At another point, we met a woman—a child really, fifteen years old—who had been kidnapped in Liberia (fifteen thousand teenage girls suffered a similar fate in the conflict), held as a sex slave, and raped repeatedly. She had managed to trick her kidnapper, take her year-old baby (whose father had been her captor), and escape. She had walked through the bush, eating wild yams, until she had made it across the border to an IRC compound, and relative safety.
These women were different from the women we met who were traumatized by amputations, or by gunfire, or by being forced to work in the diamond mines. There was something about what had happened to the rape victims that had efficiently switched a light off in them. These women, rejected by their tribes and families, moved in great groups together over the dusty mounds of earth as if they were adrift together. In spite of their individual courage, what was unmistakable was that aspects of their very souls, in some profound way, had been hollowed out of them. In any one woman, this dimming of vitality was notable; but when you saw this nation of drifting women, it was impossible to ignore. Something systemic had been done to them that had somehow, in a way unique to this trauma, blunted them at the level of engagement, curiosity, and will.
The doctor explained exactly how these women had sustained their injuries. The women had been shredded internally; deliberately. By the points of bayonets; by sharpened sticks; by broken bottles; by knives. Tens of thousands of women had been injured in exactly these ways. The doctor spoke about these injuries not as resulting from deviant acts perpetrated by random perverts, but as a common outcome in the conflict.
Why would thousands and thousands of soldiers, in a conflict situation, have used sharp objects to destroy the vaginas of thousands and thousands of women? There was nothing about the rapes, with these injuries, that seemed sexual to me or even psychodynamic. I now believe, given my understanding of the pelvic nerve and its relationship to female confidence, creativity, and will, that these tens of thousands of men were not “getting off” on damaging the internal pelvic structures of these tens of thousands of women.
Women are brutalized in conflicts in Africa and around the world in this way decade after decade. It was the commanders in Sierra Leone and in the Democratic Republic of the Congo who ordered this kind of atrocity, and who ordered their troops to rape. Individual soldiers the IRC has interviewed have explained that they had no choice but to follow these orders—lest they be shot themselves. Why would such an order go out from a commander in an armed conflict? Could these commanders be giving these orders on the basis of something that is a kind of folk wisdom? In other words, could these commanders be ordering their troops to engage in atrocities that damage the female pelvic nerve, because centuries of experience have shown that a consequence of this kind of violence is that the women who experience it will be easier to subjugate?
I later interviewed others who work with women who have been violently raped in war. Jimmie Briggs, founder of the global antirape and antiviolence organization Man Up (Briggs was named a GQ Man of the Year in 2011 for his work on behalf of women traumatized by rape in war), travels frequently to the Democratic Republic of the Congo, which is one of the Ground Zeros of this practice: the United Nations estimates that four hundred thousand women have been raped during the recent civil war in that country.1 Briggs has written a book on the subject of rape in war: “There is something different about victims of violent rape,” he said. “I will go on the record about this. I have interviewed people who have been traumatized just as severely in other ways and there is not this same outcome. I have seen the difference of the result of this kind of trauma from other kinds of trauma. It is indeed as if a light has gone out of these women’s eyes.”2
In another very different refugee camp, in a room with concrete walls painted blue-green, where white light slanted in from high unglassed windows and a few English sentences had been scratched onto a makeshift blackboard, I was introduced to some of Sierra Leone’s most brutal rapists: they were twelve-, thirteen-, and fourteen-year-old boys—child soldiers. They were being rehabilitated by the IRC, which was working to educate them and provide them with a safe harbor. Their eyes were overcast with pain; their polo shorts were ragged; drugs and terror had stunted their growth. These were simply children, who had themselves been kidnapped and traumatized, forced at gunpoint to rape. These children, who played soccer in a dusty courtyard after we had spoken with them, obviously did not do what they had done to the women in the other camp out of perverse pathology. The Freudian model that violent rape is the result of individual sexual deviancy simply does not account for the systemic use of violent rape in war.
Radical feminism sees rape as simply a demonstration of unequal power relations and takes as its motto the assertion that rape is about power, not sex. This is closer to what I now believe to be the truth, but it still misses the ultimate insight: If it is just about power, why involve the sex? Why not just beat, threaten, starve, or imprison a woman? You can get plenty of power over women in ways that are nonsexual.
But if your goal is to break a woman psychologically, it is efficient to do violence to her vagina. You will break her faster and more thoroughly than if you simply beat her—because of the vulnerability of the vagina as a mediator of consciousness. Trauma to the vagina imprints deeply on the female brain, conditioning and influencing the rest of her body and mind.
Rape is part of the standard tool kit in the deployment of genocidal army tactics. This insight allows us to understand that many men who rape—and perhaps most men who rape in war—are not doing this as a function of personal perversion. Understood in this way, rape is instrumental. Rape is a strategy of actual physical and psychological control of women, traumatizing via the vagina as a way to imprint the consequences of trauma on the female brain.
If we understand this, we understand that what happens to a woman’s vagina is far more important, for better and for worse, than we have realized. We can see that rape is a far more serious crime than the model of rape as a “sex crime” or a form of “violence” that lasts for the duration of the crime, and then perhaps posttraumatically. We should understand that while healing is possible, one never fully “recovers” from rape; one is never just the same after as before. Rape, properly understood, is more like an injury to the brain than a violent variation on sex. Rape, properly understood, is always aimed not just at the female sex organ but at the female brain.
RAPE STAYS IN THE FEMALE BRAIN
According to aid workers, body workers, and doctors I’ve interviewed, as well as according to some pioneering new research on trauma, rape can change the female brain and female body systems in complex and long-lasting ways. But do you have to suffer a dramatically violent rape like the women in Sierra Leone for trauma to the vagina to affect the brain? Dr. Burke Richmond’s research suggests not.
Dr. Richmond is a neurologist at the University of Wisconsin, Madison, Wisconsin, specializing in otolaryngology. He studies neurological problems such as chronic dizziness, vertigo (the feeling of being off-balance), and tinnitus (chronic ringing in the ears). He also runs a clinical practice for patients, mostly women, who suffer from these and related conditions. His research in perception disorders has demonstrated that there are various ways in which rape or child sexual abuse imprint the female brain and body.
I met Dr. Richmond in the summer of 2010, on a mutual friend’s boat. His three lively children scrambled about on the deck. A witty but serious physician in his forties, with dark hair and a focused expression, he told me that a disproportionate number of his female patients who suffered problems with balance had histories of rape or sexual assault. Their problems with balance often remained for years after the attacks. He had concluded that, while the causation was not yet proved—his evidence was at that point anecdotal—there was a high enough incidence of correlation between patients with balance problems and patients who had a past history of rape or sexual assault that it was statistically significant and bore a
dditional investigation. I was so gripped by his descriptions of rape apparently literally affecting some of his female patients’ abilities to “stand their ground” that I spoke to him for two hours, oblivious to the bright sunshine and the yellow-gray cliffs falling away in the distance.
His findings confirmed something I had noticed in my ten years of teaching voice—public speaking and presentation—at the Woodhull Institute, a leadership academy for young women, which I had cofounded. Part of my training involved teaching young women how to stand tall, to “stand their ground” when speaking—that is, how to occupy a four-foot space on an imagined stage. I noticed again and again, over the course of many years, that a minority of young women literally couldn’t stand their ground—they could not stand still, straight, and tall, no matter how much they wished to do so; they kept imperceptibly swaying from side to side.
These same young women’s shoulders also seemed energetically to yield, somehow, under my hands, without the natural resistance that other young women’s shoulders presented as I adjusted their posture. Finally, this same subset of young women tended to have constricted voices: tension in the larynx often made their voices sound high and childlike. When we practiced voice exercises to open their throats and diaphragms, two things happened almost universally: their voices deepened to a more natural and more authoritative register, and following shortly thereafter, they would burst into convulsive sobs.
Often these young women, after they had wept deeply, and after they had made it through the public speaking exercise successfully with their “new” voices and open throats and chests, showed an amazing transformation—a glow, a radiance, a new authenticity and vitality, as if they had just now come “into focus.” I learned again and again that the young women who presented this constellation of “symptoms” had suffered childhood or adolescent sexual assault, or had been raped. I noticed that this cluster of symptoms was very different from the presentation of the many other young women we had in the program who had suffered just as severe, but other, nonsexual forms of trauma.
So when Dr. Richmond shared with me his findings that revealed that patients of his who were literally not able to resist being “pushed over” had also had high rates of sexual assault or rape in their backgrounds, I was riveted.
Some of his patients, Dr. Richmond told me, come to him with a symptom called “phobic postural sway”—which means they sway under stress, or can be pushed over easily. Others have “conversion gait disorders”—their gait swerves, even though there is nothing apparently physically wrong with them. Still others experience “visual vertigo,” meaning that they feel dizzy for no obvious reason. Other symptom clusters he found that appeared along with histories of rape included the feeling of falling continually, or morning nausea. “In a group of women that I’ve seen who fall over easily, in a test in which I push them, I will ask about sexual abuse history—and frequently I will find it. That is a bias: I don’t ask all my patients this question. That is, I don’t ask those who don’t demonstrate these symptoms if they’ve been sexually abused. But it is useful to ask about sexual abuse when these symptoms do appear, because that can lead to the right diagnostic test.”
“So you can literally push rape and sexual abuse survivors over more easily?” I asked.
“Yes,” Dr. Richmond confirmed. “If I ask these women to close their eyes and stand, there may be a slight sway. Most people do not have a perceptible amount of sway. If you lightly push most people, they will resist. They won’t sidestep or fall over, or be grossly off balance. But these women will. If you push them, they will keep falling over; you have to catch them. It is a disproportionate physical response not congruent with their physical functioning. They have normal strength, normal reflexes, normal physical functioning; they have no objective neurological deficits—no vestibular lesions or other brain injuries, which can cause a similar finding, for instance. These women have no physical evidence of a neurological problem, but their bodies are reacting as if they do have a neurological problem.
“Once I instruct them to resist,” Dr. Richmond said, of his sexually traumatized patients, “I can push with all of my strength and they will be solid as a rock.”
That astonished me: when a rape survivor is told to resist, her body reacts differently. “So that’s a mind-body thing.”
“Exactly—for what it is worth. I imagine my role as a physician and an authority ‘allows’ them to resist. The stability is there—once they have been ‘given permission’ to resist. These are the same patients who, without the instruction, fall over when pushed.”
To restate what Dr. Richmond is saying: rape victims are sometimes literally “destabilized” by the rape.
I wondered about the relationship of this information to the brain-vagina connection: Had trauma to the vagina also affected the brain, or was it an unrelated but just as intriguing imprint on the brain from sexual abuse?
“There is no doubt that when you have extreme levels of trauma, you can see that in the body. I don’t ask everybody about sexual abuse but when I see this pattern and ask about it, it is amazing how often I will find it. I say it is an interacting variable. They may have other things going on, but this question of sexual abuse needs to be incorporated into the treatment if you want an explanation for why these symptoms are happening to this person now. They have multiple layers of medical problems that accumulate over time, from obesity to migraines to mental health disorders.”
“Because of the sexual abuse?” I asked. “Yes,” he answered. “I get that you are saying we can’t say one thing is the cause. But it sounds like you are saying that the effect of sexual abuse on the female body should be a field of study.”
Dr. Richmond agreed. “Nobody fully understands ‘conversion disorders,’ ” he explained. “The term refers to a physical abnormality generated by a mental state.” The popular expression for conversion disorders is hypochondria, or the phrase “it’s all in your mind.” With a conversion disorder, someone suffers a real symptom, but the cause is not apparently physical. “Though there is nothing apparently ‘physically wrong’ with these patients,” said Dr. Richmond, “we need to take what is happening to these women seriously. Their symptoms may be caused by an abnormality in the brain generated by abnormal memory traces or abnormal neural circuitry.
“If you’ve been attacked by somebody repeatedly, you develop a whole behavioral motor response to that attack. You may later passively dissociate and feel, ‘Somebody’s doing something to someone’s body, but it is not my body.’ ” Dr. Richmond said that one’s learned response to that attack could be carried through life.
I told him about how I was looking at pelvic nerve mutilation in women who had been violently raped in Sierra Leone, and at the interruption in dopamine delivery to the brain that the injury involved. I explained that I wanted to understand if, and if so how, sexual assault to the vagina might have a physical effect on the female brain.
“I would argue,” he said, “that it is the brain that affects the body after trauma. You get direct nerve injury from vaginal assaults such as the ones in Sierra Leone, but it is the brain affecting the entire system after that, or apart from that gross trauma. In the West you can see these effects on women from sexual trauma of less obvious kinds. Behavior is a global response: if someone is traumatizing you, your visual system is affected, your auditory system is affected; these are all integrated, and your brain is continually learning new reactions from the trauma.”
I restated: “So it is accurate for me to say that if you traumatize a woman sexually, even if there is no ‘violence,’ you are physically traumatizing her brain.”
“Yes,” he repeated. “I think that is something that is fair to say.” He thought some more. “I had this one patient who had a history of sexual abuse in childhood. As an adult, she presented with an aversion to certain sounds: this is a condition called misophonia, a spontaneous emotional response to certain sounds. Imagine how you feel about fingers
against a chalkboard; for people with this disorder, clicking or chewing or other sounds can become intolerably emotionally abrasive. The adult disorder may have some original link to early sexual abuse from her father. She remembers him in the corner, making these noises, and it was a linked memory to the abuse.”
I told him, in response to this, about the puzzle that had bothered me for so long about women’s recovery from rape—that so many women who had, through therapy, dealt intensively with the psychological effects of their rape, who had had good sexual responses before their rape, and were with safe, supportive, loving partners, simply could not enjoy sex again the way they had done before the rape.
“So,” I asked Dr. Richmond, “does this dysregulation of the autonomic nervous system after sexual trauma possibly help explain what I observed about rape survivors—that they may be having trouble with sexual arousal and pleasure after the assault in part because of actual physical changes to their autonomic nervous system, due to that trauma?”
“Can rape or sexual assault induce a permanent shift or change in the autonomic nervous system? Arguably it could; a growing literature confirms this. Some people’s systems may make them more vulnerable to this. It may be that some women are more resilient than others, some men more resilient than others, against PTSD, in terms of the question of possible damage to the autonomic nervous system from sexual trauma. But wherever your emphasis, it is clear that when people have extreme experiences outside the norm, those experiences will have an effect on vulnerable populations and will affect the autonomic nervous system.” Indeed, other recent studies confirm that women who have been raped or sexually abused, especially in childhood, show striking physically measurable brain differences from women who have not been raped through changes in the size and activation of the hippocampus, and differences in cortisol levels.3
In other words, when you rape a woman (and perhaps also when you rape a man, though the data here are based on female victims), or if you sexually abuse her in childhood, you may be repatterning her body, possibly for the rest of her life, in ways that embed fear, more easily triggered stress responses, and attendant risk aversion, into the very neural fabric of her responses to the world, and that, as we will see, in the case of the changes in the hippocampus, may even interrupt her ability to process recent memory in a way that might strengthen her ongoing sense of self.