History illustrates that,
for human beings, relationships can be complex. Instead
of life-giving, they can be harmful. Instead of enriching
and meaningful, they can be terrifying and disabling. Or
they can be all of these. Particularly important are
primary relationships &endash; those between intimate
partners, or between parent and child. Recent scientific
studies have shown that the quality of our primary
relationships can have profound effects on health, wound
healing, immune function, and responses to treatment for
a variety of mental and physical illnesses.
Given the overwhelming
importance of relationships for human health and
well-being, it is unfortunate that, in busy clinical
settings, they are often not considered in the diagnosis
and treatment of individual patients. For the past eight
years a small group of family researchers, all of them
psychologists or psychiatrists in North America, has been
amassing the scientific evidence and articulating the
conceptual and practical frameworks necessary to bring
greater attention to relationships in clinical practice.
This extraordinarily productive effort [1] has
focused primarily on mental and relational health.
To address how relational
processes might be accorded greater prominence on a
global scale, a meeting was held on October 14-15, 2010
at Eranos, in Ascona, Switzerland, with support from the
Fetzer Institute and the Eranos Foundation. Participants
included clinical psychologists, psychiatrists and
researchers from the United States; their colleagues from
China, South Africa, Lebanon, Finland, and Australia; and
key officials from the World Health Organization (WHO)
specializing in mental health, violence prevention, and
reproductive health. Areas of expertise included
child-parent relationships, child maltreatment, intimate
partner relationships and intimate partner violence,
genetics, health systems research, and disease
classification.
Wednesday,
October 13, 2010 Arrivals at Castello Seeschloss Hotel
7:00 pm Reception at
Hotel
7:30 pm Dinner at Hotel
Thursday, October 14,
2010
8:30 am Depart Hotel by
bus to Eranos property
09:00 am- 10:15 am ;
Introduction and Overview, David Addiss, Claudia
García-Moreno&endash;WHO
- Public health and economic toll of relationship
problems, David Reiss
- Current status of relational problems in the ICD,
Geoffrey Reed
- Overview/discussion of conference goals, Rick
Heyman/Heather Foran/Amy Smith Slep
10:15 am &endash; 10:30
am Morning Break
10:30 am &endash; 12:30
pm, Partner Relational Processes Partner Maltreatment
(ICD codes: T74.0-T74.9)
- Identification, Definition, Surveillance, and
Implications for Mental Health Diagnosis,
.
Richard Heyman (15
minutes)
- Impact &endash; Psychological, Physical, and Economic
Consequences,
.
Heather Foran (15
minutes)
- Global Considerations/Applicability,
.
Claudia
García-Moreno (15 minutes)
- Questions and Clarifications
11:30 am
- Group Discussion, Chair/Moderator: Nadine Kaslow
- Can we develop a reliable and useful Partner
Maltreatment Code? (1 hour)
12:30 pm &endash; 2:30 pm
Lunch
2:30 pm &endash; 4:30 pm;
Partner Relational Problems
- Identification, Definition, Surveillance, and
Implications for Mental Health Diagnosis,
.
Mark Whisman (15
minutes)
- Impact &endash; Psychological, Physical, and Economic
Consequences,
.
Steven Beach (15
minutes)
- Applicability, Generalizability, and Considerations for
Arabic couples,
.
Brigitte Khoury (15
minutes)
- Questions and Clarifications
3:30pm Group Discussion,
Chair/Moderator: Steven Beach
- Can we develop a reliable and useful Partner Relational
Problems Code? (1 hour)
4:30 pm - 4:45 pm;
Afternoon Break
4:45pm - 5:30 pm; Summary
Discussion, Partner Relational Processes,
- Moderators: Steven Beach and Nadine Kaslow
5:30 pm Depart by bus to
Hotel
Friday, October 15,
2010
8:30 am Depart Hotel by
bus to Eranos
9:00 am &endash; 10:45 am
; Parent-Child Relational Processes Child Maltreatment
(ICD codes: T74.0-T74.9)
- Child Maltreatment - Identification, Definition,
Surveillance, and Implications for Mental Health
Diagnosis,
.
Amy Slep and Richard
Heyman (15 minutes)
- Child Maltreatment - Impact &endash; Psychological,
Physical, and Economic Consequences,
.
Richard Heyman &
Amy Slep (15 minutes)
- Considerations for Low and Middle Income Countries,
.
Mokhantso Makoae (15
minutes)
- Questions and Clarifications
10:00am ; Group
Discussion Chair/Moderator: Christopher Mikton
- Can we develop a reliable and useful Child Maltreatment
Code? (45minutes)
10:45am - 11:00 am
Morning Break
11:00 am -11:45 am
Parent&endash;Child Relational Problems
- Identification, Definition, Surveillance, and
Implications for Mental Health Diagnosis,
.
Tuula Tamminen and
Amy Slep (15 minutes)
- Impact &endash; Psychological, Physical, and Economic
Consequences,
.
Kurt Hahlweg (15
minutes)
- Applicability, Generalizability, and Considerations in
China,
.
Wenhong Cheng (15
minutes)
11:45 am 1:30 pm
Lunch
1:30 pm &endash; 2:15 pm;
Group Discussion, Chair/Moderator: Marianne Wamboldt
- Can we develop a reliable and useful Parent-Child Code?
(45 minutes)
2:15 pm &endash; 3:00 pm;
Current State of Public Health Response?
- Parent-child relations,
. Ron Prinz (15 minutes)
- Family maltreatment,
. Christopher Mikton (15 minutes)
- Questions and Clarifications (15 minutes)
4:00 pm &endash; 5:30 pm;
Future Directions and Implications for the ICD
- Future directions for ICD, Geoffrey Reed, James
Harrison
- Future directions for WHO, Claudia
García-Moreno
- Future directions for science and public health, David
Reiss
- Chair/Moderator: David Reiss
7:00 pm: Dinner at
Boromeo Restaurant (walking distance from
hotel)
Conference on Classification
of Relational Processes in ICD-11,
Moscia, Ascona, Switzerland Oct. 13-15, 2010
Dr. David Addiss Holos Associates, PLC
1626 Grove St.
Kalamazoo, MI 49006
dgaddiss(mailbox)yahoo.com
Dr. Steven Beach Institute for Behavioral Research
514 Boyd, GSRC
University of Georgia
Athens, GA 30602
Tel: (706) 542-6075
srhbeach(mailbox)uga.edu
Dr. Wenhong Cheng Department of Child and Adolescent Psychiatry
Shanghai Mental Health Center
600, Wanping South Road
Shanghai, China 200030
VOICE:86 21 34289888 3357
FAX: 86 21 64387986
MOBILE PHONE 86 21 13816924612
Chengwhb(mailbox)yahoo.com.cn
Dr. Heather M.
Foran Department of Psychology
Stony Brook University, State University of New York
Stony Brook, NY 11794-2500
hforan(mailbox)notes.cc.sunysb.edu
Dr. Claudia
García-Moreno World Health Organization
Department of Gender, Women, and Health
20 Avenue Appia
Geneva 1211
Switzerland
Tel: +41 22 791 4343
Fax: +41 22 791 4328
garciamorenoc(mailbox)who.int
Dr. Kurt Hahlweg TU Braunschweig
Institut für Psychologie
Humboldstr. 33
D-38106 Braunschweig
k.hahlweg(mailbox)tu-bs.de
Dr. James Harrison Research Centre for Injury Studies, Flinders
University of South Australia
GPO Box 2100
Adelaide SA 5001
Australia
James.Harrison(mailbox)flinders.edu.au
Dr. Richard E.
Heyman Department of Psychology
Stony Brook University, State University of New York
Stony Brook , NY 11794-2500
(631) 632-7857
Richard.Heyman(mailbox)Stonybrook.edu
Heidi Ihrig HWI Consulting, LLC
10581 Country Club Dr.
Richland, MI 49083
Tel: (269) 569-2351
Heidi.ihrig(mailbox)yahoo.com
Dr. Nadine Kaslow Emory University School of Medicine
Department of Psychiatry and Behavioral Sciences
Grady Health System
12D018
80 Jesse Hill Jr. Drive NE
Atlanta, GA 30303
Tel: (404) 616-4757
nkaslow(mailbox)emory.edu
Dr. Brigitte
Khoury American University of Beirut Medical Center
Psychiatry Department
Beirut, Lebanon
Tel: 01- 374374 ext. 5650/5651
Cell: 03-607591
bk03(mailbox)aub.edu.lb
Dr. Christopher
Mikton World Health Organization
Violence and Injury Prevention
20 Avenue Appia
Geneva 1211
Switzerland
+41 22 791 3326
miktonc(mailbox)who.int
Dr. Mokhantso
Makoae Research Specialist
Population Health, Health Systems and Innovation
(PHHSI)
Human Sciences Research Council (HSRC)
69-83 Plein Street, Pleinpark Building
Private Bag X9182, Cape Town 8000 - South Africa
Tel: +27-21-466-7854
Email: mmakoae(mailbox)hsrc.ac.za
Ron Prinz, Ph.D. Carolina Distinguished Professor
Psychology Department
University of South Carolina
Columbia, SC 29208
Tel: (803) 777-7143
prinz(mailbox)sc.edu
Dr. Geoffrey M.
Reed Senior Project Officer
Department of Mental Health and Substance Abuse
(MER/MSD)
World Health Organization
20, avenue Appia
CH-1211 Geneva 27
Switzerland
reedg(mailbox)who.int
Dr. David Reiss Child Study Center
PO BOX 207900
New Haven, CT 06520-7900
dxreiss(mailbox)earthlink.net
Dr. Amy M. Smith
Slep Department of Psychology
SUNY Stony Brook
Stony Brook NY 11794-2500
Tel: (631) 632-9346 (phone)
amy.slep(mailbox)stonybrook.edu
Dr. Tuula Tamminen Nokiantie 72
FIN-33300 TAMPERE
FINLAND
tuula.tamminen(mailbox)pp.fimnet.fi
Dr. Marianne Z.
Wamboldt University of Colorado Denver School of Medicine
Chair, Psychiatry and Behavioral Sciences,
The Children's Hospital
13123 E. 16th Avenue, B130
Aurora, Colorado 80045
Tel: (720) 777-6096
Wamboldt.Marianne(mailbox)tchden.org
Dr. Mark Whisman University of Colorado at Boulder
Department of Psychology
345 UCB
Boulder, CO 80309-0345
Tel: (303) 492-8569
whisman(mailbox)colorado.edu
Representative from
funding organizations:
Lawrence Sullivan President & CEO
Fetzer Institute
9292 West KL Ave
Kalamazoo, MI 49009
Tel: 269-375-2000
e-mail: lsullivan(mailbox)fetzer.org
Fabio Merlini President
Eranos Foundation
Baraggie 3
6612 Asconad
Switzerland
The timing of this meeting
coincides with a major revision of the International
Classification of Diseases (ICD). The ICD, published by
the World Health Organization (WHO), is the global
standard for classifying diseases and related health
problems. Its importance for diagnosis and treatment of
physical and mental illness, and for understanding
disease trends worldwide, cannot be overstated. It is
used by physicians, other health workers, hospitals,
ministries of health, and health information systems
around the world. The 11th revision of the ICD will
reflect the many scientific and conceptual advances in
medicine and health since the last major revision, in
1990.
The October 14-15 meeting at Eranos
provided the first opportunity for psychologists,
psychiatrists and other mental health professionals from
a variety of cultural settings to meet with WHO officials
and others responsible for the ICD revision, to explore
how relational processes might be more fully incorporated
into the ICD-11. The two-day meeting was filled with rich
exchange and engaging discussion, at times theoretical
and conceptual, at times extraordinarily practical and
specific.
After the group reviewed the
massive public health and economic toll of relational
problems and the current status of relational problems in
the ICD, the focus shifted to four specific categories.
These included partner relational problems (which do not
necessarily involve maltreatment or abuse); partner
maltreatment; parent-child relational problems; and child
maltreatment. For each of the four categories, there were
presentations on 1) definitions, identification, public
health surveillance, and implications for mental health
diagnosis; 2) the psychological, physical, and economic
impact; and 3) their applicability and generalizability
to specific regions of the world, especially in low- and
middle-income countries. Particularly important to the
discussion were perspectives from China, the Middle East,
and South Africa. Small breakout groups focused on
definitional issues for each of the four categories of
relational problems and concrete next steps were
elucidated for developing specific codes and
recommendations for relational processes in the ICD-11.
Eranos, with its inspiring history
and special ambience, created the perfect setting for
deep reflection, clarity of expression, expansive
conceptual insights, shared understanding across
disciplines, and practical solutions. The deliberations
of this meeting, which aimed at a cross-cultural
understanding of the common challenges to relationship
faced by humans around the globe, echoed the rich history
of East-West dialogue at Eranos.
This meeting marked the beginning
of expanded collaboration. Small work groups will
continue to refine definitions for each of the four major
relational categories considered, and to clarify coding
options and language for inclusion in the ICD-11. They
will work closely with those responsible for ICD-11 to
bring relational processes into full play in the revised
document. Such collaboration promises to heighten
awareness of clinicians around the world about the
diagnostic and therapeutic importance of relationships in
human health and disease.
-- David Addiss, November 4,
2010
Reference
Beach SRH, Wamboldt M, Kaslow N,
Heyman RE, First MB, Underwood LG, Reiss D (Eds.).
Relational Processes and DSM-V: Neuroscience, Assessment,
Prevention and Intervention. 2006; American Psychiatric
Association: Washington, DC.
