Tag: mental health

Getting a Mental Detox in Rwanda

This Sunday 7 April is the International Day of Remembrance of the Victims of the Rwandan Genocide. 

Photo by Carmen Lau.

I decided to study the Rwandan genocide after attending the  Institute for Human Rights conference entitled, “Bystanders and Complicity in Nazi Germany and the Jim Crow South.”  Rwanda, viewed as a trophy of the African “mission field” by many in Western Christianity, shocked many onlookers in the period during and after the genocide as it became obvious that Christians had killed Christians.  Moreover, many estimate that most Rwandan Genocide victims were killed in churches, an assertion that stimulated my interest.  The Rwandan Genocide differs from other genocides because religion did not serve as a demarcation to target victims as “other.” Most people in Rwanda identified as Christian, and the religious affiliation did not coincide with ethnic identity.

Last summer, I tagged along with a group of teachers and professors who were passionate about using education to prevent genocide.   This was a first step in developing my thesis:  Stories from Rwandan Churches Priot to the Genocide: A Collection of Oral Histories. The travel group knew one another from collaborating with the Holocaust Museum, and they held great affection and esteem for  Carl Wilkens, our group leader. Wilkens backstory, as described on his website, is this:

As a humanitarian aid worker, Carl Wilkens moved his young family to Rwanda in the spring of 1990. When the genocide was launched in April 1994, Carl refused to leave, even when urged to do so by close friends, his church and the United States government. Thousands of expatriates evacuated, and the United Nations pulled out most of its troops. Carl was the only American to remain in the country. Venturing out each day into streets crackling with mortars and gunfire, he worked his way through roadblocks of angry, bloodstained soldiers and civilians armed with machetes and assault rifles in order to bring food, water and medicine to groups of orphans trapped around the city. His actions saved the lives of hundreds.” 

With this experience, one might not be surprised that Wilkens has chosen to position himself as a force for peace and as a catalyst to stimulate people to seek to become integrated beings with emphasis on respect, empathy, and inclusion.

I had expected to cultivate empathy and understanding and to gather context and information, but I had not considered the idea that this trip with teachers would provide space for some mental detox. I had heard Rwanda described as a country with gorillas and genocide, but I saw a place where the government exceeded expectations in the context of health care and infrastructure.  Ranking among the 20 poorest countries in the world, Rwanda is a place of paradox. When our group gathered in the small white bus outside the Kigali Airport, I first sensed that this would be different than I had expected. Carl Wilkens presided over our discussion as we rode to the hotel that would be our home for the next 11 days. Wilkens urged us to harness the power of gratitude to rewire neural circuits and reminded us that since negative thoughts stick like Velcro, one must intentionally attend to the task of noting the positive.

Photo by Carmen Lau.

Early on the first day, to fulfill Wilkens’ charge, our designated facilitator, a teacher from Nebraska, urged us to think about “The Good Life,” the motto for her home state. As the group shared visions of a good life, I noticed that already, just twelve hours in Rwanda, we had erased default notions of acquisition or competitive achievement as core building blocks in “The Good Life.” Instead, people cited nature, learning, and human connectivity as the essence of a good life.

Gratitude underpins the curriculum for Mindleaps, a thriving multinational NGO designed to empower children who come from the most impoverished homes. Mindleaps collaborates with the Gisimba Training Center, a repurposed orphanage that was featured in Wilkens’ book, I’m Not Leaving. This was our first stop on the Carl Wilkens Tour. Once a child is accepted to Mindleaps, she has the opportunity to have a noon meal, wear a special uniform, receive school supplies, learn digital literacy (as an enticement to learn English), attend academic enrichment classes, and have her mother participate in a parenting-strengthening program (fathers are often away seeking work). Oh, and the best part is the child learns to dance very well. Dancing gives the children confidence and a sense of personal achievement that will be key to developing skills to thrive.

I visited the home of a seven-year-old student who regularly walks alone to Mindleaps — a three-quarter mile jaunt down a hilly tangle of dirt roads that are jam-packed with huts. Her home has no electricity or plumbing and only a patchy tin roof. Her mom comes to the parental-enrichment class regularly. The strategies used by Mindleaps are being tested by a tracking software program to provide a nuanced evaluation of the children in the areas of memorization, language, grit, discipline, teamwork, self-esteem, and creativity. For me, the visit to the Mindleaps gated compound was a transcendent experience. I saw excellence, bright colors, simple food, and a tidy vegetable garden. A swarm of smiling students wanted to touch and thank each one in our group.

Holistic, abundant living combines heart and head. So far, this time in Rwanda has allowed me to peel off barnacles of language and worldly possessions and notice feelings of gratitude and love. Watching the children and teachers leap in grand plié’s to Leonard Cohen’s “Hallelujah” consolidated my embrace of Rwanda’s Mental Detox. Rwandans have embraced the ethos of gratitude. The security detail at the entrance to the parking lot of Hotel Des Mille Collines paused from the task of pushing mirrors on long handles under incoming Land Rovers (to check for bombs) and greeted our group of pedestrians on foot.  He said, “Thank you for visiting our hotel.” Street merchants, airport personnel, gardeners, cooks, and administrators said variations of “Thank you for visiting our country.”

As the old saying goes, “You won’t remember what they said, but you will remember how they made you feel.” In Rwanda, I feel loved and appreciated.

 

 

 

Health Care Is a Human Right

by Pam Zuber

a photo that reads "Save the ACA."
“Save the ACA”. Source: Creative Commons.

Being sick or struggling with a chronic medical condition can harm health, emotions, and finances. Sickness can hurt various aspects of a person’s life and impact society as well. It causes people to miss days of work. It creates financial costs if people have to cover medical expenses for uninsured people. Isn’t it better to help treat and prevent illness in the first place? One would think so, although some people don’t believe that health care is a fundamental right. But, restoring and maintaining health improves the quality of life and so much more. Ensuring proper health care can produce a healthier, happier, and more productive society.

What are some federal government attitudes about health care?

Attitudes about health care are different in different areas. There are many diverse opinions and proposed solutions regarding health care in just the United States alone. The Patient Protection and Affordable Care Act (also known as the Affordable Care Act, the ACA, and Obamacare) represents a microcosm of this diversity. Although it became law in 2010, the Affordable Care Act has garnered considerable controversy before its creation and continues to generate controversy after its passage. Much of this controversy has coalesced around party affiliations. Some members of the Republican Party have decried the ACA a form of socialism because it’s a federal government program that works with state government programs. In this view, the ACA is un-American because other countries sponsor their own state-funded health care programs.

While not a socialist state, Canada is one such country. According to a Canadian federal government website, “Canada’s publicly funded health care system is best described as an interlocking set of ten provincial and three territorial health systems. Known to Canadians as ‘medicare,’ the system provides access to a broad range of health services.” Canada’s federal government funds, administers and sets policies for this system under legislation known as the Canada Health Act (CHA). The goal of the CHA is “to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers,” according to the Government of Canada. The CHA thus features complex interactions between federal and provincial governments and the Canadian health care system. This is reminiscent of how the U.S. federal government administers and funds government programs in U.S. states as part of the Affordable Care Act.

How is New York approaching health care?

Federal governments aren’t the only government bodies that feel strongly about health care. In January 2019, the administration of New York, New York mayor Bill de Blasio announced that the city would offer health care for uninsured residents. City residents would pay for health services on a sliding scale. Known as NYC Care, the initiative would provide mental health care and substance abuse care. “We recognized that obviously health care is not just in theory a right,” de Blasio said. “We have to make it in practice a right.” “Health care is a right, not a privilege reserved for those who can afford it,” stated the mayor. “While the federal government works to gut health care for millions of Americans, New York City is leading the way by guaranteeing that every New Yorker has access to quality, comprehensive access to care, regardless of immigration status or their ability to pay.”

Stories about the de Blasio proposal highlighted that this health care would be available to all New Yorkers, even undocumented immigrants. This proposal occurred at a time when immigration was a hotly contested topic. In fact, immigration was so contested that the topic helped spark a partial shutdown of the U.S. federal government in December 2018 and January 2019 because of debate over funding for a wall between the United States and Mexico to prevent illegal immigration. The de Blasio administration’s decision to fund health care for undocumented immigrants reflected the view that health care should be universally accessible to all, regardless of financial cost or political repercussions. In this view, health care is a human right and the right thing to do.

Why is healthcare a right?

Health care is a human right in part because health – or more accurately, bad health – can permeate every area of a person’s life. It can even have repercussions far beyond a single individual. Say a person is struggling with depression. Depression is a mental illness. It’s also physical one since depression can cause pain, other physical symptoms, or conditions such as substance abuse. (Pain and other conditions can cause depression as well, which underscores the importance of treating mental and physical illnesses so they don’t influence each other.) Depression is more than mental and physical pain. It can wreak havoc on other areas of people’s lives. For example, conditions such as depression may prevent people from going to work. If people take frequent absences, their coworkers may have to perform work extra work to compensate for their absent coworkers. Or, taking frequent absences could lead depressed people to lose their jobs. Losing their livelihoods means people may have trouble paying for food and shelter. People without jobs may not be able to support their families. People who are depressed may lack the physical and mental energy to attend parent-teacher organization meetings, to vote, to run for office, to manage their lives, or to contribute to the lives of others. They can’t fully exercise their human rights because they’re struggling to meet their basic needs. Basic access to mental health care could prevent these struggles and ensure basic rights.

What is the status of current health care initiatives?

It’s clear that spending a little money early may prevent future health problems (and possibly save money) in the long run. But, it appears that some entities don’t want to spend money on such purposes. Others have reluctantly, grudgingly accepted health care initiatives. In 2017, the U.S. Congress passed the American Health Care Act (AHCA). This legislation would have prevented Medicare expansion and other aspects of Medicare funding and would have reduced taxes for some insurers and higher income people. The legislation never took effect, so the ACA remained intact. Commentators have noted that despite efforts to reverse the Affordable Care Act, the ACA is “gaining in popularity – despite the repeal-and-replace rhetoric Trump and fellow Republicans have voiced for years.” The commentators note that politicians realize this and are using the increasing acceptance of the program to bolster their own political fortunes. They recognize that gutting a popular program could hurt their own popularity. The administration of U.S. president Donald Trump issued rules regarding the implementation of health care programs in U.S. states in 2018, for example. This acknowledged that the programs exist, serve many people, and are well-liked and well-used by voters who could determine the political future of the administration and its members. The administration’s rules vividly illustrated the old adage, “If you can’t beat ‘em, join ‘em.”

What is the future of health care?

The future of universal health care is uncertain. On one hand, the Affordable Care Act continues. Conservative administrations and everyday voters have acknowledged the ACA and support it to various degrees. There is still considerable pushback to the ACA and similar initiatives, however. Not surprisingly, some of this pushback is from entities that could be affected by universal health care plans or other health care reforms. Private insurance companies often oppose universal health care reforms because they could affect their profits. The companies and other free-market supporters say that universal health care and other reforms are a direct rebuke to capitalism and the practice of small government. The Partnership for America’s Health Care Future is one such opponent. This organization includes a number of private insurance companies and health-related entities. Interestingly, though, it also includes a number of politicians from the Democratic Party and people affiliated with the party, such as workers from the presidential administrations of Bill Clinton and Barack Obama.

On the other hand, this organization is operating at a time when other Democrats are criticizing their fellow party members for not being progressive enough. A number of Democratic candidates running for the U.S. Congress in 2018 supported a single-payer health care system known popularly as Medicare for All to replace private health insurance. A Reuters poll in that same year reported that growing numbers of voters affiliated with both the Democratic and Republican parties also favored Medicare for All-type policies. A growing number of people and some politicians support universal health care. Other politicians and private corporations don’t. Given the increasingly divided political climate, it’s uncertain whether we’ll reach workable decisions about health care any time soon. But, given the far-reaching impact that good health can provide, aren’t they worth a try?

 

Pamela Zuber is a writer and an editor who has written about human rights, health and wellness, business, and gender.

 

The Impact of Child Abuse

A sad boy sitting outside and staring into the camera.
Sad. Source: tamckile, Creative Commons

Childhood is a time in life that should be filled with joy and imagination, and free of fear and any serious responsibility.  However, for many people, this not their reality, as abuse and trauma have warped their experience of it.  In 2014, about 702,000 children were found to be victims of some form of abuse in the United States – this number does not take into account situations of abuse that went unreported.  It is estimated that 1,580 children died “as a result of abuse and neglect” in that same year, though it is possible that this number is actually much higher due to “undercounting of child fatalities by state agencies.”  The general impact and potential trauma caused by abuse can have a significant harmful influence throughout childhood development and adulthood.

What is Child Abuse?

Child abuse is “when a parent or caregiver, whether through action or failing to act, causes injury, death, emotional harm, or risk of serious harm to a child.”  This includes many different forms of abuse, such as physical abuse, emotional abuse, sexual abuse, and neglect:

  • Physical abuse is “when a parent or caregiver causes any non-accidental physical injury to a child.”
  • Emotional abuse, which is recognized less often, is “when a parent or caregiver harms a child’s mental and social development or causes severe emotional harm,” and can include (but is not limited to) isolating a child, terrorizing, ignoring, and humiliating them.
  • Sexual abuse is “when an adult uses a child for sexual purposes or involves a child in sexual acts,” but it does not have to involve physical contact with a child. In addition to “contact abuse,” it can also include inappropriate sexual language, “making a child view or show sex organs,” and forcing a child to watch a sexual act.
  • Neglect is “when a parent or caregiver does not give the care, supervision, affection, and support needed for a child’s health, safety, and well-being,” and it occurs when an adult fails to meet even the most basic requirements for taking care of a child that they are responsible for. Neglect can physical, emotional, medical, or educational.
    • Physical neglect relates to reception of “care and supervision.”
    • Emotional neglect relates to reception of “affection and attention.”
    • Medical neglect relates to “treatment for injuries and illnesses.”
    • Educational neglect relates to a child’s “access to opportunities for academic success.”

Effects of Child Abuse

Experiencing abuse as a child can have serious, long-term effects on an individual.  Those who have experienced child abuse are at an increased risk for intimate partner violence, substance abuse issues, and mental illnesses.  Experiences of abuse also lead to children having an increased risk of exhibiting criminal behavior.  In the United States, “14% of all men in prison and 36% of women in prison” experienced child abuse.  Children who are survivors of child abuse are about “9 times more likely to become involved in criminal activity” than those who are not.  Many survivors must deal with intense negative effects of their trauma for the rest of their lives.

Trauma and Child Abuse

Trauma is “an emotional response to a terrible event, like an accident, rape or natural disaster.”  When considering the issue of trauma, people often think of veterans who suffer from Post-Traumatic Stress Disorder (PTSD).  Both PTSD and Complex Post-Traumatic Stress Disorder (CPTSD) are common in survivors of child abuse, but they differ in exactly what circumstances causes them.  PTSD results from a specific event, while CPTSD results from repetitive experiences of trauma.  In terms of child abuse, PTSD is caused by a specific incident of abuse, while CPTSD is caused by experiencing numerous incidences of abuse over a period of time.

The three main categories of PTSD symptoms are “re-experiencing trauma through intrusive distressing recollections of the event,” “emotional numbness and avoidance of places, people, and activities that are reminders of the trauma,” and “increased arousal such as difficulty sleeping and concentrating, feeling jumpy, and being easily irritated or angered.”  In addition to the symptoms of PTSD, people with CPTSD also experience problems with forming and maintaining relationships, negative views of themselves, and problems with regulating their emotions.  These symptoms negatively affect the ability of individuals with PTSD and CPTSD, including child abuse survivors, to live their lives in normal, healthy ways.

Treatments for coping with PTSD and CPTSD include individual and group therapy, medications (such as antidepressants) that help with some symptoms, and the establishment of a reliable support system.  Dealing with trauma is a life-long process.  Healing is possible for survivors of child abuse, but the impacts of their experiences will never fully disappear.

A sad boy sitting next to a dog on a couch.
Nathaniel. Source: Tony Alter, Creative Commons

The Cyclical Nature of Child Abuse

The presence of abuse can be seen as a cycle with the potential to perpetuate itself throughout the generations of a family.  According to the Child Welfare Information Gateway, around one in three of all survivors of child abuse will “subject their children to maltreatment”.  This is because many survivors who become parents believe that the way they were treated as a child is the correct way to parent.  In other cases, parents believe that if they simply treat their children better than their parents treated them, then they are not being abusive.  This way of thinking is incorrect, because abuse is abuse, even if one example of abuse is not as overtly severe as another.  By spreading information and reporting incidences of child abuse we can help to interrupt the cycle.

Child Abuse is a Human Rights Issue

There are numerous ways in which child abuse can be clearly seen as a violation of human rights.  Article 18 of the Universal Declaration of Human Rights states that “everyone has the right to freedom of thought, conscience and religion,” and Article 25 states that “everyone has the right to a standard of living adequate for the health and well-being of himself and of his family.”  How can someone utilize these rights while living in fear (whether it be as an adult or as a child)?

The Convention on the Rights of the Child also deals with child abuse as a violation of human rights.  Article 19 calls for States Parties to “take all appropriate legislative, administrative, social and educational measures to protect the child from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation…”  Article 24 states that children have the right to “the highest attainable standard of health,” which is a right that cannot be fully enjoyed in an abusive situation.  Article 27 describes the right “to a standard of living adequate for the child’s physical, mental, spiritual, moral, and social development,” and abuse is a known hindrance to childhood development.  Article 34 relates specifically to sexual abuse, stating that States Parties should do everything they can to “protect the child from all forms of sexual exploitation and sexual abuse.”

It is important that we remember that children are limited in what they can do to help themselves in any given situation.  It is the responsibility of the adults around them to protect and nurture them.  Adults should be attentive toward the well-being of the children they contact.  Adults need to be able to recognize and report abusive situations when they witness them and/or are aware of them.

Resources

Sexual Assault on College Campuses

A woman who is talking to someone.
Beautiful woman. Source: Henry Söderlund, Creative Commons

According to the Centers for Disease Control and Prevention, one in three women and one in six men have experienced sexual violence .  The term sexual assault refers to “any type of sexual activity or contact that happens without your consent.”  Though, the most obvious examples of sexual assault are physical, such as rape and unwanted touching, it can also be found in verbal and visual forms, such as sexual harassment or exposing oneself.

Sexual assault is a particularly significant concern on colleges campuses.  It is experienced by one in five college women, and the majority of survivors are women between the ages of eighteen and twenty-four.  For men between 18 and 24 years old, being a student increases the likelihood that they will be assaulted by 78%  in comparison to those of the same age who are not students.  Due to the breadth of its impact, sexual assault on college campuses is an issue that urgently needs to be addressed.

Intersectionality and Sexual Assault

When discussing this problem, it is important that we recognize that not all groups experience sexual assault at the same rates.  The people who are most at risk are those from minority communities that typically have less social and political power than majority communities.

This is an intersectional issue.  Women of color, for example, experience sexual assault at higher rates than white women.  According to the Rape, Abuse, and Incest National Network, Native American women are twice as likely to experience sexual assault when compared to people of all other races.  People with disabilities are twice as likely to experience sexual assault  in comparison with people who do not have a disability.  Members of the LGBTQ+ community are also at a greater risk.  According to the 2015 U.S. Transgender Survey, 47% of transgender individuals are sexually assaulted at some point in their lives .

Title IX

Title IX is part of the Education Amendments of 1972 and prohibits discrimination based on sex in federally funded schools.  Colleges must have systems in place to deal with sexual assault, since it can have a serious impact on an individual’s educational experience.  They should investigate every reported incident and make any necessary accommodations to make sure that the education of assault survivors is negatively impacted as little as is possible.

Secretary of Education Betsy DeVos has proposed some changes for exactly how colleges are to handle reports of sexual assault, but, at the moment, students still have the rights set forth by Title IX and the Clery Act, which include the Campus Sexual Assault Victim’s Bill of Rights.  Under the Clery Act , survivors have “the right to receive written explanation of their rights and options,” and colleges must have “a policy on campus disciplinary proceedings” for sexual assault.  In these proceedings, both the survivor and the accused have the rights to equal opportunity to have each other present as witnesses, the accompaniment of an advisor of their choosing, and “simultaneous written notification” of any updates.

If you have experienced sexual assault on a college campus, you can report it to your school, get to know your Title IX coordinator  and school’s policies, and file a police report.

College students walking across campus.
College student. Source: Yuya Tamai, Creative Commons

Rape Culture

Exacerbating the problem of sexual assault on college campuses is the prevalence of rape culture.  Rape culture consists of the behaviors, language, and beliefs through which sexual violence is “normalized and excused.”  This can range from victim blaming, to the use of phrases like “boys will be boys,” to sexual assault itself.  This is especially impactful on the relationship between women/girls and sexual assault.  Rape culture leads to people asking female sexual assault survivors questions about what they were wearing and whether or not they were drinking, as if those factors are the reasons why people are attacked.  As girls grow up, they are taught what steps to take to help them stay safe.  The responsibility to prevent rape and assault is primarily placed on the people at risk of experiencing these things rather than being focused on teaching people not to be perpetrators.  Rape culture is a huge part of why many survivors do not report their assault .  Among survivors on college campuses, more than 90% do not report.

Rape culture is also perpetuated by phenomena such as toxic masculinity, which emphasizes the gender expectation for men to be aggressive and dominant.  Many people use this traditional view of what it means to be a man to minimize the significance of sexual assault to simply “men being men.”  This idea, as well as rape culture as a whole, frames sexual assault as something that is inevitable or a normal part of life rather than a serious problem that needs to be stopped.  This also leads to the assumption that men are always the perpetrators and survivors are always women, which is completely untrue.  Men and non-binary individuals can be assault survivors. Women and non-binary individuals can be assaulters.  People can be assaulted by someone of the same or a different gender.  Sexual assault does not always fit the stereotypes we have been taught.

Safety Precautions

If you are one of the many people who worries about their safety and about assault on a regular basis, here are some things you can do that will hopefully help you feel a bit more comfortable.  If you are not someone who feels the need to think about these kinds of things, this may be an opportunity to broaden your perspective and learn more about the things many of us have do to in order to feel even slightly safe.

  • Try to avoid walking out alone at night.
  • If you have to walk alone at night, consider calling someone and staying on the phone until you reach your destination.
  • Do your best to walk in and park your car in well-lit areas.
  • Carry pepper spray with you.
  • If you are out at night, try to make sure that someone knows where you are going to be and at what times.
  • Check the back seat of your car before getting in.
  • Make sure you have a reliable form of transportation if you are out at night.
  • Avoid jogging alone at night.
  • Always be aware of your surroundings, especially if you are alone.
  • Consider taking some classes in self-defense.
  • If you get a drink at a party or bar, watch them make the drink and do not leave it alone.
  • Consider downloading an app like Noonlight, which can make it easier to contact emergency services if you feel unsafe or if you are unsure if you should call 911.

Sexual Assault Is A Human Rights Issue

It is vital that throughout the conversation about sexual assault we recognize it is a human rights issue.  It is an issue of equality for people of all genders, sexualities, races, and abilities.  Article 26 of the Universal Declaration of Human Rights (UDHR) states, “higher education shall be equally accessible to all on the basis of merit,” but many college classes do not end until it is already dark outside.  Safety concerns prevent some people from taking these classes, while other people are able to take any of the available classes they want. According to Article 27 of the UDHR, “…everyone has the right to freely participate in the cultural life of the community,” but many cultural events, such as concerts and educational events, happen at night.  If someone fears going out that late and/or has no safe mode of transportation, how can they enjoy this right?  How can they use their right to freedom of expression if they are afraid (Article 19)?  How can someone live in an environment that supports their mental health and wellbeing if they are afraid (Article 25)?  How can they enjoy the equality that all people share if they are afraid?

Resources for Sexual Assault Survivors

The Effects of Low-Income Housing on Health

by Emily Walsh

Old Chicago, Southside
Black Community Older Housing On Chicago’s West Side. This Area In 1973 Had Not Quite Recovered From The Riots And Fires During The Mid And Late 1960’s, 06/1973. Source: The US National Archives, Creative Commons

Low Income Housing (LIH) and Public Housing can have serious negative health impacts on those who need these programs the most. Unsafe living environments can be detrimental to residents’ mental and physical health. The people who utilize LIH have often exhausted all other options available to them, and only have risky situations available to them, in the form of LIH. This blog briefly highlights a few of the negative impacts resulting from the interconnection of low income and public housing.

Mobility out of these housing situations is difficult, since the average annual household income for residents of public housing is $14,511, which is well below the federal poverty line. Citizens who live in public housing disproportionately have a disability, of minority ethnicity, and/or receive social security. Whether taken as singular symptoms of a larger problem or in combination, the possibility of relocation decreases tremendously for individuals/families living below the poverty line.

The topic of the efficacy of public and LIH is not a new one. The first federal housing program was created under The U.S. Shipping Act of 1917, which aimed to provide housing for workers needed in industrial positions during World War I. These housing units championed function over comfort and health, which set a dangerous precedent for housing developments to come. Seventeen years later, the National Housing Act of 1934 sought to address housing and mortgage issues during The Great Depression. This act created many of the housing complexes still in use today, especially for lower income communities.

Low-income communities have a number of difficulties associated with them, from financial distress to lower job prospects. However, it is often easy to overlook the impact of the inadequate housing on both the physical and mental health of these populations.

Housing and Cancer

 To keep costs down during the rise of cheap housing due to the National Housing Act of 1934, builders utilized asbestos. Asbestos was a common inclusion in construction materials because of its resistance to flames and chemical reactions, sounds absorption, and low cost. The low cost made asbestos a popular choice for large scale projects like schools, offices, and apartment buildings. Usage of this mineral peaked in the U.S. between 1930 and 1980. Asbestos containing materials (ACMs) become harmful once damaged, which can happen when materials get older, are exposed to weather, or are subjected to demolition or construction.

Undisturbed ACMs pose little threat, but any sort of disruption can have catastrophic consequences because there is no safe level of asbestos exposure. This disruption can be caused by construction, accidents damaging walls, water or fire damage, and general aging over time. Once disturbed, microscopic asbestos fibers are released into the air. At this point they are at risk for inhalation and ingestion by people and animals.

After they enter the body, asbestos fibers settle into the linings of internal organs including the lungs, heart and abdomen. These particles are microscopic, and rubbing against the sensitive tissue of internal organs can cause tiny nodules to form around the fibers. This irritation can cause tumors and mesothelioma cancer to develop. Symptoms such as chest pain, coughing, and fatigue are vague, and easily attributable to a number of other ailments, which makes early diagnosis very difficult.

Exposure at any point can be dangerous and lead to mesothelioma down the road, which can take up to 50 years to appear. Individuals who are worried about mesothelioma should inform their doctor of any of these symptoms, and of any possible asbestos contact. Exposure can occur from housing, construction materials, working on shipyards, working around fire retardant materials, or in mines. After diagnosis and forming a treatment plan with your doctor, you can pursue options in financial compensation if exposed on the job.

Elderly people are most at risk for mesothelioma because they have a higher likelihood of exposure to asbestos at some point in their lives. Exposing them to even more asbestos in the home can exacerbate irritation and lead to further health complications. Sixteen percent (16%) of residents in public housing are seniors, and more than half of those seniors rely on Social Security as their primary source of income. The only safe way to deal with the concern of asbestos is to hire an abatement professional to take care of the situation. However, building owners, and even the government, are not required to do so if they feel any ACMs present are in good enough repair to not be a danger to health.

Many LIH options are still owned by private property owners, which puts the cost of abatement on them. These proprietors may be loath to shell out money to abatement professionals, but they are required to maintain livable conditions on their properties, even if they aren’t specifically mandated to get rid of asbestos. For poorer individuals, the best course of action is to keep an eye around their housing, to see if anything appears to be in disrepair. If it is, they can ask their property owners to have the building tested for dangerous asbestos. If property owners refuse, they can be at risk for lawsuit for not maintaining healthy living standards.

Southside Chicago 1973
South Side Black Community In Chicago With Small Businesses And Apartments Over The Stores In The Older Buildings Near 43rd And Indiana Avenue, 06/1973. Source: The US National Archives, Creative Commons

Impacts of Housing on Wellbeing

From 1954 to 1967, the Chicago Housing Authority built more than 10,000 public housing units. However, only 63 of these were built outside of poor and racially segregated areas. In 1966, community activist Dorothy Gautreaux, along with the support of ACLU lawyers, sued the CHA in federal court. Gautreaux’s case set a precedent that there is a serious difference between urban and suburban housing. The Gautreaux Project refers to an experiment the court set up after Gautreaux won her case. The U.S. Supreme Court ordered the CHA to randomize the placement of families with Section 8 housing vouchers. Participants were placed in either suburban or urban neighborhoods regardless of race. After many years, the outcomes of these families were measured against each other.

The families placed in urban situations were more likely to have lower performing children, remain on welfare, and have lower graduation rates than the suburban participants. The Gautreaux project was hailed as definitive proof that a person’s housing situation has a strong correlation with their overall wellbeing. Sociologist James Rosenbaum testified before Congress on the Gautreaux Project’s results, which helped inspire the Moving to Opportunity (MTO) program. The MTO emulated the Gautreaux project on a larger scale with 4,600 low-income families in Baltimore, Boston, Chicago, Los Angeles, and New York City. The official MTO report found that moving to lower areas of poverty lowered risk of diabetes and obesity for women, proving that concentrated and irresponsible low-income housing is undeniably bad for health and wellbeing.

Mental Health and Housing

 In 2015, the MacArthur Foundation released a report entitled The Link Between Housing, Neighborhood, and Mental Health which identified three linking factors between mental health and living situations. The study used a cross-section of 371 low-income Latino families living in the Bronx, with eligibility determined based on their income. The three factors identified in the report were housing quality, neighborhood cohesion, and policy. They found that poor housing conditions contribute to depression and hostility, but contravened by neighborhood cohesion and improvements to housing.

These issues are interconnected since social cohesion is less present in groups of people experiencing mental health issues, which can then contribute to further mental health issues and spiral out of control. A 2016 study in Britain found similar links between housing and mental health. The research concluded that when exposed to unstable housing conditions for more than a year at a time, children are three times as likely to experience depression and anxiety. Women are also more likely to develop these issues, though at a lower rate of 10 percent.

These connections are apparent, but can be difficult to measure since any mental health issue may have predated the move into low-income housing. Additionally, the effects of an unstable living situation can compound on each other.

Closing Thoughts

No matter the difficulty with which these effects are measured, the importance of responsible housing practices cannot be overstated. The biggest barrier to fixing this problem is the intricacy of the situation. Policy changes, shifts in public opinions, political attention, and development of alternatives can all stand in the way. The results of the studies cited above illustrate steps that could be taken to create a successful model of public housing. As these reports prove, an improvement in housing situations can also result in overall quality of life and contribution to society. By taking these factors into account, populations in need of housing assistance can be provided options for safe and healthy living, at the lower cost that they need.

For residents renting from a privately owned property that exhibits any of the risk factors for decreased health and well-being, you will need to prove that conditions are unlivable. To do this take documents and photographs that support your claim and force landlords to fix them or risk having rent withheld. For residents of public housing, the government is subject to the same rules, and if you are displeased, you can consider the MTO program as an alternative.

 

 October is Healthy Lung Month. Toxins in the home can cause harm to anyone exposed. To avoid these dangerous health risks, educate yourself about how you can avoid exposure, and what your rights are. The Mesothelioma Cancer Alliance is dedicated to seeing asbestos eradicated worldwide and ending toxin pollution for people everywhere. 

What is Gender-Based Violence?

Growing up, I was resentful of the social freedoms my male friends naturally enjoyed. Unlike the parents of my male friends, my parents were very strict about things like curfews, not being outside at night alone, and avoiding certain neighborhoods. My dad would always say, “We trust you, but we don’t trust the people around you”. Although I was still resentful, I know my father enforced those stringent rules because he was trying his best to protect me from gender based violence (GBV). GBV is defined as violence towards an individual that is motivated based on his or her gender identity, biological gender, “or perceived adherence to socially defined norms of masculinity and femininity”. The term ‘violence’ encompasses physical, sexual, and psychological abuse along with coercion, threats and compromised liberty. Examples of GBV include sexual violence like rape, domestic violence, and human trafficking. Both men and women are affected by GBV; however it is recognized women and girls are at most risk for exposure due to the imbalanced power relations between men and women “which have led to domination over and discrimination against women by men … and that violence against women is one of the crucial social mechanisms by which women are forced into a subordinate position compared with men.”

Violence against women and girls is a prevalent human rights violation resulting in disproportionate negative consequences on females’ physical, mental and sexual and reproductive wellbeing including but limited to including, but not limited to: “i) fatal outcomes; ii) acute and chronic physical injuries and disabilities, iii) serious mental health problems and behavioral deviations increasing the risk of subsequent victimization and iv)  gynecological disorders, unwanted pregnancies, obstetric complications and HIV/AIDS .”

International Womens Day Strike. Source: Molly Adams. Creative Commons

Some troubling statistics on GBV:

  • In 2014, a UNICEF study projected that ~120 million girls (almost 1 in 10) under the age of 20 have been forced to perform sexual intercourse or other sexual acts during some point of their lives.
  • Almost half of the women killed in 2012 were murdered by a family member or intimate partner.
  • Globally, the WHO estimates 35% of women worldwide have experienced either physical and/or sexual intimate partner or non-partner violence or sexual violence. Other national studies have estimated up to 70% of women experience GBV.
  • “Women and girls together account for 71 per cent, with girls representing nearly three out of every four child trafficking victims. Nearly three out of every four trafficked women and girls are trafficked for the purpose of sexual exploitation.”

Although a pressing issue, it wasn’t until 1992 when the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) formally adopted General Recommendation No. 19: Violence against Women (GR 19), which legally categorized violence against women a distinct form of discrimination. Likewise, it wasn’t until 1993 the United Nations General Assembly adopted the Declaration on the Elimination of Violence against Women (DEVAW), forming the first ever internationally-recognized definition of GBV. Both documents explicitly outline how GBV violates basic human rights mentioned throughout the UDHR such as the right to life, dignity, and health.

Health Effects of Exposure to GBV

Sexual and Reproductive Health
GBV is a major public health concern contributing to mass amounts of mortality and morbidity. Specifically, the relationship between GBV and HIV and other STIs has been recognized as an important pathway for the contraction and spread of such diseases. WHO states that, in some regions, women facing sexual partner violence are 1.5x more likely to contract HIV, and 1.6x more likely to contract syphilis. Here’s how:

First, increased vulnerability to HIV and STI’s stems from sexual violence such as rape. “Violence reduces victims’ abilities to influence the timing and circumstances of sex, resulting in more unwanted sex and less condom use, including situations where women are coerced or pressured not to use condoms.” For example, of the estimated minimum 250,000 women brutally raped during the Rwanda Genocide, 70% of those survivors tragically acquired HIV.

Second, another important pathway from GBV to HIV is men who are physically violent are also more likely to be HIV positive. Studies find violent men are more likely to engage in risky sexual behavior such as having multiple sex partners and utilizing transactional sex, increasing their chances of contracting and spreading HIV and other STIs.

Along with the spread of disease, women and girls experience unwanted pregnancies due to GBV. The WHO states that women with previous exposure to GBV are more likely to account having had a self-induced abortion. Globally, “80 million unintended pregnancies each year, at least half are terminated through induced abortion and nearly half of those take place in unsafe conditions.” A study analyzing the relationship between GBV and sexual and reproductive health among low-income youth in three Brazilian cities, supports WHO’s statement that women in abusive relationships are more likely to experience unwanted pregnancies. The study found adolescent females who became pregnant as teenagers were more likely to have been victims of controlling behavior or physical abuse compared to teenage girls whom have never gotten pregnant. Among the girls who got pregnant as a teenager during the study, “20% reported having suffered physical violence from a partner and 10% reported having been subjected to sexual violence from a partner, compared to 5% and 3% respectively of those who did not get pregnant as teenagers.”

Mental Health:

Along with physical harm, studies highlight women and children face serious mental health problems after enduring traumatic experiences with GBV. “Exposures to traumatic events can lead to stress, fear and isolation, which, in turn, may lead to depression and suicidal behavior.” According to the WHO, women abused by a non-partner are 2.3 times more likely to have alcohol use disorders and 2.6 times more likely to have depression or anxiety. A cross-sectional study based on the Australian National Mental Health and Well-being Survey in 2007 found that of the 4,451 female respondents, 1,218 (27.45%) of the women have experienced one of the four types of GBV analyzed in the study (IPV, stalking, sexual assault, and rape). Of the 139 women who experienced at least three types of GBV, the rates for mental disorders were 77.3% for anxiety disorders, 47.1% for substance abuse disorders, 34.7% for attempted suicide, and 56.2% for PTSD.

Right On. Source: Liz Spikel. Creative Commons

Potential Solutions to Address Gender-Based Violence

In light in of April being sexual assault awareness month, itself a form of GBV, it is essential to break through the culture of silence. Our health care system can be more active is addressing the prevention of GBV, and also the aftermath of GBV. First, providing survivors with mental health services such as counseling is critical for these women and girls to address their psychological trauma and progress with their lives. Mental health services are vital in providing survivors a voice to express themselves. Second, our health care system could potentially be a major stakeholder in identifying and stopping GBV.

“GBV is very common, but most health care providers fail to diagnose and register GBV, not only due to socio-cultural and traditional barriers, lack of time, resources and inadequate physical facilities; but even more so due to lack of awareness, knowledge and poor clinical practices with limited direct communication and failure to do a full physical examination, not to mention register and monitor the effectiveness and quality of care.”

Moving forward, there needs to be a systematic change within in the health sector. The World Bank, amongst other NGO’s, have provided approaches on how to address this issue. Some strategies to consider include, but of course not limited to:

1) Requiring GBV screenings during doctor visits to ensure early intervention
2) Train and educate health care personal about GBV to improve provider’s knowledge, medical services and attitudes towards GBV.
3) Providing survivors access to adequate infrastructure within hospitals which includes private counseling and examination rooms.

Women are approximately 50% of our global population, yet gender-based violence is one of the most prevalent and widespread human rights violations. Gender equity is an inalienable right protected in numerous human rights documents, however change will never be achievable until we break this vicious cycle of violence through education and strict policy changes. Ultimately, women have proven they are just as equally capable as men, and gender-based violence and discrimination over an uncontrollable biological factor is simply unjust.

Be a Real Man: Toxic Masculinity

Man turning his head to face the camera.
He-Man. Source: Reddy Aprianto, Creative Commons

What does it mean to “be a man”?  The traditional response would involve being dominant, physically strong, and emotionally closed off.  Some might see someone who is tough and intimidating, who never cries in front of others, and say that he is a “real man.”  Men in our society are pressured to fit perfectly into this traditional depiction of masculinity.  If a man fails to be strong enough or shows too many emotions, he is often shamed by others.  When a man’s masculinity is questioned, he might make a point of acting more masculine, which could lead to harmful or even violent behavior.  It can have a negative effect on his mental health, contribute to the occurrence of intimate partner violence, and marginalize certain groups.  When masculinity is forced upon individuals and is significantly harmful, it becomes toxic.

For the purposes of this blog, toxic masculinity refers to masculine traits, attitudes, and behaviors that are harmful, yet continue to be encouraged by much of society.

Impact of Toxic Masculinity on Mental Health

Masculinity is often associated with not sharing one’s feelings with other people. Men are not expected to be emotional individuals.  When they are emotional, they are often chastised.  The suppression of emotions is a negative thing for anyone to do.  Bottling up everything does not make one’s feelings go away and can have long-term consequences.  In a meta-analysis of 48 studies, there seemed to be a relationship between the suppression of emotions and an increase in negative changes in mental health, such as depression and anxiety.  There also seemed to be a relationship between the suppression of emotions and a decrease in positive changes in mental health, such as life satisfaction.

The negative effects of societal expectations of masculinity begin in childhood.  One study, which used a sample of 280 middle schoolers, found that the boys in their study began to conform to traditional expectations of masculinity between the fall and spring of their first year of middle school.  The results of that study also suggest that there is a relationship between the presence of depression and conformity to traditional masculinity.  The study defines traditional masculinity as, “a dominance-oriented ‘bravado’ with which individuals posture for social dominance through fundamentally maladaptive behaviors, such as physical toughness and emotional stoicism, that project social power and invulnerability.”  Many of the behaviors that traditional masculinity supports are “socially dysfunctional,” such as suppressing emotions and being physically aggressive.  Considering the fact that middle school is a critical point of development, one can see that long-term harm can be caused by being held to standards that relate to depression and dysfunctional social behaviors.

Suicide is the third leading cause of death for boys, which suggests that there are serious mental health issues and factors that need to be addressed.  Boys who fail to fit into the norms of traditional masculinity are often bullied by those who adhere to norms well.  Bullying is associated with symptoms of depression, which has the potential to lead to the occurrence of suicide.  One study, which used a sample 236 students, found that individuals who had experienced bullying had more symptoms of depression and suicidality four years after initially being surveyed than those who did not report that they had experienced bullying.  In addition to depression, bullying that relates to failure to meet gender norms can lead to violence against others.

Intimate Partner Violence 

Not only does toxic masculinity harm men themselves, but it also harms the other people in their lives.  One study, using a sample of 570 married men in Bangladesh, suggests that increased norms of gender equity are associated with a decrease in the use of “coercive control” over men’s partners.  The men in the study were presented with a list of coercive behaviors, such as, “when I want sex I expect my partner to agree,” and, “I have more to say than she does about important decisions that affect us.”  The majority of the men reported using most of the behaviors.  On average, the men agreed with 5.7 of the 8 traditional gender attitudes, such as, “a woman should obey her husband,” and, “a woman’s most important role is to take care of and cook for her family.”

Another study, which surveyed 600 men, looked to test the presence of a relationship between “masculine discrepancy stress” and intimate partner violence.  The study defines masculine discrepancy stress as, “a form of stress arising from perceived failure to conform to socially-prescribed masculine gender role norms.  Intimate partner violence is mental, emotional, or physical violence towards an intimate partner.  The results of the study suggest that “masculine discrepancy stress” was significantly effective in predicting a man’s history of committing intimate partner violence.  If a man felt that their masculinity was being questioned, then they felt the need to perform strong acts of masculinity, such as acts of violence.

Men standing by a wall and talking to each other.
Men Gathering. Source: Eleni Papaioannou, Creative Commons

The Marginalization of Groups

If a boy or a man is considered to be too feminine, people might call him a girl or say he’s gay in an attempt to make him feel bad about who he is. This depicts being feminine or being gay as being a bad thing, like it is shameful to be anything other than a straight man. Why are entire groups of people being marginalized in order to demean another person?  What is wrong with possessing traditionally feminine qualities?

One might suggest that it is only a problem when someone possessing those qualities breaks traditional gender roles. However, that does not explain it.  Women are frequently supported for displaying certain characteristics, such as being strong, or participating in certain activities that are traditionally masculine, such as enjoying sports, hunting, and fishing.  In other situations, their positive “masculine” characteristics are twisted around into negative “feminine” ones.  For example, if a woman is very confident and has strong leadership skills, she is likely to be called “bossy”.  If a girl is more logical and is not very emotional, then she may be considered cold-hearted and mean.  A man and a woman can act in the exact same way, but they will not receive the same response from other people.

Toxic masculinity also has a significant impact on transgender men.  Violence against the transgender community has been on the rise.  In some situations, trans-men experience “defensive masculinity,” where they conform to traditional ideas about masculinity, whether they identify with them or not, in fear of violence.  Toxic masculinity harms their mental health and puts them at risk of violence if they do not meet traditional gender norms.  It is more than a matter of people not agreeing with non-traditional ideas about gender.  Toxic masculinity has the potential to be an issue of life and death for transgender individuals.

Why Is Toxic Masculinity an Issue of Human Rights?

Ultimately, traditionally masculine traits themselves are not bad, but they become negative when they are expected and forced upon people.  Toxic masculinity has the potential to violate human rights.  It can be harmful to mental health and lead to intimate partner violence, both of which are public health and human rights issues.  According to Article 3 of the Universal Declaration of Human Rights, “Everyone has the right to life, liberty and security of person.”  Toxic masculinity can also act as a barrier to gender equality and harm the LGBTQ community.  Article of the Universal Declaration of Human Rights says that all people are entitled to the rights given in the declaration, “without distinction of any kind, such as race, color, sex, language, religion, political or other opinion, national or social origin, property, birth or other status.”

For years people have tried to explain away toxic masculinity as “boys just being boys” and simply “the way men are,” but that is not fair to anyone.  The way people act is hugely impacted by the way people expect them to.  Societal expectations need to change to support boys and men in being kind and being open with their emotions.  Violence and aggression cannot be accepted as granted parts of masculinity.  Men do not have to be strong and domineering to be men.

Diagnosing ADHD: Mental Health and Human Rights

Playground adventures. Source: BrownZelip, Creative Commons

Mental health is a topic that is becoming increasingly recognized as an important public conversation.  It is usually focused on depression and anxiety and is often overlooked in the context of human rights. It is important to recognize that mental health is a public health issue, and therefore a human rights issue. Mental health has an irrefutable impact on an individual’s physical health and their quality of life.  It can also harm their ability to receive an education. This blog will discuss Attention-Deficit/Hyperactivity Disorder (ADHD) and the issues created by the stereotypes and stigmas related to mental health.

Conditions like ADHD are frequently given a specific popularized depiction. Though the depiction may not be entirely incorrect, it is rarely inclusive of all the individuals experiencing these conditions.  When people think of ADHD for example, they often think of a boy with a lot of behavioral problems and poor grades.  The fact of the matter is that people with ADHD can be any gender and can have any kind of experience in school. Using stereotypes to inform our ideas about the people who have certain conditions impacts if and when people who have these conditions are able to receive a diagnosis and treatment. Because of this, girls with ADHD are frequently unaware of what they are experiencing.

What Is ADHD?

ADHD is a disorder that results from the way the brain develops.  According to the Centers for Disease Control and Prevention, “ADHD is one of the most common neurodevelopmental disorders of childhood.”  It is very important to understand that ADHD is not merely a behavioral issue.  It is a condition that cannot be punished away.  ADHD brains work differently than brains without ADHD.  ADHD brains lack a sufficient amount of dopamine and norepinephrine, two neurotransmitters that transport signals in the brain.  They are like filters for your brain.  Dopamine helps to regulate the reward center of the brain, movement, and emotional responses. Norepinephrine strengthens signals that are relevant and important while blocking information that is unnecessary.  Medicines that treat ADHD typically aim to support the circulation of these neurotransmitters in the brain.  These medicines decrease the frequency of the symptoms of ADHD, though they do not eliminate them.

In addition to the symptoms related to impulsiveness and inattentiveness, the lack of filter ADHD causes in the brain can lead to sensory overload, which can cause a lot of stress and anxiety.  When this occurs, one becomes overwhelmed by all of the noises you hear, the things you see, and the things you feel.  You notice everything around you, including the things that are unimportant.

Depending on an individual’s personal symptoms and experiences, they may have one of three different types of ADHD. One type of ADHD is the “Predominantly Hyperactive-Impulsive Presentation”.  This type can involve a lot of fidgeting, feelings of restlessness, and an unusually large amount of impulsive behavior, such as interrupting people.  Another type of ADHD is the “Predominantly Inattentive Presentation”.  This type often involves forgetfulness and difficulties in fully absorbing new information.  The third and final type is called the “Combined Presentation” and involves experiencing the symptoms of the other types equally.

Differences Between Boys and Girls With ADHD

Girls are significantly less likely to be diagnosed with ADHD than boys are, though they are not less likely to actually have it. One study, using data from the Danish National Birth Cohort, found that children whose parents reported ADHD behaviors and who were undiagnosed were girls more often than boys.  Because of this, girls with ADHD are more likely to go untreated than boys are.  The differences in how boys and girls experience ADHD contribute to the underdiagnoses of girls. Another study, which combined the results of 8 prior studies to have a sample of 772 boys and 325 girls, suggests that boys with ADHD are more likely to display symptoms of impulsivity that girls with ADHD are, based on the children’s performances on “Continuous Performance Tests”. Symptoms of impulsivity are often easier to recognize than inattentiveness and result in behaviors that catch people’s attention.  Inattentiveness, which girls more frequently experience, does not lead to behaviors that are as disruptive as the behaviors of impulsivity.

Children in a classroom reading with their teacher.
students-in-class-with-teacher-reading. Source: Ilmicrofono Oggionom, Creative Commons

Why It Matters

ADHD is highly connected to the issue of mental health. According to one study, girls with ADHD are more likely to experience comorbid disorders such as depression, anxiety, oppositional defiant disorder, and conduct disorder than girls who do not have ADHD. Individuals with ADHD may internalize what they are going through, blaming themselves and feeling like what they are going through is their own fault.  They may externalize what they are going through, impacting the way they interact with other people and their environments.  Internalizing and externalizing behaviors occur in individuals with ADHD regardless of the existence of a diagnosis but being undiagnosed can make the situation more difficult.

The possibility of being diagnosed with ADHD is also impacted by many social determinants. Social determinants are defined as “conditions in which people are born, grow, live, work, and age.” They lead to avoidable health disparities. It is important to recognize social determinants when it comes to mental health and human rights, because they highlight the fact that people of different backgrounds do not have access to the same resources. Factors that are out of an individual’s control impact their ability to access their human rights and maintain a good quality of life. By identifying social determinants, we can begin to identify changes that can be made to diminish injustice in the world. For example, even the country that someone with ADHD lives in can impact the chances that they will be diagnosed.

In France, 0.5% of children are diagnosed with ADHD, while about 12% of children in the United States receive a diagnosis. Different countries around the world have different views of ADHD, affecting their rates of diagnosis and the methods of treatment. The treatment of ADHD in France frequently involves prioritizing methods such as therapy and family counseling over medicines. In Germany, it is likely that students with ADHD benefit from the “outdoor component” of their education, as being outside can be more favorable for them than a traditional classroom. The United States relies more heavily on using medicinal methods to treat ADHD.

Another social determinant that impacts treatment is socioeconomic status. Even if a child in poverty has received a diagnosis, it is still possible that they cannot afford treatment. If they are uninsured, it would be difficult for them to access medication or therapy. Race also acts as a social determinant. The results of one study suggest that there is a large disparity in ADHD diagnosis and treatment that negatively impacts African-American and Latinx children.  According to the study, it is more likely that the disparity is due to African-American and Latinx children being underdiagnosed and undertreated than white children being overdiagnosed and overtreated.

Social determinants like nationality, socioeconomic status, and race can be barriers to a child’s diagnosis and treatment for conditions like ADHD. These factors are out of the child’s control and create disparities that cause further harm.  Even if an individual knows what a problem is, they cannot work towards alleviating it if they do not have the resources they need. If a black girl is born is born into a New York family in poverty, she may lack the ability to spend time outside, receive certain medications, or go to therapy. She would not have access to the same resources as children from families with higher incomes or different geographical locations. This injustice feeds into comorbid disorders and has a negative impact mental and public health, as emotional issues can develop from being able to understand the injustice.

The Universal Declaration of Human Rights includes the right to education (Article 26) and the right to an environment that promotes health and wellbeing (Article 25), along with many others.  Access to these rights is limited when individuals with conditions like ADHD are unable to seek treatment, whether that treatment be medicinal or a form of counseling.  The effect that these conditions have on one’s mental health makes a significant difference. Education is one of the human rights that is fundamental to growth and flourishing in life.

We, as a global society, must recognize the relationships between mental health, public health, and human rights. They are not isolated issues. The way we approach one impacts the outcomes of the others.  Mental health is a part of public health, impacting an individual’s physical health and their quality of life. Both mental health on its own and public health as a whole are largely influential in one’s ability to access their human rights. Everything is connected.

Bacha Posh: The Resilient Girls of Afghanistan

Three curly haired Afghan kids look up to the camera
Afghanistan Kids. Source: Army Amber, Creative Commons

Afghanistan has been embroiled in numerous civil wars and regime changes as global powers like Britain, Russia, and the United States have attempted to each bring their own version of peace and governance to the country for the past 150 years. The international community’s involvement has made little progress in quelling the violence during this time span, despite attempts at installing kings, providing assistance, backing rebels, and imposing sanctions. In some ways, the international community has instead reaped the consequence of empowering extremist groups like the Taliban, who have used the money and weapons funneled to the country for the original purpose of fighting the Soviets to stage a takeover of their own once the Soviets withdrew. With this climate as a backdrop, many of the stories from the region told in the West are often focused on soldiers and battles taking place in Afghanistan’s arid desert, with men from the Afghan government, extremist groups, and foreign armies fighting vigilantly for their homeland, whichever land that may be. When the focus shifts, Afghan women take center stage as the West’s fascination with their sheet-like garment–the burka–brings out calls for liberation of the oppressed group; however, on rare occasions, a story of the resilience and resistance of Afghan women pierces through our media landscape and introduces us to a new facet of the human experience.

Inspired by her visit to Pakistani refugee camps and encounters with many Afghan women in 1996, Deborah Ellis wrote a book about an Afghan girl who dons the persona of a boy to provide for her family. An adaption of Deborah Ellis’s The Breadwinner was released in select theaters in November. Based on the book published in 2000, the narrative follows an 11-year-old girl named Parvana who lives with her family in Kabul, Afghanistan under the rule of the Taliban. After her father’s imprisonment because of Taliban’s disdain for his western education, her mother and school teacher disguise her as a boy so she can work and become the sole breadwinner in the family, bringing in an income for the household of six. Audiences worldwide are now able to watch Parvana’s journey on the silver screen, but with the revelation that a portion of girls do dress as boys in Afghanistan, many questions arise. What happens if they are caught? How is cross dressing allowed by the families? Do the girls transition to being boys forever? If this is a more common occurrence than previously thought, why doesn’t the international community recognize this subversion being undertaken?

Jenny Nordberg steps in to dive deeper into the subject. Author of the 2014 book The Underground Girls of Kabul: in Search of a Hidden Resistance in Afghanistan, she spent months tracking down and interviewing families across the country who had a bacha posh, or a girl “dressed up as a boy” in the Dari language. Through her research, she creates the “only original non-fiction work on the practice of bacha posh”, bringing to light the ways in which women in a hostile environment have innovated and found ways to survive under incredible circumstances. Both the fictional tale in The Breadwinner and the real-life stories of bacha posh in The Underground Girls of Kabul bear striking similarities in themes, but combined they also highlight how the experience of each girl is unique to her own personal circumstances.

War

One constant held across both accounts is the presence of war and the Taliban. For the bacha posh, physical and environmental factors force their adaptation. In both the story and in the in-person interviews, Afghan parents reminisce about the brief period of peace in their youth when they freely roamed the streets in their garment of choice without fear during the Soviet rule. It was only when the Taliban took control that the practice of girls dressing as boys became necessary, as the schooling of girls became illegal and all women who had reached puberty were ordered to wear a burka, be accompanied by a male escort, and stay inside. If a woman is caught outside without an escort and a burka, she risks assault and death. This threat drove the decision of Parvana’s family in The Breadwinner, for without the father figure her family was left without a male, and this lead to her mother and siblings being trapped in the house with no way to earn money or buy food at the market. By making Parvana a boy, even at 11, she was able to escort her family members and secure a job reading and writing letters for illiterate men that passed her by on the street.

 

A line of Taliban soldiers stand beside a table handing in their weapons
Former Taliban fighters return arms. Source: Resolute Support Media, Creative Commons

Society

Yet if girls were unable to navigate the street on their own, doesn’t dressing a girl as a boy increase the risk to her safety if she is found out? Many experts Nordberg consulted when she first began her project dismissed the possibility of the bacha posh’s existence as it seemed to run contrary to the Western view of conservative Islamic societies. In a community in which the roles of males and females are so well defined, it is hard to believe that someone crossing from one role to another would not be in the greatest of violations. Shukria Siddiqui, a bacha posh until she was 20, interviewed 15 years later, clarifies this contradiction by giving an example from when she was challenged by three Mujahideen soldiers at her home when she was 17. The soldiers called out for the rumored girl who dressed like a boy, and when she went to her door to answer one of the men stated “Okay, you look like a boy, and you are completely like a boy, so we will call you a boy.”

The soldier’s statement is the stance that most Afghans, male and female, religious and nonreligious, take when confronted with a bacha posh. In The Breadwinner, Parvana lived in constant fear of being found out by those around her, but Nordberg observes that as long as the status quo of the roles remain, meaning boys complete tasks outside the home and women complete the tasks inside the home, there is nothing provoking about a bacha posh’s actions. In their eyes, the child is still conforming to societal norms, unlike if they were to stay a girl and complete traditionally male tasks. As long as the child switches back at an appropriate age to be married, around their late teens, in order to continue fulfilling their role, all is well. This sentiment is also echoed by the majority of families interviewed who raised a bacha posh. They transform their daughter to become a boy anywhere between birth and 10 years old, but as the bacha posh begins to show signs of puberty, they switch them back to assume their female identity with little problem. Only in two rare types of cases did Nordberg find that the transition back caused lasting difficulties for the girl and her family: when the girl exhibits signs of gender dysphoria, and when the transition back to being a girl occurs later in life.

Psychology

Defined by the American Psychiatric Association,

“Gender dysphoria involves a conflict between a person’s physical or assigned gender and the gender with which he/she/they identify. People with gender dysphoria may be very uncomfortable with the gender they were assigned, sometimes described as being uncomfortable with their body (particularly developments during puberty) or being uncomfortable with the expected roles of their assigned gender.”

The common term associated with someone who experiences gender dysphoria and identifies with another gender is transgender, however,

“Gender dysphoria is not the same as gender nonconformity, which refers to behaviors not matching the gender norms or stereotypes of the gender assigned at birth. Examples of gender nonconformity (also referred to as gender expansiveness or gender creativity) include girls behaving and dressing in ways more socially expected of boys or occasional cross-dressing in adult men.”

The majority of girls Nordberg spoke with fell into the category of being gender nonconforming; comfortable with being a girl even if they took on traditionally male roles. Yet Zahra, a 17-year-old bacha posh, felt the opposite. Transformed into a bacha posh at birth, she fully embraced the idea of being a boy, reveling in her male friendships and shunning interactions with girls as it was not considered manly to interact with the other sex. After working for several years, Zahra’s mother suggested that she transition back, but this caused Zahra great psychological distress. Zahra refused to change back, and feeling appalled by her now changing body she confessed to Nordberg that should she get the chance she would undergo an operation to permanently transition herself into a boy. This was outside of the norm even for a bacha posh, but it does fit into what would be diagnosed in the West as gender dysphoria. While Nordberg was unable to draw a conclusion as to whether the original bacha posh transition influenced Zahra or if the two happened in tandem, it was an important case to demonstrate that while the majority of bacha posh are not gender dysphoric, there may be gender dysphoric bacha posh.

The other case when the transition out of being a bacha posh is rendered more difficult is when the girl transitions back later in life. In Shukria’s case, she was transitioned back at 20 just before her wedding, set up by her family. She accepted this arrangement and went through with it, but she quickly found that she lacked many of the skills that women her same age were already competent in; cooking, cleaning, and recognizing non-verbal cues from other women were all difficult to pick up. It was as if her brain had settled into the male pattern of behavior and found it difficult to let go. Her steps were too long, her voice was too loud, and she found it hard to relate to idle gossip and conversations around childrearing. Yet, it is important to emphasis that all the problems she encountered stem from social, not biological, norms. When Nordberg asked Shukria if she could teach her, the Swedish born New York based reporter, how to become a man, Shukria look her over and said she was already a man due to her Western mannerisms. To Shukria, the basis of being male or female in Afghanistan was not in biology, and as Shaheed, another woman interviewed who remains a bacha posh at 30, describes, the difference is in freedom, and that “between gender and freedom, freedom is the bigger and more important idea.” 

Malala sits and speaks with David Cameron at a conference about Syria
David Cameron meets with Malala Yousafzai at the Syria Conference. Source: UK Department for International Development, Creative Commons

Heroines

The women in The Underground Girls of Kabul and The Breadwinner all demonstrate this spirit of defiance and freedom, and historically they are no exception. Much like the stories of Joan of Arc and Mulan, Afghanistan also holds a woman folk hero in high regard. During a fight against British troops in 1880 when the Afghan army was close to defeat, a woman rushed out, rallied the troops, and used her veil as flag to lead them to victory. While killed in battle, the memory of the warrior Malalai lives on to inspire both Afghan girls and boys to be strong in the face of adversity. Both Parvana and the bacha posh Nordberg spoke with bring to mind Malalai to give them strength when their own resolve begins to waiver, and even the Afghan Nobel Peace Prize winner Malala Yousafzai is named after Malalai. In 2009 at the age of 12, Malala began blogging for the BBC about her life under Taliban leadership as she was forced out of school. She continued writing for three years until, after rising to prominence for her activism for girls’ education, she was shot in the head by a member of the Taliban in an attempt to silence her. Malala survived, and after her miraculous recovery and continued activism she was awarded the Nobel Peace Prize in 2014, making her the youngest person to ever become a Nobel Laureate. Even if their life is dominated by religious leaders, threatened by the Taliban, and restrained due to cultural norms, these women cling to the stories of their collective past in the hopes that one day, they too may be recognized as courageous and valuable in the eyes of their society.

Refugees: Peace of Mind

The Storm Refugees – Tribute To The Victims Of The Harvey Storm. Source: Daniel Arrhakis. Creative Commons.


“Armed conflict kills and maims more children than soldiers,”

-Garca Machel, UNICEF

Global unrest and armed conflict are becoming more common, intense, and destructive. Today, wars are fought from apartment windows, in the streets of villages and suburbs, and where differences between soldiers and civilians immediately vanish. Present day warfare is frequently less a matter of war between opposing armies and soldiers than bloodshed between military and civilians in the same country.

In 2014, there were 42 armed conflict, resulting in 180,000 deaths worldwide. Civilian death tolls in wartime increased from 5 per cent at the turn of the century to more than 90 per cent in the wars of the 1990s. War and armed conflict is one of the most traumatic experiences any human can endure, and the brunt of this trauma is felt by civilians- most especially children.  In 2015 alone, some 75 million children were born into zones of active conflict. As of May 2016, one in every nine children is raised in an active zone of conflict. Two hundred and fifty million young people live in war zones, with the number refugees at its most prominent since World War II. Currently, there are 21.3 million refugees worldwide, and half of them children.

For refugees, the events leading up to relocation (notably war and persecution), the long and unsafe process of relocation, settlements in refugee camps, and overall disregard for human rights, takes a major emotional and mental toll. PTSD, depression, anxiety, and sleeping disorders are just few of many problems refugee children experience. Respecting human rights is essential to society’s overall mental health. Equally, a society’s mental health is essential for the enjoyment of basic human rights. Addressing the psychological needs of victims of armed conflict is essential for the prosperity of war-battered children’s future.

The Relationship between Mental Health and Human Rights
Armed conflict affects all aspects of childhood development – physical, mental, and emotional. Armed conflict destroys homes, fragments communities, and breaks down trust among people, thereby undermining the very foundations of most children’s lives. The psychological effects of loss, grief, violence, and fear a child experiences due to violence and human right violations must also be considered.

Throughout the process of becoming a refugees, the three main stages in which people experience traumatic and violent experiences include: 1) the country of origin, 2) the journey to safety, and 3) settlement in a host country. The interrelationship between human rights and mental health are recognized in various universal human right conventions and resolutions. Numerous legislative measures exists for mental health, but two main conventions that address the situations refugees experience include: 1) Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment and 2) The Convention on the Rights of a Child. These two conventions specially address mental health pertaining to violence.

UNHCR Tent. Source: Bureau of Population, Refugees, and Migration. Creative Commons.

Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment: 1987
This Convention is significant towards the promotion of mental health as a human right because “torture,” any act that creates severe pain or suffering, can be both physical and mental. This convention is particularly relevant to refugees because they are more vulnerable and susceptible to mental and physical torture.  The short video documentary released by the UNHCR provided refugees and migrants to tell their own stories of kidnap and torture during their journeys to Europe. The stories told by survivors are emotionally distressing but highlights the realities refugees continuously experience.

The Convention on the Rights of a Child: 1990
The Convention on the Rights of a Child is the first legally binding international instrument to integrate the full array of human rights. This convention is also an important document for mental health. The CRC explicitly highlights the significance of both the physical and psychological wellbeing of a child. This convention is particularly important because it addresses the relationship of affect armed conflict on mental health. First, Article 38 of the Convention highlights state parties’ obligation under international humanitarian law to protect the civilian population in armed conflicts, and shall “take all feasible measures to ensure protection and care of children who are affected by an armed conflict.” International humanitarian law is a set of rules which aim, for humanitarian purposes, to minimize and protect persons from the effects of armed conflict. Second, Article 39 of the Convention states “States Parties shall take all appropriate measures to promote physical and psychological recovery and social reintegration of a child victim of: any form of neglect,… torture or any other form of cruel, inhuman or degrading treatment or punishment; or armed conflicts.” For children refugees, the Convention on the Rights of a Child is an imperative document for the security of their right to mental health, and mental health services.

Barriers to Accessing Health Care Services
The process of becoming a refugee takes a tremendous emotional and mental toll on all refugees. PTSD, depression, anxiety, and sleeping disorders are just few psychological diagnoses given to refugee children. The fundamental right to mental health care is addressed in various international standards, such as the Convention of the Rights of the Child, however, there continues to be numerous barriers preventing access to these services. There has been an unparalleled surge in the number of refugees worldwide, the majority of which are placed in low‐income countries with restricted assets in mental health care. Currently, responsibility for mental health support to refugees is divided between a network of agencies, including the United Nations High Commissioner for Refugees (UNHCR), the World Health Organization (WHO), government, and nonprofit organizations. Yet, the reality is that most refugees with mental health problems will never receive appropriate services. Cultural barriers, such as language, persistently affect a refugee’s capability to utilize mental health series. A study examining health care barriers of post-settlement refugees reveals language is the most impeding cultural barrier to accessing healthcare. Refugees and mental health service providers often do not speak the same language, making successful communication during healthcare visits less effective. Language barriers affect every level of the healthcare system, from making an appointment to filling a prescription. A lack of multilingual interpreters for refugees and health care providers weakens the healthcare system, making miscommunication about diagnoses and treatments possibilities common. Lastly, stigma surrounding mental health is another barrier to health services. Refugees often feel the words “mental health issues” should be reserved for individuals with extreme learning disabilities, and do not understand mental health problems can be conditions like depression and anxiety.

Psychopathologies due to trauma are very powerful, however, recovery is possible. In Judith Herman’s book Trauma and Recovery, she discusses her theory of recovery. She states recovery happens in three stages: 1) establishment of safety, 2) remembrance and mourning, 3) re-connection with ordinary life.

Stage 1: Safety
Trauma diminishes the victims’ sense of control, power, and overall feeling of safety. The first stage of treatment focuses establishing a survivor’s sense of safety in their own bodies, with their relations with other people, in their environment, and even their emotions. Self-care is also an important focus point during this stage. The purpose of this stage is to get victims to believe they can take protect and take care of themselves, and they deserve to recover.

Stage 2: Remembrance and Mourning
The second stage of Herman’s recovery theory highlights the choice to confront trauma of the past rests within the trauma survivor. It’s important for victims to talk about their goals and dreams before the trauma happened so they can reestablish a sense of connection with the past.  That second stage begins by reconstructing the trauma beginning with a review of the victim’s life before the horrors and situations leading up to the trauma. This second step is to reconstruct the traumatic event as a recitation of fact. The goal of this step is to put the traumatic event into words, and come to terms with it. Testimonies are ways for survivors to get justice, feel acknowledged, and find their voice.

Stage 3: Reconnecting
In the final stage, the victim focuses on reconnecting with oneself and the recreation of an ideal self that visits old hopes and dreams. The third stage also focuses on emotionally and mentally reconnecting with other people and social reintergration. By this stage the victim should have the capacity to feel trust in others. A small but influential minority of individuals revolutionize the meaning of their trauma and tragedy, and make it the foundation for social change.

Peace. Source: John Flannery. Creative Commons.

A Peaceful Future 
Even though human rights activists are not psychological clinicians, we can still contribute to the success of these stages. At present, more than half of the refugee children population are children. Despite the violence these children have experienced, refugee children are the foundation and hope for a peaceful future. However, for that to happen, refugee children need to find peace in themselves. Respecting human rights is essential to society’s overall mental health. As activists we need to advocate for refuges and children who don’t have a voice. Activists for human and mental health rights should start focusing their goals on ensuring their communities and hospitals contain mental health care provisions. As activists, we can lobby for more accessible mental health services throughout our health care system, join and volunteer at non-profit organizations, and advocate for the rights of refugees. As Herman Melville states, “we cannot live only for ourselves. A thousand fibers connect us with our fellow men.”