[0:00]you shouldn't not go to the police just because you don't think there's enough evidence. Your job is to go to the police if you feel comfortable and let them worry about it, right? All right, so we've got a slightly different topic today and it's a little bit on the heavier side. So we're going to be talking a little bit about sexual assault. Uh, and more important, more specifically, like what happens after sexual assault? So one of my, um, experiences kind of as a psychiatrist is that people just don't know what to expect. And since they don't know what to expect, their ability to seek the appropriate support is very hampered. And the simplest way to put this is like, I had a friend recently whose kid went to the dentist for the first time. And when you've got a kid who goes to the dentist for the first time, there's a lot of anxiety, right? The kid doesn't know what to expect. And so if the kid had a choice, they would never go to the dentist because there's like a weird chair and I've heard there are drills involved and there are these metal instruments and like, you know, I have to keep my mouth, like it's a like a very frightening experience. Even first haircuts can be frightening. And so if we really think about it like, how do we help that child engage in the support that they need? We have to talk to the child, hey, here's what to expect. I know you're scared. Everyone is scared and here's the right way to proceed. And what I kind of noticed as a as a psychiatrist, I saw patients kind of in the emergency room, um, you know, immediately after sexual assaults. But then I also saw people after sexual assaults like days later, so sometimes people would be hospitalized and like they'd come in over the weekend and I show up on Monday morning for my job and they've been there for three days. I'd sometimes see people weeks later, where, you know, they they thought they were okay, but then they'd sort of present to care because they're starting to feel having flashbacks or nightmares or things like that. And then I'd also see people months or even years later. These are people that may have been abused at some point or assaulted early on and then a decade later they're having trouble in their marriage or in relationships. So I've kind of seen people like all across the spectrum of spectrum of sexual assault in terms of duration afterward. And what I realized is that like, we don't actually do a good job of telling people like what to expect. And so what I'd love to do today is share some research. So it's not just going to be my opinion, but essentially like, if you or a loved one has been sexually assaulted, what to expect? Like, what is the process like? Because there are so many things about this that are hard to begin with. Dealing with the assault in and of itself in that moment is very difficult. But a lot of times what people don't realize is there are all kinds of lingering effects, which we don't even realize may be related to the assault. And then we end up blaming ourselves for. So, for example, difficulty with sexuality or uh, I mean sexual relationships or romantic relationships after an assault is very common. But three years later, you know, what I've found when I talked to to patients that I've worked with is they're like, I should be over it by now, right? It wasn't that bad. They'll say all these different kinds of things to themselves, which are actually like really devastating and harmful. So what I'd love to do is I just kind of in a very simple way talk to y'all today about, first of all, like psychologically what to expect after a sexual assault. Um, you know, it's not going to be like perfect because everyone is different, and that's one of the key things to remember. Another thing is is sort of from a medical standpoint, like understanding what the process post sexual assault is like so that you can make an informed decision or a friend can make an informed decision about why, when and how to seek medical care. And then the third thing that I'm going to touch on, which is really well outside of my expertise, but I've had to learn some about, is sort of a a legal standpoint. So if police get involved, what is that look like, et cetera, et cetera. Okay, so I'd like to talk to you all about the psychology involving sexual assault, medicine involving sexual assault. And you may say, well, what, how are those things different? We'll explain. And then almost like a law enforcement standpoint. And the goal of this is is just to equip y'all with some basic information. Because one of the things I even remember seeing this in terms of therapy where a lot of people are scared to go to therapy because they don't know what to expect. And one of the most useful things that I've ever done is talk to people about what to expect from therapy. Really nuts and bolts stuff, so you're going to walk into a room. It's going to be you and one person and they're going to ask you some questions. If you have any questions, you can even start by asking, hey, can you tell me how this works? And so giving like really, really practical, almost advice or orientation. And the thing is sexual assault is is such a private matter, which makes perfect sense. But then we don't, you know, we'll educate people about like dangers, right? But we don't tell people what to expect. And so what I'd love to do and in whatever little way that I can is share some of my experience and some data. So a couple of disclaimers, the first is that what I'm going to be talking about is going to be culturally dependent. So the resources and science that I'm drawing on are predominantly or from systems from North America, the US, Canada and the UK and parts of Europe. So your mileage may vary a lot depending on what part of the world you're in, but generally speaking, the UK, Canada and the US have very, very similar systems and that's what we're going to kind of be leaning on. Okay, so I'd like to talk to you all about the psychology involving sexual assault, medicine involving sexual assault. Another uh kind of obvious disclaimer is that we are talking about a slightly heavier topic, so if that's something that is uncomfortable for you, you're welcome to step out or pause the video or come back later or whatever. But my hope is to present some kind of very simple resource about telling people what to expect after sexual assault. So let's start with the psychology. So the first thing to understand about sexual assault is that people respond very, very, very, very, very, very differently. So the first thing that's really bizarre is that 1/3 of people have almost no reaction to it. So I've worked like everyone sort of assumes that sexual assault is a deeply emotional and traumatizing experience. And I'm not I'm not saying that it isn't. But what I'm saying is people experience that in very different ways. So I've worked with people who, for example, will will sort of like they're not even really like they don't have PTSD or anything afterward. So there's evidence that not everyone gets PTSD, right? So there's let's just talk about that for a second. So there have been parts of the world that, you know, people have experienced genocide. So this is a population of let's say 100,000 people who have a shared traumatic experience. And what we know from research is that some people are more resilient than others. Some people will be diagnosed with things like PTSD or chronic PTSD. And some people are actually like mentally healthy. If you like kind of screen them, even though something terrible happened to them, they're able to handle it in a more healthy way and they actually don't get diagnosed with any illness. So that variability of human response is also true of sexual assault. I've worked with people who are able to acknowledge they're like, yeah, it was bad. Like, yeah, it sucked while it happened, but I'm actually okay. I still feel okay with myself. I still feel loved by my family. You know, I've definitely going to learn some things from it and it wasn't my fault and they're able to kind of cope with it in a healthy manner. So it's really bizarre, but it really only two thirds or one third of people really report almost no reaction after a sexual assault. A couple of other things to consider. The first is that people underestimate how somatic or physical the reaction to sexual assault is. So I'm talking about days and even weeks or months, people will experience physical complaints. So sometimes this is really confusing for people because they're like, I'm not having nightmares, I'm not having flashbacks. You know, I'm not paranoid every time I leave the house. I can leave the house, I can I can go to work, I can study, but I just can't eat anything. Anytime I eat solid food, I feel really, really nauseous or I've had diarrhea for weeks and I have no idea what's going on. So the first thing to understand is up to about half of people will have somatic complaints. So the primary response from their body is not psychological, it's actually physical. So there are stress hormones that are pumping through your body and so it messes with your GI system, messes makes makes people stomach upset. And I've seen GI upset and GI system related things to be the most common. You can also see flaring up of other chronic medical conditions. So you'll see worsening of things like autoimmune disorders and things like that, so you can sometimes almost have a physical manifestation. And let's remember that our body and mind are connected, so having physical problems after sexual assault is completely scientifically valid, okay? So sometimes there are absolutely somatic complaints. Next thing is that in terms of the immediate response, we talked about how a third of people don't really have any response. But it's also just as normal to experience all kinds of different emotional things. So the one very, very common experience is a sense of guilt or shame. That too is almost neurologically mediated. So we have this part of our brain that engages something called counterfactual thinking. And this is the part of our brain that helps us learn from mistakes. And usually when we make a mistake, we experience some amount of negative emotion with it. And that negative emotion is actually a moti motivator to change behavior. So if I failed a test and I didn't study, then what happens is my mind starts thinking, okay, what could I have done differently? And I feel a little bit ashamed for for failing a test. And so then I start to think, okay, well, maybe what what I should have done is start studying earlier, okay? Makes perfect sense, right, in in the case of a test. And so what we see is that after a negative outcome that is hurtful to us, we experience some degree of guilt and shame and start thinking about what we could have done differently. In the case of sexual assault, this can absolutely happen. And what we run into is something that's actually a little bit different, which is that in the case of sexual assault, it may not actually be our fault, right? But that part of our brain doesn't really know that. So in the same way that something bad happened to us, so I'm going to experience guilt and shame and I'm going to think about what I could have done differently. That can sometimes cross over into feeling responsible. So this is where other people, and this is what's so confusing, if you've gone through this, is you'll say, oh my God, let's say, heaven forbid you've been assaulted. But what I what I'll hear from patients is they'll say, oh my God, it's like I shouldn't have been so stupid. And then what other people do is they'll say, oh, no, no, no, no, no, it's not your fault, it's not your fault, it's not your fault. Don't think that way. And those kinds of statements can actually be a little bit of a double-edged sword because I agree, it's not your fault. I think that's sort of factually true. And at the same time, what do you think that does for the person who's been assaulted? It almost makes them feel more isolated and less understood. Because now do I have 10 people telling me, it's not my fault. And then I feel even worse because my brain is telling me it is my fault. So now not only did this thing happen to me, but I am so disconnected and everyone else is telling me that I shouldn't be thinking this way. Which can make people feel even worse. So we see a lot of shame and guilt, very common reactions. We'll also see dissociation. So this is where sometimes what happens even during uh, a sexual assault and there's kind of lots of interesting neuroscience that explores this phenomenon where you'll kind of unplug from yourself. So it almost feels like you're not living within your body. That your body is kind of like this robot and you're kind of watching it from the outside. So it's a very, very strange or bizarre experience. Chances are that that is almost protective. That's what I kind of, that's where my money is. That this is a protective neurological response so that you don't suffer quite as much. So dissociation tends to be triggered by traumatic events and and helps people sort of gain distance from it. So it's very common for people to experience dissociation as well. From an emotional standpoint, what we tend to see is that um the most common emotion actually is not shame or guilt. Is not fear, the most common emotion that people experience after an assault is anger. So 59% of people will feel angry, which is also something that if you look at kind of like media depictions, when someone's like anytime the media depicts someone who's been assaulted, they're withdrawn, they're quiet, they're kind of like, you know, they're crying and and I'm not saying that those aren't appropriate reactions. But it's kind of interesting because the most common experience, and this is based on research, 59% of people feel anger. About 40% of people feel fear and or anxiety. And the reason that I'm sharing these statistics with you is just to highlight that if you've gone through this, if someone you've known has gone through this or does go through this, for you to understand that if you feel pissed, and you don't react the way that people in the movies react and you don't react the way that your friends think you should react, that's actually totally fine. So what is the right reaction to sexual assault? Whatever you feel like. Obviously, I don't think you should hurt yourself or hurt other people, which, by the way, is an important thing to to consider. So after a sexual assault, you do see feelings of increased suicidal ideation. So sometimes those feelings of guilt or shame or pain or numbness or dissociation can be so overpowering that people will start to think about ending their life. If that kind of thing happens, you should definitely get medical care. I think you should get medical care, no matter what happens, and we'll get to that later later on. But that is actually a relatively common experience. So that too is is in a sense, I mean, it's not healthy, but it's normal. It's like it's it's a natural reaction. It does not mean that anything is wrong with you. The other good news is that that usually gets better with time. So the other good thing that that I've really found as a clinician is that most people who experience assault are not screwed for the rest of their life. There are all kinds of problems that happen, but that even if you look at, for example, sexual dysfunction. So here's another thing that a lot of people will experience. After a sexual assault, they'll have difficulty engaging in sex. So this could be everything from difficulty getting aroused, right? So they're not as interested in sex, to physiological changes. So sometimes, uh, you know, people will have difficulty getting an erection or, um, you know, women will have vaginal spasms.
[16:08]So like, like the, the entrance to the vagina kind of that those muscles will go into spasm and so it's hard to actually engage in sexual activity for both men and women or non-binary persons. So there are all kinds of changes that can happen in terms of psychologically, physiologically, it doesn't mean that there's anything wrong with you. The other thing that's really interesting is that, um, there's also difficulties, for example, achieving orgasm. So even if you are able to physiologically perform, your mind and whatever neuro neuro circuit is necessary to actually complete a sexual act may be kind of hampered in some way. So that too is like, honestly, like kind of normal and it's okay. It doesn't mean that you're screwed in some way. And that's the reason that I really want to give this talk is because so many of the people that I've worked with, not only does the assault happen, but all of the physiological and psychological consequences make people feel like they're even more broken. They're like, oh, crap, not only did I have to deal with this crap one day, one year ago, but now it's been a year and I still can't achieve orgasm. So the good news about this stuff, actually, is that it tends to resolve within about a year. So the majority of the research shows that sexual dysfunction following sexual assault tends to resolve within a year. There's also evidence and there are certainly cases where it doesn't resolve within a year, and that sometimes years later some things can persist. So issues of like, you know, safety, um, still difficulty with arousal and stuff like that. So a lot of it seems to naturally get better or get better with treatment over the course of a year. And there's a lot of stuff that can persist. The good news there is that even if it persists, if you engage in treatment, there's very solid evidence that shows that even if people have experienced sexual assault, chronic sexual assault, you know, all kinds of things we're talking about sexual abuse in childhood, that with uh tools like therapy, they can actually start to engage in healthy, meaningful, romantic and sexual relationships. So I'm going to just pause for a second and make sure I didn't leave anything out. Um, oh yeah, so a couple of other things. One is that, uh, the other thing I didn't mention about sexuality is that avoidance post sexual assault is very, very common. So not just avoidance of sexual stuff, but avoidance of social situations, avoidance of even leaving the home. That's all really common, so it's not unusual for people to really like want to avoid all kinds of stuff. Whether there it's their own emotions, whether it's romantic partners, whether it's leaving the house. The last thing to consider is that sometimes after a sexual assault, people will actually meet the criteria for an illness. So the most common are trauma related disorders, no surprise. So people can sometimes develop PTSD. So PTSD is post-traumatic stress disorder, which is characterized by things like nightmares, flashbacks, what we call hypervigilance or hyperarousal. So you're like paying attention to the environment, and it's difficult to relax, things like that. And mood disorders are also really, really common, um, so people will get major depressive disorder, less so bipolar disorder in my experience anyway. But you can sort of meet criteria for like medical or psychiatric illnesses and then you can also get treatment for those, which can get better. So I'm I'm really optimistic that you can get better no matter what happened. So next up, what I want to do is talk a little bit about medical stuff after a sexual assault. And you may be kind of confused by that because you're like, well, you just talked about PTSD and mood disorders, right? What do you mean? What I'm talking about is what to expect from a medical standpoint in let's say the day to weeks after an assault. So one thing that I would recommend is if you don't know what else to do, just go to the emergency room or call emergency services like 911 or whatever the number is and where you are. And you can literally walk into and this is I this is what I really wanted to share is like, here's what's going to happen. What I wanted to just tell you what's going to happen if you get sexually assaulted and walk into an emergency room. So chances are what's going to happen, and I'm this is US based, right, but it extends to other countries, is you're going to go in and then like like there's going to be a attendant and they'll be like, okay, what are you here for? And you can even tell that attendant. I'm here because I was assaulted. All you got to say. And the nurse will take it over from there. So this is the key, key thing to remember. There are multiple medical organizations that span the globe, right? So the American Association for Emergency Room Physicians, World Health Organization guidance on medical care for people victims of sexual assault. And all of these organizations develop guidelines and protocols. The goals of these guidelines and protocols are first of all to make you feel safe, okay? To a certain degree to empower you, and I know that sounds kind of weird, but what does empowerment mean? Does it mean like, oh, like we're going to march the streets? No, empowerment means you were just attacked. What you want to happen, we want to happen. So you get to make the choices. And this is what's so difficult for people post sexual assault is they feel so out of control, a lot of them hesitate to go to the ED because they don't know what's going to happen. If I go to the emergency room, does that mean that I have to go to court for the next eight weeks and and someone's going to be put on trial and I have to stand in the witness box and there's going to be cameras there and all that kind of stuff? Because no one ever tells them, no. No, that's not, that doesn't have to happen. You can it can happen if you want it to happen. So the goal of really medical treatment is first of all, safety and empowerment. What empowerment means is that you get to make the decision. Other, uh, really, really important things about medical care, so other, uh, important things include making sure that there are not medical consequences from the sexual assault. So what they're going to try to do in this and this we'll get to a legal stuff in a second is make sure that you're not hurt, right? So sometimes sexual assault comes with other things. Maybe you were physically assaulted as part of that, there could be different kinds of first aid that you need, you may have rashes, you have you may have bruises, so we want to kind of take care of that medical stuff. There are also two really, really important things that we we really kind of focus on in the medical system. The first is protecting you against consequences from the assault. So that could be things like, you know, giving you prophylactic medication to prevent sexually transmitted infections because that can happen. Right? So there's like even like there are good protocols, for example, that if you get assaulted by someone who has HIV, maybe you have no idea who has, you know, if they have HIV or not. But what the emergency room is going to give you, because heaven forbid, the last thing that you need is an STI after this experience. So there's even like really good protocols that there's post exposure prophylaxis for things like HIV. What does that mean? Post exposure means after you've been exposed to a particular infection, you can take particular medication that will prevent the infection from actually working and infecting you. So post exposure prophylaxis for HIV has pretty good outcomes. So that's the reason why I strongly recommend that people go to the emergency room because you can get medication like that. And essentially prevent as best as we can any kind of STIs or other consequences from, you know, hopefully what was one bad experience and not longer than that. Other unintended consequences that we want to focus on are preventing pregnancy. So in the case of of female victims, you know, if that's important to you, depending on what contraception you're on or things like that. Last thing that we want is is, unless you wanted of course, which you're the boss, is for people to get pregnant out of something like a sexual assault. So what we want to do is medical professionals make sure you feel safe and empowered, protect you medically from like consequences down the road. And the really sad thing is unfortunately, I've seen people who don't realize, and we don't really expect them to realize, right? Because if you're like, let's say you're a 19-year-old and you're sexually assaulted at a party, the first thing in your mind is not, oh, like what kind of STIs could I get? Like, you know, people react all kinds of different ways. Maybe you're dissociating a little bit, whatever.
[26:19]The next thing that we do that's really important, uh, in emergency rooms is actually more medico-legal. So chances are this will trigger something that in the US, we call a SANE exam. So SANE is, um, I forget what the acronym is. I'm blanking right now. So in other parts of the world, I I will get to other acronyms in a second. But let me see actually if I have it.
[26:55]Um, yeah, I didn't include what the. I'll figure out what SANE is. So we'll trigger something called a SANE exam. So a SANE exam is something where there, you know, with your permission, specially trained nurses usually, there's a specific team that's involved, where specially trained nurses, who are like, very trauma informed, right? So it's not going to be just any nurse or any doctor. It's going to be people who have gone through uh, oh, so SANE is sexual assault nurse examiner. Thank you very much. People who have gone through a specific uh, level of training and certification who know what they're doing, will go through a series of steps with you. So these are not only to document injuries and make sure you're okay, do all that kind of medical stuff, but it's also to maintain a chain of custody for evidence. So they may, uh, ask asked to do particular things. So SANE exam involves, like, so there's a SANE kit. In some places it's called a rape kit. I personally like SANE exam more than rape kit, um because not all sexual assault is rape. Um, but so they'll they'll do different things like they'll ask if they can, you know, remove like they'll bring a comb and they could like take DNA from your hair or other places. There are swabs involved, things like that. They're going to examine you in different places if you're okay with it, make sure you're not hurt, give you appropriate medical care and they will also collect evidence. Now, there's also like this is something that I want to highlight, so when a SANE exam happens, you have a really cool option, which is that you can choose to remain anonymous. So what they'll actually do is like if you don't want things to go forward in that direction, what the SANE nurse can do is collect everything, but not attach your name to it. There's a unique identifier that you're kind of that you're given so that later on they'll preserve the evidence, but they don't have to attach your name to it yet. If you decide a week later, a month later, a year later, hey, I decide I actually want to move forward with the legal process, that thing will be sitting and then will be processed appropriately. So this is really important to understand, just because you consent to a SANE exam, does not mean that anyone is going out and being arrested, okay? It doesn't mean that you're going to wind up in court and you have to, you know, skip a week of work so that you can accuse someone in court.
[29:57]The the purpose is to really give you the stuff that you may need, if you decide to move forward in a legal, uh, way, okay? Now, I'm not a certified SANE examiner, right? So if there's people, I may be getting part of this wrong. This is kind of a combination of what I've researched, as well as what I've seen. So, for example, when I'm in a a psychiatrist in the emergency room, I will help someone when they come in after a sexual assault. But once the SANE nurse shows up, I will step out of the room and let them do their thing. I may connect with them afterward and say, hey, is there any stuff, like any medical injuries that I need to be concerned about or, you know, how do you think they're doing? And then I'll step back in and talk to the patient if they're open to it. So we we'll kind of like emergency room folks will work with the SANE folks, but we call the SANE folks because they're the experts, okay? So we want to maintain a chain of evidence. We want to make sure that you're medically okay, we want to orient you. The other thing that that SANE teams can do is also connect you with appropriate aftercare. So while I think it's a good idea for you to go to the emergency room, you know, I think that's a good advice. Recognize that you can get plugged into support after you leave. So let's say a week later you do have an upset stomach. Let's say a month later you are having problems in your relationship. The key, another really awesome part of the process is that what we want to do is give you resources and plug you in to additional things, should you need them. So that's kind of like a real important goal, right? And I I've seen a difference in the people who get plugged in and can kind of start dealing with things as soon as they pop up, as opposed to people who are like, okay, like three months later. And I'm not blaming these people, right? Because it's hard. It's it's scary, and that's why we're making this video because no one knows what to expect. Three months later they're like, okay, I'm I'm having like some kind of PTSD or something, and then they call someone, and then they schedule an appointment, and that appointment is 10 weeks away. And then, you know, six months have gone by, now you've had untreated PTSD for six months. You're on academic probation, or you're on probation at work because you can't sleep at night because you've got nightmares. And then things become a lot harder. So I'd strongly recommend that people go and get medical care, you know, it's it's we're really there to help. And the key thing to remember is that ultimately, you're the boss, and we're going to do or not do whatever you want. There may be some really important exceptions to that, like so, for example, if you're acutely suicidal, after a sexual assault, like we're not going to let you leave the hospital. You may be hospitalized in that kind of case, but that's it's really for your safety. Generally speaking, 99% of the time, and by 99% of the time, I mean, you know, I may have seen a hundred patients who are in that situation, I can only think of hospitalizing one.
[33:36]But the vast, vast majority, I mean, the the goal is to keep you safe, empower you and mitigate the damage that's been done and sort of help support you in the next steps. The third thing that I want to talk a little bit about is law enforcement. So this is once again, um, a resource that is a little bit, the most outside of my wheelhouse. But it's important to remember that in law enforcement, hopefully, and I I feel pretty good about this, by the way. I know that there's a lot of, um, negative press and media around law enforcement. My experience with law enforcement around sexual assault has been overwhelmingly positive, okay? So I trained in Boston, so that may have something to do with it because the law enforcement there is particularly good. Um, but generally speaking, I I do think that there are so there's there are specific officers that much like nurses, go through a special kind of training for sexual assault victims. And so this is called the SART, which is sexual assault response team. So if you call 911, the other thing that you can do, in addition to going to the emergency room, is you can walk into a police station. And you can walk into a police station or call, you know, the police hotline or whatever, you can do it minutes after the assault, days after the assault, weeks after the assault, or years after the assault. You can go in anytime. And when you go in, they're actually going to be special, you just tell them, hey, I I've experienced a sexual assault. In the case of the emergency room, sometimes the SART team is combined. So the the SART team can include nurses. So the goal of of the sexual assault response team is to have kind of medical and law enforcement stuff kind of work together to to give the victim, uh, or the survivor kind of the best experience possible. And so they may do things like interview you and and things like that.
[36:00]And the and the most important thing that I kind of learned by talking to some of my colleagues who are in law enforcement is that a lot of people hesitate to engage in law enforcement for reasons that their brain tells them, like the assault wasn't that bad, or I don't have enough proof, right? Like maybe you were assaulted and and the person used gloves or or, you know, used other kinds of things, sort of like you don't think there was DNA or like whatever. There are all kinds of reasons or another really, really common thing is that, oh, the person was someone that I knew or was even in a relationship with, right? So I recently saw that there was a a court in India that for the first time declared that sexual assault is possible within the marital relationship. So prior to this ruling, like there was kind of this idea that if you're married, like, you can't be sexually assaulted by your partner. And so, you know, there are all kinds of things that people will believe like, oh, if I got sexually assaulted by my husband or wife or whatever, that I can't report it because no one will believe me.
[37:17]And all of those kinds of thoughts, the officers that I've worked with like they recognize that and it's not you shouldn't not go to the police just because you don't think there's enough evidence.
[37:39]Your job is to go to the police if you feel comfortable and let them worry about it, right? So don't worry if there aren't like visible injuries or anything like that. Those are the kinds of thoughts that people have, but it's actually completely okay to go to the police immediately after, a day after, a week after, and don't worry about the evidence or anything like that. We'll they'll kind of do the best that they can and whatever, you know, is appropriate in that situation. So the good news is that hopefully they have specially trained officers that are part of the SART. Be careful about some of the things that your mind may tell you, and generally speaking, I hope that you have a good experience if you work with law enforcement. My experience has generally speaking been very good. Okay?
[38:40]So, as a friend, follow their lead and also if they don't know what to do, I think it's fine to explain some of these options to them. And encourage them to seek medical care. How to support friends? So I'd say the most important thing, if you want to support friends, is to follow their lead.
[38:40]So this is where like, honestly, I've seen some pretty toxic friendships where one friend will impose their value system on the other friend. Like, I I don't know how to say that. But like, sometimes I like, honestly, I've worked with people, you know, remember, a third of people have no reaction whatsoever. I've worked with people who are like, yeah, it sucked. I'm going to be more careful in the future, or it was like a random thing, right? And like I don't, I don't, I I feel okay. I went home, I made a sandwich, I woke up the next day, I took my dog for a walk. Was it a terrible experience? Yes. Do I hope it never happens again? Yes. And like, I want to continue living my life. This doesn't need to define me and doesn't need to occupy. I wasted one hour of my life with this event and I don't want to give anything about this an additional hour of my life. I've met people who think like that. I've also met people who don't think like that, are dissociating, ashamed, guilty, suicidal. So I think the most important thing to do as a friend is to ask, how can I help? You know, and I do think like orienting them a little bit and sort of letting them understand that, hey, if at any point you want to engage in a legal process, then we do need to contact law enforcement sooner rather than later. So for example, something that people want to do immediately after a sexual assault is shower because they feel dirty. And I totally, I mean, I can't honestly, I can't empathize with that because I've never been in that situation. But I I sort of understand it intellectually, that like you feel dirty, you feel ashamed, you just want to wipe it clean. But if you do that, your legal options get vastly reduced. So just to have people understand that and as a friend, like ask people, hey, are you open to like, can we talk about this a little bit? I don't need to hear details about what happened. I'm very concerned about the next 24 hours, and I would I would love it if I could help you feel safe and like do things that like will be protective towards you. What do you think about seeing a medical professional? Even explaining things like post exposure prophylaxis, explaining things like the possibility of engaging in law enforcement. Even these kind of tidbits like the SANE exam can be anonymous, so you don't even have to give them your name. So if you never want to claim it, you'd never have to, it's just going to sit on the shelf for some amount of time and then maybe get thrown away, who knows, maybe a decade later. But explaining some of these things will actually hopefully help people like get in the door. And then once they get in the door, I'd like to think that my colleagues will be able to do a good job both on law enforcement and on the medical side. It's a fantastic question. So as a friend, follow their lead, and also if they don't know what to do, I think it's fine to explain some of these options to them. And encourage them to seek medical care. Wow, dude, this is by far the longest responses I've gotten in chat. Um, so it's just hard for me to read them.
[42:04]Okay.
[42:49]So so Cutie is asking, only one can win in co-op. Let me explain something to you. If y'all are playing a co-op game and there's only one winner, you're not going to keep queuing up for very long with that party. Let me tell you that. Sometimes there's just one winner, and usually those parties fall apart over time. If you want to keep queuing for a long period of time, you got to make sure everybody wins. Right, so you guys can be on the same team and really be doing everything together, or like one of y'all can be the DPS and one of y'all can be the healer. And I don't even know what that analogy means. My point is that there are different roles that you can there are different ways that you can gradually move towards fun and intimacy and things like that.
[43:52]And having people go through the detail of, okay, like, then what happened, and then what happened, and then what happened, actually appears to retraumatize them. So you want like a healthy amount of numbness. Now, the other thing is that for whatever reason, we just look at it at data, and it appears that most people who have sexual difficulties after part after sexual assault, within a year, it just kind of gets better. And how and why does that work? Honestly, we don't know. So what we do know is that the body tends to naturally move towards homeostasis or equilibrium. And what does that mean? It's kind of like, okay, well, like if I ate a piece of fish and I got sick. The next day, let's say I get a like a stomach flu or like food poisoning. I may avoid fish for the next day, the next week, the next month, but in a a in a year, I'll like most human beings will start eating fish again. So we just know that that when when humans are hurt by something, that over some amount of time, the body naturally heals. And so that can absolutely be the case for people who have who've experienced sexual assault. For a couple weeks or a couple months, it's like hard. I'm not I don't I don't feel aroused. I have difficulty, let's say with vaginal lubrication or erection or achieving orgasm. I have those kind of difficulties, and just as time goes on, like it's really cool, but our body kind of heals. So that's very common. Now, for some people, it lingers for months, years, decades. And if that's the case, then I would strongly recommend, I mean, you don't have to wait a decade before you go see a therapist. I'd say go see a therapist right away, but we just know that sometimes things get better because that's like, that's how the human body is designed. It's designed to just kind of like keep going. Um, and and, you know, that's where like therapy with these people is really to understand why you feel ashamed. Where is that disgust coming from? You know, like to validate those kinds of feelings that I feel gross after this, like, which is a very common experience to feel disgusting. And to say, I can understand why you would feel that way. And then like, sometimes, especially when it comes to like intimate with partners, like having a partner be a part of that conversation when it's the right time, right? And and there's there's all kinds of like intimacy building that can happen gradually and slowly with intimate partners. So when when one partner says, I feel disgusting, and the other partner is like, you're not disgusting, that can be helpful. But it can also be like, okay, like if you feel disgusting, can we just can I just hold you? We don't have to do anything. I don't find you disgusting.
[47:28]You know, I can understand that you feel that way. I'm so sorry that you've been through this, but like, it does doesn't bother me. I think you're great.
[47:39]Not saying that you're wrong, but that's just not how I feel. Right? I respect you, love you, et cetera, et cetera, et cetera. Like, like there are there are ways to have those conversations and facilitate those conversations. And once you've kind of do that in a healthy and persistent way, I've seen people be fantastic afterward. Right, like back to normal. Or even in some cases, I know it sounds kind of weird, but you see this a lot when it comes to medical outcomes. Sometimes people are even better, right? So I'm not suggesting that we go through that because the vast majority of people are not better, but they just come back to normal, is the most important thing. But what really does is in some ways it tests the relationship, but it also like gives people an opportunity to really form a very powerful bond. That when a relationship gets through that, and when one person is feeling so disgusting and the other person accepts them, even though they feel disgusting, there's a level of like commitment and love that wasn't possible because, I don't know if that kind of makes sense. Is like, if you like, the more disgusting I am, and the more that you choose to love me anyway, the more love I can feel in a weird way. I don't know if that makes any sense.
