Response to commentary

Abstract

The main thrust of our article 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’.