The Gory Details: Asylum, Sexual Assault, and Traumatic Memory

Round 1

Reviewer 1 Report

 

Thank you for the opportunity to review ‘The gory details: Asylum, sexual assault, and post traumatic stress disorder (PTSD)’. This is a mostly well-written paper that is based on interviews with asylum seekers and a range of individuals who work in the asylum determination industry. The author uses her data to argue that the harm of rape evidenced by PTSD symptoms impacts how asylum seekers articulate stories of persecution. At the outset let me state clearly that I am very sympathetic to the overall aims of the article, and this review is an attempt to make the paper stronger, rather than to discourage its publication (or its author). That being said, the paper is based on interviews of more than two decades ago (something the author does not disclose except in the footnotes), and outdated references. For reasons I’ll set out below, I’m also not sure that the argument holds. I think the data need a major reconsideration, and the references a thorough revamp if the paper is to have relevance in 2023.

PTSD presentations, like most psychological diagnoses, vary widely from person, culture to culture, and context to context. Further, the author is not a mental health worker (to my knowledge) competent to diagnose her asylee-participants, nor does it appear that the asylee-participants have  been diagnosed by a qualified mental health provider. All we know is that these asylees present in ways that are consistent with a PTSD diagnosis. Given that all the asylee-participants, by definition, were not American, it seems to me that attempting to impose a western psychiatric diagnosis (line 279) on a group of people based on American criteria merely reproduces colonialism and the hegemon of a particular mental health worldview. To my mind it is no different that requiring asylees to meet American statutory definitions of rape or persecution which the author critiques. I have no doubt that this will be difficult for the author to hear. Nevertheless, I encourage the author to remove all references of PTSD from this article.

The good news is that I think this article would be much stronger without the distraction of PTSD lurking in the background. In fact, there are only a few sentences in the Discussion section (lines 1185-1196) that even allude to PTSD. Where necessary in the text I think the author can substitute ‘presentations consistent with trauma survivors’ (or similar) and leave it at that. PTSD is a notoriously controversial as a diagnosis, and in the event, it isn’t a diagnosis in this paper.  Relying on a catchall diagnostic category that has not actually been diagnosed weakens the overall impact of the paper. I don’t think there would in fact be much rewriting on this score—just revising the argument, introduction and conclusions.

I think a much stronger, and perhaps more important, paper lies between the lines. The stronger paper names cis-hetero understandings of penetrative sex as the sine qua non of a rape claim. The author could critique this understanding in law and in practice (she begins to do so when she claims that ‘asylum law is androcentric and gender based’, line 120). However, this claim is also weakened by presenting data from two gay men in the paper. Of course, their stories should be included, but they are men, which undercuts all the discussion about women in the introductory material—and I’m sure I don’t have to add that gay men are not the moral equivalents of women, which is one possible interpretation here. But equally, they are not cis-hetero men. A 2019 Women’s Refugee Commission study found that male migrants/refugees (in this case, to Europe)—and presumably asylum-seekers—are almost as routinely raped and sexually abused as women (https://www.euronews.com/2019/03/26/male-migrants-raped-and-sexually-abused-as-routinely-as-women-study-finds ) I have not researched extensively in this area, but it would not surprise me to learn that men less frequently disclose sexual assault, particularly to other men, for the same reasons that women do not: it re-enacts the humiliation and forces the disclosure of a stigmatised identity, quite probably to the very people who are stigmatising it. The citation the author includes about rape in men is from 2008, which to my mind is quite dated for such a current topic; there is much that has been done more recently in this area. It seems clear that the law (at least American law) requires a particular understanding of sexual assault in order to call it rape. The International Criminal Court (which I know America does not recognise, but much of the world does) has revisited its understandings of rape relatively recently, and it might add to this paper to compare American with international understandings of rape, particularly in the cases of war crimes and refugees. This would be useful because asylees will be coming from other countries, cultures, and understandings of sexual assault and rape. I would argue based on the author’s own research, that American asylum law is outdated because it relies on cis-hetero and exclusively western notions of sexual assault and rape. Has this law not been changed in two decades?

I am sure that the author has held on strongly to her argument throughout the study, but a self-critique by the author will need to address the point as to whether these notions of rape are not only dated, but overly limited. Another example of this is that the author does not include so-called ‘corrective rape’ (a term I use with the greatest reluctance) in her list of other sexual violence (lines 180-186), but surely gender or sexually non-conforming persons are being persecuted, raped (under the theory that once you’ve experienced male violence you will want more of it), and murdered as a class of people, particularly in southern Africa and the Caribbean. But it seems quite likely that if a victim of such rape presented for asylum to the US authorities they would not be recognised as persecuted survivors, even though their rapists may be the very police that have the responsibility of protecting them. That suggests a flaw in the law or the algorithm rather than in the way survivors present their stories.  

The author also relies on ‘all states that are signatories’ to the UN Convention on the status of refugees and the 1967 Protocol’; it is important to note that only 149 of the 192 UN member nations have signed one or both of these agreements, and it is even more noteworthy that many south and south-eastern Asian nations (including India, Bangladesh, Malaysia and others) are not signatories. This becomes particularly important when considering Rohingya refugees from Myanmar (I wonder why the author uses the colonial name ‘Burma’, line 406ff. without explanation? The regime may be genocidal, but they still get to define themselves in a post-colonial world).  The signatory issue isn’t central to her thesis, but it is worth noting that there is not global endorsement of these agreements with some very significant holdouts, which is itself problematic and worthy of consideration. If these nations did not sign because they did not want to have western notions or values thrust upon them, then we need also to interrogate the agreements.

While the materials and method section is detailed, it omits how the participants of the study were actually recruited and selected, and most particularly the asylee-participants which form the basis of this paper. If this was a sample of convenience, then that needs clearly to be stated. Were these participants selected by the researcher, or were they referred by officials, for instance?

Finally (and this may be part of the problem) of the 84 references cited (excluding interviews with the author, which I would note are now over 20 years old), 56, (66.6%) are more than 15 years old, and only two resources were published in the most recent five years. There are a number of journals that would not publish a paper that relied on such old data, but I can say that the author would certainly benefit from considering some of the more contemporary literature in the field. I acknowledge that quite a few of the citations are court cases, but again—are there no more recent decisions to consider? Has nothing changed in the last 20 years? We don’t know because the author does not include recent literature, data or developments. As I noted in my introduction, I think the paper needs a significant theoretical reconsideration to make the data and the literature relevant in today’s environment.

Minor issues:

Please clearly separate the quotations from the text, preferably by indenting them on both sides (since they are mostly over 40 words). As it is, it is easy to miss that you have shifted into participant quotations, and it is quite confusing.

Line 408: Burma—why not Myanmar?

Line 662: Do you mean ‘unspeakable’?

Line 900: spelling, I think you mean devastated.

Comments for author File: Comments.pdf

Author Response

Dear Reviewers,

Thank you for the opportunity to revise the manuscript. I have made the changes, please see the attachment.

Author Response File: Author Response.docx

Reviewer 2 Report

Thank you for this interesting, and often moving paper about sexual assault and PTSD in the context of asylum seekers into the US. It provides a series of important insights into the topic (including a background of legal definitions) 

The paper is well-written and structured, though in places it was difficult to differentiate interview excerpts from your own text. I’ll make comments and recommendations in each of the sections below. 

1. INTRODUCTION

This section provides a useful and detailed background to the topics being discussed in the main paper that I enjoyed reading. I also appreciated reference to the Dorfman text to illustrate the basis for discussions later in the text. 

 Several citations are relatively old – this is inevitable given the historic perspective you are taking, though it would be useful to see more information about the current status of some of the issues you address. Have things changed in the last decade for better or worse?

METHODS

This section provides useful detail of your methodology and the source of your data. I acknowledge that you’ve taken a qualitative, narrative approach, which is appropriate for the subject matter. However, I also note that the data were collected some time ago (the earliest 2001, and the most recent 2010). Given the methodology, this is less crucial than, say, quantitative scientific research, but I think the paper should reflect somewhere a comment on more recent events/examples/research to embed your findings into a more recent context. 

It would be useful to know a little more about your analytical approach for identifying the main themes. You mention content analysis – what did this entail?

I note that consent was obtained from respondents, and ethical approval granted for the study. 

RESULTS

These are described in depth, and several interview excerpts are provided to support the themes you describe. These are important stories (narratives) of personal experience and are often moving. That said, this section could be edited down to improve clarity on the main points you are making and the nuances between them. 

It is in this section that it’s sometimes difficult to differentiate between interview excerpt and your own text (e.g., lines 504-512). Can this be made clearer? 

DISCUSSION

This section draws together the results section. It’s structured like a summary of what has already been said, which is useful but could be made stronger by citations from other sources to add depth and validation to some of your important findings. Also, because the data are ‘old’, it would be important to add a comment as to the more recent situation, especially given the turbulence of politics around the issue of asylum seekers in the US and many other western countries over the past decade. 

Are there any limitations of the study that you wish to highlight here?

CONCLUSION

The conclusion is strong and appropriate – your recommendations are valid (perhaps even more so in 2023), and I especially appreciated the reference back to the Dorfman segment in the introduction. 

REVIEWER RECOMMENDATIONS

1.     In the introduction, if possible, add more material about the current situation regarding the status of asylum seekers in the context of sexual assault (I note that you do provide a 2019 source, but are there others?).

2.     In the methods section, provide few more details about your data analysis.

3.     In the results section, ensure clarity around what are excerpts and what is your own text. This may be a layout rather than textual issue. Also, consider editing some of these examples down so the points you are making are clearer. 

4.     In the discussion section, at the moment this is more like a summary of the results. This is fine (though could be more concise, perhaps?), but given the data were collected some time ago the discussion should refer in places to more recent studies and/or reports.

5.     Also in the discussion, are there any limitations you wish to highlight? Qualitative research by its nature has boundaries relating to the perspectives of the respondents and the author. What is your view?

Author Response

Dear Reviewer,

Thank you for the opportunity to revise the manuscript. I have made the changes, please see the attachment.

Author Response File: Author Response.docx

Reviewer 3 Report

 

first of all, I congratulate the researcher for their work. At a time when humanitarian medicine is more on the agenda, the elements emphasized by the study are very important. As much as I appreciate the importance I put in the content and the subject matter of the study, I have some concerns that need to be issued before publication.

Why does the author not mention the Istanbul Protocol? Such guidelines are very important in the context of asylum seekers and can't be ignored in the manuscript. Also, I'd like to know much about physical assessment of these problems, which are mainly psychological but in this context have more probability to be associated with physical violence.

Some forensic literature can be added, for example from Italy (Milan in particular) or France (Nantes for instance) where very attention seems to be paid recently.

Author Response

Dear Reviewer,

Thank you for the opportunity to revise the manuscript. I have made the changes, please see the attachment.

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

Thank you for the opportunity to re-review the paper now titled 'The Gory Details: Asylum, Sexual Assault, and Traumatic Memory'. I acknowledge and appreciate the author's attention to the original feedback, and in particular how she has addressed both the PTSD and referencing issues. I think the paper is much more focussed and stronger for it. The paper makes a powerful case, and I think including more up-to-date literature and context makes it even more powerful.

Just two minor editorial items to draw to the author's attention: In line 520 the use of 'subjects' in a social sciences paper is a little dated, and given the topic of the paper, a little incongruous. Consider using 'participants' instead. 

The sentence in line 1523 is awkwardly worded, and you may wish to consider rewording just that sentence. The meaning is well-concealed by the syntax. Neither of these editorial changes would require re-review.

Otherwise, I commend the author on work well done.

Author Response

Thank you for your suggestions. I made both of the editorial changes. Please see the attachment.

Author Response File: Author Response.docx