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PubMed2004

Humanitarian military medical mission in a postconflict environment: lessons from Cambodia.

In the aftermath of a genocidal civil war, the Government of Cambodia is left with major deficiencies in its healthcare system. This article recounts a military medical mission to Cambodia; the authors describe the objectives of the mission and provide a summary of the lessons learned. Specific areas of concern include healthcare infrastructure, logistics, standards of care, social traditions, organizational issues and potential problems in civil-military collaboration. This report is offered as a heuristic device to illuminate some of the issues that can mediate the success of military medical missions in postconflict environments.

Altruism↗

PubMed2003

Street children and political violence: a socio-demographic analysis of street children in Rwanda.

OBJECTIVE: The aims were: (1) to examine the profile of African street children and to assess the link between street children in Africa and political violence; (2) to undertake a systematic examination of causal factors of street children in postgenocide Rwanda; and (3) to situate this analysis in the context of the socio-cultural and political impact of the genocide on Rwandan communities. METHOD: Observational mapping examined the profile and activities of Rwandan street children. Structured interviews were carried out with 290 children in four regional towns to obtain information on socio-demographic, familial, educational background, causal factors surrounding street life involvement, psychological well-being, and relationship to the street. Focus group discussions and key informant interviews examined the relationship between street children and the broader Rwandan society. RESULTS: Street children in Rwanda were predominantly adolescent boys, almost half of whom were homeless (42%), with a high proportion of orphaned children or children who had lost at least one parent. Two variables predicted homelessness: child's guardian and reason for being in street. Qualitative accounts of children conveyed the impact of death of family members, repatriation, imprisonment of parents, and poverty on their lives. CONCLUSIONS: The analysis highlighted the need for community based support for children in alternative guardianship care and for policies to support the reintegration of male youths in postconflict welfare strategies as prevention strategies for street migration.

Adolescent↗

PubMed1996

Ethics of cochlear implantation in young children.

Certain leaders of the Deaf community are attempting to generate opposition to cochlear implants in children by pitting the rights of deaf children and their families against the needs of deaf society. They have labeled physicians as unethical and CIs as "child abuse," resulting in misunderstanding, anger, and violence. However, the arguments of these leaders are internally contradictory: they hold that deafness is not a disability but support disability benefits for the deaf; they maintain both that cochlear implants do not work and that they work so well that they are "genocidal" (i.e., they will eliminate deafness). Their positions oppose the ethical principles of beneficence and autonomy as they relate to self-determination and privacy. Ethical standards hold that the best interests of the child precede those of a special interest group and that parents have the responsibility to determine their children's best interests.

Child↗

PubMed2002

Working with suffering.

The past century has shown that human beings are capable of genocidal destruction of millions of other humans based on ethnicity or race. Clinicians today are likely to encounter patients who are survivors of inflicted atrocities and abuse. People fleeing horrendous circumstances bring persisting memories that produce symptoms even for the next generation. Families carry the knowledge-personal, cultural, familial, and sometimes individual-of the depths of destruction that human beings can do to one another. Suffering derives from the memory, both physical and mental, of what other persons inflicted; it has multiple dimensions that patients may not express explicitly; instead they may frame their experience of suffering in terms of pain. Diagnostic labels such as post-traumatic stress disorder or somatization are inadequate to convey human comprehension of suffering. Clinicians around the world need to be willing and able to acknowledge and witness the profound sources of experiential pain in the lives of their patients.

Homicide↗

PubMed2000

Health, welfare reform, and narratives of uncertainty among Cambodian refugees.

Massive disruptions to a way of life, such as those brought on by widespread violence, terror, and genocide, disorder the body as well as the social order. When they flee their homelands, refugees bring their experiences of violence and terror with them. Drawing on an ethnographic study of 40 Cambodian refugees between the ages of 50 and 79 who suffered from one or more chronic illnesses, we explore how refugees who live with chronic illnesses and are dependent on government support were affected by the threat of welfare reform. When welfare reform threatened to cut Cambodian refugees' income, it posed a new crisis for those who were chronically in limbo and placed further constraints on their lives. Through their narratives, Cambodian refugees enacted their bodily distress and resisted the threat of welfare reform. The story of threatened welfare reform in the U.S. and its possible consequences for refugees is a story of quixotic U.S. politics, policies and antidotes for refugeeism gone awry.

Aged↗

PubMed2003

Children and war.

Children bear disproportionate consequences of armed conflict. The 21st century continues to see patterns of children enmeshed in international violence between opposing combatant forces, as victims of terrorist warfare, and, perhaps most tragically of all, as victims of civil wars. Innocent children so often are the victims of high-energy wounding from military ordinance. They sustain high-energy tissue damage and massive burns - injuries that are not commonly seen in civilian populations. Children have also been deliberately targeted victims in genocidal civil wars in Africa in the past decade, and hundreds of thousands have been killed and maimed in the context of close-quarter, hand-to-hand assaults of great ferocity. Paediatricians serve as uniformed military surgeons and as civilian doctors in both international and civil wars, and have a significant strategic role to play as advocates for the rights and welfare of children in the context of the evolving 'Laws of War'. One chronic legacy of contemporary warfare is blast injury to children from landmines. Such blasts leave children without feet or lower limbs, with genital injuries, blindness and deafness. This pattern of injury has become one of the post-civil war syndromes encountered by all intensivists and surgeons serving in four of the world's continents. The continued advocacy for the international ban on the manufacture, commerce and military use of antipersonnel landmines is a part of all paediatricians' obligation to promote the ethos of the Laws of War. Post-traumatic stress disorder remains an undertreated legacy of children who have been trapped in the shot and shell of battle as well as those displaced as refugees. An urgent, unfocused and unmet challenge has been the increase in, and plight of, child soldiers themselves. A new class of combatant comprises these children, who also become enmeshed in the triad of anarchic civil war, light-weight weaponry and drug or alcohol addiction. The International Criminal Court has outlawed as a War Crime, the conscription of children under 15 years of age. Nevertheless, there remain more than 300000 child soldiers active and enmeshed in psychopathic violence as part of both civil and international warfare. The typical profile of a child soldier is of a boy between the ages of 8 and 18 years, bonded into a group of armed peers, almost always an orphan, drug or alcohol addicted, amoral, merciless, illiterate and dangerous. Paediatricians have much to do to protect such war-enmeshed children, irrespective of the accident of their place of birth. Only by such vigorous and maintained advocacy can the world's children be better protected from the scourge of future wars.

Adolescent↗

PubMed1998

[The relevance of ethology for psychiatry].

Darwin's evolutionary theory was the starting point for ethology, associated with an impact on scientific psychiatry. Psychiatry and ethology have common scientific and methodological prerequisites: inductive and deductive methods and "gestalt theory" as a basis for observing and describing behaviour patterns with subsequent causal analysis. There have been early endeavours to anchor ethological thinking in psychiatry but this tendency did not prevail for the following reasons: on the one hand, the methodology of ethology was immature or not applicable to man, whereas on the other hand the dominating experiential phenomenological school of Karl Jaspers and Kurt Schneider stressed the privileged position of human thinking, perception, and feeling. These fundamental categories of human existence did not appear amenable to any causal ethological analysis. Psychiatry and evolutionary biology were linked in an atrocious manner during the Nazi regime, both being abused for propaganda purposes and genocide. More recently, there is a "reconciliation" of both disciplines. In psychiatric nosology, operational, behaviour-oriented diagnostic systems have been introduced; ethology has opened up for theories of learning; new subsections like human ethology and sociobiology have evolved. The seeming incompatibility of (behavioural) biological psychiatry and experiential phenomenological psychopathology may be overcome on the basis of Konrad Lorenz' evolutionary epistemology. The functional analysis of human feeling and behaviour in psychotic disorders on the basis of Jackson's theory of the evolution and dissolution of the nervous system may serve as an example. The significance of an "ethological psychiatry" for diagnostic and therapeutical processes of psychiatric disorders derive from prognostic possibilities and the analysis of non-verbal communication in therapist-patient-interactions, but have not yet been systematically investigated.

Animals↗

PubMed2004

Explaining wartime rape.

In the years since the first reports of mass rapes in the Yugoslavian wars of secession and the genocidal massacres in Rwanda, feminist activists and scholars, human rights organizations, journalists, and social scientists have dedicated unprecedented efforts to document, explain, and seek solutions for the phenomenon of wartime rape. While contributors to this literature agree on much, there is no consensus on causal factors. This paper provides a brief overview of the literature on wartime rape in historical and ethnographical societies and a critical analysis of the four leading explanations for its root causes: the feminist theory, the cultural pathology theory, the strategic rape theory, and the biosocial theory. The paper concludes that the biosocial theory is the only one capable of bringing all the phenomena associated with wartime rape into a single explanatory context.

Battered Women↗

PubMed2006

The socio-demographic legacy of the Khmer Rouge period in Cambodia.

The study presented in this paper is an examination of the long-term impact of genocide during the period of the Khmer Rouge regime (1975-79) in Cambodia. The very high and selective mortality of the period had a major impact on the population structure of Cambodia. Fertility and marriage rates were both very low under the Khmer Rouge, but recovered immediately after the regime's collapse. Because of the shortage of eligible men, the age and education differences between partners tended to decline. The period also had a lasting impact on the educational attainment of the population. The school system collapsed during the period and therefore individuals -- especially men -- who were of school age at the time have a lower educational attainment than those from the preceding and subsequent birth cohorts.

Adolescent↗

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

Narrative constructions of sexual violence as told by female rape survivors in three populations of the southwestern United States: scripts of coercion, scripts of consent.

There is a growing literature on the narrative construction of rape as sexual violence. This is puzzling, since, in certain contexts, violence may stifle narrative production. Researchers of atrocities, for example, propose that the experience of recurring terror disrupts narrative cohesion in reporting lived trauma. Genocidal horror occurs in the context of communities and ethnic groups. Our rape survival data from women of three populations in the southwestern United States reflect traumas of sexual violence against women, experienced within everyday lives. From interviews with 62 female rape survivors, we (1) identify narrative conventions and linguistic devices to show how these women structure accounts of sexual assault that reflect their cultural background; (2) contrast scripts of coercion and consent; (3) examine how the way in which these women describe the coercive actions of the perpetrator(s) contradicts the assumptions of legal discourse; and (4) discuss the narrative production of several women in abusive relationships and compare it to the narrative production (or lack thereof) of persons who experience state-engineered terror.

Adolescent↗

PubMedDate not supplied

Intergroup atrocities in war: a neuroscientific perspective.

Studying the most extreme outcomes of intergroup hatred--murder, mass killings and genocides--has long been part of historical and social research. Neuroscientists and psychologists have also been interested in interpersonal and intergroup violence. This article considers the question of how atrocities arise from a neuroscientific perspective, focusing on war as the context in which they most often occur. It describes relevant aspects of brain function, relates them to social psychological research on intergroup hostility and applies the resulting framework to a case study: the US prison camp at Guantanamo Bay.

Brain↗

PubMed2006

Suicide among indigenous peoples: introduction and call to action.

Indigenous people around the world have the highest suicide risk of any identifiable cultural (or ethnic) group. It is a youth epidemic. The World Health Organization (WHO) has called for action; this special issue of Archives of Suicide Research (ASR) is an attempt to heed this call. Scholars, indigenous and non-indigenous, present data from the Arctic, Canada, Australia, New Zealand, Brazil, and other regions. It is concluded that not only data, but also explanations are needed. Suicide is multi determined. Colonialism and its associated genocide are, however, cited as a common factor. Yet, much greater cooperative international efforts are needed to not only understand, but also predict and control the epidemic.

Global Health↗

PubMed1999

Diseases of meaning, manifestations of health, and metaphor.

Disease and health are commonly thought of as distinct opposites. We propose a different view in which both may be seen to be facets of healthy functioning, each necessary for the other, each giving rise to the other. Thus, disease may be thought of as a manifestation of health. It is the healthy response of an organism striving to maintain physical, psychologic, and spiritual equilibrium. Disease is not necessarily to be avoided, blocked, or suppressed. Rather, it should be understood to be a process of transformation. The process should therefore be facilitated because it is an integral part of the dynamic equilibrium that we ordinarily think of as health. In many cases, perhaps all, people get ill because there is something going "wrong" in their lives. This could occur in a whole range of ways-relationships, environment, food, or job. Our view, however, is that disease is a meaningful state that can inform health workers how to help patients to heal themselves. In this way, instead of being meaningless, people's problems become diseases of meaning, enabling people to see that things are not necessarily "going wrong" but are, in fact, helping them become stronger, to live more fully and with more understanding. Seen from this perspective, depression; cancer; heart disease; neurodegenerative and autoimmune disease; dementia; and conditions such as community violence, genocide, and the problem of environmental devastation are "diseases of meaning." World Health Organization forecasts make it clear that diseases of meaning will continue well into the next millennium to be the major cause of suffering and death worldwide. To deal with them, the world needs to reformulate the biomolecular paradigm that has been exploited in the last two centuries. It does not address the reasons why these diseases arise, attending mainly to their molecular consequences. A paradigm that includes the importance of meaning must now be given top priority. The concept that diseases are a manifestation of health-a call to a different relationship with ourselves and our environment, both animate and inanimate- is in itself a different approach. Programs for care and education based upon it would have immediate application in medicine, industry, education and ecology. We believe that this model would have far-reaching consequences for the understanding, treatment, and prevention of diseases and behaviors that lead to violence and environmental destruction.

Adaptation, Psychological↗

PubMed2005

In one's own image: ethics and the reproduction of deafness.

The ethics of the use of genetic screening and reproductive technologies to select against and for deafness is presented. It is argued that insofar as deafness is a disability it is ethical to act in such a way as to avoid the conception or birth of children with genetic or congenital deafness. The discovery and recognition of signing deaf communities as cultural and linguistic communities (minorities) does not alter this basic ethical position, although the consequences of widespread application of this technology appears destined to lead to the eventual disappearance of these communities. The argument that acting to avoid deafness is unethical because it will lead to the elimination of a linguistic or cultural group (genocide or ethnocide) or conversely that acting to ensure deafness is ethical, if not praiseworthy, can only be sustained if deafness is not regarded as a disability at all. I argue that the premise that deafness is not a disability of some sort is false and thus the claim that genetic selection against deafness is unethical is untenable.

Adult↗

PubMed1987

Genetics after Auschwitz.

The fast growth and flourishing of science and technology in a vacuum of values was instrumental in organizing the various genocide programmes in Nazi Germany. This use of science and scientists for both ideological and practical goals has been overlooked by most observers including the scientists themselves. Some reasons for this are discussed herein.

Biomedical Research↗

PubMed1987

Essay: On the place of the Holocaust in history. In honour of Franklin H. Littell.

The Holocaust was a human event, perpetrated for human reasons which can be historically explained. As an event within history, it is unique in terms of the murderers'S motivation: a mission to rescue Germany, Europe and the world from their supreme enemy, the Jews. Other events, such as that which seems to most closely parallel the Holocaust, the Armenian massacres by the Turks in World War I, bear certain similarities to the Holocaust. Yet. In its attempt at total physical annihilation of all Jews everywhere, the Holocaust is unique. It stands at the extreme end of a continuum of human brutality, extending from mass murder, which has become commonplace, to genocide, and to Holocaust.

Death↗

PubMed2002

Prevalence of depression in rural Rwanda based on symptom and functional criteria.

The authors' objective was to estimate the prevalence of major depressive disorder among Rwandans 5 years after the 1994 genocidal civil war. They interviewed a community-based random sample of adults in a rural part of Rwanda using the Hopkins Symptom Checklist and a locally developed functional impairment instrument. The authors estimated current rates of major depression using an algorithm based on the DSM-IV symptom criteria (A), distress/functional impairment criteria (C), and bereavement exclusionary criteria (E). They also examined the degree to which depressive symptoms compromise social and occupational functioning. Three hundred sixty-eight adults were interviewed, of whom 15.5% met Criteria A, C, and E for current major depression. Depressive symptoms were strongly associated with functional impairment in most major roles for men and women. The authors conclude that a significant part of this population has seriously disabling depression. Work on appropriate, feasible, safe, and effective mental health interventions should be a priority for this population.

Adaptation, Psychological↗