Stigma Against Survivors of Conflict-Related Sexual Violence in Bosnia and Herzegovina

No. of pages: 20

Publication date: 20 June 2015

Author: UNFPA

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In today’s societies, social stigma refers to negative stereotypical views of certain groups of persons such as persons with mental disorders and even some physical illnesses, people with certain sexual orientation, education, skin colour, people prone to committing crimes, including those determined by the nationality or ethnic origin or religion. In understanding the forms of stigmatization it is important to have a clear idea of the following four concepts: attitude, stereotype, prejudice, and discrimination.

Attitude is a combination of seemingly evidence-based views of the world with values and emotional reactions to these views. Attitudes can be positive and negative. In a broader sense, the term attitude for social psychologists implies its three components: cognitive – pertaining to the disposal of some, but not necessarily accurate information about the attitude object and a certain opinion about it; emotional – reaction of more or less differentiated comfort or discomfort accompanied by the reflection on the attitude object; and behavioural – pertaining to the behaviour, i.e. to the preparedness for a certain activity in terms of treating the attitude object. Stereotypes are the attitudes about groups of persons. They help us to think more effectively, because thanks to them we are able to “understand” people (or at least we often think so) only on the basis of their belonging to a specific group. Stigma is a negative stereotype.

Just because someone is aware of a stereotype, does not mean that he/she is in agreement with this attitude.

Prejudice is when one supports a negative stereotype about a certain group. Discrimination is a form of behavior that results from prejudice. These are the modes of conduct and behaviour that occur when people believe in a negative stereotype and agree with it. Self-stigma – in the absence of internationally harmonized understanding of this concept, this research implies that self-stigma is related to situations in which persons exclude themselves from the community; when survivors give credence to the feeling of shame and guilt on which community insists and in the case of majority of survivors it is manifested in them seeking not to speak about the events, to keep these as a family secret, to hide their pain from the loved ones, to neglect their own needs, avoid friends and the public, etc.

CONSEQUENCES OF TRAUMA OF CONFLICT-RELATED SEXUAL VIOLENCE

Probably the most common determinant of the phenomenon of trauma and psychopathological phenomena in connection with the traumatic experience, and which experts in the field of mental health care put before the public – is the statement that this is a normal reaction to an abnormal event. Experiencing trauma is by definition such that involves injuries, loss, or someone’s death; it is capable of causing fear, feeling of helplessness or terror as a response of a person who is subjected to threat of injury or death; it includes the perceived or real threat to life or physical integrity of that person or someone else. Experts have sufficiently reliable ways of predicting which persons, who undergo a traumatic event, will develop acute stress disorder or manifest proportionally permanent consequences in the form of post-traumatic stress disorder (PTSD). It is estimated that the developed PTSD can be identified in 35 to 50% of persons who survived rape in peacetime and it is believed that in these cases, about a third of them do not receive adequate psychological support.

The diagnosis of post-traumatic stress disorder was introduced in 1980, in the third edition of the Diagnostic and Statistical Manual (DSM-III) of the American Psychiatric Association.

PTSD, until the fifth edition of the Manual (DSM- 5TM) of 2013 has been classified under the group of anxiety disorders. Numerous experts from Bosnia and Herzegovina agree that PTSD as can be seen, for example, in war veterans of BiH, has some specific characteristics in relation to its description in the world’s literature, but generally speaking one can recognize subaudition of the following diagnostic criteria that were in force also in period when the victims of the war in BiH were mainly receiving appropriate treatment: exposure to a traumatic event in addition to the presence of at least some of the symptoms from all of the three groups of symptoms and after more than a month after the event:

1) persistent re-experiencing of the traumatic event (intrusive memories, nightmares, flash-backs, experiencing intense psychological distress in response to the reminder, intense physiological responses to such reminders);

2) persistent avoidance of irritation associated with the trauma (which can include amnesia for an important part of the traumatic event) or dulling of the response capability (places, people, activities, etc.); and

3) persistent symptoms of increased arousal (difficulty falling asleep or sleep duration (this sometimes involves fears of nightmares and other sleeping disorders, especially among victims of sexual violence), irritability (both in feeling and behaviour), or outbursts of anger, difficulty in maintaining attention, increased sensitivity and concern about security, excessive reflex response to sounds or movements, etc.).

Today there is a consensus among experts that PTS an also occur with a significant delay in relation to the time when the traumatic event happened. Traumatic events in the theory and the treatment can be approached, inter alia, according to the age at the first occurrence, the degree of interpersonal violence or threat, duration, scope (whether it is an individual or collective experience), the degree of social support received after the event (repeated traumatizing denial versus high level of support), whether it was the case of a repeated experience, etc. These factors and conditions to some extent probably contribute to the fact that even the subsequent manifestations vary and even somewhat penetrate into the domain of a person’s personality. This makes it difficult for the surrounding, especially for the laypersons to assess whether it is the case of an aspect of daily functioning of the person or these are the symptoms that actually stem from a specific life experience as some sort of coping with difficulties.