Rape Trauma Syndrome or RTS is a devastating form of post-traumatic stress disorder (PTSD, familiar to many military combat veterans) which has been recognized and described only in the past two decades. In some form and degree it affects virtually all victims of sexual assault, including ones who avoided a completed rape. Even verbal sexual aggression without physical coercion a common experience for prisoners can leave the target psychologically damaged. For male survivors of an actual rape the disorder is likely to be severe and even life-threatening. Institutions should brook no delays in getting new rape victims into counseling within hours of the victimization; this is a true psychiatric emergency.
RTS was first discerned and described in connection with female victims. Males experience the same problems, but in addition must deal with a number of serious issues specific to their gender which add greatly to the traumatization. Male victims who remain incarcerated and are thus unable to withdraw from the setting of their victimization are seriously handicapped in attempting to recover from the trauma. Those who are exposed to repeated victimization and must even adapt on a daily basis to being a perpetual and continual victim of unwanted sexual penetration, and who must undertake numerous daily compromises in order to avoid the most catastrophic situations (a description which unfortunately comes to characterize most incarcerated rape survivors), must endure the most extreme form of the syndrome. The literature on therapy, written for male survivors in the community, does not yet take these sharply intensifying factors affecting prisoners into account.
Anyone likely to be in a therapeutic or counseling relationship with a rape survivor should become familiar with the psychological and medical literature. Other staff members, however, also have to deal with rape survivors and should have at least a basic familiarity with RTS in order to avoid unwittingly contributing to the further victimization of the survivor.
This begins with an understanding of the nature of the worst psychological injuries suffered, since it is in these hypersensitive areas that the survivor is most vulnerable to additional, albeit unintentional, traumatization caused by others who deal with him after the physical assault.
First there is the total loss of control over even the insides of one's own body, resulting in feelings of utter vulnerability and powerlessness. This makes control and power key psychological issues for all rape survivors. In the case of men, who are brought up to expect internal inviolability, are expected to be able to defend themselves against attack, and are socialized to consider total helplessness incompatible with masculinity and thus intolerable, these issues are heightened. In the setting of imprisonment, the very environment, with its all-pervasive theme of control by the state, continually exacerbates this wound. Whenever decisions are made for the survivor, rather than by him, this has the effect of rubbing more salt into the open wound. Therefore persons in positions of authority should wherever possible allow the survivor to make his own choices, even if the alternative options presented are unacceptable, in order to help him combat the feeling of total helplessness which will, if left intact, defeat all attempts to improve his condition. Often this is a question of style rather than substance, but in psychological matters it is the impression which counts. However, when conflicts arise over confidentiality, participation in prosecution or informing, housing placement, etc., staff members should keep in mind that every action taken which the victim perceives as one of peremptory control will in fact aggravate the trauma and thus, from the survivor's perspective, further victimizes him.
Second, there is the perception that the victim's sexual identity as a male has been compromised or even demolished and reversed. All but those homosexuals who identify themselves as feminine are gravely affected by this perception. It results from very widespread attitudes relating to sexual penetration and defeat in personal combat (sexuality and aggression being the two primary remaining sources of male identity to most prisoners), and it is exacerbated by the daily behavior of other prisoners who are aware of the victimization and lose no opportunity to remind the survivor of his supposed "loss of manhood." If allowed to go unaddressed, this belief will frequently lead to suicide attempts, other self-damaging behavior, or violently aggressive compensatory behavior. It is absolutely imperative, therefore, that staff persons refrain from implying any slight to the victim's masculinity. To the contrary, all persons in contact with the survivor should go out of their way to emphasize his male status verbally and through body language at every opportunity.
The third major injury, for heterosexual survivors, is often related to manhood issues, and results from peers who spread the unfounded belief that the victim's sexual orientation is compromised or even transformed by his involuntary experience. This perception, if not countered, can also produce suicidal behavior. Unfortunately, staff people frequently contribute to this belief by failing to distinguish between homosexuals and heterosexuals who have been pressured into passive sexual activity or roles. Only careful staff training with regard to the realities of prisoner sexuality can work to counter this deplorable tendency. Even in cases where prisoners label themselves as "homosexual," staff should be careful to ascertain that this identity existed prior to confinement before reinforcing it by repeating the label; an unsophisticated prisoner may simply be repeating what others, seeking to justify his sexual subordination, have told him, or may be using it as a temporary condition rather than a basic trait.
Ultimately one must question whether there is any rationale for making official distinctions of sexual orientation in the environment of same-sex confinement, where sexual behavior both active and passive so commonly involves those who behave heterosexually both before and after confinement. Most specifically, staff members should avoid any implication that a rape survivor would have any less interest in the opposite sex.
Suicidal impulses are so common among males who have recently experienced their first or second rape that any such victim should be presumed suicidal until a mental health professional determines that this is not the case.
RTS has been observed to proceed in most victims in a series of stages, though they are not universal. The description which follows applies to the untreated survivor; those victims who are given effective psychotherapy or counseling, or even merely exposed to Tape II, may avoid the worst aspects of RTS or be better able to control their actions and feelings.
At first the new victim, especially when removed from the site of the attack, tends to be numb, withdrawn, talks slowly or inaudibly if at all, and denies or disbelieves the experience. Some victims however, are visibly upset and highly emotional, sometimes palpably terrified. These two states may even alternate. Feelings of helplessness and extreme vulnerability (which may appear as indifference to one's fate) are endemic; they may together with the re-experiencing of the original terror induce a kind of paralysis in the face of new sexual aggression; staff members must avoid interpreting such paralysis as consent. Nightmares and sleep disturbances are common. Shame, humiliation, and embarrassment are characteristic. The ability to concentrate may be lost and dissociation ("spacing out") become frequent. Memory may be impaired. Victims should be encouraged but not forced to express themselves. This stage can last up to a week, but many of its features remain.
The second stage displays some or all of the following features: self-worthlessness or self-contempt, self-blame for the victimization (reinforced by those around him both staff and prisoners who "blame the victim" in various ways), sense of being a failure, various forms of shame, severe depression, homophobic panic, anxiety, extreme insecurity, obsession with body areas involved in the rape, restlessness, urge to escape, compulsive movement, other compulsive behaviors, inability to trust (including those who are trying to help), disturbances in sexual functioning, resistance to intimacy of any kind, ambivalence towards females, fear of males, fear of being or going "crazy", fear of persecution, cynicism, social isolation, loss of motivation, anger, and rage, often with body and mind at odds (one agitated, the other calm; later switched). Personal boundaries are confused, and relationships chaotic and conflicted. Again, some of these symptoms may persist into later stages.
This stage, when outside confinement, commonly develops a marked suppression of feelings combined with an attempt to "carry on like normal." For a prisoner who may be involved in perpetual if less violent sexual exploitation and who must continually compromise to avoid further gang-rape, this may show itself in mechanical compliance with sexual demands while remaining basically numb to the experience, and strong dependency with regard to his new master and protector. Feelings of security and protection, desperately needed, are associated with sexual performance and submission to more powerful men. Survival needs to comply with demands for a submissive role frequently overrule urges to rebel and reclaim autonomy, suppressing these but causing deep conflicts which appear as disturbances in other psychological areas.
In the third stage, which may be postponed until after release, the suppressed rage resurfaces and may be accompanied by violent behavior, obsession with vengeance or with the rape experience itself, belligerence towards all holders of power (including institutional staff), disturbing sexual fantasies, phobias, substance abuse, disruption of social life, self-destructive behavior and revictimization,lifestyle disorganization, antisocial and criminal activity, and aggressive assertion of masculinity, including the commission of rape on others. The suppression period can last for many years, even decades. It is important that survivors be steered towards opportunities for continued treatment after release (with therapists knowledgeable about RTS), when their progress, once outside of the traumatic environment, is likely to dramatically improve.
The final stage involves a partial or complete resolution of these issues and a reintegration of the self which allows the past victimization to recede in importance, though traces will remain for the rest of his life.