Much has been said, discussed, and reported in the media in the wake of the December 16, 2012, Delhi rape and murder incident, and a myriad other incidents of sexual crime in the country. It is therefore important for mental health professionals to re-examine psychosocial issues related to sexual coercion in the context of the current public debates on the subject.
Sexual coercion is the act of being physically, psychologically, financially or otherwise forced or tricked into engaging in sexual activity; victims are most commonly women and children. Women run the risk of sexual abuse and violence across their whole life span. The risk of partner violence and rape, including dating violence and domestic violence; begins in late adolescence, peaks by middle age, and may even continue in the elderly. These acts are not a distinct phenomena and have a degree of overlap that can be viewed along a continuum of sexual violence as they have common causes and methods of prevention.
It is commonly believed that sexual coercion is perpetrated by the male sex against the female sex. However, this gender effect is less pronounced in child sexual abuse where women represent a large proportion of perpetrators and children of both sexes are subjected to sexual advances from adolescents and adults. Childhood sexual abuse includes three important elements: (1) Age and size difference between the child and perpetrator; (2) presence of sexual behaviors such as nudity, fondling, and penetration; and (3) gratification to the perpetrator.
Sequelae of coercive sexuality in children include subsequent development of sexual disorders, emotional instability, interpersonal withdrawal, and maladaptive coping in new situations. In young women, self-blame, guilt, shame, poor self-esteem, mistrust of others, and other repercussions get reflected in relationships and can be enduring.
In any case of child sexual abuse, rape, domestic violence, or elder abuse; there is a common thread of betrayal, vulnerability, and ambivalence in the social norms that tolerate the abuse and the abuser.
ROLE OF MENTAL HEALTH PRACTITIONERS AND PHYSICIANS
As is with all forms of sexual assault, the most serious health effects of rape are not physical but psychological. While some acts may traumatize the survivor immediately, other acts may additively manifest many years later, making it more difficult over time to resist overt acts of aggression. Long-term clinical problems include hypervigilance, anxiety and phobias, somatic complaints, dissociative disorders, depression, substance abuse, suicide attempts, and risk of revictimization.
While most abuse associated with fatality occurs to young children, adolescent abuse can lead to risk taking behavior that, in turn, increases the risk of current and later morbidity and mortality. Clinicians must therefore recognize that recurrent injury at each stage of a woman's life cycle is predictable; and it requires safety planning in order to address the intratraumatic stress responses. There is also an urgent need to target the commonplace barriers to physician involvement, such as lack of training and awareness about community services, time constraints, and unresolved personal issues that would facilitate a nonjudgmental and supportive safe encounter with the victim.
The role of a physician is not just to evaluate, document, and treat women who have been sexually assaulted. They also serve as an educator to guide the victim, her family, and those who become involved in her care. Here, it may be noted that it is important to address a common misperception in society that if women avoid certain behaviors they are not vulnerable to sexual assault. This belief and the subsequent tendency to blame; especially by the main supportive caregivers of the victim, needs to be addressed openly. Therapists should ensure that the theme of blame is not perpetuated in therapy settings.
ADDRESSING COMMON MYTHS AND MISPERCEPTIONS
Biased sampling in studies estimating the prevalence of rape and the relationship between the victim and rapist characterizes much of the research in the field of rape and sexual coercion. This has resulted in popular myths. An example is that rape is perpetrated by strangers in dangerous places; epidemiology, however, proves it to be otherwise. It is also false that perpetrators are deviates or perverts, and more likely that they are socially and psychologically normal acquaintances.
The motivations that lead men to behave in a sexually aggressive manner (whether by physical force, threat, or other forms of coercion) usually include the desire to have a sexual experience. Most heterosexual rapes involve young women and an analysis of existing data reveals that penile-vaginal intercourse during sexual assaults almost always occurs when victims are of reproductive age group (12 to 44 years). However, like any other human behavior, the motivations for rape are complex and numerous and require greater understanding in order to effectively address the issue.
UNDERSTANDING THE BIOPSYCHOSOCIAL ROOTS OF SEXUAL COERCION
The general mating strategy often includes sexual coercion in one or another form in order to obtain sexual intercourse. This behavior has been explained on the basis of the sexually dimorphic structure of the human psyche. Major differences exist in the context of motivation and competition between the sexes; however, the psychology of sexual motivation is not designed by selection to achieve copulation with a mate who is sexually uninterested or actively resistant. Hence, the idea that men have an evolutionary psychological adaptation to rape is false.
It has been hypothesized that the sexual motivation of men and their motivation to dominate and control the sexuality of their mates is integrated in the male psychology as a sex-specific and species-wise adaptation. Sexual aggression also enforces male domination and female submission, but this is a relatively common theme among men across several cultures rather than a deviant behavior. Thus, societal tolerance in this respect for aggressive behavior may reduce the perception that sexual aggression against women is as serious a problem as other social disorders that affect millions of people. Interestingly, the response of society towards sexual aggression against women is oriented largely towards victim-centered prevention. For example, sexual assault programs typically involve women subtly suggesting that women are responsible for prevention of sexual aggression against themselves. This problem appears more notable when contrasted against prevention programs for other types of crimes such as child physical abuse. The overemphasis on victims and survivors is explained by society's negative judgment of the passive or receptive partner in a sexual relationship, who is usually a female.
In contrast to male victims of nonsexual forms of assault who are rarely held responsible for the same; the potential responsibility of female victims of assault that is of sexual nature is considered negatively in court proceedings as well as by the public. Even in situations in which a victim may be perceived as contributing to the coercive behavior; issues of power disparity between perpetrator and victim (dependence on the perpetrator for family and financial support) that make it difficult for the victim to take protective action must be given due importance.
Official statistics show that incidence rates of sexual coercion have been rising during recent decades, partly due to an increased ability of women to label these experiences, report them, and seek help. Also the growth of women with regard to personal and economic freedom has increased their ability to challenge male power. This explodes the myth that sexual violence is a result of power inequality between males and females and is an attempt to maintain this inequality. However, child sexual abuse always reflects the power difference between adults and children.
Although reforms have improved existing rape laws, the specific wording of legal statutes is not as much of a problem as is their interpretation. Consequently, changing the terms of the laws may not be as important as changing society's attitudes about what constitutes rape. Courts still continue to place much blame on victims of rape (rather than on the rapists) for their dress, demeanor, previous sexual activities, and relationship with the rapist. Laws about rape address the male behavior of violence and not to the female experience of fear, invasion, and humiliation. The latest amendment of the Indian Penal Code concerning rape laws in 2013 claims to be not only gender neutral, but also worded broadly. However, regarding the definition of force and consent, it continues to be ambiguous and fails to address many issues. An example is the exemption from marital rape which assumes marriage to be a generalized sort of consent for a man to have sexual intercourse with a woman whenever he wants. Problems in interpretation of consent also exist in cases in which the defendant and complainant are non-married acquaintances.
Reasonable resistance by the victim is also implicitly required to prove that the sexual act was indeed forced. If the victim does not physically resist, it is taken to mean that consent was given, and no differentiation is made between aggravated rape involving extrinsic violence, multiple assailants, and no prior relationship and simple rape involving a single defendant who did not beat or threaten the victim with a weapon. The gender neutrality in rape laws further complicates the issue by obscuring the differences in amount of force required to overcome a man or a woman, hence making legal interpretations biased in favor of traditional male definitions of force.
PREVENTION AND FUTURE DIRECTIONS
The many negative and pervasive effects of sexual coercion are well-established. Regrettably, as a result of underreporting of these crimes and as a result of varied definitions across studies, quantification of actual incidence and prevalence is difficult. This requires to be resolved in future research using better measures with deeper conceptual understanding of the crime. The effects of prostitution on women, which is part of the sexual violence continuum, also needs to be better explored.
Self-defense as a means of prevention of sexual coercion has been widely accepted and applauded. Preventive strategies, however, must go beyond individual solutions and also address the underlying social problems. Socio-situational factors that contribute to rape involve several factors that have helped to maintain male dominance. The role played by social institutions in tolerating sexual coercion by legitimizing behaviors such as male dominance is another important contributing factor. The economic institution that is structured so that women are dependent on men makes it harder for women to escape oppression and victimization. Devaluation of housework and child care as well as the family structure, and division of labor in the family, especially lack of involvement of men in child care, promotes circumstances that can spawn sexual coercion behaviors. Objectification of women by the media also contributes to the risk of sexual violence.
A comprehensive restructuring of social institutions and alternative parenting techniques (based on an analysis of the social and psychological processes underlying sexual violence) is required at the societal as well as interpersonal levels to decrease the prevalence of sexually aggressive acts.
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