The Pelvic Wars: Peace Psychology as Part of Recovery

Written by Dr. Anna Rae

Edited by Dr. Gunjan Bansal

Christie et al (2008) identified structural violence as a violence that harms or kills people slowly through normalized social compositions and deprivation of basic needs.  Overt violence, contrastingly, are personal, intentional, and can be politically motivated.  Pelvic obliteration was a focus of war in Kosovo (Kosova Rehabilitation Center for Torture Victims in Pristina, 2019; UN Women, 2016), sexual violence is a focus of the war in Ukraine (Amos, Jul 15, 2022), and sexual slavery was a part of the ISIS financial machinery (Human Rights Watch, 2015).  It is done not only to hurt the victims, but also communities (Yaffa, 2002). I call this battle focus of pelvic harm, the ‘pelvic wars.’ 

Sadly, the pelvic wars have a second phase out of combat for victims through structural violence.  Pelvic trauma (sexual assault, rape, violent rape, pelvic injury from blunt force trauma, genitourinary injuries; Pisquiy et al., 2020; Balzano & Hudak, 2018; ) reduces a survivor’s social standing in many countries(Begisholli, 2019), increases the chance of pregnancy, increase incidents of damaging and painful sexually transmitted infections, reduces the chance of educational and economic attainment for survivors, and also increases their chance of familial and communal discrimination (Rae, 2022).  Unwanted pregnancies can induce mental trauma, miscarriages, pelvic organ prolapse, and other complications, especially during times of increased stress such as war and migration (Begisholli, 2019).  It should be noted, that pelvic trauma injury occurs to males as well as females through war (Pisquiy et al., 2020; Balzano & Hudak, 2018) and while there is not a chance males can be impregnated through the pelvic wars, the trauma they experience is just as worthy of mention as the trauma females experience.  Many victims suffer in silence with these complications despite them having a high chance of reducing quality of life, not being identified due to lack of available providers, or being seen as not important next to activities required to survive (obtaining water, food, and shelter).  However, if left unaddressed, these complications and structural violence violations could also lead to extreme health complications, discrimination, and death in some cases (Rae, 2022).

Peace psychologists have a vital role to play in the recovery from the pelvic wars by actively engaging in the post-violent peacebuilding (Niemiec, 2002) phase as part of the overall larger cultural context in any country in which they work.  This is especially true given the increased migration across the globe from war and conflict in recent years (xx).  Culturally sensitive service provision is important and offers opportunities for peace psychologists.  This is because of the interaction the pelvic wars have with local and familial structures.

The progression of war and how it influences the flow water to a water wheel of services, the education about the psychosocial effects of the pelvic wars, and how it influences the pelvic war survivor is detailed in the figure below.

Pelvic Wars and Recovery Water Wheel

Geography influences resource allocation and climate, which influences war, which influences income, which influences housing and food stability or vulnerability.  Then service provision has many elements.  And then that all influences the survivor’s perception of their pelvic recovery (Rae, 2022).  Psychologists have a role in the education or ‘the water wheel’ with pelvic recover at a macro level as well as at the individual and familial level.  This is because Rebuilding pelvic health and self-perception of pelvic health can increase not only esteem but can reduce discrimination, role accomplishment, increase capability for work/economic attainment, which has the chance to reduce food insecurity (Rae, 2022).  Recognition and rehabilitation are processes that fall within the area of comprehensive reparation defined by the United Nations (Lira et al., 2022). This rebuilding is part of positive peace (Niemiec, 2002).  Peace psychologists can utilize positive psychology with those recovering from their pelvic injuries to help increase harmony within the survivor, but also help the family restore equity to the survivor if their position in the family hierarchy has been lowered due to their injuries.  Further, peace psychologists can work to increase balance between those who are healing from their pelvic war related injuries and those who have not been pelvically injured in war by increasing education of psychosocial effects of pelvic injury in war to other pelvic health care and systemic influencers in the water wheel to reduce differences between the two groups regarding access to care and collaborative care.

Not every country has a nationalized health system, making access to physical and mental health assistance to recover from pelvic trauma accessible variable dependent upon geography and financial capability (Rae, 2022); however, understanding what resources are available, being willing to discuss culturally sensitive pelvic recovery with other providers, and/or working with a public health department or other agency that provides free services for those with health access vulnerability can help.  The more the wheel of services works to repair physical and psychological damage from the pelvic wars the more peace is being constructed within families and communities because education can decrease misunderstanding and discrimination (Rae, 2022).

Questions you can ask yourself and colleagues providing services within the water wheel can be: 

How can rape investigations (health and legal) for victims of pelvic wars be made culturally sensitive? 

How can you as a psychologist interact with an OBGYN to help with this? 

How can you explain how to seek help from medical providers to a rape survivor? 

How can you refer to a pelvic floor physical therapist when a client complains about walking/sitting/movement/pelvic pain? 

How can you discuss family healing from the rape/birth/prolapse with family clients in family therapy? 

What is the legacy of pelvic protection within the family?  What is the legacy of pelvic protection within the community? 

Because of the pelvic wars, what has functioned differently individually, in the family, and in the community?

Utilizing positive psychology, you could also ask clients how they have increased their coping since becoming a survivor, and brainstorm with them what strengths they have that have gotten even strong since becoming a survivor.

By asking these and other questions focused on recognition, rehabilitation, increasing access to care, reducing differences among groups, and reducing discrimination for survivors of pelvic wars, peace psychologists are contributing to increase post-violent peacebuilding (Niemiec, 2002).  And can help individuals and communities heal.  Extending this type of integrated care to clients and communities is an important piece of the overall care as we see clients from across the globe, including those who have been migrants from other countries before they join our local communities, those who are family members who have lived through conflict, as well as those who have experienced pelvic injury and/or trauma. 

Anna Rae is an International Psychologist, a Licensed Professional Counselor, and a Certified Substance Abuse Counselor.  She is an international speaker, and has presented at multiple conferences on ethics, asylum seekers’ and refugees’ needs, and the perception of a health systems treatment of pelvic organ prolapse and its overlap with quality of life.  She consults with international health organizations to integrate mental health and physical health services. In her work helping people across the world for two decades, Dr. Rae has worked in drug court, community mental health, and in the health system in the military in the field and at headquarters behavioral health levels.  She currently owns a private practice, Bridge to Wellness Centers.  Her clinical focus is on reproductive mental health and the intersection of physical, psychological, social, and spiritual wellness.  She tailors her approach to meet each of her clients’ unique needs and help them build upon their strengths so they can heal from some of their challenges. She is a registered clinical supervisor and enjoys mentoring students and new professionals in the field of counseling and psychology.

Link to Anna’s Psychology Today page:  https://www.psychologytoday.com/us/therapists/anna-rae-bridge-to-wellness-centers-vienna-va/489493

References

Amos, D. (July 15, 2022). Ukraine’s first war rape case is underway – but prosecutions are rare. NPR. https://npr.org/2022/07/091110667115/ukraine-russia-rape-war-crimes-prosecution

Balzano, F., & Hudak, S. (2018). Military genitourinary injuries: past, present, and future. Translational Andrology and Urology, 7(4), 646-652. doi: 10.21037/tau.2018.04.05

Begisholli, B. (May 1, 2019). Kosovo War Rape Victim Urges US Congress to Seek Justice. Balkan Transitional Justice. Retrieved from https://balkaninsight.com/2019/05/01/kosovo-war-rape-victim-urges-us-congress-to-seek-justice/

Christie, Tint, B. S., Wagner, R. V., & Winter, D. D. (2008). Peace Psychology for a Peaceful World. The American Psychologist, 63(6), 540–552. https://doi.org/10.1037/0003-066X.63.6.540

Gjerde, J., Rortveit, G.,  Muleta, M.,  Adefris, M.,  & Blystad, A. (2017). Living with pelvic organ prolapse: voice of women from Amhara region, Ethiopia. International Journal of Urogynecology, 28, PP361-366. Doi: 10.1007/s00192-016-3077-6

International Rescue Committee (2022). Refugee crisis: 100 million displaced. International Rescue Committee. https://rescue.org/topic/refugee-crisis-100-million-displaced

Kosova Rehabilitation Center for Torture Victims in Pristina. (2019). Kosova Rehabilitation Center for Torture Victims in Pristina.  https://krct.org

Lira, Cornejo, M., & Morales, G. (2022). Human Rights Violations in Latin America : Reparation and Rehabilitation. Springer International Publishing AG.

Human Rights Watch (April 14, 2015). Iraq: ISIS escapees describe systematic rape. Yezidi survivors in need of urgent care. Human Rights Watch. https://hrw.org/news/2015/04/14/iraq-isis-escapees-describe-systematic-rape

Niemiec. (2022). Pathways to peace: Character strengths for personal, relational, intragroup, and intergroup peace. The Journal of Positive Psychology, 17(2), 219–232. https://doi.org/10.1080/17439760.2021.2016909

Pisquiy, J., Carter, J., Chan, A., & Adler, A. (2020).  Incidence of pelvic ring factures in the U.S. military population. Cureus. 6; 12(2).  doi: 10.7759/cureus.6899.

Rae, A. (2022).  Quality of Life Impacts for Women Who Receive a Pelvic Organ Prolapse Diagnosis and Integrated Care. ProQuest Dissertations Publishing.

UN Women. (August 15, 2016). Path to justice for survivors of Kosovo’s sexual violence:  Q&A with Siobhan Hobbs. https://www.unwomen.org/en/news/stories/2016/8/q-and-a-with-siobhan-hobbs

Yaffa, J. (July 14, 2002). The psychologists treating rape victims in Ukraine. A grassroots effort is offering mental-health care to Ukrainians who’ve faced sexual violence at the hands of the Russian invasion force. The New Yorker. https://newyorker.com/news/dispatch/the-psychologists-treating-rape-victims-in-ukraine