Archive for the 'human rights' Category

The (non)essentialism of dehumanization

It is a given that those who persecute others get to the point of committing barbarous acts by first dehumanizing them. In Today’s New York Times Book Review, David Berreby offers an intelligent critique of the essentialism of this tendency to dehumanize “the other” via a review of David Livingstone Smith’s Less than Human: Why We Demean, Enslave, and Exterminate Others. Berreby explains that Smith, as a philosopher, makes the argument that humans’ “cognitive architecture,” which places ideas and concepts into immutable categories, leads to categorizing other humans, which then leads to rejecting those who do not fall into the ethnic or cultural category into which they belong. Berreby tells us that Smith says this then leads to Nazis calling Jews “rats,” Hutus calling Tutsis “cockroaches,” and Arab Darfuris referring to Black Darfuris as “monkeys.”

Berreby, who writes Mind Matters, a blog on psychology on Big Think, correctly identifies this somewhat warmed over Social Psych 101 argument as “only half right:”

people do categorize themselves and others using essences, but there’s nothing immutable about them. If, like trained philosophers, we could settle for good who is essentially human and who is a zombie vampire squid, we wouldn’t have, or need, this drama of dehumanization, rehumanization, then more dehumanization, and so on. Instead, the who-is-and-isn’t-human question is never truly settled. In fact, it is the dynamic, even mercurial nature of “real human” status that makes this mystery of our psychology so fascinating.

It is certainly true that genocidaires and those who place themselves above others in general do so by demeaning their victims. But what is equally true is that they don’t always do this, and, if human history and diversity is any record, they usually don’t do this in ways that leads them to exterminating others. In other words, certainly it is the case that dehumanization is critical in getting humans to commit atrocities against other humans, but the reason this is so is that “we readily see others as human” and “we need reminding that our enemies are supposedly different.” It is the shift between “human” and “dehuman” categories that is really interesting, and probably more important if we are going to find some way to avoid the effects of the latter more often.

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Defining forced migration: Report from the Northwestern University Conference on Human Rights

The Northwestern University Conference on Human Rights (NUCHR) is in its 8th year, and this year’s topic is Human Rights in Transit: Issues of Forced Migration. NUCHR is probably the best student-organized conference on human rights issues, addressing a given topic over a three days of lectures, study sections, and speeches. NUCHR involves college students from around the US through a lengthy application process which attracts hundreds. Successful applicants become NUCHR “Delegates,” with assigned working groups and specific areas in which they become experts. After a day and half here, I can tell you that this is really one top-notch group of thinkers and doers, at any level of the academic hierarchy.

Today’s panels were “Defining Forced Migration” and “The Displaced: The Psychological and Cultural Effects of Forced Migration” (which is why yours truly is here — I was a panelist in the latter). Defining Forced Migration featured legal scholars Deborah Anker of Harvard Law School Immigration and Refugee Clinical Program, Howard Adelman from the Griffith University in Brisbane (Australia), Susan Gzesh of the Human Rights Program at University of Chicago, and Maureen Lynch of Refugees International in Washington, DC. It’s always instructive for refugee service providers (and people who think a lot about providing refugees services, like me) to hear legal perspectives on our field. Anker made the point that refugee law is first and foremost “palliative, not political” — meaning that it is primarily designed to relieve tension instead of solve the difficult situations that cause displacement — and so it’s place in the “human rights regime” (which is political) is tenuous. I have often thought that refugee healthcare — also primarily palliative — is in a similar bind; while healing may have political consequences in that it may make people able to more easily demand that their rights be respected, it is not the case that healing is in and of itself a political act (not usually anyways). When people ask me about “health and human rights” I usually tell them that what I do is health, rarely human rights.

Howard Adelman gave a comprehensive history of refugee policy, and said something I had been completely ignorant of: the first refugee policies in international law were Wilsonian (as in Woodrow Wilson) efforts to bolster the idea of nation states by transferring minority ethnic groups out of one state to others. In other words, their goal was to make homogenous states and these “ethnically pure” states would somehow be less likely to have internal conflicts. It wasn’t until after World War II (during which ethnic purity had some rather nasty consequences) that refugee law began to shift to protection of individuals who would be persecuted if they returned to their home countries. This was primarily designed with Cold War refugees in mind. Adelman also pointed out that the “right of return” — a value at the intersection of human rights and refugee rights — has never been successfully implemented by anything other than force (e.g., Tutsis in Rwanda); most peacefully negotiated returns have involved only a few, mostly older refugee returnees and many who came home, sold their stuff, and went back to their (richer) host countries (e.g., Bosnian refugees). Adelman’s history lesson leaves us with some sobering contemplation about where we go from here — although exactly what we should do differently isn’t quite clear.

Blogoshpere updates from the Darfur crisis

A couple notable developments from the Darfur. The first is a news item (hat tip to Gabrielle Grow of the Institute for War and Peace Reporting office in The Hague, Netherlands), the Sudanese government is relocating thousands of IDPs within Darfur because of security concerns:

The recent turmoil started in late July when demonstrations by opponents of peace talks with the government turned violent. Backers of the Sudan Liberation Army, SLA, clashed with supporters of the talks currently taking place in Doha. Several deaths were reported in the violence.

“The problem is that weapons are flowing all over the place, not just in the camps but outside,” Russia’s UN ambassador Vitaly Churkin, who currently chairs the Security Council, said following a meeting on the situation.

The Sudanese government says the planned move is being undertaken for security reasons as well as because of the camp’s proximity to an airport and railway lines.

The second is a study undertaken last year of displaced Darfur refugees  (in Chad) carried out by the group 24 Hours for Darfur.

The US-based non-profit research organization spent four months in the 12 Darfurian refugee camps in eastern Chad, interviewing 1872 randomly-sampled civilians and 280 civil society and rebel leaders. The data gathered from the civilian sample is representative of the adult refugee population in Chad, and sheds light on important questions about participants’ specific beliefs about the root causes of the conflict, past peace negotiations and agreements for Darfur and southern Sudan, the nature and importance of justice in bringing about a sustainable peace, the possibility of reconciliation, land-related issues, democracy, power-sharing, and the national elections, and which actors, if any, best represent their views.

I was in Chad at the same time as the folks who put this project together. They had assembled an impressive group of interpreters and interviewers (so impressive, in fact, it was tough to find good interpreters for anyone else!). Connect to the report via Jonathan Loeb’s blog (Jonathan was one of the organizers of the study).

Physicians for Human Rights release report on CIA’s enhanced interrogation research

Monday Physicians for Human Rights (PHR) released a report on research on interrogation methods undertaken by the CIA under the Bush administration. (Disclosure: My boss Allen Keller is a longtime member of PHR and one of the co-authors of the report.) The report goes to great pains to document medical professionals’ judgments as to the extent of pain inflicted by such techniques as waterboarding, sleep deprivation (in one case as much as 180 hours), and forced stress positions, all in the service of protecting CIA personnel from prosecution under anti-torture statutes.

At issue here is the “severe pain or suffering” threshold of the United States’ antitorture statute. Medical professionals were apparently asked to figure out whether these acts, alone or in combination with one another, caused pain or suffering that was sufficiently “severe” to make their abuse count as torture. In the course of this research, the report makes clear that medical professionals were asked to violate their golden rule: Do no harm.

Reading through the report (16 pages, with Appendices on the SERE program and ethics statutes against health professionals’ participation in interrogation) one is struck by the absurdity of trying to fit what are essentially barbaric acts into the framework of modern law. For instance, it seems that in order to address the severity of waterboarding doctors recommended that saline solution be used (instead of fresh water) in order to reduce the risk of infection. So, you can suffocate someone and it won’t cause severe pain as long as you take precautions against infecting them.

I also have to wonder if the fact that PHR feels the need to call attention to the fact that research ethics were violated is not also a bit absurd. The following passage about the failure of the CIA’s Office of Medical Services (OMS) to get informed consent from their subjects makes my point:

OMS personnel were likely performing this particular experiment without informed consent because they were engaging in purposeful torture of the subject. Even with some form of IRB approval, this research and subsequent modification of waterboarding or any other torture technique would still represent a serious violation of medical ethics and international human rights law because of the nature of the two acts being carried out — research on a prisoner and the infliction of torture.

As the second sentence makes clear, the real problem isn’t that they didn’t get their research ethics right, it’s that they didn’t get their morality right. Of course I understand that PHR has good reason for pointing out that OMS personnel undertook unethical research — and that fact alone is indeed chilling, particularly given the roots of modern research ethics in Mengele’s research at Auschwitz and Ishii’s on Chinese prisoners of war — but to emphasize the lack of informed consent and IRB approval in light of the gross human rights violations feels a bit like burying the lead. I applaud PHR for their work, but have to shake my head that this is what must be done to draw attention to our continuing failure to hold anyone accountable for these acts.

For a decent popular press summary of the findings, see the New York Times’ coverage online on Sunday and an editorial today.

Book review of Crazy Like Us on STATS.org

STATS is an organization that examines the reliability and validity of quantitative findings in social science and medicine for laypeople, specifically journalists. Today they feature a book review of Ethan Watters’ Crazy Like Us: The Globalization of the American Psyche, by none other than yours truly. Here’s a teaser:

those of us who work in the small corner of mental health research that examines the differences in diagnoses and symptoms between cultures are somewhat surprised by Crazy Like Us; our field, generally, remains well hidden in the crease between psychology and anthropology. That our first popular treatment should be a highly critical survey of this field of mental health is doubly shocking.

Keep reading, here .

Vikram Patel at NYU, and a genuine global mental health agenda

Last Friday, March 6, the good folks at NYU’s program in Global Public Health hosted a lecture and discussion with global mental health luminary Vikram Patel. Dr. Patel is one of the forces (perhaps the driving force) behind the field of global mental health, and one of the architects of the Lancet’s series on the subject in 2007. This relatively new field combines public health, cross-cultural psychology, and human rights, and seeks to expand concern for mental health disability from it’s purview as a Northern luxury into a worldwide movement. For more general information on the topic, visit www.globalmentalhealth.org.

Dr. Patel’s talk at NYU was largely a call to action, as opposed to an empirical evaluation of the field’s successes and failures to this point. This is not to his discredit; Dr. Patel knows of what he speaks. From his groud-breaking work on Shona idioms of distress in his native Zimbabwe to his more recent clinical trials of community health workers’ delivery of mental health services in his family’s homeland India, Dr. Patel is well-steeped in several of the field’s parent disciplines. But Friday’s purpose was to spread the word. Lauding the success of the HIV/AIDS public health movement, Dr. Patel called on public health workers — or at least the public health trainees present — to take up similar strategies to convince public officials and other healthcare workers that mental health must be a priority in the developing South as well as developed North.

As for research, Dr. Patel noted that 90% of mental health research is done in the developed North (and within that, most in the US), and insisted that that must change. Research must guide practice in order to avoid the mistake of simply applying US or European models elsewhere. Along these lines, he pointed to recent funding interest in global mental health, even by the US’s NIMH (specifically, a recent blog post by director Thomas Insel titled “Disorders without Borders” — good grief!), a research body not known to fund many international projects.

This brought a question from the crowd (well, actually a question from me): If 90% of the mental health research is done in the developed North — the place where academics have the technology, funding, and financial interests to do research — and more research needs to be done in the less developed South, how should this be accomplished without running roughshod over local explanatory models of mental distress and local service models that may do some good? Dr. Patel acknowledged that this was a major concern, and provided the following solution: work with and teach local practitioners to do the research.

This simple-sounding solution is actually a tall order. The money and research technology (and here I’m talking about specialized research training as well as computer software) is in the North. The academic motivation for high-quality research is also largely Northern — “publish or perish.” It’s hard to see how NIMH-funded research would not evince a preference for US-led projects. So at the moment, beyond projects that hire locals to collect data, it’s hard to find projects that really substantively involve local ideas and researchers and people schooled and based in the research-resourced North (like the students at NYU last Friday). But there are a few — although very few — projects that fit the bill.

The first is Patel’s own work. Although he holds several professorships throughout the Europe and North America, he is based in Goa, India, and his research is there, and includes local staff. However, until more Vikram Patels arise (which won’t be too long, I think), his remains a special case of a culture-spanning researcher, trained in Northern/Western models and adapting, applying and distributing them throughout the developing world.

The best example of a US-led project is a USAID-funded program out of the Center for Victims of Torture (CVT) in Minneapolis, the International Program Evaluation Collaborative, or IRPEC. The brainchild of Jon Hubbard, the Research director at CVT, IRPEC aims to transfer the technology of empirical research to NGO’s working in mental health and human rights around the world in order better collect and analyze data to improve their services (and, of course, to get grants from Northern foundations which require such information). At this point I should probably disclose that I was an evaluator for IRPEC this past summer (see entries on Cambodia and Peru for related material), and that I was pretty impressed.

During this evaluation Jon told me a story of meeting a researcher who evaluates such programs who asked him, “Okay, but where’s your data?” Jon replied, “It’s not my data. It’s their data.” Until we can take up Hubbard’s example, those of us in the North who work in global mental health will always be in danger of “getting it wrong” — both ethically as well as empirically — in our quest to answer Vikram Patel’s call.

ICE systematically hid the truth on immigrant deaths in detention

The other big story relevant for readers of this blog is the New York Times’ expose on Immigration & Customs Enforcement’s (ICE) systematic cover-up of persistent medical malfeasance in immigration detention facilities. The negligent healthcare available in immigration facilities has long been known and protested by a number of us, but only in the past few years with a number of publicized deaths has it got media attention.

I won’t go into this much, as you can connect to the article here . Make sure you watch the video along the sidebar, “What happened to Boubacar Bah?” I first saw the footage a few months ago (most of it has made the rounds of those of us concerned about detention conditions); it is chilling that this can happen in a land which calls itself a “land of immigrants.” Oh, and if you think this is some holdover from the previous administration, think again: ICE has been on a tear lately, detaining immigrants left and right, and several — one of them a patient of mine, in fact — have significant health problems.


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