Tuesday, August 23, 2011

The Case Assange and the Misuse of the PTSD Diagnosis in Swedish Rape Trials

By Marcello Ferrada-Noli

“Evidence of PTSD occasioned by rape (or RTS) is not a scientifically reliable means of proving that a rape occurred. PTSD is simply a diagnostic category created by psychiatrists, it is a human construct, an artificial classification of certain behavioural patterns . . . It was not developed or devised as a tool for ferreting out the truth in cases where it is hotly disputed whether the rape occurred” (US Court statement in Spencer v. General Electric Co. 1988, at 1075) [21]

In this second part of the series Pseudo-Science in Swedish Rape Trials [22] I further introduce the inquiry into the scientific value of PTSD-diagnosis (posttraumatic stress disorder) at the Swedish courts, concretely as been issued by the "Emergency Clinic for Raped Women in Stockholm" (Akutmottagning för våltagna kvinnor - AVK, Söder sjukhuset) [23]. The analysis as such (to be publish in PART III) is made in the context of potential developments in the Assange case in Sweden. Several sources have elaborated on the eventuality that one woman-accuser of Julian Assange would have been “interviewed” at the said Stockholm rape-clinic for the purpose of documenting and certificate-issuing. The assumption derives from the fact  - as informed in the main Swedish newspaper Dagens Nyheter on July the 7th 2011 - the AVK clinic have issued forensic expert-statements (rättsintyg) at rape trials in "most of the rape cases in the Stockholm area" [24]. Secondly, the documentation and certificate-issuing done by the AVK includes areas of expertise far away gynaecology. They even issue psychiatric diagnoses!

The powerful role of this clinic in the course of Swedish rape trials can be measured by the huge number of expert statements the clinic issues every year to the courts, and which correspond to nearly 50 per cent of all cases processed by the clinic (265 out of 579 new cases in 2010) [24]. The Stockholm Clinic for Raped Women (AVK) started activities year 2005. After that very same year of 2005 the convictions for rape in Sweden increased from an average of 103 per year (period 1975-1980) to 220 per year [25]. The institution of the clinic has clear correspondence with the new Swedish legislation (2005) that widened the rape-concept.

Indeed, the Swedish politicians’ original initiative regarding the establishment of the AVK aimed to provide unbiased medical assistance and psychosocial support to women that have been victimized amid the horrors of rape and physical abuse. It was - and still it should be - a noble, progressive and needed enterprise. However, the hospital facility AVK has become notorious in the Swedish public instead for the following items:

  1. A reportage in the main Swedish newspaper Dagens Nyheter by journalist Stefan Lisinski titled “Clinic for raped women criticizes for certificate", 14 July 2011, picture above) [25] disclosed that the Clinic had issued deceitful statements on behalf of a plaintiff in a debatable case of rape-accusation. In concrete, an expert statement issued by the Clinic head Dr. Lotti Helström, and delivered to the authorities, described a fissure-like wound in the vagina of the plaintiff (the woman accuser) “which can have resulted of a violent vaginal penetration”. The statement was regarded as sufficient evidence for the arresting of the accused man.  However, a separate medical investigation conducted by a forensic doctor before the plaintiff’s visit to the AVK Clinic blunt contradicted Helström’s statement. The forensic doctor had not found such wound at all at the moment of the examination. Further, it was later established that the original file by AVK did mention only a “tiny” (svag) fissure, which apparently did not correspond to what Helström’s later manifested in her statement. The prosecutor decided ultimately to drop the case and the man was freed.  Lisinki’s reportage on the other hand was never published on-line by Dagens Nyheter, as it is customary with important articles of the kind regarding the Swedish legal system. In the context of the international discussion around the Swedish management of the Assange case, such attempts by the mainstream media to difficult access to information entailing critic to the Swedish legal system in rape trials is deplorable, and highly contra-productive.

  1. It became known that the Clinic head, Dr. Lotti Helström – also an Associate professor at the Karolinska Intitutet – although being a gynaecologist without specialization in psychiatry, had issued an undisclosed number of expert statements to the courts diagnosing mental status of alleged rape victims. Many among the cases have been diagnosed with Posttraumatic stress disorder, which is presented as causally linked to the alleged assaults. One of these cases - leading to conviction for rape 2009 and later acquitted at the Appeal court 2010 – [26] is analysed here in detail.

Further, Dr. Helström’s excursions in the field of public health and psychiatric epidemiology – while talking to the media or through other means in addressing the Swedish public or colleagues – have been various, erroneous and dangerously misleading. For instance, I will here comment her inaccurate statistical presentations on “violence of men against women” [27], in psychiatric populations [28] or her picture on the epidemiology of traumatic resulting in PTSD [29].

  1. Dr. Lotti Helström - also publicly known as radical-feminist activist - have repeatedly made understood to the media that a purpose of her mission and that one of the clinic would be the obtaining of a higher number of rape convictions at the Swedish courts. In this line, she regrets that the police authority does not fully take her documenting achievements at the clinic [30]. The Clinic is state-administrated (Stockholm's landsting) and public funded.

  1. With regard to the officially declared methods of work at the clinic, as well as the clinic’s stand on scientific objectivity: The head and employees at the clinic maintains that women coming to their examinations are “by principle” to be believed in every word, every statement, any detail and description of both the happenings they narrate as experienced, and – this is a crucial element in our analysis deployed in Part III – regarding the symptoms they say to bear. Only this fact - the official "clinical" attitude at the AVK - would be sufficient to scrutinize every and each of those certificates issued under such subjective premises. What is the point to bring at the courts "certification" of symptoms that are not medically verifiable? Or that they have not been clinically penetrated beyond the narrative of the subject interested in using such diagnose for litigation purposes?  One thing is in any case pristine clear: they should not be regarded as psychiatric diagnoses.

  1. Lastly, it became recently known through a reportage by Ewa Tures published 23 August 2011 both by Svenska Dagbladet (“Läkarråd om bröllopsblod ifrågasätts) and DN (id),  that the same Dr. Lotti Helström had previously issued while in her position at the Karolinska Institute o Karolinska Hospital the most peculiar professional advice to be reach by gynaecologists to immigrant young woman (born in what Sweden euphemistically calls “hederskultur” countries, i.e. "honour cultures"). In order to manifestly overstate a "virginity status" at their weeding night, what the Karolinska University Hospital [31] advices the girls is to puncture themselves with nails-like instruments to produce a certain bleeding. Thus, the immigrant men – supposedly ignorant chauvinist pigs born in "other" countries, a construction typical for Swedish radical feminists  - will be “in the worst case” deceived or in the best case reassured. The "Vårdprogram" Omhändertagande av kvinnor med oskuldsproblematik ("Care-managment of women with virginity problem") was published 2004 by Karolinska University Hospital and the Unit for Sexual Health (SESAM - Enheten för sexuell hälsa).

This is the the advice doctors should give give to the immigrant brides, according to the cited program authored by Karolinska Institute’s Assoc. professor Lotti Helström:

"Blood on the sheet can be achieved in different ways. Most effective is that she immediately after intercourse goes to the bathroom and stick herself in the inner labia. The stinging must be practiced at home in advance so that she should know how hard she must puncture and how much it hurts. (For) Which is worse: to be murdered or to puncture oneself? Hide the needle in the toilet bag, or in the wedding gown (pretending) it was left behind by the seamstress. In case of emergency use a safety-pin that can be hidden in the vagina or rectum.”

According to the article's author Ewa Ture, the counseling is contained in the Program ""Care-managment of women with virginity problem" (Omhändertagande av kvinnor med oskuldsproblematik) published 2004 by the SEASM unit at the Karolinska University Hospital.

The exact quote from the information included in the DN's article:  

"Så ska bruden sticka sig. Vårdprogrammet är skrivet av doktor Lotti Hellström och heter Omhändertagande av kvinnor med oskuldsproblematik. Det gavs ut 2004 av Karolinska sjukhuset och SESAM (Enheten för sexuell hälsa). Så här formuleras det råd läkaren kan ge till den blivande bruden: "Blod på lakanet kan åstadkommas på olika sätt. Effektivast är att hon omedelbart efter samlaget går på toaletten och sticker sig i inre blygdläppen. Sticket måste övas hemma i förväg för att hon skall veta hur hårt hon skall sticka och hur ont det gör. (Vad är värst:att bli mördad eller att sticka sig?). Göm nålen bland sybehör i toalettväskan eller i brudklänningens fåll (kvarglömd från sömmerskan). Använd i nödfall en säkerhetsnål som göms i slidan eller ändtarmen."

    Continues. . . in Part III

    Notes and References

    21. The full text of the quote is:

    “Evidence of PTSD occasioned by rape (or RTS) is not a scientifically reliable means of proving that a rape occurred. PTSD is simply a diagnostic category created by psychiatrists, it is a human construct, an artificial classification of certain behavioural patterns. RTS was developed by rape counsellors as a therapeutic tool to help identify, predict, and treat emotional problems experienced by the counselor’sclients or patients. It was not developed or devised as a tool for ferreting out the truth in cases where it is hotly disputed whether the rape occurred” quote found in “page 42 Restrospective assessemnts of mental states in litigation.” Robert Simon & Daniel Shuman

    22. M. Ferrada-Noli. Pseudo-Science in Swedish Rape Trials. With an Introduction on the Origins of State-Feminism in Sweden. The Professors blog, 29 July 2011

    23. In the AVK clinic homepage there is a link with an English translation

    24. Source: Stefan Lisisnski “Klinik för våldtagna kritiseras för intyg”. Dagens Nyheter 14 / 7 , 2011 http://maukonen.files.wordpress.com/2011/07/20110714_nyheter

    The article also reports that the AVK clinic "utfärdar rättsintyg för de flesta våldtäktsfall i Stockholmsområdet" 

    25. Source Wikipedia (Swedish): Sexualbrott i Sverige 

    26. SVEA HOVRÄTT DOM B 4280-10
    Avdelning 07 


    28. Lotti Helström, Arma själar del 3: Slaget om hjärnan. Dagens Nyheter, 27 October 2009

    29. Lotti Hellsröm, För kvinnofrid krävs insatser på alla fronter. Läkartidningen nr 7 2008 volym 105

    30. Dagens Nyheter. Nya metoder ska ge fler våldtäktsåtal. 25 November 2008

    media, journalists

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