As I write, I hear news of the attempted death of an unnamed victim who sprinkled petrol on her body and attempted suicide. The Lahore High Court (LHC) has announced that it will take notice of this suicide attempt by a mother of three children against the assault by the men of a landlord in Narang Mandi. This has led some observers to comment whether justice will only examine the facts of the unlawful act of rape and violence or will also look at the cause of the attempted death so it could at least be said to have been consistent. I was hoping that someone in our profession might, at some point, have elucidated a reason, or at least a clue, for the trail of quiet destruction among the helpless women we find occurring in our society but silence seems all that is likely to remain. It is a pity that mental health professionals and human rights activists and social media have not published their observations, as if we are getting immune and pathologically desensitised to the stories of death. However, I must end with the great leap of faith for humankind that maintains what is still left within us to take us forward. Thirteen of the fourteen men charged with raping Mukhtaran Mai were acquitted in a case that was appealed all the way to the Supreme Court (SC) in 2011. Many Pakistani women have committed suicide due to the psychological pressure and severe social stigma associated with rape and Mai admits that she tried repeatedly to end her own life. Instances of rape have increased from 778 in 2008 to 827 in 2011, with 928 in both 2009 and 2010. In 2012, the media covered over 150 reports on cases of rape and their follow-ups across the country but the actual number of incidents is likely much higher as the stigma of rape, arrests by police and low prosecution rates leaves this crime largely unreported. While statistics are few and far between, the Awaz Foundation Centre for Development has reported as many as 2,713 cases of violence against women in 15 districts of southern Punjab since January 2012. The shamefully unabated ‘rape culture’ continues to exist where men victimise women with impunity. The strongest factor in determining the psychological effects after rape is the character of the traumatic event itself. Individual personality characteristics count for little in the face of overwhelming events. Physical harm or injuries are also not as great a factor since individuals with little or no physical harm may yet be severely affected by their exposure to a traumatic situation. Trauma is usually compounded by the myths, prejudice and stigma associated with rape. Survivors who have internalised these myths have to fight feelings of guilt and shame. The burden can be overwhelming, especially if the people they come into contact with reinforce those myths and prejudices. Not only is there the element of surprise, the threat of death and the threat of injury, there is also the violation of the person that is synonymous with rape. This violation is physical, emotional and moral and associated with the closest human intimacy of sexual contact. The intention of the rapist is to profane this most private aspect of the person and render his victim utterly helpless. The character of the event is thus connected to the perpetrator’s apparent need to terrorise, dominate and humiliate the victim. Women, who are directed by society to stereotypical views of men occupying a position of dominance and authority relative to women, are treated as passive and submissive, hence may be at increased risk. Intense fear and helplessness are likely to be the core reactions to any sexual assault. As a crime against the person, rape is uniquely horrible in its long-term effects. It is the only crime where women are the majority victims. Statistics show that females attempt suicide more often than males. Prior to the assault, the rapist had been indistinguishable from non-rapists. After the rape, all men may be seen as potential rapists. For many victims, hyper vigilance towards most men becomes permanent. For others, a long and difficult recovery process must be endured before a sense of normalcy returns. In suicide, the closest diagnosis is depression and post traumatic stress disorder. Prosecution, sentencing and imprisonment, however, can have a positive effect in persuading men to take increased responsibility for their behaviour. Although it may be difficult if not impossible to detect someone who will commit rape, there are some characteristics that can signal trouble. Emotional intimidation in the form of belittling comments, bullying, death threats and sexual harassment may indicate high levels of hostility. Projecting an overt air of superiority or acting as if one is more powerful and resourceful than the other is associated with coercive tendencies. Threatening remarks and behaviours such as gang bullying, blocking ways or deriving pleasure from physically startling or scaring are forms of physical intimidation. Many of these characteristics are similar to each other and contain themes of hostility and intimidation. Maintaining an awareness of such a profile may facilitate quicker, clearer and more resolute decision making in problematic situations. Theoretical models of suicide suggest that suicidal behaviour is rarely the result of a single cause or event but rather depends on the cumulative and interactive effects of several social, environmental, familial, personality and mental health factors. These are likely to involve an underlying vulnerability to suicide, which becomes heightened under the influence of particular stressors. This is why it is essential that all legal, medical and police procedures must not cause further trauma to survivors who must be given all possible support to overcome and survive the ordeal. Courts are now beginning to use evidence of this kind in the trial stage of a court case as well as at the sentencing stage where the effect that the rape has had on the victim’s life is taken into consideration when sentencing the perpetrator. Clearly, there are distinct psychological clues left in the survivor’s mind that add up to the evidence of trauma of a very particular character that we know as the crime of rape. The writer is a member of the Diplomate American Board of Medical Psychotherapists, a fellow of the Royal College of Psychiatrists, Dip.Soc Studies, member Int’l Association of Forensic Criminologists, associate professor Psychiatry and consultant Forensic Psychiatrist at the Huntercombe Group United Kingdom. He can be reached at fawad_shifa@yahoo.com