIONALS
Until recently, many psychiatrists felt that rape was not a psychiatric issue and that psychiatrists had little to offer the rape victim. They often shared the view that the victim “asked for it,” and she was seen as acting out her unconscious fantasies and therefore was not a “true victim. Thus the woman who had been raped did not receive the empathy and understanding usually extended to people in a crisis. There is also the common beliefthat many accusations ofrape are false. We have not found this to be true in the majority of cases seen at the Rape Crisis Intervention Program at Beth Israel Hospital, nor have others in this field with whom we have spoken. Professionals have shared the image of the rape victim as a young, sexually attractive woman who in some way exposes herself to an avoidable danger or uses the accusation of rape to save herself from criticism. This view of rape implies that it happens only to marginal people, who collude in some way, and this idea fulfills several functions. It protects the individual who accepts the view from anxiety about his/her feelings of vulnerability. It is also another way to deny that rape occurs and that its incidence is increasing. This defensive position is further expressed by the focus on the sexual aspect of rape. If it is sexual, then one can think that the victim and the rapist were both seeking sexual gratification. The professional is thus protected from any sense of guilt or responsibility. In our own experience in the development of a rape crisis program at Beth Israel, we saw a change of attitudes in participating professionals. An increase in interest results in recognition of the crisis nature of the experience and increased dignity for the individual victim. “
CONSEQUENCES
Attention tant. It is the rape proceeds may lead would be 412
OF
RAPE
to the long-term effects of rape is impordifficult to predict all the long-term needs of victim, since the working out of the trauma in many different ways. The feelings aroused to behavior that seems out of character and puzzling if it were not for the rape. Some of Am J Psychiatry
133:4,
April
/976
the issues that reemerge in some women at a later time are I) mistrust of men, with consequent avoidance or hesitation; 2) a variety of sexual disturbances; 3) phobic reactions to situations that are reminiscent of the rape; and 4) anxiety and depression, often precipitated by seemingly unrelated events that in some small details bring back the original trauma.
COUNSELING
CONSIDERATIONS
Counseling of rape victims should involve an assessment of previous adjustment, including stress tolerance and adaptive resources. In addition, it is also important to learn whom in hen environment the victim views as supportive and to attempt to involve these people if possible. The woman in this situation needs support and reassurance about the way in which she handled the encounter and her efforts to cope afterward, even if she seems volatile, disorganized, on guilty. Negative countertransference feelings may be evoked ifshe displaces her anger onto those who are attempting to help, e.g., friends, doctors, on the police. It is important that she have the opportunity for constructive catharsis with a caring and empathic person. The counselor’s patience may be tested by the victim’s repetitive retelling of the story. The counselor may need to be available frequently for the more overtly upset rape victim. The more subdued victim may need to be encouraged to communicate and should be offered the opportunity for future counseling. Each woman presents special considerations and requines the acknowledgment and support of the counsebor in verbalizing and working through the complex problems she faces. The young woman needs help in confronting hen family, hen relationships with men, and her feelings about her sexuality; the woman with children must deal with her communication with them; and the older woman may have to face hen sexual anxiety more openly.
REFERENCES I. Burgess
AW,
Psychiatry 2.
Tyhurst
Holmstrom
131:981-986.
iS:
Individual
LL:
Rape
trauma
syndrome.
Am
I
1974
reactions
to community
disaster:
the ha-
bitual history of psychiatric phenomena. Am I Psychiatry 107:764-769, 1951 3. Lindemann E: Symptomatology and management of acute grief. Am J Psychiatry 101:141-156, 1944 4. Glover E: Notes on the psychological effects of war conditions on the civilian population: I. The Munich crisis. Int I Psychoanal 22:132-146, 1941 5. Glover E: Notes on the psychological effects of war conditions on the civilian population: III. The blitz. Intl Psychoanal 23:1737, 1942 6. Schmideberg M: Some observations on individual reactions to air raids. Int I Psychoanal 23:146-l76, 1942 7. Rado S: Pathodynamics and treatment of traumatic war neurosis (traumatophobia). Psychosom Med 4:362-369. 1942 8. Deutsch H: Some psychoanalytic observations in surgery. Psychosom Med 4:105-115. 1942
WOLBERT
ANN
9. lanis
IL:
Psychological
Stress.
New
York,
John
Wiley
& Sons.
12.
1958 10.
11.
Weiss Ri, Textbook Baltimore,
Kardiner York,
Payson
A, Spiegel PB
ANN
Gross
of Psychiatry. Edited Williams & Wilkins Hocher,
Coping BY
HE:
H: War
stress by Co.
Stress
reaction,
in Comprehensive
Freedman 1967, pp
AM, Kaplan 1027-1031
and
Neurotic
Illness.
HI.
13.
New
WOLBERT
of the
BURGESS,
Rape
D.N.SC.,
AND
BEHAVIOR
of
people
faced
with
critical
LYNDA
LYTLE
life
situ-
ations is receiving increased attention in the literatune (I). The immediate efforts people use to deal with highly stressful situations are an important assessment point for clinicians who see patients in acute crisis. These coping behaviors may be viewed as problemsolving attempts an individual makes when facing demands that are highly relevant to his/her safety and that tax adaptive resources (2). Before describing the various coping strategies used by rape victims facing attack, it will be useful to review some coping strategies found in other types of crisis or stressful situations.
Presented Association,
at the 128th Anaheim,
Dr. Burgess is Associate Associate Professor of
Mass.
02167.
annual Calif., Professor Sociology.
meeting of the American May 5-9, 1975. of Nursing Boston
LYNDA
Kardiner A: The Traumatic Neuroses of Medicine Monograph Il-Ill. Washington. search Council. 1941 Grinker R, Spiegel I: Men Under Stress. ton, 1945
LYTLE
HOLSTROM
War. Psychosomatic DC. National Philadelphia.
Re-
Blakis-
of the rape
vic-
Victim
The coping behavior ofrape victims can be analyzed in three distinct phases-the threat ofattack, the attack itself and the period immediately thereafter. The authors analyzed the reported coping behavior of 92 women diagnosedas having rape trauma. Most of the women used verbal, physical, or cognitive strategies when threatened, although 34 were physically or psychologically paralyzed. The actual rape prompted coping behaviors in all but I victim. Escaping the situation or the assailant is the primary task immediately after the attack. In counseling the rape victim, it is important to understand her individual style ofcoping, to be supportive ofit, and to suggest alternativesforfuture stressful situations.
THE
AND
14. Burgess AW, Holmstrom LL: Coping behavior tim. AmI Psychiatry 133:413-418. 1976
1941
Behavior
BURGESS
Psychiatric
and Dr. Holmstrom College. Chestnut
is Hill,
HOLMSTROM,
PH.D.
Researchers have focused on different aspects of the coping process. Extrasensory awareness of disaster situations was studied by Stevenson (3) in 19 people who survived the sinking of the Titanic. Glass (4) considered behavior over time in order to be able to view various phases ofbehavior separately. Most ofthe dinical studies have reported on the use of psychological mechanisms as part of the coping process: examples include denial in people with acute myocardial infanction (5), isolation of affect, denial, and regressive behavior in victims ofconcentration camps (6), denial, isolation ofaffect, and motor activity in parents of children with malignant disease (7), and emotional constniction, repression, suppression, denial, and delusion-hallucination formation in severely burned patients (8). Lazarus (9) took a behavioral approach and classified four important coping reaction patterns: I) actions aimed at strengthening the individual’s resources against harm, 2) avoidance, 3) attack. and 4) inaction. There have been several recent studies of victim crisis situations involving major crimes, including forcible rape and situations in which victims have successfully interrupted or prevented attack (10-12). Giacenti and Tjaden (13) reported that out of915 cases in the Denver area, 3 19 victims were able to interrupt the rape by active resistance, fleeing, physically fighting, crying aloud, verbal refusals, and outside intervention. In studying rape prevention, Brodsky (14) has focused primarily on verbal or vocal responses in the interpersonal prerape situation. We saw a variety of ways to look at the coping behavior of rape victims in the literature. We drew on these studies and took a combination of areas to analyze, emphasizing the thoughts. feelings, and actions of rape victims as they related to specific time phases of the attack. Am J Psychiatry
/33:4,
April
/976
413
VICTIM
counterattacking.
Here,
the contradiction
The
Rape
BY MALKAH
Victim: T. NOTMAN,
Psychodynamic M.D.,
AND
The
of nonbeing
creates panic. In a society such as ours, where the fantasy of power is a constant stimulus and Superman, John Wayne, James Bond, and Kissinger are cultural heroes, while powerlessness and alienation are the reality, it is inevitable that rape occurs frequently. Males denied power in their daily lives find means to act as if they had it. Women are the obvious victims because male society still defines them as powerless, functional nonpersons. Providing men with the feeling of power has been considered to be one of woman’s duties. In 1968 I was raped at gunpoint. Later, lying naked on the floor, I could only whisper over and over again, “One doesn’t treat people like this.” I had had only a momentary glimpse of the rapist, a stranger. From my brief description, a police artist drew a face identical to a photo I later identified in police records. This man, who was on parole, had been incarcerated for rape. His parole officer called him in for questioning but concluded on the basis of an alibi that he had been too far from the scene of the crime.
CAROL
C. NADELSON,
The authors are with Beth Israel Hospital. 330 Brookline Ave., Boston, Mass. 02215. where Dr. Notman is Psychiatrist and Dr. Nadel-
Am J Psychiatry
/33:4,
April
1976
account
I wrote
of the rape
(in an
REFERENCES I.
Paz 0: The Labyrinth of Solitude. 1961 2. Metzger D: Skin: Shadows/SILENCE: Form of a Novel. West Coast Poetry
New
York, A
Grove
Review
Love Letter (in press)
rape
range
Press, in the
M.D.
THE
408
fictional
Considerations
Rape challenges a woman ‘s ability to maintain her defenses and thus arousesfeelings ofguilt, anxiety, and inadequacy. Women ‘s individual responses are determined by life stage considerations as well as their defensive structures: concerns about separationindividuation may be aroused in the young woman; a divorced or separated woman may find her credibility questioned; older women ‘sfears of sexual inadequacy may be compounded. In counseling, the victim’s previous adjustment should be assessed, she should be given support and reassurance, and specific considerations related to her life circumstances should be acknowledged and dealt with.
son is Associate Psychiatrist and Director, Medical tion. They are also with Harvard Medical School, where Dr. Notman is Assistant Clinical Professor Dr. Nadelson is Assistant Professor of Psychiatry.
first
unpublished novel titled “Flying With a Rock”) was couched in fantasy. I described the nape of a madwoman. I was still maddened by the assault and could only develop a character who had lost all sense of herself. Four years later I wrote a more accurate version, which describes a woman both overpowered and divested of her power (2). Her last words are “I cannot.” She is emptied out. I decided to make this public in order to break some of the silence and isolation which reinforces the personlessness of women. The private voice in the public sphere confirms our common experience through which we begin to assert ourselves. Unlike my character, now, I can.
Student EducaBoston, Mass., of Psychiatry and
EXPERIENCES
that
we
call
from
sur-
prise attacks with threats of death or multilation to insistence on sexual intercourse in a social encounter where sexual contact is unexpected or not agreed upon. Consent is crucial to the definition ofrape. The importance of mutual consent is often overlooked and misinterpreted; many people assume that certain social communications imply willingness for a sexual relationship. Although men, women, and children are raped, the majority of rape victims are women; this paper will focus on understanding rape as a psychological stress for the woman victim. Burgess and Holmstrom (1) divided the nape victims they studied into three groups: 1) victims of forcible completed or attempted rape, 2) victims who were “accessories” because of inability to consent, and 3) victims of sexually stressful situations where the encounter went beyond the woman’s expectations and ability to exercise control. Despite the different circumstances, the intrapsychic experiences of rape victims in all categories have much in common.
MALKAH
The rape victim usually has had an overwhelmingly frightening experience in which she fears for her life and pays for her freedom in the sexual act. Generally. this experience heightens a woman’s sense of helplessness. intensifies conflicts about dependence and independence. and generates self-criticism and guilt that devalue her as a person and interfere with trusting relationships. particularly with men. Other important consequences of the situation are difficulty handling anger and aggression and persistent feelings of vulnerability. Each rape victim responds to and integrates the experience differently depending on her age. life situation, the circumstances of the rape. hen specific personality style, and the responses of those from whom she seeks support.
RAPE
AS A STRESS
Rape can be viewed as a crisis situation in which a traumatic external event breaks the balance between internal ego adaptation and the environment. Since it is an interaction between an extreme environmental stimulus and the adaptive capacity of the victim. rape is similar to other situations described in the literature on stress. including community disasters (2, 3), war (4-7), surgical procedures (8, 9), etc. The unexpectedness ofthe catastrophe and the variability of victims’ resources for coping with an experience that may be viewed as life-threatening are critical factors in rape, as in other crisis situations. Although there are cultural and personality style differences, descriptions of stress reactions generally define four stages, which vary in intensity and duration (10). These responses, listed below, are also found in rape victims. I. Anticipatori’ or threat phase. In this stage. anxiety facilitates perception ofpotentially dangerous situations so that they can be avoided. Most people protect themselves with a combination of defenses that maintain an illusion of invulnerability. with enough reality perception to allow them to protect themselves from real danger. When a potential stress is planned (i.e. elective surgery), an individual can protect his/her ego integrity by strengthening those defenses which will ward off feelings of helplessness. 2. Imnpact phase. Varying degrees of disintegration may occur in a previously well-adapted person during this second phase. depending on the degree of trauma and the adaptive capacity of the individual. There may be major physiological reactions, including vasomotor and sensorial shifts. Tyhurst (2) reported on the extremes of fire and flood victims’ reactions, which ranged from “cool and collected” to “inappropriate” responses. with “states of confusion, paralyzing anxiety, inability to move out of bed, hysterical crying, on screaming.” The majority of these victims showed variable but less extreme responses-they were “stunned and bewildered” and demonstrated restricted attention and other fear responses, such as automat,
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ic on stereotypical behavior. This picture is also seen in rape victims. 3. Posttraumatic or ‘recoil’ phase. Emotional cxpncssion, self-awareness, memory, and behavioral control are gradually regained in the recoil phase. Howeven, perspective may continue to be limited and dependency feelings are increased. The individual perceives adaptive and maladaptive responses in him/herselfand may question his/her reactions. A positive on negative view of one’s ability to cope may affect the course of resolution of the trauma and future capacity to respond to stress, and self-esteem may be enhanced or damaged. Group support during this phase enables the victim to feel less isolated and helpless. Obviously, the rape victim, who is usually alone during the attack, can only hope for support later. Women are often disappointed by the failure offamily, friends. and the community to validate their experience. Janis (9), in his study of surgical trauma patients, noted that any threat that cannot be influenced by the individual’s own behavior may be unconsciously perceived in the same way as were childhood threats of parental punishment for bad behavior. This results in attempts to control anger and aggression in order to avoid provoking punishment. The absence of overt anger is also a very prominent finding in rape victims. 4. Posttremumnatic reconstitutiomi phase A process occurs during this phase that may alter future life adjustment. The loss of self-reassuring mechanisms that had fostered a sense of invulnerability may result in a decrease in self-esteem. The victim then blames him/hense+f for back of perception or attention to danger. Kardiner and Spiegel (I I) studied war stress and stated, As soon as fear is directed inward in the form ofquestioning the individual resources to cope with cxtennal danger. or toward the group in the form of questioning its ability to be a protective extension ofthe individual, then a new and more serious danger situation is created. Maladaptive responses have been reported in the war neuroses ofWorld War II (12), in which the individual develops mechanisms that are protective against further exposure to trauma but are psychologically costly and may involve loss of pnide and selfesteem (13). The rape trauma syndrome described by Burgess and Holmstrom ( I ) can be considered a form of stress reaction that can lead to traumatic neurosis. They reported an acute disorganizational phase with behavioral, somatic, and psychological manifestations and a long-term reorganizational phase with variable components depending on the ego strength. social networks, and specific experiences of the victim. They focused on the violent life-threatening aspects of the crime. Two types of response they noted are: “the expressed style,” in which the victim is emotional and visibly upset. and the “controlled style.” in which denial and reaction-formation seem to be the most prominent defenses. They also described feelings of shock and disbelief in many victims and the prevalence of ‘
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guilt and self-blame in the initial phase. The reconstitution phase varies considerably with each individual; however, the patterns of response appear to be similar to those reported in the other types of stress reactions we have discussed.
THE
DYNAMICS
OF
THE
RESPONSE
The important considerations dynamics ofwomen’s responses 2) unconscious fantasies, and sive ego styles.
TO
RAPE
in understanding the to nape are I) affects, 3) adaptive and defen-
vented the attack on the rape are frequent. The assumption is that the woman should on could have handled the situation better, that her unconscious wishes perhaps prevented more appropriate assessment and more adaptive behavior. The guilt of the victim is further increased by focusing on the sexual rather than the violent aspect of the expenience. Although aggression is most prominent in the victim’s perception, society regards nape as sexual. Since long-standing sexual taboos still persist for many people. even an unwilling participant in a sexual act is accused and depreciated. The popular adage that advises the woman who cannot avoid rape to relax and enjoy it’ misconstrues the attack as a sexual experience. In reality, the rape experience is depensonalizing and dehumanizing. The woman is often a faceless object for the rapist’s expression of hostility, and the victim feels degraded and used. Furthermore, since women are expected to exert impulse control in sexual encounters, the nape victim’s sense offailure in setting limits. impossible though this may have been, contributes to hen guilt. ‘ ‘
‘
Anger A striking phenomenon in rape victims is the initial display offean, anxiety, guilt, and shame-but little direct anger. There are several probable reasons for this. I. Since rape may evoke memories of childhood threats ofpunishment for misdeeds (9). the victim may feel that she is being punished on is in some way responsibbe. Her anger may be repressed and experienced as guilt and shame, despite her concomitant feelings of helplessness and vulnerability. Most of the angry feelings appear later in recurrent nightmares, explosive outbursts, and displacement of anger as the woman attempts to master the assault. 2. Expression of aggression in women has been highly conflictual because of cultural restrictions and expectations of passivity and greaten compliance for women. Women have often tended toward a masochistic orientation, in which anger is transformed into cubturally supported patterns of self-blame. Identification with the aggressor. a mechanism that serves as an attempt to gain mastery. may also make it difficult to acknowledge anger toward the rapist. 3. The socially reinforced suppression of aggression in women has a possible adaptive function, since women are usually smaller and physically weaken than men. Therefore, not responding with a counterattack may prove beneficial. This is an important consideration in understanding the concept of consent. In the past. legal expectations included evidence of force on a struggle in order to establish rape. Current laws accept threat of force as sufficient, recognizing that a woman may submit in fear rather than risk fighting and being overcome. Guilt
and
Shame
Despite the varying circumstances of nape and the different degrees of violence, surprise, and degradation involved, guilt and shame are virtually universal. The tendency to blame the victim, thereby assigning responsibility to hen, fosters guilt and prevents her from adequately working through the crisis. It is common for a nape victim to feel that she should have handled the situation differently, regardless of the appropriateness of her actual response. Concerns about the amount of activity or passivity that might have pre410
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(Jncomiscious
Famitasies
The question of unconscious wishes translated into provocation of a rape must be seriously considered. While undoubtedly there are unconscious fantasies in which rape plays a pant. and some women do have fantasies in which submission to a stronger man may be linked with forbidden oedipal wishes, on the conscious level the women knows she is submitting because any other behavior would result in real danger to hen life. However, this is not so cleanly differentiated in the unconscious. The universality of nape fantasies certainly does not make every woman a willing victim-on cvcry man a rapist. The unconscious fantasy does not picture the actual violence of the experience. An individual’s defensive organization usually protects him/her from acting out such fantasies. However, if the defensive barrier breaks down and unconscious destructive. aggressive, on masochistic wishes gain cxpression, anxiety oven the boss of control combines with guilt regarding the impulses. Rape involves an overwhelming confrontation with another individual’s sadism and aggression and one’s own vulnerability. This challenges the woman’s confidence in her ability to maintain her defenses and controls. Many women feel some ambivalence toward men as a result of past developmental experiences. Women expect men to be their protectors and providers, as well as relating to them sexually. Men may also be seen as potential aggressors and exploiters, and the experience of nape confronts the woman with this violent potential. The betrayal by the supposed protector who turns aggressor has a profound effect. Almost all nape victims say they trust men less after the nape. All men may be suspect, and all are potentially on trial. Uncertainty about one’s ability to control the environment neverbenates with concerns about the ability to control and cane for oneself.
MALKAH
Men’s
Responses
to Rape
It is important to consider the responses of men who participate in discussions about rape. They often feel indignation and sometimes identify with both the victim and aggressor. They may feel their masculinity is violated by both the attack on a woman who is felt to “belong’ to them and by their own helplessness denying in part from early feminine identification as well as from their actual failure to have prevented the attack. This may be particularly threatening to men who need to reject any latent feminine components of their own personalities and may lead to a defensive identification with the rapist in an attempt to escape the anxiety of their own sense of vulnerability. Some men have difficulty coping with the impulse for revenge. which would reestablish their sense of control and the ability to protect “their’ women. A man whose daughter, girlfriend. or wife has been raped may react by becoming overprotective. partly as a result ofhis sense ofguilt for not having been protective enough. However, it may also evolve as a defensive means of handling his anger at the attacker of “his” woman and at the woman for having allowed herself to get in this position. A complex series of feelings about his own sexual impulses may be evoked. and a man may find himself unable to be supportive or helpful to the woman after the rape, despite a previously close relationship. He may have difficulty with his own rape fantasies, his concerns about “used merchandise,” and even the breakthrough of homosexual impulses. He may withdraw from the woman as a result of this anxiety. The woman who is deprived of support from a man who is important to her is particularly vulnerable to adverse reactions after a rape. The man may be unaware that he is not supportive, since denial operates to minimize the experience so it can be forgotten. ‘
‘
LIFE
STAGE
CONSIDERATIONS
It is difficult for anyone to predict how he/she will actually behave in a crisis. In the state ofpanic evoked during a rape, most women think about how to behave to avoid being physically injured on killed. Some talk. some resist, and others become passive, depending on their assessment of what is going on and their past styles of managing stress (14). There are, however, some specific issues related to age and life stage. The
Young
Simigle
Womnami
The single woman between the ages of 17 and 24 is the most frequently reported rape victim. She is vulnerable often by virtue of being alone and inexperienced. Hen relations with men have frequently been limited to the trusted, caring figures of her childhood or the young men she dated in high schoOl. She enters the adult world with little sophistication in some of the nuances of human interaction, and she may easily be-
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come involved in an unwelcome sexual encounter. In this age group. the frequency with which nape victims report prior knowledge of the rapist is striking. and this is often the reason for a victim’s refusal to prosecute. A young woman may have been raped by a date, an old friend. or even an ex-husband. and she oftens reproaches herself because she should have known better’ or been more active in preventing the rape. As was discussed earlier. feelings of shame and guilt are prevalent regardless of the circumstances of the rape; coupled with the victim’s sense of vulnerability, these feelings color the victim’s future relationships with men. This is especially tnue for the very young woman who may have had her first sexual experience in the context of violence and degradation. The experience of rape may revive concerns about separation and independence. A young woman’s sense ofadequacy is challenged when she asks. “Can I really take cane ofmyself?” Parents. friends, and relatives often respond with an offer to involve themselves in taking care of her again. Although the offers may be supportive and reassuring. they may also foster regression and prevent mastery of the stress and conflict evoked by the experience. Problems for the younger rape victim also affect her perception of and tolerance for gynecological examination. She may have suffered physical trauma. she is susceptible to venereal disease. and she may become pregnant. An examination is indicated, but it may be perceived, especially by an inexpenienced or severely traumatized woman. as another rape. She is concerned about the intactness and integnity of her body and wants reassurance. However. she may have difficulty dealing with the necessary procedures ifthey stimulate memories of the original rape experience. ‘ ‘
‘
Time Divorced
or Separated
Womnami
The divorced or separated woman is in a particularly difficult position because she is more likely to be blamed and have her credibility questioned. Her lifestyle. morality, and character are frequently questioned. Hen apparent sexual availability makes her seem more approachable sexually. She may expenience the rape as a confirmation of hen feelings of inadequacy, and she is especially likely to feel enormous guilt that can lead to failure to obtain aid on to report the crime. Her ability to function independently is challenged. If she has children, she may worry about her ability to protect and cane for them, and others will probably raise questions about her adequacy as a mother. The woman with children must deal with the problem of what, how, and when to tell them about the rape. If the event is known in the community. its implications for hen and her children may be difficult to manage. The Middle-Aged For ability dence
Womnan
the middle-aged to have control are particularly
married woman, issues of her and her concerns about indepenimportant. She is often in a pen-
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od of critical reassessment of her life role, particularly in the face of changed relationships to her grown-up children. Husbands in their own midlife crises are often less responsive and supportive to their wives’ sexual and emotional needs. There is a common misconception that a woman, married or single, who is past her most sexually active period has less to lose than a younger woman. One cannot quantify the self-devaluation, feelings of worthlessness, and shame in any woman-especially a woman who may already be concerned about her sexual adequacy.
ATTITUDES
OF
PROFESSIONALS
Until recently, many psychiatrists felt that rape was not a psychiatric issue and that psychiatrists had little to offer the rape victim. They often shared the view that the victim “asked for it,” and she was seen as acting out her unconscious fantasies and therefore was not a “true victim. Thus the woman who had been raped did not receive the empathy and understanding usually extended to people in a crisis. There is also the common beliefthat many accusations ofrape are false. We have not found this to be true in the majority of cases seen at the Rape Crisis Intervention Program at Beth Israel Hospital, nor have others in this field with whom we have spoken. Professionals have shared the image of the rape victim as a young, sexually attractive woman who in some way exposes herself to an avoidable danger or uses the accusation of rape to save herself from criticism. This view of rape implies that it happens only to marginal people, who collude in some way, and this idea fulfills several functions. It protects the individual who accepts the view from anxiety about his/her feelings of vulnerability. It is also another way to deny that rape occurs and that its incidence is increasing. This defensive position is further expressed by the focus on the sexual aspect of rape. If it is sexual, then one can think that the victim and the rapist were both seeking sexual gratification. The professional is thus protected from any sense of guilt or responsibility. In our own experience in the development of a rape crisis program at Beth Israel, we saw a change of attitudes in participating professionals. An increase in interest results in recognition of the crisis nature of the experience and increased dignity for the individual victim. “
CONSEQUENCES
Attention tant. It is the rape proceeds may lead would be 412
OF
RAPE
to the long-term effects of rape is impordifficult to predict all the long-term needs of victim, since the working out of the trauma in many different ways. The feelings aroused to behavior that seems out of character and puzzling if it were not for the rape. Some of Am J Psychiatry
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the issues that reemerge in some women at a later time are I) mistrust of men, with consequent avoidance or hesitation; 2) a variety of sexual disturbances; 3) phobic reactions to situations that are reminiscent of the rape; and 4) anxiety and depression, often precipitated by seemingly unrelated events that in some small details bring back the original trauma.
COUNSELING
CONSIDERATIONS
Counseling of rape victims should involve an assessment of previous adjustment, including stress tolerance and adaptive resources. In addition, it is also important to learn whom in hen environment the victim views as supportive and to attempt to involve these people if possible. The woman in this situation needs support and reassurance about the way in which she handled the encounter and her efforts to cope afterward, even if she seems volatile, disorganized, on guilty. Negative countertransference feelings may be evoked ifshe displaces her anger onto those who are attempting to help, e.g., friends, doctors, on the police. It is important that she have the opportunity for constructive catharsis with a caring and empathic person. The counselor’s patience may be tested by the victim’s repetitive retelling of the story. The counselor may need to be available frequently for the more overtly upset rape victim. The more subdued victim may need to be encouraged to communicate and should be offered the opportunity for future counseling. Each woman presents special considerations and requines the acknowledgment and support of the counsebor in verbalizing and working through the complex problems she faces. The young woman needs help in confronting hen family, hen relationships with men, and her feelings about her sexuality; the woman with children must deal with her communication with them; and the older woman may have to face hen sexual anxiety more openly.
REFERENCES I. Burgess
AW,
Psychiatry 2.
Tyhurst
Holmstrom
131:981-986.
iS:
Individual
LL:
Rape
trauma
syndrome.
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I
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reactions
to community
disaster:
the ha-
bitual history of psychiatric phenomena. Am I Psychiatry 107:764-769, 1951 3. Lindemann E: Symptomatology and management of acute grief. Am J Psychiatry 101:141-156, 1944 4. Glover E: Notes on the psychological effects of war conditions on the civilian population: I. The Munich crisis. Int I Psychoanal 22:132-146, 1941 5. Glover E: Notes on the psychological effects of war conditions on the civilian population: III. The blitz. Intl Psychoanal 23:1737, 1942 6. Schmideberg M: Some observations on individual reactions to air raids. Int I Psychoanal 23:146-l76, 1942 7. Rado S: Pathodynamics and treatment of traumatic war neurosis (traumatophobia). Psychosom Med 4:362-369. 1942 8. Deutsch H: Some psychoanalytic observations in surgery. Psychosom Med 4:105-115. 1942
WOLBERT
ANN
9. lanis
IL:
Psychological
Stress.
New
York,
John
Wiley
& Sons.
12.
1958 10.
11.
Weiss Ri, Textbook Baltimore,
Kardiner York,
Payson
A, Spiegel PB
ANN
Gross
of Psychiatry. Edited Williams & Wilkins Hocher,
Coping BY
HE:
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stress by Co.
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reaction,
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Freedman 1967, pp
AM, Kaplan 1027-1031
and
Neurotic
Illness.
HI.
13.
New
WOLBERT
of the
BURGESS,
Rape
D.N.SC.,
AND
BEHAVIOR
of
people
faced
with
critical
LYNDA
LYTLE
life
situ-
ations is receiving increased attention in the literatune (I). The immediate efforts people use to deal with highly stressful situations are an important assessment point for clinicians who see patients in acute crisis. These coping behaviors may be viewed as problemsolving attempts an individual makes when facing demands that are highly relevant to his/her safety and that tax adaptive resources (2). Before describing the various coping strategies used by rape victims facing attack, it will be useful to review some coping strategies found in other types of crisis or stressful situations.
Presented Association,
at the 128th Anaheim,
Dr. Burgess is Associate Associate Professor of
Mass.
02167.
annual Calif., Professor Sociology.
meeting of the American May 5-9, 1975. of Nursing Boston
LYNDA
Kardiner A: The Traumatic Neuroses of Medicine Monograph Il-Ill. Washington. search Council. 1941 Grinker R, Spiegel I: Men Under Stress. ton, 1945
LYTLE
HOLSTROM
War. Psychosomatic DC. National Philadelphia.
Re-
Blakis-
of the rape
vic-
Victim
The coping behavior ofrape victims can be analyzed in three distinct phases-the threat ofattack, the attack itself and the period immediately thereafter. The authors analyzed the reported coping behavior of 92 women diagnosedas having rape trauma. Most of the women used verbal, physical, or cognitive strategies when threatened, although 34 were physically or psychologically paralyzed. The actual rape prompted coping behaviors in all but I victim. Escaping the situation or the assailant is the primary task immediately after the attack. In counseling the rape victim, it is important to understand her individual style ofcoping, to be supportive ofit, and to suggest alternativesforfuture stressful situations.
THE
AND
14. Burgess AW, Holmstrom LL: Coping behavior tim. AmI Psychiatry 133:413-418. 1976
1941
Behavior
BURGESS
Psychiatric
and Dr. Holmstrom College. Chestnut
is Hill,
HOLMSTROM,
PH.D.
Researchers have focused on different aspects of the coping process. Extrasensory awareness of disaster situations was studied by Stevenson (3) in 19 people who survived the sinking of the Titanic. Glass (4) considered behavior over time in order to be able to view various phases ofbehavior separately. Most ofthe dinical studies have reported on the use of psychological mechanisms as part of the coping process: examples include denial in people with acute myocardial infanction (5), isolation of affect, denial, and regressive behavior in victims ofconcentration camps (6), denial, isolation ofaffect, and motor activity in parents of children with malignant disease (7), and emotional constniction, repression, suppression, denial, and delusion-hallucination formation in severely burned patients (8). Lazarus (9) took a behavioral approach and classified four important coping reaction patterns: I) actions aimed at strengthening the individual’s resources against harm, 2) avoidance, 3) attack. and 4) inaction. There have been several recent studies of victim crisis situations involving major crimes, including forcible rape and situations in which victims have successfully interrupted or prevented attack (10-12). Giacenti and Tjaden (13) reported that out of915 cases in the Denver area, 3 19 victims were able to interrupt the rape by active resistance, fleeing, physically fighting, crying aloud, verbal refusals, and outside intervention. In studying rape prevention, Brodsky (14) has focused primarily on verbal or vocal responses in the interpersonal prerape situation. We saw a variety of ways to look at the coping behavior of rape victims in the literature. We drew on these studies and took a combination of areas to analyze, emphasizing the thoughts. feelings, and actions of rape victims as they related to specific time phases of the attack. Am J Psychiatry
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