Bringing Sanitation into the Spotlight

As a child in India, Sunil Bhatia, PhD, used to bike past two slums every day on his way to school. As he did, he would see people defecating openly in the streets because they had no toilet to use.

Today, there are 2.5 billion people in the world who do not have access to a toilet, Bhatia told attendees at a session here honoring him with the 2015 APA International Humanitarian Award for his work bringing sanitation to India’s urban poor. Bhatia has brought “a taboo subject — open defecation — into the spotlight to show how lack of sanitation is connected to psychological constructs of dignity, humiliation and safety,” the award committee said.

Bhatia, a psychology professor at Connecticut College who studies culture and identity in the context of globalization and transnational migration, founded the group Friends of Shelter Associates (FSA) in 2005. The group works with Shelter Associates, an NGO that runs sanitation and other projects in his native Pune, India. To date, Bhatia said, FSA has funded more than 625 toilets that reach 4,000 people, and just received a grant to build 3,000 more toilets.

The toilets — which cost just $250 to $300 — change lives. Exposure to feces spreads diarrhea, cholera, typhoid and other diseases that kill millions of children each year.

“The lack of sanitation wreaks havoc on the physical and psychological health of the urban poor,” Bhatia said.

The hardships go beyond disease. Bhatia told of a woman who was dying of AIDS, who had to walk half a kilometer to defecate behind the railway tracks. “A simple toilet eased her life in her dying days,” he said. And a lack of toilets can lead to fear and physical violence — women have told Shelter Associates that they are scared of going to the bathroom alone, and that they may limit themselves to before sunrise and after sunset because they fear harassment from men.

For these women, and others, “having a toilet represents a ‘life-changing dream,'” Bhatia said.

For more information about Friends of Shelter Associates, visit http://www.friendsofsa.org/.

Identity-Based Bullying Is a Social Justice Issue

Most psychologists are likely familiar with bullying and its detrimental effects. However, they may not be familiar with the term “identity-based bullying,” which includes any form of bullying related to the characteristics considered particular to a child’s actual or perceived social identity. Identity-based bullying is one form of discrimination, and it is also a
method through which children learn prejudicial attitudes and stereotypes.

Identity-based bullying can include:

  • Ostracizing a student with a disability
  • Teasing a black student by saying he or she is “acting white”
  • Calling a girl a “slut” or shaming her about sexual activity or her body
  • Teasing an overweight teen about her/his body
  • Using anti-gay terms or teasing adolescents who identify as LGB

Participants had the opportunity to learn about these types of bullying during a session organized by Mindy J. Erchull, PhD, and Michelle M. Perfect, PhD. I had the privilege of opening the session with a presentation describing why psychologists should address identity-based bullying as a social justice issue.

anti- bullying

Identity-based bullying includes behaviors that are rooted in discrimination. Unfortunately, most discourse within schools about bullying minimizes power relations based on social identities. Some schools intentionally avoid discussing issues of identity out of fear that the conversations will be too controversial. In these cases, the term bullying may be used in place of terms such as sexism, racism and homophobia to minimize discussions about systemic problems rooted in cultural stereotypes and oppression.

During my presentation, I asserted that psychologists should address identity-based bullying as a social justice issue–examining systemic causes so as to change not only the outcomes for individuals, but to transform the processes that lead to identity-based bullying. Identity-based bullying is both reflected in and influenced by cultural factors including legal and political battles, media messages and social movements. Many societal structures (including schools) often serve to reinforce and reproduce messages about inequality.
However, schools can be sites for intervention. At this session, Susan Swearer, PhD, described school-based approaches for identifying, preventing and intervening in bullying, sharing the promising research findings for a number of programs. She discussed how she has engaged multiple stakeholders, such as school nurses, to be involved in the battle against bullying.

Identity-based bullying is a societal problem and the most effective prevention and intervention strategies extend beyond changing any one individual (or a series of individuals). As scholars and mental health professionals, we have a responsibility to embrace such possibilities because all children deserve to attend schools that provide safe, supportive environments that reinforce equality and teach respect for all people.

In Lebanon, psychologist helps Syrian refugees cope

Since the Syrian civil war began in 2011, nearly 2 million Syrian refugees have flooded into neighboring Lebanon, straining the resources of a country with a population of only about 4 million.

In addition to basic needs like food and shelter, these refugees — victims of war and trauma — need psychosocial aid, Dr. Brigitte Khoury told attendees at a 2015 APA convention session on working with refugees in international settings. So Khoury, a psychologist at the American University of Beirut, has been working with the United Nations Population Fund (UNFPA) to develop a series of problem-solving and support groups for refugee women, run by local nurses, social workers and midwives.

Map of Syria. A detail from the World Map provided by RAND McNALLY.
Map of Syria. A detail from the World Map provided by RAND McNally.

“There are not enough psychologists to provide help,” Khoury said. “So we have to train others.”

Khoury’s program trains these local nurses and social workers to run a previously validated 12-session group intervention in which refugee women learn problem-solving and stress-management skills. The interventions’ loose structure allows the women to bring up specific problems in their lives and talk through solutions with each other and the group’s leader.

Most of the problems are related to the daily hassles of refugee life — such as finding adequate housing and food — as well as issues with children and parenting, family and in-laws, and financial difficulties, Khoury says.

“It was not really about trauma and PTSD,” she said. “It was about their daily lives and how to survive in these difficult circumstances.”

At first, some of the women were reluctant to participate because they weren’t sure what the point was of coming together “just to talk,” with no concrete reward, Khoury said. The groups faced other serious challenges as well. Occasionally, some of the sites — towns on the border with Syria — would be too dangerous for the facilitators to get to, Khoury said.

But the intervention worked: By the end of the 12 weeks, most of the women said that they felt less depressed and anxious. They also established close and supportive friendships with the other women in the group — friendships that could continue to provide support even after the 12-week program ended. 

Khoury’s pilot program reached 25 trainers and 300 women. This month, she is starting a new training session with another group of nurses and social workers. She said she also hopes to expand it to men, as many of the women in the groups said that their husbands could benefit from similar groups.

Don’t Believe These 7 Bullying Myths

Two teenage boys bullying their classmate in school hall.
Two teenage boys bullying their classmate in school hall.

Bullying has been a favorite media topic since 2011 when President Obama launched his anti-bullying campaign. But too often, the media’s reports on bullying are just plain wrong, according to Dorothy Espelage, PhD.

“It’s not grounded in science or evidence,” she said at a Friday plenary address on the topic at APA’s Annual Convention.

Espelage, a professor at the University of Illinois-Urbana-Champaign, who for 20 years has conducted research on bullying, homophobic teasing, sexual harassment, dating violence and gang violence, listed seven the myths the media are irresponsibly reporting:

Myth #1: Bullying is an epidemic. Wrong. Bullying rates vary from school to school and some kids go to schools where there is no bullying.

Myth #2: Bullying is linked to suicide. No, it’s just one of many predictors of suicide.

Myth #3: Bullies are budding criminals. Research shows bullies have diverse outcomes.

Myth #4: Bullies need to be punished –- the idea of “zero tolerance.” That doesn’t work, she said, because it ignores that bullying is a group phenomenon that starts around fifth grade.

Myth #5: Bullies come from dysfunctional families. Not true. Lots of bullies come from typical families.

Myth #6: Bullying is “hard-wired” in youth. Really wrong -– it’s malleable and it’s environment that matters when it comes to bullying.

Myth #7: Cyberbullying is unique. No, cyberbullying is just one mode of bullying. Bullying usually starts face to face and continues online.

The fact Espelage wishes more people would realize is that 1 out of 3 boys and 1 out 5 girls engage homophobic teasing –- name calling or phrases like, “That’s so gay.” It emerges in middle school, but often teachers don’t address it. The result? “We are setting the groundwork for sexual harassment in our schools,” Espelage said.

Women’s Life Problems Aren’t Always Medical Problems

Medicine and the media are helping to medicalize everyday life experiences like anxiety, sadness, weight loss, menopause, and reproductive health, and women are the primary targets, according to psychologists and co-authors of a new book, “The Wrong Prescription for Women,” who spoke at a symposium on the topic.

While it’s important to acknowledge and treat real illness, women are too often prescribed medicines and medical procedures, more so than men, even when their experiences are normal.  “Many of these treatments aren’t problematic,  but the problem is they make normal parts of our lifes and bodies and experiences [seem abnormal]. The pharmaceutical industry created [these issues] to sell drugs to everyone, and sadly they’ve been very effective at this,” said Maureen McHugh, PhD, of Indiana University of Pennsylvania.

For example, modern society has a tendency to look at the prolonged grief that may naturally accompany a loss as depression that needs medication. Women are more likely to express their grief more explicitly and intensely, said Leeat Granek, PhD, Ben-Gurion University of the Negev.

“Women [have long been] expected to carry grief for their families and communities and states. Today, women are being pathologized for doing this job too well,” Granek said. Society — and clinicians — see grieving as a much briefer process with a deadline for moving on, which can be as little as two weeks, she said.

Woman taking medicines

Women are far more likely than men to be diagnosed with depression and to be prescribed medications for it, which can be a broad form of social control, said Alisha Ali, PhD, of New York University. “If you’re a deviant outside the norm, we are believed to have the responsibility of ‘fixing you’ so we can bring you inside of the norm,” she said.

However, women most prone to depression are also the most marginalized, including those who are abused, poor or victimized. When they take medication for depression, women report reduction in self-destructive thoughts, but also report apathy and disengagement, Ali said.

“Therefore, treatment for depression chemically neutralizes the very feelings most needed to fight for social change. We need approaches to depression that can support women in changing the material conditions of their lives. We need empirical research documenting the effectiveness of feminist-informed approaches to treating depression and other mental health problems,” she said.

Even menstruation is becoming taboo, said Jessica Barnack-Tavlaris, PhD, of The College of New Jersey. Perhaps influenced by advertisements that promote convenience, women are increasingly using contraceptives to suppress menstruation, and doctors giving them to young women to counter the effects of early puberty.

“Viewing menstruation as negative, not normal, or unnecessary has implications for women’s physical and emotional well-being. Some women will then experience shame with menstruation and those who do that are more likely to self-objectify,” she said.

Mindy Erchull, PhD, associate professor at the University of Mary Washington, spoke of how media promote an unnaturally thin body, with the result that it has become the norm for women to be dissatisfied with their bodies.

The thin ideal now often encompasses a fit ideal, especially in advertisements, Urchell said – a dual standard that may be even harder to achieve, as “Most people assume that to be fit you have to be thin. But muscles take up room,” she said. At the same time, breasts are seen as desirable, yet they mainly consist of body fat.

Even public health officials may cause undue worrying with the so-called war on obesity that primarily targets women, said Christine Smith, PhD, of the University of Wisconsin-Green Bay. Women are more likely to be labeled obese and more likely to turn to bariatric surgery – now offered to women who are as little as 20 pounds overweight — which can have serious side effects, such as digestive problems and nutritional deficiencies. Yet the link between weight and health isn’t definitive, she said: “The war on obesity is common trope … that we need to have people lose weight, otherwise our health system is going to collapse.”

Worrying about your body can limit women’ lives on multiple levels, including “how we think of our bodies, of ourselves and how we think of other women,” McHugh said. “When you feel your or your body isn’t good enough, it makes it hard to become socially engaged. And worrying about our thighs takes attention away from other activities.”