The Impact of Sexual Trauma: Working With Men and Boys in a Psychiatric Inpatient Field Placement

by Jesse Douglas Raynak, BSW, MSW

     I have spent the last eight months of my MSW program interning at an inpatient psychiatric hospital in California. This is a locked facility, and patients who are admitted meet criteria for being a danger to self, danger to others, or gravely disabled. My interest in this internship stemmed from my desire to gain firsthand experience in working with people with mental illnesses. What I did not realize, however, was how common the experience of interpersonal trauma was to the clients I would be serving.  

     This facility serves a broad population of men and women ages 13 and up. My work has consisted mostly of the completion of biopsychosocial assessments, treatment plans, family consultations, case management, and group treatment facilitation. In completing assessments, I have heard hundreds of stories from people who have survived various forms of abuse, including physical violence, emotional attacks, neglect, sexual abuse, rape, and incest. In discussing these various forms of abuse, I believe it is important to discuss how they interplay with mental illness. 

Interpersonal Violence

    Interpersonal violence (IPV) is a tough subject for many to discuss. By interpersonal violence, I mean any kind of harm inflicted on a person by another human being. What makes interpersonal violence so damaging is that it effectively shatters faith in the trust of others (D’Andrea, et al., 2012). When faith and trust in others has been destroyed, people may choose to isolate themselves or retract socially (D’Andrea, et al., 2012). This becomes problematic because we, as humans, are wired to be social creatures. We are born into this world requiring care and nurturing from those around us for development. In modern society, people are able to more easily make decisions to avoid social interaction and retreat into a world where they can avoid being harmed. 

IPV and Mental Illness

     Interpersonal violence mixes with mental illness in that interpersonal violence alters how we view ourselves, the world, and others who live in our world (D’Andrea, et al., 2012). If someone sexually assaulted me, it might change my behavior and how I feel about connecting with people. I might start dressing differently and avoiding people who look a certain way. I might wonder whether the assault was my fault, and thus experience shame and guilt. I might not feel safe enough to open up about this experience, because I might be afraid my weaknesses would be used against me as they had been used in the past. I might worry that others would label me if they knew what had happened, and I might lose the few friends I feel comfortable with.

     I have seen these types of behaviors and heard these stories from many clients who want so badly to experience happiness and ease in their relationships with others, but so often experience fear, worry, pain, and paranoia. It then becomes a snowball effect, as the more someone pulls away from connecting with others, the more disconnection and hopelessness they will feel, which inevitably affects their mental health.   

     In addition to these behavioral responses to abuse/neglect/victimization, researchers have found links that show how neurodevelopment is negatively affected by traumatic experiences (Heim & Nemeroff, 2001). These links show that traumatic experiences can manifest in mood and anxiety disorders, which surface later in development. Additionally, an individual’s biology can contribute to the likelihood that the individual will experience certain events as more traumatic and impactful than others (Heim & Nemeroff, 2001). Noting these biological phenomena in the understanding of trauma can help practitioners better understand how to educate their clients on the meaning of their experiences. 

Boys, Men, and Sexual Violence—A Taboo Topic

     So often, when we think of victims or survivors of interpersonal violence, specifically sexual assault, we think of girls and women. In reality and throughout history, boys and men have also experienced sexual violence. The Centers for Disease Control and Prevention note that 1 in 6 males and 1 in 5 females experience sexual abuse before the age of 18 (Centers for Disease Control and Prevention, 2005). These numbers are from people who have disclosed incidents of abuse. Boys and men face difficulties in disclosing their abuse and are often less likely to report these incidents than their female peers, which may indicate that boys and girls are abused at roughly similar rates (Lalor & McElvaney, 2010). 

     In my field work, I have spoken with many boys and men who are living with the lasting emotional scars of sexual violence inflicted upon them by friends, family members, and acquaintances. Sexual abuse is a difficult topic under any circumstance, but I have found that men in particular have an extremely difficult time viewing themselves as victims in these circumstances, or even discussing these issues.  

     What makes sexual violence toward men such a taboo topic? For one, I believe that men are under a great deal of societal pressure to perform or maintain a “mask of masculinity.” This mask says that men are not allowed to be viewed as weak, and when it comes to sex, they are expected to enjoy it. For example, if the perpetrator of the assault is female and the victim is a heterosexual male, he may not be able to open up to his buddies, as they may not take him seriously. They might say something like, “Well, it sounds like you got lucky!” If he views this experience as problematic, he may fear that his friends might question his sexuality. If the perpetrator is a male, he may internalize guilt and question his own sexuality.  

     In analyzing the impact, we can see that men and women experience the malaise of sexual violence in similar ways. Mental illness may manifest or become exacerbated after such an incident, and suicidal thoughts may begin or increase. Sexual dysfunction may occur, and victims may seek out future sexual interactions that are coerced or exploitative.  

     What makes this issue so profound, in my understanding, is the added layer of humiliation piled upon an experience that is already wrought with shame and guilt. In essence, the problem with sexual violence toward men is not only in the acts of violence, but in the inability for men to find their voice in coming forward and seeking help.

Where Do We Go From Here?

    As providers, we may have mixed feelings about how we would respond to a man who disclosed a history of being a victim of sexual violence. What is important to remember is that the same ground rules apply. We want to provide a space where the client feels open to discussing these issues. We want to always commend a disclosure of sexual violence and acknowledge the difficulties in choosing to come forward. In my experience, asking permission to discuss these issues during assessments goes a long way. This shifts back some of the power imbalance that clients have experienced in terms of their histories of past abuse, as well as the confines of their treatment (a big deal in inpatient psychiatric settings). In addition, men may not be in a place to view themselves as victims, so asking what their perceptions are can give us insight into a client’s thoughts and feelings about the impact the event has had on their mental health.  

     Once trauma has been assessed, aside from taking into consideration mandated reporter requirements, it is important to guide our clients and help them connect their past experiences with current behaviors. In the hospital setting, we discuss sexual violence or molestation as one of the most extreme forms of invalidation. When people are invalidated, they are told that their basic needs are not important, and their bodies are no longer their own. 

     The pain that results from an invalidating event can be compared to the pain inflicted by a burn. When someone is still healing from a burn, even the rush of air that passes over the burn is enough to cause someone to scream out in pain. In the same way, even a slight form of invalidation can affect someone who was emotionally burned in ways that others may be unable to comprehend. By comparing the pain of our clients to physical pain, we can guide them and their families to a greater understanding of how the wake of trauma can leave lasting implications.  

     In working with boys and men specifically, I believe that male providers have the opportunity to create a safe space in which their clients can feel comfortable with disclosing sensitive issues such as sexual violence. For myself, I struggled with figuring out how I could be this person, especially since I work on a very short-term basis with my clients. I found that the most helpful way I could do this was to be myself. I found success when I stopped giving in to my own thoughts that I had to have all of these magical answers to help my clients feel better. By being up-front and honest about our role with our clients, we can provide them with the trust that they likely have not experienced. I found after working with men and boys who have experienced these issues, the greatest positive impact I had on them was being another male who could be supportive and mirror a positive male influence.  

     Being this person has not been an easy journey. I found that I have just now begun to embrace my male clients. I realize now that I initially struggled in connecting with male clients because of my own trust issues toward other men. As social workers, it is important for us to recognize issues of our own and how those issues may affect our work.  

     The most beneficial part of this field placement was that it brought my own struggles into the light and allowed me to begin working toward improving my connections with male clients, and thus my effectiveness as a budding social worker. 

References

Centers for Disease Control and Prevention. (2005). Adverse childhood experiences study: Data and statistics. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.

D’Andrea, W., Ford, J., Stolbach, B., Spinazzola, J., & van der Kolk, B. A. (2012). Understanding interpersonal trauma in children: Why we need a developmentally appropriate trauma diagnosis. American Journal of Orthopsychiatry, 82(2), 187-200.

Heim C., & Nemeroff C. (2001). The role of childhood trauma in the neurobiology of mood and anxiety disorders: Preclinical and clinical studies. Biological Psychiatry 49 (12), 1023-1039.

Lalor K., & McElvaney R. (2010). Child sexual abuse, links to later sexual exploitation/high-risk sexual behavior, and prevention/treatment programs. Trauma Violence Abuse, 11, 159-177. 

Jesse Douglas Raynak, BSW, MSW, is a graduate of California State University, Chico. His internships were at an inpatient psychiatric hospital and case management services for low-income older adults. Jesse accepted a position with Sacramento County, working with children and families who have experienced abuse/neglect.