Psychosocial Problems Caused by Mass Rape

Sexual assault can affect long-term physical, psychological, and relational health, and further inquiry will continue to elucidate relationships between resilience, vulnerability, and contextual factors in the development of the traumatic response (Allen, 2003; Campbell & Wasco, 2005; DiLillo & Damashek, 2003; Messman-Moore & Long, 2000; Wasco, 2003). Mass rape causes psychological and social problems for women and their families, but it is difficult to assess the true level of devastation left in the wake of these brutal campaigns because often assessment or intervention services are not available to women in these war zones, rape camps, or internally displaced persons camps (Muller, 2000).

The World Health Organization (2002) lists anxiety, anger, shame, depression, post-traumatic stress, and suicide as potential psychological consequences of sexual violence. However, it must be acknowledged that even the “terms by which psychology understands the word rape are rendered grossly insufficient, if not meaningless by the experiences” of mass rape survivors in Darfur, Rwanda, and Bosnia-Hercegovina because of the level of compound traumas these women have suffered (Boose, 2002, p. 71).

Genocidal rape survivors have been exposed to “interactive traumatic stressors;” they have been emotionally and physically impacted in ways that psychology is not prepared to handle (Fischman, 1996, p. 161). These additional traumas can include detention in rape camps, forced pregnancy, death of loved ones, threat to survival, torture, war-related illnesses or injuries, “loss of home and community,” “stresses of migration and dislocation, cultural shock, lack of familiar support systems, and fear of deportation” (Fischman, 1996, p. 161). The victim’s sense of structure and safety may have been shattered by the compound traumas she has experienced. Rapes may be combined with physical abuse and torture, starvation, verbal abuse, and other forms of domination and humiliation in order to maximize the trauma to the survivor. Weapons such as guns, axes, and whips were commonly used to intimidate and threaten the women in Darfur, while machetes and AK-47s were wielded in Rwanda. It has been shown that these techniques often increase the intensity of the traumatic response (Physicians for Human Rights, PHR, 2006).

The survivor’s psychological response may be influenced by the context and level of brutality of the assault. Rapists often used dehumanizing epithets and racialized or gendered slurs directed at the raped woman and her community. In Daufur, “slave” and “black slave” are common ways the perpetrators refer to African women from the Fur, Masalit and Zaghawa ethnic groups (Wax, 2004). In Bosnia-Hercegovina, women were commonly called “Turks” or “Ustasha whores” (Boose, 2002). This form of ethnically oriented verbal abuse increases the suffering of the raped woman, and it is considered a message to others in her group, who may be forced to watch the assault. The perpetrators of genocidal rape attempt to maximize suffering and trauma, in order to cause the highest level of damage to the survivor and her community (WHO, 2002).

The degree to which survivor mental health is affected by sexual assault trauma varies by severity, type, frequency, degree of physical injury and perceived threat to life, as well as whether the survivor received medical or mental health intervention after the incident (Allen, 2003; Draijer & Langeland, 1999; Golding, Wilsnack, & Cooper, 2002; Wasco, 2003). The biological outcome of rape may influence the severity of psychological symptoms: rape without impregnation, rape resulting in pregnancy, and pregnancies followed by abortions or by childbirth resulted in differing levels of emotional trauma for survivors (Fischman, 1996; Kozaric-Kovacic, Folnegovic-Smalc & Skrinjaric, 1993). Pregnancy followed by childbirth was associated with the most severe levels of distress (Fischman, 1996, p. 161; Kozaric-Kovacic, Folnegovic-Smalc & Skrinjaric, 1993).

Increasingly severe levels of impairment may develop from the combination of sexual assault and a “lifetime history of multiple traumas” (Allen, 2003, p. 213). The intersections of gender, class, ethnicity, and previous victimization history, and exposure to a “pervasive toxic culture” that condones violence against women, may increase the traumatic response (Brownmiller, 1994; Cahill, 2001; Stiglmeyer, 1994; Wasco, 2003, p. 318). Individual and contextual factors such as genetics, resilience, and social support may mediate the development of psychological problems following exposure to trauma (Epstein, 1997; Messman-Moore, 2000).

Dissociation, psychotic symptoms, sexual dysfunction and self-harming behaviors are commonly reported by survivors (Allen, 2003; Draijer & Langeland, 1999; Messman-Moore & Long, 2000). Sexual abuse has been associated with the development of borderline personality disorder or complex PTSD (Allen, 2003; American Psychiatric Association, APA, 2000). Elevated levels of substance abuse, depression, eating disorders, and anxiety have been noted (DeLillo & Damashek, 2003; Messman-Moore & Long, 2000). Survivors are also likely to experience other types of psychological distress, including low self-esteem and self-worth, feelings of objectification, guilt, and self-blame (Kulkoski, 1997; Messman-Moore, 2000; Wasco, 2003).

Acute and Posttraumatic Stress Disorders

The diagnosis of posttraumatic stress disorder (PTSD) was adopted in 1980 to describe the condition of Vietnam veterans, who reported great psychological distress, long after the traumatic events causing the distress had ceased (Douglas, 2001; Stover, 2005, p. 25). One specific causal factor of PTSD is exposure to a traumatic stressor so severe that it “would evoke significant symptoms of distress in almost everyone” and that is “generally outside the range of human experience” (Douglas, 2001, p. 2; Stover, 2005). The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, 2000), published by the American Psychiatric Association (APA) lists the essential components of acute or posttraumatic stress disorder. The most essential feature of actue or posttraumatic stress is exposure to a traumatic event in which the “person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others” (APA, 2000, p. 467). Additionally, the person’s response to the experience or event must have involved “intense fear, helplessness, or horror” in order to qualify for a diagnosis of acute or posttraumatic stress disorder (Association, 2000, p. 467).

While the sequelae of sexual assault are “shaped by the particular social and cultural context in which the rape occurs,” one of the persistent features of rape survivors is the development of these reexperiencing, avoidant, and arousal responses to posttraumatic reminders of the event (APA, 2000; Association, 2000; Herman, 1992; Stover, 2005; Swiss, 1993). Descriptions of PTSD demonstrate how “the contradictory responses of intrusion and constriction establish an oscillating rhythm. This dialectic of opposing psychological states is perhaps the most characteristic feature of posttraumatic syndromes” (Herman, 1992, p. 42). If these symptoms occur during or immediately following the trauma, the survivor could be diagnosed with an Acute Stress Disorder (APA, 2000). If the symptoms persist longer than 1 month, a diagnosis of posttraumatic stress disorder (PTSD) may be appropriate (APA, 2000).

Survivors of rape often report “reexperiencing” symptoms such as intrusive memories or dreams of the event or the perpetrator (APA, 2000; Stover, 2005). Avoidant tendencies, including emotional numbing, detachment, depersonalization, derealization and amnesia, are frequently reported by sexual assault survivor (Allen, 1996; Allen, 2003; DiLillo, 2000; Draijer, 1999). Arousal symptoms include heightened psychological distress, physiologic arousal, and hypervigilance (Allen, 2003; APA, 2000). Chronic sleep disturbance including insomnia, nightmares and nocturnal awakenings are common, especially if the survivor associates nighttime, being asleep, or being in the bedroom with the assault (Allen, 2003; APA, 2000). The survivor may vividly relive the assault while sleeping, experienced through frightening and upsetting dreams, which may be unsettling for family members, particularly children (Herman, 1992).

Survivors of sexual assault comprise the largest group of individuals currently diagnosed with PTSD (APA, 2000). Rape is among the most salient PTSD risk factors (Allen, 2003, p. 213; DiLillo, Tremblay, & Peterson, 2000; Draijer & Langeland, 1999). It is reported that one in four women who had been raped said four to six years after the rape that she still had not recovered (Stover, 2005).
The American Psychiatric Association notes that “survivors of rape, military combat and captivity, and ethnically or politically motivated internment and genocide” were found to have the highest rates of posttraumatic stress disorder (APA, 2000). People who endure repeated, prolonged trauma or imprisonment are particularly vulnerable to the development of intrusive symptoms that may linger for decades after the experiences, as demonstrated with groups of Korean War prisoner and survivors of Nazi concentrations camps (Stover, 2005).

Many of the women described in the case studies of Bosnia, Rwanda, and Darfur could fit in to all of these risk categories, so they are extremely vulnerable to developing posttraumatic stress disorder (PTSD). Not surprisingly, PTSD has been prevalent among rape survivors in Darfur, Rwanda, and Bosnia-Hercegovina. Physicians for Human Rights reported that PTSD is common in rape survivors in Darfur, and noted that posttraumatic stress can result in depression, anxiety, nightmares, difficulty sleeping, social phobias, and physical complaints (Allen, 2003; PHR, 2006; WHO, 2002).

Witnesses to rape and torture may also develop posttraumatic symptoms or PTSD, particularly if they have a relationship with the survivor/victim or the perpetrator. The terrorizing effects of rape are often exploited when perpetrators force family members or others to witness acts of sexual violence and torture (Boose, 2001; Swiss & Giller, 1993). For a diagnosis of PTSD, the person may have “witnessed or been confronted by a traumatic event,” without directly experiencing a threat to oneself (Association, 2000).

Public rape was regularly used in Bosnia-Hercegovina as an act of community intimidation because “the psychiatric consequences in [witnesses] can be very pronounced, sometimes even greater than in primary victims” of rape (Zalihic-Kaurin, 1994, p. 171). Rapes committed “in front of the victim’s immediate family—children, parents, husband—result in severe trauma” for the survivor and the witnesses (Folnegovic-Smalc, 1994, p. 175). Family members may have varying responses to witnessing rape, and they would sometimes cast out the survivors and any children born of rape because they reminded the witnesses of the collective trauma inflicted on the community.

Traumatic Reminders Cause Fleeing

One of the hallmark features of PTSD is the tendency to avoid reminders of the traumatic event, such as places, people, and things that are associated with the trauma. Survivors and witnesses of rape have a tendency to avoid the location where the rape occurred (Zalihic-Kaurin, 1994). The perpetrators of these rapes used the common knowledge that people tend to avoid places where terrible things have happened to them in order to encourage fleeing from areas of contested territory. In this way, rape can be used “as an instrument of forced exile” to drive the population from certain areas (MacKinnon, 1994, p. 190). In each conflict presented, the perpetrators purposely maximized the level of trauma to victims and witnesses in order to disperse the civilian population. When perpetrated on a mass scale as in these conflicts, the “terrorism of rape … forces entire communities into flight,” serving the goals of genocide and ethnic cleansing (Swiss & Giller, 1993).

Rape (especially excessively brutal and public rape) causes survivors, witnesses, and other community or family members to leave their homelands Hilsum, 2004). Bosnian women were raped in public in order to “spread fear and induce the flight of” non-Serb inhabitants of contested lands (Stiglmayer, 1994, p. 85). It was common for the JNA to enter a village and rape every girl and woman in succession, from the youngest child to the most elderly grandmother (MacKinnon, 1994, p. 190). Survivors and witnesses do not wish to return to the scene of the crime, and so maximizing trauma in the target population through public displays of brutal sexual violence leads to mass fleeing from areas of contested territory. After the genocides ended in Bosnia and Rwanda, some perpetrators have continued brutalizing their past victims, and many survivors are simply too afraid to return to their homes because of what they experienced and/or witnessed there (Stover, 2005). Others have relocated back to the areas where the crimes occurred, and report difficulties with traumatic reminders on a frequent basis.

Public rapes are common in Darfur, with family members and/or the wider community witnessing the rape and torture. Anyone who intervenes may be beaten, stabbed, or killed. The rape survivor may feel betrayed by the witnesses for not protecting her. Those who witnessed and did not defend the raped woman may feel ashamed, which they may express as aversion, anger, or even hatred toward the survivor. Exposing the community and family to the rape of women magnifies the intensity and complexity of the traumatic response, while exponentially increasing the number of survivors who may be psychologically impacted by these events (WHO, 2002).

Social Consequences of PTSD

Survivors of sexual assault often experience social problems, which may be related to the psychological trauma of rape. Some of the symptoms of PTSD have an impact of the survivor’s ability to relate socially. Among the symptoms listed as criteria for a PTSD diagnosis are: “feelings of detachment or estrangement from others,” “markedly diminished interest or participation in significant activities,” “restricted affect,” “a sense of foreshortened future,” “irritability or outbursts of anger,” and “hypervigilence” (APA, 2000, p. 468).

A survivor may experience dramatic mood swings or changes in personality due to the profound sense of loss and grief that they experience, and these changes can be very upsetting for family members and friends, who may withdraw from the survivor in the aftermath of these difficult mood swings or negative encounters. Sometimes the family members, friends, or neighbors of the survivor do not understand or comprehend the magnitude of the assault’s impact on the survivor (Stover, 2005). This lack of understanding or awareness of the traumatic response by friends and family can make the survivor feel isolated and misunderstood (Herman, 1992; Stover, 2005). Because of the impact these symptoms have on their social functioning and the reactions of others to their changed behaviors, survivors with PTSD may have “difficulty reestablishing intimate relationships” after the violence (Swiss & Giller, 1993, p. 614).

Sexual assault is associated with “increased difficulties across several domains of interpersonal functioning” (DiLillo, Tremblay, & Peterson, 2000, p. 768; Chen & Kaplan, 2001; DeLillo & Damashek, 2003). Survivors tend to report smaller support networks, more social isolation, and less emotional support than other women (Chen, 2001; Golding, 2002). Survivors often report difficulty establishing and maintaining trusting relationships after the rape, and this difficulty with trust may manifest itself in social isolation or self-harming behaviors (DiLillo, 2000).

Within the realm of romantic and sexual relationships, this lack of trust can be particularly problematic (Golding, 2002). Clinicians have reported that survivors of mass rape may consider “all male persons [to be] identified with torturers” and rapists (Kozaric-Kovacic, 1993). Sexuality may be perceived as a threatening reminder of a brutal victimization, and the survivor may be unwilling or unable to have sex with her husband or partner. One survivor, whose perspective echoed many others, reported, “for me there’s not such thing as sex anymore; that’s all in my past” (Folnegovic-Smalc, 1995, p. 177).

PTSD symptoms may decrease or eliminate interest and participation in sex, which can cause difficulties in intimate relationships. Sexual trauma in particular may lead to “an aversion to sexuality” in both survivors and witnesses of rape (Cahill, 2001; Folnegovic-Smalc, 1994, p. 177). “Aversion to sexuality” is not a desired characteristic for wives in most cultures, so this may place survivors at risk for rejection by current or prospective spouses. Decreased interest and participation in sex also reduces the likelihood that the woman will give birth to children within her community. Through these social means, the psychosocial consequences of rape can have practical and long-term population reductive effects (WHO, 2002).

The trauma of rape may prevent the survivor from assimilating back in to her previous roles in her family or society. Serbs made “deliberate use of this social information” as they perpetrated genocide. Rapes were designed to maximize trauma to the survivors, witnesses, and the targeted community as a whole (Turshen, 2000, p. 803). Rapes were “intended to disable an enemy by destroying the bonds of family and society” through the perpetration of trauma and stigma (Swiss & Giller, 1993, 613).

Stigma of Rape

Rape is considered shameful in many cultures, and the survivor is often shunned or punished for being raped (WHO, 2002). A woman’s sexual virtue is highly valued by the community as a marker of the purity and prestige of her family. Being raped means that she has been “spoiled” and reflects poorly upon herself and her family. One survivor said, "after rape, you don't have value in the community” (Human Rights Watch, 1996).

To avoid the stigma associated with rape, survivors may attempt to conceal the assault from public awareness. Three adolescent survivors in Darfur attempted to conceal the rapes by telling neighbors about the Janjawid attack, without mentioning the sexual assaults. Assumptions and gossip spread. It was clear that neighbors knew the girls had been raped, because they changed their treatment of the girls. One of the survivors told a journalist that when people discover a woman has been raped, "They scorn you. They laugh at you… They look at you as if you are strange, as if they haven't seen you before" (Timberg, 2006).

The perpetrators of genocidal rape use their knowledge of the social consequences of sexual assault to maximize damage to the target population. Rapes are conducted in such a way that they are difficult for victims to conceal, such as rapes in public and in broad daylight. Women who are clearly pregnant have no chance to hide what happened to them, and this is one of the intentions of forced pregnancy: to compel the woman to suffer the stigma her community deems appropriate for a rape survivor.

Survivors and children of rape remind the family and community of their collective defeat, which can be both demoralizing and terrifying. The family or community may cast the woman or child out, abuse them further, or even kill them (Amnesty International, 2004; Turshen, 2004). This causes deeper emotional damage for all involved and tears at the fabric that holds families and the community together. Perpetrators of genocidal rape intentionally continue population-reducing effects over time by using the social stigma of rape to render a generation of childbearing women unlikely to do so (Turshen, 2000).

In Rwanda, Darfur, and Bosnia-Hercegovina, survivors or rape are generally not considered acceptable wives. Survivors may be cast out if they are married at the time of the assault, especially if injuries affect reproductive capacities. Care of the children and the household is the sole responsibility of women in these cultures, and injured or traumatized women are considered less valuable as wives (Amnesty International, 2004). One Darfuri survivor described how excited she had been about her engagement until she was raped; her fiancé said he would not marry her because she was “disgraced and spoilt” [sic] (Duroch, 2005). The survivor said, “It is the worse thing for me” (Duroch, 2005).

The stigma of rape is a crushing burden because of the associated social and economic disadvantages. Unmarried women do not have the financial and physical protection that married women do in the Sudan, Darfur, and Bosnia-Hercegovina, and this places survivors at further risk for abuse and starvation. Because of the widespread sexual assaults of young women and girls, families in Darfur worry that they cannot protect their young women’s sexual virtue, upon which their basic safety depends.

As a result, parents attempt to marry off their daughters early in order to preserve the family honor. The “bride price” in the internally displaced persons camps has decreased to the point where families will marry their daughters to anyone who can scrape together minimal compensation for the family. This exposes young women and girls to potentially abusive spouses, early sexual intercourse (with the husband), and young marriage with few choices. Since marriage is technically no protection against rape, early marriage of daughters may not ultimately protect the family honor if the daughters are raped after marriage and subsequently left by their husbands, which is the common practice.

In the Bosnian wars, the Serb forces made use of cultural information about women’s roles to maximize the impact of the psychosocial trauma of rape. It is known that a Bosnian husband would divorce his wife if she were raped, and an unmarried raped woman would not be considered eligible for marriage (Stiglmayer, 1994). ). Regardless of their utter lack of complicity in their sexual victimization, “wartime rape victims’ husbands held their wives responsible for the deed or ended their relationships because of the rape” (Seifert, 1994, p. 59). A Muslim physician in Bosnia, reported, “if a man has even the slightest suspicion that his wife may have cooperated voluntarily, the marriage is over;” many Bosnian men acknowledge that they would abandon a wife even if she had not cooperated with the perpetrators (Stiglmayer, 1994, p. 91). These social rejections of rape survivors have long-term reductive effects on population over time.

Consequences for Social Structures and Communities

Sexual violence is perpetrated against women during ethnic conflict because women “keep the civilian population functioning” through their role as mothers, wives, and caretakers (Copelon, 1994, p. 207). The suffering inflicted may cause permanent psychological symptoms or social consequences that impact the woman’s ability to relate, work, or care for her children (Amnesty International, 2004). Because large numbers of individual women experienced the deterioration of the familial structures in their lives, the social structures of the community crumbled as more and more individual women became traumatized (MacDonald, 2003, p. 1). Thus the collapse of community structures begins with individual and familial collapse (see Diagram 2).

“Women hold communities together, and attacking them contributes to the defeat and disintegration in a number of ways” including the collapse of community structures beginning with the most basic family unit (MacDonald, 2003, p. 1). The trauma of rape can cause pervasive problems that may prevent the survivor from assimilating back in to her family or society as a functional and productive member, so women become “prime targets because of their cultural position and their importance in the family structure” (Seifert, 1994, p. 63).
In these ways, rape leads directly to the destruction of family and community structures that is the ultimate goal of genocide. The men, especially the victim’s father, husband, or brothers, may feel that they failed to protect the victim, they may feel humiliated when they see the victim. Survivors of rape broadcast a message of defeat to the family and community of the victimized woman, which can both demoralize and terrify them. They may cast the survivor out or abuse her further, causing deeper emotional trauma and tearing at the fabric that holds the family and the community together.

“Memories of wartime atrocities, like all memories, are local; they are embedded in the psyche of individual victims and witnesses and, through the process of retelling and memorialization, they are deposited in the collective memory of the community” (Stover, 2005, p. 143). Rape survivors and the children born of rape evoke these memories for the community, and the community’s desire to avoid or exclude survivors may be partially in an attempt to shield itself from the reminder of the cultural defeat, and the internalization of the assault of its members as an assault on the community. The experiences of individual women are magnified and become applicable to the whole population through these processes of collective memory, deterioration of family and social structures, and the internalization of the assault against the community by its members.