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Monday, February 21, 2011

Mid Term Question #3



Mid-Term Quiz Question #3
  
 Consider the nature of structural violence as it affects health and mental health services internationally. What might you as a social worker do, in your community, that could have an impact on this problem in a global perspective?

41 comments:

  1. In his 1969 article “Violence, Peace and Peace Research,” Johan Galtung describes violence as “the difference between what could have been and what is.” That is to say that it is an act of violence when a person is denied the ability to live their life to the fullest expression.
    Further thought on the topic of structural violence in action was outlined in the notion of Labeling Theory developed by Howard Becker. In his theory, he outlines the ways that people believe or are influenced by the names (labels) they are assigned. When society applies harmful names or labels to a person or persons, we may negatively impact their ability to achieve their full potential. In his 1984 book, Being Mentally Ill, Thomas Scheff applied this Labeling Theory to the mentally ill population.
    An example of how this has played out in my own life came about a few years back. I was working at a day program for adults with disabilities. The core objective of our program was to help people to live to their highest potential in the least restrictive environment as possible. One day, a participant in our program came in and told us all about some activism that he was participating in. He planned to attend his little sister’s high school and to interact with the student body to raise awareness about how labels can be harmful. He was involved with a program called Spread The Word To End The Word. This program consists of a group of up-start activist who are keenly aware of the fact that the R-word is demeaning, harmful and hurtful.
    At the time, this experience raised my consciousness about how vocabulary can be incredibly powerful. Coupling this memory with new information that I have been exposed to thus far in our semester, I can more clearly see how vocabulary can be violent. My support of this participant was an action step that I was able to take in an effort to have an impact, if only in a small way, on this global problem of structural violence.

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  2. I agree, Labeling, as you discussed is so detrimental. Thanks for the great references and thorough first post! I think this is such a good example of a way to stand up and be educated and vocal in your own personal community. Many times people say the best way to get business is by way of mouth. This is also how we can change structures. Knowledgeable and vocal, it is not as easy as it seems but it is so important!

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  3. This is a complex problem as discussed in class, in the readings, and outside of class. I think being aware and vocal is one of the best advocates against structural violence. To be educated in the things we say is essential. For example, I come from a small town and recently I went home to visit. While home at the supper table, my mom's husband (my parents are divorce so not my dad) said something like we should just go "bomb them all" when discussing the conflicts in Egypt. In this case, being able to explain the real conflicts and explaining that American way is not always the "best way" can help in my personal community. The affects of structural violence removes responsibility and personal significance of the individuals being touched by these violent stereotypes. If people and countries are not supported and understood it is difficult to move forward. This then leads people to become disconnected to those in mental health and physical health dangers. When the structure labels these conflicts as "their problem" and "hopeless" no one wants to support these cause or people will be likely to blame the individuals instead of hear their stories.

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  4. In the “Trauma and PTSD Symptoms In Rwanda” article, it was found to be that education level was negatively correlated openness to reconciliation amongst the Rwandan people, which is contrary to the more commonly held belief that the reverse is true. In fact, it is economic stability which proved to be more highly correlated with reconciliation (Pham, P.N., Weinstein, H.M., &Longman, T. 2004). This is a very interesting fact to keep in mind in the current worldwide economic climate. It is a nearly universal that economic conditions are currently strained to say the least in most areas around the world. It was also during a similar period of economically challenging times worldwide that World War II broke out, including incredible amounts of genocide and dehumanization amongst both the Axis powers as well as the Allies. It is thus incredibly important that we as social workers not only promote cultural embracement amongst ourselves, but amongst all of our clients.
    In my current field placement, we now have 6 Somali youth. All 3 have extremely traumatic stories of their personal journeys to the United States. When I first started in August, 2 of these youth were living in Sheil Home where I work. They were extremely withdrawn from their peers and had a very difficult time relating to and communicating with staff. Many of the other youth were not welcoming towards them as well. They had many misconceptions about Muslims in general, a variety of prejudices towards African immigrants versus African Americans, and misunderstood the Somali youth’s cultural differences and shyness as hostility.
    It was a very long process, and I am not quite sure how everything was able to change so drastically or precisely when, but these two Somali youth present as completely different people in program if you were to meet them today. They interact with everyone in program, and they are even legitimately friends with some of them. All of the staff and therapists took extra time out to spend with these two youth on their own, away from the other youth. Through this special attention, the Somali youth, I think, were able to feel more comfortable sharing not only their differences, but communicating where we both misunderstood one another. I think the greater understanding that developed over time helped them relate to their peers more effectively and contributed to the positive relationships they were able to form over time.
    I think that it is very difficult for this kind of growth to occur, especially in settings where our clients are not forced to interact with one another each day, let alone live together. However, whenever we can take the time to completely be present for clients from other cultures and really hear how they interpret us and themselves, we must never fail to do so. I think also it is our responsibility to take this knowledge we gain to constantly attempt to bridge our clients from other backgrounds to one another whenever possible. I think it is an extremely slow process, and we might not even see any results ourselves. It is still completely our responsibility to work forward at all times.

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  5. I believe that it is social worker’s duty to help combat structural violence by fighting for and giving opportunities to those affected by such violence. Many of the clients I work with are affected by structural violence issues and if I am not politically and globally fighting for changes in these issues and peace among individuals, I do not feel like I am fighting at the roots of this violence. As a social worker in my community I think helping individuals in the community to focus on the benefits of cooperation instead of competition could start a lifetime of working together. This way the climate of the community can be focused on the greater good and what everyone in the community can do to help each other. By starting this type of change in a community it could inspire other communities to see the need for a focus on working together along with everyone’s personal ideas involved. There should also be a pull for more early education that teaches youth about other countries, cultures, and lifestyles. When I was in high school I remember learning about different cultures in history class but it was just coming from a historical perspective on things that have happened rather than learning about people of the world. If children are to learn early about acceptance of other cultures and working together, our future could possibly have less structural violence engrained in it. This will also teach individuals to know how to really help themselves when they may get into difficult situations of their own.
    Many of the individuals and families that are already dealing with structural violence in their lives need mental health and extended health services due to this violence. Since there are often barriers holding them down from getting the services they need it is often hard for them to focus on wanting to take care of themselves. For many individuals in communities and other countries, structural violence is the “norm” and it may scare individuals away from receiving help. Many families are more worried about basic needs such as housing and food rather than getting the medical services they need to live enriching lives. People are taking the resources they have just to live in some countries that there is no time to think about getting mental health and often even health services. Providing advertising about the needs of health and mental health centers while teaming these centers up with places like daycares and transportation, individuals needing these services could have more of an opportunity to get the help they may need.

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  6. Kaitlyn, I like how you brought up the idea that some individuals have been told that their issues are no ones problem but their own. This can often deter individuals from seeking services because they are not only a victim of structural violence but they are being told that this is their own fault for who they are. Realizing that clients we have in the future may blame themselves for their problems because of other's responses towards them is critical. This can aid social workers in knowing how to approach topics such as structural violence with their clients.

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  7. Structural Violence is defined by Castro and Farmer in “Understanding and addressing Aids-Related Stigma: From Anthropological Theory to Clinical Practice in Haiti” as social forces such as “racism, sexism, political violence, poverty, and other inequalities that are rooted in historical and economic processes that script the distribution and outcome” of a illness (p. 55-56). Castro and Farmer also state that structural violence “determines who has access to counseling, diagnostics, and effective therapy.” (p. 55). Structural violence also “determines who suffers from stigma and discrimination” of the illness (p. 55).

    Based off of this definition we can see that in order for a social worker to make an impact on this problem in a global prospective, we first have to start at the community level and focus on the racism and stigma attached to many health and mental health issues. Castro and Farmer discussed in their article that “addressing the root cause of stigma will require addressing structural violence” (p. 58). As discussed in the article there are variables that need to be addressed in order for people to understand the stigma attached to health and mental health illnesses. Though the article focused on HIV/AIDS, I believe that the variables discussed can be applied to other health and mental health issues. Important variables that need to be addressed that are apparent across societies are experiences of people living with a certain health or mental health issue, public perceptions of the illness, local experiences of stigma and discrimination and their influence in care-seeking activities, varied degrees of stigma over the course of the illness, and impact of stigma on quality of life (p. 55).
    If more awareness is brought up about the stigma attached to many health and mental health issues, I believe that it can help people and communities realize the effects the stigma is having on people with the illness. Also, another important aspect that could bring impact on this problem is to educate people about different disorders, education can bring light to the situation and can help in reducing stigma. I think that if we are able to bring more awareness about stigma and educate people about different health and mental health issues in our own communities it will encourage more people to provide services internationally, may it be social workers, doctors, or nurses. The increase in health professionals internationally may also help in decreasing the stigma attached to health and mental health issues internationally because it may help people to realize that it is not the individuals fault. It may also help encourage people in our community to work internationally to educate people about health and mental health issues in order to reduce stigma.

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  8. According to Johan Galtung (1969) structural violence is social injustice. In other words, it is a form of violence which is precipitated by inequality in the distribution of power. This type of violence is so much a part of the society’s culture that it becomes institutionalized in the form of stigma and discrimination (Castro & Farmer, 2005). In other words, this stigmatization permeates society’s systems so that it harms people by preventing them from obtaining their basic needs such as physical safety and protection and access to health care. It is also extremely difficult to eradicate because of its institutionalized nature where people in power maintain the status quo by keeping the less privileged down.

    Given this knowledge, it is not difficult to understand how structural violence can result in horrible physical and mental health issues. For example, the genocide and resulting PTSD symptoms, in Rwanda that Pham, Weinstein and Longman (2004) discuss, is one such form of structural violence and the mental health issues it can lead to. At a different level Castro and Farmer (2005) discuss the structural violence, which leads to stigmatization of individuals with AIDS and the resulting lack of health care. Although these issues take place in countries far from the United States they are nonetheless, for a variety of reasons, issues we can easily see right here in our own communities, as well. Both of these examples indicate the need for us, as social workers, to advocate for change on a community, national, and global level.

    One way we can impact the issue of structural violence is by pushing to change discriminatory attitudes, even as idealized or overwhelming as that may sound. We can do this by educating others around us perhaps specifically our national government and advocating for provision of equal funding and access to health care and on a more global level in the form of aid to other countries. Students and workers in our field also must be educated on the importance of advocating not only against the injustices our own clients face, but also those injustices the less privileged and stigmatized individuals around the world face. Another way we can impact the issue of structural violence is to be aware of our own biases and labels we place on individuals. When treating our clients we need to be aware of the historical roots of the stigmatization they face and our part in perpetuating it. Because our field is largely about working with, helping, and advocating for marginalized populations we must deal with structural violence on a daily basis, whether we are in the U.S. working with, for example, a gay man and the discrimination he faces or in Rwanda working towards reconciliation between the Hutus and Tutsis. Just as Castro and Farmer (2005) discuss the “virtuous social cycle”, by providing marginalized individuals with better and ultimately equal access to their basic needs, both physical and mental, we can increase human social and economic rights, which will ultimately decrease structural violence.

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  9. According the article "Understanding and addressing AIDS-Related Stigma: from Anthropological Theory to Clinical Practice in Haiti" social group creates a person based on some physical behavior, or social trait perceived as being divergent form the norms. So I could interpret that it is like labeling of some things. It is related to structural violence. People are labeling others because of different reasons: thinking, hobby, appearance. They are saying that it is not normal. But I could ask “What is it normal?” Should we all to be the same: to think, the same wear the same clothes, to have the same hobbies? Is it normal for all people?!
    According the article „Globalisation of consciousness and new challenges for international social work“ stated that: „Democracy and a greater possibility to prevent conflicts. This implies new tasks and new challenges for social workers if they are to continue to have an effect on emerging postmodern global societies. International social work can and should play an important role in consolidating democracy, social justice and the implementation of international conventions against women, rights of children, as well as preventing conflicts and supporting peace by promoting global cultural integration“. I and all social workers in Lithuania could seek to communicate and collaborate with all world social workers. When we are one group, who has huge common purposes, we will do more. We all could understand that in our life there are a lot of factors, which have influence health and mental health services. For example: pension for elderly people is the main income for food, medication. But small pension influence that, elderly people could not eat different food, buy basic medication and this can mean, that health services are not available for them. So small pension is relatad to health and mental services. Maybe more services could be free or partly free? But this is social politic of nation.
    I as a community social worker have to get in touch with agency, whose activities are to help people. There are a lot of non-goverment institutions (NGO), and a community social worker could cooperate with them and try to help for those people. For example, there is Red Cross organization in Europe, which assist poor people with food. Also, there is United Nations Children fund, which purpose is to provide social services, food, water and provide other help. We, social workers, should organize and initiate more international projects and the basic idea is to cooperate for people’s health and mental welfare. Moreover, the important factor is to muster up all forces.
    To sum up, a community social worker must help for people, who needed help to get basic services, which influence health and mental services. The main direction is collaboration, with other people and social workers around the world and try for change social politic of nation.

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  10. I think it would be possible to set up more Charitable Support Foundation that could help to provide care for the poor, exclusion of various groups of people, large families, the disabled, the unit of society, which is the weakest and least able to benefit from social capital. Non-governmental organizations that would take care of the problem of exclusion and education, health services, social services, cultural values, would be accessible to all, especially for those who are most affected by structural violence.
    It would also be good to initiate discussions, open talks between politicians, journalists, social workers, public representatives, to seek ways to curb corruption, unfair distribution of social capital, to consider ways to create a welfare state.

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  11. I think it would be possible to set up more Charitable Support Foundation that could help to provide care for the poor, exclusion of various groups of people, large families, the disabled, the unit of society, which is the weakest and least able to benefit from social capital. Non-governmental organizations that would take care of the problem of exclusion and education, health services, social services, cultural values, would be accessible to all, especially for those who are most affected by structural violence.
    It would also be good to initiate discussions, open talks between politicians, journalists, social workers, public representatives, to seek ways to curb corruption, unfair distribution of social capital, to consider ways to create a welfare state.

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  12. Violence is the expression of physical or verbal force against self or other, compelling action against one's will on pain of being hurt. Worldwide, violence is used as a tool of manipulation and also is an area of concern for law and culture which take attempts to suppress and stop it.
    Violence can be classified into many types; there are direct violence, domestic violence, structural violence and cultural violence.
    Structural violence is a term first used in the 1960s commonly ascribed to John Galtung. It refers to a form of violence based on the systematic ways in which a given social structure or social institution "kills people" by preventing them from meeting their basic needs. Institutionalized elitism, ethnocentrism, classism, racism, sexism, adultism, nationalism, heterosexism and ageism are just some examples of structural violence. Life spans are reduced when people are socially dominated, politically oppressed, or economically exploited.
    Structural violence and direct violence are highly interdependent. Structural violence inevitably produces conflict and often direct violence, including family violence, racial violence, hate crimes, terrorism, genocide, and war.
    Structural violence, however, is almost always invisible, embedded in ubiquitous social structures, normalized by stable institutions and regular experience.
    There are several types of structural violence such as: economic, political, cultural and religious and causes of violence usually are poverty, vulnerability which means that a person is susceptible to being affected by sudden change; powerlessness.
    Structural violence has very bad impact on health and especially on mental health of the people.
    For example concerning the AIDS problem in the world, 90 percent of the HIV epidemic is concentrated in developing countries. In poor countries, many people are trapped in wage slavery.
    Poverty is intimately connected with the HIV epidemic. Structural violence connected with a large variety of factors including economic privation, gender inequality, lack of opportunity for education and work, and migration for work increases the risk of contracting HIV and makes prevention strategies less actionable.
    New funding through multilateral and bilateral agencies for treatment and prevention must address economic and educational opportunities, the lack of which will continue to foment the epidemic.
    The problem of structural violence is very large, meaning it covers all sides of person’s life: economical, political, cultural, therefore it’s difficult to find only one way for solving this problem, we might think differently and find many ways which are suitable for different communities.
    In my community, Russian, I can notice that we also have this demonization of Islam, especially after recent terrorist attacks in airport Domodedovo. So I think as social worker for reducing this kind of structural violence I can create some events or meetings to speak and know better Islamic culture and to understand the difference between Islamic culture and radical Islam.
    Also to reduce structural violence we have to demand social justice and living wages, provide prenatal care, alleviate sexism, organizing globally, also can be good to find non-militaristic avenues to express our deepest spiritual motives about peace and respect to all cultures and nations.

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  13. Structural violence is an incredibly immense problem. In order to begin to look at how to tackle the problem it is perhaps important to look at the roots of it. Structural violence as described by the originator, John Galtung (1969), is when social structures prevent people from meeting their basic needs. In the article by Castro and Farmer (2005) they describe the roots of structural violence being historical and economic processes. Therefore to begin any sort of change it is essential to start at the roots. Often people and institutions continue to function with the same routine, without looking at the impact or effects it may have. Nobody tends to question these things because they may not have ever known a different way of functioning. I think this is incredibly important when looking at social structures and institutions.

    One of the great things about modern technology is the communication that is available between people and organizations. There is an extensive knowledge base that can be looked at, which gives people the opportunity to see what other people in different areas and countries are doing. They then have the possibility of adapting these new ideas to fit their own community. I think I would then start there. I would begin a vigorous research program to look at other communities to see what they were doing to help alleviate this problem.

    There are two different ways to look at the problem of structural violence. It can be looked at as a large problem that involves all these institutions and governments that help to promote it. Therefore, when looking at how to fix this problem, one could begin by trying to create awareness of the issue at a state, national or global level. By beginning at the grassroots and organizing people to begin to start to pressure those who run the country. It could then ultimately result in some policy changes. However, that is a tenuous and extensive plan. It is perhaps a more pessimistic view, but I believe structural violence seems to be too big of an issue to fix. I believe it will always be present in society. Therefore it may be important to begin to help those who are most impacted by it be having services and resources available to them so that the impact is not as harsh.

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  14. Structural violence is a type of violence that targets and affects particular social and economic groups by making resources or opportunities unavailable because that social or economic group is devalued in or excluded from important societal systems. An example of how this structural violence plays out in health service systems internationally is the HIV/AIDS crisis in Haiti (Castro & Farmer, 2005). In Haiti, it has been shown that an increase in HIV- related health care leads to a decrease of stigma, which then leads to an increase in HIV testing (Castro & Farmer, 2005). The authors of this particular study, however, found that while stigma does play a role in access to HIV testing and health care, logistics and economics play an even larger role. These economic and logistic systems that prevent people from accessing life- saving medical treatment is a form of structural violence, as the man-made systems themselves are preventing people from being healthy.

    As a social worker in my community, I could have a global impact on the problem of structural violence by advocating for community, state, and federal policies that address the historical systemic violence perpetrated by the United States. While my reach as a community social worker might not initially have a global reach, the changes in my community effect the changes in my state and country. Changes in my country have a huge impact globally, as the United States is often seen as an international leader. One specific area of policy I could address in my community would be policy surrounding access to affordable mental health services. As social workers, we know that mental health services are an integral part of overall health and well-being. However, these services are often not covered on basic insurance plans, and are not at all covered for people without insurance. This is a form of structural violence because our economic and health services systems disproportionately leave out low-income populations and groups of color when distributing access to health and mental health services (access largely determined by income bracket). By advocating to state-run and private hospitals and mental health service agencies to increase access and affordability to mental health services for low-income populations, and by educating my community about the importance of mental health services, I can have an impact on my community, which then has a ripple effect on the global community.

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  15. Grace, I totally agree. I think that you have said it very succinctly:

    "By advocating to state-run and private hospitals and mental health service agencies to increase access and affordability to mental health services for low-income populations, and by educating my community about the importance of mental health services, I can have an impact on my community, which then has a ripple effect on the global community."

    You highlight some tangible action steps that we, as social workers, can put into our private and professional lives.

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  16. I think the conflict in Egypt is a stellar example of structural violence and how it effects both health and mental health services abroad. The rage felt by the protesters in Egypt manifested itself violently after having enough time without intervention to bubble over. Perhaps if there had been support groups for those who felt the most afflicted by the issues going on in Egypt, the protests may not have gotten out of hand. Had there been people standing with petitions to present to the president to show their unity over his leaving office instead of rallies, the president's supporters may not have acted out in force. But I can't play a "should've could've" with this situation. It seems like the only work for a social worker in that country would have been to help in cleaning up the aftermath.

    In my community, I think we need to learn by the example we have been presented with in Egypt. Structural violence starts from the top and works its way down. Social workers should help lead groups for those who feel afflicted by those is power and offer counseling for individuals who have been harmed by those who are in control of politics. Social workers can also encourage clients and help them to organize peaceful ways to resolve problems. I think that the two most famous protesters in the world are two individuals who protested with peace against structural violence: Martin Luther King, Jr. and Mahatma Gandhi. These two individuals worked within their own communities against issues of social injustice but have left impressions that have stood the test of time and impacted the world. If we can learn from their examples- marching peacefully and making speeched as Dr. King did and speaking out against injustice as Gandhi did, we as social workers can help impact the world through peaceful means and show those who feel powerless that power is not necessarily gained through violence; peaceful means can bring change and power as well.

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  17. Structural violence manifests itself in many forms of inequality. It is most commonly seen in racism, sexism, and poverty. These beliefs perpetuate the stereotypes and stigma that are associated with these forms of discrimination. This is in direct conflict with the Healy’s definition of social work: “the social work profession promotes social change, problem solving in human relationships, and the empowerment and liberation of people to enhance well-being” (Healy, 2008, p. 374). This definition calls for social workers to mobilize individuals to work against structural violence. While working in the mental health and health care fields it is difficult to see how these concepts impact one’s treatment and well-being. These ingrained concepts have impacts on how the individual conceptualizes themselves, their self-esteem, and their ability to move forward in their lives. Furthermore, these ideas affect individuals both domestically and aboard.

    I believe, as a social worker, it is important to discuss that these topics exist as a way to diffuse their power. As the stigma is removed from these concepts individuals are able to build their opinions and take steps forward. Therefore, I believe that advocating for the disempowered populations is the first step to empowerment. In the article Defining social work for the 21st century, Isadore Hare discusses how the process of globalization and social work collide; stating, “social welfare should be investment oriented, seeking to enhance human capacities to participate in the productive economy” (p.408). Hare speaks to social workers ability to get communities invested in their citizens. Advocacy then becomes the tool that is utilized to help mobilize people in a larger community. These steps embrace the idea that social workers must advocate for those who cannot advocate for themselves which is often seen in the mental health and health care fields.

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  18. When I think about the term “structural violence,” images of developing countries in Sub-Saharan Africa or South America come to mind. Genocide, crimes against humanity, war, hate crimes, and terrorism also resonate in my head as I think about this topic. However, the more I research it, the more I realize that structural violence does not necessarily have to be drastic and overt. John Galtung referred to the term structural violence as “the form of violence based on the systematic ways in which a given social structure or social institution “kills people” by preventing them from meeting their basic needs.” What this means is that whenever people have limited or unequal access to resources, such as health care and mental health services, structural violence occurs.

    Indeed, certain forms of suffering, such as war or terrorism, are easy to observe, but the suffering of those oppressed by structural violence is so very complex and deeply ingrained in our world's structures, that it almost becomes invisible. Structural violence easily becomes "the way the world works" or "an unfortunate reality” and is then dismissed by many (knowingly or unknowingly) as too difficult to discuss, confront, or change. What we, as social workers need to do is to look at these structures and to break them down.

    To answer the question, “What might you as a social worker do, in your community, that could have an impact on this problem in a global perspective?” I decided to look no further, then into my very own backyard. So many communities in the Chicago area lack access to adequate health care and mental health services that they match the standards currently present in some of the most undeveloped from the developing countries. The numbers of uninsured, especially in this time of economic insecurity, are so critically high that it is almost impossible not to label this crisis with the term structural violence.

    It is our job then, as social workers, to raise awareness and educate communities about the fact that this is not really how the world works, and that they have the right to fight against such injustice. Medical and mental health services should not be sold as a commodity, remaining only available to those who can afford them. Pushing for advancements, such as the universal health care system, for instance, is just one example of how community action can impact the problem of structural violence.

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  19. In the article by Castro and Farmer (2005), structural violence is defined in terms of stigma and how stigma has affected the availability of health and mental health treatment of HIV/AIDS as a result of structural violence. According to Castro and Farmer, structural violence “predisposes the human body to pathogenic vulnerability by shaping risk of infection and also rate of disease progression” through social forces—racism, sexism, political violence, and poverty (p. 54-55).
    At first, it is difficult to see how our work as social workers in a community could have a global impact. How can my work reach someone half way across the world, let alone in the next community 20 miles away?
    However, I am reminded by an example illustrate by George Vaillant in his book, Spiritual Evolution (2008). A woman lost her son through violence by young man who had no family of his own except for the gang who sent him out to kill another in order to be accepted as their member. This young man was tried and found guilty, and he was sent to a juvenile detention center. This woman visited her son’s killer often and brought with her food and money. She talked to this young man about his future and goals. And when it came time for his release, she asked him: “Where will you go?” He had no family and no support, so she offered him a place to stay in her home and helped him find a job. After some time, this young man became integrated into society under the care of this woman. And one day, she came home to this young man and asked him if he remembered what she had said to him the day he was prosecuted—“I’m going to kill you.” And that is what this woman had done…the young man who killed this woman’s son was dead; he was no longer that lost and alone young man she visited, but a man with purpose and a future.
    It is amazing to think what helping one person and providing them with care and the basic necessities of life such as a home, health, and peace of mind can do for their future. Whether we find ourselves working in a small community or in a much larger global setting, the work we do will have an affect on many people. We must advocate for every person regardless of race, sex, political belief, or socioeconomic status. We must fight for each young man or woman’s life and provide them with purpose and a future that is often hindered by the structural violence that affects millions. What this woman did for that young man affected not only his life, but those living in the community as well.

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  20. According to Robert Gilman a structural form of violence implies a "physical and psychological harm imposed by exploitive, unjust, political and economic systems". In order to help, we as social workers have to have the cultural competence and the knowledge on the political, economic and social situation in the country to understand the issue from the perspective of the people, as well as their perspective on mental health care in general.

    During my time in Central America, I experienced many forms of structural violence in the communities I worked with. People were pushed into a class system which is categorized by skin color. I have met many young people telling me about strategic violence through police and military forces on behalf of the government. Hopelessness or rather resignation is one of the worst impacts of structural violence and a crucial element that often leads to mental health issues such as depression. I again agree with Michael that structural violence can persist because of harmful labels imposed on certain groups of people, preventing them to develop to their full potential. In Guatemala for instance, the majority of the indigenous lives in poverty, the majority in extreme poverty. Most of them never get beyond first grade education and a great number of women with Mayan heritage have to work as servants and endure many ways of humiliation and abuse. For many of them, it is an unobtainable objective to find a way out of their misery, to believe that they, as well as any other Guatemalan, deserve access to good education, to health care, and to humane treatment by government officials free from any form of discrimination.

    Another challenge that social worker have to face in terms of providing support to those that, because of events of structural violence, suffer from mental health issues. Especially in Latin America, psychological problems are synonymic to being crazy. Furthermore, "machismo" is widespread and the inhibition to seek psychological help even greater for men. For this reason, I would start to educate the community about the importance of mental health, about the significance to get help when needed, and discuss their reasons why it has been dismissed before. Again, a cultural understanding of the social worker is vital.

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  21. I really like what Aarika mentioned about learning how to cooperate as opposed to being in competition with one another. I think this can be the root cause of so many misunderstandings on a personal level; when it is expanded to a larger scale it becomes that much more magnified.
    I think especially in the United States, it is very difficult to get everyone on board to support social welfare for this very reason. I think that at bottom, many people are terrified of anyone getting something for nothing in their eyes. We have such a large population of working poor and a quickly disappearing middle class, and so many of these individuals are forced to not only work grueling amounts, many unfortunate and painful things also happen to them on top of everything else. This incredible amount of stress makes them angry, which stems from being very hurt and scared. It is hard to be empathetic to anyone when you are pushed to your limit. Because of these situations, it sets the stage for many to vote in a way that is not only counterproductive to the welfare of us all, but especially to themselves. It is imperative that we not lose sight of the humanity within us all rather than to be out for only “number one”.

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  22. By its nature, structural violence disenfranchises members of society and leaves them vulnerable. According to Castro and Farmer (2005) structural violence comes from social forces that include “racism, sexism, political violence, poverty, and other social inequalities that are rooted in historical and economic processes” (p.54-55). This social injustice prohibits individuals from receiving basic human rights, including health and mental health service, because of the stigma and discrimination that accompanies it. It is so deeply engrained into society that it is hard eliminate.
    When it comes to the health and mental health services that individuals can receive, structural violence puts limits on who is diagnosed, who can receive treatment and what kind of treatment they can. According to Castro and Farmer (2005) structural violence has a profound impact on creating and perpetuating stigmas associated with AIDS/HIV related treatment, making treatments unattainable for those suffering from the disease. Pham, Weinstein and Longman (2004) discuss the implications of structural violence on the Rwandan genocide and consequences on the mental health of the four million displaced Rwandans. Both situations reflect inequalities where the problems were exacerbated by the structure of the society. Although these countries are far from the United States it is not hard to think of similar instances where structural violence impacts our own society. Currently, the debate over who has the right to receive quality healthcare highlights structural violence in our own society.
    In order to have an impact on structural violence in our own society it would be important for social workers to work to reduce stigmas. This could be done by advocating and educating for an intended cause. In the issue of health care coverage it is important that a social worker educates themselves on both sides of the issue, advocates to their legislature and public official and joins collations working towards healthcare solutions. Although these tasks may seem overwhelming it is important to break it down into manageable chunks, in order to be the most effective. By working to reduce stigmas associated with healthcare coverage a social worker can give a voice to those silenced by structural violence.
    Another way social workers can impact communities is to promote cultural competence. In doing so social workers must be cognizant of the power of language and how it is used. It is also important to be aware of the negative stereotypes of certain cultures and to work to dissuade their use. Working to promote inclusive language and dispelling myths results in a community that is better educated and more accepting of differences. Both of these examples are ways that social workers can make an impact in our local and national communities which can in turn impact how the issue is seen on an international level, thus aiding in the reduction of stigmas and discrimination worldwide.

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  23. In Wong - When Asian Immigrant Women Speak: From Mental Health to Strategies of Being, it states, “Recent social science theory and research on the relationship between culture and mental health are beset by the problems of a group-based analytic framework. This framework contributes to the perpetuation of the homogeneity assumption and failure to engage with the multidimensionality of the social and personal contexts within which cultural processes are realized.” It would be very difficult to have a quick impact on this issue in a global perspective. However, you could address the affected population on a local level first. I would meet with certain cultures and discuss how this structural violence affects these services locally and internationally. My main goal would be to let the community know all of the issues that are affecting them, and then allow them to go to their country and begin to make a change. I believe in fighting for change, but I also believe in educating the afflicted and allowing them to lead a movement for change. As a social worker, I want to make the greatest possible global impact on a community. So by looking for answers within the community and coming up with answers, the community then has the ability to make an international impact.

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  24. Speaking about structural violence first thing what comes to my mind is stigma – labeling other people for some reasons. For me the article „Understanding and Addressing AIDS – related Stigma: from Anthropological theory to clinical practice in Haiti” show how one illness can bring a lot of different diseases. When Samuel found out that he has HIV has changed not only his appearance but also he was left alone with his problem what could arouse and some mental health problems, because when he needed support from other people they turned away from him. It is just one example, but, in general, I think that speaking about structural violence we have to mention that it doesn’t have to be direct violence. A lot of different things which happens to person in his life is the reason for other problems (when person doesn’t have a job, he is losing incomes, this mean he is not able to pay for health security services, also it is the reason why he has no food, what means he may start starving and everything is interrelated). The point is that structural violence is the one which is in community and which affects person’s individual life. I think that problems can be solved only when to the situation will be looked from different perspectives and from different contexts. In article „Globalisation of consciousness and new challenges for international social work“ it is said that:
    „By studying and becoming involved in the practice of social work in other countries, international social workers are in a position to observe how the social politics of these countries work in reality and to learn from the experiences of others how to adapt these practices to national and international law“. (p. 14) Considering that technologies and other issues are available to us we can share our working ideas with other countries, we can colaborate with international social workers and to show to our community that we as a social worker together with community people can reach our goals.
    Community social work have to comunicate with NGO, different institutions which take care of person health, intergration into society also they need to collaborate with social workers from other countries and to make posibilities to give or to get needed help. I think social worker just have to start to do this collaborating work, to iniciate some international programmes and projects. As I know in Lithuania there are some such kind of collaborating projects, for example one of institution for disabled youth is getting help from Red Cross institution from other Europe country, also there is some kind of programme named „Bank of food“, which help with food for people in poverty, one more is also institution of Red Cross which help to refugees to integrate to our society.
    Sumarizing this I would like to say that social worker in community have to find how to help the people with problems not to feel worse, because usually some physical problems may arouse mental problems (I mean that in many cases if person is loosing job, or getting ill he is starting to think he is not anymore the same, he is starting to stigmatyzing himself).

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  25. I think in every country appears structural violence, but people do not mostly even know that, because it is legitimized by government. Most universal form of structural violence is poverty. It appears every country despite of how committed countries are to the democracy. People, who are living under the poverty line or who have minimal incomes, have to struggle every day to get the day´s necessities. This will wear people´s strengths out, and test both people´s health and mental health. It is also proved by many researches that people with low incomes are suffering much more health problems than those who make a better living. People with low incomes have also lower life expectancy. One reason is that they just have not enough money to buy medicines or use health care, for example. If those people do not have money enough to prevent their health problems, the problems will accumulate and eventually be much bigger problem to resolve for health and mental health services. That, which makes structural violence a global problem, and affects health and mental services internationally, is that, it drives people to move country to country to find better living conditions. Structural violence is able to make people´s life impossible in their own country.

    I as a social worker in my community, can impact that problem by advancing ideals of democracy, human rights and social justice, so that people in my country are able to live there without leaving somewhere else, and advancing Finnish immigration policy that people who have escaped from structural

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  26. Structural violence refers to a form of violence based on the systematic ways in which a given social structure or social institution harms people by preventing them from meeting their basic needs, that includes hunger, war, terrorism, genocide, etc. Gernot Kohler and Norman Alcock (Journal of Peace Research, 1976) submits a surprisingly simple method for estimating the grosser forms of structural violence, at an international level – to ask the question “How many extra deaths occur each year due to the unequal distribution of wealth between countries?” And it is very sad to agree with them and to admit that consuming, competing and “moneying” makes one human being harm against other human being. Not only violence costs countries billions of dollars each year in health care, law enforcement, and lost productivity, even though for every person who dies as a result of such violence, many more are injured and suffer from a range of physical and mental health problems.
    Considering myself as a social worker in a Lithuanian community I have to come back to the idea (that was said answering the first question) of thinking globally and acting locally. Nobody is protected from this amount of pain and consequences of stuctural violence, so we should learn how to use Our Own Freedom and not to take away another Man's Freedom, to stick with principles of real democracy and cooperation. And it is necessary help people to understand that perhaps the most prevalent form of structural/cultural violence is the belief that the lives of one’s own group (religion, ethnicity, nation) are more worthy and valuable than the lives of others.

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  27. When I used to think of structural violence on an international level, I would mainly consider countries going through civil wars, violent crimes, or instances of large scale physical harm to masses of people, such as bombings and other forms of terrorism. My mind has been opened in the last few years that structural violence includes various forms of cruelty happening to people all over the world. Allowing various forms of physical harm to not only be done to people, but allowed to continue, such as poverty, lack of water, food, nutrition, the spread of HIV/AIDS and other diseases, etc., definitely fit under the umbrella that defines structural violence. It has to do with organization of resources and how they are distributed to the masses. This is in direct relation to the authority and power structure running these countries and in their place in the world. In poverty-stricken countries where basic needs for life are not being met, it is hard for the population to accept the importance of receiving health and mental health services.

    Castro and Farmer give an irrefutable example of this in their article Understanding and Addressing AIDS Related Stigma: From Anthropological Theory to Clinical Practice in Haiti. In the story of Samuel Morin, who was dying of AIDS in Haiti, they explain that Samuel worked on his farm and in his tiny shop throughout his illness until he was physically unable to do so. Despite being poor, Samuel would help his neighbors obtain their basic needs with any money he had to spare after doing this for his own family. It was until Samuel lost complete control of his family’s welfare that he sought help for his illness. When he was completely unable to provide for his wife and children, and still not taking care of his own health and on the verge of dying, Samuel sought treatment. After receiving treatment and regaining his health and wellness, his family reconnected with him and he was able to return to work and provide for them once again. This provides proof that there is a need for proper health care in low-income and impoverished communities across the world. Because parents and families are so focused on maintaining their ability to provide their immediate and basic needs, they disregard their own health and mental health care which is proven to suffer as a result.

    As a social worker, I would plan to work with movements and organizations that advocate and raise awareness for the struggles occurring across the world. By gaining support and recognition for these international issues, fundraising can be done to help these populations and support them by providing them with their basic needs for survival and teaching them how to sustain these things and build on them. This effort would involve advocacy, fundraising, direct service and psycho education, etc. On the direct service effort, teaching these people how to obtain clean water and food and sustain the methods they use to do these things, we can set them up to succeed in meeting their basic needs so that they can be physically and emotionally open to consider their own health and mental health concerns. I believe the work being done to relieve these international concerns are successful and will continue to grow and garner attention and support with the help of social workers and philanthropists with an interest in international contexts and social problems. We have an obligation to humanity to help people in need, regardless of location, context, barriers, and other obstacles we may encounter.

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  28. We can find various forms of structural violence: institutionalized elitism, ethnocentrism, classism, racism, sexism, nationalism, heterosexism and ageism. These phenomena are not inherent for one particular country, this type of violence, I think, we can find in every country, of course degree may vary. It is important to think and speak about it, because structural violence affects people’s health and wellbeing. It is also important, because structural violence is directly coherent with physical violence. For example nationalists attack foreign-born. This type of incidents not only causes physical distress, but also generates tension and fear, as in our example for foreign-born. This example illustrates how nationalistic/racist creed can cause physical violence. Of course question occurs – why is it happening and where are the roots of it. I believe that we shout take a look to the tendencies of our epoch. I think I won’t be misunderstood if I would say that we are living in era of deregulated free market and wild capitalism. Main worth become capital determinated by an amount of money and power. And greed has no limits. This context allows us to envisage the change of worth. For example, what kind of person is considered best? Most likely the one, who works and do not complain. Then we must ask how we consider person who does not make surplus value? What is ours standpoint towards this person? Is he as a person and his wealth is the greatest value? Another thing we must be mention – policy. Legislations which will determine may peoples’ wealth also are formed under the influence of some sort of attitude towards human being. Country’s policy will be determinated by current priorities. I think great amount of structural violence comes from government’s short-sightedness in the process of establishing the law. Politics do not evaluate the consequences of particular legislation.
    Social worker can be on of the connections between people who influence state social policy. Although at this moment social workers do not have a lot of power in formation of the state’s social policy, but this is the right way to change the situation. Another thing is that social worker shout take a look at the existing forms of violence in his community and seek for a constructive dialog with other community members. Also try to collaborate with social workers for other countries. Analysis and ways to overcome structural violence should be done in a collaboration with other countries.

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  29. Lithuanian society is competitive. „Competition people attain their goals only if other participants do not“ (Bruce D. Bonta, 1997: 300). People who deal with complicated problems (person`s or family member`s disease or disability), need complex assistance (medical, social, education services) and often they don`t get all the information they need in time. These three sistems operate separately and the employee of one sistem often doesn`t know about the services the other provides. Community social worker could be the person who would be able to provide information about the services which are provided in his town or in his country. It is important that a person wouldn`t feel alone with his problem and would get the assistance he needs.

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  30. Structural violence - this concept was new for me. Structural violence is a term first used in the 1960s commonly ascribed to John Galtung. It refers to a form of violence based on the systematic ways in which a given social structure or social institution „kills people” by preventing them from meeting their basic needs. Life spans are reduced when people are socially dominated, politically oppressed, or economically exploited. Structural violence inevitably produces conflict and often direct violence, including family violence, racial violence, hate crimes, terrorism, genocide, and war. Robert Gilman (1983) writes that hunger and poverty are two prime examples of what is described as „structural violence”, that is, physical and psychological harm that results from exploitive and unjust social, political and economic systems. Country’s economic situation and attention to health care forms a special situation to health care system. It is common that quite a sum of money has to be spent to get professional and qualified services. The major flaw in the dominant model of medical care is that medical services are sold as a commodity, remaining only available to those who can afford them. In other words health care becomes accessible only for financially strong groups. As a social worker firstly I should initiate health care service accessibility to poorest and most vulnerable social groups. Possibly it can be reached by encouraging volunteering among health care specialists. Hence in my opinion people should be encouraged to insure themselves with compulsory health insurance (to register in job seeking agency or work officially). Consequently free off charge medical care would be guaranteed, of course not the highest quality service. Speaking in international social work dimension social workers could share their job experience dealing with problems in medical health care sphere.

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  31. This comment has been removed by the author.

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  32. The formal educational system of a nation is its most significant and influential institution, according to sociologist Elise Boulding. I would like to talk about structural violence in education. This is the topic which is from my point of view is very actual in Azerbaijan and needs to be paid more attention.
    The educational system in Azerbaijan is unfortunately sometimes serves to the monopoly and corruption. Students who study in different state universities, are always under different nonlegal or legal but useless and stressful factors.
    To be more precise, those students who are eager to enter to one particular university and to become successful and professional in the filed they have chosen, are extremely changed after getting the place they wanted. Existing corruption system and unfairness it causes kills the motivation of the students who were ready to study by their own.
    Another point is that students often meet teachers who are far from being professionals. Young, unexperienced teachers can give few to the students who some times even know more than teachers.
    Lack of practice lessons students after graduating university, with their degree diploma, almost able to work nowhere, because theories, which had been taught to them in a very surface level, can be useful only a little bit.

    Factors mentioned above, are brief examples to the structural violence in the educational system, when government itself causes a lot of young but low-educated and unmotivated mass of youth - nonprofessionals.

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  33. Mairin, you remember me about Mahatma Gandhi. This person were announced the basic thesis of global social worker practice. One of the most thesis of Mahatma Gandhi is: „Be the change you want to see in the world.” Let‘s all think more deeply about this...

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  34. At first, we should start from ourselves - by defining our own (as a social workers‘) goals, setting the purpose (what we want to achieve, for example, to reduce the structural violence) and identifying the targets (for example, reducing poverty, achieving social equity and so on.), and then initiate holistic social changes.
    In order to find out the extent of the problem and its solutions, we must take interest in studies (read foreign periodicals and books, related to this issue), interact with social workers from other countries, work on probation abroad, participate in or organize international events and conferences, where the people could be sharing their best practices, and study how the more economically developed countries cope with the problem of structural violence. Positive experiences could be transferred to our own country.
    Then I would organise a team (at first national and then international or even global), so that we can solve problems together. The creation of the international support system to each other can solve many problems and develop effective problem-solving techniques and strategies because cooperation based relationships is always more effective. I believe that a group of people can do much more than one person.
    Therefore I would prompt the establishment of non-governmental organizations (NGOs). The primary objective would be to defend the basic human rights and provide social and legal assistance to all the people, and to those who need it (regardless of gender, race, religion, property, and other factors). It is extremely important that the NGOs would be in strategically advantageous location and that as many people as possible could benefit from the services of these agencies. I would also suggest to pay attention to volunteering because everyone who is contributing automatically reduces magnitude of the problem.

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  35. Structural violence relates to our health. This voilence influences our well-being and our mental health. This form of voilence can to observed in different situations.
    I want to introduce one situation from secondary school. Children can get dinner at school if family does not have enough money and there are more than three children in the family. Schoolchildren stand in two rows in canteen at school: children, who pay money for dinner and another row, who do not need to pay. Reality is such that children often feel bad that they get dinner without money. They feel shame and sometimes are offended by children who pay for dinner themselves. In this case I think a social worker can help the children to feel better. The first step is to initiate one row in the canteen. Social worker could organize meeting with schoolchildren. She/he could tell about this situation, explain why there are schoolchildren who get dinner. Social worker aims to provide information and seeks to show that it is not shameful.
    Social worker has to express his/her opinion about sneering. Schoolchildren have to know position in this issue. They have to know that social worker can help them.
    Now briefly I will tell the situation where social worker can be useful at school.. In school sport competitions are organized. Schoolchildren participate in competition. However, winners are usually only three. Winners get presents also. All schoolchildren admire them. So, a social worker can initiate change. A social worker may seek to make children who lost competition feel better. All participants have to get evaluation.
    In my mind there are many situations where we can find equality or invisible violance. I think sometimes not much is needed that a person would feel better..

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  36. About Grace´s answer.

    Thanks for remembering me the actual problem that we have also in Finland. People are suffering many mental health problems, but there are not enough mental health services for them who are most needed. People are treated by medicines not by theraby for example. And this is one form of structural violence. Of course, we have a different kind of social welfare system, but it is not equal access to menthal health services anymore in Finland, too. And as you said "as social workers, we know that mental health services are an integral part of overall health and well-being" we must advocate for those are needing mental health services.

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  37. Aysel what you said about situation in Azerbaijan is very similar in Lithuania too...here also there is corruption and bureaucracy everywhere. If you have money or good connections with powerful people you can reach what you want. So a lot of students graduated from university are going abroad to work any work because here our government is not giving us an opportunity. Every time we are looking for a job they are asking about our work experience but how we can get it if we are not able to find any job? It seems like a vicious circle...

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  38. That's a great Gandhi quote.

    Thanks for sharing.

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  39. Structural violence of human rights was a term created in the 1960’s by Johan Galtung and liberation theologians. The term structural violence describes “social structures – economic, political, legal, religious, and cultural- that stop individuals, and groups, and societies from reaching their full potential”(Galtung, 1969). Structural violence has a significant impact on health and mental health throughout the world. In the medical field in general there tends to be a “desocialization” of scientific inquiry. The person(s) are looked at from a biological perspective and the biosocial aspect is over looked. There is often a stigma and discrimination that is attached to disease and mental health issues. When a person experiences structural violence there is an impairment of basic human needs which could have been avoided.
    As a social worker I could use the four points for reconciliation laid out in the article, Trauma and PTSD Symptoms in Rwanda. 1. To create a common vision and a community like atmosphere. 2. To establish mutual relationships and interdependence across traditional social and ethnic lines. 3. To acknowledge, accept, and encourage an individual’s human rights and to support equal opportunity and social justice. 4. To implement peaceful nonviolent alternatives to conflict. In my community there is a high rate of poverty and homelessness. I was a part of an effort to support those that were homeless in my community. Throughout my experience I began to see many people with mental health and medical issues that contributed to their homelessness. Among this group many of them got together and created a small community which they called tent city. Within this sub-community there was a democratic system in place that promoted the well being of the group as a whole. There was an elected board that made co-operate decisions. Each group member shared resources and responsibilities and the group as a whole dealt with problems that arose. The group as a whole was a resource for each other which in turn allowed the individuals to have a source of empowerment. As a social worker I can advocate for the needs of the individuals and the community.

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  40. Aarika,
    I like how you want to deal with the root of structural violence, and how you would do this through both advocating for, and providing opportunities for those impacted by structural violence. I agree that a community’s collective voice has a greater impact than a single individual’s voice or needs. As a community works together they gain strength and encouragement from each other. I also agree that it is hard for individuals and families who do not have their basic needs met to focus on others. If a true sense of community and co-operation can be established individuals that have their basic needs met can help those who don’t.

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