Historical Primer on Obstetrics and Gynecology Health Inequities in America: A Narrative Review of Four Events.

Four historical events provide context for racial injustices and inequities in medicine in the United States today: the invention of race as a social construct, enslavement in the Americas, the legal doctrine of Partus sequitur ventrem, and the American eugenics movement. This narrative review demonstrates how these race-based systems resulted in stereotypes, myths, and biases against Black individuals that contribute to health inequities today. Education on the effect of slavery in current health care outcomes may prevent false explanations for inequities based on stereotypes and biases. These historical events validate the need for medicine to move away from practicing race-based medicine and instead aim to understand the intersectionality of sex, race, and other social constructs in affecting the health of patients today.

Recordar la dictadura chilena visitando lugares de memoria / Lembrar da ditadura chilena visitando locais de memória / Remembering the chilean dictatorship by visiting places of memory

Resumen En el marco de los estudios sobre lugares de memoria vinculados a las violaciones a los derechos humanos cometidas por la dictadura cívico-militar en Chile (1973-1990), este artículo presenta el análisis de visitas a dos lugares de memoria de Santiago de Chile - Villa Grimaldi y Londres 38 - realizadas por personas de distintos grupos etarios. El análisis aborda la interacción de los visitantes con el lugar, considerando los afectos y percepciones que provoca la visita, y la interpelación que estos lugares hacen a las memorias que los visitantes construyen sobre el pasado reciente. Los resultados muestran que, si bien existe acuerdo en la condena a las violaciones a los derechos humanos y la importancia de una cultura de la memoria y los derechos humanos, se produce una distancia entre las generaciones al valorar conflictos del pasado que refieren a distintos momentos históricos.

Resumo No marco dos estudos sobre os lugares de memória vinculados às violações dos direitos humanos cometidos pela ditadura cívico-militar no Chile (1973-1990), este artigo apresenta a análise de visitas a dois lugares de memória de Santiago do Chile - Villa Grimaldi y Londres 38 - realizadas por pessoas de diferentes faixas etárias. O estudo aborda a interação dos visitantes com o lugar, considerando os sentimentos e as percepções que a visita provoca e a interpelação que estes lugares fazem às memórias que os visitantes constroem sobre o passado recente. Os resultados mostram que, embora haja acordo na condenação das violações dos direitos humanos e na importância de uma cultura de memória e dos direitos humanos, um distanciamento entre as gerações aparece ao avaliar conflitos do passado que se referem a diferentes momentos históricos.

Abstract In the framework of the studies on places of memory related to human rights violations committed by the Chilean military-civic dictatorship (1973-1990), this article presents the analysis of visits to two places of memory of Santiago de Chile - Villa Grimaldi and London 38 - made by people of different age groups. The analysis addresses the interaction of the visitors with the place, considering the affections and perceptions that the visit caused, and the interpellation that these places cause to the memories that the visitors build on the recent past. The results show that, although there is an agreement on the condemnation of human rights violations and the importance of a culture of memory and human rights, there is a distance among the generations when assessing past conflicts that refer to different historic moments.

The political use of psychiatry: A comparison between totalitarian regimes.

BACKGROUND: After the end of Second World War, the recent experience of the Nazi horrors stimulated a debate about the political use of psychiatry. Over the years, the focus shifted on major dictatorships of the time and especially on Soviet Union. AIMS: This article aims to provide a critical review of the ways in which psychiatry was used by totalitarian regimes of the 20th century. METHODS: We summarized relevant literature about political use of psychiatry in totalitarian regimes of the 20th century, with particular focus on Fascism, Nazism, Argentina dictatorship, Soviet Union and China. RESULTS: One of the features that are common to most of the dictatorships is that the use of psychiatry has become more prominent when the regimes have had the need to make more acceptable the imprisonment of enemies in the eyes of the world. This for example happened in the Nazi regime when sterilization and killing of psychiatric patients was explained as a kind of euthanasia, or in the Soviet Union after the formal closure of the corrective labor camps and the slow resumption of relations with the capitalistic world, or in China to justify persecution of religious minorities and preserve economic relations with Western countries. CONCLUSION: Psychiatry has been variously used by totalitarian regimes as a means of political persecution and especially when it was necessary to make acceptable to public opinion the imprisonment of political opponents.

Unit 731 and moral repair.

Unit 731, a biological warfare research organisation that operated under the authority of the Imperial Japanese Army in the 1930s and 1940s, conducted brutal experiments on thousands of unconsenting subjects. Because of the US interest in the data from these experiments, the perpetrators were not prosecuted and the atrocities are still relatively undiscussed. What counts as meaningful moral repair in this case-what should perpetrators and collaborator communities do decades later? We argue for three non-ideal but realistic forms of moral repair: (1) a national policy in Japan against human experimentation without appropriate informed and voluntary consent; (2) the establishment of a memorial to the victims of Unit 731; and (3) US disclosure about its use of Unit 731 data and an apology for failing to hold the perpetrators accountable.

Incommunicado detention and torture in Spain:Part I: The Istanbul Protocol Project in the Basque Country.

There is increasing evidence to show that torture is a serious problem in the Basque Country. Whilst such evidence can be found in reports of international human rights monitoring bodies, sentences of Spanish and international courts, and empirical studies, they are limited in not having followed the Istanbul Protocol (IP) in order to evaluate the reliability of torture. A working group composed of professional associations of psychiatrists, psychologists, physicians and lawyers, in collaboration with the University of the Basque Country, conducted a four-year study on the medical and psychological consequences of torture in incommunicado detainees, including an assessment of credibility in line with the IP. The methodological design included a multi-level peerreviewed blind assessment and input by an external expert (from the Independent Forensic Expert Group facilitated by International Rehabilitation Council for Torture Victims (IRCT)). A sample of 45 Basque people held in short-term incommunicado detention under anti-terrorist legislation (between 1980 and 2012) in Spain who had reported ill-treatment or torture was selected. The findings are divided into four papers: the present introductory paper; the second analyses the credibility of the allegations of torture and introduces an innovative methodology that enhances the IP, the Standardized Evaluation Form (SEC); the third provides an analysis of the methods of torture and introduces the concept of Torturing Environments; and, in the last paper, the psychological and psychiatric consequences of incommunicado detention are analyzed. The collection of papers are intended to be useful not only in the documentation of torture in the Basque Country and Spain, but also as an innovative example of how the IP can be used for research purposes.

Incommunicado detention and torture in Spain, Part II: Enhanced credibility assessment based on the Istanbul Protocol.

BACKGROUND: The Istanbul Protocol (IP) is the key instrument in the documentation of allegations of torture. However, few scientific studies have evaluated its effectiveness as a tool to assess credibility of allegations of ill-treatment or torture. OBJECTIVE: Present data on the credibility of allegations of torture in a sample of 45 Basque people held in short-term incommunicado detention between 1980 and 2012, using a modified version of the Standard Evaluation Form for Credibility Assessment (SEC), a new tool to assess credibility based on the IP. METHOD: Each case was evaluated by two psychiatrists, a psychologist and a physician through a layered system of simultaneous, independent assessments, blind audits and peer-review processes. Clinical interviews following the IP were contrasted with psychometric tests and external documentary evidence by independent experts. All available data were structured using the SEC and cases were accordingly classified as having Maximum consistency, Highly Consistent, Consistent or Inconsistent. FINDINGS: According to the SEC, 53% of allegations of torture were considered to have Maximum Consistency, 31% Highly consistent, 15% Consistent and 0% Inconsistent. The items that most contributed to the overall credibility assessment came from the psychological evaluation, including the description of alleged torture, emotional reactions, objective functional changes, changes in identity and worldviews and clinical diagnosis. There was little contribution from previous medical reports. INTERPRETATION: When applied competently, the IP is an essential tool in the documentation of torture. Our study shows: (a) evidence that allegations of ill-treatment and torture in the Basque Country are consistent and credible, being ascertained beyond reasonable doubt and aside from any political debate; (b) the wider use of the IP as a tool to assess credibility of allegations of ill-treatment and torture; and, (c) the usefulness of the SEC as a tool. The SEC can help as a tool for documenting torture in contexts where there are political differences and figures are distorted as a result of polarized political debates, and where legal documentation is needed for judicial purposes. Forensic science can help by providing an objective assessment of the credibility of allegations.

Incommunicado detention and torture in Spain, Part III: 'Five days is enough': the concept of torturing environments.

BACKGROUND: Torture is changing in western societies, evolving from pain-producing torture to more subtle mixed psychological methods that are harder to detect. Despite this, there is not an adequate understanding of the complexities of contemporary psychological techniques used in coercive interrogation and torture. METHODS: The interrogation and torture techniques used on 45 detainees held in short-term incommunicado detention in Spain during the period 1980-2012 were analyzed. The list of torture categories set out in the Istanbul Protocol (IP) were assessed quantitatively. Software-aided qualitative analysis of the testimonies was conducted, using both inferential and deductive approaches to deduce a classification of torture techniques from the point of view of the survivor. FINDINGS: The most frequent methods according to the IP categories used against detainees were isolation and manipulation of environment (100%), humiliation (93%), psychological techniques to break down the individual (91%), threats (89%) and forced positions and physical exercises until extenuation (80%). Additionally, with a frequency of between 51 and 70%, mild but constant blows, being forced to witness the torture of others, hooding (mainly dry asphyxia) and unacceptable undue conditions of detention were also frequent. Sexual torture was also widespread with sexual violence (42%), forced nudity (38%) and rape (7%). Qualitative analysis showed that most detainees were submitted to coercive interrogation using a wide array of deceptive techniques. This is often a central part of the torturing process, frequently used in conjunction with many other methods. It was found that giving false or misleading information or making false accusations was most frequently used, followed by maximization of responsibility or facts and giving false information regarding relatives or friends. Different patterns of harsh interrogation, ill-treatment and torture are described that appear to have been tailored to the profile of Basque detainees. INTERPRETATION: The study shows the need to improve the conceptualization of psychological torture suggested by the IP. Key to this view is the idea that we must not concern ourselves with 'torture methods' but with Torturing Environments. The concept of Torturing Environments is defined and proposed as a focus for future study.

La explotación sexual comercial infantil en la ciudad de Bucaramanga: análisis y propuestas de intervención socio-sanitaria / The sexual exploitation of children in the city of Bucaramanga: analysis and proposals for social and health care intervention

Objetivo: Fortalecer la oferta institucional para la prevención y atención de la problemática de la explotación sexual comercial infantil en la ciudad de Bucaramanga (Colombia). Método: Se realizó una investigación bajo una perspectiva cualitativa con un enfoque de investigación acción y muestreo intencional: 6 grupos focales y 10 entrevistas en profundidad con diferentes actores implicados en la explotación sexual comercial infantil. Resultados: La percepción de la explotación sexual comercial infantil como una forma de trabajo por parte de las víctimas dificulta el reconocimiento de la situación como una violación de derechos humanos. La educación, la salud sexual y reproductiva y la protección desde sectores institucionales, son las mayores debilidades en las que hay que incidir para la prevención y atención de la problemática. Conclusiones: El entorno de pobreza junto con la cultura patriarcal androcéntrica, favorecen la explotación sexual comercial infantil en la ciudad de Bucaramanga. Es necesario priorizar en su agenda pública recursos para la atención y prevención de la explotación sexual comercial infantil poniendo énfasis en la dimensión social y de salud de la misma (AU)

Objective: To strengthen the institutional offer for the prevention and treatment of the problem of sexual exploitation of children in the city of Bucaramanga (Colombia). Method: We performed a qualitative research under an action research approach and a purposive sampling: 6 focus groups and 10 in-depth interviews with different actors involved in children commercial sexual exploitation. Results: The perception of sexual exploitation of children as a form of work on the part of the victims makes difficult to recognize the situation as a human rights violation. Education, sexual and reproductive health, and protection from institutional sectors are the major weaknesses that would need to face it for the prevention and care of the problem. Conclusion: The poverty environment together with androcentric patriarchal culture, promote the sexual exploitation of children in the city of Bucaramanga. It need prioritize in public agenda to resources for care and prevention of sexual exploitation of children by emphasizing the social and health dimensions (AU)

Calming the mind: Healing after mass atrocity in Cambodia.

After catastrophic events in which people's survival has been threatened, as happened during the Khmer Rouge regime in Cambodia 1975-1979, some continue to suffer from painful mental symptoms. Surveys carried out in Cambodia based on Western diagnostic categories have found a high prevalence of posttraumatic stress disorder (PTSD), depression, and anxiety symptoms in the population. This study explored Cambodian approaches to healing trauma, examining the ways in which Cambodians appeal to elements of Buddhism in their efforts to calm their minds, situating this mode of coping in the context of broader Khmer Buddhist practice and understandings. Western psychology may have much to learn from local, contextualised methods of dealing with the aftermath of trauma, including Khmer understandings of distress and approaches to relief. Methods of assessment and treatment of distress cannot be transposed wholesale from one cultural setting to another but require considerable cultural adaptation. This kind of cultural interchange may give rise to innovative, hybrid discourses and methods that may have much to offer in the support of victims of organised violence.

Stratified reproduction, family planning care and the double edge of history.

PURPOSE OF REVIEW: There is a growing clinical consensus that Medicaid sterilization consent protections should be revisited because they impede desired care for many women. Here, we consider the broad social and ideological contexts for past sterilization abuses, beyond informed consent. RECENT FINDINGS: Throughout the US history, the fertility and childbearing of poor women and women of color were not valued equally to those of affluent white women. This is evident in a range of practices and policies, including black women's treatment during slavery, removal of Native children to off-reservation boarding schools and coercive sterilizations of poor white women and women of color. Thus, reproductive experiences throughout the US history were stratified. This ideology of stratified reproduction persists today in social welfare programs, drug policy and programs promoting long-acting reversible contraception. SUMMARY: At their core, sterilization abuses reflected an ideology of stratified reproduction, in which some women's fertility was devalued compared to other women's fertility. Revisiting Medicaid sterilization regulations must therefore put issues of race, ethnicity, class, power and resources - not just informed consent - at the center of analyses.

Los torturadores medicos: medical collusion with human rights abuses in Argentina, 1976-1983.

Medical collaboration with authoritarian regimes historically has served to facilitate the use of torture as a tool of repression and to justify atrocities with the language of public health. Because scholarship on medicalized killing and biomedicalist rhetoric and ideology is heavily focused on Nazi Germany, this article seeks to expand the discourse to include other periods in which medicalized torture occurred, specifically in Argentina from 1976 to 1983, when the country was ruled by the Proceso de Reorganización Nacional military regime. The extent to which medical personnel embedded themselves within the Proceso regime's killing apparatus has escaped full recognition by both scholars and human rights activists. This article reconstructs the narrative of the Proceso's human rights abuses to argue that health professionals knowingly and often enthusiastically facilitated, oversaw, and participated in every phase of the "disappearance," torture, and mass murder process.

La dictadura militar en la historia oficial del psicoanálisis chileno: sobre la construcción de un pathos discursivo / The military dictatorship in the official history of Chilean psychoanalysis: on the construction of a discursive pathos

A partir del análisis de una controversia suscitada en los preparativos del Congreso de la Asociación Psicoanalítica Internacional, realizado en Santiago de Chile en julio de 1999, este artículo intenta trazar los modos en los que la dictadura militar de Pinochet aparece en el corpus de textos con vocación histórica producidos en el seno de la Asociación Psicoanalítica Chilena. Se revela, así, la construcción de un pathos discursivo, caracterizado por la negación, la búsqueda apresurada del consenso y el eufemismo, que sin embargo no sólo nace de los fantasmas de la única sociedad psicoanalítica local de la época, sino que se alimenta de las políticas institucionales implementadas por la asociación internacional a partir del nazismo y por la retórica de la reconciliación elaborada en Chile desde la recuperación de la democracia (AU)

Drawing from the analysis of a controversy developed before the Congress of the International Psychoanalytical Association, held in Santiago, Chile, in 1999, this article attempts to retrace the ways in which the military dictatorship appears in the corpus of texts with historical inspiration produced within the Chilean Psychoanalytical Association. The building of a discursive pathos is thus revealed, characterized by denial, hasty search for consensus and the use of euphemisms. Nevertheless, not only from the ghosts of the local psychoanalytic society is this pathos constructed. It also feeds on institutional policies implemented by the International Association since Nazism and on the rhetoric of reconciliation elaborated in Chile since the recovery of democracy (AU)

[IMMUNE OR SOFT TARGET? THE BOMBING OF OTTOMAN HOSPITALS].

World War I was one of the worst wars in terms of human rights violations. The then valid Geneva and La Haye Conventions were ignored by most of the involved states, and serious war crimes were committed. The most serious human rights violations included the following: confiscating, bombing or impeding in their function the hospitals of the Red Cross and Red Crescent, as well as their hospital ships, healthcare workers, vehicles and supplies; mistreating prisoners of war; using prohibited weapons or poison gas; and directly or indirectly killing or violating the right to life of uninvolved civilians. Throughout the entire war, Red Cross and Red Crescent hospitals were bombed in an attempt to prevent the healthcare workers' activities, even though both the Geneva and La Haye Conventions had granted them "immunity" and accepted them as "neutral." The motivation behind these actions was to damage and destroy the enemy's logistic channels and to inflict psychological harm. The enemy wanted to create the worst possible shock and fear by bombing hospitals and clinics considered "soft targets"; by doing so, it attempted to break the other army's morale and break its determination to continue the war. These crimes-which today are openly accepted as war crimes-were greatly assisted by the facts that the conventions lacked any binding statutes concerning breaches and that their enforcement remained very limited. Although at the end of the war a commission was brought to life with the aim to punish was crimes, Germany was held responsible for the war, leading to war crime convictions being limited to this state only. No international court was established to adjudicate and punish war crimes in general. This article examines the correspondence between the Ottoman state and the Red Crescent concerning the Entente Powers' attacks on Ottoman hospitals during World War I and the ensuing human rights violations, in the light of records from the Prime Ministry's Ottoman Archives and Red Crescent Archive.

Bodies of science and law: forensic DNA profiling, biological bodies, and biopower.

How is jurisdiction transferred from an individual's biological body to agents of power such as the police, public prosecutors, and the judiciary, and what happens to these biological bodies when transformed from private into public objects? These questions are examined by analysing bodies situated at the intersection of science and law. More specifically, the transformation of 'private bodies' into 'public bodies' is analysed by going into the details of forensic DNA profiling in the Dutch jurisdiction. It will be argued that various 'forensic genetic practices' enact different forensic genetic bodies'. These enacted forensic genetic bodies are connected with various infringements of civil rights, which become articulated in exploring these forensic genetic bodies''normative registers'.