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PubMed2004

Doing criticism in 'symbiotic niceness': a study of palliative care nurses' talk.

This paper examines how palliative care nurses do criticism of other professionals in talk within settings for care of the dying (two hospices and one general hospital). Strategies for the production of moral identities include the use of direct criticism, indirect criticism and quoted speech, hence 'inverted comma criticism'. Criticism is done through the construction and reconstruction of 'atrocity stories'. Atrocity stories are used as a medium by nurses to express their opinions and feelings about doctors who might have behaved insensitively. At the same time, it allows doctors to redeem themselves. The analysis of talk reveals that the voices of absent patients are reactivated and co-opted into the nurses' talk. The stories serve to produce an image of nurses as caring, morally responsible patient advocates and loyal characters to their medical colleagues. Through the analysis of talk, the communication skills and strategies for the maintenance of interactional order are made visible and displayed. Skills for the production of the palliative care team work are also made visible. Emotional labour is analysed as a project for the production of particular kinds of niceness which in turn require particular types of emotional labour. This paper argues that educators should aim to identify and make conscious use of nurses' own available interactional skills, and focus on valuable cultural (rules of decorum) and material resources (the disease process) which are readily available and accessible for nurses, as a starting point in communication training. The theory of an account of co-production of niceness which benefits each other, hence, symbiotic niceness, reveals that being nice to each other can be rewarding and therapeutic in that it helps to smooth, distance and ameliorate problems occurring in the reality of palliative care nurses' and their patients' life-worlds.

Anecdotes as Topic↗

PubMed1999

Female genital mutilation: the penultimate gender abuse.

OBJECTIVE: The five goals established for the development of this article were to: (1) provide an historical overview of the practice, (2) describe the procedure and its sequelae in realistic terms, (3) explore cultural justifications for the continuation of this action, (4) evaluate inherent moral/ethical/legal issues and, (5) focus worldwide professional attention on a gender-specific child atrocity. METHOD: A review of the past and current historical, popular and professional literature was undertaken to determine the precursors, magnitude, settings, rationale, and moral-ethical-legal-treatment issues associated with this mutilating procedure. RESULTS: Four forms of female genital mutilation were identified. These are: (1) sunna (removal of the prepuce of the clitoris); (2) clitoridectomy (removal of the prepuce and the clitoris); (3) excision (removal of the prepuce, clitoris, upper labia minora and perhaps the labia majora); and, (4) infibulation (removal of the prepuce, clitoris, labia minora, and labia majora). The "surgery" is performed most frequently by untrained midwives who use sharp rocks, razor blades, kitchen knives, broken glass, or even their teeth. As a rule, no anesthetics, antiseptics, analgesics or antibiotics are available to victims. Consequently, these females typically suffer from massive short-term and long-term physical, emotional, sexual and obstetrical sequelae. CONCLUSIONS: The justifications tendered by proponents do not withstand moral-legal-ethical scrutiny. Female genital mutilation is a violation of human rights and an atrocity perpetrated against helpless individuals who are unable to provide informed consent and who must therefore be protected through education and legislation.

Child↗

PubMed1999

Chronic pain in Holocaust survivors.

There is limited research on the connection between the Holocaust and chronic pain, despite evidence suggesting that medical and psychological sequelae are common in survivors. The goals of this study were: (1) to define Holocaust survivors' (n = 33) chronic pain characteristics as manifested 50 years after the war, (2) to compare survivors with controls (n = 33) who did not experience World War II atrocities, and (3) to investigate the connection between past trauma and chronic pain. Data were collected through questionnaires that included a detailed medical and pain history, visual analog scale (VAS), McGill Pain Questionnaire (MPQ), Beck Depression Inventory (BDI), Symptom Check List-90 (SCL-90), and Pain Disability Index (PDI). A comparison of variables between the two groups was conducted using multivariate analysis of variance (MANOVA) and ANOVA, and canonical discriminant analysis. Results showed that Holocaust survivors reported higher pain levels (73 +/- 18 vs. 56 +/- 21; P < 0.005), more pain sites (4.5 6 2.8 vs. 2.7 6 1.4; P < 0.05), and significantly higher depression scores (17.6 +/- 8.4 vs. 9.2 +/- 4.6; P < 0.001); they tended to utilize more medical services (5.9 +/- 3.0 vs. 5.1 +/- 2.8). Nonetheless, survivors did not regard themselves more disabled as compared with controls. They reported a higher activity level as measured by walking distance capacity, and spent significantly fewer hours resting (4.3 +/- 3.6 vs. 7 +/- 4.6; P < 0.05). This paradoxical combination of high pain intensity, moderate to severe depression, and high activity level characterizes Holocaust survivors' chronic pain. It is conceivable that by remaining active Holocaust survivors fight back their pain, distress, and depression. These findings suggest that Holocaust atrocities affect survivors' chronic pain even years later.

Aged↗

PubMed2002

Autobiographical memory specificity, intrusive memory, and general memory skills in Dutch-Indonesian survivors of the World War II era.

A lack of specific autobiographical memory may result from exposure to psychological trauma, intrusive memories of adverse events, and/or a general memory deficit. This study explored the role of these variables in 25 patients with various psychiatric diagnoses and 15 healthy controls. All participants had been exposed to war atrocities during their childhood in Indonesia. Patients produced significantly less specific memories than did controls. In addition, rather than performance on general neuropsychological memory tests, the frequent occurrence of intrusive memories and the avoidance of reminders of trauma predicted less autobiographical memory specificity. These results replicate and extend earlier findings on intrusive and nonspecific autobiographical memory in depressed samples to a group of people who experienced war atrocities in childhood.

Adaptation, Psychological↗

PubMed1999

Disorders of extreme stress following war-zone military trauma: associated features of posttraumatic stress disorder or comorbid but distinct syndromes?

Disorders of extreme stress not otherwise specified (DESNOS) and posttraumatic stress disorder (PTSD) were found to be comorbid but distinct among military veterans seeking inpatient PTSD treatment: 31% qualified for both conditions, 29% were diagnosed PTSD only, 26% were classified DESNOS only, and 13% met criteria for neither. PTSD diagnosis was associated with elevated levels of war-zone trauma exposure and witnessing atrocities and with impairment on the Mississippi Scale for Combat-Related PTSD and the Penn Inventory. DESNOS classification (but not PTSD) was associated with (a) early childhood trauma and participation in war-zone atrocities, (b) extreme levels of intrusive trauma reexperiencing, (c) impaired characterological functioning (object relations), and (d) use of intensive psychiatric services. PTSD and DESNOS may be comorbid but distinct posttraumatic syndromes and, as such, warrant careful clinical and scientific investigation.

Adult↗

PubMed1990

Children of perpetrators of the Holocaust: working through one's own moral self.

The present study tests stages in the ability of some children of perpetrators of the Holocaust in Germany to work through emotional and moral issues regarding their fathers' perpetrating role during the Third Reich. The following questions are raised: Did they try to distance themselves by playing down the Holocaust and the moral meaning of their fathers' involvement in it? Did any children try to work through issues relating to their fathers' impaired morality? Did any children successfully reach the stage of integration? Fifty-seven persons were contacted by the author between September 1985 and June 1987, of whom 9 refused to be interviewed. Thirty interviewees were children whose fathers had taken an active part in the implementation of the euthanasia program, in the Einsatzgruppen, in the extermination camps or in related activities. The fathers of the remaining 18 interviewees were affiliated with SS units at times and in places where the atrocities took place, but what they actually did or did not do was not proven. In general, there was an almost total silencing of accounts of the extermination process in homes and schools. Acknowledgment, if any, of the atrocities appeared through accounts of trials and friends and in newspapers or, only recently, through the children's active searching. When children who learned what their father-perpetrator had done during the war also came to understand the moral implications, they usually experienced severe emotional conflict, which they had to confront on their own. Only a few succeeded in walking across a very narrow bridge to a working through of the related issues and emotions. The implications of the present analysis for future research on the prevention and outcomes of genocide are discussed.

Adaptation, Psychological↗

PubMedDate not supplied

The social, cultural and political dimensions of contemporary war.

There have been more than 160 wars and armed conflicts since 1945, almost all in the Third World, and more than 50 currently. More than 90% of these are internal rather than between sovereign states. There has been a sixfold increase in the number of war refugees worldwide since 1970, who now number 1% of the global population. Ninety per cent of all casualties are civilians. A key element of modern political violence is the creation of states of terror to penetrate the entire fabric of grassroots social relations as a means of control. The valued institutions and ways of life of whole populations are routinely targeted for destruction. In the 1980s many such wars were played out on a terrain of subsistence economies. The back-drop is of environmental degradation, poverty, embedded social injustice, pressure on the nation-state, a global rise in food insecurity and a widening gulf between the wealthiest 20% and the poorest 20% in the world. The World Health Organization is warning of a health catastrophe, with life expectancy in the world's poorest countries falling by the year 2000 and one-third of the world's children undernourished. Understanding a complex and evolving set of causes and effects surrounding war is a considerable challenge to the international humanitarian field, not least the health professions. In recent years there has been a burgeoning interest in the psychological impact of the atrocities of war, and in trauma programmes based on Western psychological concepts and techniques. This individualistic focus risks neglecting the core issue: the role of a social world, invariably targeted in war and yet still embodying the capacity of survivor populations to manage their suffering, adapt and recover on a collective basis. Using the example of Mozambique, Guatemala and others, this paper will discuss the way in which contemporary war damages social and cultural forms, and the range of traditions, values and understandings which these carry. However, society and culture also engage actively with war, with changes in the social order that may come to outlast the violence itself. This paper will also pinpoint the quest for justice as an issue that may distinguish the subjective experience of war from those that arise after peacetime or natural disasters. The work of anthropologists, sociologists, historians and poets in both West and Third World, allied to the voices of survivors themselves, can help the humanitarian field to acquire a more richly textured understanding of the range of responses to war and atrocity, and outcomes over time.

Altruism↗

PubMed2006

Suicide in the major Western countries 2000-2002: the violent deaths of September 11, 2001.

Following the September 11th 2001 atrocity, Western Government policies focused more on 'defense,' which undermines Government's commitment to reducing suicide. Annual US and major Western countries suicides were compared with '9/11' deaths to highlight the extent of mortality associated with mental disorder, homicide and road deaths are reviewed for contrast. The 3,074 fatalities of 9/11 are set against the US three year annual average 29,691 suicides, 17,077 homicides and 47,775 road deaths, thus every two weeks more US citizens died violently than on 9/11. In the majority of countries, there were more suicides than 9/11 victims, with suicides exceeding the 9/11 atrocity 18 times in Russia, nine in Japan and the US and three times in France and Germany. Annual suicides compared with terrorist violence should inform policy.

Australia↗

PubMed1993

A preliminary study of PTSD and grief among the children of Kuwait following the Gulf crisis.

This preliminary study of Kuwaiti children confirms the significant impact of exposure to war atrocities on children. This pilot sampling provided evidence that: (1) many children who remained in Kuwait during the occupation had multiple war-related exposures; (2) more than 70 per cent of the children reported moderate to severe post-traumatic stress reactions; and (3) witnessing death or injury and the viewing of explicit graphic images of mutilation on television had measurable influence on severity of reaction. The highest mean Child Post-Traumatic Stress Disorder Reaction Index (CPTSD-RI) score was found for those children who reported hurting someone else. Older children had both greater exposure to atrocities and higher CPTSD-RI scores. Findings suggest the need for public policy to minimize children's exposure to graphic depictions of war-related injury, death and mutilation.

Adolescent↗

PubMed1996

The Nuremberg Code and the Nuremberg Trial. A reappraisal.

The Nuremberg Code includes 10 principles to guide physician-investigators in experiments involving human subjects. These principles, particularly the first principle on "voluntary consent," primarily were based on legal concepts because medical codes of ethics existent at the time of the Nazi atrocities did not address consent and other safeguards for human subjects. The US judges who presided over the proceedings did not intend the Code to apply only to the case before them, to be a response to the atrocities committed by the Nazi physicians, or to be inapplicable to research as it is customarily carried on in medical institutions. Instead, a careful reading of the judgment suggests that they wrote the Code for the practice of human experimentation whenever it is being conducted.

Codes of Ethics↗

PubMed2006

Differential experiences during the holocaust and suicidal ideation in older adults in treatment for depression.

Data were used on 275 Jewish individuals aged 50 and older in outpatient treatment for depression in this retrospective cross-sectional study. Holocaust survivors who were in work camps, in ghettos, or in hiding (HS-WGH) and holocaust survivors who were in concentration camps (HS-CC) were more likely to suffer posttraumatic stress disorder compared to other survivors (HS-OT) and controls. The HS-WGH and HS-CC groups had at least a threefold greater odds of suicidal ideation compared to controls. Suicidal ideation rates did not differ significantly between HS-OT group and controls. Among survivors, HS-WGH had a threefold greater odds of suicidal ideation compared to HS-OT. The results are applicable to survivors of similar atrocities and show that differing types and severities of traumatic experiences have important implications for treatment planning.

Aged↗

PubMed2005

Refugee children--a concern for European paediatricians.

Many refugees, about 33% of them children, come to Europe from several different countries. Their somatic state of health is sometimes impaired and they have often been exposed to persecution, war and atrocities with consequences for their psychological health status. The period of application for asylum is often long and strenuous, both socially and psychologically. Their needs are often disregarded. According to the United Nations Convention on the Rights of the Child, European paediatricians should take it as their responsibility to provide health care for them at the same level as that for children of the host country.

Adolescent↗

PubMed2006

Cold as a therapeutic agent.

The use of cold as a therapeutic agent has a long and colorful history. The Edwin Smith Papyrus, the most ancient medical text known, dated 3500 B.C., made numerous references to the use of cold as therapy. Baron de Larrey, a French army surgeon during Napoleon's Russian campaign, packed the limbs in ice prior to amputations to render the procedures painless. In the early twentieth century, a neurosurgeon, Temple Fay, pioneered "human refrigeration" as a treatment for malignancies and head injuries. In 1961, Irving Cooper developed the first closed cryoprobe system and ushered in the modern era of cryogenic surgery with his imperturbable convictions. Fay's early work fell victim to the disruptive sequel of the World War II. The Nazis confiscated his data (presented before the Third International Cancer Congress in 1939) forwarded to Belgium for publication and brutally applied his refrigeration techniques experimentally without any benefit of anesthesia in the concentration camps, especially Dachau. Hypothermia became associated in the public mind with the atrocities exposed at the war trials in Nürnberg. After lying dormant for decades, the interest was rekindled in the late 80s when mild hypothermia was shown to confer dramatic neuroprotection in a number of experimental models of brain injury. With several large multi-center clinical studies currently under way, hypothermia is receiving unprecedented attention from the medical and scientific communities.

Cryosurgery↗

PubMed1993

The impact of war on children's health in Mozambique.

Since 1982, South African destabilization of Mozambique has caused children's health to deteriorate. Destabilization has functioned through support of a surrogate movement and economic pressure. Attacks on economic and civilian targets have included the health services, leading to closure of 48% of the primary health care network. The war has caused displacement of over 3,000,000 persons and an estimated 494,000 excess childhood deaths between 1981 and 1988. An estimated 200,000 children have been separated from their families or orphaned; many children have also witnessed atrocities and suffered violence. A deepening economic crisis has been followed by an economic structural adjustment programme. Responses to the war include changes in vaccination strategy and programmes to reunite families and heal psychological trauma.

Child↗

PubMed1993

Co-chairman's remarks: genetics and the twentieth century.

Genetics, the study of the gene, developed all through the twentieth century. It began with a search for mutations in a variety of organisms and the mapping of these mutations on chromosomes. Since it applied to humans, genetics became of interest to some of the ideologies that flourished during this century. In particular, eugenic ideas were used as an argument by the Nazis for the atrocities they committed in concentration camps. The gene long remained a 'being of reason', until the middle of the century, when it turned out to be made of DNA. In 1953, the discovery of the structure of DNA gave a completely new turn to genetics.

Animals↗

PubMed1988

'Stranger' child-murder: issues relating to causes and controls.

Most industrialised countries are concerned with a perceived increase in the killing of children and adolescents by strangers. Though reliable statistics are lacking, the growth of serial murder suggests that more young persons may be at risk than ever before. Explanations, either of a psychological or sociological kind, of child murder by strangers are inadequately developed. Despite the tendency to see such killers as psychiatrically ill a number of studies suggest that the majority of offenders do not differ significantly, at least in psychological traits, from non-offenders. Subcultural and other sociological perspectives stressing "social disadvantage" have low levels of exploratory power and do not assist greatly in understanding child killings. Despite sketchy and contradictory evidence on the effects of the media on sexual and violent crime case study material supports the view that pornography, including popular music, may increase the propensity of individuals to commit atrocities. Counter-measures to control stranger child killing lie in more sophisticated law enforcement (profiling and computer links between police forces) long periods of incarceration of the offender and more sophisticated analyses of the crimes.

Child↗

PubMed1992

Health effects of military service. Lessons learned from the Vietnam experience.

This article examines the methodologic difficulties encountered in studies of the long-term effects of the Vietnam War on the psychological and physical health of veterans. Alternate study designs and exposure and outcome measurements are examined in relation to psychological (post-traumatic stress disorder and alcohol use or abuse) and physical (mortality and birth defects in children) health outcomes. All major epidemiologic studies of post-traumatic stress disorder and alcohol use or abuse utilize cross-sectional research designs. Mortality and birth defect studies use cohort, case-control, or proportionate mortality strategies. Exposure is measured using either definitive dichotomous indicators of service in Southeast Asia or more complex indicators of the Vietnam experience (i.e., combat, herbicide exposure, atrocities, abusive violence) that are of suspect validity. In studies of psychological health, outcomes are based exclusively on self-reported symptoms, while investigations of mortality and birth defects use death certificates and hospital records. Epidemiologic research on the effects of the Vietnam conflict has been hampered by problems in research design and the inherent difficulties of measuring wartime exposures and long-term health outcomes.

Alcoholism↗

PubMed2006

The psychosocial effects of combat: the frequently unseen injury.

The psychosocial issues related to deployment and combat duty are complex. Deployment may result in psychiatric casualties that are either the result of inadequate coping with the stressors of deployment or acute stress reactions caused by the trauma of battle, that is, combat stress reactions. Combat duty is associated with traumatic events, deprivation, and exposure to war atrocities that may result in acute, delayed or chronic psychosocial issues during and afer returning from deployment. Although protective and mediating factors ar in place, 11% to 17% of combat veterans are at risk for mental disorders in 3 to 4 months after return from combat duty. Combat veterans include service members directly involved in combat as well as those providing support to combatants, that is, nurses. All combat veterans are at risk for experiencing the negative effects of deployment. Frequent deployments of active duty, reserve, and National Guard members have become commonplace. This translates into a disruption of live for anyone associated with the military, as well as an increased focus on the psychosocial impact of combat across the nation. Modern warfare has resulted in multiple changes in policy that govern military operations. Initiatives that focus on the stabilization of service members and their families may impact mental health outcomes of service members returning from combat duty. An initiative toward decreasing the stigma of receiving mental health care is warranted. Mental health issues must be addressed before and during deployment to ensure optimum individual and unit functioning. Early identification and treatment of mental health problems may decrease the psychosocial impact of combat and thus prevent progression to more chronic and severe psychopathology such as depression and PTSD.

Anger↗