You’ll know that We Can’t Consent To This are extremely down on the normalisation of violence against women, particularly ‘choking’. The idea that there is ‘safe’ strangulation not only causes real life harm to women, but has also helped the men who try to use ‘rough sex’ claims: if strangulation is safe and what she wanted, how was he to know she’d be harmed or killed?
In case you’re not convinced, we’d like to share a sobering new piece of research on the damage caused by non-fatal strangulation. The researchers (Bichard, Byrne, Saville & Coetzer, 2020) have summarised this research for us to share with you.
Although it is common for strangulation to leave no visible signs of injury, this research sets out the terrible harm suffered by victims of non-fatal strangulation, with the onset of symptoms sometimes delayed by days or weeks. Harms can include stroke, cardiac arrest, miscarriage, incontinence, seizures, paralysis, speech disorders, and other forms of long term brain injury.
We already knew the potential injury from victims’ reports. But, for the first time, this synthesises the medical evidence in its terrifying and convincing entirety.
Research Summary - A Systematic Review of the neuropsychological outcomes of non-fatal strangulation in domestic and sexual violence
Up to 10% of the population have experienced strangulation.
This rises to over 50% of women subject to routine domestic abuse, and up to 20% of women who have been sexually assaulted.
Strangulation is an overwhelmingly gendered crime: in a review of 300 forensic records in San Diego, 298 involved a man strangling a woman.
if a woman has been strangled, the chance of her subsequently being murdered rises eightfold.
Neck structures are alarmingly fragile: blocking the jugular vein can take less pressure than opening a can of Coke.
Consciousness can be lost within as little as 4 seconds of arterial pressure. Losing consciousness indicates at the very least a mild brain injury. Consciousness was lost in between 17% and 38% of strangulation incidents identified.
It is thought strangulation might be the second most common cause of stroke in women under 40.
In terms of pathology, strangulation was shown to lead to dissection of the main neck arteries, blocking of blood flow to and from the brain, brain swelling, cardiac arrest, miscarriage, and stroke (which can be delayed by weeks).
Neurological consequences of strangulation include: loss of consciousness (which indicates at least mild brain injury), paralysis, movement disorders, speech disorders, incontinence, and seizures.
Cognitive consequences include: amnesia, and impaired ‘executive function’ (e.g. decision-making, planning, judgement).
Psychological consequences include: PTSD, dissociation, suicidality, depression, anxiety, and personality change
Behavioural consequences include: increased compliant and submissive behaviour, and survival-based aggression
Strangulation and Risk
From this it should be clear that strangulation, even when non-fatal, carries with it the very real potential to cause significant and life-changing injury to brain and mind. It is also a significant marker of future risk: if a woman has been strangled, the chance of her subsequently being murdered rises eightfold.
Strangulation is more dangerous than waterboarding: this is because it doesn’t just block the airway, but also the brain’s blood supply. Waterboarding is now considered inhumane, even when its stated aim is to prevent mass terrorism. But there is something morally wrong about a society which still turns a blind eye to the intimate terrorism of thousands of women each week in the UK.
The paper also draws attention to how the legal system fundamentally misunderstands strangulation’s effect on the brain. In a recent British case, a prostitute had been strangled by a client[1]. When she lost consciousness, he panicked, believed her to be dead, and was in the process of abandoning her body by the roadside when she came to. The victim then went to her attacker’s house, where they drank wine together. Her behaviour after the event was used to undermine the severity of the attack, and he was sentenced to just two years. Based on this new research, we now know her behaviour could have been due to existential fear: compliant behaviour in order to survive. Having lost consciousness she would almost certainly have had amnesia for that portion of the attack, but she could also have had wider memory loss: she had simply forgotten what he had done. It could be the result of damage to brain areas involved in problem-solving or planning an escape, or symptomatic of general confusion due to an oxygen-starved brain.
Strangulation and ‘Consent’
Consent always needs to be informed, and it needs to be able to be withdrawn at any point. Neither of these can possibly pertain in the so-called ‘rough sex’ defence. The vast majority of laypeople do not currently understand the very severe risks of strangulation, and so they cannot make informed decisions: how could they, when the law minimises it, and culture glamorises it? Secondly, how many people know they will likely not be able to withdraw consent? This is because the very organ needed to provide consent – the brain – is compromised by strangulation. For a start, consciousness can be lost in as little as four seconds. And someone who is unconscious cannot withdraw consent. But there are other changes to the brain that nullify any concept of consent.
In a bizarre and unethical experiment in the 1940s in which prisoners and psychiatric patients were strangled to observe the effects, the lead researcher first tried the equipment on himself[2]. There was an emergency release button. He found himself unable to press it, even when he wanted to. He was unsure whether this was due to forgetting he could (amnesia) or messages from the brain not getting to his hand (dyspraxia). He almost died. Both these impairments were the result of altered brain and mind functioning as a result of strangulation.
Research detail
This research was conducted by clinicians working at the North Wales Brain Injury Service (Betsi Cadwaladr University Health Board, NHS Wales) and Bangor University.
Given its importance and timeliness the authors have shared a pre-print of the full paper on the Open Science platform: https://psyarxiv.com/c6zbv/.
The authors systematically reviewed 1,433 papers, which were distilled down to 27 international, peer-reviewed studies. These were largely based on A&E case reports, or analysis of police and forensic records.
We would urge you to read the full paper
[1] Armstrong, (2012). Man choked prostitute after watching Billie Piper in Secret Diary of a Call Girl. The Mirror. Retrieved from https://www.mirror.co.uk/news/uk-news/man-choked-prostitute-after-watching-145613
[2] Kabat, H., & Anderson, J. P. (1943). Acute arrest of cerebral circulation in man: Lieutenant Ralph Rossen. Archives of Neurology & Psychiatry, 50(5), 510-528.
