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Emotional violence and
mental disorders
– and how to study this
Program for this presentation
• The psychiatric disorders in ICD-10
• Different concepts of violence – emotional, IPV,
GBV…..
• The anthropological approach to mental
disorders
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
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)
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
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
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)
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?
Definitions of concepts
• How we define and talk about phenomena have
consequences for how we perceive these
phenomena
• (Social constructivism)
Concepts of violence within
intimate social relations Gender violence/
Gender based violence (GBV)
Emotional violence Intimate partner violence
Psychological violence (IPV)
Violence against women
(VAW)
Domestic violence
Family violence
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”
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
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)
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……
Other concepts of violence
• Domestic violence
• Family violence
• Battered women syndrome
• Structural violence
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
Concepts of violence within
intimate social relations Gender violence/
Gender based violence (GBV)
Emotional violence Intimate partner violence
Psychological violence (IPV)
Violence against women
(VAW)
Domestic violence
Family violence
Concepts of violence within
intimate social relations Gender violence/
Gender based violence (GBV)
Emotional violence Intimate partner violence
Psychological violence (IPV)
Violence against women
(VAW)
Domestic violence
Family violence
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?
– ……
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 question-naires are highly problematic to use in another cultural context than where they were originally created
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
Examples of culture bound
syndromes
• Amok
• Susto
• Ataque de nervios
• Kayak dizziness
• Semen loss
• …
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
The cultural formulation interview
(CFI)
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