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.
