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VOLUME XII | U-Z
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THE
INTERNATIONAL
ENCYCLOPEDIA OF
ANTHROPQ'gDGY
EDITOR-IN-CHIEF
HILARY CALLAN
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6368
VIOLENCE AND HEALTH
REFERENCES AND FURTHER READING
Das, Veena. 2000. Violence and Subjectivity. Berkeley: University of California Press.
Donnelly, Peter D., and Catherine L. Ward, eds. 2015. Oxford Textbook of Violence Prevention:
Epidemiology, Evidence, and Policy. Oxford: Oxford University Press.
Galtung, Johan. 1969. "Violence, Peace, and Peace Research." Journal of Peace Research 6 (3):
167-91.
Gilligan, James. 1999. "Structural Violence." In Violence in the United States: An Encyclopedia,
edited by Ronald Gottesman, 229-33. New York; Charles Scribner's Sons.
Krug, Etienne G., Linda L. Dahlberg, lames A. Mercy, Anthony B. Zwi, and Rafael Lozano. 2002.
World Report on Violence and Health. Geneva: World Health Organization.
Kurtz, Lester. 1999. Encyclopedia of Violence, Peace, and Conflict. 3 vols. Cambridge, MA: Aca-
demic Press.
Leckman, James E, Catherine Panter-Brick, and Rima Salah, eds. 2014. Pathways to Peace: The
Transformative Power of Children and Families. Cambridge, MA; MIT Press.
Lee, Bandy X. 2019. Violence: An Interdisciplinary Approach to Causes, Consequences, and Cures.
Chichester: Wiley Blackwell.
Lee, Bandy X., James F. Leckman, and J. K. K. Mbwambo. 2014. "Violence and Health: Cur-
rent Perspectives of the WHO Violence Prevention Alliance." Aggression and Violent Behavior
19 (6): 609-15.
Rylko-Bauer, Barbara, Linda Whiteford, and Paul Farmer. 2009. Global Health in Times ofVio-
knee. Santa Fe, NM: School for Advanced Research Press.
Scheper-Hughes, Nancy, and Philippe Bourgois. 2004. Violence in War and Peace: An Anthology.
Oxford: Blackwell.
United Nations. 2015. "Transforming Our World: The 2030 Agenda for Sustainable Develop-
ment." Accessed July 7,2017, http://wr»vw,un.org/ga/search/view_doc.asp?symbol=A/RES/70/
l&Lang=E.
Vazquez, Carmelo, Pau Perez-Sales, and Cristian Ochoa. 2014. "Posttraumatic Gro\vth: Chal-
lenges from a Cross-Cultural Viewpoint." In Increasing Psychological Well-being in Clinical and
Educational Settings, edited by Giovanni Andrea Fava and Chiara Ruini, 57-74. Dordrecht:
Springer.
WHO (World Health Organization), UNODC (United Nations Office on Drugs and Crime),
and UNDP (United Nations Development Program). 2014. Global Status Report on Violence
Prevention 2014. Geneva: World Health Organization.
Zwi, Anthony B. 2004. "How Should the Health Community Respond to Violent Political Con-
flict?" PLoS Medicine 1 (I): el4.
Violence, Structural and Interpersonal
KRISTEN E. MCLEAN AND CATHERINE PANTER-BRICK
Yale University, United States • '
Layers of violence
Violence has significant impact on human health; it engenders suffering and harm,
through death, disability, deprivation and through precarious livelihoods and
compromised usage of health and social resources. It has significant impact on human
VIOLENCE, STRUCTURAL AND INTERPERSONAL
6369
Y, bringing chaos, marginalization, and disorder in its wake but also resistance,
resilience, and domination. Without doubt, violence poses a threat to human rights
and to physical, emotional, and social wellbeing. There are, however, many different
TS of violence that engender harm. Anthropologists raise important questions
regarding which dimensions of violence are most salient in peoples lives and which
are structurally condoned and reproduced, as well as questions regarding how people
articulate their suffering, negotiate conflict, manifest resilience, and strive for peace.
Personal, interpersonal, and collective violence
In its World Report on Violence and Health (WHO 2002), the World Health Organi-
zation highlighted three types of violence; self-directed, interpersonal, and collective.
This typology differentiates between violence that is inflicted upon an individual by a
person or a small group of people and violence that is inflicted by larger groups, such
as militia. The WHO defined violence as 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, psychologi-
cal harm, maldevelopment or deprivation" (2002, 5). The WHO has been instrumental
in making global epidemiological data on violence more readily accessible. It has also
focused on global violence prevention to better understand national policies that work
toward addressing child maltreatment, youth violence, sexual violence, and elder abuse
(WHO 2014).
Political, structural, symbolic, and everyday violence
Reflecting on the links between violence, suffering, power, and social order, anthro-
pologists have focused attention on oth&r critical dimensions of violence, ones that are
not explicit in WHO typologies. This is exemplified by Rylko-Bauer, Whiteford, and
Farmer in Global Health in Times of Violence (2009), which caUs attention to the ethnic,
gendered, class-based dimensions of violence—namely, to its sodopolitical and eco-
nomic roots. They have emphasized the intersections of multiple forms of violence, the
cultural contexts in which violence is perpetrated, and the ways in which violence is
experienced—physically, psychologically, and socially—in ordinary or extraordinary
times. Anthropologists, many argue, are particularly well poised to unearth and bring to
light invisible forms of violence and the oft-hidden linkages between violence, suffering,
and power.
In summarizing research to date, Bourgois (2001) distinguished between four
types of violence: political, structural, symbolic, and everyday (normalized) violence.
By political, he referred to violence perpetrated directly in the name of a "political
ideology, movement, or state (Bourgois 2001, 7). Such violence is often meted by
governments—the army or police—but also includes popular resistance against the
state. This contrasts with structural violence, a turn of phrase credited to Johan Galtung,
who defined it as the indirect violence built into repressive social orders creating
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VIOLENCE, STRUCTURAL AND INTERPERSONAL
enormous differences between potential and actual self-realization" (1975, 173).
The concept also derives from anticolonial resistance movements and from Catholic
liberation theology (see Farmer et al. 2006).
Symbolic violence refers to the reading of power structures that results in the in-
ternalization of humiliations and legitimations of inequality and hierarchy" (Bourgois
2001, 8). On the part of the subjugated portion of society, this results in self-blame for
their misfortunes and a naturalization of the status quo. Ethnographic work in US inner
cities has revealed this well: in East Harlem, New York, it is not uncommon for struc-
tural forms of violence to lead to the subordination of the poor, who blame themselves
for their position in society (Bourgois 2001). Segregation, poverty, and social inequality
led crack dealers to self-harm, via substance abuse, as well as to harm one another and
their communities, via domestic violence, assault, and robbery,
The concept of everyday violence was developed by anthropologist Nancy
Scheper-Hughes (1996) to draw attention to insidious forms of violence that occur
in times of peace—and to what she called the small wars and invisible genocides"
that affect the poor. This trope is indeed useful for explaining how experiences of
violence can be routine, consonant with Michael Taussig's "culture of terror" whereby
out-of-the-ordinary events such as death and torttire become normalized due to the
sheer prevalence of brutality (Taussig 1984). In becoming routine, expected, and
normalized, everyday violence is often associated with both political and interpersonal
violence.
Health inequalities and social suffering
Scheper-Hughes and Bourgois (2004) conceived of violence along a continuum,
ranging from direct forms of violence, such as assault, to more hidden forms such as
symbolic and everyday violence. Structural violence is one such form of "invisible
violence that results in clearly visible health disparities: it roots itself in the unequal
distribution of power and the chronic sociopolitical and economic causes of suffering,
resulting in toxic health disparities, given that certain populations are placed at risk
of harm or injury while others are buffered or spared (Farmer et al. 2006). Such
violence is structural in that it considers the political economy in which people live,
work, and interact. It is violent specifically because it results in premature death or
disability.
As a theoretical trope, structural violence has been powerfully yielded by medical
anthropologists such as Paul Farmer to demonstrate how macrolevel inequalities
in society lead to suffering, ill-health, and the perpetuation of everyday violence.
Importantly, structural violence has been described as severely constraining human
agency (Farmer 2004). Addressing the roots of violence thus requires tackling the
social determinants of health—poverty, racism, gender discrimination, exposure to
pollution, war—and a biocultural approach to research and intervention. Farmer
has written extensively on the relationship between structural violence and clinical
medicine as it relates to HIV and tuberculosis in Haiti and other low-income settings:
"choices both large and small are limited by racism, sexism, political violence, and
v n
VIOLENCE, STRUCTURAL AND INTERPERSONAL
6371
poverty (Farmer 2004, 40). In his words, we need to resocialize our
understandings of who is at risk of disease and why (Farmer et al. 2006), paying close
attention' to the upstream drivers of ill-health—the ultimate causes of disease that
are rooted in harmful social and political structures. He called upon anthropology to
detangle the forces of history and political economy in order to better understand and
respond to modern plagues in settings such as Haiti (Farmer 1992).
Thus structural violence has close ties to issues of social justice, health inequities, and
social suffering. It "results from what political, economic, and institutional power does to
people and, reciprocally, from how these forms of power themselves influence responses
to social problems" (Kleinman, Das, and Lock 1997, ix). It is inherently structural in
societybecause it affects specific population groups, such as ethnic or gender minorities;
it is experienced not just individually but also socially. Situating suffering in political and
economic contexts, beyond the capturing of individual experiences, has been a major
contribution of anthropologists in connecting insidious forms of violence to power and
wellbeing.
The machinery of war and political violence
Collective violence, in the form of militarized conflict, is also toxic to health in ways
that go beyond the very obvious consequences on the brains and bodies of people
caught in the forks of conflict. Contemporary wars lead to other forms of suffering
beyond injury and death: sexual violence, mass displacement, disease, hunger, and
the destruction of health and social infrastructure (Singer and Hodge 2010). War
disrupts family and community social supports, especially where it engenders, as a
last resort, forced displacement on a massive scale. Singer and Hodge have captured
this multilayered phenomenon by referring to the "machinery of war" to cast a wider
focus on both the direct and indirect effects of political violence. Indeed, the trope
captures both the health effects of armed combat—"the bullets, bombs, and battles
(Singer and Hodge 2010, 4)—in addition to war industries, international weapons
trade, and exorbitant war budgets, all of which place people in harms way and divert
resources from health and social needs. Importantly, the health consequences of
war—such as trauma, emotional suffering, and nutritional stress—can be long term
and intergenerational.
Political violence need not be the result of war or obvious conflict. Auyero (2015),
for example, explained how interpersonal violence in the marginalized neighborhoods
of Buenos Aires is deeply political, though political dimensions are hidden from view.
He described criminal violence that is intimately connected to state actors such as the
police—implicated in the daily production of violence. The violence is also political
in that it has the potential to generate community collective action that will target
the state. Writing about the civil war in El Salvador, Bourgois (2001) has described
how political violence against revolutionary peasants became embedded in everyday
realities, normalizing interpersonal aggression and structural violence into a dynamic
of the everyday. Nancy Scheper-Hughess work is on invisible political violence also.
In her ethnographic study in a northeastern Brazilian shantytown, she described how
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VIOLENCE, STRUCTURAL AND INTERPERSONAL
infant deaths became routinized by the indifference of political leaders, by the Catholic
practice of referring to babies who prematurely die as angels, and by necessary
maternal detachment. Within the shantytown, babies deemed too weak to survive were
casually written off as having no will for life, falling prey to "institutionalized social
indifference" by their mothers and by the community at large (Scheper-Hughes 1996,
890-91). This is political violence—the poor are marginalized into making impossible
choices about life and death, in contexts where there is no political will to bring about
better life conditions.
Toxic social, political, and economic structures breed many forms of violence: it is
thus unsurprising that, along the continuum of visible and invisible forms of violence,
we find that interpersonal, structural, and political layers of violence intersect. Given
this complex landscape, anthropologists have examined which dimensions of violence
are most salient, when and for whom; which acts of violence are permissible or
condoned; and which narratives of violence help make sense of chaos, uncertainty,
or trauma. In Afghanistan, for example, ordinary violence inside the family is a
critical predictor of adolescent mental health, one that can trump experiences of
war-related violence (Panter-Brick et al. 2011). The drip-drip of everyday economic
and social stressors imposes a major burden on family relationships, triggering
domestic violence—which for youth was found to be the main predictor of changes
in their mental health. In fact, there is a cultural narrative of war and martyrdom
that helps to "make sense" of collective violence and can enhance family honor in the
midst of suffering, while senseless violence inside the home is toxic to the educational,
social, and economic aspirations of adolescents (Panter-Brick, Grimon, and Eggerman
2013). There are many layers of violence that injure physical, social, and emotional
wellbeing; rupture hope; and cascade poor mental health from one generation to
another.
Agency and resilience
Until recently, anthropological writings on violence have been dominated by tropes of
social suffering, trauma, and other forms of ill-health, with relatively little attention
paid to other dimensions of human experiences in the face of adversity, such as agency,
hope, human dignity, and social resilience (Eggerman and Panter-Brick 2010). This is
because the concepts of social suffering and structural violence, though widely use-
ful, are not without limitations. Wacquant (2004), for example, argued that the concept
of structural violence collapses various forms of violence—physical, economic, polit-
ical, symbolic—that need to be considered separately. He also noted that it conflated
full-on domination with social disparity. Others have argued that tropes of structural
violence and social suffering ignore important expressions of human agency, even by the
most vulnerable. Thus Bourgois (1995), in his ethnography of drug use in East Harlem,
illustrated individual expressions of autonomy, despite tremendous structural violence,
given that crack dealers were able to maintain dignity and autonomy through partic-
ipation in an underground economy, counteracting a context of political, social, and
ideological oppression.
VIOLENCE, STRUCTURAL AND INTERPERSONAL
6373
An emerging body of work thus examines resilience and agency in the context of
violence and marginalization engendered by interpersonal, structural, or collective
violence. Such analyses nuance the often made but rather obvious point that violence
has nefarious impacts on health: any critical analysis on violence needs to go well
beyond such normative statements that "war is bad" for people. More sophisticated
analyses of violence examine, for instance, what really matters in settings of conflict,
namely the moral dimension of human experiences where people live a life of great
uncertainty and danger (Kleinman 2006). Deploying a specific ethnographic lens,
current anthropological work is also highlighting how humanitarian interventions
are created and implemented to remedy the physical and psychosocial conditions
engendered by war-related violence (Abramowitz and Panter-Brick 2015; Good et al.
2014). It increasingly looks upstream in order to better understand the articulation
of policy and advocacy initiatives (e.g., de Waal 2015). Other works cast a focus on
family-based or community-based negotiation of violent conflict, including strategies
for social resistance, reintegration, and active peace building in the wake of war. They
examine intergenerational impacts over time, aware that resilience as well as adversity
may cascade from one generation to the next.
Future directions
Our understandings of the visible and invisible forms of violence and their impacts
on social power dynamics and human wellbeing are now fairly robust: there are many
exemplars in the literature contributing both relevant epidemiological data on the ind-
dence and prevalence of violence and its impacts on health, as well as powerful social
sciences data contributing insights on the genesis and negotiation of violence within
given social and political structures. Nonetheless, there are stiU many critical insights
to be gained in this field. Some directions for future work include interdisciplinary
analyses regarding the ways in which interpersonal, structural, and political violence
specifically intersect, the ways in which conflict is nested or negotiated in microfamily
contexts, and which are the tipping points for social action with respect to conflict or
peace building across generations.
SEE ALSO: Birthmg Practices; Conflict and Security; Crime; Cultural Politics;
Detention; Ethnicity in Anthropology; Ethno- and Cultural Psychiatry; Ethnoeco-
nomics; Expert Witnesses, Anthropologists as; Feminism and Anthropology; Gangs;
Gender and Human Rights; Gender, Sexuality, and Caste; Gender Violence; Global
Health; Global Mental Health; Health Care Systems; Health Determinants; Health
and Inequality; Human Rights; Idioms of Distress; Interethnic Friction; Intergroup
Conflict; Medical Anthropology; Militarization; Nationalism; Peace; Peacekeeping;
Penal State; Postcolonial Theory and Feminism; Refugee Health; Resilience and
Complex Adaptive Systems; Rights; Sex Work; Slums and Shanty Towns; Stigma;
Stress; Syndemics; Vigilantism; Violence and Health; Violence and Warfare; Virchow,
Rudolf (1821-1902); World Health Organization (WHO)
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VIOLENCE, STRUCTURAL AND INTERPERSONAL
REFERENCES AND FURTHER READING
Abramowitz, Sharon, and Catherine Panter-Brick, eds. 2015. Medical Humanitarianism: Ethno-
graphics of Practice. Philadelphia; University of Pennsylvania Press.
Auyero, Javier. 2015. "The Politics of Interpersonal Violence in the Urban Periphery. Current
Anthropology 56 (Sll): S169-79.
Bourgois, Philippe. 1995. In Search of Respect: Selling Crack in El Barrio. New York: Cambridge
University Press.
Bourgois, Philippe. 2001. "The Power of Violence in War and Peace: Post-Cold War Lessons from
El Salvador." Ethnography 2 (I): 5-24. doi:10.1177/14661380122230803.
de Waal, Alex, ed. 2015. Advocacy in Conflict: Critical Perspectives on Transnational Activism.
London: Zed Books.
Eggerman, Mark, and Catherine Panter-Brick. 2010. "Suffering, Hope, and Entrapment:
Resilience and Cultural Values in Afghanistan." Social Science df Medicine 71: 71-83.
doi:10.1016/j.socscimed.2010.03.023.
Farmer, Paul. 1992. Aids and Accusations: Haiti and the Geography of Blame. Berkeley; University
of California Press.
Farmer, Paul. 2004. Pathologies of Power: Health, Human Rights, and the New War on the Poor.
Berkeley: University of California Press.
Farmer, Paul E., Bruce Nizeye, Sara Stulac, and Salmaan Keshavjee. 2006. "Structural Violence
and Clinical Medicine." PLoS Medicine 3 (10): e449. doi:10.1371/journal.pmed.0030449.
Galtung, Johan. 1975. Peace: Research, Education, Action: Essays in Peace Research. Vol. 1. Copen-
hagen: Christian Ejlers.
Good, Byron J., Mary-Jo DelVecchio Good, Sharon Abramowitz, Arthur Kleinman, and Cather-
ine Panter-Brick. 2014. "Medical Humanitarianism: Research Insights in a Changing Field of
Practice." Social Science 6- Medicine, 120: 311-16. doi:10.1016/j.socscimed.2014.09.027.
Kleinman, Arthur. 2006. What Really Matters: Living a Moral Life amidst Uncertainty and Dan-
ger. Oxford: Oxford University Press.
Kleinman, Arthur, Veena Das, and Margaret M. Lock. 1997. Social Suffering. Berkeley: University
of California Press.
Panter-Brick, Catherine, Anna Goodman, Wietse Tol, and Mark Eggerman. 2011. "Mental
Health and Childhood Adversities: A Longitudinal Study in Kabul, Afghanistan."
Journal of the American Academy of Child dr Adolescent Psychiatry 50 (4): 349-63.
doi:10.1016/j.jaac.2010.12.001.
Panter-Brick, Catherine, Marie-Pascale Grimon, and Mark Eggerman. 2013. "Caregiver-Child
Mental Health: A Prospective Study in Conflict and Refugee Settings." Journal of Child Psy-
chology and Psychiatry 55 (4): 313-27. doi:10.11H/jcpp.l2167.
Rylko-Bauer, Barbara, Linda Whiteford, and Paul Farmer. 2009. Global Health in Times ofVio-
lence. Santa Fe, NM: School for Advanced Research Press.
Scheper-Hughes, Nancy. 1996. "Small Wars and Invisible Genocides." Social Science 6- Medicine
43; 889-900. doi:10.1016/0277-9536(96)00152-9.
Scheper-Hughes, Nancy, and Philippe Bourgois. 2004. "Introduction: Making Sense of Vio-
lence." In Violence in War and Peace: An Anthology, 'edited by Nancy Scheper-Hughes and
Philippe Bourgois, 1-27. Oxford: Blackwell.
Singer, Merrill, and Derrick Hodge, eds. 2010. The War Machine and Globfil Health: A Critical
Medical Anthropological Examination of the Human Costs of Armed Conflict and the Interna-
tional Violence Industry. Lanham, MD: AltaMira Press.
Taussig, Michael. 1984. "Culture of Terror—Space of Death: Roger Casement's Putumayo Report
and the Explanation of Torture." Comparative Studies in Society and History 26: 467-97.
VIOLENCE AND WARFARE
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t, Loic. 2004. Response to "An Anthropology of Structural Violence," by Paul Farmer.
Current Anthropology 45 (3): 322.
WHO (WoridHealth Organization). 2002. WorldReport on Violence andHealth. Geneva: WHO.
WHO (World Health Organization). 2014. Global Status Report on Violence Prevention 2014.
Geneva: WHO.
Violence and Warfare
WINIFRED TATE
Colby College, United States
Warfare, long the purview of political scientists and historians, increasingly has
come under anthropological scrutiny since the 1960s. While conventional warfare
between states conducted by uniformed troops on well-defined battlefields using
conventional—as opposed to nuclear or biological—weapons is frequently imagined
as the primary form of war, counterinsurgency war has been a dominant mode
of warfare in many regions. Counterinsurgency involves, as the name suggests, a
conflict against insurgent forces, characterized by the use ofguemUa tactics (including
psychological warfare, sabotage, and terrorism) because of the asymmetrical power
relations between the forces. Viewed in historical context, the forms of fighting in
the European theater during World War I and World War II are the exception rather
than the rule. Anthropological study of war has been transformed as the discipline
has expanded from the study of small-scale societies to explore the state, oppositional
political movements, and bureaucracies. The traditional anthropological attention to
daily life, cultural meaning, and lived practice has contributed to the vast literature
on the communal legacies of war, including memory work. The more recent turn to
complex transnational bureaucracies has contributed to the smaU but growing schol-
arship examining military institutions, their ideologies, practices, and role in identity
formation. Anthropology of war is particularly concerned with the impact of warfare
on the social worlds of civilians as well as soldiers and as such is well suited for the
study of guerrilla warfare and terrorist movements. Ethnographic study of war presents
particular methodological challenges, including issues of access, safety, and the ethical
uses ofanthropological data during wartime. The study of war is part of anthropology s
broader consideration of violence, including theorizing the process through which
violence is made socially legible through the production of collective meaning.
War and the state in the twentieth century and beyond
Anthropological views of war have been influenced by the predominant view in the
discipline that war is a cultural construct. Early anthropology focused on the internal
dynamics of tribal and small-scale societies, largely ignoring the wars waged in the first
half of the twentieth century, with only a handful of articles on anthropology of war in
