On 12 June 1993, the editors of the British Medical Journal published an account by a male doctor of being sexually assaulted by another male doctor. Due to the sensitive nature of the account, the editors allowed the victim to remain anonymous. In the short article, the doctor graphically described how a medical friend had sexually abused him when they were sharing a room in a ‘bed and breakfast’ during a medical conference. Although the doctor was numb and furious, in turn, like most victims of sexual assault, he fretted about whether he was partly culpable for being assaulted. After all, he admitted, he had been drinking alcohol and, during the attack, had frozen instead of vigorously resisting. He admitted that the attack had left no physical scars; psychologically, though, he was still in turmoil.
Not all physicians reading this physician’s harrowing account were sympathetic. One physician writing into the journal even condemned the victim for being ‘childish’, claiming that his story ‘reflects no credit on him’ since he had been a ‘drunken stupor at an international conference’. The editors had to defend their decision to protect the victim’s anonymity, reminding readers that ‘we accepted that the author might suffer unnecessarily if the article was signed’.
Although this exchange took place 23 years ago, the events described by the anonymous doctor are not uncommon and victims continue to be seen as culpable in their own abuse. In England and Wales today, 11 people are raped every hour. In other words, approximately 85,000 women and 12,000 men are raped every year; another half a million adults are sexually assaulted. Physicians and other medical professionals play a crucial role in examining, treating, and counselling these men and women.
For historical reasons, however, victims of sexual violence have often struggled to get their voices heard by the medical profession. In the nineteenth and early twentieth century, the most influential textbooks in medio-legal education still claimed that ‘real rape’ always leaves physical traces and that most rape accusations are false. Some textbooks even informed doctors that female victims who subsequently became pregnant should be presumed to have consented. More commonly, these medical texts insist that it is impossible to rape a resisting woman. In the words of Horatio Storer in his influential article published in The Quarterly Journal of Psychological Medicine and Medical Jurisprudence in 1868, it is ‘impossible to sheath a sword into a vibrating scabbard’. Metaphorically, the penis was coded as a weapon; the vagina, its passive receptacle. Merely by ‘vibrating’, this receptacle could ward off attack. Storer had relatively little to say about the kind of sexual assault experienced by the anonymous doctor in the BMJ.
From the 1970s, however, medical responses to victims of sexual violence began to be debated, even on public television. On 22 January 1977, BBC2 broadcast a play entitled ‘Act of Rape’, which claimed to be based on recent events. The broadcast was followed by a panel discussion, during which serious allegations were made about the medical aspects of rape investigations. The president and secretary of the Association of Police Surgeons of Great Britain signed a joint letter of protest, complaining that the programme ‘gave an impression of a complete disregard by the police surgeon of normal medical ethics and courtesy to his patient’.
Exactly five years later – on 18 January 1982 – BBC1 broadcast a remarkable episode in the documentary series called ‘Police’, a ‘fly on the wall’ exposé of the Thames Valley police station in Reading. Produced by Roger Graef and Charles Stewart, the episode was called ‘A Complaint of Rape’. It showed a woman being aggressively interviewed by the police about her allegation of rape. The interrogators accuse the woman of lying. She is asked why she did not resist more forcefully. She is forced to tell them how many men she has slept with in her life, when was the last time she had sex, and how regularly she menstruates. Not only is she reminded that giving evidence in court is a ‘pretty nasty experience’, but also that the medical examination will require a lot of ‘probing about’. It’s ‘pretty awful’, they warn.
The episode created an uproar. And not only from women’s groups – including Women Against Rape and the Rape Crisis Centre – but the general public as well. As a result of the broadcast, whistleblowers came forward with evidence of medical examinations of rape victims being performed in unsuitable premises and by unsympathetic doctors. In the words of one police surgeon, victims were examined in ‘bloody awful places’, which were not only ‘bleak [and] badly equipped’ but were ‘mainly used for the examination of prisoners and drunks’. A large proportion of police doctors were not trained in the medical examination of sexual assault victims. Lack of resources meant that forensic science laboratories were unable to provide police surgeons with feedback about the way they collected biological evidence of assaults. As Dr Hugh de la Haye Davies (secretary of the Association of Police Surgeons of Great Britain) explained, this made it ‘hard for doctors to know if they have performed examinations correctly’. Furthermore, victims were not offered counselling for the emotional trauma they might be experiencing. Was it any wonder that a survey in 1991 revealed that 40 per cent of rape victims claimed that the doctor examining them had been ‘unsympathetic’.
Three main problems with the medical examination of victims of sexual violence were identified. First, there was the shortage of female medical examiners. Although it was widely agreed that the sex of the doctor did not matter as much as their skill and sensitivity, nevertheless, many rape victims expressed a strong preference to be examined by a woman. Second, victims’ perceptions about the medical examination and how they would be treated in court were deterring woman from reporting attacks.
Finally, like the public in general, it was observed that medical professionals had imbued many false beliefs about rape. This was forcefully brought to public attention when, in 1984, Geis, Wright, and Geis published a critical article about medical personnel working for the police. They revealed that the majority of police surgeons believed that nearly one-third of rape complaints were lies. Seventy-five per cent believed that a complainant’s previous sexual history was relevant to their assessment and over 80 per cent argued that they were entitled to offer an opinion about whether the complaint was legitimate or not. Critics began asking whether police doctors were facing a conflict in roles: were they primarily there to provide medical assistance (including tests for venereal diseases and prophylaxes for women anxious about pregnancy) or to collect evidence? Was it their role to serve the ‘patient’ or the police?
The public outcry over the two television programmes in 1977 and 1982 coincided with some high profile scandals in rape trials. For example, only a few days before the 1982 documentary was broadcast, a judge imposed a lenient fine on a man who violently raped a 17-year-old woman. The reason? The judge argued that the young woman had been ‘guilty of a great deal of contributory negligence’ for hitchhiking at the time of the attack.
Reforms came swiftly. Peter Imbert, who had been chief constable of Thames Valley police during Graef’s and Stewart’s filming, later recalled that he watched the rape investigation scene in the ‘Police’ series with ‘chilling presentiment’. As ‘the ring of truth peeled louder in my ears’, he remembered thinking: ‘when I got to work the next day – if I still had a job – that things would change’.
Within six months, the Thames Valley Police had set up a 5-woman rape squad, to be on-call 24-hours a day. By March 1983, the Home Office issued guidelines to police, emphasising the need to conduct medical examinations of rape victims in a ‘proper clinical environment’, to make available a female doctor when possible, and to show ‘tact and understanding’ to distressed victims. The Metropolitan Police also commissioned a working party to examine its procedures and make recommendations. Under the chairmanship of Detective Chief Superintendent Thelma M. Wagstaff, they advised that such a ‘serious and difficult crime’ should be deal with by senior officers and that specific training should be introduced, including education in Rape Trauma Syndrome. By the 1990s, Graef’s and Stewart’s documentary was being used to train police on ‘how not to treat rape victims’.
While these reforms are important, they could not tackle the underlying problem: that is, medical professionals are as susceptible as other people to believing ‘rape myths’. Then, as now, there continues to be scepticism about allegations of sexual assault and suspicions about whether victims are partly responsible for being attacked.
Nearly a quarter of a century after the anonymous young doctor complained in the BMJ of being sexually assaulted by another doctor, the pivotal roles played by forensic medical examiners, GPs, emergency-room personnel, gynaecologists, surgeons, nurses, midwives, psychiatrists, and therapists in providing medical and psychiatric help for victims of sexual violence is increasingly acknowledged. However, a better understanding of medical responses to sexual violence continues to be imperative given its significant health outcomes – including physical harms (injury, venereal disease, AIDS, unwanted pregnancy), psychological disturbance (anxiety, depression, PTSD), and life outcomes (sexual and social dysfunction, drug and alcohol abuse, suicide). A sustained analysis of the history of medical engagement with sexual violence is needed to address current debates about the treatment of rape victims and the needs of justice.
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