Visible Support for the Invisible Pain: Psychiatric Service Dogs and Sexual Assault Survivors

After completing an investigative inquiry on the relationship between sexual assault and Post-Traumatic Stress Disorder, I asked myself what a possible solution could be. Psychiatric Service Dogs were a possible solution that I discovered, yet they were not being used in any amount of mass popularity though they proved to be helpful in a victim’s healing process. This paper delves into the question, “Why are service dogs not widely used to improve the quality of life for sexual assault survivors?”

Visible Support for the Invisible Pain: Psychiatric Service Dogs and Sexual Assault Survivors

Over the past few decades, the mental health industry has grown in understanding phenomenally. Much of this is due to breakthroughs in medicine and technology. But what if there was a method of treatment that has been accessible for centuries, yet is ignored and underfunded in today’s society? One may ask how this could be, and the answer is capitalism. If this treatment is not an object “big pharma” can profit off, it has very little hope of widespread popularity without intentional awareness being brought to the public’s attention. Psychiatric Service Dogs (PSDs) have been proven to lessen symptoms of mental illness and allow their human companions to become less dependent on drugs, they show promise in improving the lives of sexual assault (SA) victims yet because of lack of research funding and the high cost of training the animal they are not widely used aside from military veterans suffering from PTSD.

Introduction of Psychiatric Service Dogs

A common image of a service dog is a seeing eye dog, yet there are many other disabilities that can be mitigated with the help of a service dog. Marshall specifies a PSD as the following: “A service dog trained individually to mitigate the effects of their disabled partner’s psychiatric disabilities by performing specific tasks” (Marshall, 1998). The intention of including PSDs in mental health treatment is to mitigate the handler’s symptoms and improve quality of life through independence (2012). There are different tasks a PSD can be trained to perform. One of the most relevant tasks is an alert, which is an extremely important action to many who suffer from seemingly random panic and anxiety attacks. An alert is an immediate and obvious change in the dog’s behavior, often manifesting in an act of barking, jumping, or pawing to attract the owner’s attention. The dog is trained to alert once they sense a rise in the handler’s blood pressure or heartrate, or sporadic breathing. An alert allows the handler to realize what is happening and to curb the effects before they become full blown (Marshal, 2012).  Reports were made specifying how have a service dog has changed a person’s life. One testimony being, “Robert discussed how even signing up for the training with Amy had pushed him to go back into public spaces and to attempt things that he had not been comfortable doing for years. He also discussed how having a goal to work towards gave him strength” (Marshall, 2012). Another testimony states the following, “I mean, it’s been life changing. It’s given me more of a clear path and direction as to where I want to be a few years from now. It’s given me more hope and light at the end of the tunnel. I can accomplish things; I can get back to some type of normalcy” (Marshall, 2012). Though these animals bring great joy, a “conservative estimate” of the number of PSD-handler teams determined by the PSDs equaled 10,000 (NIMH, 2017). This number is minute compared to the amount of PSDs that could possibly be used today.

Psychiatric Issues and Current Relations to PSDs

Mental disorders are prevalent in today’s society. Studies funded by the National Institute of Mental Health found that major mental disorders cost the nations at least $193 billion a year in lost earnings alone. Combined with disability benefits and health care expenditures, the total cost of major mental illness to the nation is over $300 billion a year. According to studies by the National Institute of Mental Health, 46.4% will be expected to experience a diagnosable mental disorder in their lifetime. Only 39.2% of those with a diagnosed disorder receive mental health services (2017). This should lead to asking the question, would PSDs lower this cost? PSDs are a small investment that could save this nation billions of dollars annually, yet private insurance agencies do not currently subsidize PSDs for mental health treatment though they have been proven to alleviate symptoms. This is worrisome as PSDs have been proven to be beneficial to those suffering from mental illness. Studies have been done to look at how PSDs may help those with PTSD.

Newton’s research found that:

“On July 22, 2009, Senator Al Franken introduced bill S. 1495, the Service Dogs for Veterans Act (SDVA) of 2009, as his first piece of legislation. The Act requires the VA to begin a three-year pilot program “to assess the benefits, feasibility, and advisability of using service dogs for the treatment or rehabilitation of veterans with physical or mental injuries or disabilities, including post-traumatic stress disorder.”

            Another issue those whom rely on PSDs face is discrimination due to the lack of visible disabilities. Due to the invisibility of mental illness and PTSD, PSDS are often discriminated against in public, illegally being barred from access to locations protected by the ADA. There is also no certification that proves a PSD is legitimate, and a rise in fake service dogs has caused suspicion against anyone who is not obviously handicap (Newton, 2014). In a study, Newton observed that, “Every participant had experienced having someone ask them to leave their place of business or tell them that they were unable to bring their dog with them inside. For some participants, it was a small inconvenience that could be dealt with either by going to another business that did not object or by explaining their legal rights to enter as the dogs were licensed service dogs (Newton, 2014).” This issue, though not wanted, should not effect how many people look to PSDs to improve their quality of life.

Sexual Assault and Psychiatric Disorders

Rape is traumatic because it includes a loss of control over one’s body during assault. This can lead to a shattering of women’s beliefs about their own safety in the world. In a study done by Chang et al  involving female college students, it was discovered that female victims of sexual assault, compared with nonvictims, reported significantly greater depressive symptoms (2014). General Anxiety Disorder (GAD) is another mental disorder alike PTSD that SA victims often acquire after an assault due to the change of perspective while looking at the world around them. GAD often affects a person’s quality of life as “individuals with GAD experience frequent feelings of anxiety and worry about several events or circumstances, which they find difficult to control. This condition has lasted for at least six months prior to diagnosis (Holmes, 1998).” In her research, Kolk found that victims rarely suffer from flashbacks like war veterans and instead their symptoms mainly include being unable to be present and calm, being “out of it,” being overwhelmed by rage, and lacking meaningful involvement with their current lives (2013). A large majority of rape survivors suffer from intense psychological reactions directly after the attack, and often lasts for up to three months. Severe symptoms lasting longer than this acute phase is what most diagnose as PTSD. The definition of PTSD has newly changed, the greatest difference is the shift from an anxiety disorder to a new category of trauma. The diagnosis has remained mainly stagnant with symptoms including recurrent, involuntary and intrusive distress memories, avoidance of distressing memories and thoughts, as well as hypervigilance.

Many victims begin to show symptoms of PTSD after losing important societal connections and ties that are severed after an incident. Individuals blame themselves for the assault due to making choices that allowed the incident though legally they cannot be faulted for. This type of self-blame often comes up in dialogue as “I should have left the party earlier,” or “I could have parked somewhere else.” It is completely irrational, as no one could possibly know the future. These thoughts are illogical, but often put much weight on a victim as they try to discover what could have possible prevented their assault. No one is at fault except the person who decided to prey on another. In Miller’s paper, “Self-Blame Among Sexual Assault Victims”, ‘‘The locus of violence rests squarely in the middle of what our culture defines as ‘normal’ interaction between men and women.’’ (2007) She found that in her study, 73% of rape victims directly denied that they had been raped. One theory to explain this curiosity is that because violent and crass behavior is expected of young males, female victims do not believe their experience was anything out of the norm nor anything worth reporting. The tendency to blame women for their victimization is internalized by victims, leading to statistics reporting of hiding victimization rather than reporting it. When initially seeking help after an assault, these women report of disturbances in sleep patterns, sexual function, appetite, and spoke of assault-related fears. Even with these severe and often life-altering symptoms, only a total of 31% of victims returned to a follow-up visit, most never seeking psychological help again afterwards (Holmes, 1998).

The Possible Benefits of Paring PSDs with SA Survivors

Animals are known to serve as social lubricants by stimulating conversation and facilitating human-interaction. The study  done by Holmes showed that female abuse survivors who were paired with a PSD after being diagnosed with PTSD resulted in increased self-esteem, feelings of empowerment, decreased anxiety and decreased depression. One argument for the use of PSDs is the fact that they are a non-invasive form of therapy (1998). PSDs are able to reduce their handler’s symptoms without the use of medication or allow their handlers to become less dependent on traditional medication. This allows those affected with mental disorders to avoid unwanted side effects and reducing or removing medication can increase the treatment options of possible other health conditions. Animal therapy is not widely used in western-medicine, though there are many types that have been proven to do wonders for those who utilize the human/animal bond.

Marshal references a study by Meinmersmann that looked at the cost effectiveness of Equine-Facilitated Psychotherapy with female abuse survivors. Participants found that they experienced much more dramatic results within a short time period compared to traditional conversational psychotherapy. Though the equine therapy did cost more per session, the fast results made it less expensive overall to get the same results of conversational therapy (2014). Service and therapy animals are used in many different situations. The cost would not differ greatly from traditional therapy if insurances covered the same amount as they did for conversational therapy.

One type of therapy dog that has become popular in recent years is a Residential Mascot (RM) (Marshal, 2012). These dogs live in a facility, often nursing homes, and provide emotional support for residents. Not only do they offer support, but they create and facilitate an atmosphere of social bonding within the facility. One issue many SA survivors struggle with is withdrawing from society after the attack and the use of dogs in this context would surely mitigate symptoms.

PSDs are trained to perform tasks to assist their handler in everyday living and many tasks these dogs are trained for would be beneficial to SA survivors. Some of the most often seen tasks include: Alerting a handler to mounting anxiety levels, proving reality to a handler believed to be hallucinating, rousing a handler when sedated in the presence of danger, forcing a depressed handler out of bed with persistent activity, using their bodyweight to perform deep pressure therapy with handler, interjecting when handler begins to self-harm, alerting and rousing handler during night terrors, turning on lights during night terrors or panic attacks, providing a barrier in public places, alerting to the presence of others in an environment, “clearing” a home for intruders before the handler enters, finding exits during panic attacks, and grounding a handler in the present during flashbacks of an assault (Marshal, 2012). This disbands the claim that PSDs do nothing more than offer companionship. Though companionship is an important part of the works these animals do.

 In Newton’s study of pairing PTSD suffers with PSDs, most participants recorded that they felt as if they had lost all hope before beginning the study. All participants expressed great improvement once they were paired with a PSD. After obtaining their PSD, participants reported that they were able to venture into public spaces with far less anxiety and were able to return to feeling like “a normal person”. All participants reported a decrease in their dependence of medication after receiving their dog. This is included in the six most reported side effects of receiving a PSD. The six are decreased fear of public spaces, decreased anxiety, decreased depression, nightmare interruption, medication reduction, and compatibility with other treatments (2014). To say anybody with a mental illness should get himself a dog would be irresponsible. If a person can’t go into public spaces without their dog, that’s a condition that should be treated, not encouraged. These animals should be used to help a victim through recovery rather than become a crutch for one to lean of for the rest of their life.

PSDs Act as a Physical Testimony

When a veteran returns home from war, they will not be forced to testify to prove the fact that they had been in the military. They will not be asked what they were wearing when a bomb was set off. They are socially accepted as a hero who sacrificed for their country. These are not the same reactions that SA survivors receive when they express their ordeal. A study by Ullman in 2014 looked at how reactions of loved ones and strangers effected a woman’s healing process after SA. Common negative social reactions to the disclosure of their ordeal include victim blaming, attempting to force the victim into an action (ex: telling the police), or focusing on how the disclosure impacted their relationship with the aggressor rather than caring for the victim. As predicted, negative social reactions to a victim speaking on the SA was related to greater PTSD symptoms. This is because negative social reactions to assault disclosure were associated with less perceived control over recovery, causing a victim to deem the world around them as unsafe and feel the need to protect themselves accordingly with damaging coping habits (Ullman, 2014). A PSD could be useful in curbing these habits. Using a dog to be aware of surroundings allows a handler to feel as if they no longer need to be on-guard at all times. Having a larger animal in proximity is it’s own measure of safety as a possible assailant may be more hesitant to act than if a female was walking alone.

Necessary But Not Profitable

PTSD has in the past, been closely related to those in combat. Yet SA victims are diagnosed with the disorder at a 10% higher rate than veterans. Today, almost all media attention, research, and funding regarding PSDs is associated with the military and the expanding population of veterans coming home with PTSD symptoms. Increasing amounts of privately funded nonprofits provide service dogs to veterans at no cost. One reason PSDs are used at a higher capacity with veterans is because most civilians do not have the resources to pay for a $20,000 animal. Service dog research is scattered and underfunded as pharmaceutical companies aren’t interested in non-drug therapy (Jacobson, 2014). Though insurance companies do not cover service dogs, the federal government is looking at whether to provide them in certain cases to veterans. After dogs proved to be helpful with wounded Iraqi war veterans, this year the Department of Veteran Affairs kicked off a three-year study to assess the benefits. The VA is reimbursing nonprofit organizations $10,000 for each dog they provide to a veteran (Patriot-News, 2010). No such federal program exists for SA survivors.

One reason that PSDs may be especially beneficial to SA victims is because they are often abused by people close to them and can have more issues with trust and relationships than people who have suffered trauma like a natural disaster (Jacobson, 2014). Nancy Fierer, the director of Susquehanna Service Dogs, said 70 percent of people who need dogs can’t afford them. While the organization offers financial assistance for some and won’t turn away anyone in need, not being able to pay the fee extends how long a person has to wait for a dog. Those who receive a dog are required to pay $5,000 — an amount that is sometimes hard for those suffering from disabilities to pay. It costs the organization approximately $20,000 to train a single dog (Patriot-News, 2010). This would be considered cruel to withhold treatment if it was in any other form,

Sexual assault is prevalent in today’s society, yet it is only recently being accepted that women cannot just get up and walk away from said ordeal. PSDs are a way not only to improve the quality of life for a SA survivor, but also create awareness for the problem that is mental health disorders. PSDs should become more accessible to those in need of them, just as any other treatment should be. Dogs should not be used as a crutch to walk with the rest of a SA survivor’s life, but a tool to be used in healing. This can only become a norm once both the work service dogs do and the trauma of sexual assault is taken seriously by the general public.

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