Ursula Gruenenwald, Frankfurt/M. Finding the path back to life. The psychosocial work of medico international
- The beginnings of medico’s psychosocial projects are closely associated with the ideas of Marie Langer, a psychoanalyst who died in 1987. Born in Vienna, Langer fought in the Spanish Civil War, emigrated to Argentina and later lived in Mexico and Nicaragua. Throughout her life, she strove to utilize the insights and experience of psychoanalysis to further the liberation of human beings. According to Langer, changes in society would only succeed if the needs of people and the suffering which had left its impression on their lives were taken into account.
Langer’s goals corresponded to the approach applied by medico when it began supporting the establishment of community psychosocial services in Nicaragua in the early eighties. The aim of this work was to provide aid for mentally and/or physically injured persons and to ease their suffering and at the same time relate this aid to the living conditions and political and social framework within which it was carried out.
The project group Salud Mental
Four years ago, an internal medico project group was established under the title Salud Mental or Psychosocial Health. The project group discusses fundamental elements and concepts of psychosocial projects in the face of today’s advancing globalization and the end of a number of civil wars and wars of liberation.
These discussions focus on the situation and psychic status of people living in post-war societies, in regions where natural disasters have occurred, or where extreme poverty reigns – situations characterized by political instability and pervasive violence. The group aims to elucidate opportunities for supporting psychosocial projects in post-conflict situations and the explore the conditions which can promote or hinder processes of reconciliation. Based on medico’s own practical experience, the group’s work also focuses on the critique of an increasing trend towards integrating short-term psychological programs into emergency aid operations.
The results of the project group’s work are regularly presented to a broader (specialist) public. A medico report on the concept of trauma and its reception, which criticized the narrow perspective of PTSD, was published in 1997. One year later the group presented a report on the Truth Commission in South Africa, which aimed to promote a deeper understanding of the reconciliation process in South Africa and to present a critical analysis of the commission’s work. (For information on ordering these publications, see below.)
The project group currently organized a conference in summer 2000. Specialists who cooperate in their practical work in various psychosocial projects and organizations with medico international were invited to report on their experience to date and discuss perspectives for innovative and context-oriented project concepts. Based on a critical evaluation of various therapeutic approaches, we aimed to reflect on the development of concepts for psychosocial projects which are conscious of the reciprocal relationship between psychic, political and social dimensions of "working-through" traumatic experiences, rather than reducing psychosocial work to a kind of context-free psycho-technique.
Framework conditions for psychosocial project work today
In recent years, entire societies have been cut off from those regions of the world which are still prospering. One result of this development is an increase in the numbers of civil wars and of economies marked by civil war, in which hundreds of thousands of people are forced to organize their daily survival under conditions lacking even a minimum of legal protection. In numerous countries, people are subject to torture and repression. Millions are refugees and hope to resist total marginalization by migrating to other countries. In the rich countries, in contrast, a "citadel culture" is spreading; the inhabitants of these countries strive to defend the privileges of their "site" at all costs, with increasing paranoia and with the use of force "if need be."
The material misery of people in marginalized regions is coupled with psychic misery, which implants itself all the more tenaciously within individuals. A destroyed bridge may be rebuilt rather quickly; soon after a peace agreement has been ceremoniously signed, a reconstruction fund for rebuilding bombed-out factories is usually established. But the changes in people and in a society’s organizations which result from war and on-going violence are not so easily undone. The seeds of mistrust that have been sown, the fear, the broken families, the torn fabric of social relations, the loss of inhibitions which check violent behavior, the "evil" that has become normality – all of this remains, in tragic continuity, in extreme cases even for generations to come.
Such experiences manifest themselves in symptoms such as chronic anxiety, aggression, overwhelming feelings of shame and guilt, self-hatred, the feeling that one will never again be at home anywhere, and a multitude of psychosomatic disorders. Often, the wounds inflicted upon a person condense into a tyrannical force, taking hold of the subject and penetrating all of his/her life expressions. If trauma dominates not only individuals but entire societies in this way, then emancipatory developments may be stifled in their earliest stages. Herein lies the significance of policies of individual and social memory which have been the focus of public debate in societies ravaged by internal wars in recent decades.
The de-privatization of suffering – conceptual reflections
This last point serves to again underline the insight that psychosocial work is confronted with wounds which cannot be dealt with psychotherapy alone. What is needed is a balancing act, a strategy of action which offers individual victims therapeutic assistance and at the same time makes it very clear that sustainable changes can only be achieved if the social causes of psychic wounds are eliminated.
If the political and historical context of traumatization is ignored, there can be neither an understanding of the conditions leading to trauma, nor can there be effective therapy. On the contrary: if the complexity of traumatic events are overlooked, help for trauma victims may itself in fact serve to perpetuate the traumatization process. People who have experienced deep-seated psychic wounds due to violence perpetrated during war or dictatorships should not be pathologized and stigmatized individually, as is the case with the concept of Post-Traumatic-Stress-Disorder (PTSD). PTSD defines traumatic experience by the symptoms it creates and thus labels trauma as a clear-cut, easily diagnosed inner-psychic illness.
Treatment becomes possible when the suffering which victims perceive as private is "de-privatized" and treated under recognition of the social conditions which evoked trauma. Thus, as representatives of psychotherapeutic institutions which work with the victims of the Pinochet dictatorship in Chile report, the arrest of the former dictator effectively promoted the successful treatment of many of these patients. Suddenly, their suffering was again a public issue and aggressive impulses which had been turned inward again found their way into the open. Without hatred, there can be no reconciliation. Whether or not Pinochet was convicted seemed to be of little importance in promoting successful treatment. What was significant was the fact that the dictator was not left unmolested and would be unable to travel abroad without restrictions in future.
Four examples of the practical work of the project group
Working with the victims of torture and repression – Santiago de Chile
The victims of extreme traumatization have experienced death and yet are still alive. That is how colleagues at the "Istituto Latinoamericano de Salud Mental y Derechos Humanos" (ILAS), who have accomplished innovative work for many years, describe the effects of traumatization. The real catastrophe is not being able to die - to have to continue living. Help for people who have been catapulted out of their lives in this way calls for carefully spinning new threads to connect a seemingly unspeakable past and a present which is, as yet, unsurmounted.
Therapy for victims of extreme traumatization aims to overcome the "experienced" death, so that individual psychic structures and relationships with other persons can be reconstructed. A central element of treatment is the special bond which therapist and victim enter into (vinculo compremitido). Since victims of torture in effect perceive what has been done to them as a kind of self-dissolution, the therapist aims to aid the victim in experiencing this destruction as something inflicted upon him/her deliberately from outside. An active and partisan standpoint of the therapist is useful in this process, for it aids in making reality, as it existed before torture, visible once again. By utilizing the psychic structures of the therapist, who leaves no doubt that she/he is "on the same side" politically, the patients can again recognize themselves and find their way back into life. In Chile, medico supports ILAS’s work with victims of extreme trauma as well as the work of the "Comité de Defensa de los Derechos des Pueblo" (CODEPU), which offers family therapy and legal assistance to the victims of repression and their family members.
The preventive confrontation with the "culture of violence" – Cape Town, South Africa
For a large part of the world’s population, which is forced to live in the growing urban favelas, slums, and townships, daily life parallels in many respects life under the reign of violence. The fact that a large portion of the world’s population has been excluded from more or less secure, formal economic systems has far-reaching psychic consequences for those involved.
To experience one’s material existence as constantly threatened and to realize that one plays no appreciable role as a producer or consumer and is therefore literally worthless produces feelings of shame and guilt - feelings which can be contained only at the expense of significant personal losses. Since too much energy is expended in warding off anxiety-ridden affects, creative potential and the ability to imaginatively shake off the fetters of daily life are almost completely stifled. Creative capacities are replaced by a biographical propensity to violence, undirected hatred and irrationality, which finally seemed to legitimate continued repression and discrimination.
Breaking out of this vicious cycle calls for preventive measures, beginning in the earliest possible phase of the development of children and youths. The "Children’s Resource Center" is a small project dedicated to these aims. The Center’s work with several thousand children from the townships of Cape Town has become known beyond the limits of its immediate surroundings. The Center’s main goal is to provide young people, whose lives are characterized by shortages, frustration, daily beatings and sexual abuse, with opportunities to utilize self-determined spaces in which creativity can develop, as well as those other capabilities, which refuse to be blocked by the supposedly overriding necessities of current conditions.
Reconciliation requires justice – South Africa
Following the end of authoritarian regimes formerly opposed by liberation movements – some involved in conflicts lasting until the nineties – a number of countries, such as Guatemala and South Africa, have established so-called Truth Commissions. These are charged with promoting reconciliation within these societies by investigating the nature and the extent of former crimes and human rights violations.
As necessary as revealing the truth is, it is also essential to assert that reconciliation is impossible without justice. Justice is not to be equated with legal acts of revenge on the part of the victors but instead refers to a process whereby a reasonable balance is reached among survivors, including perpetrators, beneficiaries and victims.
Victims and perpetrators are not only those who actually fought with one another - former guerilla fighters and employees of the regime’s repression apparatus. People who suffered economic losses and a limitation of opportunities must also be considered victims, just as there are "quiet" beneficiaries, who profited from the regime of violence.
Complete reconciliation also calls for economic improvement, social transfers and compensation payments – these are the demands of a growing movement in South Africa.
medico therefore supports the "Khulumani Support Group" in Cape Town. This is a coalition of self-help groups organized by victims of human rights violations during the apartheid regime and their families, who have testified before the Truth Commission. The network aims to assert the interests of these victims and survivors in the public debate about "truth" and "reconciliation". This includes the initiation of income-generating projects and the establishment of a legal aid fund, providing resources which enable members of Khulumani to apply for compensation or pursue legal action against perpetrators whose crimes are not covered by the general amnesty.
Salud Mental Communitaria – psychosocial community work in Guatemala
The Guatemalan government’s campaign to repress political opposition aimed to destroy local community structures, the economic foundations of community life, social relationships, and cultural identity. In this context, psychosocial community work entails promoting and supporting the restructuring processes (rehabilitation) of the communities in an equally comprehensive sense. In the Rabinal district, where nearly 10% of the population were victims of massacres in the course of the repression campaign, the psychosocial community program implemented by the "Equipo de Estudios Communitarios y Acción Psicosocial" (ECAP) strives to support people in their efforts to break the many years of silence about experiences of violence and their work to change the present. Among the various components of the program are training for health workers in the area of mental health and the effects of violence, support for (therapeutic) self-help groups, and various forms of assistance for communities, ranging from support in exhuming victims buried in mass graves to establishing a community museum with exhibits on the community’s culture and the politics of destruction.
Translation from German: Paula Bradish
- Further information and publications
- Please contact us if you would like to receive more information about medico and its projects.
If you would like to be informed about medico’s psychosocial projects on a regular basis (including announcements about publications, conferences and workshops etc.) please contact us so we can put you on our mailing list.
Account for donations
Please note the project name "Salud Mental":
1800 Frankfurter Sparkasse (BLZ 500 502 01) and/or 6999-508 Postbank Koeln (BLZ 370 100 50). medico international has the seal of approval of the Deutsches Zentralinstitut für soziale Fragen (German Central Institute for Social Affairs).
The two reports mentioned at the beginning of this article can be ordered directly from medico in writing or by phone:
medico-Report 20: Schnelle Eingreiftruppe "Seele". Texte für eine kritische Traumaarbeit (Rapid deployment squad "soul". Texts for a critical approach to trauma), 1997, 96 pp., DM 10,-
medico-Report 21: Der Preis der Versoehnung. Suedafrikas Auseinandersetzung mit der Wahrheitskommission (The price of reconciliation. South Africa grapples with the Truth Commission), 1998, 96 pp., DM 14,-
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Short biographical note medico international is a Germany based development organisation, founded in 1968. All the activities of medico international are directed towards promoting and supporting initiatives striving to improve health condition of human beings. medico cooperates with local partners presently in 15 countries of Africa, Latin America and the Middle East. Support is given in the following sectors: primary health care, mental health and human rights, emergency aid for refugees in situations of war and natural disasters, social movements and community based initiatives.
In addition medico is active in campaigning und publishing around development issues, social movements and globalisation.
medico is member of Health Action International (HAI), the International Campaign on Apartheid-Caused Debt in Southern Africa and the campaign FATAL TRANSACTIONS which informs about the economonic and political background of wars in Africa.
medico is co-founder of the International Campaign to Ban Landmines (ICBL), Nobel Prize winner in 1997.
Ursula Gruenenwald
Email U.Gruenenwald@t-online.de
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Citation Ursula Gruenenwald, Finding the path back to life. The psychosocial work of medico international. In: Trauma Research Newsletter 1, Hamburg Institute for Social Research, July 2000.
URL http://www.TraumaResearch.net/net1/forum1/grun.htm
Copyright © 2000, Ursula Gruenenwald and trauma newsletter, all rights reserved. This work may be copied for non-profit educational use if proper credit is given to the author and the trauma newsletter. For other permission questions, please contact via email the editor Cornelia_Berens@his-online.de
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