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Title: Response to commentary
Authors: Giacaman, Rita 
Abu-Rmeileh, N.M.E. 
Husseinia, A. 
Saabb, H. 
Boyceb, W. 
Keywords: Humiliation - Social aspects
Issue Date: 2007
Abstract: The main thrust of our article2 entails pointing to humiliation as prevalent during war and conflict, and to its association with health outcomes. Humiliation seems to be given insufficient attention by the Anglo-Saxon public health literature on conflict-affected zones, perhaps because humiliation is a construct that has diverse meanings and significance to identity and self-worth in different cultures. We understand the particular conceptualization cited by Neria and Neugebauer,3 but we also question how humiliation (a feeling or internal experience) could ever be rated independently of the study participant’s own assessment. The use of inter-rater reliability3 is worrisome, given that ‘levels of loss, humiliation, entrapment, and danger were rated contextually using a five-point scale’, taking into account descriptive information provided in the interview itself, the narrative summary and the tape-recorded interview. However, reports of emotional reactions were ignored. Brown et al.3 did not explain how separation of the narrative from the emotional reaction is possible, and how this process is viewed as ‘objective’. Furthermore, the commentators conceptualize humiliation as a characteristic of an event. Brown et al. used the Stressful Life Events Battery in their study, indicating that humiliation is an event leading to or contributing to a psychological manifestation, and also implying that humiliation is contextual and cannot be standardized, especially in the Occupied Palestinian Territory where the political context is overwhelming, leaving little room for subtleties in humiliation experiences. It is important to remember that our study is a population study rather than a clinical study; a point that is likely to clarify the differences between Neria and Neugebauer’s approach and our own.
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