What I want to talk about may seem overwhelming and scary but it happens sometimes and the more of us who know how to help, the better. Many people who have been sexually assaulted develop a condition called Post Traumatic Stress Disorder, PTSD for short. The National Institute of Mental Health defines PTSD as “an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened.” They cite personal assaults, natural or human-caused disasters, accidents, or military combat as experiences that can trigger PTSD. The disorder is characterized by various degrees of re-experiencing the trauma: recurrent memories, nightmares, frightening thoughts, and what I want to discuss here, flashback episodes. Other symptoms are sleep disturbance, emotional numbness, anxiety, irritability, depression, and outbursts of anger.
Though this cluster of symptoms has probably been around as long as people have been hurting each other, it was not diagnosed until men began to exhibit symptoms in great numbers during and following World War I. Before, women were considered by the medical establishment to be the only bearers of physical manifestations of a mental condition; the disorder was called hysteria and was generally considered a contrivance of attention-seeking females. World War I sent home men who had experienced more than their minds could bear. They relived their experiences of war, their bodies shut down; they could not function. Suddenly, doctors decided that this mental state, shell shock they called it, could happen to anyone, not only to members of what they considered the weaker sex. What had previously been viewed the folly of women became a legitimate disorder worthy of attention. Unfortunately, this attention usually consisted of institutionalization and heavy sedation. However negative the treatment, at least people who suffered from this disorder had a name for it. They could see that the mind sometimes collapses under stress, that it is a normal response to unbearable strain, not a sign of weakness. As the women’s movement of the 70s grew, women who began to examine sexual assault and its effects saw the symptoms of PTSD in many women who had been assaulted or had lived in abusive environments. People who wanted to create a supportive framework for dealing with sexual assault developed strategies for helping people who exhibited signs of what they called Rape Trauma Syndrome. These strategies were implemented and taught to volunteers throughout the network of Rape Crisis Centers and Domestic Violence Shelters and they still are today.
When I trained at a rape crisis center, we spent part of one short class talking about what to do if a client started to relive an assault. Many of the volunteers expressed concerns that they were not prepared to deal with such an extreme situation. Our advisor explained that it hardly ever happened and that she hadn’t dealt with a flashback in all her years at the center.
At least we spent those few minutes on flashbacks, because within a few weeks, one of my clients showed up at the center fully in the throes of reliving a rape. She had been in an abusive marriage for years, during which time her husband had repeatedly raped her. Though she had been on her own for a while and lived in a different town from him, she still had nightmares and felt continually unsafe. I don’t remember what triggered her flashback, but it happened while she was driving. Luckily, she was near the rape crisis center and was able to pull in there. She walked in shaking and staring straight ahead. I led her to the couch as she described her assault as it was happening. She was terrified.
First, I slowly put my arms around her and spoke in a low voice, telling her she was in a safe place. Here is the important part: since the person is not in the present moment, you need to get them someplace safe in their mind. This might sound silly but it works. As they told us to do in training, I told her to picture a safe place and to put herself there, a place where no one can get her and she feels free from any possible harm. I then asked her to describe the place for me. This gives the person something to do, a task to occupy the mind until the crisis is over. She told me about a boat. I asked a lot of questions about the boat and the area around the boat. No question is too detailed. The person needs to focus on this safe place. After a few minutes of describing her boat, she quit shaking, her heartbeat slowed down, and her eyes saw her immediate surroundings again. She was still upset, but the crisis was over. We talked until she felt okay to leave and I checked on her frequently for the next few days.
The fact is, you may never be around when someone you know relives a trauma. But if you are, remember these few things:
1. Speak in soothing tones.
2. If you touch the person, be gentle as you comfort them, there’s a fine line between feeling held and feeling held down.
3. Ask them to picture a safe place and to tell you all about it.
4. Ask a lot of questions so they really have to inhabit the safe place.
5. Once the immediate crisis is over, talk to the person about what happened, what triggered the flashback.
6. Make a plan to stay with your friend or find another person they trust to stay with them if you have to leave.
7. Offer to be available for the person to talk to or spend time with in the immediate future.
8. Remember, these symptoms may get better with time, but you may need to actively support this person for a long time. They are dealing with a lot and this flashback is just an extreme manifestation of what they may be thinking of every day.
9. While therapy is sometimes maligned in our community, it can be very helpful. When someone is dealing with this much mental stress, talking to a trained counselor is probably a good idea. Don’t be afraid to suggest this option, and help them find a therapist. Some rape crisis centers offer free counseling to survivors, regardless of how much time has passed since the assault. They also may be able to give you some referrals to experienced counselors in the area.
10. Keep up the support. Keep checking in.
This piece is written by Janet Kent and is an excerpt from Cindy Crabb's book, In Learning Good Consent.
Top image courtesy of Stranded-angel-Aaya art.
More from BUST
In Learning Good Consent, Cindy Crabb provides a DIY tour of the promise and perils of sexual relationships. Her edited collection is an indispensable guide to both preventing sexual violence and helping its survivors to heal. Available from AK Press.