In Conversation with Compassion & Care This series of essays examines compassion and care in relation to gender. Through these accounts, we see a poignant reminder that acts of compassion are responses to pain, though delivering compassion takes courage and strength. Acts of violence against women questions whether inequality is embedded deep within societal and communities’ infrastructure, yet this does by no means exempt from individual accountability. Collectively, the essays in this series call for a change in how we deal with difference, how we deal with courage and respect for women, our mothers, our sisters , our daughters; I would like to thank all of the contributors for providing touching, yet hard hitting accounts of compassion and gender. All the people involved with careif, Trustees, International Advisors, Patrons, Friends, Supporters, etc give their time as volunteers. If you want to be part of this careif experience or indeed contribute your own testimony on Compassion and Care; email us at enquiries@careif.org

1. In Conversation with
Compassion and Care
Editor’s Note
This series of essays examines compassion and care in relation to gender. Through these accounts, we see a
poignant reminder that acts of compassion are responses to pain, though delivering compassion takes
courage and strength. Acts of violence against women questions whether inequality is embedded deep
within societal and communities’ infrastructure, yet this does by no means exempt from individual
accountability. Collectively, the essays in this series call for a change in how we deal with difference, how
we deal with courage and respect for women, our mothers, our sisters , our daughters; I would like to thank
all of the contributors for providing touching, yet hard hitting accounts of compassion and gender. All the
people involved with careif, Trustees, International Advisors, Patrons, Friends, Supporters, etc give their
time as volunteers. If you want to be part of this careif experience or indeed contribute your own testimony
on Compassion and Care; email us at enquiries@careif.org
June 2015
Dr. Yasmin Khatib
Careif Advisor on International Women’s Affairs and Compassion and Care
Centre for Applied Research &Evaluation
International Foundation
National Office:
The Centre for Psychiatry
Barts and The London School of Medicine and Dentistry
Queen Mary University of London
Old Anatomy Building
Charterhouse Square
London EC1M 6BQ
Tel 020 7882 6118
Fax 020 7882 5728
Email: enquiries@careif.org
Website: http://www.careif.org
Twitter: @careif
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2. The Power of Compassion: The Story of Tim and Emma
Dr Anna Preston.
"As mental health practitioners we are in the position where we can influence someone's way
forward by showing compassion"
I have worked in many different services within the world of mental health. Mostly, this has included
my work with people who struggle with very complex difficulties in acute and forensic care services.
So many of these individuals have experienced significant trauma histories, and often (but of course,
not always) the abuse they have suffered has been at the hands of the opposite gender. When their
methods of coping with the damage they have experienced leads them to an acute or forensic
hospital setting somewhere along their journey, they are often faced with fear and uncertainty, with
less freedom and control over their everyday situation. This is the freedom and control which we
take for granted in our everyday lives.
During my conversations with some of these struggling people, they have described the fear invoked
in them when they are around people of the opposite gender because of the connections they make
between them and the people who have hurt them so much in the past. To feel safe, some use the
strategy of aggression, which in the short term feels as though it fulfils that protective function, but
in the longer term just makes things even worse. But there's something so powerful about fear that
it means the survival mechanism wins every time. So you would imagine that being a staff member
who is faced with that aggression, the capacity for compassion would be greatly tested. Sometimes,
it is the case that compassion is lost because the challenge to it is too great. But often, it is not lost.
And what we see instead is quite remarkable.
I worked with a lady (who I shall call Emma) in a forensic mental health unit. Emma was one of these
hurt and struggling people whose self-protective mechanism of aggression was triggered when she
was around males and a perceived sense of loss of control over her surroundings. This is because the
fear she experienced when around males was incredibly intense and unbearable for her, and where
she had no control, she felt vulnerable and exposed. Emma's self-protective instinct led her to
significantly hurt a male member of staff (who I will call Tim) one day and on a number of other

3. occasions her words had a function of pushing him away and invoking his own fear, paralleling just
what she was experiencing in that moment.
What Emma had become used to in life was that people she hurt would leave; and indeed, most
people in her life had left her eventually, thereby confirming what she already believed about
herself; i.e. that she was worthless and bad. She had also become used to being hurt by the same
people who were meant to protect her, and consequently this was all she ever expected. Over the
course of months though, what I saw this time was something completely different. Tim stayed.
Every time he reached out a hand, and every time he was still there to help her. Despite the
challenges he faced, in every interaction with her he showed compassion and caring. He didn't hurt
her and he didn't leave.
Tim's compassion for Emma had such a powerful impact that it changed her experience. And
through our ongoing life experiences, we learn something new that sometimes contradicts what we
thought we had known. Over time, Emma learnt many new things; that men did not need to be
feared; that people don't all leave; that maybe there was an alternative way forward for her. I don't
think we should underestimate the power of just being there, showing compassion, and showing
people something different to what they are used to, no matter what challenges we are faced with.
As mental health practitioners we are in the position where we can influence someone's way
forward by showing compassion, and we can help those who are struggling to choose a path which
enables them to believe they are worth something good; to nurture themselves and their
relationships. If we can remain mindful, self-aware and reflective, then we will find it possible to
remain compassionate in the face of challenges to that compassion. Tim did, and the outcome was
that he helped towards changing Emma's path, therefore indirectly also affecting the experience of
those who enter her life, both now and in the future. Tim didn't realise this though. Through his
eyes, it was his job to remain compassionate. For Emma and her future generations, it is so much
more than that. This is the power of compassion.

4. Dr Anna Preston is a Consultant Clinical Psychologist and a trust-wide Lead Psychologist for Acute
Psychiatric Care Services in Surrey and Borders NHS Foundation Trust.
India’s Daughter
Khurshid Khatib
“She was beggar girl. Her life was of no value.”
These are the words of a convicted rapist in India. His casual dismissal of both poverty and gender,
striking in its stark lack of compassion and perversely defiant in the knowledge that the girl in
question was only five-years-old.
In India, a country with a population of 1.2 billion, a female is raped every 20 minutes. According to
India’s Home Ministry, more than half (54.7%) of the victims are aged between 18 and 30. The rape
case that made international headlines in December 2012, was that of 23 year-old Jyoti Singh from
Delhi, who was gang-raped and thrown off a moving bus, as she returned from watching a film with
a friend. She died 13 days after suffering a catalog of grotesque injuries at the hands of her attackers
that included the pulling out of her internal organs.
The film documentary, ‘India’s daughter’ recently shown on BBC4 (BBC Storyville, 2015) and which
has subsequently been banned by the Indian government, interviews one of the men, Mukesh Singh,
who shows not an iota of emotion or remorse in his recollection of this merciless assault. The
perpetrator remains firm in his conviction that it was Jyoti who had asked for trouble by being out in
the evening saying, ‘A good girl won’t roam about at nine o’clock at night’, and ‘People had a right to
teach her a lesson. The disturbing vocalisation of victim blaming is a theme regularly echoed through
the film-from Singh’s reassertion that Jyoti should not have resisted the rape ‘When being raped, she
shouldn’t fight back-she should just be silent and allow the rape’ to the lawyer who claims that if he
had a ‘daughter or sister engaged in pre-marital activities…’ he would ‘pour petrol on her and set her
alight.’
Deeply embedded male misogyny is not the only hindering progress on gender equality. In Jan 2014,
female politician Asha Mirje publicly endorsed such sexism, stating;
‘Rapes take place also because of a woman’s clothes, her behaviour and her presence at
inappropriate places’.
Disturbingly, essential support mechanisms for victims have been reduced; News outlet DNA (DNA,
2015), says that Modi’s government has ‘downsized its first large-scale initiative for women,
trimming the plan for a rape crisis centre in every district.’
It would be unfair to point to India as a definitive example of abuse in women’s rights and human

5. dignity, or for this abuse to be attributed to particular customs or ethnicity. The worldwide
occurrence of sexual crimes as reported by the World Health Organisation (WHO) in November 2014
stated that, ‘Recent global prevalence figures indicate that 35% of women worldwide have
experienced either intimate partner violence or non-partner sexual violence in their lifetime’ (WHO
Violence Against Women, 2014). Furthermore, ‘The unequal position of women relative to men and
the normative use of violence to resolve conflict are strongly associated with both intimate partner
violence and non-partner sexual violence.’
I often question not only our capacity for violence and injustice, but also the regular acceptance of
deep suffering as a consequence of such trauma. The Just World Hypothesis, where people believe
the world is an ordered, just place and that people ultimately get what they deserve is a theory that
may go some way in explaining this observation for appropriating blame, rather than empathy
towards victims. Research conducted by social psychologist Dr. Melvin Lerner validated this view,
concluding that ‘the sight of an innocent person suffering without possibility of reward or
compensation motivated people to devalue the attractiveness of the victim in order to bring about a
more appropriate fit between her fate and her character.’Surveys conducted by Harvard & UCLA
psychologists Zick Rubin and Letitia Anne Peplau appear to substantiate Lerner’s findings; they have
found that believers in a just world ironically tend to ‘feel less of a need to engage in activities to
change society or to alleviate the plight of social victims.’
Rape is just one of the many violations against females, which includes increases (as indicated by
Indian police records in 2011) in human trafficking, kidnapping and child abuse. Abuse cases, such as
those in Oxford UK, where it was learned that up to 373 girls, (some as young as ten), may have
been targeted for sex by grooming from gangs over a sixteen year period, highlight once again, a
failure in society through the denial of compassion, even to children; social workers and the police
allegedly ‘turned a blind eye to sexualized crime’. NSPCC spokesman Jon Brown said ‘we mustn’t
assume this kind of abuse is a thing of the past. Every year we work with around 200 children who
have been sexually exploited or are potential victims of this appalling crime.’
Unsurprisingly rape is more prevalent where there are wider gaps in gender equality. Hierarchical
traditions thus perpetuate the stigma of rape victims whilst fear and shame wrongly imposed upon
already deeply traumatised girls and women following sexual crimes, also means that many rapes
are never reported. Additionally, Human Rights Watch report that those with disabilities are ‘at an
increased risk of gender-based violence in their homes, schools, institutions and the community at
large.’ They are also ‘often excluded from support services’.
In many parts of the world, before a child is even born, anticipation of a female birth is met with the
mentality that a girl by her very definition, will always belong to someone else. The indoctrination
that allows a girl to be seen as a burden that must be removed and shifted on to another, and
therefore not be deemed as worthy as her brothers in receiving adequate nutrition, education and
healthcare, appears to be a key factor underlying renowned academic Amartya Sen’s estimation that
a ‘100 million women are missing’ because of gender inequality. An absence of compassion through
the breeding of cultural dogma remains a contributor to creating and maintaining endemic social
injustice.

6. The steps that will shift gender equality from debate and advocacy, as drawn to the forefront when
thousands of protestors poured onto the streets of India’s cities, following Jyoti Singh’s horrific rape
and death are already in motion, with activists around the world working for change and definitive
action. The acceptance of female stigma and blame will continue to be perpetuated unless the long-
held, very much learned narratives of social hierarchy, that endorse misplaced shame are challenged
and consistently readdressed; it must become a given that every individual, throughout their life, is
afforded the empathy and equal opportunity that will provide them with their basic human rights,
regardless as to whether they are male or female.
The description of a homeless beggar girl as having no value is a view that allows millions of
individuals whose abodes are the streets in our cities around the world, to remain a sad reflection of
society’s collective acceptance of inequality. One of the UN’s Millennium goals for 2015 was to
promote gender equality and empower women. Today on International Woman’s Day on 8th March
2015, I can’t help but think of Jyoti Singh. ‘India’s daughter’ was our daughter. Lack of compassion in
this world is our choice. I think of words spoken by the Dalai Lama at India’s Kalindi College for
Women, in January this year, ‘Humans create problems by discriminating on account of our
differences, but these are secondary. At the level of our basic humanness there is no source of
conflict. Basic human nature is compassion’ (Dalai Lama).
Khurshid Khatib is a writer and human rights campaigner.
https://twitter.com/khurshidkhatib
https://khurshidkhatib.wordpress.com/
References
BBC Storyville. 2015. India's Daughter. [ONLINE] Available at:
http://www.bbc.co.uk/programmes/b05534p0. [Accessed 12 May 15].
Bingham, J. Oxford grooming: social workers and police ‘turned blind eye to sexualized culture’. The
Telegraph March 3 2015
Dalai Lama speech on compassion, Kalindi College for Women New Delhi 28 Jan 2015
DNA. 2015. Modi government says no to rape crisis centres in every district. [ONLINE] Available at:
http://www.dnaindia.com/india/report-modi-government-says-no-to-rape-crisis-centres-in-every-
district-2063977. [Accessed 12 May 15].
Human Rights Watch website: Include Women, Girls With Disabilities in Anti-Violence Efforts New
Resource on Gender-Based Violence for People With Disabilities March 6 2015
Lerner, M.J. (1980). The Belief in a Just World: A Fundamental Delusion. New York: Plenum Press.
Lerner, M.J. and Lerner, S.C. (1981). The Justice Motive in Social Behavior: Adapting to Times of
Scarcity and Change. New York: Plenum Press.
Sen, A (1990). More Than 100 Million Women Are Missing. The New York Review of Books.
WHO. 2014. Violence Against Women. [ONLINE] Available at:
http://www.who.int/mediacentre/factsheets/fs239/en/. [Accessed 12 May 15].
Rubin, Z and Peplau, L.A (1975). Who Believes in a Just World. Journal of Social Issues, 31(3), pp. 65-
89.

7. Compassion and Care at the End of Life
Elisabetta Lucchi.
"Compassion is essential to humanity, relationships and a fulfilling life".
A Death Cafe is a frank and open discussion group with the conversation directed towards the topic
of death. There is no agenda and there are no objectives or themes. Its purpose is simply ‘to increase
awareness of death with a view to helping people make the most of their (finite) lives’. The Death
Cafe model was developed in 2011 in London by Jon Underwood and Sue Barsky Reid and it is based
on the Cafés Mortels originated by Swiss sociologist Bernard Crettaz. The meetings are open to all,
regardless of gender, religion, faith, ethnicity and disability: There is no intention to lead participants
to any conclusions about life, death or life after death and the discussion groups are always offered
on a non-profit basis in an accessible, respectful and confidential space. Death Cafes have spread
quickly across Europe, North America and Australasia. Since September 2011, 1439 Death Cafes
have been held in 25 different countries all over the world.
Death Cafe Verona started in February 2013. So far we have had sixteen meetings, with between 5
and 8 participants. Many issues come out during the meetings, among them: loss, in its various
forms (loss through death or separation, loss of a pet, of work, of friendship, of family relationships),
thoughts about the afterlife, grief, accompanying the dying (the difficulty of communication
between family members, doctors and patients, how listening helps, the practical help that can be
offered to those who take care of a family member with a terminal illness), fear of death and end-of-
life choices.
The people who take part in Death Cafes in Verona are mostly women and even though end-of-life
wishes and decision making are common topics for both sexes, there are actually some differences
between women and men regarding the issues that come up during the discussions. I have observed
that women talk more about their experiences of taking care of people at the end of life or about
grief (both in their own families and when doing voluntary caretaking at people’s homes or in a
hospice) and, although these women often have very different cultural and spiritual backgrounds,
they share common values as affection, compassion and care.
What I can say from my own experience as a Death Cafe facilitator is that it seems that women are
more in touch with their inner feeling, are sensitive to their own vulnerability and that of other
people and also feel more confident about sharing their feelings and emotions. However, these
women often complain about the lack of compassion and care that they encounter when their loved
ones are hospitalized. Communication with doctors is difficult and they are uncomfortable about the
often massive use of invasive treatments and technologies. This last point is crucial and represents a
much discussed, controversial topic in Italy. First of all, in Italy there aren’t any laws regarding end-
of-life decisions and therefore any decisions made are not considered to be legally binding.
Moreover, public opinion is polarized between two opposite views of life and its end and so far no
middle ground has been found. In addition, the strong influence and frequent interference of the
Catholic Church only serves to increase the polarization. Thus at the present time any decisions are
still trusted to the compassion and responsibility of doctors and relatives.

8. The concept of vulnerability has recently become more topical in philosophical discussions
(especially for women) and this has led to the development of the theory that human beings are
individuals who depend on and relate to others. Judith Butler (2004) in particular thinks of the body
as the seat of our common human vulnerability and she also points out that vulnerability must be
perceived and recognized as being applicable to all individuals. This suggests the need for a
transformation. I personally think it is precisely by cultivating and practicing compassion that this
shift can take place, particularly at the end of life, where vulnerability is at its limit and taking care
means taking care of the time of dying (Gensabella Furnari, 2008). Moreover, care always has a
practical dimension, it is made up of actions, connections, resources, obstacles, thoughts, feelings
and stories. In Carol Gilligan’s opinion (1982) it "combines heart and mind", resulting in an ethic of
care based on the criteria of interdependence, relatedness and responsibility to others. Because of
this deeply ingrained human interdependence, compassion is essential to humanity, relationships
and a fulfilling life. I strongly believe that compassion is one of the highest spiritual values and I
make efforts to cultivate and practice it every day. I have found inspiration and support in the
seminars of Frank Ostaseski (whose work focuses on issues related to death and dying, grief, loss
and supportive compassionate care) and in Death Cafes, which offer a great opportunity to talk with
others about death and dying and share thoughts, emotions and feelings. This type of seminar and
discussion group enables us to recognize how vulnerable we all are and to cultivate awareness, love
and compassion. We can thus acknowledge that we all share the same conditions of mortality. We
all suffer and we all die.
Elisabetta Lucchi is a qualified shiatsu practitioner and founder of Death Café.
References
Butler, J. (2004). Precarious Life: The Powers of Mourning and Violence. London-New York: Verso
Crettaz, B. (2010). Cafés mortels: Sortir la mort du silence. Gèneve: Editions Laboret Fides
Furnari Gensabella, M. (2008).Vulnerabilità e cura.Bioeticaedesperienza del limite. Soveria Mannelli
(Catanzaro): Rubbettino.
Gilligan, Carol. 1982. In a Different Voice: Psychological Theory and Women’s Development.
Cambridge, MA: Harvard University Press.
Ostaseski, F. (2006).Saperaccompagnare.Aiutareglialtri e se stessiadaffrontare la morte. Milano:
Arnoldo Mondadori Edizioni S.p.A.
Related links
Death Cafe www.deathcafe.com
Jon Underwood from Death Cafe on BBC World News
https://www.youtube.com/watch?v=hHk71wec198
www.facebook.com/deathcafeverona
Bernard Crettaz, Cafés Mortels http://www.dailymotion.com/video/xio51b_bernard-crettaz-cafes-
mortels_webcam
Frank Ostaseski - Metta Institute, Sausalito (California) http://www.mettainstitute.org/index.html

9. Global Insights into Compassion and Gender
Dr. Ayesha Ahmad
"I remember the moment a woman confronted me with her eyes to search my soul for an answer".
On March 8th
, International Women’s Day was celebrated around the world. Whilst reflecting on the
simultaneous festivals across cultures, religions, languages and societies to illuminate the plight of
those fighting against and suffering from gender inequality; I remembered some of the struggles I
have witnessed around the globe.
South Africa—I remember a grandmother who cradled in her weathered arms and hands that had
wiped too many a tear her disabled—and orphaned—grandson. His mother had died during
childbirth in a rural shack too far from the interests and concerns of modern healthcare systems. The
grandmother stayed quiet for much of the time that I saw her, communicating with a silent
compassion to comfort and contain the cries of her dead daughter’s legacy of life.
Cambodia—I remember a young girl too embroiled in the struggles of a society recovering from
genocide. She fell into that grief as if it were her own and could not bear the anguish of the bodies
and minds around her. Her world had become a crying circus of loss and pain. She could not see
beyond the graves to find the life she had yet to live. She swallowed a poison to take her to the place
where all of those who made up her past were resting.
Palestine—I remember the moment a woman confronted me with her eyes to search my soul for an
answer. How could she, she asked, accept that a young child who lay comatose in a hospital bed was
not going to recover? How could she, she begged, be a Muslim if she did not have hope? In that
conversation, we stood on the same land and we reached across her tragedy to find hope where it
was lost. I replied to her that sometimes our faith teaches us to have hope in a different way. We
found a peace by believing that there is hope when we pray that death can be a blessing; hope that
the child will receive a gracious afterlife.
In these stories, we often are struck by their clear expressions of pain. We are used to seeing and
understanding women as personifying suffering; their lives embodied by the burden of being a
woman in societies where just by virtue of being a woman means that you suffer. We see injustice;
we hear sorrow; we sense stagnancy—that change is difficult, though not impossible, even when it is
being fought for.

10. Compassion, though, often evades us. Compassion is a moral emotion—beyond feeling empathy,
compassion compels us to help alleviate suffering. To have compassion is to enter another person’s
narrative and to see the hidden amongst the patterns and language that a person conceals their pain
by. I found that the women I witnessed suffered from their compassion; they were able to perceive
and then receive the suffering that was surrounding them and they tried to hold out their hands to
rescue the fallen. Then they fell too.
When there is compassion held by a woman, how may that compassion translate beyond gender so
that compassion can have ownership by us all? Gender is an organizing principle in our society and a
force that can render a person powerful or powerless, silent or voiced.
A dangerous aspect of propelling the stories of women considered powerless and silent into the
media and global news-stream is how these stories are received. Perceiving pain in ‘the other’ may
elicit our compassion; but it can also eclipse the compassion that is nuanced and existing in the
stories of women who have suffered or died for the consequences of their compassion. Perhaps a
component of compassion is a paradox between strength and vulnerability. We may perceive the
woman who is bombarded with dictations about what behaviour is honourable and who bears the
frustrations of the conflicts that modern masculinity is facing in societies challenged by age-old
structures of religion and culture as being buried alive. But her strength may come from having
compassion with those around her albeit even if she is surrounded by perpetrators. This form of
compassion can foster silence too; a prioritization of another person’s voice above and over her
own. I am reminded in this instance of a reflection by activist, Brooke Axtell, who believed that her
compassion could heal another person, until she realized that her compassion was incomplete
because it did not include being compassionate to herself.
As we enter forthcoming dialogues about reaching gender equality and attending to the shocking
statistics regarding horrifying acts of violence against women, our compassion can become our
greatest saviour. Compassion can enter even the most gated of cultures and penetrate justifications
by raising lowered eyes to the gaze of the world. Yet we will only see when we can feel our sight;
when we can find the discourse of the silent narrative. Psychiatrist, philosopher and revolutionist,
Frantz Fonan, West Indian psychiatrist, psychoanalyst and social philosopher, known for his theory
that some neuroses are socially generated and influential in the fields of post-colonial
studies,warned us in the 1950’s that we were in dire need of re-conceptualizing what it means to be
a person. We need to use our compassion now as a tool, and bring the women who are victim to
gender inequality into the world. Their suffering must be understood with compassion and not
silenced into non-existence.
Dr Ayesha Ahmad is a Tutor at University College London Medical School and is a Philosopher
specialising in Medical Ethics, Culture, Mental Health, Disaster and Humanitarian Ethics.