Hadi Wijaya
The experience of falling victim to sexual violence is a profound trauma that can shatter a child’s sense of safety and fundamentally alter their psychological development. Without immediate intervention, professional assistance, or sustained psychological support, these experiences frequently escalate into severe mental health disorders that can haunt a survivor well into adulthood. 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 consequences of such trauma are multifaceted, ranging from immediate emotional distress to chronic psychiatric conditions including anxiety disorders, clinical depression, bipolar disorder, psychosis, and complex personality disorders.
The psychological landscape for a child survivor is often a turbulent one, marked by a constellation of symptoms that manifest across physical, emotional, behavioral, and cognitive domains. Physically, the body remains in a state of high alert, often resulting in chronic headaches, heart palpitations, shortness of breath, gastrointestinal distress, and persistent muscle tension—a phenomenon often described as the body "keeping the score" of the trauma. Emotionally, the victim may be overwhelmed by waves of intense anxiety, anger, and profound sadness. These feelings are frequently accompanied by a sense of total isolation, loneliness, and the crushing weight of feeling ostracized from their peers and community.
Behaviorally, the impact is equally disruptive. Survivors often exhibit significant changes in their daily routines, such as disrupted sleep patterns, insomnia, or nightmares, alongside changes in appetite that can lead to eating disorders. Many become lethargic or "lazy" as a result of depressive symptoms, while others may display uncharacteristic aggression or a tendency to procrastinate on tasks they once handled with ease. Cognitively, the trauma impairs the brain’s executive functions, making it difficult for the child to focus, maintain concentration, or remember daily details. Decision-making becomes a monumental task, and the mind may become trapped in a cycle of repetitive, intrusive thoughts regarding the assault.
The Chronology of Trauma: Acute and Long-Term Phases
According to Dr. Lahargo, the psychological journey of a survivor typically unfolds in two distinct stages: the acute phase and the long-term phase. Understanding this chronology is vital for caregivers and professionals to provide the appropriate level of care at the right time.
The acute phase begins immediately following the incident and typically lasts for two to three weeks. During this window, the victim often experiences a profound state of cognitive and behavioral chaos. The emotional reactions can be unpredictable and intense; a child might fluctuate between uncontrollable sobbing and inappropriate laughter or smiling, which are often involuntary responses to extreme stress. Conversely, some victims may appear eerily calm and controlled, as if nothing has happened. Dr. Lahargo notes that this outward composure is frequently a mask for internal shock, terror, and deep-seated anger. These acute reactions are biologically driven by a fear of physical injury, a lack of safety, and a literal fear of death.
Once a sense of physical safety is established, the trauma enters a transitional period where new symptoms emerge. As the initial shock wears off, the survivor may begin to experience rapid mood swings. Feelings of humiliation, low self-esteem, and shame become prominent. The child may feel powerless and hopeless, occasionally harboring desires for revenge or, tragically, turning the blame inward. This self-blame is one of the most destructive elements of sexual trauma, as it prevents the survivor from externalizing the guilt that belongs solely to the perpetrator.
The long-term phase is characterized by the survivor’s attempt to reorganize their life and integrate the experience. Dr. Lahargo explains that this phase generally leads to one of two outcomes. In the first scenario, with a robust support system and professional help, the survivor begins to adapt. They slowly regain their ability to function, return to school or work, and eventually lead a productive life, though the memory of the trauma remains. In the second, more concerning scenario, the survivor is unable to adjust. The symptoms from the acute phase become chronic and entrenched, severely hindering their ability to perform daily activities and maintain relationships.
Factors Influencing Recovery and the Risk of Escalation
The ability of a survivor to navigate the long-term phase successfully depends on several critical variables. Age plays a significant role; younger children may find it more difficult to adapt because they lack the cognitive framework to process what has happened to them. Additionally, the survivor’s baseline personality, the specific circumstances of their life, and the strength of their "support system"—comprising family, friends, and community—are decisive factors in the recovery process.
If the trauma is not addressed with competent care, the risk of developing permanent psychiatric disorders increases exponentially. Survivors are at high risk for Post-Traumatic Stress Disorder (PTSD), characterized by flashbacks and avoidance behaviors. They may also develop psychotic disorders, where the individual loses touch with reality, experiencing hallucinations or delusions. Furthermore, sexual violence can lead to long-term sexual dysfunction or disorders in adulthood, as the survivor’s relationship with their own body and intimacy has been compromised.
Perhaps the most alarming consequence of untreated trauma is the risk of self-harm. Dr. Lahargo warns that when mental health issues are neglected, the resulting despair can lead to suicidal ideation or actual suicide attempts. This reality underscores the necessity of treating mental health as a primary priority in the aftermath of any report of sexual violence.
Statistical Context and the Need for Systematic Intervention
The insights provided by Dr. Lahargo are reflected in broader global and national data. According to the World Health Organization (WHO), approximately one in three women worldwide has been subjected to physical or sexual violence, with a significant portion of these incidents occurring during childhood or adolescence. In Indonesia, data from the National Commission on Violence Against Women (Komnas Perempuan) and the Ministry of Women Empowerment and Child Protection consistently show high numbers of reported sexual violence cases, with many more likely remaining unreported due to social stigma.
The enactment of the Sexual Violence Crimes Law (UU TPKS) in Indonesia marks a significant step toward legal protection, but experts argue that legal recourse is only one side of the coin. The "hidden" epidemic is the mental health crisis that follows the legal proceedings. Statistics suggest that survivors who do not receive psychological counseling within the first month of an incident are significantly more likely to develop chronic PTSD compared to those who receive immediate crisis intervention.
Therapeutic Approaches and Professional Support
Recovery from sexual violence is rarely a linear process and almost always requires a multi-disciplinary approach. Dr. Lahargo outlines several therapeutic modalities used to help survivors reclaim their lives. These include:
- Supportive Psychotherapy: Aimed at stabilizing the victim and providing a safe space to express emotions.
- Re-educative Psychotherapy: Focused on helping the survivor understand the nature of trauma and unlearning maladaptive coping mechanisms.
- Reconstructive Psychotherapy: A deeper form of therapy that seeks to rebuild the survivor’s personality and address the core wounds caused by the trauma.
In many cases, psychological therapy must be supplemented with psychofarmaca—medication managed by a psychiatrist. This may include antidepressants to manage mood, anti-anxiety medications to reduce physiological hyper-arousal, antipsychotics for those experiencing a break from reality, and mood stabilizers to address extreme fluctuations in temperament.
Beyond clinical treatment, psychosocial rehabilitation is essential. This involves reintegrating the survivor into society and ensuring that their environment—family, school, and neighborhood—is supportive rather than judgmental. "The hope for recovery is quite high if treatment is provided immediately by competent professionals such as psychiatrists, mental health nurses, psychologists, counselors, and social workers," Dr. Lahargo concludes.
Implications for Policy and Society
The analysis of the psychological impact of sexual violence suggests that society must shift its focus from mere "punishment of the perpetrator" to "holistic healing for the survivor." The implications are clear: mental health services must be integrated into the first-response protocols for sexual violence. This includes training law enforcement to be trauma-informed so that the process of reporting a crime does not further traumatize the child.
Furthermore, there is a dire need for public education to dismantle the stigma surrounding sexual violence. When a community supports a survivor instead of shaming them, the "support system" factor that Dr. Lahargo identified becomes a powerful catalyst for healing. The economic and social cost of neglected trauma—manifesting in lost productivity, healthcare expenses, and the potential for a cycle of violence—is far higher than the cost of providing comprehensive mental health care.
In conclusion, the path to recovery for a child victim of sexual violence is long and fraught with challenges. However, with the right combination of clinical intervention, family support, and societal empathy, the transition from "victim" to "survivor" is possible. The priority must remain the mental well-being of the child, ensuring that the trauma of the past does not dictate the possibilities of their future.
