There is a severe paucity of counselling services for survivors of sexual violence in India. Organisations like CEHAT and RAHI are trying to plug a gigantic gap in the mental health system in India
When Lalita* was raped by her 18-year-old nephew, she did not know that filing a case would have dramatic social consequences. The morning after the attack, Lalita went to Rajawadi Hospital, a government-run hospital in Mumbai. There she was examined and medicines were prescribed. She went straight to the police station to file a complaint. A day later, she was still there.
When counsellors from the non-profit organisation CEHAT (Centre for Enquiry for Health and Allied Themes) reached, they found she had slept on a narrow bench and been unable to buy her medicines. After filing the report, Lalita reached home to find her belongings dumped outside her shanty hut. The community wanted her and her HIV+ husband to leave, not because she had been assaulted but because she had filed the report. They wanted her to forgive the boy. “Uski zindagi kharaab mat karo, don’t spoil his life,” said elders in the community.
Lalita and her husband have little support and even less money. They moved to another settlement. She is still waiting for justice.
“That was one sort of reaction,” says Padma Deosthali of CEHAT who has written extensively about feminist counselling for survivors of violence. “In another case, the girl did not want to file a report. She was middle class and had support but she did not want to file. This poor woman with no support wanted to file but they made her wait in the police station for hours. Still, she remained adamant. So every person reacts differently to sexual violence.”
CEHAT works with three government-run hospitals in Mumbai to provide social and psychological support to rape survivors. It is this understanding of difference that the organisation brings to its work. While counsellors are trained to look out for symptoms of Rape Trauma Syndrome (RTS), they are also warned that all survivors will not display all symptoms. This is important because the physical, emotional, cognitive, behavioural, and interpersonal symptoms can vary wildly from one rape survivor to the next. Symptoms include crying more than usual, restlessness or agitation, but survivors can also withdraw from society or shun solitude, develop speech difficulties, avoid reminders or tend toward silence.
During her conversation with me, Deosthali emphasises that there has to be a nuanced understanding of the effects of sexual violence on mental health. In a culture where there is a tendency to write off survivors as “zinda laash” (living corpse), such an understanding is crucial.
CEHAT has to fight misconceptions on a regular basis. A woman may not be taken seriously by the police or court unless she seems distraught. Sometimes days or even years have passed since the incident and she has, in keeping with healthy efforts, tried to get on with her life. But unless she fits in with the ‘image’ of a rape survivor, she runs the risk of being dismissed by a system that is already loaded against her. “Sometimes children who have been subjected to sexual violence sit and play even at the hospital. This doesn’t mean they are not in pain,” says Deosthali. “But we get worried that they will not be believed.”
For women like Lalita, mental health cannot be viewed in isolation. Social aspects inform and influence how they deal with the violence. Women or children from poor or even middle income families are often ostracised, restricted or punished in some way for the sexual assault. This aggravates the trauma sharply.
“In the case of children, mothers and fathers are concerned about the child but when the victim is an adolescent, fathers are likely to curb the girl’s mobility and freedom,” says Deosthali. This is why CEHAT counsels families and even community members of survivors whenever they can.
For most survivors, the reaction to their disclosure will affect how they feel about it for years to come. This is especially true in the case of children. “If the child discloses and the parent doesn’t believe, the child feels a sense of double betrayal—first by the abuser and then by the parent,” says Anuja Gupta, founder and director of the Delhi-based non-profit RAHI (Recovering and Healing from Incest).
“Nobody can afford to blame the survivor or suggest that she forget or that she should just get on with her life. Social support is very important. Offering immediate support is important,” she adds.
It sounds like common sense but a vast majority do not follow these simple principles. Despite higher levels of education, even the middle class is no role model. “The middle class is also unaware,” says Gupta. “Sexual violence has always been hidden and taboo (among them).”
Organisations like CEHAT and RAHI are trying to plug a gigantic gap in the mental health system in India. There just aren’t enough mental health professionals dealing with sexual violence. “(People need to be trained) to remove morality, tradition and these sort of value systems, to be able to recognise CSA,” says Gupta. “Nobody really knows how to handle what a rape victim needs. What is Post Traumatic Stress Disorder? What happens to the life of a person who has been assaulted? This kind of understanding or training is really not there in our country. The protocol for handling rape survivors does not really exist.”
Dr Indira Sharma of the Indian Psychiatric Society, an organisation set up to promote the improvement of mental health services and education, says the profession is plagued with a shortage of talent.
There are also complex class dynamics at work here. While government hospitals work with non-profits to provide counselling, these services are entirely absent from private hospitals. The middle class will seldom approach a government hospital with a case of sexual violence. “So where are they going?” asks Deosthali.
Some visit private psychiatrists. “Even if the presenting symptoms are not that of violence, we do work with them,” says Dr Sadia Rawal of Inner Space, one such practice in Mumbai. “Five to eight percent of our cases come with abuse as one of the dramatic components. Another 10% are cases where abuse has happened but they have come because of other issues.”
At Inner Space, counsellors charge Rs 750-1,500 per session. Middle class patients are willing to pay this for problems such as stress or marital troubles; not many seek treatment for trauma related to sexual violence. “For problems like depression, anxiety etc, the symptoms are in your face so that has become mainstream but sexual violence is not mainstream,” says Dr Rawal. What she means is that nobody is talking about it as a mental health issue. This may be because seeking counselling for sexual violence is replete with concerns about reputation or honour. “Sometimes, mothers want their (abused) children to come but elders in the family will object.” she says. “There are facilities, there are a lot of NGOs,” she adds, doubtfully.
Stigma cuts across classes. Speaking of the poor who approach government facilities, Dr Sharma says: “People won’t be sent unless they are severely affected. They will be handled at the family or community level,” says Sharma. This “handling” as is evident from other reports, may be inadequate.
The question of how one can tackle the stigma remains. While sexuality education is one way to shape minds at an early age, what qualifies as such education is also disturbing. Sharma is all for boys being “taught how to behave” but she also wants to preserve Indian culture and the hetero-normative ideal of the marital relationship. “The Shiva-Parvati model is what we need to project. If someone’s marriage is successful in the true sense, not just physically but also in the pious, spiritual way, then they will not commit such crimes.”
The fact that mental health professionals hold such views compounds the problem. For the moment, non-profits seem to be the only beacons in an otherwise bleak scenario. CEHAT, for example, is a proponent of feminist counselling, something that Deosthali has written about extensively. “Feminist counselling practice questions abuse and puts the onus of abuse on the perpetrator, rather than the victim,” she says in Feminist Counselling for Domestic Violence (Routledge, 2013), a book she has co-edited. “It also provides the necessary tools and strategies that equip women with skills that facilitate healing and stop violence. The primary goal of counselling is to validate women's feelings and experiences, support their decisions, respect their intelligence, and mitigate feelings of inferiority, powerlessness and disrespect.” The book lays out guidelines for practitioners and aims to popularise a consistent practice. Amidst misconceptions and stigma, survivors of sexual violence must struggle through a cesspool of despair and silence. The rise and spread of practices like feminist counselling may provide some hope.
*not her real name
(Anindita Sengupta is a writer and journalist based in Mumbai.)
Infochange News & Features, May 2013