It was the usual Monday morning round in the psychiatric ward
and the medical assistance was reporting incidences of violence involving patients in the ward. Managing violence has been part and parcel of my training in Psychiatry. The public tends to strongly associate mental patients with violence. However, my experience suggests to me that there is much more violence in the world, beyond the psychiatric ward. Criminological studies have actually supported my observation that rates of violent and criminal behavior are similar in the mentally ill and non-mentally ill people. So, I inevitably have to open up my mind to a bigger picture of violence, a disease of pandemic scale.
What is violence? Violence takes many forms and is understood differently in different countries and among different cultures. There is no universally accepted definition of violence but the following is a working definition accepted by World Health Organization (WHO), that encompasses a broad range of understanding:
*"Violence is the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation. "** *
There main categories of violence are identified from a public health point of view:
1. Self-inflicted violence: *This refers to intentional and harmful behavior directed at oneself e.g. self mutilation, attempted suicide or completed suicide.
2. Interpersonal violence: *This is violence among individuals e.g. violence against women, child abuse, bullying, sexual harassment and criminally-linked violence such as assault, rape and homicide.
3. Organized violence: *This is violent behavior of social or political groups motivated by specific political, economic or social objectives. War may be considered the most highly organized type of violence. Other examples include racial or religious conflicts.
Sad to say, there is not a single day these days whereby violence is not reported in the media. Since violence is now rampant, the United Nations have proclaimed the period 2001-2010 as the "International Decade for a Culture of Peace and Non-violence for the Children of the World". As defined by the United Nations,
"Culture of Peace is a set of values, attitudes, modes of behavior and ways of life that reject violence and prevent conflicts by tackling their root causes to solve problems through dialogue and negotiation among individuals, groups and nations"*
In response to calling for peace, the Young Buddhist Association of Malaysia (YBAM) is organizing a "Say NO to Violence Campaign" from 5th-15th May, 2007 in conjunction with the Wesak Day celebration and "Hari & Minggu Belia 2007". Thank God, religious freedom is practiced in this country and this is a significant contribution to the peace that we have been enjoying all this while. It's great to hear that the government is making concerted effort to promote peace in our beloved country. This is a very wise move as peace is a crucial prerequisite for nation building. We should give our full support to this and future peace promoting activities.
*"Together, we must build and develop for the future a culture of peace based on non-violence, dialogue, and mutual respect and social justice. This is neither easy nor a quick task. Nevertheless, it is possible and at a time of rising waves of new forms of conflict and violence, it is absolutely necessary."*
-The Dalai Lama-
(Nobel Price for Peace winner, 1989)
What are the factors that contribute to violence? Factors that are thought to contribute to the development of violent behavior include:
- Drug and alcohol use
- Access to firearms and weapons
- Having witnessed or victimized by interpersonal violence
- Lack of parental affection and support
- Physical punishment and child abuse
- Family history of criminal behavior
- Poor communication skills
- Poverty, urbanization and overcrowding
- Rapid economic development with unemployment
- Unequal power relations between men and women or different ethnic groups
For peace and non-violence to prevail, the United Nations have suggested these strategies:
- Foster a culture of peace through education
- Promote sustainable economic and social development
- Promote respect for all human rights
- Ensure equality between women and men
- Foster democratic participation
- Advance understanding, tolerance and solidarity
- Support participatory communication and the free flow of information and knowledge
- Promote international peace and security
Violence prevention efforts that address factors at all levels will be the most successful. However, I hereby would like to highlight peace and non-violence education program at school level as this has several advantages. Firstly, it's easier to start educating people while they are young before the personality is fully developed. Secondly, it can reach out to many people as the program can be easily incorporated into the existing school curriculum. Thirdly, there have been a lot of scientific studies to support the efficacy of school-based peace and non-violence education program.
The school-based educational intervention should include knowledge and skills in these areas:
- Assertive and non-violent communication
- Anger and stress management
- Conflict resolution
- Problem solving & decision making
- Mediation intervention
- Making friends and socializing
- Dealing with peer pressure
- Crime prevention and law-related education
- Religious and ethnic education
Since we spend a big portion of our life communicating with people around us, let me share with you in more detail on assertive and non-violent communication. Assertive and non-violent communication is the ability to express your thoughts, feelings and needs clearly, honestly, directly and at the same time considering the needs and feelings of others. The principles are as follows:
1. Honestly and clearly express your thoughts or feelings in a non-hostile way e.g. "John, I'm very upset and worried when you didn't call up after you missed our appointment yesterday". It's important to be specific and direct in expressing ourselves.
2. Be firm but friendly in your tone of voice and non-verbal language e.g. look up, have direct eye contact, smile and use opened postures. Be courteous, don't be defensive and never quarrel or fight.
3. Allow the other person to express himself or herself. Acknowledge the person's feelings or conditions e.g. "I understand that you had something emergency and I'm sorry to hear that........
4. Make your request clear, precise and in a positive manner (ask the person to do something rather than stop doing something) e.g. "I would be grateful if you could give me a call the next time whenever you miss our appointment. Is that ok with you?" Be diplomatic and willing to negotiate on the request.
5. Thank and compliment the person for agreeing to you request. You can also tell the person how happy you are because of the successful negotiation e.g. "Thank you very much for been so understanding. It means a lot to me and I'm very happy about that".
For further information on how to effectively and creatively run school-based peace education program, you can refer to UNESCO's compilation of "Best Practices" from various countries all over the world (* http://www.unesco.
org/education/). With this, I will end my little essay over here and may all of you be suffused with abundance of peace all the time. nved/index. html*
1. WHO information series on school health – Violence Prevention: An important element of a health-promoting school.
2. UNESCO - Best Practices of conflict resolution in and out-of-school.
Dr. Phang Cheng Kar
20th April, 2007.