The problems of victims of sexual assault who are courageous enough to identify themselves as such are notorious. The act of reporting a rape initiates a most complex process. The victim is confronted with the usual institutional patterns of the hospital and the criminal justice system, which are likely to be perceived as confusing and alien. It is emphasized that she presents herself to the authorities at a time of crisis. It is a crisis which differs from other crises in that one's usual support system is more likely to be disrupted. Families, friends, and lovers, because of their own perceptions about rape, may desert and further isolate her. Additionally, the crisis is never limited to one's person since the victim, by the act of reporting, becomes public property, and is at the mercy of the hospital, police, courts, media, and community opinion. Rape represents an act of violence and humiliation in which the victim experiences not only overwhelming fear for her very existence, but an equally overwhelming sense of powerlessness and helplessness which few other events in one's life can parallel. The victim's needs are for empathy and safety, and for a sense of control over what has happened to her and what will happen to her in her dealings with hospital and law enforcement. In the absence of sensitivity to these needs, the experience of reporting becomes another assault.
The profound impact of the rape stress is best understood in the context of rape as a crime against the person and not against the hymen. Victims of violent crimes frequently experience a life crisis which more often than not goes unrecognized. Bard and Ellison 1 describe the spectrum of stresses confronting the victim depending on the extent of the personal violation. Burglary, for example, is experienced as a violation of the self in that one's home and possessions are symbolic extensions of the self. Armed