Mental Distress and Gender-Based Violence in Forced Displacement Settings from Conflict: Cultural and Ethical Considerations for Health Care Professionals Ayesha Ahmad
Introduction: Presentation and Re-Presentation of Stories of Conflict Mental distress relates to disharmony of the bearing of oneself and the relation of the self to the surrounding world. A focus on conflict through health paradigms has allowed a wider and greater health-inclusive perception of conflict-related traumatic experiences in recent decades. However, the medicalization of mental distress has led to difficulties in understanding the nature of suffering born from conflict and subsequent forced displacement. Gender-based violence towards displaced people as an aspect of mental distress is a further nuance that requires narrative introspection involv ing reflections on identity and land connections. The Pashtu word ‘zmaka’ simultaneously refers to the land and a person’s connection to it. Similarly, the concept of the Persian word ‘malang’ reveals a sentiment of remaining connected to the land even when not upon its soil, which is particularly pertinent for tribal identities and communities. However, these small linguistic examples only merely illustrate the wealth of words overlooked in dominant English-speaking and biomedical discourses of mental health. Considering narratives as a marker and gateway into lived experiences was the basis of work achieved by anthropologist Arthur Kleinman and has threaded into the debate on mental health needs of refugees by highlighting the social suffering (Kleinman et al., 1997) of conflict-related trauma. Mental health distress stemming from a combination of lived experiences of conflict and gender-based violence, which becomes a focal point for health care professionals in humanitarian contexts such as a refugee camp for Internally Displaced Persons (IDPs) and in the receiving country is a result of “deep-seated structural causes” and “the medicalization of collective suffering and trauma reflects a poor understanding of the relationships among critically important social determinants and the range of possible health outcomes of political violence” (Pedersen, 2002, p. 175). The purpose of this chapter offers hope for renewed and revised discourses on mental distress and gender-based violence in forced displacement settings from conflict for the cultural and ethical considerations of health care professionals. Without a critical understanding rooted in lived experiences of social suffering of the “manner in which communities try to regain their worlds,” these very communities, “which have been marginalized through the structured violence
