Emotional violence and mental disorders. and how to study this

Transcription

1 Emotional violence and mental disorders and how to study this

2 Program for this presentation The psychiatric disorders in ICD-10 Different concepts of violence emotional, IPV, GBV.. The anthropological approach to mental disorders

3 Mental disorders International Classification of Diseases Chapter V: Mental and behavioural Disorders F00-09 Organic mental disorders (fx dementia) F10-19 Mental and behavioural disorders due to psychoactive substance use F20-29 Schizophrenia, schizotypal and delusional disorders F30-39 Mood (affective) disorders F40-48 Neurotic, stress-related and somatoform disorders F50-58 Behavioural syndromes associated with physiological disturbances and physical factors (fx eating disorders and postpartum depression) F60-69 Disorders of adult personality and behaviour F70-79 Mental retardation F80-89 Disorders of psychological development (fx autism) F90-98 Behavioural and emotional disorders with onset usually occurring in childhood and adolescence (fx ADHD) F99 Unspecified mental disorder

4 Mental disorders International Classification of Diseases Chapter V: Mental and behavioural Disorders F00-09 Organic mental disorders (fx dementia) F10-19 Mental and behavioural disorders due to psychoactive substance use F20-29 Schizophrenia, schizotypal and delusional disorders F30-39 Mood (affective) disorders F40-48 Neurotic, stress-related and somatoform disorders F50-58 Behavioural syndromes associated with physiological disturbances and physical factors (fx eating disorders and postpartum depression) F60-69 Disorders of adult personality and behaviour F70-79 Mental retardation F80-89 Disorders of psychological development (fx autism) F90-98 Behavioural and emotional disorders with onset usually occurring in childhood and adolescence (fx ADHD) F99 Unspecified mental disorder X60-84 Intentional self-harm (suicide)

5 Diagnosing depression At least two of the following three symptoms must be present: 1. depressed mood to a degree that is definitely abnormal for the individual, present for most of the day and almost every day, largely uninfluenced by circumstances, and sustained for at least 2 weeks 2. loss of interest or pleasure in activities that are normally pleasurable 3. decreased energy or increased fatiguability

6 Diagnosing depression An additional symptom or symptoms from the following list should be present, to give a total of at least four: 1. loss of confidence and self-esteem 2. unreasonable feelings of self-reproach or excessive and inappropriate guilt 3. recurrent thoughts of death or suicide, or any suicidal behaviour 4. complaints or evidence of diminished ability to think or concentrate, such as indecisiveness or vacillation 5. change in psychomotor activity, with agitation or retardation (either subjective or objective) 6. sleep disturbance of any type 7. change in appetite (decrease or increase) with corresponding weight change

7 Mental disorders International Classification of Diseases Chapter V: Mental and behavioural Disorders F00-09 Organic mental disorders (fx dementia) F10-19 Mental and behavioural disorders due to psychoactive substance use F20-29 Schizophrenia, schizotypal and delusional disorders F30-39 Mood (affective) disorders F40-48 Neurotic, stress-related and somatoform disorders F50-58 Behavioural syndromes associated with physiological disturbances and physical factors (fx eating disorders and postpartum depression) F60-69 Disorders of adult personality and behaviour F70-79 Mental retardation F80-89 Disorders of psychological development (fx autism) F90-98 Behavioural and emotional disorders with onset usually occurring in childhood and adolescence (fx ADHD) F99 Unspecified mental disorder ---- X60-84 Intentional self-harm (suicide)

8 The relation between emotional violence and mental disorder Psychiatry: Mental disorders are bio-psycho-social entities Mental disorders are caused by stress-factors in vulnerable individuals (the stress-vulnerability model). The vulnerability can be cause by genetic factors, damages during birth, learned inappropriate reactions. Stress could be violence Anthropology: Does not have its own defined perception What is the local perception of the relationship?

9 Definitions of concepts How we define and talk about phenomena have consequences for how we perceive these phenomena (Social constructivism)

10 Concepts of violence within intimate social relations Gender violence/ Gender based violence (GBV) Emotional violence Psychological violence Intimate partner violence (IPV) Violence against women (VAW) Domestic violence Family violence

11 Intimate partner violence Violence exercised by an intimate partner WHO (Ellsberg & Heise 2005: 11) part of violence against women: Any act of violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or private life

12 Emotional violence/ emotional abuse WHO (2005: 9): Being insulted or made to feel bad about oneself Being humiliated or belittled in front of others Being intimidated or scared on purpose (for example by a partner yelling and smashing things) Being threatened with harm (directly or indirectly in the form of a threat to hurt someone the respondent cared about

13 Emotional violence/ emotional abuse Because of the complexity of defining and measuring emotional abuse in a way that is relevant and meaningful across cultures, the results of the WHO Study s investigation of emotional violence and controlling behaviour should be considered a starting-point, rather than a comprehensive measure of all forms of emotional abuse (WHO 2005: 9)

14 Gender violence Merry (2009: 3): Gender violence as violence whose meaning depends on the gendered identities of the parties Gender violence is now an umbrella term for a wide range of violations from rape druing wartime to sexual abuse in prisons to insults and name-calling within marriages female genital cutting, dowry deaths, trafficking of women as sex-workers, vulnerability of illegal immigrants

15 Other concepts of violence Domestic violence Family violence Battered women syndrome Structural violence

16 Comparing definitions Different definitions foreground and background different aspects of violence E.g. family violence highlight that the violence takes place between persons that are intimate related but hides that it is often women who are the victims E.g. gender violence highlights that victim and perpetrator have different gender but hides the fact that gender is not important in every violent episode

17 Concepts of violence within intimate social relations Gender violence/ Gender based violence (GBV) Emotional violence Psychological violence Intimate partner violence (IPV) Violence against women (VAW) Domestic violence Family violence

18 Concepts of violence within intimate social relations Gender violence/ Gender based violence (GBV) Emotional violence Psychological violence Intimate partner violence (IPV) Violence against women (VAW) Domestic violence Family violence

19 Anthropological approaches to the study of emotional violence The informants /the women's own words on: What is emotional violence? How is emotional violence different than other types of violence? Who is practicing emotional violence? What are you own experiences? Do you recognize the definition? Have you suffered from any of these actions?

20 Anthropological approaches to the study of mental disorders Psychiatry is a cultural system The psychiatric diagnosis is a cultural taxonomy where different symptoms have been put together into psychiatric syndromes that makes sense within the western cultural tradition Definitions of normality and deviances are closely linked to culture Diagnostic tools, assessments and questionnaires are highly problematic to use in another cultural context than where they were originally created

21 Culture and psychiatric disorders (as extreme positions) Psychiatry Psychiatric disorders are primarily biological entities Psychiatric disorders are more or less the same all over the world The presentation of symptoms may vary somewhat with culture Anthropology Psychiatry is a western cultural system Psychiatric disorders vary across the world as they are influenced by social and cultural factors What is interesting is local peoples own perceptions of social suffering

22 Examples of culture bound syndromes Amok Susto Ataque de nervios Kayak dizziness Semen loss

23 The cultural formulation an pragmatic approach A question guide to make cultural sensitive and meaningful diagnosis Appeared the first time i DSM-IV (The American diagnostic manual for mental disorders, 4th. Edition) Has been given a much more prominent position in the newest edition (DSM-V) from 2013 Developed in corporation between anthropologists and psychiatrists Draws among other things on the medical anthropological concept explanatory models

24 The cultural formulation interview (CFI)

25 To conclude Epidemiological data points out that there is a connection between emotional violence (and violence) and mental disorders From an anthropological perspective we are interested if people themselves experience such a connection and how they explain any possible connection And how people live with problems such as violence, mental disorders and social suffering generally