Miscarriage misconceptions boost feelings of guilt and shame, study says

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causes, guilt, isolation, loss, miscarriage, misconceptions, pregnancy, shame, stigma

Miscarriage misconceptions boost feelings of guilt and shame, study says

Feelings of guilt and shame in women who experience miscarriages are exacerbated by misconceptions over the causes, a US study suggests.

An online survey of 1,084 people, which formed the basis for research published in the Obstetrics & Gynecology journal on Monday, found that almost half of those who had a miscarriage felt guilty. Two in five said they felt like they had done something wrong, and the same number reported feeling alone.

A significant number of the respondents were under misapprehensions as to what caused the loss of the pregnancy. Three-quarters believed that a stressful event could bring about a miscarriage, 64% thought that lifting a heavy object could be a cause, and a fifth that previous use of oral contraceptives could induce pregnancy loss.

Coupled with the fact that 57% of those who had suffered a miscarriage said they were not given a cause for the loss, the researchers, from the Albert Einstein College of Medicine at Yeshiva University and Montefiore Medical Center, both in New York, believe such misapprehensions could contribute to the the negative feelings experienced.

Dr Zev Williams, the director of the programme for early and recurrent pregnancy loss, said: “The results of our survey indicate widespread misconceptions about the prevalence and causes of miscarriage. Because miscarriage is very common but rarely discussed, many women and couples feel very isolated and alone after suffering a miscarriage. We need to better educate people about miscarriage, which could help reduce the shame and stigma associated with it.”

The respondents, who were self-selecting, filled in a 33-question survey, which was open for three days in 2013, to assess perceptions of miscarriage, with 10 of the questions specifically directed at men or women reporting a history of miscarriage.

Of those who took part 15% said they or their partner had suffered a miscarriage, but the majority of respondents (55%) believed that miscarriages are uncommon (defined as less than 6% of all pregnancies). The truth is that miscarriages end one in four pregnancies and are by far the most common pregnancy complication, the paper says.

A fifth of people incorrectly believed that lifestyle choices during pregnancy, such as smoking or using drugs or alcohol, were the single most common cause of miscarriage, more common than genetic or medical causes. In reality, 60% of miscarriages are caused by a genetic problem.

The importance of hearing from others who have gone through the same experience was highlighted by a significant minority of those who had suffered a loss in pregnancy. Almost half said they felt less alone when friends disclosed their own miscarriage and 28% stated that celebrities’ disclosure of miscarriage had eased their feelings of isolation.

The authors concluded: “Patients who have experienced miscarriage may benefit from further counselling by healthcare providers, identification of the cause, and revelations from friends and celebrities. Healthcare providers have an important role in assessing and educating all pregnant patients about known prenatal risk factors, diminishing concerns about unsubstantiated but prevalent myths and, among those who experience a miscarriage, acknowledging and dissuading feelings of guilt and shame.”

The majority (55%) of respondents were women and all were aged 18-49. The sociodemographic distribution across gender, age, religion and geographic location and household income was consistent with 2010 national census statistics but race and ethnicity were not.

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Australia’s detention regime sets out to make asylum seekers suffer, says chief immigration psychiatrist

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adolescents, asylum seekers, Australia, Children, detainees, detention, doctors, harm, mental health issues, policy, shame, suffering, suicidal, Torture

Australia’s detention regime sets out to make asylum seekers suffer, says chief immigration psychiatrist

The chief psychiatrist responsible for the care of asylum seekers in detention for the past three years has accused the immigration department of deliberately inflicting harm on vulnerable people, harm that cannot be remedied by medical care.

“We have here an environment that is inherently toxic,” Dr Peter Young told Guardian Australia. “It has characteristics which over time reliably cause harm to people’s mental health. We have very clear evidence that that’s the case.”

Young is the most senior figure ever to condemn the detention system from within. Until a month ago he was director of mental health for International Health and Medical Services (IHMS), the private contractor that provides medical care to detention centres on the Australian mainland, Christmas Island, Nauru and Manus Island.

Young has extensively briefed Guardian Australia about a system he says is deliberately harsh, breaks people’s health, costs a fortune, compromises the ethics of doctors and is intended to place asylum seekers under “strong coercive pressure” to abandon plans to live in Australia. “Suffering is the way that is achieved.”

He believes this process is akin to torture: “If we take the definition of torture to be the deliberate harming of people in order to coerce them into a desired outcome, I think it does fulfil that definition.”

Young strongly criticised the immigration department for:

• Delays that endanger health in bringing patients to Australia from Manus and Nauru: “It is seen as undesirable because it undermines the idea that people are never going to Australia and also because of the concern that if people arrive onshore then they may have access to legal counsel and other assistance.”

• Leaving people in detention who are acutely suicidal: “Trying to manage them in a non-therapeutic setting like that is just inherently futile. It’s not going to work.”

• Returning patients with less severe problems to detention despite medical advice that they cannot be expected “to fully respond to treatment in an environment that was making them sick”.

• Misusing patient information. “People disclose a lot of personal information which is then recorded in notes which are then available to non-medical people for other purposes.” Young says the dual role of IHMS staff treating detainees but reporting to the department raises fundamental ethical problems for doctors in the system.

• Displaying an obsession with secrecy: “Speaking out of turn is clamped down on whenever it occurs … they continue to maintain the fantasy that they can keep everything a secret.”

• Reluctance to gather and use mental health statistics that might “result in controversy or threaten the application of the policies of deterrence”.

• Directing doctors not to put in writing that detention has led to deterioration in their patients’ mental health. IHMS doctors ignored the direction. Young said they saw evidence all around them of detainees “sick because they are there and getting sicker while they remain there”.

The Manus camp particularly appalled Young. “When you go to Manus Island and you walk down what is called the ‘walk of shame’ between the compounds and you see the men there at the fences it’s an awful experience,” he says.

“You have to feel shame. You have to understand what that feeling is about in order to be able to be compassionate. By feeling the shame you stay on the right side of the line.”

Young told Guardian Australia IHMS figures had shown for some time that a third of adults and children in the detention system had what he called “a significant-level disorder”. If they were living in Australia, that would require the care of specialist medical health services. The figures only got worse as detainees stayed longer in detention: “After a year it approaches 50%.”

Last week, in alarming evidence to an Australian Human Rights Commission inquiry, Young said the immigration department had refused to accept IHMS statistics proving damage to children and adolescents held in prolonged detention. He told the inquiry: “The department reacted with alarm and asked us to withdraw the figures.”

In a belligerent appearance before the inquiry, the secretary of the immigration department, Martin Bowles, accused the president of the Human Rights Commission, Gillian Triggs, of making “highly emotive claims” about health problems in the detention system. He had not heard evidence of the problems provided by Young and other IHMS doctors earlier in the day.

His hand shook as he confronted Triggs. When his evidence produced laughter he demanded the room be silenced. He refused to answer some questions and retreated at times behind a wall of bureaucratic prose.

But Bowles did not deny a link between prolonged detention and mental illness. He called this a “well-established” issue and insisted his department was doing “everything it humanly can” to provide “appropriate medical care” to address the mental health problems of detainees.

Young told Guardian Australia that was impossible: “The problem is the system.”

Young is confident that in his time at IMHS the men and women working for him made better assessments of detainees’ health and delivered much better treatment than in the past.

“But you can’t mitigate the harm, because the system is designed to create a negative mental state. It’s designed to produce suffering. If you suffer, then it’s punishment. If you suffer, you’re more likely to agree to go back to where you came from. By reducing the suffering you’re reducing the functioning of the system and the system doesn’t want you to do that.

“Everybody knows that the harm is being caused and the system carries on. Everybody accepts that this is the policy and the policy cannot change. And everybody accepts that the only thing you can do is work within the parameters of the policy.”

The window of reasonableness closes
Young arrived in the system in 2011 at a crucial moment: the high court was about to knock back the Gillard government’s proposed “Malaysia solution” and, as the boats arrived in ever-increasing numbers, the detention system was bursting at the seams. So the government began processing detainees quickly and releasing large numbers into the community on bridging visas. “The problems that we were seeing from a mental health perspective decreased massively.”

Young has been a psychiatrist for nearly 20 years, most of that time working in public health. He joined IHMS believing the detention system was problematic but confident that good could be done from the inside. “I felt that given the experience I had I could work between the immigration department and IHMS and the detention health advisory group to bring about positive change.”

The year before Young’s arrival, the immigration department had been put on notice once again that prolonged detention harms mental health. Professor Kathy Eager of Wollongong University reached that conclusion in a study commissioned by the department itself.

“There is,” she wrote, “almost universal criticism of the policy of detaining asylum seekers, particularly in terms of the mental health implications.”

Her findings were backed by the department’s independent Detention Health Advisory Group (Dehag), the Australian College of Mental Health Nurses and the Australian Psychological Society. In 2011 the Royal Australian and New Zealand College of Psychiatrists declared: “Prolonged detention, particularly in isolated locations, with poor access to health and social services and uncertainty of asylum seeker claims, can have severe and detrimental effects.”

While detainees were being rapidly released, Young observed attitudes towards them improved throughout the system. They were not treated as prisoners.

Their mental health was generally good: “These people are actually quite robust and psychologically healthy individuals despite all the suffering that they have been through.”

But what Young calls “the window of reasonableness” stayed open for only six months. With boats arriving in unprecedented numbers and the opposition in full cry, the government reversed direction. Once again boat people were to be held for long periods. The camps on Manus and Nauru were reopened. Kevin Rudd announced that no new boat arrivals would end up living in Australia.

“You just can’t overstate how things changed so rapidly when the policy changed,” Young says. Once again the system treated them as prisoners. The impact on their mental health was as predicted: fine for a few months, then increased depression, anxiety and stress.

“Most people have a level of resilience which allows them to function fairly well for a few months, but after that time there is a steady deterioration … after six months the cumulative harms accelerate very rapidly.”

Asylum seekers self-harming is ‘seen as bad behaviour’.
Uncertainty does the worst damage, Young says. Then comes hopelessness. “They are constantly given a message that they are on a negative pathway, meaning their claim is not going to be accepted. This is despite what we know about the outcomes of processing in the long term, which is that greater than 80% of people are found to be genuine refugees.”

And they have so little autonomy. “Just the day-to-day daily lives that they experience living in the detention system means that they have very little control over what they do. It makes things particularly difficult for people who are there with their children as well. Their capacity to act as parents and to make decisions on behalf of their families is so restricted.”

Young sees immigration detention as inherently more harmful than prison. “In prison those with mental health problems generally improve. People are more well on their release than when they entered. What we see in detention is the opposite of that. Over the course of time in detention, they get sicker.

“We don’t have families in prisons. Secondly, when people go to prison they go through a recognised independent judicial process. It’s not arbitrary. This is an arbitrary process and people see it as being unfair and that is another factor.

“Also, when people are in prison they have a definitive sentence so they know there is an end point. This is not like that at all. This is indefinite.”

Each quarter IHMS presents the department with figures on the health of detainees. The data for July to September 2013 showed a third of those held in detention for more than a year were experiencing extremely severe depression; 42% were suffering extremely severe anxiety; and 42% were extremely stressed. The report notes these figures are consistent with internationally published research: “The pattern shows the negative mental health effects of immigration detention with a clear deterioration of mental health indices over time in detention.”

Abbott takes power
“People didn’t really take Rudd seriously,” Young recalls. “But everybody was saying when the Libs get in it’s really going to get tough. So there was a building up of expectation that things were going to get worse, which made it worse in itself.”

When the change came in late 2013, there was no radical shift in policy. “Everything just got harsher.”

Relations between the department and its independent health advisers were already rocky. Dehag had been set up in 2006 at a time of acute embarrassment after it was discovered that a schizophrenic Australian resident, Cornelia Rau, was being held in the detention.

She was thought to be German, was desperately ill and the immigration department refused to release her for treatment. She was finally identified naked in the yards of the Baxter detention centre.

Dehag had an independence the department came to regret. Its dozen members were nominated by peak medical authorities, including the Australian Medical Association, the Mental Health Council of Australia and the professional colleges for nursing, general practitioners and psychiatry. The experts were at the table but the department found itself dealing with people who could neither be corralled nor muzzled.

“It’s always been a very tense relationship,” says Louise Newman, director of the centre for developmental psychiatry and psychology at Monash University. Newman chaired the group for a time. “At every meeting until they disbanded us we would make a statement that we did not support mandatory detention or prolonged detention of any form, that it was damaging and that it created problems that we could not fix.”

Young, who sat in on the group’s meetings, confirmed the experts’ fundamental objection to detention: “That’s been the baseline position that they have always held and they have always presented.”

The group watched with concern as the Gillard government reversed its policy of swift release for asylum seekers. Newman sees the second round of detention as worse than the first because it came as the evidence of harm was even more firmly established. “They replicated the very conditions that they have admitted contribute to mental harm and deterioration,” she said.

“It’s seen as collateral damage. The department does what it can to reduce it but in the name of the greater good of border protection and deterrents it doesn’t really matter. We’re saving lives by sending people mad.”

The group drove change. “The department was very pleased to use things that we brought in, so any positive reforms that have gone on in the system in terms of screening people and healthcare and health standards were all done by Dehag.”

But Newman alleges the department later sabotaged medical screening of asylum seekers for signs of torture and trauma. “We argued that no one who had been tortured should be detained or particularly not in remote places. The departmental doctors decided the best way to get around that was not to do the screening, so they didn’t find out who was tortured. They stopped it on Christmas Island so people could be shipped away before it was even known if they were trauma survivors.”

Tension between Dehag and the department intensified after Bowles was appointed secretary of the department in 2012, Newman says. Bowles is not a doctor but for much of his career was a health administrator before joining the defence department. He is one of a group of former army and defence figures who now hold the most senior positions in the immigration department.

Bowles announced a review of Dehag, which he renamed the Immigration Health Advisory Group (Ihag). He failed in manoeuvres to change its membership but imposed a former military doctor, Paul Alexander, as its chairman. “It was meant to be a much more controlled group,” Newman says.

Bowles wanted the experts to withdraw from public debate. Young says: “They wanted the thing to be more watertight.” The experts were not accused of leaking. “But they expressed views in public which were relevant to the business before the committee.” They continued to do so. The most vocal was Newman.

The experts and the department continued to be at loggerheads over the standard of care for detainees. Newman says Dehag and Ihag always argued that detainees had to be looked after “regardless of visa status” while they were in Australian hands, and it was an ethical obligation on all medical practitioners working in the system to provide care to Australian standards.

But once Nauru and Manus reopened, the department began to demand treatment be pegged to the much lower standards of care on those islands. There would have to be exceptions – no inpatient mental healthcare is available on Manus or Nauru – but the department’s wish was to lower the general standard of care for detainees in those camps.

At what was to be the last meeting of Ihag in August 2013, the issue was debated at length. An impasse was reached, says Newman. “The department at a very high level from secretary down argues the Australian government is not obliged to provide our standard of care to these people.”

But experts insisted that standards must be maintained and that the department’s plan was an ethical minefield for doctors. “Clinicians who go along with it are absolutely compromised,” says Newman.

Ihag experts continued to work in the system, but they never met as a group after Abbott’s victory in the federal election of September 2013. A long pattern of suddenly cancelled meetings ended with no meetings called at all. In mid-December the experts received letters thanking them for their service. They were dismissed. Alexander was now to be the sole adviser on medical matters to the renamed Department of Immigration and Border Protection.

Scott Morrison, the new minister, issued a statement: “The large membership of the group made it increasingly challenging to provide balanced, consistent and timely advice in a fast-moving policy and operational environment.”

Young says: “That doesn’t wash at all. Ihag had consistently told the department things it didn’t want to hear and the department had pretty transparently sabotaged the operation of it for more than 12 months.”

The chiefs of peak medical bodies, including the AMA’s Dr Steve Hambleton, expressed shock at Ihag’s demise. Abbott condemned the generally negative reporting of the move as “a complete beatup by the ABC and some of the Fairfax papers”. The prime minister declared: “This was a committee which was not very effectual.”

The rising tide of data
Morrison had been in the job only a few months when he assured Australia that mental health problems among detainees were on the wane. In mid-December, Nine News reported: “Immigration minister Scott Morrison yesterday said diagnosed mental health problems among detainees in Australia had fallen from a peak of 12% in 2011 to the current rate of 3.4% as a result of greater resourcing.”

Young is scathing about Morrison’s figures. “That’s not a prevalence rate. It never has been. It’s a pale shadow of what the real prevalence rate is because of the way that data is derived.”

Young says Morrison was ignoring the figures revealed by regular screening and instead using a count of visits to GPs or psychiatrists where mental health problems were raised. “It doesn’t take into account people who may have a disorder who are not seeing either of those two categories of clinicians.”

Gathering better statistics was one of Young’s key ambitions in his time at IHMS. The department dragged its feet on his proposals to use new measures to screen mental health problems. “There seemed to be a fear that it would result in controversy or threaten the application of the policies of deterrence,” Young says.

But the chief psychiatrist finally got his way and the new measures were used for the first time in the first quarter of this year. Young presented these figures to the Royal College of Australian and New Zealand Psychiatrists in May. They confirmed the long-established pattern: about a third of all those in detention had clinically significant problems – and the longer the detention, the worse the problems.

Half those who had been detained for 19 months or more were extremely or severely depressed; 40% were extremely or severely stressed; and 40% were extremely or severely anxious. The worst scores were gathered on Manus and Nauru. But the figures show a common pattern across the whole detention system.

In a PowerPoint presentation provided to Guardian Australia by the college, Young concludes: “All show linear deterioration in mental health status over time in detention.”

Young’s staff were also collecting figures on the impact of detention on children. “Changing to instruments more appropriate for children has been something the department has dragged their feet on for quite a long time.”

Young shocked the Human Rights Commission inquiry last week by alleging the department refused to accept these Honosca (Health of the Nation Outcome Scales for Children and Adolescents) figures.

He told Guardian Australia: “This is not the only instance where data which has been seen as controversial or just difficult to understand has been buried.”

But Triggs requested the figures be given to her inquiry. They show across the mainland detention system a large number of children showing emotional distress or related symptoms. Young considered the figures a sign of serious problems that needed urgent consideration and action. Some of these children are those that IHMS doctors reported as showing issues of self-harm, regression, aggression, bed-wetting and despair.

The Health of the Nation Outcome Scales for Children and Adolescents figures
When Bowles was questioned at the inquiry, he did not deny his department issued instructions to IHMS to withdraw the figures but was at pains to suggest to the commission that they remained under consideration by the department. He said: “I have no doubt that most of this sort of reporting is mainstream.”

Giving evidence to Triggs’s inquiry was Young’s last assignment for IHMS. As his three years with the commercial providers drew to a close, he decided to make a professional and public assessment of the detention system once he was free to do so.

“As a medical practitioner your duty is always to your patients and the people you look after,” he says. “To them you have a broader moral and ethical responsibility. In this case you see harm being done and as the primary duty of a doctor is to do no harm, your duty is to speak out against that harm – to say that harm should not be done.”

Schizophrenia: the most misunderstood mental illness?

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diagnosis, discrimination, fear, help, media, mental health issues, paranoia, psychosis, recovery, schizophrenia, shame, silence, stereotypes, stigma

Schizophrenia: the most misunderstood mental illness?

Let’s face it, when most people think about schizophrenia, those thoughts don’t tend to be overly positive. That’s not just a hunch. When my charity, Rethink Mental Illness, Googled the phrase ‘schizophrenics should…’ when researching a potential campaign, we were so distressed by the results, we decided to drop the idea completely. I won’t go into details, but what we found confirmed our worst suspicions.

Schizophrenia affects over 220,000 people in England and is possibly the most stigmatised and misunderstood of all mental illnesses. While mental health stigma is decreasing overall, thanks in large part to the Time to Change anti stigma campaign which we run with Mind, people with schizophrenia are still feared and demonised.

Over 60 per cent of people with mental health problems say the stigma and discrimination they face is so bad, that it’s worse than the symptoms of the illness itself. Stigma ruins lives. It means people end up suffering alone, afraid to tell friends, family and colleagues about what they’re going through. This silence encourages feelings of shame and can ultimately deter people from getting help.

Someone who knows first hand how damaging this stigma can be is 33 year-old Erica Camus*, who was sacked from her job as a university lecturer, after her bosses found out about her schizophrenia diagnosis, which she’d kept hidden from them.

Erica was completely stunned. “It was an awful feeling. The dean said that if I’d been open about my illness at the start, I’d have still got the job. But I don’t believe him. To me, it was blatant discrimination.”

She says that since then, she’s become even more cautious about being open. “I’ve discussed it with lots of people who’re in a similar position, but I still don’t know what the best way is. My strategy now is to avoid telling people unless it’s comes up, although it can be very hard to keep under wraps.”

Dr Joseph Hayes, Clinical fellow in Psychiatry at UCL says negative perceptions of schizophrenia can have a direct impact on patients. “Some people definitely do internalise the shame associated with it. For someone already suffering from paranoia, to feel that people around you perceive you as strange or dangerous can compound things.

“I think part of the problem is that most people who have never experienced psychosis, find it hard to imagine what it’s like. Most of us can relate to depression and anxiety, but a lot of us struggle to empathise with people affected by schizophrenia.”

Another problem is that when schizophrenia is mentioned in the media or portrayed on screen, it’s almost always linked to violence. We see press headlines about ‘schizo’ murderers and fictional characters in film or on TV are often no better. Too often, characters with mental illness are the sinister baddies waiting in the shadows, they’re the ones you’re supposed to be frightened of, not empathise with. This is particularly worrying in light of research by Time to Change, which found that people develop their understanding of mental illness from films, more than any other type of media.

These skewed representations of mental illness have created a false association between schizophrenia and violence in the public imagination. In reality, violence is not a symptom of the illness and those affected are much more likely to be the victim of a crime than the perpetrator.

We never hear from the silent majority, who are quietly getting on with their lives and pose no threat to anyone. We also never hear about people who are able to manage their symptoms and live normal and happy lives.

That’s why working on the Finding Mike campaign, in which mental health campaigner Jonny Benjamin set up a nationwide search to find the stranger who talked him out of taking his own life on Waterloo bridge, was such an incredible experience. Jonny, who has schizophrenia, wanted to thank the man who had saved him and tell him how much his life had changed for the better since that day.

The search captured the public imagination in a way we never could have predicted. Soon #Findmike was trending all over the world and Jonny was making headlines. For me, the best thing about it was seeing a media story about someone with schizophrenia that wasn’t linked to violence and contained a message of hope and recovery. Jonny is living proof that things can get better, no matter how bleak they may seem. This is all too rare.

As the campaign grew bigger by the day, I accompanied Jonny on an endless trail of media interviews. What I found most fascinating about this process was how so many of the journalists and presenters we met, were visibly shocked that this young, handsome, articulate and all-round lovely man in front of them, could possibly have schizophrenia.

Several told Jonny that he ‘didn’t look like a schizophrenic’. One admitted that his mental image of someone with schizophrenia was ‘a man running about with an axe’. It was especially worrying to hear this from journalists, the very people who help shape public understanding of mental illness.

Many of the journalists also suggested that through the campaign, Jonny has become a kind of ‘poster boy’ for schizophrenia and in a way, I think he has.

Jonny has mixed feelings about the label. “I hope that by going public with my story, I’ve got the message out there that it is possible to live with schizophrenia and manage it. It’s not easy, it’s an ongoing battle, but it is possible. But I’m aware that I’m one of the lucky ones. I’ve been given access to the tools I need like CBT, but that’s not most people’s experience. Because of our underfunded mental health system, most people don’t get that kind of support. I can’t possibly represent everyone affected, but I hope I’ve challenged some stereotypes.”

As Jonny rightly says, one person cannot possibly represent such a diverse group of people. Schizophrenia is a very broad diagnosis and each individual experience of the illness is unique. Some people will have one or two episodes and go on make a full recovery, while others will live with the illness for the rest of their lives. Some people are able to work and be independent and others will need a lot of support. Some people reject the diagnosis altogether.

What we really need is a much more varied and nuanced depiction of mental illness in the media that reflects the true diversity of people’s experiences.

What I hope Jonny has managed to do is start a new conversation about schizophrenia. I hope he has made people think twice about their preconceptions of ‘schizophrenics’. And most importantly, I hope he has helped pave the way for many more ‘poster boys’ and girls to have their voices heard too.

For more information, visit Rethink Mental Illness

*Name has been changed

 

On the front lines: Documenting evidence of rape is a fraught task

Tags

accountability, army personnel, asylum seekers, conflict, disclosure, evidence, humiliation, impunity, medical care, perpetrators, police, psychological services, rape, sexual assault, Sexual Violence, shame, survivors, testimony, Torture, trauma

On the front lines: Documenting evidence of rape is a fraught task

In my line of work it’s impossible not to notice the chilling impact rape has on its victims. The shame and humiliation they are made to feel means disclosure can be very difficult, even in a ‘safe’ setting such as a doctor’s examination room.

Taking statements and documenting evidence of rape for use in legal proceedings is not easy – it requires skill and experience to gather all of the required information from a survivor of such a terrible crime while respecting their rights, supporting their health care needs, ensuring their safety, their confidentiality and minimizing further traumatization. Giving this kind of harrowing testimony often comes at a personal cost to the survivor, and their courage never fails to astound me.

In the UK it is estimated that almost 90 per cent of victims of serious sexual assault never disclose it to the police, and around 38 per cent tell no one (at the time of the crime.) Yet, in the UK we have support available for survivors of sexual violence and a comparatively open society that generally supports the victim and does not stigmatise them.

Imagine then, how hard it is to disclose rape in a place like the Democratic Republic of Congo where the perpetrators of such crimes are often the police and army personnel – the very officials charged with the protection of civilians.

A new report by Freedom from Torture reveals the routine use rape, gang rape and multiple rape to torture politically active women in official state detention centres in the country. The levels of impunity enjoyed by those who commit these crimes is breathtaking and it is this lack of accountability that the Global Summit aims to address.

The Protocol on Investigation and Prevention of Sexual violence in Conflict which will be launched by Angelina Jolie and William Hague at the Global Summit on Wednesday and will set out best practice for obtaining witness testimony of crimes of sexual violence in conflict.

It will ensure that the evidence collected is of a standard that can be used in international criminal courts to charge not just those who committed the crimes directly but also their commanding officers. Though work still needs to be done to get this document right, and to resource evidence collection, it is a very welcome step towards holding perpetrators to account both nationally and internationally.

My big concern is that while so much noise is being made about the protection of survivors of sexual violence in conflict at the Global Summit, the Home Office remains out of step.

Every week I see survivors of persecutory rape who have fled their countries and are seeking protection in the UK from the horrors that have been inflicted on them and their families. Sadly their experiences as asylum seekers rarely afford them the dignity, security and peace they need in order to be able to disclose sexual violence.

Repeated interrogation by Home Office officials about what they have been through – all too often conducted from a clear standpoint of officials’ disbelief inadequate welfare support and difficulties in accessing the medical care and psychological services they so desperately need all serve to compound their trauma.

Protection through asylum is a key element in the fight to end sexual violence and support survivors of these crimes. Accordingly, it should be at the forefront of this week’s discussions.

Facing up to rape: Victim speaks out about the ‘faceless’ crime

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anxiety, attention-seeking, awareness, educate, embarrassment, fear, humiliation, powerlessness, rape, report, sexual assault, sexual harassment, Sexual Violence, shame, stigma, violated

Facing up to rape: Victim speaks out about the ‘faceless’ crime

Up until two weeks ago, Francesca Ebel had never told anyone in her family – or indeed most of her friends – that she had been raped. Yet she has now gone public, and the response has been overwhelming.

There were no dark alleys or threats of knives. There were no dodgy areas of town or even strangers involved. And that’s the whole point, explains the 20-year-old student, who is in her first year of studying Russian and French at Cambridge University.

“It happened three years ago. I was 17 and at a party. I got drunk and so friends helped me up the stairs and into bed. It was there that I was awoken by a crashing noise and burst of white light. I realised that someone was wrenching back the duvet and clambering on top of me, frantically pressing his lips to mine. Then my legs were pulled apart and I felt a sudden, tearing pain.”

Even in her drunken stupor, Francesca knew instinctively that something was very wrong and tried to shove him off. She even said “No”. More than once. “But he ignored me, breathing heavily in my ear.”

When it was over, Francesca stumbled outside, to find him smoking and laughing with his friends, and in the days afterwards, he boasted and joked about their sexual encounter.

Suspecting that she would be branded, at least by some, as an attention-seeker and a liar, she did not accuse him of rape. In fact, even when she confided in a close friend, it didn’t occur to her to use the word rape. “How could I claim to have been raped when ‘rape’ conjures up such violent images? How could my experience possibly parallel brutalities such as gang-rapes in India? It was unthinkable. Mine was not a violent rape; my rapist’s motives were not hateful or destructive. Furthermore, I felt embarrassed, ashamed and humiliated. So I put it behind me and got on with my life.”

And to a large extent, she succeeded. “Thankfully, my enjoyment of sex has not been affected and I’ve flourished in functional relationships. So how could I even begin to claim to identify with other victims’ experiences?” she says.

But about a year ago, when Francesca was in a relationship with a lawyer, she told him what had happened. “He stared at me and said: ‘You do realise that that is legally rape. You said no and that you didn’t want it to happen’. It was the first time I saw things clearly.”

Shortly afterwards, Francesca started university and was struck by how many other women, including a close friend, talked about similar experiences – something that certainly doesn’t surprise Rape Crisis, the charity, which claims that an estimated 90 per cent of those who experience sexual violence know the perpetrator in some way.

“There was a major survey that came out last month, which found that more than one in 13 women at Cambridge University had been sexually assaulted and that the vast majority – 88 per cent – did not report it,” Francesca says. “The study got people talking about their own experiences.”

According to the survey, women at the university are routinely groped, molested and raped. Like Francesca, one of the rape victims explained that she did not report her attacker because she thought that nothing would come of it. “I have no reason to believe that my report will be taken seriously, be investigated or result in a conviction. On the contrary, I have every reason to believe that he would be acquitted,” the woman stated. A couple of weeks later, an article appeared in the Cambridge Tab – of which Francesca is news editor – on what to do if you are raped. “We had run a few anonymous stories of sexual assault in our publication, but this one, which was written by the brother of a rape victim, really got to me, because it listed all of the things that I wish I’d done at the beginning. Suddenly, I just felt sick of this feeling of frustration, powerlessness and stigma about what had happened to me and so many others, and I felt a need to speak out. So I did.

“By storing the incident up inside me, I had let it gnaw away at me – the questions, anxieties and fury had built up to a level which was almost intolerable,” she explains. “And perhaps most critically of all, I wanted to turn a negative experience into something constructive.”

Francesca’s article appeared in the next issue, on 17 May, titled “There are people behind recent rape statistics and you must take their stories seriously”. What followed the headline was a candid, honest and brave account of her own experience, together with a plea for readers to recognise that behind stories of rape and sexual harassment, there are people who have to carry on with their lives and come to terms with what has happened, no matter how violent or “ordinary” their experience.

“Rape can happen to anyone at any time and I hoped that my story would demonstrate that,” she explains. “I also wanted to shed some light on why it is so hard to report an incident, and finally, I want to educate and initiate. Rape is not just confined to shady, impoverished corners of the globe; and it has to stop.”

It would have been far easier to write it anonymously, she admits. “Speaking out about rape has its consequences, not just for the person themselves, but for their family and friends. But there are too many faceless victims. I wanted to put a face to a story that has happened to so many people. I’m not disparaging anonymity in any way, but it does depersonalise the issue and I think that, as a result, people often don’t realise that rape is so common.”

Almost instantly, the article went viral, having had more than 28,000 views so far. Francesca has also been inundated with private letters and comments online, mostly from women who tell similar stories.

“It has been chilling to see the same story told again and again, and they all say the same thing – that they were full of self-doubt and fear of being labelled as an attention-seeker or that they wouldn’t be believed. Many, like me, don’t see themselves as a victim or the incident as defining them, but it has nonetheless affected them hugely.”

The responses also revealed just how frightened people are of reporting it. “Many of the women explained how they couldn’t face the trauma of the very system that is meant to protect us.”

Others wondered if it would even get to court – and with just 6 per cent of cases reported to police ultimately ending in a conviction, according to Rape Crisis, who can blame them?

“For reasons I can’t express even to myself, I have no current plans to report my case,” Francesca says. “But actually for me, what has been most empowering is to have gone public, to have helped raise awareness of both how ‘normal’ this is and how harmful it is.”

On reflection, Francesca’s original fear of attention-seeking has a certain irony: “I am certainly seeking attention now. That night, I was forced to share a level of intimacy which I usually reserve for the people I trust and care for. I was violated against my will, by a friend who unfortunately remains on the periphery of my life.

“Rape is incredibly complex and can have devastating consequences, whatever the situation. Right now, there is a critical and pressing need for us to broaden our understanding of the issues and educate future generations on the nature of consent.”

Jolie to seek end to sexual violence as war weapon at London summit

Tags

Bosnia, conflict, DRC, rape, Rwanda, Sexual Violence, shame, silence, soldiers, systematic rape, the UN, War Crimes, weapon of war

Jolie to seek end to sexual violence as war weapon at London summit

Angelina Jolie has said she hopes a global summit on sexual violence she will co-host in London with the UK government will bring lasting change to global peacekeeping and war crimes prosecutions, deterring the use of mass rape as a weapon in future conflicts.

The four-day summit, beginning on 10 June, will bring together governments from 141 countries to discuss how to improve and standardise the investigation of large scale sexual violence in wartime, to bring an end a culture of impunity that has severely limited prosecutions up to now.

Speaking to The Guardian during a visit to Bosnia, Jolie said: “I would hope that years down the line when war breaks out, people who are considering raping a man, woman or child would be very aware of the consequences of their actions, and that a woman crossing a checkpoint would be aware there was someone collecting evidence and that evidence would have a … result for her.”

“When that begins to happen on masse, then things will change. That’s why its important that this effort isn’t just one single [approach]. We are working with everyone who has worked on this issue for years, with every NGO and every government, to assist these people on all fronts.”

Jolie visited Bosnia at the end of last week with Britain’s foreign secretary, William Hague, as part of a two-year partnership aimed at preventing sexual violence in conflict. In the course of the trip they spoke in private to several women survivors of the 1995 massacre in Srebrenica, where the slaughter of 8,000 Muslim men and boys has overshadowed another crime against humanity committed at the same time, the systematic rape of women and girls.

The meeting with the Srebrenica women took place in a disused battery factory where in July 1995, thousands of Bosnian Muslims sought the shelter of Dutch UN peacekeepers. The UN promise of protection proved hollow and the factory is now echoing and empty apart from a sombre memorial – two black boxes each as big as a house. In a cemetery outside a stone monument records the names of the 8,000 men and boys slaughtered by General Ratko Mladic’s Serb army.

One of the women, Edina Karic, was taken from her family by Serb soldiers and held at a nearby lead and zinc mine, where she was repeatedly raped.

“I was taken to the mine, where I was raped many times along with two other girls. Then we were eight days in an abandoned house where we were raped again,” Karic said. “When these things were happening to me, it was as if I wasn’t there in my body. I was looking at it from outside.”

None of Karic’s rapists has been prosecuted, even though she could definitively identify at least three of them, and has followed their lives, in a town a few miles away, through Facebook.

More than 20,000 Bosnian women and girls were raped. Over a decade in the Democratic Republic of Congo there are thought to have been 200,000 victims. There were up to half a million rapes in Rwanda in 1994, and there are widespread reports of systematic sexual violence in Syria.

The silence surrounding rape as a war crime is deepened because the victims are often shunned by their own communities. Edina Karic is a rarity in that she is prepared to speak openly about what happened to her.

“I realised I’m not the one who should feel shame. It’s for the perpetrators to feel ashamed,” she said.

In Sarajevo, Hague and Jolie spoke to a hall full of Bosnian army officers who have, with British assistance, developed a training course meant to equip peacekeeping contingents from around the world to detect and prevent the commission of mass rape. As part of the Hague-Jolie campaign, every UN peacekeeping mission is now supposed to provide for the protection of civilians against sexual violence in conflict.

“At times, you may be all that stands between a child and violence that will scar him or her forever,” Jolie told the soldiers in Sarajevo. You may sometimes be the first person outside their family that a survivor of rape encounters. Your actions may make the difference between a successful prosecution, or aggressors going unpunished.”

So far, for the 20,000-50,000 wartime rapes in Bosnia, there have been 30 convictions at the Hague war crimes tribunal and another 33 at the Bosnia state court. Thousands more perpetrators, like Edina Karic’s rapists, remain at liberty.

“There is no forensic evidence, often no medical reports. All you have usually are witness statements, and in a very conservative society, most victims don’t want people to know what happened to them, so most rapes are not reported,” said Dubravko Campara, a Bosnian war crimes prosecutor.

The Bosnian state court has hundreds of open investigations on its docket and just 17 prosecutors. But with the help of UK funding, another 15 are going to be added to the staff to ease the backlog. The court now has a witness support unit to ease the pressure on women witnesses.

The global Preventing Sexual Violence Initiative was launched two years ago after Hague saw Jolie’s 2012 film about the Bosnian rape camps, Land of Blood and Honey. The hardest part of the effort is likely to be translating goodwill at the summit into real change in future conflicts. When Hague and Jolie visited Goma in DRC last March, they heard that women fleeing the fighting with their families were being frequently raped when they ventured out of refugee camps to look for firewood, despite the proximity of thousands of UN peacekeepers nearby. Keeping the women safe was not part of the soldiers’ mandate.

Hague conceded that progress in changing UN peacekeeping practices had been slow, but added: “The UN will be heavily involved in the summit. A big ally of ours is Zainab Bangura, the UN special representative on sexual violence. I think we are getting somewhere with that, but it means systematically building our objectives into all peacekeeping training.”

“There is a lot of goodwill,” Jolie said. There is a lot of understanding of what’s right and wrong, but there is a disconnect. So if we can try to put the pieces together and fill the holes, then maybe there can be a real change.”

Lack of support for parents who live in fear of their teenagers, study shows

Tags

domestic violence, parenting, parents, shame, stigma, support, teenage violence, Teens, violence

Lack of support for parents who live in fear of their teenagers, study shows

Parents living in fear of their abusive and violent teenagers are being left without support because of a lack of understanding of adolescent violence directed at parents, according to the first academic study into the issue.

Data from the Metropolitan police revealed that there were 1,892 reported cases of 13- to 19-year-olds committing violence against their own parents in Greater London alone over a 12-month period from 2009-10.

Dr Rachel Condry, lead researcher at the University of Oxford, which carried out the study, said there was little support for parents in such circumstances from police, youth justice teams or other agencies.

“The problem has, until now, gone largely unrecognised, which can mean that parents can find it very difficult to get help,” she said.

“The parents we spoke to said they were stigmatised and felt ashamed – they were experiencing patterns of controlling behaviour that were similar to domestic violence. One woman told us she would get up in the middle of the night to make her teenager dinner because she feared the consequences if she didn’t; others talked about walking on eggshells.”

Britain’s incoming director of public prosecutions, Alison Saunders, warned last month that teenage violence in the home was a hidden aspect of domestic violence: “There is a lack of respect and a lack of regard for authority. When I was growing up the thought of striking a parent was beyond the pale. Is that peers? Is that TV? Is that the general environment in the house? You are not born to commit domestic violence.”

Nicola, a mother in West Yorkshire who did not want to be named, said her daughter first started to behave violently towards her when she was 13. “She’d push me, punch me, lose her temper and smash the house up – it got to the stage where I was scared stiff,” she said.

“I thought it was me, my mothering skills. People were asking me why I couldn’t control her, but what was I supposed to do? Beat her up?”

Nicola was sent on a parenting course, but felt there was no one to help her. “I’ve got three other kids and none of them were like this – it wasn’t like I didn’t know what I was doing,” she said.

The study, co-authored by Caroline Miles, found that 87% of suspects in the London study were male and 77% of victims were women, although fathers could feel more reluctant to report the issue, said Condry.

The study found that, in the reported cases analysed, 60% of victims were classified as white European, while 24.3% were African-Caribbean. It says: “Families reporting adolescent-to-parent violence are likely to be at the lower end of the socioeconomic scale”.

Of those who recorded a profession, 46.7% were unemployed, 11.6% described themselves as housewives, while 3.4% were teachers and 2.9% were nurses.

Condry said it was a problem that could hit families in any demographic. “It is not the fact of being a single parent that is causing this issue, but parenting an adolescent is difficult and perhaps if a parent is on their own there is more potential for things to go awry.” The study found that a range of issues, including exposure to domestic violence, peer influence, mental health issues and drug problems had played a role, but there was no one reason for adolescent violence against parents.

“There may be issues around what we think of as poor parenting but many families we spoke to did not have those type of histories – that is uncomfortable for society, but we have to get a handle on the complexity of this issue,” she said.

When asked what she thought had provoked her daughter’s behaviour, Nicola said: “She has always seen me dominated, but I’m having counselling now and I’m starting to stand up for myself.”

Eventually she got support from the Rosalie Ryrie Foundation, a charity that deals with family violence. “They were fantastic; they showed me different techniques and it’s much better – she still loses her temper but she’s not as violent,” she said.

“It’s hard to ask for help. Other people should remember that it’s easy to say stand up to them, but it’s much more difficult when you are in that position.”

Condry said: “We want our victims to be entirely blameless. We think parents should be in control of their own children – but this is not an issue that can simplistically be blamed on bad parenting.”

US military struggling to stop suicide epidemic among war veterans

Tags

'moral injury', guilt, Military, PTSD, self-harm, shame, suicide

US military struggling to stop suicide epidemic among war veterans

Libby Busbee is pretty sure that her son William never sat through or read Shakespeare’s Macbeth, even though he behaved as though he had. Soon after he got back from his final tour of Afghanistan, he began rubbing his hands over and over and constantly rinsing them under the tap.

“Mom, it won’t wash off,” he said.

“What are you talking about?” she replied.

“The blood. It won’t come off.”

On 20 March last year, the soldier’s striving for self-cleanliness came to a sudden end. That night he locked himself in his car and, with his mother and two sisters screaming just a few feet away and with Swat officers encircling the vehicle, he shot himself in the head.

At the age of 23, William Busbee had joined a gruesome statistic. In 2012, for the first time in at least a generation, the number of active-duty soldiers who killed themselves, 177, exceeded the 176 who were killed while in the war zone. To put that another way, more of America’s serving soldiers died at their own hands than in pursuit of the enemy.

Credit: Guardian graphics

Across all branches of the US military and the reserves, a similar disturbing trend was recorded. In all, 349 service members took their own lives in 2012, while a lesser number, 295, died in combat.

Shocking though those figures are, they are as nothing compared with the statistic to which Busbee technically belongs. He had retired himself from the army just two months before he died, and so is officially recorded at death as a veteran – one of an astonishing 6,500 former military personnel who killed themselves in 2012, roughly equivalent to one every 80 minutes.

‘He wanted to be somebody, and he loved the army’

Busbee’s story, as told to the Guardian by his mother, illuminates crucial aspects of an epidemic that appears to be taking hold in the US military, spreading alarm as it grows. He personifies the despair that is being felt by increasing numbers of active and retired service members, as well as the inability of the military hierarchy to deal with their anguish.

That’s not, though, how William Busbee’s story began. He was in many ways the archetype of the American soldier. From the age of six he had only one ambition: to sign up for the military, which he did when he was 17.

“He wasn’t the normal teenager who went out and partied,” Libby Busbee said. “He wanted to be somebody. He had his mind set on what he wanted to do, and he loved the army. I couldn’t be more proud of him.”

Once enlisted, he was sent on three separate year-long tours to Afghanistan. It was the fulfillment of his dreams, but it came at a high price. He came under attack several times, and in one particularly serious incident incurred a blow to the head that caused traumatic brain injury. His body was so peppered with shrapnel that whenever he walked through an airport security screen he would set off the alarm.

The mental costs were high too. Each time he came back from Afghanistan. between tours or on R&R, he struck his mother as a little more on edge, a little more withdrawn. He would rarely go out of the house and seemed ill at ease among civilians. “I reckon he felt he no longer belonged here,” she said.

Once, Busbee was driving Libby in his car when a nearby train sounded its horn. He was so startled by the noise that he leapt out of the vehicle, leaving it to crash into the curb. After that, he never drove farther than a couple of blocks.

Nights were the worst. He had bad dreams and confessed to being scared of the dark, making Libby swear not to tell anybody. Then he took to sleeping in a closet, using a military sleeping bag tucked inside the tiny space to recreate the conditions of deployment. “I think it made him feel more comfortable,” his mother said.

After one especially fraught night, Libby awoke to find that he had slashed his face with a knife. Occasionally, he would allude to the distressing events that led to such extreme behaviour: there was the time that another soldier, aged 18, had been killed right beside him; and the times that he himself had killed.

William told his mother: “You would hate me if you knew what I’ve done out there.”

“I will never hate you. You are the same person you always were,” she said.

“No, Mom,” he countered. “The son you loved died over there.”

Soldiers’ psychological damage

For William Nash, a retired Navy psychiatrist who directed the marine corps’ combat stress control programme, William Busbee’s expressions of torment are all too familiar. He has worked with hundreds of service members who have been grappling with suicidal thoughts, not least when he was posted to Fallujah in Iraq during the height of the fighting in 2004.

He and colleagues in military psychiatry have developed the concept of “moral injury” to help understand the current wave of self-harm. He defines that as “damage to your deeply held beliefs about right and wrong. It might be caused by something that you do or fail to do, or by something that is done to you – but either way it breaks that sense of moral certainty.”

Contrary to widely held assumptions, it is not the fear and the terror that service members endure in the battlefield that inflicts most psychological damage, Nash has concluded, but feelings of shame and guilt related to the moral injuries they suffer. Top of the list of such injuries, by a long shot, is when one of their own people is killed.

“I have heard it over and over again from marines – the most common source of anguish for them was failing to protect their ‘brothers’. The significance of that is unfathomable, it’s comparable to the feelings I’ve heard from parents who have lost a child.”

Incidents of “friendly fire” when US personnel are killed by mistake by their own side is another cause of terrible hurt, as is the guilt that follows the knowledge that a military action has led to the deaths of civilians, particularly women and children. Another important factor, Nash stressed, was the impact of being discharged from the military that can also instil a devastating sense of loss in those who have led a hermetically sealed life within the armed forces and suddenly find themselves excluded from it.

That was certainly the case with William Busbee. In 2011, following his return to Fort Carson in Colorado after his third and last tour of Afghanistan, he made an unsuccessful attempt to kill himself. He was taken off normal duties and prescribed large quantities of psychotropic drugs which his mother believes only made his condition worse.

Eventually he was presented with an ultimatum by the army: retire yourself out or we will discharge you on medical grounds. He felt he had no choice but to quit, as to be medically discharged would have severely dented his future job prospects.

When he came home on 18 January 2012, a civilian once again, he was inconsolable. He told his mother: “I’m nothing now. I’ve been thrown away by the army.”

The suffering William Busbee went through, both inside the military and immediately after he left it, illustrates the most alarming single factor in the current suicide crisis: the growing link between multiple deployments and self-harm. Until 2012, the majority of individuals who killed themselves had seen no deployment at all. Their problems tended to relate to marital or relationship breakdown or financial or legal worries back at base.

The most recent department of defense suicide report, or DODSER, covers 2011 . It shows that less than half, 47%, of all suicides involved service members who had ever been in Iraq or Afghanistan. Just one in 10 of those who died did so while posted in the war zone. Only 15% had ever experienced direct combat.

The DODSER for 2012 has yet to be released, but when it is it is expected to record a sea change. For the first time, the majority of the those who killed themselves had been deployed. That’s a watershed that is causing deep concern within the services.

“We are starting to see the creeping up of suicides among those who have had multiple deployments,” said Phillip Carter, a military expert at the defence thinktank Center for a New American Security that in 2011 published one of the most authoritative studies into the crisis . He added that though the causes of the increase were still barely understood, one important cause might be the cumulative impact of deployments – the idea that the harmful consequences of stress might build up from one tour of Afghanistan to the next.

Over the past four years the Pentagon, and the US Department of Veterans Affairs, have invested considerable resources at tackling the problem. The US Department of Defense has launched a suicide prevention programme that tries to help service members to overcome the stigma towards seeking help. It has also launched an education campaign encouraging personnel to be on the look out for signs of distress among their peers under the rubric “never let our buddy fight alone”.

Despite such efforts, there is no apparent let up in the scale of the tragedy. Though President Obama has announced a draw-down of US troops from Afghanistan by the end of 2014, experts warn that the crisis could last for at least a decade beyond the end of war as a result of the delayed impact of psychological damage.

It’s all come in any case too late for Libby Busbee. She feels that her son was let down by the army he loved so much. In her view he was pumped full of drugs but deprived of the attention and care he needed.

William himself was so disillusioned that shortly before he died he told her that he didn’t want a military funeral; he would prefer to be cremated and his ashes scattered at sea. “I don’t want to be buried in my uniform – why would I want that when they threw me away when I was alive,” he said.

In the end, two infantrymen did stand to attention over his coffin, the flag was folded over it, and there was a gun salute as it was lowered into the ground. William Busbee was finally at rest, though for Libby Busbee the torture goes on.

“I was there for his first breath, and his last,” she said. “Now my daughters and me, we have to deal with what he was going through.”

Rape is not a dirty secret, it is a violent crime

Tags

blame, crime, culture, myths, secret, sexual assault, shame

Rape is not a dirty secret, it is a violent crime

It is troubling enough that such a small proportion of reported rapes make it to court, worse still that so few victims come forward in the first place. But most disturbing of all is the reason why so many people keep their suffering to themselves: because they do not think they will be believed. That rape is still a dirty secret, hedged about with so much blame and shame that victims feel they cannot come forward, is testament to how far we still have to go.

There are, of course, great legal difficulties in rape trials. Sexual assault is one of the few crimes where proof lies not in the physical facts of the matter, but in the subjective intentions of those involved. One person’s word against another’s, with no corroborating witnesses, is highly problematic for a legal system predicated on the concepts of innocent until proven guilty and proof beyond reasonable doubt.

This is no call for the wholesale abandonment of basic tenets of justice. But simply to shrug our collective shoulders, blame intractable issues of principle, and thereby leave a swathe of victims of violent assault with insufficient legal protection cannot be acceptable in what purports to be a civilised society.

The latest statistics make gruelling reading. More than a third of British women have been subjected to some kind of sexual assault, and one in 10 has been raped, according to the Mumsnet social networking site. Barely a third of victims go to the police, and another third tell no one at all, not even close friends.

In fairness, there has been significant progress in terms of institutional procedures. In many areas of the country, for example, there are now specially trained police officers and court prosecutors for cases of sexual assault. But uneven regional conviction rates only underline the extent to which such practices remain an optional extra rather than standard.

Equally, although victims no longer face the prospect of being cross-questioned by their attacker in court, pursuing a case to trial remains a horrifying ordeal. As a witness for the prosecution, the victim has no legal support, and faces intensely personal questioning from defence lawyers, often while face-to-face with their rapist for the first time since the assault. Even within the framework of innocent until proven guilty, there is more that can be done to ease the burden on victims, not least allowing them legal representation in court.

But the shortcomings of our institutions are merely part and parcel of a wider cultural understanding of rape that still militates against justice. It is that culture that must change if victims are to be encouraged to speak up. Comments from the Justice Secretary last year that appeared to imply that some rapes are more “serious” than others have hardly helped, adding to the persistent fallacy – often stoked by the media – that a person being either drunk or dressed in a certain way must take some responsibility for the actions of their attacker.

Part of the problem is the myth that rape is primarily a threat on the streets at night. Far from it. In fact, rape rarely occurs in the proverbial dark alley. The truth is both more banal, and more appalling: two-thirds of victims know their attacker, and assaults commonly take place in the home of either the victim or the rapist. Perpetrators rely on shame to keep their crime secret. Too often they are proved right. And if the conspiracy of silence is a problem for women who are raped, it is even worse for men.

Mumsnet is, therefore, to be applauded for its efforts to create a climate where victims feel they can come forward. The current Survivors UK ad campaign encouraging male victims to seek help is also welcome. But each is just one small step. Rape is one of the more appalling things that one human being can do to another, and yet there is no other crime about which our society is so ambivalent. That must change.