The sound of barking dogs: violence and terror among Salvadoran families in the postwar

Exploring syndemic vulnerability across generations: A case study of a former fishing village in the Netherlands

This qualitative case study uses a life-course approach to explore syndemic vulnerability in a former fishing village in the Netherlands. Building on four years of fieldwork in a low-income neighborhood, we explored salient themes between and across families and generations. Elderly community members (>65 years) were interviewed to map village history and explore how contextual factors have affected family life, health, and wellbeing since the 1940s. We systematically traced and compared processes leading to or from syndemic vulnerability by studying seven families across three generations. Adults with at least one of clustering diseases, their parents (when possible), and their children participated in semi-structured life-course interviews. A complex interaction of endemic social conditions, sociocultural normative processes, learned health behaviors, and disheartening life events shaped families' predispositions for a syndemic of psychological distress, cardiometabolic conditions, and musculoskeletal pain. Educational attainment, continued social support, and aspirational capabilities emerged as themes related to decreasing syndemic vulnerability. This study demonstrates that syndemic vulnerability is potentially intergenerational and reveals the need for culturally sensitive and family-focused syndemic interventions. Future longitudinal research should focus on unravelling the pathogenesis of the clustering of psychological distress, cardiometabolic conditions, and musculoskeletal pain among young people.

Social Violence, Structural Violence, Hate, and the Trauma Surgeon

Violence can be committed against oneself or against another person or group. As trauma surgeons, we are often required to administer urgent surgical interventions on patients who have sustained life-threatening injuries, including from violence. The roots of such violence, nationally and globally, are related to structures of discrimination and alienation, termed “structural violence.” This is embedded in ubiquitous social structures and normalized by stable institutions and regular experience while “normalizing the abnormal.” Surgeons and physicians have a long history of critical analysis of the upstream “causes of the causes” to understand and prevent further harm. Hate can be well adapted to the classic public health model of the spread of “disease,” with hate speech as the vector leading to direct violence. Social medicine views social inequality as the cause of disease, with political action required to protect and improve population health. It acknowledges the need to address and end structural violence, through political solutions. It is our responsibility to create the dignified environments of growth and progress for our patients and to challenge the agents of harm such as hate and discrimination. As Dr. Norman Bethune, the father of social surgery stated, “Charity should be abolished, and replaced by justice.”

Intergenerational transmission of violence and resilience in conflict-affected Burundi: a qualitative study of why some children thrive despite duress

BACKGROUND

Research suggests that in environments where community conflict and violence are chronic or cyclical, caregiving can impact how children may begin to reproduce violence throughout the various stages of their lives. The aim of this study is to understand how caregiving affects processes of reproducing violence and resilience among children in conflict-affected Burundi.

METHODS

We combined a socio-ecological model of child development with a child-actor perspective. We operationalized the core concepts 'vulnerable household', 'resilience', and 'caregiving' iteratively in culturally relevant ways, and put children's experiences at the center of the inquiry. We carried out a comparative case study among 74 purposively sampled vulnerable households in six collines in three communes in three provinces in the interior of Burundi. Burundian field researchers conducted three consecutive interviews; with the head of the household, the main caregiver, and a child.

RESULTS

Our findings reveal a strong congruence between positive caregiving and resilience among children. Negative caregiving was related to negative social behavior among children. Other resources for resilience appeared to be limited. The overall level of household conditions and embedment in communities attested to a generalized fragile ecological environment.

CONCLUSIONS

In conflict-affected socio-ecological environments, caregiving can impact children's functioning and their role in reproducing violence. Interventions that support caregivers in positive caregiving are promising for breaking cyclical violence.

The Perceived Consequences of Gold Mining in Postwar El Salvador: A Qualitative Study

OBJECTIVES

We investigated themes related to the health and environmental impacts of gold mining in El Salvador.

METHODS

Over a 1-month period in 2013, we conducted focus groups (n = 32 participants in total) and individual semistructured interviews (n = 11) with community leaders until we achieved thematic saturation. Data collection took place in 4 departments throughout the country. We used a combination of criterion-purposive and snowballing sampling techniques to identify participants.

RESULTS

Multiple themes emerged: (1) the fallacy of economic development; (2) critique of mining activities; (3) the creation of mining-related violence, with parallels to El Salvador's civil war; and (4) solutions and alternatives to mining activity. Solutions involved the creation of cooperative microenterprises for sustainable economic growth, political empowerment within communities, and development of local participatory democracies.

CONCLUSIONS

Gold mining in El Salvador is perceived as a significant environmental and public health threat. Local solutions may be applicable broadly.

[Historical trauma. Systematic review of a different approach to armed conflict]

INTRODUCTION

Historical trauma (HT) is a collective trauma inflicted on a group of people who share an identity or affiliation, and is often characterized by the transgenerational legacy of traumatic experiences, and expressed through various psychological and social responses. This construct is proposed in contrast to post-traumatic stress disorder (PTSD) due to limitations identified with the latter diagnostic category when addressing collective trauma, especially in situations of political and social violence. The purpose of this article is to review the literature published so far on HT.

METHODS

A search was performed using the terms "historical trauma" and "mental health" or "trauma histórico" and "salud mental" in the scientific databases, EMBASE, Ebscohost, JSTOR, ProQuest, LILACS, SciELO, PsycARTICLES, ISI Web of Science and PubMed.

RESULTS

The authors reviewed HT definition, paramount characteristics of its traumatic experience, and several theories of on the transgenerational succession if these experiences occur, as well as possible consequences of traumatic events at individual, family and social level. Common characteristics of different therapeutic models are highlighted, in addition to some recommendations for their application.

CONCLUSIONS

PTSD has clear limitations in addressing community and cumulative traumatic experiences related to specific social and historical contexts. The authors discuss the potential utility of HT in this task. Finally, several gaps in current knowledge regarding this construct are mentioned, and some recommendations for future research are indicated.

Mediators of the relation between war experiences and suicidal ideation among former child soldiers in Northern Uganda: the WAYS study

BACKGROUND

Globally, suicide is a public health burden especially in the aftermath of war. Understanding the processes that define the path from previous war experiences (WE) to current suicidal ideation (SI) is crucial for defining opportunities for interventions. We assessed the extent to which different types of previous WE predict current SI and whether post-war hardships and depression mediate the relations between WE and SI among former child soldiers (FCS) in Northern Uganda.

METHODS

We performed cross-sectional analyses with a sample of 539 FCS (61% male) participating in an on-going longitudinal study. The influence of various types of previous WE on current SI and mediation by post-war hardships and depression were assessed by regression analyses.

RESULTS

The following types of war experiences: "witnessing violence", "direct personal harm", "deaths", "Involvement in hostilities", "sexual abuse" and "general war experiences" significantly predicted current SI in a univariable analyses whereas "direct personal harm", "involvement in hostilities", and "sexual abuse" independently predicted current SI in a multivariable analyses. General WE were linked to SI (β = 0.18 (95% CI 0.10 to 0.25)) through post-war hardships (accounting for 69% of the variance in their relationship) and through depression/anxiety (β = 0.17 (95% CI 0.12 to 0.22)) accounting for 65% of the variance in their relationship. The direct relationship between previous WE and current SI reduced but remained marginally significant (β = .08, CI: (.01, .17) for depression/anxiety but not for post-war hardships (β = .09, CI: (-.03, .20).

CONCLUSION

Types of WE should be examined when assessing risks for SI. Interventions to reduce SI should aim to alleviate post-war hardships and treat depression/anxiety.

Children enacting idioms of witchcraft and spirit possession as a response to trauma: therapeutically beneficial, and for whom?

This article examines children's enactment of spirit possession idioms and witchcraft in Africa including the meanings such idioms provide and the local healing resources they mobilize. Idioms of haunting spirits in Northern Uganda and witch-children elsewhere in Africa can be interpreted as manifestations of social crises and mass traumatic stress. On the other hand, such idioms also allow children to articulate, reflect upon, and communicate the complex feelings resulting from their precarious positions within families and communities under duress. With the help of Dow's transactional model of symbolic healing, this article explores obstacles to the effectivity of the rich variety of symbolic healing available for haunting spirits in Uganda and points to the generational gap between children and their families and communities. Elsewhere, witchcraft idioms may act as a healing resource at the group level, but at the expense of the accused child. The idioms of evil spirits and witchcraft speak of these children's navigation of the moral universe of their postconflict communities. Given that children's appraisal of their experiences through these notions may also exacerbate their anxiety, interdisciplinary research examining the microprocesses that lead to children being haunted or accused, including emotional and physiological levels effects, is urgently needed.

The cross-cultural validity of posttraumatic stress disorder: implications for DSM-5

BACKGROUND

There is considerable debate about the cross-cultural applicability of the posttraumatic stress disorder (PTSD) category as currently specified. Concerns include the possible status of PTSD as a Western culture-bound disorder and the validity of individual items and criteria thresholds. This review examines various types of cross-cultural validity of the PTSD criteria as defined in DSM-IV-TR, and presents options and preliminary recommendations to be considered for DSM-5.

METHODS

Searches were conducted of the mental health literature, particularly since 1994, regarding cultural-, race-, or ethnicity-related factors that might limit the universal applicability of the diagnostic criteria of PTSD in DSM-IV-TR and the possible criteria for DSM-5.

RESULTS

Substantial evidence of the cross-cultural validity of PTSD was found. However, evidence of cross-cultural variability in certain areas suggests the need for further research: the relative salience of avoidance/numbing symptoms, the role of the interpretation of trauma-caused symptoms in shaping symptomatology, and the prevalence of somatic symptoms. This review also indicates the need to modify certain criteria, such as the items on distressing dreams and on foreshortened future, to increase their cross-cultural applicability. Text additions are suggested to increase the applicability of the manual across cultural contexts: specifying that cultural syndromes-such as those indicated in the DSM-IV-TR Glossary-may be a prominent part of the trauma response in certain cultures, and that those syndromes may influence PTSD symptom salience and comorbidity.

CONCLUSIONS

The DSM-IV-TR PTSD category demonstrates various types of validity. Criteria modification and textual clarifications are suggested to further improve its cross-cultural applicability.

A mother's heart is weighed down with stones: a phenomenological approach to the experience of transnational motherhood

Although recent scholarship on transnational mothers has rigorously examined the effect of migration on gender constructs and ideologies, it neglects analysis of the lived experience of separated mothers and children. In privileging the exploration of transnational separations through the single analytical lens of gender, such research reduces the embodied distress of mothers and children to mere "gender false consciousness." This paper calls upon anthropologists to redress this oversight by undertaking a phenomenological analysis of the lived experience of transnational motherhood. Eschewing an analysis of mothers and children as isolated social roles, I show that the suffering of mothers and children is profoundly relational. Through analysis of the narratives of undocumented Salvadoran mothers residing in the U.S., I show how the strain of such mothers' undocumented status is lived and shouldered within the intersubjective space of the family.

Understanding Native women's health: historical legacies

PURPOSE

Theoretical underpinnings of two theories are examined for their applicability in guiding practice and research when understanding Native American women's health outcomes.

METHOD

Published studies testing two independent theories, historical trauma and weathering, are reviewed. Key theoretical concepts that are applicable in the study of Native women and understanding their intergenerational heritage of injustice and cultural context are discussed.

RESULTS

The authors infer underlying assumptions and definitions of both theories and present a hypothetical diagram blending both theories.

CONCLUSION

By understanding historical legacies and the surrounding context, researchers and clinicians can develop knowledge to improve and enhance optimal health outcomes and life opportunities for Native women.