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Eisenbruch M. "The Mole on His Penis Lassos Her:" Cultural Understandings of Coercive Control and Emotional Abuse of Women in Cambodia. Violence Against Women 2023:10778012231174349. [PMID: 37306224 DOI: 10.1177/10778012231174349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Throughout world history, moles and birthmarks have occupied a special place as omens. Little is known of the cultural beliefs concerning the determinants of coercive control. In this ethnographic study of coercive control in Cambodia, the focus is on popular beliefs that moles are omens portending that men shall control women. Lachrymal moles (under the eye) signify women weeping as a result of misery. Penile moles portend men attracting, controlling, even abusing women. They have implications for reinterpreting an "insider" view of hegemonic masculinity and for culturally responsive interventions against gender-based violence.
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Affiliation(s)
- Maurice Eisenbruch
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Royal University of Phnom Penh, Phnom Penh, Cambodia
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Mannell J, Tevaga P, Heinrich S, Fruean S, Chang SL, Lowe H, Brown LJ, Vaczy C, Tanielu H, Cowley-Malcolm E, Suaalii-Sauni T. Love Shouldn't Hurt - E le Sauā le Alofa: Co-designing a theory of change for preventing violence against women in Samoa. Glob Public Health 2023; 18:2201632. [PMID: 37054449 DOI: 10.1080/17441692.2023.2201632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Despite the widespread adoption of Theories of Change (ToC) for programme evaluation, the process of collaboratively developing these theories is rarely outlined or critical analysed, limiting broader methodological discussions on co-production. We developed a ToC as part of E le Sauā le Alofa ('Love Shouldn't Hurt') - a participatory peer-research study to prevent violence against women (VAW) in Samoa. The ToC was developed in four phases: (1) semi-structured interviews with village representatives (n = 20); (2) peer-led semi-structured interviews with community members (n = 60), (3) community conversations with 10 villages (n = 217) to discuss causal mechanisms for preventing VAW, and (4) finalising the ToC pathways. Several challenges were identified, including conflicting understandings of VAW as a problem; the linearity of the ToC framework in contrast to intersecting realities of people's lived experiences; the importance of emotional engagements, and theory development as a contradictory and incomplete process. The process also raised opportunities including a deeper exploration of local meaning-making, iterative engagement with local mechanisms of violence prevention, and clear evidence of ownership by communities in developing a uniquely Samoan intervention to prevent VAW. This study highlights a clear need for ToCs to be complemented by indigenous frameworks and methodologies in post-colonial settings such as Samoa.
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Affiliation(s)
- Jenevieve Mannell
- Institute for Global Health, UCL, London, United Kingdom
- Centre for Samoan Studies, National University of Samoa, Apia, Samoa
| | | | | | | | | | - Hattie Lowe
- Institute for Global Health, UCL, London, United Kingdom
| | - Laura J Brown
- Institute for Global Health, UCL, London, United Kingdom
| | - Caroline Vaczy
- Institute for Global Health, UCL, London, United Kingdom
| | - Helen Tanielu
- Centre for Samoan Studies, National University of Samoa, Apia, Samoa
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Marutani T, Chhim S, Taing S, Nishio A. Causal beliefs regarding schizophrenia and help-seeking behaviors among patients with schizophrenia and family caregivers attending psychiatric clinics in Cambodia. Transcult Psychiatry 2022:13634615221107207. [PMID: 35837740 DOI: 10.1177/13634615221107207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Schizophrenia often follows a chronic or recurrent course, placing an immense burden on patients and their families. Mental health services in Cambodia are still highly limited, thus there is a major treatment gap. It is common that people consult traditional healers (Kru Khmer) and monks. In this culture, people who receive psychiatric medical treatment are expected to exhibit higher mental health literacy, but little is known about this factor. In this study, we interviewed 59 patients with schizophrenia and 59 family caregivers attending psychiatric clinics in Cambodia. Through qualitative analysis using a thematic analysis approach, we extracted eight themes of causal beliefs regarding schizophrenia: (1) spiritual beliefs, (2) cultural symptoms, (3) physical problems, (4) heredity, (5) substance abuse, (6) traumatic events, (7) stress in human relationships or in one's social environment, and (8) socioeconomic position. We found that "thinking too much" (kit chroeun) and "worrying too much" (prouy / barom chroeun), cultural idioms of distress, were recognized as causal factors of schizophrenia by both parents and family caregivers. Some participants were aware of the possible causal factors in light of the latest psychiatry findings, such as genetic factors and childhood trauma. Our data show that causal beliefs are not a decisive factor in shortening the duration of untreated psychosis (DUP). In Cambodia, where the treatment for schizophrenia is pluralistic, we suggest that it is crucial to embed the meaning of psychiatric treatment into local meaning worlds for better help-seeking behaviors.
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Affiliation(s)
| | - Sotheara Chhim
- Transcultural Psychosocial Organization (TPO) Cambodia, Cambodia
| | - Sopheap Taing
- Transcultural Psychosocial Organization (TPO) Cambodia, Cambodia
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Brody C, Reno R, Chhoun P, Ith S, Tep S, Tuot S, Yi S. Developing a WhatsApp hotline for female entertainment workers in Cambodia: a qualitative study. Mhealth 2022; 8:5. [PMID: 35178436 PMCID: PMC8800199 DOI: 10.21037/mhealth-21-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/30/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Female entertainment workers (FEWs) in Cambodia experience high levels of stress due to economic hardship, exposure to violence, and harassment by law enforcement due to their employment. This study aims to gather qualitative data on stressors, coping strategies, and preferences for chatline functions to inform the development of a WhatsApp hotline (chatline) for FEWs in Cambodia. METHODS This qualitative study includes data from 5 focus groups and 10 in-depth interviews (IDIs), at which point data collectors felt we approached saturation. Participants were asked to respond to open-ended questions, a comic strip showing how the hotline might work and an audio recording of a hypothetical hotline conversation. Primary structural coding was used to identify the preferred functions and type of support participants want to receive from hotline staff. As more secondary themes arose during codebook development, an inductive thematic analytical approach was selected to categorize these data. RESULTS Participants identified several stressors associated with female entertainment work, including concerns about physical and mental health, fear related to experiences with the police or threat of arrest, and exposure to violence. Passive/avoidance and active coping strategies were also identified. Participants preferred a 24 h chatline that provides emotional support from a kind and comforting female staff person. The types of support participants were looking for were advice about personal problems, encouragement to achieve their goals and address depression, and immediate help for violence. Most participants felt that the hotline could bring them a sense of relief and safety and improve their mood. Some stated that the hotline alone would not alleviate the stressors they were exposed to, particularly related to violence and called for more transformational change. CONCLUSIONS This study offers textured evidence to inform the WhatsApp hotline development and staff training tailored to meet the needs of this specific population. Linking this hotline with crisis response, legal support, and longer-term in-depth counseling and using information gathered from this project to inform more extensive structural and policy-level changes should also be part a foundational part of this project.
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Affiliation(s)
- Carinne Brody
- Public Health Program, Center for Global Health Research, Touro University California, Vallejo, CA, USA
| | | | - Pheak Chhoun
- KHANA, Center for Population Health Research, Phnom Penh, Cambodia
| | - Sopherean Ith
- KHANA, Center for Population Health Research, Phnom Penh, Cambodia
| | - Sovanvorleak Tep
- KHANA, Center for Population Health Research, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA, Center for Population Health Research, Phnom Penh, Cambodia
| | - Siyan Yi
- Public Health Program, Center for Global Health Research, Touro University California, Vallejo, CA, USA
- KHANA, Center for Population Health Research, Phnom Penh, Cambodia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
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Makleff S, Garduño J, Zavala RI, Valades J, Barindelli F, Cruz M, Marston C. Evaluating Complex Interventions Using Qualitative Longitudinal Research: A Case Study of Understanding Pathways to Violence Prevention. QUALITATIVE HEALTH RESEARCH 2021; 31:1724-1737. [PMID: 33980080 PMCID: PMC8438767 DOI: 10.1177/10497323211002146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Evaluating social change programs requires methods that account for changes in context, implementation, and participant experience. We present a case study of a school-based partner violence prevention program with young people, where we conducted 33 repeat interviews with nine participants during and after an intervention and analyzed participant trajectories. We show how repeat interviews conducted during and after a social change program were useful in helping us understand how the intervention worked by providing rich contextual information, elucidating gradual shifts among participants, and identifying aspects of the intervention that appear to influence change. Long-term effects of social change interventions are very hard to quantify or measure directly. We argue that a qualitative longitudinal approach provides a way to measure subtle changes that can serve as proxies for longer term impacts.
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Affiliation(s)
- Shelly Makleff
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Monash University, Melbourne, Victoria, Australia
| | - Jovita Garduño
- Fundación Mexicana para la Planeación Familiar, A.C., Mexico City, Mexico
| | - Rosa Icela Zavala
- Fundación Mexicana para la Planeación Familiar, A.C., Mexico City, Mexico
| | | | | | | | - Cicely Marston
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Eisenbruch M. "His body is human, but he has a tiracchāna heart": An ethnographic study of the epigenesis of child abuse in Cambodia. CHILD ABUSE & NEGLECT 2019; 88:129-143. [PMID: 30502578 DOI: 10.1016/j.chiabu.2018.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/25/2018] [Accepted: 10/28/2018] [Indexed: 06/09/2023]
Abstract
In Cambodia, more than half of all children experience physical, emotional, or sexual abuse. This article examines how Cambodians view the causes and effects of child abuse and analyses its underlying cultural forces. Adopting a conceptual framework originally developed for the cultural context of violence against women, 110 cases of child abuse were ethnographically studied, comprising 61 cases of sexual abuse (50 girls and 11 boys), 26 cases of physical abuse (13 girls and 13 boys), and 23 cases of emotional abuse or neglect (13 girls and 10 boys). The perpetrators included fathers and other close relatives, lay Buddhist officiants and monks, and neighbors. Most informants viewed the sexual or physical abuse of children as stemming from "cultural attractors," including blighted endowment caused by deeds in a previous life, a bad character starting early in life, astrological vulnerability to abuse, preordained entanglement between the child and the abuser (they are "fated" to meet), sexual craving, "entering the road to ruin," and a moral blindness that portrays the abuser as blameless. Although these traits are similar to those identified in the explanations of violence against women, there were notable differences such as the role of the tiracchāna in explaining sexual abuse, including incest. Using these findings, this article identifies a cultural epigenesis of child sexual abuse, and provides a blueprint for developing a culturally responsive plan to prevent child abuse.
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Affiliation(s)
- Maurice Eisenbruch
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia.
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