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The need for psychiatrists to address the effects of human rights abuses on victims has never been greater.
Massive human rights violations have marked the second half of the 20th century. The list of areas where these have occurred includes Iraq, Cambodia, Rwanda, and Bosnia-Herzegovina, according to Justice Richard Goldstone of the Constitutional Court of South Africa.
Goldstone presented the William C. Menninger Memorial Lecture at the Convocation of Fellows at APA's 1998 annual meeting in Toronto.
Goldstone heads the board of the Human Rights Institute of South Africa and was the chief prosecutor of the United Nations International Criminal Tribunals investigating human rights abuses in the former Yugoslavia and Rwanda between 1994 and 1996.
In Rwanda more than one-seventh of the population was slaughtered in a three-month period in mid-1994. A recent survey by UNICEF and World Vision shows there are more than 60,000 homes with no adults left alive. About 300,000 children out of a total population of under 7 million live in homes without any adults to take care of them.
In Bosnia, the organization Physicians for Human Rights, based in Boston, has recently uncovered more mass graves where Muslim men and boys were buried after their cold-blooded execution by the Bosnian-Serbian army outside Srebrenica in July 1995. Estimates are that the army murdered about 8,000 people. "Now there are thousands of survivors who are still in a state of extreme trauma, many of whom are holding vainly onto a thread of hope that their loved ones may have somehow survived the genocide," said Goldstone.
According to social workers, the loss of a family member without the possibility of burial or positive identification of death makes the mourning process particularly difficult.
"These matters concern all of us. That was implicitly recognized by APA when in 1992 it established a task force on human rights, charged with investigating the psychiatric impact and consequences on individuals and their families of human rights violations arising from torture and extreme and cruel methods of incarceration," Goldstone remarked.
In 1978 APA sent a delegation to South Africa. They found no evidence of the misuse of psychiatry but they commented on the disparity in psychiatric care between whites and blacks in a 1979 report. In a population of more than 35 million people, there were only 200 psychiatrists, only four of whom were black and 10 child psychiatrists.
In 1985 APA passed a resolution condemning apartheid and noted that the mental health of both the victims and the perpetrators of discrimination are affected.
A 1990 report of a multidisciplinary delegation that included APA members revealed that 51,000 people had been detained in South Africa including children who had been assaulted and tortured, he said. The report concluded that most physicians in South Africa did not report or speak out against those practices and that some of them were involved in the abuses.
"I encourage you and your association to continue campaigning wherever human rights are violated. South Africa is a good example of the success of an international campaign in bringing an evil system to an end," Goldstone stated.
Psychiatrists can help the international community in assessing the most appropriate responses to human rights violations in particular contexts. Insufficient attention has been given to the support needed by victims who permit their past trauma to be recorded in public.
The effects of PTSD after genocide and massive human rights abuses have occurred have not been adequately researched. "I would suggest, as a layman, that the condition of PTSD in countries with massive human rights abuses such as Rwanda or Bosnia-Herzegovina might be different than that of North America or Western Europe. Whether treatment is the same remains to be researched," Goldstone said.
Psychiatrists can also recommend suitable remedial programs. A multidisciplinary approach would be valuable, he said.
"I would also suggest that the subject of human rights violations and its effects on victims should be part of every medical school curriculum, particularly in psychiatry training," he urged.
"I can only repeat the exhortation expressed by your task force that you have a duty to learn of and speak out against the too many regimes in the world that use attacks on human dignity to retain power and subjugate or silence their opponents. You can and you should make a difference."