DR MAX THE MIND DOCTOR: A lifetime of therapy is the last thing rape victims need

Sexual assault was once an issue shrouded in guilt and shame. Too often, victims were made to feel that they were to blame for what had happened to them.

Recently, though, there has been a sea-change in attitude. People are encouraged to report such incidents to the police and to talk openly about their experiences as a way of dealing with the trauma.

This, combined with a greater understanding of mental health, has prompted calls for improved psychological services — and this week, the NHS responded with a pledge that victims of sexual assault will be offered a ‘lifetime of counselling’.

Having worked with victims of sexual violence over the years, I can think of nothing worse.

Sexual assault was once an issue shrouded in guilt and shame. Too often, victims were made to feel that they were to blame for what had happened to them

The idea that they need — or would even want — a ‘lifetime’ of counselling is ludicrous.

Yes, they may seek treatment for any acute psychological effects they suffer, but what they really want is to get on with their lives.

They don’t want to be defined by what has happened, or for it to dominate their future, but this offer of a lifetime of counselling casts them as perpetual victims.

In a heartfelt article in the Mail this week, Jenni Murray, doyenne of BBC Radio 4’s Woman’s Hour, wrote about how, after a horrific, violent rape when she was a teenager, she resolved that she would not let it shape her life.

Murray was responding to controversial comments by the author and feminist Germaine Greer, who also experienced violent rape aged 18. Like Murray, Greer said she refused to live the rest of her life as a ‘rapee’.

She then went on to call for the lowering of punishment for rape, saying society should not see it as a ‘spectacularly violent crime’, but view it more as ‘bad sex’. Quite rightly, those latter comments infuriated many who felt that Greer was trivialising rape.

What struck me, though, was the similarly robust response of both women — a reaction that is shared by so many of my patients, men and women.

And at a time when the NHS is advocating ‘evidence-based treatment’, I wonder why a strategy of ‘lifetime counselling’, for which there is no evidence of benefit, is being promoted. On the contrary, there’s good evidence that time-limited therapy best helps those with mental health problems, while periods away from treatment are an opportunity for them to consolidate what they have learned in therapy and to develop their own coping skills.

Too much therapy can lead to them becoming dependent on a therapist and never trying to overcome their problems.

The new pledge risks making things worse for patients — so why is the NHS suggesting it?

The real reason, I suspect, is political, rather than medical.

With the spread of the #MeToo movement, being seen to ‘do something’ about sexual violence is in vogue.

However, the NHS should not be responding to fashionable diktats, but only to what patients need and what is clinically indicated.

Recently, though, there has been a sea-change in attitude. People are encouraged to report such incidents to the police and to talk openly about their experiences as a way of dealing with the trauma

Timely therapy should be the focus, not never-ending therapy.

Prompt psychological support can reduce the risk of long-term problems, yet waiting lists for those who need help following sexual assault are too long.

Recently, a patient of mine was raped and needed expert therapy. She was too distressed to call the local rape support centre, so I did it for her while she sat beside me.

I was told that after an initial assessment by a nurse, she would be put on a waiting list — currently around six months.

In some areas, the waiting list is even longer.

What are these very distressed women and men meant to do in the meantime?

Access to mental health support at the time of need is what the NHS should be focusing on.

Instead, it chases headlines with meaningless offers of never-ending therapy. 

Sex robots make me feel very uneasy, but there has been widespread speculation that they might reduce sexual crimes, by providing an outlet for people’s proclivities.

A report in the BMJ this week dismisses such claims. I would go further and say the increasing availability of ‘sexbots’ will raise the risk of sex crimes, by allowing individuals to act out perverted fantasies. 

We’ve seen this with online pornography, with extreme sex acts becoming more mainstream. My fear is that sexbots risk normalising deviant behaviour, which will then spill out into the real world.

A smile is worth a small fortune

Judy Murray has revealed that she had her teeth fixed, splashing out an estimated £30,000 on orthodontic work — and she looks fantastic.

I know first-hand how this can transform how you feel about yourself. When I was in my late teens, the teeth on one side of my jaw started collapsing inwards.

As a result, several of my front teeth stuck out almost at right angles and my lips appeared set in a permanent snarl.

I became paranoid about my goofy teeth, trying not to smile or covering my mouth when I did.

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Bad dental work in childhood was to blame and my new dentist decided the best option was to remove the teeth and fit me with dentures. I was devastated.

Thankfully, a kind aunt who knew the perils of dentures intervened and paid for me to have orthodontic work.

All in all, it took about five years, but it meant I kept all my teeth — and I’m not overstating it when I say it changed my life.

It’s hard to feel happy when you are afraid to smile. But suddenly, my confidence rocketed and I wanted to beam at everyone.

Sadly, orthodontic work is rarely available for adults on the NHS, but I tell everyone that if there is any way they can afford it, it’s worth it to put a smile back on your face and give a massive boost to your self-esteem.

A caring idea we could use 

In France, a ‘revolutionary’ village is being created for Alzheimer’s patients, where they will live alongside carers, researchers and volunteers and be free to roam unrestricted.

The village will have a supermarket, restaurant, hair salon, gym and library, and be set around a central square.

It sounds a wonderful idea, but I hardly think it’s revolutionary.

What the French are doing is re-inventing what was once the norm — where the elderly and vulnerable were cared for within their family and community.

These days, care is outsourced to dreary care homes and it seems we’re only just coming to appreciate what we’ve lost.

n On the subject of carers, the Government has announced plans to support some six million people nationwide who look after vulnerable relatives, with flexible working arrangements and paid ‘carers’ leave’.

The carers need caring for, too. This cannot come soon enough.

Blame parents, not cuts, for rising crime

An epidemic of violent crime is sweeping London. In the past week, we’ve seen footage of a man wielding a ‘zombie knife’ in a road rage incident, while comedian Michael McIntyre was robbed at knifepoint after his car window was smashed.

One young woman is fighting for her life after her mobile was grabbed by two men on mopeds as she walked home in North London; and a gang armed with knives and hammers raided a London jewellers. Since the start of the year, there have been more than 60 killings in the capital.

Metropolitan Police Commissioner Cressida Dick has been quick to blame budget cuts.

But I find this ‘excuse’ quite disturbing. The vast majority of us do not require a police presence in order to behave ourselves. We know what’s right and wrong.

Psychologists tell us that morality develops in stages.

A young child’s understanding of what is right and wrong is based solely on whether or not they will get punished.

In a teenager, however, feelings of guilt about their actions should prevent wrongdoing. By adulthood, a more nuanced, balanced morality will have developed, where actions are guided by principles of ethics or being in the public good. Movement through these stages is guided by parents.

The fact that so many people appear to need the threat of punishment to enforce lawful behaviour suggests that, from a psychological viewpoint, they are profoundly developmentally stunted.

So, rather than blaming government cuts, we should be asking why it is that so many parents seem incapable of instilling a sense of morality in their children.

 

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