What to say to a rape victim: What can we tell her that might help her begin the process of healing? After 30 years in the emergency room, this is my best attempt.

The Rape Exam

I don’t know if people associate rapes with the emergency room, but that’s where most rape victims are taken first. They come to address any possible injuries, but primarily they are brought to the E.R. for a forensic rape exam, to collect evidence.

It’s a really bad situation for everyone. The exam is, in many ways, a repeat of the assault. A woman – or sometimes a man, or a child – must submit to much the same de-personalization, objectification, and penetration, that they just suffered through. I can’t begin to imagine how the victim feels. I know it make me feel like crap. And you never know what to say to a rape victim, how to express support, compassion, and encouragement. I’m not sure much encouragement is possible at that initial stage.

But for a few years, I was on staff in the busiest emergency room, at the largest teaching hospital, serving a a good quarter of my state. As a result, most of the rape victims were brought to us. So in addition to worrying about the suffering of the patient, the doctor has to put a busy ER on hold, and take 45 minutes or more to do a proper medical and forensic examination, meticulously collecting specimens and documenting everything. And through all of this, I had to struggle over what to say to the rape victim.

I got more than my share. Some of the Rape Crisis volunteers specifically requested that I perform the exams. I thoroughly despised it, and I admit with embarrassment that I often took out my frustration on the volunteers. Apparently some of them decided it was worth it; I think they recognized that as asinine as I was with them, I was patient with the victims, and tried to treat them with as much kindness and dignity as the situation allowed.

The Wounds

After three decades of doing these exams, I realized something. Almost none of the victims had any physical injuries. Except for one particularly depressing case, a prostitute who had been beaten with a garden hose by her pimp, the victims I saw rarely had so much as a bruise or a scratch.

Their injuries were psychological. That’s not to say that the injuries weren’t real; psychological injuries are all too real, and they can be as debilitating as any infection, broken bone, or malignancy. In fact, they can be far worse, because many of the victims never completely recover, they are never restored to full health. And each of them will spend years trying to accept what was intellectually obvious to her, and to everyone, from the outset: it wasn’t her fault. There is nothing wrong with her, she isn’t damaged goods.

But the victim will, nevertheless, accept the assertion of the rapist. His actions treat her as someone who is worthless, insignificant, even disposable. And at some level, she accepts his degradation of her, at some basic level, she agrees with him. Only after years of effort and counseling can she even begin to crawl out of that hole.

So what can we say to a rape victim that might help her?

Searching for Words

Recently I was confronted by a rape case where there was nothing left to do but despair. It was a young teenager, a good student from a good family, who unfortunately lived in a poor neighborhood. The rape had taken place a week before. She had been afraid to tell her mother because of course, the victim blames herself.

So it left me with little to do medically. Before that, I had never realized that the rape exam, as bad as it was, at least gave me something to do. It allowed me to contribute a tiny mote of value in a very bad situation.

But in this case, I was bewildered. I was left wondering what to say to a rape victim. It occurs to me that family and friends also ask themselves the same question. So I thought I would write this post.

Before continuing, there are some things we never want to say to a rape victim. And we should always say that we believe her, and try to gently remind her it’s not her fault. Most of all, we should give her love, lots of patience, and lots of time.

I have tried these things in the past, but I also try to pay attention to how the patient is responding. The fact is, right after the attack the patient is in deep emotional shock, bewilderment, and a desperate need to deny all of it. It doesn’t seem to be the appropriate time for much counseling. So during the exam, I just try to be gentle and patient. When I’m finished, I try to briefly drop a seed or two that might blossom later: This wasn’t your fault. You didn’t do anything wrong. He did.

What to Say to a Rape Victim

But in this case, the rape was in the past, the initial emotional shock was gone. So I was wondering, again: What to say to a rape victim? I cast about for something that I could tell her that wouldn’t make the situation worse, and that might allow her to begin healing. I stood there awkwardly for several moments, while the young lady and her mother waited quietly for the ‘wise‘ doctor to speak.

This is what came out. Looking back on it, it seems as valid as anything else I have read or heard:

Some people will tell you that everything happens for a reason. I don’t believe that. Things only happen for a reason if we choose a reason, if we design a reason. If there is anything positive to come out of this, if there is any growth or value, then it will only be because you create it. Right now, your attacker has tried to tell you what you are, and who you are. He has tried to rob you of your dignity and your value as a human being. When you can take what happened to you and create sense of it, when you can reject what he thinks and instead decide what you think, then you can begin to heal. Once you create your own interpretation of what happened, and what it means, then you will reclaim your power, and you will deny him his power. By writing what your own interpretation of what happened, and by re-writing what it means, you can begin to take back your dignity for yourself. And with it, you will begin to take back your life.

Make or Break

I don’t know if that was the right thing to say. I also don’t know where it came from. Do muses exist? Perhaps a muse is simply the result of long-term subconscious rumination. It’s possible it wasn’t even a muse. Recently I came across a forgotten quote in my files from Jean Paul Sartre, “Freedom is what you do with what’s been done to you.” Maybe I subconsciously remembered that, and just restated it.

Anyway, some weeks later I saw her mother and she said that she was telling her daughter, “Remember what the doctor said: This will make you or break you.” It’s not exactly what I was trying to say, but I guess it’s close enough. And if that interpretation helps the young lady, I’m fine with it.

Other Victims

Since then, I have realized that perhaps this approach can help others who are struggling. Perhaps what we say to the rape victim we could also offer to other people who are demoralized, people who have been victimized in other ways.

From time to time in the ER we see young men from a local juvenile facility. Before continuing, I have to say that I have been very impressed by the counselors who bring the kids in: by and large, these guys appear to be genuinely committed to the young men, and they work hard to help them. Some of the counselors speak from experience, because many of them struggled with their own rebellious behavior and/or illegalities when they were young. It’s one of our worthwhile tax expenditures that often gets missed in complaints about government waste.

Anyway, some of these young men have typical teenage injuries and illness. But some of them come to us because they are deeply resentful and angry, even suicidal: they are away from their homes, they are in a strictly controlled environment, and they think they will never get out. With that, even though the counselors monitor them as best they can, there is still bullying and fighting. When I think it appropriate, I give them a version of the same talk I gave to the young lady.

Smaller Violations

Because maybe it’s advice that we can all use. Rape is an extreme, something that should never happen to anyone. But it’s also a metaphor for what we all face in much smaller ways. At times we are all violated, beaten down and humiliated, often by other people, but sometimes just by circumstances. When that happens, we all have a strong drive to climb into a hole and accept our feelings of degradation and victimization.

There is a Buddhist aphorism, “Pain is inevitable, suffering is optional.” We all have the same choice when we are in pain: either our adversity will carry important meaning for us, or it will be meaningless suffering. How we deal with our pain is up to us.

So I hope I helped the young lady, and the other people with whom I have shared this insight. But I can’t be sure. Perhaps it will help you; it has certainly helped me.

Or at least it helps me when I remember it.

When I’m struggling and out of energy (like I am today, probably the reason I picked this for today’s blog post), I try to remember what I told the young lady. It is up to each of us to create value in our lives. To quote a somewhat corny bromide, we need to figure out how to take our lemons, and make lemonade.

Doing so doesn’t always make me feel better, but it usually gets me up and moving again.

Which, I suppose, is the first step in simply living.

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Photograph courtesy of Frédéric Poirot on Flickr.

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