Hadi Wijaya
The psychological aftermath of sexual violence, particularly when the victims are children, represents one of the most complex challenges in modern mental health and social welfare. Experts warn that without immediate and specialized intervention, the trauma of sexual abuse can escalate into chronic psychiatric conditions that fundamentally alter a person’s life trajectory. Dr. Lahargo Kembaren, SpKJ, a prominent psychiatrist and the Head of the Psychosocial Rehabilitation Installation at the National Mental Health Center, Dr. H. Marzoeki Mahdi Hospital in Bogor, emphasizes that the impact of such trauma is not merely emotional but deeply physiological and cognitive, necessitating a multidisciplinary approach to recovery.
The spectrum of psychological disorders triggered by sexual violence is broad and debilitating. According to Dr. Lahargo, victims are at a significantly heightened risk of developing anxiety disorders, clinical depression, bipolar disorder, and even psychotic disorders characterized by a detachment from reality. Furthermore, the trauma often manifests as personality disorders, which can affect the survivor’s ability to form healthy relationships and maintain stability throughout their adult life. The failure to provide adequate psychological support or counseling during the early stages of trauma often serves as the catalyst for these long-term mental health crises.
The Multidimensional Symptoms of Trauma
Trauma from sexual violence does not exist solely within the mind; it manifests through a complex array of physical, emotional, behavioral, and cognitive symptoms. This multidimensional impact often makes diagnosis and treatment challenging for those not trained in trauma-informed care.
Physically, survivors frequently experience somatic symptoms that lack a clear medical cause but are deeply rooted in the body’s stress response. These include chronic headaches, heart palpitations, shortness of breath, acute abdominal pain, and persistent muscle tension. These symptoms are often the result of the body remaining in a state of hyper-arousal, where the nervous system is constantly scanning for threats long after the danger has passed.
Emotionally, the toll is equally heavy. Dr. Lahargo notes that victims often grapple with intense anxiety, explosive anger, profound sadness, and a sense of pervasive frustration. A particularly damaging aspect of this emotional burden is the feeling of isolation. Victims often report feeling "different" or "tainted," leading to a self-imposed or socially-driven sense of exclusion. This loneliness can exacerbate the trauma, as the victim lacks the social buffers necessary to process their experiences.
Behaviorally, the disruption is often visible to those around the victim. Changes in eating and sleeping patterns are common indicators of distress. Some victims may become lethargic or "lazy," which is often a symptom of depressive withdrawal rather than a lack of willpower. Conversely, others may exhibit heightened aggression or a tendency to procrastinate on daily tasks, reflecting an internal struggle to focus or a subconscious attempt to regain control over their environment.
Cognitively, the trauma impairs the brain’s executive functions. Survivors often struggle with concentration and focus, making academic or professional pursuits difficult. Memory lapses and difficulty in decision-making are also frequent, as is the presence of "intrusive thoughts"—recurring, unwanted memories of the traumatic event that force the victim to relive the experience repeatedly.
The Temporal Progression: Acute and Long-Term Phases
Dr. Lahargo outlines a specific chronology for the psychological response to sexual violence, dividing the experience into two primary stages: the acute phase and the long-term phase. Understanding these phases is crucial for families and healthcare providers to offer the right support at the right time.
The acute phase typically occurs immediately after the incident and lasts for approximately two to three weeks. During this period, the victim’s internal world is often in a state of total chaos. Their behavior and thoughts may seem erratic or disorganized. Dr. Lahargo explains that emotional reactions during this phase can be unpredictable; a victim might cry uncontrollably or, paradoxically, smile and laugh without an obvious cause.
In some cases, the victim may appear eerily calm and controlled, as if nothing has happened. This is often a survival mechanism known as dissociation or "emotional numbing." Beneath this facade, the individual is usually experiencing profound shock, fear, and worry. These acute reactions are primarily driven by the immediate fear for their physical safety and the existential threat of death.
Once a sense of physical safety is established, the victim enters a transitional period where different symptoms emerge. This is when mood swings become more prominent, and the victim may begin to internalize the trauma. Feelings of humiliation, low self-esteem, shame, and helplessness often take root. In many cases, victims begin to blame themselves for the incident, a psychological phenomenon where the brain attempts to find a reason for the inexplicable violation they suffered.
The long-term phase is defined by the victim’s attempt to reorganize their life. Dr. Lahargo suggests that there are two primary paths in this phase. In the first scenario, with proper support, the survivor begins to adapt, regaining their functionality and productivity. In the second, more concerning scenario, the individual is unable to adjust. If the symptoms of the acute phase persist or worsen, they can become permanent fixtures of the individual’s personality, severely hindering their daily activities and long-term potential.
Factors Influencing Recovery and the Risk of Escalation
The ability of a survivor to navigate the long-term phase depends on several critical factors. Age is a primary determinant; younger children often find it more difficult to adapt because they lack the cognitive frameworks to process the violation. Additionally, the presence of a robust support system—comprising family, friends, and community—is perhaps the most significant predictor of a positive outcome. The individual’s baseline personality and the overall stability of their current living situation also play vital roles.
If these factors are unfavorable and the trauma remains unaddressed, the victim may spiral into severe psychiatric conditions. Post-Traumatic Stress Disorder (PTSD) is a frequent outcome, characterized by flashbacks and extreme avoidance behaviors. Even more severe is the risk of psychotic disorders, where the individual may experience hallucinations or delusions as their mind attempts to cope with the unbearable reality of their past.
Perhaps the most tragic consequence of neglected mental health care for survivors is the risk of suicide. Dr. Lahargo warns that when the burden of depression, shame, and hopelessness becomes too great, and when professional intervention is absent, survivors may see self-harm or suicide as the only escape from their pain.
Statistical Context and the Need for Professional Intervention
While the original report focuses on clinical observations, broader data underscores the urgency of Dr. Lahargo’s warnings. According to global data from the World Health Organization (WHO), approximately one in three women worldwide has been subjected to physical or sexual violence. In Indonesia, data from the Ministry of Women Empowerment and Child Protection (PPPA) and the National Commission on Violence Against Women (Komnas Perempuan) has shown a consistent rise in reported cases of sexual violence over the last decade. This increase is attributed both to a rise in incidents and a growing willingness of victims to come forward, thanks in part to the passage of the Law on Sexual Violence Crimes (UU TPKS) in 2022.
However, the "treatment gap"—the difference between the number of people who need mental health care and those who actually receive it—remains vast. Professional intervention is not just a recommendation; it is a necessity for recovery. Dr. Lahargo emphasizes that the hope for recovery is high if the victim is quickly connected with competent professionals, including psychiatrists, mental health nurses, psychologists, counselors, and social workers.
Therapeutic Approaches and the Path to Healing
The treatment for survivors of sexual violence is multifaceted, involving both psychological and pharmacological strategies. Dr. Lahargo details three primary types of psychotherapy:
- Supportive Psychotherapy: Focuses on providing a safe space for the victim to express their feelings and helping them manage immediate stressors.
- Re-educative Psychotherapy: Aims to help the victim understand their reactions and develop new, healthier coping mechanisms.
- Reconstructive Psychotherapy: A deeper form of therapy that addresses the fundamental changes in personality and self-perception caused by the trauma.
In addition to therapy, "psychofarmaka" or medication is often necessary to stabilize the patient’s brain chemistry. This may include antidepressants to manage mood, anti-anxiety medications to reduce hyper-arousal, antipsychotics for those experiencing a break from reality, and mood stabilizers to address severe fluctuations.
Beyond clinical treatment, psychosocial rehabilitation is essential. This involves reintegrating the survivor into society and ensuring they have the tools to lead a functional life. This stage requires the active participation of the family and the community. Dr. Lahargo stresses that the environment must be supportive and non-judgmental to prevent re-traumatization.
Conclusion: Prioritizing Mental Health in Legal and Social Frameworks
The insights provided by Dr. Lahargo Kembaren serve as a critical reminder that the impact of sexual violence does not end when the physical wounds heal or when the legal proceedings conclude. The mental health of the survivor must be the central priority of any intervention strategy.
For the state and society, this means moving beyond a purely punitive approach to justice. While the prosecution of offenders is necessary, the long-term health of the community depends on the successful rehabilitation of survivors. This requires increased funding for mental health services, the reduction of social stigma surrounding sexual violence, and the implementation of trauma-informed protocols across all levels of the judicial and healthcare systems.
As Dr. Lahargo concludes, rapid and appropriate handling is the key to recovery. By acknowledging the severity of the psychological impact and providing the necessary professional resources, society can help survivors transform from victims into resilient individuals capable of reclaiming their lives and their futures.
