By Alberto M. Goldwaser, MD, DFAPA
Cinderella – the persecuted heroine – was forced to perform with the enticement of an immediate reward (going to the party), and a promotion of sorts (being treated equally). The Little Mermaid picked out (teased) her suitor, pursued him, and after a long, far-reaching, and conflicted relationship, she ended up down and under.
Just as rape is a crime of violence, nor of sex, sexual harassment is a manifestation of power, not of seduction.
According to the United States law, sexual harassment is a form of gender discrimination in employment that is prohibited by title VII of the Civil Rights Act of 1964. In 1980, the Equal Employment Opportunity Commission (EEOC) issued its final guidelines of sexual harassment: “Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature constitute sexual harassment when (1) submission to such conduct is made either explicitly or implicitly a term or condition of an individual’s employment, (2) submission to or rejection of such contact by an individual is used as a basis for employment decisions affecting such individual, or (3) such conduct has the purpose or effect of unreasonably interfering with an individual’s work performance or creating an intimidating, hostile, or offensive working environment.”
The first two situations described in the EEOC guidelines corresponds to what is called “quid pro quo” sexual harassment, a form of sexual harassment in which sexual compliance is exchanged, or proposed to be exchanged, for an employment or academic opportunity. In quid pro quo behavior, the coercion behind the advances is brought to light by the reprisals that follow a refusal to comply. While quid pro quo harassment requires a difference in power between the perpetrator and victim, the last situation (3) does not. It sis called the “hostile environment” sexual harassment.
A less clear, yet more pervasive situation involves persistent behavior that simply makes the work environment unbearable.
In short, sexual harassment has two forms: (1) quid pro quo (by manager or supervisor), as in the classic situation when a manager requests sexual favors in exchange for promotion; and (2) hostile work environment, if the harasser is a co-worker. In this type, the standard (respondeat superior) is that the employer knew or should have known and did nothing to remedy the situation.
Sexual harassment covers a diverse group of behaviors. It includes remarks of a sexual nature, such as repeated requests for dates, whistles, staring, and sexual propositions not directly linked to employment, as well as unwanted physical contact of a non-sexual nature. The harassment can escalate to sexual propositions linked to job enhancement or job threats, unwanted physical conduct of a sexual nature, sexual assault.
Perceptions of behavior as sexual harassing differ according to the type of person that experiences it as offensive. It greatly depends on what’s called the pre-trauma risk factors.
A “reasonable woman” standard is used in sexual harassment cases for both genders, primarily because the sexually blind reasonable person standard tends to be male-biased and to ignore the experiences of women. A victim may choose to submit to the harassment, ignore the behavior, avoid the perpetrator, confront the perpetrator, change jobs or class, report the behavior to a superior or a grievance committee, or seek legal assistance. The last two routes are infrequent. They are uncertain that reporting harassment can help them in any way and are concerned that it can hinder their personal, occupational, or educational progress. There is a sense that while formal action tries to assess the guilt or innocence of the alleged harasser, informal efforts try to put an end to the problem.
Psychiatric experts perform an examination for the purpose of fact finding and evidence gathering. We rely on historical reconstruction by using the interview with the plaintiff and perusing legal and medical documents.
The role is to help the attorney prepare for deposition of an adverse expert. This includes review of the adverse expert’s report and notes, consulting with the attorney regarding issues likely to be important, and playing a role in deciding whether plaintiff should attend depositions of the adverse expert.
The forensic psychiatrist can serve several functions as expert witness in sexual harassment cases. This encompasses evaluation of the presence or absence of preexisting psychological disorders, the psychological injury attributable to the harassment, the relationships between preexisting disorders and posttraumatic symptoms, or the prognosis for future disability and necessity for treatment with some estimate of cost to the plaintiff.
Above all, the expert witness has to be able to educate the jury by explaining (digesting) what “trauma” is, how it comes to happen, and how it applies or not to the case in question.
The credibility of the plaintiff – even though this is for the jury to determine – can be touched upon based on the study of the underlying personality style, as well as the risk of re-traumatization in the course of litigation. Issues of sincerity relate to the overall examination of the plaintiff’s social, occupational and, critically, mental functioning, rather than concentrating on the narrative style of the event(s) reported by the plaintiff. For example, calmness may indicate malingering, or, in contrast, a symptom of the plaintiff’s disorder (e.g. dissociation).
The goal is to advocate for one’s expert opinion, rather than for a social cause that repudiates harassment.
The forensic psychiatrist participates in elucidating its occurrence (did it happen?), but predominately, if it indeed happened, whether psychiatric affliction is present or not in its aftermath, and it quality and quantity.
The literature suggests that sexual harassment is a widespread phenomenon affecting 42% of women and 15% of men in occupational settings. Despite the pervasive nature of this problem, only 1-7% of victims file formal complaints.
Sexual harassment produces an array of psychological and psychophysiological symptoms in over 90% of victims and 12% seek help from mental-health professionals. Self doubt is a central issue regardless of gender.
It is critical that therapists avoid blaming the victim. Empathy, validation and empowerment are the key therapeutic tasks.
Sexual harassment is a destructive behavior that can cause profound psychiatric problems for its victims, who commonly keep quiet about the offense. If it happens in the clinical (medical/psychiatric) setting, it is called sexual misconduct, or boundary violation.
Sexual harassment is different from flirtation, flattery, a request for a date, and other acceptable behavior occurring within the workplace or the classroom. It lacks the elements of choice and mutuality inherent in a normal relationship. It is also distinct from other forms of harassment that do not involve conduct of a sexual nature.
Harassment may be motivated by race, religion, and politics. In addition, it is distinct from rape. It is a type of sexual coercion that relies on the power of the perpetrator to affect its victim’s economic, occupational, or academic status, and does not necessarily involve physical force. It has the potential to affect its victim’s ability to perform on the job or in school, their career opportunities, their personal relationships, their self-esteem, their psychological well-being, and even their physical health.
Victims report a wide array of symptoms, including anger, fear, depression, crying spells, anxiety, irritability, loss of self-esteem, feelings of humiliation and alienation, and a sense of helplessness ad vulnerability. There are also symptoms of psychological sequelae, such as headaches, decrease or increase in sleep and appetite, weight loss or gain, respiratory and urinary symptoms.
The list of the above reported symptoms needs to be fastidiously and sensibly examined. Moreover, the likelihood of symptoms is directly associated with the quality and severity of the behavior in question and the possible risk factors already present in the victim.
Victim’s initial reactions (reasonable woman) to sexual harassment are typified by self doubt and confusion. They often feel guilty and wonder whether they might have caused and/or encouraged the behavior. They may minimize or deny what has happened, in part because it is frightening to realize that those in positions of authority may be neither just nor trustworthy.
Eventually, anxiety – an unpleasant emotion related to the idea that something bad is about to happen – is replaced by depression, an unpleasant emotion related to the idea that something bad has already happened. Self-confidence erodes to the point of crisis. According to the quantity and quality of the pre-trauma risk factors, a turning point may occur, and the victims may become angry, answer their own questions of self blame, and determine that their civil rights had been violated. Responses from passivity and resignation, to activity and accusation depend on the predisposing, determining, and triggering traumatic factors, as well as on the victim’s personality structure (habitual or characteristic way of responding to difficult or afflicted situations).
If a person chooses to stay in the situation where there is harassment, victimization will be reinforced, with feelings of helplessness, humiliation and anger are heightened by remaining silent. If on decides to quit one’s job or to drop course, then the consequences are profound in terms of tangible losses as well as the loss of self respect. And, as it happens in all other examples of harassment/discrimination, if the victim files a complaint while remaining at the same job, the work environment may actually become more stressful. Grievance procedures can thereby accentuate feelings of isolation and anger.
The victim experiences a “second injury” (re-victimization) if there is a retaliation by the perpetrator, a disappointing institutional response, lack of support from coworkers, insensitivity or blame at home or a lengthy, and unsatisfactory grievance procedure. The victim then again feels isolated and vulnerable; thus the basis for the development of depressive symptoms is formed. It engenders loss. There are tangible losses: of a job, seniority, promotion, or income. There is a loss of professional/occupational performance, lack of the guarantee of another, at least similar position and of time while living through the crisis. We also see intangible losses of confidence in one’s ability and of enthusiasm at work.
People who have been assaulted without a great deal of physical force are especially prone to self blame and adjustment disorder. Aggressive acts (sexual harassment being one example) can invoke intense anger, the expression of which is “unfeminine” and destructive in relationships.
Many victims appear “unstable” by the time they seek psychiatric care. The therapist may be inclined to suspect that these persons created their own problems at work. The role of the treating psychiatrist is to assume that harassment has indeed occurred, and this favors the establishment of the therapeutic alliance. In marked contrast, the role of a forensic psychiatrist is to investigate, with tact and sensitivity, so as not produce a “secondary injury”, if harassment has in fact occurred.
Alberto M. Goldwaser, MD, DFAPA,
Is president of the Forensic Psychiatric Association, with offices in Paramus and West New York. He is a clinical assistant professor of Psychiatric at New York University School of Medicine, past president pf the New Jersey Psychoanalytic Society, Chairman, Professional Ethic Committee of the Psychoanalytic Association of New York, Distinguished Fellow, American Psychiatric Association, and a member of the Forensic Psychiatric Committee of the New Jersey Psychiatric Association.
By Alberto M. Goldwaser, MD, DFAPA
Cinderella – the persecuted heroine – was forced to perform with the enticement of an immediate reward (going to the party), and a promotion of sorts (being treated equally). The Little Mermaid picked out (teased) her suitor, pursued him, and after a long, far-reaching, and conflicted relationship, she ended up down and under.
Just as rape is a crime of violence, nor of sex, sexual harassment is a manifestation of power, not of seduction.
According to the United States law, sexual harassment is a form of gender discrimination in employment that is prohibited by title VII of the Civil Rights Act of 1964. In 1980, the Equal Employment Opportunity Commission (EEOC) issued its final guidelines of sexual harassment: “Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature constitute sexual harassment when (1) submission to such conduct is made either explicitly or implicitly a term or condition of an individual’s employment, (2) submission to or rejection of such contact by an individual is used as a basis for employment decisions affecting such individual, or (3) such conduct has the purpose or effect of unreasonably interfering with an individual’s work performance or creating an intimidating, hostile, or offensive working environment.”
The first two situations described in the EEOC guidelines corresponds to what is called “quid pro quo” sexual harassment, a form of sexual harassment in which sexual compliance is exchanged, or proposed to be exchanged, for an employment or academic opportunity. In quid pro quo behavior, the coercion behind the advances is brought to light by the reprisals that follow a refusal to comply. While quid pro quo harassment requires a difference in power between the perpetrator and victim, the last situation (3) does not. It sis called the “hostile environment” sexual harassment.
A less clear, yet more pervasive situation involves persistent behavior that simply makes the work environment unbearable.
In short, sexual harassment has two forms: (1) quid pro quo (by manager or supervisor), as in the classic situation when a manager requests sexual favors in exchange for promotion; and (2) hostile work environment, if the harasser is a co-worker. In this type, the standard (respondeat superior) is that the employer knew or should have known and did nothing to remedy the situation.
Sexual harassment covers a diverse group of behaviors. It includes remarks of a sexual nature, such as repeated requests for dates, whistles, staring, and sexual propositions not directly linked to employment, as well as unwanted physical contact of a non-sexual nature. The harassment can escalate to sexual propositions linked to job enhancement or job threats, unwanted physical conduct of a sexual nature, sexual assault.
Perceptions of behavior as sexual harassing differ according to the type of person that experiences it as offensive. It greatly depends on what’s called the pre-trauma risk factors.
A “reasonable woman” standard is used in sexual harassment cases for both genders, primarily because the sexually blind reasonable person standard tends to be male-biased and to ignore the experiences of women. A victim may choose to submit to the harassment, ignore the behavior, avoid the perpetrator, confront the perpetrator, change jobs or class, report the behavior to a superior or a grievance committee, or seek legal assistance. The last two routes are infrequent. They are uncertain that reporting harassment can help them in any way and are concerned that it can hinder their personal, occupational, or educational progress. There is a sense that while formal action tries to assess the guilt or innocence of the alleged harasser, informal efforts try to put an end to the problem.
Psychiatric experts perform an examination for the purpose of fact finding and evidence gathering. We rely on historical reconstruction by using the interview with the plaintiff and perusing legal and medical documents.
The role is to help the attorney prepare for deposition of an adverse expert. This includes review of the adverse expert’s report and notes, consulting with the attorney regarding issues likely to be important, and playing a role in deciding whether plaintiff should attend depositions of the adverse expert.
The forensic psychiatrist can serve several functions as expert witness in sexual harassment cases. This encompasses evaluation of the presence or absence of preexisting psychological disorders, the psychological injury attributable to the harassment, the relationships between preexisting disorders and posttraumatic symptoms, or the prognosis for future disability and necessity for treatment with some estimate of cost to the plaintiff.
Above all, the expert witness has to be able to educate the jury by explaining (digesting) what “trauma” is, how it comes to happen, and how it applies or not to the case in question.
The credibility of the plaintiff – even though this is for the jury to determine – can be touched upon based on the study of the underlying personality style, as well as the risk of re-traumatization in the course of litigation. Issues of sincerity relate to the overall examination of the plaintiff’s social, occupational and, critically, mental functioning, rather than concentrating on the narrative style of the event(s) reported by the plaintiff. For example, calmness may indicate malingering, or, in contrast, a symptom of the plaintiff’s disorder (e.g. dissociation).
The goal is to advocate for one’s expert opinion, rather than for a social cause that repudiates harassment.
The forensic psychiatrist participates in elucidating its occurrence (did it happen?), but predominately, if it indeed happened, whether psychiatric affliction is present or not in its aftermath, and it quality and quantity.
The literature suggests that sexual harassment is a widespread phenomenon affecting 42% of women and 15% of men in occupational settings. Despite the pervasive nature of this problem, only 1-7% of victims file formal complaints.
Sexual harassment produces an array of psychological and psychophysiological symptoms in over 90% of victims and 12% seek help from mental-health professionals. Self doubt is a central issue regardless of gender.
It is critical that therapists avoid blaming the victim. Empathy, validation and empowerment are the key therapeutic tasks.
Sexual harassment is a destructive behavior that can cause profound psychiatric problems for its victims, who commonly keep quiet about the offense. If it happens in the clinical (medical/psychiatric) setting, it is called sexual misconduct, or boundary violation.
Sexual harassment is different from flirtation, flattery, a request for a date, and other acceptable behavior occurring within the workplace or the classroom. It lacks the elements of choice and mutuality inherent in a normal relationship. It is also distinct from other forms of harassment that do not involve conduct of a sexual nature.
Harassment may be motivated by race, religion, and politics. In addition, it is distinct from rape. It is a type of sexual coercion that relies on the power of the perpetrator to affect its victim’s economic, occupational, or academic status, and does not necessarily involve physical force. It has the potential to affect its victim’s ability to perform on the job or in school, their career opportunities, their personal relationships, their self-esteem, their psychological well-being, and even their physical health.
Victims report a wide array of symptoms, including anger, fear, depression, crying spells, anxiety, irritability, loss of self-esteem, feelings of humiliation and alienation, and a sense of helplessness ad vulnerability. There are also symptoms of psychological sequelae, such as headaches, decrease or increase in sleep and appetite, weight loss or gain, respiratory and urinary symptoms.
The list of the above reported symptoms needs to be fastidiously and sensibly examined. Moreover, the likelihood of symptoms is directly associated with the quality and severity of the behavior in question and the possible risk factors already present in the victim.
Victim’s initial reactions (reasonable woman) to sexual harassment are typified by self doubt and confusion. They often feel guilty and wonder whether they might have caused and/or encouraged the behavior. They may minimize or deny what has happened, in part because it is frightening to realize that those in positions of authority may be neither just nor trustworthy.
Eventually, anxiety – an unpleasant emotion related to the idea that something bad is about to happen – is replaced by depression, an unpleasant emotion related to the idea that something bad has already happened. Self-confidence erodes to the point of crisis. According to the quantity and quality of the pre-trauma risk factors, a turning point may occur, and the victims may become angry, answer their own questions of self blame, and determine that their civil rights had been violated. Responses from passivity and resignation, to activity and accusation depend on the predisposing, determining, and triggering traumatic factors, as well as on the victim’s personality structure (habitual or characteristic way of responding to difficult or afflicted situations).
If a person chooses to stay in the situation where there is harassment, victimization will be reinforced, with feelings of helplessness, humiliation and anger are heightened by remaining silent. If on decides to quit one’s job or to drop course, then the consequences are profound in terms of tangible losses as well as the loss of self respect. And, as it happens in all other examples of harassment/discrimination, if the victim files a complaint while remaining at the same job, the work environment may actually become more stressful. Grievance procedures can thereby accentuate feelings of isolation and anger.
The victim experiences a “second injury” (re-victimization) if there is a retaliation by the perpetrator, a disappointing institutional response, lack of support from coworkers, insensitivity or blame at home or a lengthy, and unsatisfactory grievance procedure. The victim then again feels isolated and vulnerable; thus the basis for the development of depressive symptoms is formed. It engenders loss. There are tangible losses: of a job, seniority, promotion, or income. There is a loss of professional/occupational performance, lack of the guarantee of another, at least similar position and of time while living through the crisis. We also see intangible losses of confidence in one’s ability and of enthusiasm at work.
People who have been assaulted without a great deal of physical force are especially prone to self blame and adjustment disorder. Aggressive acts (sexual harassment being one example) can invoke intense anger, the expression of which is “unfeminine” and destructive in relationships.
Many victims appear “unstable” by the time they seek psychiatric care. The therapist may be inclined to suspect that these persons created their own problems at work. The role of the treating psychiatrist is to assume that harassment has indeed occurred, and this favors the establishment of the therapeutic alliance. In marked contrast, the role of a forensic psychiatrist is to investigate, with tact and sensitivity, so as not produce a “secondary injury”, if harassment has in fact occurred.
Alberto M. Goldwaser, MD, DFAPA,
Is president of the Forensic Psychiatric Association, with offices in Paramus and West New York. He is a clinical assistant professor of Psychiatric at New York University School of Medicine, past president pf the New Jersey Psychoanalytic Society, Chairman, Professional Ethic Committee of the Psychoanalytic Association of New York, Distinguished Fellow, American Psychiatric Association, and a member of the Forensic Psychiatric Committee of the New Jersey Psychiatric Association.
