Healing the Body and Spirit

After she was raped in her bed by a man with a knife, Patti Lancaster felt paralyzed by fear, unsure how she’d make it through each day.

“I felt everything I had been was gone,� she recalls. “I wanted out of my life.�

She found refuge a few miles away at the Rape Treatment Center at Santa Monica-UCLA Medical Center.

From the moment she entered the center’s private waiting room, far from the chaos of emergency patients, she felt protected. No one rushed her. A doctor specially trained in treating rape victims took the time to explain each part of the medical examination before touching her.

Lancaster said she felt “really comfortable� with him and the therapists who helped her over time see “the things that were important to me were still there and I could rebuild.�

Looking back, she says, “they truly saved my life.�

Lancaster, a 46-year-old producer of television commercials, was fortunate. After her May 1992 attack, she landed at the Santa Monica center, which is considered a national model program for comprehensive rape treatment.

Most U.S. communities provide advocacy and referrals through rape crisis centers and hotlines, many of them founded during the women’s movement in the 1970s. The vast majority, however, are not equipped or licensed to furnish medical care. That means that rape victims are directed to often-chaotic hospital emergency rooms, where they can languish for hours while busy doctors attend first to the critically ill and wounded. Some women walk away in frustration.

Emergency room exams are often hurried, with little if any counseling, and perhaps some advice about possible pregnancy or sexually transmitted diseases, experts say. Women are typically left to their own devices to cobble together follow-up medical care and counseling services.

The Rape Treatment Center is different. It delivers free, comprehensive services to meet the woman’s physical and emotional needs in an atmosphere of safety, privacy and calm. It’s one of the few facilities in the country that takes into account that a fragile rape victim is unlikely to want to travel to several locations or chase down prescriptions in the middle of the night.

It is also a leader in the training of advanced-practice nurses in how to collect evidence after a rape and in working with the police to help them deal more effectively with rape victims. The clinic offers rape survivors immediate and follow-up treatment based on the latest advances in medicine and technology.

This kind of attention to a rape victim’s needs reflects a major shift in how the aftermath of sexual violence is dealt with. Rape is now viewed as more than just a crime; researchers and doctors increasingly have come to view rape as a health issue, with not just physical injuries but also long-term mental-health consequences.

Research during the last decade has shown that the sooner a rape survivor gets help, the better her emotional and physical recovery. (The studies have focused on adult women, but men and children are victims as well.) Rape victims suffer more from chronic pain, headaches, stomachaches and sexual difficulties, and they seek more medical services over the years than other women. Women who suffer silently, without counseling, develop more stress-related mental health problems.

Although an estimated one in six U.S. women is a victim of rape or attempted rape--the majority committed by an acquaintance-- only about a third of adult women report it. Because the costs of forensic exams typically are borne by police agencies, women are often required to file a report to ensure payment of their exams.

Comprehensive rape counseling and medical service programs, such as that of the Santa Monica clinic, are rare throughout the country. Moreover, rape treatment services vary widely, depending on local financing and community attitudes.

“There’s no broad universal standard of care and services for victims of sexual violence,� said Ann Burdges, executive director of the sexual assault center in Gwinnett County, Ga., near Atlanta, which is also cited by experts as one of the nation’s best facilities. “It’s just a roll of the dice where you happen to be.�

Cooperation Can Lead to Better Care

New federal laws, though, have provided more money for improving the forensic medical care that victims receive. And rape kits are becoming standard equipment at most medical centers.

Services improve, said Liz Flowers, national spokeswoman for the Rape Abuse and Incest National Network, when doctors, prosecutors, advocates and law enforcement cooperate.

In rural Georgia, for example, advocates from several counties lobbied successfully for federal funds to purchase sophisticated instruments called colposcopes, which improve the ability of health professionals to detect genital injuries, Burdges said. Colposcopes, she points out, are not yet available for rape exams in Atlanta, where nearly a third of the state’s rapes and sexual assaults occur.

Rape treatment centers are designed to help women regain control after a degrading crime has rendered them powerless. Many victims aren’t even sure what constitutes rape, in legal terms beyond sexual intercourse to which they did not consent. Under most definitions, rape involves forced vaginal, anal or oral sex. California law also includes penetration with fingers or other objects.

Although many victims are wary of reporting sodomy or oral sex, experts say, the information guides their physical exams. That’s where the clinic staff’s skill and ability to engender trust come in.

“A lot of times, they disclose things during the exam they didn’t feel comfortable telling law enforcement,� said Tish Tighe, a nurse practitioner at the Santa Monica center.

When the nurse knows where to look for injuries, she can provide a better examination and utilize advanced technology, such as video colposcopes with monitors that let the victim see her injuries and watch how they heal. When women can see proof of the force used against them, it often helps to validate the experience for them, making them more likely to file a police report, experts said. Light-staining microscopes may be used to pick up traces of semen--the sperm cells appear yellow on a blue background--and provide DNA evidence that also helps make a criminal case.

Knowledge of which sexual acts occurred can help the nurse assess potential exposure to sexually transmitted diseases and to recommend preventive medications.

Sometimes, the victim may not know or recall what was done to her. In those cases, collection of urine samples within the first three days of the rape can detect whether she’s been drugged with the so-called date-rape drugs, Rohypnol or GHB. (Many experts disdain the term “date-rape drugs,� noting that many women are drugged not by their dates but often by strangers or acquaintances at bars or parties.)

A Closer Look at Rape’s Lasting Effects

In recent years, more attention has been focused on the long-term mental health consequences of rape. It wasn’t until 1994 that the widely used manual of psychiatric diagnoses, known as the DSM-IV, listed rape as a source of post-traumatic stress disorder.

Psychological trauma in most cases “is more severe than any physical injuries,� said social worker Gail Abarbanel, founder of the Rape Treatment Center. Counseling can stave off post-traumatic stress disorder, major depression, suicidal thoughts, substance abuse, sexual problems and social withdrawal.

Although rape victims often received supportive therapy in the past, research has found that the most effective psychotherapy focuses on the trauma, said psychologist Naomi Himmelfarb, clinical director of the Rape Treatment Center.

One successful form of therapy stresses exposure by encouraging the victim to imagine, write or talk about the trauma rather than avoid it. “When you avoid something,� Himmelfarb said, “your anxiety grows and grows.�

Therapists use another technique called “processing� to help victims reexamine their worldview. Many women assume the world is a safe place as long as they do everything “right.� But after a rape they blame themselves for doing something “wrong.� Said Himmelfarb: “Processing is about trying to help people get away from these distortions.�

The trauma can be made worse when those who are supposed to help, instead make things worse--often unknowingly. So Abarbanel and other advocates train police and prosecutors in responding to victims’ reactions.

Donna, a radio producer attacked by two men in March 1985 when she was 24, went into a tailspin spurred in part by the behavior of untrained police officers. After a rape that left her battered, bloodied and disoriented, police officers arrived on the scene. She expected protection. Instead, “They asked if I had been drinking,� she recalled. “And they sniffed at me.�

The officers’ words and actions, she said, felt like another assault. She was not offered medical attention. Donna, who later was found to have suffered hairline skull fractures, loss of smell, and hearing damage, spent the next few weeks in her childhood bedroom.

Eventually Donna resumed her usual routines, but her anger couldn’t stay buried. In 1998, she came to the Rape Treatment Center looking for “emancipation from the rape.� Retelling the rape and reviewing the attendant emotions reduced it to a “small part� of her past. Therapy, while “not a miracle . . . gives you back your wholeness,� she says today.

First Response Has a Profound Effect

Although Donna’s recovery demonstrates “it’s never too late� to get help, Abarbanel said healing could have begun right away “if she had a different response from police officers.�

Swift intervention helped Anna, a former massage therapist.

She was robbed and raped at gunpoint in May 1999 en route to treat a client in an industrial area of the San Fernando Valley.

During the rape, Anna, a Quaker, remembers praying: “Let him take my body, not my soul.�

After she drove home, her boyfriend took her to the Rape Treatment Center’s Verna Harrah Clinic, which had just opened in a new space at Santa Monica-UCLA Medical Center, where nurse practitioners had taken over the task from ER staff of examining patients.

Anna met immediately with a female psychologist, who “sat with me and talked to me, getting the facts and also [asking], ‘How did it feel?’ � Anna recalled. The clinic, she said, “was like being in someone’s living room. There was a couch, a lamp, there were no fluorescent lights, there was no one screaming. I felt I had entered a safe place. I was surrounded by extremely compassionate women. A lot of my questions got answered quickly. At every step of the way, I was given options.�

Within a week, she began individual counseling, which gave her a chance “to weep and be insecure. I needed to have a place where I could go and get messy.�

What a difference between her experience and that of a friend raped in college, who “drove herself to the ER of a hospital and waited four hours. When she was dealt with, she was treated like another medical emergency.�

Anna was lucky to go to a center that provided comprehensive services at no charge. But until the 1994 Violence Against Women Act, victims like her often had to pay for their own rape exams, which can cost as much as $700, Flowers said.

Under federal and most state laws, a victim isn’t charged for a forensic medical exam if she reports the crime. She may be charged for treatment of injuries and prevention of sexually transmitted diseases and pregnancy. The laws can deter poor women who fear retaliation or being stigmatized, said Dean Kilpatrick, director of the National Crime Victims Research and Treatment Center at the Medical University of South Carolina in Charleston.

Both the 1994 law and the Victims of Crime Act provide money to help pay for exams. However, Aileen Adams, formerly director of the Justice Department’s Office of Victims of Crime, bemoaned federal legislation that this year capped VOCA funds to victim programs. “Because of the cap, California lost millions of dollars,� said Adams, now secretary of the State and Consumer Services Agency in Sacramento.

However, she said, the state’s victim compensation program limits rose on Jan. 1 from $46,000 to $70,000, which can help victims of reported crimes obtain counseling and medical care. “It’s still hard to get the kind of comprehensive care the Rape Treatment Center provides,� said Adams, “but we’re light-years ahead of where we were a decade ago.�

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Health Risks

* Physical injuries, including cuts, abrasions, bruises, trauma to the genital areas.

* Sexually transmitted diseases, including chlamydia, gonorrhea, herpes simplex virus, syphilis, hepatitis B and HIV.

* Unwanted pregnancy.

* Psychological trauma, including shock, feeling of numbness and symptoms of acute stress disorder such as detachment, flashbacks, nightmares, avoiding reminders of the trauma, irritability, problems concentrating.

* Long-term medical problems, including stress, anxiety, tension headaches, stomachaches, nausea, back pain, allergies, skin disorders, chronic pain, menstrual and other gynecological complaints.

* Long-term emotional problems, including depression, sexual problems, social withdrawal, suicidal feelings, diminished self-confidence and loss of self-esteem; post-traumatic stress disorder symptoms such as flashbacks, sleep disturbances, difficulty concentrating.

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What to Do if You Are Raped

1. Go to a safe place.

2. If you want to report the crime, immediately notify the police, who will help you get a medical forensic examination to collect evidence. A friend, family member or rape crisis center worker may accompany you during a police interview. Reporting the crime can help you regain a sense of control and ensure the safety of other potential victims. It is never too late to make a police report.

3. Ask a friend, family member or someone else you trust to stay with you.

4. Preserve all physical evidence of the assault. Do not shower, bathe, douche or brush your teeth. Do not eat or drink anything. Save the clothing you were wearing at the time of the assault, placing each item in a paper--not plastic--bag. Do not disturb anything where the assault occurred.

5. Seek medical care at a hospital emergency department or a specialized rape treatment clinic. Local rape crisis centers or police departments can refer you to providers with sexual assault expertise. Even if you have no apparent physical trauma or are unsure about reporting the crime, you should have a medical examination. You may have internal or other injuries.

A health-care worker can explain the risks of sexually transmitted diseases and pregnancy and provide preventive medications that must be taken within 72 hours of the assault. If you suspect you’ve been given a “date rape� drug, such as Rohypnol or GHB, ask your medical provider to take a urine sample for evidence. These drugs are more likely to be detected in urine than blood.

6. Consent to collection of forensic evidence during the medical exam, regardless of whether you’re making a police report, because physical evidence deteriorates rapidly. Sometimes the evidence can be preserved in case it is needed if a criminal case is brought later. In California, you have the right to be accompanied during your exam by a rape counselor and another support person.

If you report the rape, law enforcement will pay for the evidence-collection portion of your examination. If you decide not to report the incident, you can contact a rape crisis center about financial aid to pay for your medical care.

7. Talk with a trained counselor. To find one, contact a hotline, rape crisis center or counseling agency. The Rape Abuse and Incest National Network hotline at (800) 656-4673 will connect you to a rape crisis center in your area.

8. Every state has a victim compensation program that provides financial help with medical care and counseling, usually contingent upon cooperation with law enforcement. Contact the district attorney’s office or the state victim compensation program. In California, call (800) 777-9229.

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Source: “Taking Action: What to Do If You Are Raped,� published by the Rape Treatment Center, Santa Monica-UCLA Medical Center.

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Counseling, Care and Legal Resources for Coping After a Rape

You can get information about your legal rights, medical and counseling services and other assistance by contacting a local rape crisis center or a national referral service.

Southern California 24-hour hotlines and rape crisis centers:

* Antelope Valley Sexual Assault Response Service, Lancaster, (661) 723-7273.

* Center Against Sexual Assault of Southwest Riverside County, (Spanish available) Hemet, (909) 652-8300, or toll-free, (866) 373-8300.

* Center for Community Solutions Crisis Line, San Diego, (858) 272-1767.

* Center for Pacific Asian Families Shelter and Hotline, (Asian languages available), Los Angeles County, (323) 653-4042 or (800) 339-3940.

* Coalition to End Domestic and Sexual Violence, (Spanish available), Oxnard, (805) 656-1111.

* Compton YWCA Rape Hotline, (310) 764-1403.

* East Los Angeles Rape and Battering Hotline (Spanish available), (800) 585-6231.

* Long Beach Rape Hotline, (Spanish available), (562) 597-2002.

* Los Angeles Commission on Assault Against Women Crisis Line, (Spanish available), Los Angeles, Hollywood, (213) 626-3393; Pasadena, West San Gabriel Valley, (626) 793-3385.

* Project Sister, (Spanish available), Pomona, (909) 626-4357.

* Rape Treatment Center at Santa Monica-UCLA Medical Center, 1250 16th St., Santa Monica, CA 90404 (Spanish available), (310) 319-4000. The center provides free medical care, legal services and counseling to rape victims and their families, as well as education and outreach. The center also has free copies of three booklets: “Taking Action: What to Do If You Are Raped,� “Medical Care Following a Sexual Assault,� and “Legal Rights and Protections for Sexual Assault Victims.� More information is available through its Web site: https://www.911rape.org.

* Riverside Area Rape Crisis Center, (Spanish available) Riverside, (909) 686-7273.

* Rosa Parks Sexual Assault Crisis Center, (Spanish available), Los Angeles, (323) 751-9245.

* San Bernardino Sexual Assault Services, (Spanish available) San Bernardino, (909) 885-8884.

* Sexual Assault Victim Services Hotline, (Spanish available), Santa Ana, (714) 957-2737.

* Valley Trauma Center, (Spanish available), San Fernando Valley, Van Nuys, (818) 886-0453; Santa Clarita Valley, Santa Clarita, (661) 253-0248.

For a national organization, you can contact the Rape Abuse and Incest National Network, which operates a hotline at (800) 656-4673 for rape crisis centers nationwide. The group’s Web site is https://www.rainn.org.