The Brain Under (Sexual) Assault

The Day After

According to a Rutgers University study, sexual assault trauma can remain vivid in the mind of a victim longer than many other types. Should we look for commonalities across assaults to more effectively identify and mitigate against the post traumatic stress disorder (PTSD) that can result?

Doctor of psychology and trauma specialist Dr. Anjhula Mya Singh Bais says she’s seen responses common to many rape victims, several of which have helped form the definition of PTSD for psychiatry manuals like the DSM-V and ICD (International Statistical Classification of Diseases and Related Health Problems). They include flashbacks, irritability, insomnia, isolation, repetition of thoughts, ideas about suicide, guilt, and blaming oneself.

In fact, guilt and shame are among the strongest and longest-lasting effects experienced by rape victims. To Alexandra Allred, it’s bad enough victims are routinely asked what they were wearing, whether they’d been drinking, etc. When they look back on their own freeze response, self-criticism like “why didn’t you scream? why didn’t you fight back?” only compounds feelings of guilt and shame, making the healing process exponentially harder.

And just like the freezing response itself, shame and guilt seem particularly counterproductive as emotional responses go. Shame might have had some part to play in socializing behavior as pair bonds, families and culture emerged in protohumans, but why are guilt and shame so deeply embedded in is after sexual assault — and so hard to dislodge?

“Guilt and shame are encoded through cultural learnings and conditioning,” Bais says. “A sexual assault survivor may respond with those emotions because they’ve been taught that people with questionable morals are at X place, wearing Y thing, would never drink and go back to someone’s place, etc.”

She also believes it can be contextual around race, identity, etc., which can affect both the automatic response and longer term impact. “There appears to be both universals and context-specific responses,” she says. “For example, what may be experienced as clear cut assault in America might seem like a marital right in [somewhere like] India. A wife in an Indian context may absolutely hate the experience of rape but not have the [cultural] repertoire to characterize it as assault because it’s her husband.”

The other principle that has huge ramifications for the way we help rape victims process and heal is the way the brain encodes memories under extreme stress — and retrieves them later. Whether it’s so the victim can recognize their ordeal for what it is, or establishing facts when we try to prosecute rapists, what actually happened (quite separate from what anyone involved remembers) matters.

Again, it’s common for lawyers on the attack to question the victim when they can’t remember the assault in perfect and sequential detail. But even though memories of stressful situations can be incomplete, fragmentary, and out of order, Hopper says, the brain can be no less robust at encoding the details that matter at that moment.

“It’s common for people not to remember the order in which unforgettable parts of the experience occurred, but that doesn’t mean their memories are unreliable,” Hopper says. “We just need to understand which aspects of memory tend to be reliable and which don’t. The fragments of memory of particularly horrific parts of the experience can be extremely reliable.”

It seems that gives neuroscience a job to do — educate law enforcement and courts that stress has time-dependent effects on the encoding and storage of memories about traumatic experiences. “If [courts and investigators] understand traumatic memories often lack time sequence information, especially for things that happened after the initial phase of the assault [which he calls the “super encoding phase”], it can stop misleading and scientifically unfounded attacks on memory and credibility,” Hopper says.

Back to Life

Brains and what goes on in them have amazing healing potential, especially when their owners have the support and understanding of friends and family, skilled professionals, and communities.

If you know a rape victim, you have just one job — be that support. “To be assaulted, including sexually, is to be disempowered and related to in a disconnected way by another person,” Hopper says. “So to help someone heal from the trauma, we have to relate to them in ways that are genuinely emotionally connected and empowering. It can mean small things like giving them options about where they’d like to sit, what they want to drink, etc.”

Dr. James Giordano, professor of neurology at Georgetown University Medical Center, Washington, D.C., says offering those simple gestures of empathy and respect can have a big impact on the neural wiring in a similar biological way as the assault already has.

“Any profound experience — positive or negative — can activate a wide network of neurological systems in the sensory integration and cognitive processing,” he says. “All cognition involves emotion, and the strength of the emotion can affect the way experiences are processed.”

Giordano believes such processing can produce durable patterns of network activity in the brain, which explains why they bubble up so strongly in response to memory-based and physical triggers, leading to the characteristic feelings of being overcome or debilitated by memories, emotions, or behavioral prompts.

Empathy, respect, and empowerment towards the victim, he says, can induce neuro-cognitive processes that change the pattern of response. “Such therapeutic interventions cause alterations in patterns of neural activity to evoke more positive, beneficial neural ‘firing and functional [re-]wiring’.”

In fact — and as with many coping and trauma disorders — cognitive behavioral therapy has long been known to ease PTSD, loosening the guilt and shame that plague so many rape victims for so long as they challenge habitually irrational thoughts. Just one of the treatments related to and derived from it is eye movement desensitization and reprocessing (EMDR), where the patient is asked to recall distressing images while generating one type of bilateral sensory input like side-to-side eye movements or hand tapping.

It might like pseudoscience, but as far back as 2013 the World Health Organization recommended it in its official guidelines, saying the treatment helped “reduce vivid, unwanted, repeated recollections of traumatic events.”

And if there’s one sector of the community who might benefit the most from knowing how the brain responds to, encodes, and suffers because of rape, it’s victims themselves. “Many survivors have said understanding how their thinking and behaviors during the assault were normal responses, shaped by evolution, reflexes, and habits is a huge relief,” Hopper says. “It can really reduce the shame and guilt impeding recovery.”

“I see people on a daily basis who walk in thinking ‘what’s wrong with me, why can’t I get over it, it’s a ‘weakness of character,’ etc.,” Bais says. “When I explain the science they start reframing. At first it’s awkward, like learning any new language, but they become fluent and life completely changes. They build upon each success in a positive upward spiral and realize that they don’t become their feeling anymore, they observe them, and are less triggered.”