Is the Silence Broken?

30 years after rape crisis centers, women are being heard.

From the WebMD Archives

March 27, 2000 (Berkeley, Calif.) -- More than once a minute, 78 times an hour, 1,871 times a day, girls and women in America are raped.

When this traumatic event happens to a woman in the vicinity of Duke University Medical Center in Durham, N.C., now she'll be spared the glaring lights of the ER.

Instead, while she goes through the necessary medical treatment, evidence gathering, and questioning by police, she'll be cared for in a softly lit room with comfortable furnishings and pastel-painted walls.

The team of medical personnel -- including specially trained female nurses who collect evidence using state-of-the-art equipment -- will do what they need to do, but will also pay close attention to the emotional needs of the survivor, whether she's 15 or 45. The full spectrum of care will be on hand, from trained counselors to practical amenities such as fresh clothing and toiletries.

Much has changed since the first rape crisis centers sprang up 30 years ago in the wake of the "Break the Silence" movement that began in New York. The message was a profound and powerful one, says Marybeth Carter of the California Coalition Against Sexual Assault (CALCASA): Rape affects all of us, and you are not alone.

Out of that early movement came the early hotlines, staffed at first by untrained volunteers. Then in 1974, realizing that women who had been raped had nowhere to turn for help, Gail Abarbanel founded the Rape Treatment Center in Santa Monica, Calif., offering psychological intervention as well as medical help.

Specialized Care in the Aftermath of Assault

This past fall, when Duke's specially designed center opened, it joined an evolving nationwide trend toward gentler, specialized, more effective treatment in the aftermath of assault. The facility, like others across the country, has been consciously designed as a safe, calm setting, where patients who've undergone sexual trauma can be offered more than emergency medical treatment.

There is mounting evidence that early intervention and immediate counseling speeds a rape survivor's recovery. Every state now has Coalitions Against Sexual Assault (CASA) programs designed to support rape crisis centers and the clients they serve. Most states now have Sexual Assault Response Teams (SARTs) composed of specially trained legal, medical, and counseling professionals and advocates working together.

Such teams today routinely offer advice on sexually transmitted diseases, HIV, pregnancy, infection, and other risks. They usually have on hand the morning-after pill, as well as other treatments and drugs for specific medical needs. Trained counselors are on hand 24 hours a day. Some institutions, such as Stuart House in Santa Monica, have special services just for children who've been raped.

Advances in Psychological Care

Research underscores the profound and complex trauma experienced by rape victims. A study funded by the National Institute of Drug Abuse found in the early 1990s that survivors were at increased risk for a broad array of mental health problems, from attempted suicide, to increased drug and alcohol abuse, to major depressive episodes.

Post-traumatic stress disorder, a debilitating condition arising after trauma such as combat, is now recognized as a common consequence of rape, said Ivonne Zarate, educational coordinator of the Santa Barbara Rape Crisis Center. Zarate noted that a form of this disorder -- referred to as rape trauma syndrome (RTS) -- strikes, at some point in their lives, a third of those who've been raped.

Fortunately, advocates and counselors at many rape trauma rooms are trained to recognize the physical, mental, and behavioral stress reactions that come with RTS and can address the problem early. Spouses, children, lovers, and friends may also be significantly affected by a survivor's rape. Most crisis centers provide free counseling to all those in her circle.

Despite the innovations, though, a majority of people fall through the cracks. According to a U.S. Department of Justice survey, only about 16% of rape victims -- of all ages -- report the crime in the first place. Overall, says Marybeth Carter, the message still needs to get out to communities, to parents, to doctors: Rape can happen to anyone, anywhere -- and when it does, comprehensive care is a necessity.

Jolie Ann Bales is an attorney based in Berkeley, Calif. She has written for a number of legal and business publications.