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PubMed1997

[Rwanda, a retrospective to aid rendered following the 1994 genocide].

Some 700,000 Tutsi were killed in Rwanda in 1994, and 1.2 million Hutu fled to neighbouring countries. The United Nations and the non-governmental organizations recently issued a document assessing the aid given. Several matters could have been better. Security in the camps, for instance, was a crucial problem and relief workers and armed forces were unprepared for the involuntary cooperation. Also, estimates of numbers of refugees were inadequate and such estimates were manipulated for political purposes. Relief organizations resorted too quickly to import of goods that were available locally, thereby making the aid unnecessarily expensive. The refugees themselves were involved too little in establishing relief priorities. Life of the original population round the camps was disrupted, a fact that received hardly any attention.

Disasters↗
PubMed1999

Listening psychoanalytically to the Shoah half a century on.

The author discusses the repercussions of the Nazi genocide of the Jews on descendants of victims and survivors, with particular reference to identifications. A typical vampiric form of identification is discussed, in which the subject is stated to be neither alive nor dead, unborn, in an imageless, timeless and spaceless condition, and imprisoned in an earlier generation's traumas. Analysis of such cases must, the author shows, tackle the genocide-induced fantasies of a vampire complex involving infanticide and parricide in addition to the incestuous and parricidal wishes of the Oedipus complex. These ideas are illustrated by a case history in which the female patient concerned, although born after the Shoah, carried the unrepresentable parental traumas within her to the detriment of her affective and professional life. The patient was effectively linked with her mother in a deadly circulation through communicating vessels, which was repeated in the transference countertransference constellation and resulted in a disavowal of both birth and death, mediated by the genocidal project. The author shows how the analysand was gradually released from this vampiric fusion and became able to reappropriate her secondary narcissistic and oedipal identifications, the resulting triangulation opening the way to sublimation and creativity.

Adult↗
PubMed2006

Millions of missing girls: from fetal sexing to high technology sex selection in India.

The morality and acceptability of using prenatal diagnosis for sex selection is being extensively debated around the world as advances in assisted reproductive technologies (ART) and embryology have enabled selective implantation of embryos of the desired sex (George and Dahiya, 1998; Savulescu, 1999; Raphael, 2002; Harris, 2005; Robertson, 2005; Snider, 2005). Sophisticated methods of separation of semen, originally developed for cattle breeding, are being used for human sex selection. Recently, non-invasive methods of fetal sex determination in the first trimester (from 6 weeks) of pregnancy have also emerged (Hahn and Chitty, 2005). Market forces that promote sex selection along with libertarian ideologues have assisted in blurring the ethical limits (Paul, 2001; President's Council on Bioethics, 2003). The widespread misuse of sex selection for eliminating girls before birth in India and among the Indian diaspora needs to be brought into the global 'intellectual discourse'. It is imperative that Western ethicists recognize the genocidal nature of sex selection taking place in certain Asian countries. Even if they believe that these trends will not affect mainstream Western societies, the promotion or tolerance of sex selection amounts to a 'crime of silence' against this ongoing genocide in China and India. I have been concerned with issues of the girl child in India for over two decades and sex selection among Asian Indians in North America (George et al., 1992; George et al., 1993; George and Dahiya, 1998). This article examines the missing millions of girls, but will not consider the 1980s campaign against fetal sex determination, Indian feminists' recognition of sex selection as violence against women (unlike several Western feminists, Moazam, 2004), or the Government's response to regulate prenatal diagnostic techniques in 1994 (George and Dahiya, 1998; George, 2002).

Abortion, Induced↗
PubMed2002

Spatial and temporal patterns in civil violence: Guatemala, 1977-1986.

Civil violence is a complex and often horrific phenomenon whose characteristics have varied by era, setting, and circumstance. Its objective analysis has rarely been feasible at spatial and temporal scales great enough and resolutions fine enough to reveal patterns useful in prevention, intervention, or adjudication. An extraordinary data set simultaneously meeting scale and resolution criteria was collected during conflict in Guatemala from 1977 through 1986. Reported here is its spatial-temporal analysis; reported as well is a putatively novel method for estimating power-law exponents from aggregate data. Analysis showed that the relationship between ethnic mix and killing was smooth yet highly nonlinear, that the temporal texture of killings was rough, and that the distribution of killing-event sizes was dichotomous, with nongenocidal and genocidal conflict periods displaying Zipf and non-Zipf distributions, respectively. These results add statistical support to claims that the Guatemalan military operated under at least two directives with respect to killing and that one of these effected a genocidal campaign against an indigenous people, the Mayans. Implications for group-behavioral modeling, conflict prevention, peace-keeping intervention, human-rights monitoring, and transitional justice are noted.

Journal Article↗
PubMedDate not supplied

Mortality and morbidity among Rwandan refugees repatriated from Zaire, November, 1996.

INTRODUCTION: Following renewed ethnic violence at the end of September 1996, conflict between Tutsi rebels and the Zairian army spread to North Kivu, Zaire where approximately 700,000 Rwandan Hutu refugees resided following the 1994 genocide. After a major rebel offensive against the camps' militia groups on 15 November, a massive movement of refugees towards Rwanda through Goma town, the capital of North Kivu, began. Massive population movements such as this are likely to be associated with substantial mortality and morbidity. OBJECTIVE: To study patterns of mortality, morbidity, and health care associated with the Rwandan refugee population repatriation during November 1996. METHODS: This study observed the functioning of the health-care facilities in the Gisenyi District in Rwanda and the Goma District in Zaire, and surveyed mortality and morbidity among Rwandan refugees returning from Zaire to Rwanda. Patterns of mortality, morbidity, and health care were measured mainly by mortality and health centre consultation rates. RESULTS: Between 15 and 21 November 1996, 553,000 refugees returned to Rwanda and 4,530 (8.2/1,000 refugees) consultations took place at the border dispensary (watery diarrhea, 63%; bloody diarrhea, 1%). There were 129 (0.2/1,000) surgical admissions (72% soft tissue trauma) to the Gisenyi hospital in the subsequent two weeks. The average number of consultations from the 13 health centres during the same period was 500/day. Overall, the recorded death rate was 0.5/10,000 (all associated with diarrhea). A total of 3,586 bodies were identified in the refugee camps and surrounding areas of Goma, almost all the result of trauma. Many had died in the weeks before the exodus. Health centres were overwhelmed and many of the deficiencies in provision of health care identified in 1994 again were evident. CONCLUSIONS: Non-violent death rates were low, a reflection of the population's health status prior to migration and immunity acquired from the 1994 cholera outbreak. Health facilities were over stretched, principally because of depleted numbers of local, health-care workers associated with the 1994 genocide. Health-care facilities running parallel to the existing health-care system functioned most effectively.

Adolescent↗
PubMed2006

Conspiracy beliefs about the origin of HIV/AIDS in four racial/ethnic groups.

We examined beliefs about the origin of HIV as a genocidal conspiracy in men and women of four racial/ethnic groups in a street intercept sample in Houston, Texas. Groups sampled were African American, Latino, non-Hispanic white, and Asian. Highest levels of conspiracy theories were found in women, and in African American and Latino populations (over a quarter of African Americans and over a fifth of Latinos) with slightly lower rates in whites (a fifth) and Asians (less than one in ten). Reductions in condom use associated with such beliefs were however only apparent in African American men. Conspiracy beliefs were an independent predictor of reported condom use along with race/ethnicity, gender, education, and age group. Data suggest that genocidal conspiracy beliefs are relatively widespread in several racial/ethnic groups and that an understanding of the sources of these beliefs is important to determine their possible impact on HIV prevention and treatment behaviors.

Adolescent↗
PubMed1993

The great slippery-slope argument.

Whenever some form of beneficent killing--for example, voluntary euthanasia--is advocated, the proposal is greeted with a flood of slippery-slope arguments warning of the dangers of a Nazi-style slide into genocide. This paper is an attempt systematically to evaluate arguments of this kind. Although there are slippery-slope arguments that are sound and convincing, typical formulations of the Nazi-invoking argument are found to be seriously deficient both in logical rigour and in the social history and psychology required as a scholarly underpinning. As an antidote, an attempt is made both to identify some of the likely causes of genocide and to isolate some of the more modest but legitimate fears that lie behind slippery-slope arguments of this kind.

Beneficence↗
PubMed2005

Conspiracy beliefs about birth control: barriers to pregnancy prevention among African Americans of reproductive age.

This article examines the endorsement of conspiracy beliefs about birth control (e.g., the belief that birth control is a form of Black genocide) and their association with contraceptive attitudes and behavior among African Americans. The authors conducted a telephone survey with a random sample of 500 African Americans (aged 15-44). Many respondents endorsed birth control conspiracy beliefs, including conspiracy beliefs about Black genocide and the safety of contraceptive methods. Stronger conspiracy beliefs predicted more negative attitudes toward contraceptives. In addition, men with stronger contraceptive safety conspiracy beliefs were less likely to be currently using any birth control. Among current birth control users, women with stronger contraceptive safety conspiracy beliefs were less likely to be using contraceptive methods that must be obtained from a health care provider. Results suggest that conspiracy beliefs are a barrier to pregnancy prevention. Findings point to the need for addressing conspiracy beliefs in public health practice.

Adolescent↗
PubMed1999

The roots of evil: social conditions, culture, personality, and basic human needs.

Evil actions are defined as repeated or persistent, not commensurate with provocation and causing extreme harm, at times due to repetition. Evil develops or evolves. As individuals and groups harm others, they tend to develop characteristics that make further and more intense harmdoing probable. In this article, I explore instigating conditions (difficult life conditions in a society, group conflict); cultural characteristics; the nature of evolution, with its psychological and social processes in individuals and groups; and the passivity and complicity of bystanders that lead to genocide and other collective violence. I consider the question of whether bystanders can be regarded as evil, focusing on the genocide in Rwanda as an example. I examine the socialization and experience of children and youth that lead to aggression and the subsequent evolution of aggression toward greater violence and evil. I explore the way personal characteristics and a system of relationships can lead to sexual abuse by fathers. One organizing concept in understanding the generation of violence that causes extreme harm is the frustration of basic human needs and their subsequent destructive fulfillment.

Journal Article↗
PubMedDate not supplied

Complex humanitarian emergencies: a review of epidemiological and response models.

Complex emergencies (CEs) have been the most common human-generated disaster of the past two decades. These internal conflicts and associated acts of genocide have been poorly understood and poorly managed. This article provides an epidemiological background and understanding of developing and developed countries, and chronic or smoldering countries' CEs, and explains in detail the prevailing models of response seen by the international community. Even though CEs are declining in number, they have become more complex and dangerous. The UN Charter reform is expected to address internal conflicts and genocide but may not provide a more effective and efficient means to respond.

Altruism↗
PubMed2004

Trauma and PTSD symptoms in Rwanda: implications for attitudes toward justice and reconciliation.

CONTEXT: The 1994 genocide in Rwanda led to the loss of at least 10% of the country's 7.7 million inhabitants, the destruction of much of the country's infrastructure, and the displacement of nearly 4 million people. In seeking to rebuild societies such as Rwanda, it is important to understand how traumatic experience may shape the ability of individuals and groups to respond to judicial and other reconciliation initiatives. OBJECTIVES: To assess the level of trauma exposure and the prevalence of posttraumatic stress disorder (PTSD) symptoms and their predictors among Rwandans and to determine how trauma exposure and PTSD symptoms are associated with Rwandans' attitudes toward justice and reconciliation. DESIGN, SETTING, AND PARTICIPANTS: Multistage, stratified cluster random survey of 2091 eligible adults in selected households in 4 communes in Rwanda in February 2002. MAIN OUTCOME MEASURES: Rates of exposure to trauma and symptom criteria for PTSD using the PTSD Checklist-Civilian Version; attitudes toward judicial responses (Rwandan national and gacaca local trials and International Criminal Tribunal for Rwanda [ICTR]) and reconciliation (belief in community, nonviolence, social justice, and interdependence with other ethnic groups). RESULTS: Of 2074 respondents with data on exposure to trauma, 1563 (75.4%) were forced to flee their homes, 1526 (73.0%) had a close member of their family killed, and 1472 (70.9%) had property destroyed or lost. Among the 2091 total participants, 518 (24.8%) met symptom criteria for PTSD. The adjusted odds ratio (OR) of meeting PTSD symptom criteria for each additional traumatic event was 1.43 (95% CI, 1.33-1.55). More respondents supported the local judicial responses (90.8% supported gacaca trials and 67.8% the Rwanda national trials) than the ICTR (42.1% in support). Respondents who met PTSD symptom criteria were less likely to have positive attitudes toward the Rwandan national trials (OR, 0.77; 95% CI, 0.61-0.98), belief in community (OR, 0.76; 95% CI, 0.60-0.97), and interdependence with other ethnic groups (OR, 0.71; 95% CI, 0.56-0.90). Respondents with exposure to multiple trauma events were more likely to have positive attitudes toward the ICTR (OR, 1.10; 95% CI, 1.04-1.17) and less likely to support the Rwandan national trials (OR, 0.90; 95% CI, 0.84-0.96), the local gacaca trials (OR, 0.80; 95% CI, 0.72-0.89), and 3 factors of openness to reconciliation: belief in nonviolence (OR, 0.92; 95% CI, 0.87-0.97), belief in community (OR, 0.92; 95% CI, 0.87-0.98), and interdependence with other ethnic groups (OR, 0.86; 95% CI, 0.81-0.92). Other variables that were associated with attitudes toward judicial processes and openness to reconciliation were educational level, ethnicity, perception of change in poverty level and access to security compared with 1994, and ethnic distance. CONCLUSIONS: This study demonstrates that traumatic exposure, PTSD symptoms, and other factors are associated with attitudes toward justice and reconciliation. Societal interventions following mass violence should consider the effects of trauma if reconciliation is to be realized.

Adult↗
PubMed1996

Legacy of German psychiatric genetics: hindsight is always 20/20.

The history of psychiatric genetics is informed by this paper, which serves to review the legacy of German psychiatric genetics and its antecedents during the twentieth century. It also serves as an introduction to two new annotated abstracts of basic research papers on family studies of schizophrenia by Ernst Rüdin in 1916 and by Bruno Schulz in 1932, submitted by Kenneth Kendler and Edith Zerbin-Rüdin, together with another paper by them describing the origin and activities of Rüdin's Munich School of Psychiatric Genetics (1917-1945). Our paper also introduces an invited critical summary of the work of Ernst Rüdin by his biographer Matthias M. Weber, a medical historian working in the Historical Archives of the Clinical Institute of the Max Planck Institute of Psychiatry in Munich. We raise a number of bioethical questions in the context of the uses and misuses made of genetic information in the service of the Nazi programs of eugenics, "euthanasia," and genocide.

Adolescent↗
PubMed1976

Aboriginal new world epidemiolgy and medical care, and the impact of Old World disease imports.

Various workers, including T. D. Stewart, claim that the aboriginal Americas were relatively disease-free because of the bering Strait cold-screen, eliminating many pathogens, and the paucity of zoonotic infections because of few domestic animals. Evidence of varying validity suggests that precontact Americns had their own strains of treponemic infections, bacillary and amoebic dysenteries, influenza and viral penumonia and other respiratory diseases, salmonellosis and perhaps other food poisoning, various arthritides, some endoparasites such as the ascarids, and several geographically circumscribed diseases such as the rickettsial verruca (Carrion's disease) and New World leishmaniasis and trypanosomiasis. Questionably aboriginal are tuberculosis and typhus. Accordingly, virtually all the "crowd-type" ecopathogenic diseases such as smallpox, yellow fever, typhoid, malaria, measles, pertussis, polio, etc., appear to have been absent from the New World, and were only brought in by White conquerors and their Black slaves. My hypothesis is that native American medical care systems--especially in the more culturally advanced areas--were sufficiently sophisticated to deal with native disease entities with reasonable competence. But native medical systems could not cope with the "crowd-type" disease imports that struck Indian and Eskimos as "virgin-field" populations. Reanalysis of native population losses through a genocidal combination of diease, war, slavery and attendant cultural disruption by Dobyns, Cook and others strongly suggest that traditiona estimates underplayed the death toll by a factor of the general order of ten. This would make for an immediately pre-contact Indian population of some 90-111 million instead of the tradition 8-11 million. Evidence is growing that Indians may have been no more susceptible to new pathogens that are other "virgin soil" populations, and thus their immune systems need not be considered less effective than those in other people. Present-day high mortality rates in Indians of both continents from infectious disease imports may be more socioeconomic than anything else.

Delivery of Health Care↗
PubMed2003

The genetics of deafness.

Deafness is an etiologically heterogeneous trait with many known genetic and environmental causes. Genetic factors account for at least half of all cases of profound congenital deafness, and can be classified by the mode of inheritance and the presence or absence of characteristic clinical features that may permit the diagnosis of a specific form of syndromic deafness. The identification of more than 120 independent genes for deafness has provided profound new insights into the pathophysiology of hearing, as well as many unexpected surprises. Although a large number of genes can clearly cause deafness, recessive mutations at a single locus, GJB2 or Connexin 26, account for more than half of all genetic cases in some, but not all populations. The high frequency may well be related to the greatly improved social, educational, and economic circumstances of the deaf that began with the introduction of sign language 300-400 years ago, along with a high frequency of marriages among the deaf in many countries. Similar mechanisms may account for the rapid fixation of genes for speech after the first mutations appeared 50,000-100,000 years ago. Molecular studies have shown that mutations involving several different loci may be the cause for the same form of syndromic deafness. Even within a single locus, different mutations can have profoundly different effects, leading to a different pattern of inheritance in some cases, or isolated hearing loss without the characteristic syndromic features in others. Most cases of genetic deafness result from mutations at a single locus, but an increasing number of examples are being recognized in which recessive mutations at two loci are involved. For example, digenic interactions are now known to be an important cause of deafness in individuals who carry a single mutation at the Connexin 26 locus along with a deletion involving the functionally related Connexin 30 locus. This mechanism complicates genetic evaluation and counseling, but provides a satisfying explanation for Connexin 26 heterozygotes who, for previously unknown reasons, are deaf. A specific genetic diagnosis can sometimes be of great clinical importance, as in the case of the mitochondrial A1555G mutation which causes gene carriers to be exquisitely sensitive to the ototoxic effects of aminoglycosides. This potentially preventable genetic-environmental interaction was the most common cause of genetic deafness in countries where these antibiotics were used indiscriminately in the past. Advances in genetic knowledge along with the use of cochlear implants have posed unique ethical dilemmas for society as well as the deaf community. Since most deaf children are born to hearing parents, it seems likely that deaf culture, and intermarriages among those born with deafness will recede during this century. Will future critics view this as one of the medical triumphs of the 21(st) Century, or as an egregious example of cultural genocide? On the other hand, genetics can provide empowering knowledge to the deaf community that for the first time can allow many deaf couples to know whether their children will be hearing or deaf even before they are conceived.

Biotinidase Deficiency↗