Sexual Assault Survivors Who Are Mentally Ill Often Suffer In Silence

June 13, 2018

This piece was originally published here on


Content warning: discussion of rape


My name is Hollie Smith, and when I was 19, I was raped. After a night out on vacation, I woke up with a strange man holding me face down in a strange place, penetrating my body while I was unconscious.


It wasn’t until last year, when the #MeToo movement awakened, that I was finally starting to surface from the shame of my rape. I was inspired by the women who were tackling this difficult conversation, not living in silence anymore. A living statistic, I was no longer just 1 in 6 women, or 1 in 33 men, who report experiencing an “attempted or completed rape.” My voice was traveling in a crowd of brave, powerful, warrior females — finally. But my circumstance was still a nuance.


I live with a mental illness: rapid-cycling bipolar II and PTSD. According to the National Institute of Mental Health, 5.7 million adult Americans live with bipolar disorder, and by some estimates, women with disabilities, mental illness included, are four times more likely to experience a sexual assault than women without.


But we aren’t talking about it.


And though I want to shout about #MeToo from the rooftops, and stand firmly behind its message of empowerment, this movement has the same problem that our society is facing daily: It excludes those of us who fall into the category of “minority” from its narrative.


That’s missing the point, though, because mental illness and sexual assault are, almost inherently, connected.


According to Dr. Sal Raichbach, a practicing psychiatrist at the Ambrosia Treatment Center, which provides evidence-based behavioral health treatment nationwide, “Sexual assault can have a variety of impacts on the mental health of the victim. Victims are much more likely to develop a mental illnesses, such as addiction, depression, anxiety, and PTSD. Victim-blaming often compounds these issues, forcing many victims to live in shame and keep an attack secret.”


It can go the other way, too. As Dr. John Huber, chairman for Mainstream Mental Health, explains, “people with mental health issues are more likely to be victimized in the first place. The perpetrator likely sees the individual as an easy target, less likely to retaliate or tell someone else about an encounter because of their mental state.”


Huber adds, “More mentally ill individuals are victims than they are perpetrators of violent crime, but a mentally ill individual’s concept of consent can surely be skewed by their disease or condition.” In other words, “individuals that suffer from mental illness are at an increased risk for sexual assault as a result of their mental illness,” in part because their mental illness can have an impact on judgment. “Bipolar disorder may interfere with the individual’s ability to stay reality-based and to take excessive risk such as a willingness to participate in unprotected sex or participate in anonymous sexual activities.”


This isn’t victim-blaming but identification of a real risk factor, since, as Dr. Laura McGuire, sexologist and consultant, explains, “consent is the dividing factor in whether something is sex or assault. Consent has many dimensions and factors; it must be continuous, clear, affirmative, non-coerced, and between people of sound mind and body.” Unfortunately, the line of consent can be blurred in adults with mental illness.


With a mental illness such as bipolar, hypersexuality is a symptom that can firmly blur the lines between what is consent and what is not. Dr. Huber told me that, “hypersexuality creates special situations where the mental illness drives the desire for sex but makes the decision to participate in sex problematic.” He continued, “the individual in a manic hypersexual state is not in their right mind and may not fully comprehend the potential ramifications of the sex act at hand. This creates the illusion of consent but may not be consent as the person’s judgement is clouded by their mental illness.”


That’s one reason why I spent two years after my assault in silence. I was told by others that my alcohol intake, my leather dress, and the hypersexuality that’s symptomatic of my bipolar disorder meant I was “asking for it.” And at 19, I was suffering my first clear spike of hypomania, so I knew my own concept of consent would be questioned, especially if I went to the authorities. “How did you know them? What were you wearing? Were you intoxicated? Did you lead them on?” And my all time favorite: “Are you just saying this for attention?” It was only after a nervous breakdown that I was able to confide in a family member that I was sexually assaulted.


I was flooded with systemized shame.


Even though I was in a manic state, I was also unconscious. This is a situation in which consent went beyond my mental illness. But it was still presumed that my hypersexuality and flirtatious behavior in my manic state led to the illusion that I gave this consent. Because I am mentally ill, I am part of a community that is taught to keep our mouths shut and not to bring more shame to ourselves. Those of us with mood disorders are so frequently told that everything is in our heads, that we don’t think anyone will believe us if we come forward.


Because I am mentally ill, I am part of a community that is taught to keep our mouths shut and not to bring more shame to ourselves.


“The mentally ill start with a disadvantage, they have an invisible illness,” Melony Hill, author, life coach, and advocate, told me. “People have a hard time understanding what they can’t see…and they can’t even attempt to relate to.” Hill, who started her own site, Stronger Than My Struggles, about her experiences as a legally, emotionally disabled woman, explained, “What they do see, is a mentally ill person who requires extra attention, care, and understanding. In today’s fast pace, instant gratitude world, that’s asking the world of some people.”


That’s one reason why we need to actively include this minority in the conversations around sexual assault and #MeToo. “We need safe spaces where the mentally ill, at all levels, can get free and affordable therapy and resources. They need to be able to report a crime against them to trained staff who know how to work with trauma victims and the mentally ill,” said Hill, especially since both groups are so intertwined.


Huber agrees: “We need to discuss mental illness and sexual assault in terms of legal responsibility and awareness.” That might even mean adjusting the definition of consent. As Huber explained, “If an individual knows that an individual with a mental health issue is having a manic episode, then engages them in a sex act that they have said ‘no’ to in a normal mental state, they may be committing a sexual assault.”


It’s only by having these conversations about mental illness and sexual assault that we’ll be able to define these boundaries. And the more people who talk about this subject, the closer we are to shedding a light and encouraging resources to be allocated for mentally ill warriors. We refuse to be quiet and marginalized anymore.


If you or a loved one is affected by sexual abuse or assault and need help, call the National Sexual Assault Telephone Hotline at 1–800–656–4673 to be connected with a trained staff member from a sexual assault service provider in your area.

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