Social suffering and the psychological impact of structural violence and economic oppression in an ongoing conflict setting: The Gaza Strip

Structural violence and economic oppression (e.g. control over resources, politically engineered poverty and unemployment) are common features of warfare, yet there is a lack of research exploring the impact this has on civilian wellbeing in conflict-affected areas. This study, embedded within a human rights and community liberation psychology framework, aims to address this need by studying young Palestinian university graduates living under military blockade and occupation in the Gaza Strip. Semi-structured interviews were conducted. Thematic analysis indicated that economic and political domains adversely affected multiple aspects of civilian life and wellbeing. The findings revealed the deleterious effects of structural violence and economic oppression which created: human insecurity; poor psychological wellbeing and quality of life; existential, psychological and social suffering; humiliation; injuries to dignity; multiple losses; and led to life being experienced as 'on hold'. Local expressions and idioms to express distress were identified. The findings contributed to unique insights regarding how continual, systemic, and structural oppression can be potentially more psychologically detrimental than specific incidents of conflict and violence. The implications and the relevance of the findings to mental health and disaster relief are considered. Interventions providing human security and economic security should be prioritised.

The "hot potato" topic: challenges and facilitators to promoting respectful maternal care within a broader health intervention in Tanzania

In recent years, mistreatment during childbirth has captured the public health and maternal health consciousness as not only an affront to women's rights but also a formidable deterrent to the uptake of facility-based childbirth - and thus to reductions in maternal mortality. The challenge ahead is to determine what can be done to address this public health problem. A modest but growing body of research has demonstrated that interventions to foster Respectful Maternity Care (RMC) can enact change, albeit in the relatively controlled context of a trial or study. Herein we describe our experiences in weaving elements of RMC across tiers of an existing maternal and newborn health program. As a commentary, this document does not outline program results, but instead highlights challenges and facilitators to promoting RMC within a large-scale, multi-district health platform. We conclude with lessons learned during the process and urge that others share their program learning experiences in an effort to strengthen the knowledge base on what works and what does not work in terms of addressing this complex, context-sensitive issue.

Expanding the agenda for addressing mistreatment in maternity care: a mapping review and gender analysis

BACKGROUND

This paper responds to the global call to action for respectful maternity care (RMC) by examining whether and how gender inequalities and unequal power dynamics in the health system undermine quality of care or obstruct women's capacities to exercise their rights as both users and providers of maternity care.

METHODS

We conducted a mapping review of peer-reviewed and gray literature to examine whether gender inequality is a determinant of mistreatment during childbirth. A search for peer-reviewed articles published between January 1995 and September 2017 in PubMed, Embase, SCOPUS, and Web of Science databases, supplemented by an appeal to experts in the field, yielded 127 unique articles. We reviewed these articles using a gender analysis framework that categorizes gender inequalities into four key domains: access to assets, beliefs and perceptions, practices and participation, and institutions, laws, and policies. A total of 37 articles referred to gender inequalities in the four domains and were included in the analysis.

RESULTS

The mapping indicates that there have been important advances in documenting mistreatment at the health facility, but less attention has been paid to addressing the associated structural gender inequalities. The limited evidence available shows that pregnant and laboring women lack information and financial assets, voice, and agency to exercise their rights to RMC. Women who defy traditional feminine stereotypes of chastity and serenity often experience mistreatment by providers as a result. At the same time, mistreatment of women inside and outside of the health facility is normalized and accepted, including by women themselves. As for health care providers, gender discrimination is manifested through degrading working conditions, lack of respect for their abilities, violence and harassment,, lack of mobility in the community, lack of voice within their work setting, and limited training opportunities and professionalization. All of these inequalities erode their ability to deliver high quality care.

CONCLUSION

While the evidence base is limited, the literature clearly shows that gender inequality-for both clients and providers-contributes to mistreatment and abuse in maternity care. Researchers, advocates, and practitioners need to further investigate and build upon lessons from the broader gender equality, violence prevention, and rights-based health movements to expand the agenda on mistreatment in childbirth and develop effective interventions.

Which will Trump: human rights and professional ethics, or torture redux?

Recent political developments in the United States raise concerns about the potential return of aggressive interrogation strategies, particularly in the event of another large-scale terror attack on the U.S. mainland. This essay reviews various legal, ethical and policy responses to revelations of torture during the Bush administration. It asks whether they improve the prospect that, in future, human rights will trump torture, not vice versa. The essay argues that physicians could help prevent further abuses - especially given their access, social status and expertise - but that insufficient steps have been taken to empower them to do so.

Community Coping Strategies in Response to Hardship and Human Rights Abuses Among Burmese Refugees and Migrants at the Thai-Burmese Border: A Qualitative Approach

We conducted 10 focus groups (n = 49) with community members and key informant interviews (n = 28) to explore hardships and community coping strategies for sequelae of abuse among Burmese refugees/migrants in Thailand. Transcripts were coded and analyzed for major themes. In Burma, they universally experienced human rights violations and economic hardship. Hardships continued in Thailand through exploitation and threat of deportation. Coping was achieved through both personal and community-based mechanisms including self-reflection, sharing experiences, spirituality, and serving their community. Western psychosocial counseling, although available, was used infrequently. Effective psychosocial support often originates from the community and should be supported by international organizations.

A comparative study of the use of the Istanbul Protocol amongst civil society organizations in low-income countries

The Istanbul Protocol (IP) is one of the great success stories of the global anti-torture movement, setting out universal guidelines for the production of rigorous, objective and reliable evidence about allegations of torture and ill-treatment. The IP is explicitly designed to outline 'minimum standards for States'. However, it is all too often left to civil society organizations to investigate allegations of torture and ill-treatment. In this context, important questions remain as to how and where the IP can be used best by such organizations. These questions are particularly acute in situations where human rights groups may have limited institutional capacity. This paper explores the practical challenges faced by civil society in using the IP in Low-Income Countries. It is based on qualitative research in three case studies: Nepal, Kenya and Bangladesh. This research involved over 80 interviews with human rights practitioners. The conclusions of the paper are that the Istanbul Protocol provides a useful framework for documentation, but more comprehensive forms of documentation will often be limited to a very small - albeit important - number of legal cases. In many cases, the creation of precise and standardized forms of evidence is not necessarily the most effective form of documentation for redress or accountability. In the absence of legal systems willing and able to respond effectively to allegations of torture and ill-treatment, there are severe limitations on the practical effectiveness of detailed and technical forms of documentation.

Stigma and Human Rights Abuses against People Who Inject Drugs in Russia--A Qualitative Investigation to Inform Policy and Public Health Strategies

INTRODUCTION

Drug policing practices in the Russian Federation (Russia) are often punitive and have been shown to be associated with HIV risk behaviors among people who inject drugs (PWID). Less is known about strategies to address the problem in that setting, where substance use stigma is highly persistent. A better understanding of forms, causes and consequences of drug policing in Russia could inform drug policy in a context of substantial policy resistance. This qualitative study's goal is to characterize the phenomenon of police involvement with Russian PWID and to explore strategies for drug policing in the Russian country context.

METHODS

Using a semi-structured interview guide, we collected data from a purposive sample of 23 key informants including PWID, police officers, and experts from civil society and international organizations in Russia. We used a thematic analysis approach to inductively generate new insight into the phenomenon of police involvement and potential strategies to address it.

RESULTS

Policing practices involving PWID include unjustified arrests, planting of false evidence and extrajudicial syringe confiscations, and often constitute human rights violations. Russian PWID personally experienced police violence as ubiquitous, taking on various forms such as beating, unjustified arrests, verbal harassment, and coercion. The persistent societal stigma dehumanizes PWID, and such stigmatization facilitates police abuse. To address stigma and overcome the PWID-police adversity, study participants suggested fostering a mutual understanding between the police and public health sectors.

CONCLUSIONS

Participants describe substantial human rights violations as part of policing illicit drug use in Russia. Police should include principles of effective prevention of substance use and HIV risk reduction in their trainings. Alignment of public safety and public health goals could address drug use-related risks and HIV prevention among key populations in Russia.

Intermittent explosive disorder amongst women in conflict affected Timor-Leste: associations with human rights trauma, ongoing violence, poverty, and injustice

Introduction

Women in conflict-affected countries are at risk of mental disorders such as posttraumatic stress disorder and depression. No studies have investigated the association between experiences of abuse and injustice and explosive anger amongst women in these settings, and the impact of anger on women's health, family relationships and ability to participate in development.

Methods

A mixed methods study including an epidemiological survey (n = 1513, 92.6% response) and qualitative interviews (n = 77) was conducted in Timor-Leste. The indices measured included Intermittent Explosive Disorder, posttraumatic stress disorder; severe distress; days out of role (the number of days that the person was unable to undertake normal activities); gender-specific trauma; conflict/violence; poverty; and preoccupations with injustice.

Results

Women with Intermittent Explosive Disorder (n = 184, 12.2%) were more disabled than those without the disorder (for >5 days out of role, 40.8% versus 31.5%, X²₍₂₎  = 12.93 p = 0.0016). Multivariable associations with Intermittent Explosive Disorder, controlling for the presence of PTSD, psychological distress and other predictors in the model, included the sense of being sick (OR 1.73; 95% CI 1.08–2.77); victimization as a result of helping the resistance movement (OR 2.33, 95% CI 1.48–3.68); war-related trauma specific to being a woman (OR 1.95, 95%, CI 1.09–3.50); ongoing family violence and community conflict (OR 1.88, 95% CI 1.27–2.77); extreme poverty (OR 1.23, 95%, CI 1.08–1.39); and distressing preoccupations with injustice (relating to 2/3 historical periods, OR 2.10, 95% CI 1.35–3.28). In the qualitative study, women elaborated on the determinants of anger and its impact on their health, family and community functioning, child-rearing, and capacity to engage in development. Women reflected on the strategies that might help them overcome their anger.

Conclusions

Intermittent Explosive Disorder is prevalent and disabling amongst women in conflict-affected Timor-Leste, impacting on their health, child-rearing and ability to participate fully in socio-economic development.

Complex posttraumatic stress disorder and survivors of human rights violations

PURPOSE OF REVIEW

This article reviews recent findings on Complex Posttraumatic Stress Disorder (CPTSD) and proposes future research which would help to establish the nature of CPTSD in relation to Posttraumatic Stress Disorder (PTSD).

RECENT FINDINGS

Research on survivors of torture and war has found that CPTSD can occur when there is no history of childhood abuse. fMRI studies appear to highlight differences in neural activity in individuals exhibiting primary dissociation compared with individuals exhibiting secondary dissociation. Research has begun to show that, when symptoms of secondary dissociation are appropriately managed, exposure-based therapies are an effective treatment for individuals with CPTSD.

SUMMARY

Much research on CPTSD has emphasized its developmental basis and the disruptive effects of trauma in childhood and adolescence on subsequent emotional development. However, some studies on survivors of torture in adult life identify similar symptom patterns, despite there being no history of childhood trauma. It is argued that comparative research is required between victims of developmental trauma (such as childhood sexual abuse) and victims who experienced prolonged interpersonal trauma in adulthood (such as torture), as this could be useful in establishing the cause of CPTSD and in delineating clinically and therapeutically meaningful subtypes. It is also proposed that a focus on underlying neurobiological processes would help in developing and refining CPTSD as a construct and informing treatment.

Experiencing rights within positive, person-centred support networks of people with intellectual disability in Australia

BACKGROUND

This research describes issues related to human rights as they arose within the everyday lives of people in nine personal support networks that included adult Australians with an intellectual disability (ID).

METHOD

The research was part of a wider 3-year ethnographic study of nine personal support networks. A major criterion for recruitment was that people in these networks were committed to actively developing the positive, meaningful future of an adult family member with an ID. Data were collected from November 2007 to March 2011 via interviews, participant observations and analysed within the framework of situational analysis. Findings were checked with network members.

RESULTS

The issue of rights was challenging to network members. Subtle rights violations could have a major impact on an individual with a disability. Network members worked to protect the rights of people with ID by building and maintaining an empathic and respectful support network, developing the person's self-confidence and autonomy and ensuring that the person with an ID was an active member of the personal support network.

CONCLUSION

The maintenance of rights within a supportive environment remains a difficult task. It can be facilitated by a deep knowledge and respect for the person being supported, the promotion of his or her active participation in the planning and provision of support, and an experimental and reflective approach.

Bodies of science and law: forensic DNA profiling, biological bodies, and biopower

How is jurisdiction transferred from an individual's biological body to agents of power such as the police, public prosecutors, and the judiciary, and what happens to these biological bodies when transformed from private into public objects? These questions are examined by analysing bodies situated at the intersection of science and law. More specifically, the transformation of ‘private bodies’ into ‘public bodies’ is analysed by going into the details of forensic DNA profiling in the Dutch jurisdiction. It will be argued that various ‘forensic genetic practices’ enact different forensic genetic bodies'. These enacted forensic genetic bodies are connected with various infringements of civil rights, which become articulated in exploring these forensic genetic bodies’‘normative registers’.

Poisoned social climate, collective responsibility, and the abuse at Abu Ghraib--Or, the establishment of "rule that is lack of rule"

The authors draw upon the experiences of one of the co-authors as an expert witness in sociology for mitigation at three of the courts-martial pertaining to the abuse at Abu Ghraib that were held at Ft. Hood, Texas in the year 2005 (for Javal Davis, Sabrina Harman, and Lynndie England). In addition, this paper is based upon the thousands of pages of affidavits, testimony, and U.S. Government reports concerning Abu Ghraib. These internal government reports, as well as the Levin-McCain report, point to collective responsibility and the responsibility of individuals high in the chain of command for establishing unlawful techniques. We review the shortcomings of a purely psychological approach for understanding the abuse, and turn to Durkheim's original understanding of anomie as a state of social derangement or rule by lack of rule to introduce the ideas of the social origins of and social responsibility for the abuse. We conclude with sociological suggestions for reforming some of the legal, medical, psychiatric, and other professional complicity in the abuse at Abu Ghraib.

Forced disappearance in an era of globalization: biopolitics, shadow networks, and imagined worlds

In this article, I argue that the practice of forced disappearance of persons on the part of paramilitary groups has become linked to specific processes of globalization. Global flows related to biopolitics, global crime networks, and dehumanizing imaginations reproduced by mass media together constitute a driving force behind forced disappearances. Drawing on ethnographic fieldwork in the Colombian city of Medellín, I analyze how these global flows interact with local armed actors, helping create a climate conducive to forced disappearance. These mechanisms in Colombia show similarities to those in some African and Asian countries. Gaining insight into the mechanisms behind forced disappearance may help prevent it from occurring in the future. Enhancing social inclusion of residents, unraveling the transnational crime networks in which perpetrators are involved, and disseminating rehumanizing images of victims all contribute to curbing the practice of forced disappearance.

HIV/AIDS and sexual minorities in Mexico: a globalized struggle for the protection of human rights

The fight against HIV/AIDS is an example of a global struggle for the promotion of sexual health and the protection of human rights for all, including sexual minorities. It represents a challenge for the understanding of its impact on political, social, and economic processes. My central goal in this piece is twofold. First, I underline the importance of a political and human rights perspective to the analysis of the global response to the pandemic, and I introduce the concept of policy networks for a better understanding of these dynamics. Second, I argue that, in the case of Mexico, the constitution of HIV/AIDS policy networks, which incorporate civil society and state actors, such as sexual minority activists and public officials, and their actions—both domestic and international—have resulted in a more inclusive HIV/AIDS policy-making process. However, serious human rights violations of HIV/AIDS patients and sexual minorities still remain.

Advertising Phuket's nightlife on the Internet: a case study of double binds and hegemonic masculinity in sex tourism

One significant human rights violation in Southeast Asia is the exploitation of women through sex tourism. Such sexual exploitation occurs in Thailand because institutions are complacent and society accepts the practice. This case study, guided by the concepts of double binds and hegemonic masculinity, sought to understand if Thai culture is symbolically constructed in ways to portray Thailand as a desirable "sex tourist" destination. Websites portray Phuket as a patriarchal world where men can live their fantasies of being perfect hegemonic males because Thai bar girls are young nymphomaniacs that have no need to be talked to or understood.

How to combat torture if perpetrators are supported by a religious "justification"

While there are some examples of legal cases which have resulted in the prosecution of perpetrators and successful reparation for survivors, in countries such as Iran such due procedure is close to impossible since torture is practiced by state officials mostly based on religious codes, and the legal system is controlled by practices that makes it close to impossible to achieve justice. This article discusses the implications of such a situation that also include health care professionals in third party countries who have an obligation to document evidence using the Istanbul Protocol based on a case example of a survivor exposed to different forms of torture.

The limits of oral history: ethics and methodology amid highly politicized research settings

In recent years, oral history has been celebrated by its practitioners for its humanizing potential, and its ability to democratize history by bringing the narratives of people and communities typically absent in the archives into conversation with that of the political and intellectual elites who generally write history. And when dealing with the narratives of ordinary people living in conditions of social and political stability, the value of oral history is unquestionable. However, in recent years, oral historians have increasingly expanded their gaze to consider intimate accounts of extreme human experiences, such as narratives of survival and flight in response to mass atrocities. This shift in academic and practical interests begs the questions: Are there limits to oral historical methods and theory? And if so, what are these limits? This paper begins to address these questions by drawing upon fourteen months of fieldwork in Rwanda and Bosnia-Hercegovina, during which I conducted multiple life history interviews with approximately one hundred survivors, ex-combatants, and perpetrators of genocide and related mass atrocities. I argue that there are limits to the application of oral history, particularly when working amid highly politicized research settings.

Reconciliation in Cambodia: thirty years after the terror of the Khmer Rouge regime

During the Khmer Rouge regime one quarter of the Cambodian population was killed as a result of malnutrition, overwork and mass killings. Although the regime ended 30 years ago, its legacy continues to affect Cambodians. Mental health problems as well as feelings of anger and revenge resulting from traumatic events experienced during the Khmer Rouge regime are still common in Cambodia. These conditions continue to impede social coexistence and the peace-building process in society. Thirty years after the Khmer Rouge regime this article gives an overview on the status of the country's current reconciliation process and recommends potential future steps.

Horror and hope: (re)presenting militarised children in global North-South relations

This article examines the (re)presentations of militarised children in contemporary global politics. In particular, it looks at the iconic image of the 21st century's child soldier, the subject of which is constructed as a menacing yet pitiable product of the so-called new wars of the global South. Yet this familiar image is a small, one-dimensional and selective (re)presentation of the issues facing children who are associated with conflict and militarism. In this sense it is a problematic focal point for analysing the insecurity and human rights of children in and around conflict. Instead, this article argues that the image of the child soldier asserts an important influence in its effect upon global North-South relations. It demonstrates how the image of the child soldier can assist in constructing knowledge about the global South, and the global North's obligations to it, either through programmes of humanitarianism, or through war.

Holding harm: narrative methods in mental health research on refugee trauma

In this article, we question narrative inquiry's predominant ethics of benefit when engaging in narrative research on trauma and social suffering. Through a particular focus on the use of a narrative methodology in a refugee health study, we explore the potential risk and protective function of narrative trauma research with vulnerable respondents. A review of ethical questions emerging during the course of a multiple-case study with refugee families documents how narrative methods' characteristics clearly revisit the impact of traumatization on autonomy, narrativity, and relationship building in participants and, thus, evoke the replay of traumatic experience within the research relationship itself. Blurring a straightforward ethics of benefit, this reactivation of trauma accounts for the research relationship's balancing movement between reiterating and transforming traumatic distress, and urges for the need to contain coexisting aspects of both harm and benefit in developing narrative research with traumatized participants.

Problematizing therapeutic assumptions about narratives: a case study of storytelling events in a post-conflict context

Narrative approaches to health communication research have often been characterized by assumptions of the therapeutic and ameliorative effect of narratives. In this article, I call these assumptions into question by critically engaging extant research in narrative health communication research in light of testimony by a participant in South Africa's Truth and Reconciliation Commission. Drawing on his personal narrative, numerous retellings of his story in public and academic discourse, and his responses to his story's appropriation, I demonstrate the importance of conducting narrative research and theorizing with an appreciation of its therapeutic potential, as well as its ability to harm.

Torture by Cieng: ethical theory meets social practice among the Dinka Agaar of south Sudan

Here I detail violence in South Sudan by first discussing a specific Dinka Agaar practice alongside existing discourses on the social aspects of violence and universal human rights, then I show how these acts had meaning and purpose using data from personal accounts of violence. I posit that the violence described was consistent with Dinka Agaar concepts of justice and basic human rights and that it cannot be judged against any universal human rights standard, devoid of local context or of an overarching metanarrative. These events highlight conflicting subjectivities, ethical norms, and the painful difficulties inherent to advocacy in areas of conflict. Viewed from the perspective of the larger social unit, it is easy to see how violence was required to end violence. However, witnessing punitive violence purposefully enacted on innocent individuals to achieve peace has the potential to create conflicting positions that modern anthropological discourse cannot reconcile.

Association of sexual violence and human rights violations with physical and mental health in territories of the Eastern Democratic Republic of the Congo

CONTEXT

Studies from the Eastern Region of the Democratic Republic of the Congo (DRC) have provided anecdotal reports of sexual violence. This study offers a population-based assessment of the prevalence of sexual violence and human rights abuses in specific territories within Eastern DRC.

OBJECTIVE

To assess the prevalence of and correlations with sexual violence and human rights violations on residents of specific territories of Eastern DRC including information on basic needs, health care access, and physical and mental health.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional, population-based, cluster survey of 998 adults aged 18 years or older using structured interviews and questionnaires, conducted over a 4-week period in March 2010.

MAIN OUTCOME MEASURES

Sexual violence prevalence and characteristics, symptoms of major depressive disorder (MDD) and posttraumatic stress disorder (PTSD), human rights abuses, and physical and mental health needs among Congolese adults in specific territories of Eastern DRC.

RESULTS

Of the 1005 households surveyed 998 households participated, yielding a response rate of 98.9%. Rates of reported sexual violence were 39.7% (95% confidence interval [CI], 32.2%-47.2%; n = 224/586) among women and 23.6% (95% CI, 17.3%-29.9%; n = 107/399) among men. Women reported to have perpetrated conflict-related sexual violence in 41.1% (95% CI, 25.6%-56.6%; n = 54/148) of female cases and 10.0% (95% CI, 1.5%-18.4%; n = 8/66) of male cases. Sixty-seven percent (95% CI, 59.0%-74.5%; n = 615/998) of households reported incidents of conflict-related human rights abuses. Forty-one percent (95% CI, 35.3%-45.8%; n = 374/991) of the represented adult population met symptom criteria for MDD and 50.1% (95% CI, 43.8%-56.3%; n = 470/989) for PTSD.

CONCLUSION

Self-reported sexual violence and other human rights violations were prevalent in specific territories of Eastern DRC and were associated with physical and mental health outcomes.

Spirits and social reconstruction after mass violence: rethinking transitional justice

A vibrant debate in the field of transitional justice concerns the relative ability of global, national, and local mechanisms to promote justice after violent conflict. Discussion largely focuses on more formal mechanisms of justice (courts, tribunals, or truth commissions), implying that state institutions and the law are solely responsible for shaping the process of social healing. This article suggests that scholars should take seriously more informal, socio-cultural processes outside the purview of the state, particularly for how they promote social reconstruction at the micro level. Examining the phenomena of spirit possession and ritual cleansing in northern Uganda, I illustrate how such efforts are expressions of injustice and reflect ordinary people’s attempts to seek moral renewal and social repair. This approach is particularly illustrative in cases where ‘intimate enemies’ exist - that is, settings where ordinary people who engaged in violence against one another must live together again.

The League of Nations' rescue of Armenian genocide survivors and the making of modern humanitarianism, 1920-1927

The essay centers of the efforts by the League of Nations to rescue women and children survivors of the 1915 Armenian Genocide. This rescue -- a seemingly unambiguous good -- was at once a constitutive act in drawing the boundaries of the international community, a key moment in the definition of humanitarianism, and a site of resistance to the colonial presence in the post-Ottoman Eastern Mediterranean. Drawing from a wide range of source materials in a number of languages, including Turkish, Armenian, and Arabic, the essay brings the intellectual and social context of humanitarianism in initiating societies together with the lived experience of humanitarianism in the places where the act took form. In so doing, it draws our attention to the proper place of the Eastern mediterranean, and its women and children, in the global history of humanitarianism. The prevailing narrative of the history of human rights places much of its emphasis on the post-World War II era, the international reaction to the Holocaust, and the founding of the United Nations. yet contemporary human rights thinking also took place within practices of humanitarianism in the interwar period, and is necessarily inseparable from the histories of refugees, colonialism, and the non-West.

Domestic violence and social responsibility in contemporary Spanish cinema: a portfolio view of behavioral dynamics

Domestic abuse continues to claim many lives in Spain despite a series of new laws to protect women and to punish abusers. This essay explores the cultural influences of contemporary Spanish cinema on domestic violence. Four films are assessed against a Portfolio Model of social responsibility that uses two basic dimensions: realism and human rights. Realism in each film is determined by the behavioral components of the internationally recognized Duluth Model and the Wheel of Power and Control. The human rights dimension addresses equality, power and agency for women. This study focuses on Icíar Bollaín's "Te doy mis ojos" (2003), Javier Balaguer's "Sólo mía" (2001), Benito Zambrano's "Solas" (1999), and Pedro Almodóvar's "Pepi, Luci, Bom y otras chicas del montón" (1980). The results demonstrate significant variations in the measure of social responsibility indicating that contemporary Spanish cinema may play a role in perpetuating gender-based violence.

Claims to protection: the rise and fall of feminist abolitionism in the League of Nations' Committee on the Traffic in Women and Children, 1919–1936

This article examines the League of Nations Advisory Committee on the Trafficking of Women and Children (CTW) to assess the impact of international feminists on the interwar anti-sex trafficking movement. It argues that women who were firmly embedded in the transnational and international women's rights movement built a coalition on the CTW to ensure the prominence of the feminist abolitionist position of sex trafficking in the 1920s. This position was defined by calls for equal standards of morality between the sexes, resistance to laws that treated prostitutes as a group and infringed on their human rights, and unwavering demands for the abolition of state-regulated prostitution. Changes in the personnel and bureaucratic structure of the CTW and the rising tide of nationalism served to undermine the feminist abolitionists' position in the League in the 1930s.

The modernizing bias of human rights: stories of mass killings and genocide in Central America

This article analyses selected cases of mass killings and genocide during the civil wars in El Salvador and Guatemala in the 1980s and the way in which the truth commissions in both countries reframed locally grounded narratives to fit the state-centred language of human rights. Redefining wrongdoings as human rights violations produces stories that communicate poorly with local worldviews because the 'truths' that human rights language proposes disregard local realities and transform local conflicts into a type of 'modern', nationwide struggles. Thus, while the concept of genocide might capture well the horrendous nature of a mass killing, it will also ethnify the conflict. Comparisons between local readings and human rights-based reinterpretations reveal a 'modernizing' or 'Westernizing' bias of international law; the article argues for more awareness about such effects in analysis as well as in policy-making.

Rare models: Roger Casement, the Amazon, and the ethnographic picturesque

In 1910 Roger Casement was sent by the British government to investigate the alleged humanitarian abuses of the Peruvian Amazon Company in the Putumayo, a disputed border zone in North West Amazonia. Casement brought more than verbal and written testimony back to London. On 26 June, some six months after he returned from the Amazon, Casement collected two Amerindian boys - Omarino and Ricudo - from Southampton docks. This paper will reconstruct the brief period that these young men spent in Britain in the summer of 1911 and assess, in particular, to what extent they were treated as 'exhibits' by Casement, who not only introduced them to leading members of the British establishment but also arranged for them to be painted and photographed following contemporary ethnographic conventions.

Human dignity, humiliation, and torture

Modern human rights instruments ground human rights in the concept of human dignity, without providing an underlying theory of human dignity. This paper examines the central importance of human dignity, understood as not humiliating people, in traditional Jewish ethics. It employs this conception of human dignity to examine and criticize U.S. use of humiliation tactics and torture in the interrogation of terrorism suspects.

Human exploitation is not a joke--so don't laugh!

In a previous article, I called for an open discussion and debate on health psychology perspectives on social and political issues relevant to health, in particular the issue concerning racism and the media (Estacio, 2009). In this article, I raise three topics for discussion which the controversial BBC 'Harry and Paul' sketch (un)intentionally exposed to the public domain: (1) racist humour, the media and health; (2) human rights abuses against domestic workers; and (3) third world poverty and labour migration. Its implications on health psychology theory, research and practice are also explored.

Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis

CONTEXT

Uncertainties continue about the roles that methodological factors and key risk factors, particularly torture and other potentially traumatic events (PTEs), play in the variation of reported prevalence rates of posttraumatic stress disorder (PTSD) and depression across epidemiologic surveys among postconflict populations worldwide.

OBJECTIVE

To undertake a systematic review and meta-regression of the prevalence rates of PTSD and depression in the refugee and postconflict mental health field.

DATA SOURCES

An initial pool of 5904 articles, identified through MEDLINE, PsycINFO and PILOTS, of surveys involving refugee, conflict-affected populations, or both, published in English-language journals between 1980 and May 2009.

STUDY SELECTION

Surveys were limited to those of adult populations (n > or = 50) reporting PTSD prevalence, depression prevalence, or both. Excluded surveys comprised patients, war veterans, and civilian populations (nonrefugees/asylum seekers) from high-income countries exposed to terrorist attacks or involved in distal conflicts (> or = 25 years).

DATA EXTRACTION

Methodological factors (response rate, sample size and design, diagnostic method) and substantive factors (sociodemographics, place of survey, torture and other PTEs, Political Terror Scale score, residency status, time since conflict).

DATA SYNTHESIS

A total of 161 articles reporting results of 181 surveys comprising 81,866 refugees and other conflict-affected persons from 40 countries were identified. Rates of reported PTSD and depression showed large intersurvey variability (0%-99% and 3%-85.5%, respectively). The unadjusted weighted prevalence rate reported across all surveys for PTSD was 30.6% (95% CI, 26.3%-35.2%) and for depression was 30.8% (95% CI, 26.3%-35.6%). Methodological factors accounted for 12.9% and 27.7% PTSD and depression, respectively. Nonrandom sampling, small sample sizes, and self-report questionnaires were associated with higher rates of mental disorder. Adjusting for methodological factors, reported torture (Delta total R(2) between base methodological model and base model + substantive factor [DeltaR(2)] = 23.6%; OR, 2.01; 95% CI, 1.52-2.65) emerged as the strongest factor associated with PTSD, followed by cumulative exposure to PTEs (DeltaR(2) = 10.8%; OR, 1.52; 95% CI, 1.21-1.91), time since conflict (DeltaR(2) = 10%; OR, 0.77; 95% CI, 0.66-0.91), and assessed level of political terror (DeltaR(2) = 3.5%; OR, 1.60; 95% CI, 1.03-2.50). For depression, significant factors were number of PTEs (DeltaR(2) = 22.0%; OR, 1.64; 95% CI, 1.39-1.93), time since conflict (DeltaR(2) = 21.9%; OR, 0.80; 95% CI, 0.69-0.93), reported torture (DeltaR(2) = 11.4%; OR, 1.48; 95% CI, 1.07-2.04), and residency status (DeltaR(2) = 5.0%; OR, 1.30; 95% CI, 1.07-1.57).

CONCLUSION

Methodological factors and substantive population risk factors, such as exposure to torture and other PTEs, after adjusting for methodological factors account for higher rates of reported prevalence of PTSD and depression.

Probable posttraumatic stress disorder and disability in Cambodia: associations with perceived justice, desire for revenge, and attitudes toward the Khmer Rouge trials

CONTEXT

Millions of Cambodians suffered profound trauma during the Khmer Rouge era (1975 to 1979). A joint United Nations-Cambodian tribunal (the "Khmer Rouge trials") was empanelled in 2006 to prosecute top Khmer Rouge leaders and began substantive hearings in March 2009.

OBJECTIVES

To establish the prevalence of probable posttraumatic stress disorder (PTSD) among adult Cambodians and to assess correlates of PTSD symptoms and disability with perceived justice, desire for revenge, and knowledge of and attitudes toward the trials.

DESIGN, SETTING, AND PARTICIPANTS

A national probability sample of 1017 Cambodians was assembled using a multistage, stratified cluster design, including 813 adults older than 35 years who had been at least 3 years old during the Khmer Rouge era and 204 adults aged 18 to 35 years who had not been exposed to the Khmer Rouge era. Face-to-face interviews were conducted between December 2006 and August 2007.

MAIN OUTCOME MEASURES

Prevalence of probable PTSD using the PTSD Checklist, Civilian version (cutoff score of 44), and mental and physical disability using the Medical Outcomes Study 12-item Short Form Health Survey.

RESULTS

The prevalence of current probable PTSD was 11.2% (95% confidence interval [CI], 8.6%-13.9%) overall and 7.9% (95% CI, 3.8%-12.0%) among the younger group and 14.2% (95% CI, 11.0%-17.3%) in the older group. Probable PTSD was significantly associated with mental disability (40.2% vs 7.9%; adjusted odds ratio [AOR], 7.80; 95% CI, 3.90-15.60) and physical disability (39.6% vs 20.1%; AOR, 2.60; 95% CI, 1.26-5.39). Although Cambodians were hopeful that the trials would promote justice, 87.2% (n = 681) of those older than 35 years believed that the trials would create painful memories for them. In multivariate analysis, respondents with high levels of perceived justice for violations during the Khmer Rouge era were less likely to have probable PTSD than those with low levels (7.4% vs 12.7%; AOR, 0.54; 95% CI, 0.34-0.86). Respondents with high levels of desire for revenge were more likely to have probable PTSD than those with low levels (12.0% vs 7.2%), but the difference was not statistically significant in the multivariate analysis (AOR, 1.76; 95% CI, 0.99-3.11).

CONCLUSIONS

Probable PTSD is common and associated with disability in Cambodia. Although Cambodians had positive attitudes toward the trials, most were concerned that the trials would bring back painful memories. Now that the trials have begun, longitudinal research is needed to determine the impact of the trials on Cambodians' mental health.

Perpetration of gross human rights violations in South Africa: association with psychiatric disorders

BACKGROUND

A nationally representative study of psychiatric disorders in South Africa provided an opportunity to study the association between perpetration of human rights violations (HRVs) during apartheid and psychiatric disorder. Prior work has suggested an association between perpetration and post-traumatic stress disorder (PTSD), but this remains controversial.

METHODS

Subjects reported on their perpetration of human rights violations, purposeful injury, accidental injury and domestic violence. Lifetime and 12-month prevalence of DSM-IV (Diagnostic and Statistical Manual, 4th edition) disorders were assessed with Version 3.0 of the World Health Organization Composite International Diagnostic Interview (CIDI 3.0). Socio-demographic characteristics of these groups were calculated. Odds ratios for the association between the major categories of psychiatric disorders and perpetration were assessed.

RESULTS

HRV perpetrators were more likely to be male, black and more educated, while perpetrators of domestic violence (DV) were more likely to be female, older, married, less educated and with lower income. HRV perpetration was associated with lifetime and 12-month anxiety and substance use disorders, particularly PTSD. Purposeful and DV perpetration were associated with lifetime and 12-month history of all categories of disorders, whereas accidental perpetration was associated most strongly with mood disorders.

CONCLUSION

Socio-demographic profiles of perpetrators of HRV and DV in South Africa differ. While the causal relationship between perpetration and psychiatric disorders deserves further study, it is possible that some HRV and DV perpetrators were themselves once victims. The association between accidental perpetration and mood disorder also deserves further attention.

The Tree of Life: a community approach to empowering and healing the survivors of torture in Zimbabwe

The article explores the effectiveness of the use of an empowerment workshop, called the Tree of Life, in the treatment of torture survivors. The approach is based on a survivor-to-survivor model of assistance. Research into the effectiveness of the method is carried out using a pre- and post measures using a psychiatric screening instrument, measuring depression and anxiety. Participants were also asked for feedback in a structured self-report upon completion of the workshop. In addition, an exit interview was conducted after follow-up, three months after the first workshop session. A total of 73 persons attended the workshops, and detailed follow up data was only available for 33. 36% showed significant clinical improvement, and the sample as a whole showed significant changes in their psychological state. More complete information was available for a smaller sample [19], which showed 39% having significant improvement. On follow-up, 44% were still experiencing difficulties, with most (72%) experiencing economic difficulties. On the positive side, 56% reported coping better, only 9% reported health problems, and most were still connected to the group with which they participated in the process. All felt that that the process had helped them, had helped them new things, and had changed in the way that they felt about their torture. The Tree of Life appears to be a useful, cost-effective, non-professional method of assisting torture survivors.