Let us now consider the practical utility of the RSI model in light of the confusion the concept of PTSD (post-traumatic stress disorder) has created for legal proceedings concerning victims traumatized by crime.

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The medical concept of PTSD was introduced in Japan and began to be used in mental health practice in 1995, under the impetus of the Kobe Earthquake and the Tokyo subway sarin gas attack (Goto & Wilson, 2003; Norris, 2011). Because the concept of PTSD posits a causal relation between an incident and specific symptoms, it has been increasingly used in criminal prosecutions and in civil proceedings (-----, 2005).

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However, legal remedies for traumas have entailed many problems. The most fundamental problem is that the more severe the injury, the less access the victimized have to legal remedies  (Herman, 2005; -----, 2005). The RSI phenomenon appears here unmistakably.

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The reasons are as follows. First, when PTSD symptoms are too severe, the victimized cannot endure the requirements of the criminal process: reporting the injury to the police, attending repeated investigations, or testifying in court. One of the symptoms of PTSD is re-experience, when an apparently minor event causes a victim to vividly relive the terror of the crime. This compels survivors to avoid situations that may induce such a re-experience (Herman, 20051992/97). Also, PTSD is often accompanied by clinical depression, so the victimized might well be deprived of the energy necessary to file and pursue a claim for damages (Herman, 2005).

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Second, when the injury is serious and long-lasting, the victimized tends to be attacked by questions in the course of legal proceedings such as, ‘Why didn’t you seek help much earlier,’ or ‘Why didn’t you resist the offender before this much injury was done?’ The victim thereby loses credibility as a ‘guiltless victim.’ This victim-blaming, which happens often in cases of domestic violence and sexual abuse, further injures and demoralizes the victimized (Davies & Frawley, 1994; Gartner, 1999).

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Third, when the victimized person has severe symptoms such as flashbacks, panic attacks or dissociation, the police or the prosecution can mistake them for hallucinations or delusions, and as a consequence question the victim’s credibility or sanity.

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Fourth, for the victimized to go through lengthy criminal proceedings, there must be sufficient time, economic resources, and human support. But the more severe the symptoms, the greater the risk that victims will lose their jobs, their source of income, and the greater the risk they will experience relationships with others as burdensome, and thus often lose the necessary personal support (Herman, 1992/97, van der Kolk, 1996).

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This tendency appears to be even stronger when the crime is a sexual one. Japan’s system of criminal justice provides that most sexual offenses are subject to prosecution only upon complaint by the victim. But the stigma attached to the victimized is still huge. ‘Second rapes’ are frequent during investigation and/or court proceedings (-----, 2005). Thus, although I myself have treated many persons victimized by sexual violence, only a small minority has reported it to the police[i]. An even smaller number has obtained investigation or prosecution, or legal remedies[ii]. The vast majority suffer from traumatic symptoms, blame and shame themselves, and fear that their cases will come to be known. Although angry at the injustice that the perpetrators continue, with impunity, to live normal lives, they live in fear of them still.

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I am afraid that if we emphasize this phenomenon, people might doubt that a victimized individual who is able to stand up and claim to have PTSD actually has it. Are eloquent speakers only slightly injured? We cannot necessarily say so. Exceptional people do exist. Even if the injury is serious and other conditions are not favorable, some would manage to cling to the inner slope of the RSI and cry for help. Even if the symptoms are severe, some could find information about PTSD, through the internet, perhaps, to assess their situation and gain enough energy to go to a doctor. Of course, some might decide to sue the perpetrators, but then might need to stop fighting halfway through as their symptoms worsen, as if they are slipping down the slope toward the inner sea again.

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[i] According to a Japanese government survey, 7.3% of women experienced of being raped and 62.6% of them told no one about it. Only 4.1% of them went to the police (Naikakufu, 2009).

[ii] Improvements in the legal process such as shielding a testifying witness from view, or using in camera hearings to take testimony in private only began in 2000 in Japan.