Mental Health Work with People Affected by State Terrorism in Uruguay: a Personal Reflection on 25 Years Work Intervention 2013, Volume 11, Number 1, Page 94 - 100

Mental health work with people affected by state terrorism in Uruguay: a personal reflection on 25 years work Intervention 2013, Volume 11, Number 1, Page 94 - 100

Mental health work with people affected by state terrorism in Uruguay: a personal reflection on 25 years work

Celia Maria Robaina

In this personal re£ection, the author describes her palpable in the streets, and military and mental health work and experience with people police vehicles invaded the city.The violence who have su¡ered from the political violence impacted those people and institutions that occurred during the dictatorship in Uruguay, nearest and dearest to me: family, friends, 1973 ^ 1985. She presents a personal account of school and neighbourhood. I remember the socio-political processes and her experience as how abruptly the harmony of my childhood a psychotherapist, from then until today.The author memories changed. At that time, I did not, argues that the psychosocial trauma that has been of course, know that I would later study in£icted by the state cannot be healed by only ‘mental psychology.Today, I realise that the violence health’ work, as the process for reparation and I had seen as a child pushed me to choose this justice in Uruguay has been very slow and painful. profession, trying to overcome the sense of Furthermore, she has observed that the impunity powerlessness it had created, and to help granted perpetrators may re-victimise survivors, reverse the damage. and further damage their mental health. Psycho- Uruguay is a small country in southern logical work with people a¡ected by state terrorism Latin America with around 3 million requires interdisciplinary analysis and, as the inhabitants. In the past, it had had a strong author argues, mental health professionals should democratic tradition and was, at one time, join in the struggles of their patients. In Uruguay, called ‘the Switzerland of America’. All that as elsewhere in Latin America, psychotherapists changed in the late 1960s, when the repres- have formed organisations to assist the survivors, sion began. However, it was not until June and raised their voice within the public discourse. 1973, the start of the dictatorship, that This has contributed to breaking the silence sur- Uruguayans learned what the loss of the rule rounding events, and has helped to come to terms of law actually meant. During the dictatorial with the psychological e¡ects of state organised regime, silence and fear grew as state violence. In her work, the author has learned the terrorism advanced. What happened in importance of exchange of information between Uruguay was similar to other countries in colleagues, including colleagues from other countries. the southern part of the continent; dictator- ships received signi¢cant support from the Keywords: dictatorship, mental health, United States, aiming to destroy popular political violence, state terrorism, Uruguay mobilisation by sowing fear and isolation among citizens, and to impose neoliberal Introduction economic policies. Political violence in Uruguay began when The Uruguayan military specialised in I was a child. A repressive climate was systematic torture (both physical and

psychological) and prolonged detention. di¡erent disciplines (physicians, psycholo- Prisoner numbers, including people who gists, social workers, physical therapist),with were tried by military courts and people the goal of providing comprehensive health held in detention without any form of pro- care to: former political prisoners and their cess, amounted to a ratio of 31 per every families, the families of the disappeared, 10,000 inhabitants (Servicio Paz y Justicia, political exiles and their families, and 1989). Torture was applied systematically to relatives of politicians killed. destroy the militants,‘to teach a lesson’ and to In the1980s, many former political prisoners create a passive society that was numb, and consulted doctors in SERSOC for their therefore, would not rebel. As a result of this physical symptoms. In most cases, they political persecution, about 100,000 people denied having any psychological problems were forced into exile. The organisation, and took pride in this stance. Many said Asociacio¤n de Madres y Familiares de that, although the enemy had tried to break Detenidos Desaparecidos (Mothers and them psychologically, they were psychologi- Relatives of Disappeared Detainees), esti- cally unbroken. It was a general period of mates that about 230 people disappeared euphoria, in which they intended to catch without a trace. Others were killed, or died up and engage in personal and social in prison due to lack of medical care. projects. During the dictatorship, psychologists work- In 1985, the country returned to democracy. ing with victims met their clients in private The new government granted amnesty to o⁄ces, in other words, in isolation. Mental political prisoners and provided support for health professionals were unable to network exiles to return to the country. However, in or consult each other, at least until 1983 1986, parliament passed a law that left those when a strong popular mobilisation started responsible for the military dictatorship against the dictatorship. In 1983, the asso- unpunished. Attempts to overturn this ‘law ciation of psychologists was created, as of impunity’, through a referendum, failed. well as two nongovernmental organisations This has had a signi¢cant impact on all (NGOs) that worked with victims of the victims who felt that by not bringing the oppression: the Comisio¤n por el Reencuen- perpetrators to justice, the entire democra- tro de los Uruguayos (Commission for the tic system was discredited. In response, the Reunion of Uruguayans) and the Centro president said that those who spoke about de Orientacio¤n y Consulta (Counselling the past had ‘eyes in the neck’ (meaning their and Consultation Centre). focus was not on the future) and continued I started working with the Servicio Paz y to pursue a public policy that promoted Justicia (Peace andJustice Services), the ¢rst silence, oblivion, fear and lies. human rights organisation in Uruguay, This created a huge challenge for psy- when I was at college. I workedthere for over chotherapists working with survivors of a decade. This experience largely guided political violence. The psychoanalytic train- my career, urging me to re£ect on the links ing that we had had was not su⁄cient to between psychology and human rights. In understand the issues raised by these clients. 1985, just after I ¢nished my undergraduate We were young and had primarily learnt studies, I joined the NGO Social Rehabilita- by trial and error. tion Service (SERSOC). This organisation Psychoanalysis had taught us that therapy was created in 1984, by professionals from should be directed primarily to the analysis

95 Copyright © War Trauma Foundation. Unauthorized reproduction of this article is prohibited. Mental health work with people affected by state terrorism in Uruguay: a personal reflection on 25 years work Intervention 2013, Volume 11, Number 1, Page 94 - 100

of unconscious con£icts, with great emphasis provide comprehensive health care services, on early childhood issues. However, people o¡ered them a safe framework. did not consult us for mental illness, but We had to work not only with the e¡ects of because of disturbances in their lives that state terrorism, but also the e¡ects of impu- had resulted from traumatic experiences. nity. Policies of forgetfulness and impunity These problems did not ¢t in our therapeutic have e¡ectively silenced victims for 20 years, models, which were aimed at the treatment and as a result, these policies have of ‘neurosis’or‘psychosis’. It was insu⁄cient to ‘re-victimised’ them. The lack of social proces- analyse them fromthe perspective of the per- sing of state violence prevented the social son’s individual history, or what happened validation of the damage. Impunity gener- in the family during childhood, while at the ates denial, ignorance and lack of public same time ignoring social, ideological and recognition for the victims. Their stories political factors. Unlike the work with other were not integrated into the history of traumatic experiences, we were confronted families, communities or national history. with clients that had traumatic experiences Clinical work faced serious constraints; that were in£icted by the state, the institu- social trauma could not be healed if pro- tion that was to suppose to be the guarantor cesses of recognition did not accompany it of good life in society. As result, we turned by the societyandthe state. As of today,there to social psychology to understand collective isstillalongwaytogo. and group processes, to analyse the dialecti- The o⁄cial discourse of forgetfulness cal link between socio-political factors and created a general lack of interest in the the intra-psychic. The insights created from psychosocial consequences of violence and the ¢elds of sociology, anthropology and torture. However, a few human rights political philosophy were used, as we needed organisations continued to work on these to understand the psychosocial e¡ects of themes, patiently and persistently. Popular state terrorism, as well as the importance mobilisation and claims of Truth, Justice and of collective identity, and the social impacts Memory1 were revived by the end of the of the crimes committed against the people 1990s. New organisations of a¡ected people that were referred to us. appeared, and new literary, journalistic or The 1990s were di⁄cult years. The media academic works were published. After every did not talk about what had happened public event related to the past occurred, during the dictatorship. The technical team the number of consultations to SERSOC of SERSOC was reduced. International increased. A shared public discourse in agencies abruptly withdrew their ¢nancial Uruguay eventually emerged that admitted support, arguing that the state should take what had happened, which empowered indi- care of the politics of reparation. In my viduals to talk about those experiences that clinical work, patients spoke little of the had been previously dissociated or buried. trauma experienced, and whole families As therapists in the team of SERSOC, we appeared to share silence and secrets that looked for literature to understand the prevented processing what had happened. experiences of our patients. We were enligh- In general, patients did not link present tened by texts by Levi (1986), Arendt (1963), di⁄culties with past experiences. However, Frankl (1979), and Kae«s (1995) who re£ected the fact of attending an institution such on the horrors of the Second World War. as SERSOC, with a clear commitment to In South America, a generation of therapists

emerged who had theorised based on mental including forensic research, and an o⁄cial, health work with people a¡ected by state historic enquiry5 that will open the archives terrorism. This resulted in publications of the dictatorship. Some torturers and the from Argentine (Kordon et al., 1995; Ri¡o main dictators were put on trial. The Uru- & Freraut,1992),from Chile (Weinstein, Lira guayan parliament adopted two laws (2006; & Rojas, 1987; Lira & Castillo, 1991) and 2009) concerning reparations to victims of from Urugay (Vin‹ ar & Vin‹ ar, 1993; Gil, state terrorism, o¡ering material, symbolic 1990; SERSOC,1995). and health care compensations. Since then, We observed that psychosocial trauma within our clinical consultations, clients are should not be addressed with purely clinical able to easily and more directly link their approaches. It was also necessary to promote current su¡ering with trauma’s experienced actions within the social and political during state terrorism. We have also spheres to foster truth, justice and commem- observed that the political and social pro- oration. This meant that professionals work- cesses, dealing with injustices of the past, ing within the clinic, with this population, generate positive outcomes in the victims, had to also be citizens committed to partici- and in general, positively in£uence the pate in the same struggles as those of our psychotherapeutic processes with these patients. clients. In 2000, the Peace Commission2 was In 2006, I strongly felt I needed to deepen created, which implied recognition that the my training. Many other teachers from the state had a debt to the families of the disap- university agreed and we attended a course peared. However, the commission estab- on ‘Psychosocial Work in Political Violence and lished to ¢nd the missing, achieved scant Disasters’, organised by the School of results. Relatives turned to SERSOC Psychology, at the University of the Repub- because they did not get the information lic, in collaboration with the Community they needed: what had happened to their Action Group in Spain and the Universidad relatives? Where did it happen? Who was respon- Complutense de Madrid This allowed us to sible? Where were the remains? learn from experiences in other countries, From the 2000s, some colleagues and I felt and to create a network with other Latin we needed to share the knowledge we had American colleagues (see Pe¤rez-Sales, 2006). accumulated in our professional lives, not SERSOC had always advocated that the only within the academic world, but also state should take responsibility in providing within the wider society. I believed that psy- reparation to the victims of state organised chologists could o¡er the Uruguayan society violence. When this was done, the mission explanations and education, in terms of psy- of SERSOC was largely achieved. The chosocial trauma. Such knowledge helped Ministry of Public Health established a to break the silence and begin to integrate programme providing mental health care the past. Four NGOs3 involved in mental for victims of the dictatorship. In 2009, a health and human rights organisations from group of eight mental health professionals Argentina, Chili, Brazil and Uruguay established a new NGO, the Cooperativa jointly wrote a book: Landscapes of Pain, Paths de Salud Mental y Derechos Humanos of Hope (EATIP et al., 2002).4 (COSAMEDDHH, Mental Health and In 2005, the leftist president Tabare¤Va¤zquez Human Rights Cooperative). We were launched some public policies of reparation, contracted by the Public Health Ministry

97 Copyright © War Trauma Foundation. Unauthorized reproduction of this article is prohibited. Mental health work with people affected by state terrorism in Uruguay: a personal reflection on 25 years work Intervention 2013, Volume 11, Number 1, Page 94 - 100

to serve the population that we were As of 2011, we entered a new phase. Some assisting before as an NGO. However, while victims have formed groups that litigate in the government promised to provide free order to achieve justice. COSAMEDDHH health care to victims and their children, is assisting and supporting a group of the funding for the mental health services female, ex-political, prisoners who have is limited and our NGO can only cover reported cases of sexual violence su¡ered in around 200 patients a year in the capital hostage situations, and during imprison- Montevideo. ment. These brave women have broken Wehad high hopes in 2010, whenJose¤Mujica taboos, and have had the courage to speak was elected president of Uruguay. Mujica to the media so that these crimes do not hadbeen a leader of the revolutionary move- remain hidden. The work of accompanying ment Tupamaros, and a political prisoner this process went through several stages. for 13 years, in the worst conditions. How- The ¢rst was to consolidate a group that ever, he merely continued some of the was strong and acted as container. Then, it policies inaugurated by his predecessor, wastimetowritetestimonials, elect lawyers, and in e¡ect, not much changed. In my ¢le a complaint, go to the hearings and clinical work with COSAMEDDHH, I use undergo psychiatric forensic reports. only group psychotherapy. I believe group Currently, the witnesses are making their psychotherapy is the best therapeutic option statements. The accused will be cited later. because it promotes collective processes Those who were victims, now cry out for and allow polyphony of speeches, as well as justice. Nevertheless, the Uruguayan a kaleidoscope of views that enriches the justice system has not yet established case analysis. Group therapy also allows the law regarding these crimes against human- rebuilding of puzzle pieces and amalgamat- ity. The obstacles are many. For now, the ing shared stories that were previously goal of prosecuting those responsible for damaged, isolated or silenced. As therapists, sexual violence now joins the goal of creat- we intend to integrate the past life history ing courts and prosecutors specialised in of each individual and family, work with these crimes. the ghosts generated by the injuries, and modify the subjective marks of horror suf- References fered by the victims. We work to enable the Arendt, H. (1963). Eichmann en Jerusalem. (Eich- client to build new personal and social mann in Jerusalem: a Report on the Banality projects, and to increase the potential of of Evil.) Barcelona: Editorial Lumen. the subject to built narratives that include those that allow them to bear the torments. Equipo Argentino de Trabajo e Investigacion Other elements of therapeutic work include Psicosocial (EATIP). Grupo Tortura Nunca strengthening the healthy aspects of survi- Mas R|¤o de Janeiro (GTNM/RJ). Centro de vors, and to generate movements that are Salud Mental y DD.HH. (CINTRAS). Servi- directed toward the social sphere in order cio de Rehabilitacio¤n Social (SERSOC). to ‘deprivatise’ damage, and to promote a (2002). Paisajes del dolor. Senderos de Esperanza. society that acknowledges the dark parts of Salud mental y Derechos Humanos en el Cono Sur. our history. A therapist should accompany (Landscapes of pain, paths of hope. Mental the process of empowerment of survivors of health and human rights in the Southern organised violence. Cone.) Buenos Aires: Polemos.

Equipo Argentino de Trabajo e Investigacion Guilt and Grief. Towards an Integrative Psicosocial (EATIP). Grupo Tortura Nunca Psychotherapy.) Madrid: Editorial Descle¤ede Mas R|¤o de Janeiro (GTNM/RJ). Centro Brouwer. de Salud Mental y DD.HH. (CINTRAS). Servicio de Rehabilitacio¤n Social (SERSOC). Ri¡o, J. & Freraut, V. (1992). Estudio de Salud (2009). Dan‹ o Transgeneracional: Consecuencias de Mental en Presos Pol|¤ticos en Per|¤odo de la represio¤npol|¤tica en el Cono Sur. (Transgenera- Transicio¤n a la Democracia. (Mental health tional Damage: Consequences of Political study political prisoners in transition to Repression in the Southern Cone.) Santiago: democracy.) Santiago de Chili: Coleccio¤n Gra¤¢ca LOM. Cintras.

Fran k l, V. (1979). El hombreen busca de sentido. Barce- ServicioPazyJusticia.(1993[1989]).UruguayNunca lona: Editorial Herder S.A. (in Spanish. Mas: Human RightsViolations,1972^1985 (trans- Originally published in English in 1962 as lated by Elisabeth Hampston). Original title: Man’sSearch for Meaning) Uruguay Nunca Ma¤s, Informe sobre la violacio¤na los Derechos Humanos 1972 ^ 1985. Philadelphia, Gil, D. (1990). ElTerror y laTortura. (The terror and PA: Temple University Press. the torture.) Coleccio¤n Bibliotecas de Psicoa- na¤lisis SerieTextos. Montevideo: EPPAL. Social Rehabilitation Service (SERSOC). (1995). Represio¤n y Olvido. Efectos psicolo¤gicos y sociales de Kae«s, R. (1995).La impunidad amenaza contra lo la violencia pol|¤tica dos de¤cadas despue¤s. (Repres- simbo¤lico. In La Impunidad. Una perspectiva sion and oblivion. Pyschological and social psicosocial y cl|¤nica. (Impunity. Psychosocial e¡ects of political violence two decades later.) and clinical perspective.) Buenos Aires: Montevideo: RocaViva. Editorial Sudamericana. Vin‹ ar,M.&Vin‹ ar,M.(1993).Fracturasde memoria. Kordon, D., Edelman, L., Lagos, D.& Kersner, D. Cro¤nicas para una memoria por venir. (Fractures (eds) (1995). Asistencia Psicoterape¤utica. In of memory: Chronicles for a memory to come.) La Impunidad. Una perspectiva psicosocial.y Montevideo: Trilce. cllinica. (Impunity. Psychosocial and Clinical Perspective.) Buenos Aires: Editorial Suda- Weinstein, E., Lira, E. & Rojas, E. (1987).Tr a u m a mericana. Duelo y Reparacio¤n. Una experiencia de Trabajo Psicosocial en Chile. (Trauma, Grief and repair: Levi, P. (1986). Los hundidos y los salvados. (The psychosocial work experience in Chile.) drowned and the saved.) Trad al espan‹ ol 1988. Santiago: FASIC/Editorial Interamericana. Barcelona: El Aleph. 1 The work by these Human Rights Organis- Lira, E. & Castillo, M.I. (1991). Psicolog|¤adela ations was summed up in this slogan:Truth, Justice Amenaza Pol|¤tica y el Miedo. (The psychology of and Memory (Truth, to know what happened; political threat and fear.) Santiago de Chile: Justice, to prosecute those responsible; and Ediciones ChileAme¤rica CESOC. Memory, to integrate this past into the national history). Pe¤rez-Sales, P. (ed.) (2006). Trauma, culpa y duelo. 2 The Peace Commission was established by Hacia una psicoterapia integradora. (Trauma, Resolution of the President of the Republic on

99 Copyright © War Trauma Foundation. Unauthorized reproduction of this article is prohibited. Mental health work with people affected by state terrorism in Uruguay: a personal reflection on 25 years work Intervention 2013, Volume 11, Number 1, Page 94 - 100

August 9 2000, in response to the need to deter- 5 The research is the responsibility of the Univer- mine the status of those detained and dis- sity of the Republic. Two teams were created: one appeared during the dictatorial period, as well consisting of historians, and the other of anthro- missing children, on equal terms. pologists. 3 Equipo Argentino de Trabajo e Investigacion Psicosocial (EATIP). Grupo Tortura Nunca Mas Maria Celia Robaina is a psychotherapist R|¤o de Janeiro (GTNM/RJ). Centro de Salud with the nongovernmental organisation Mental y DD.HH. (CINTRAS). Servicio de COSAMEDDHH (Mental Health Coopera- Rehabilitacio¤n Social (SERSOC). tive and Human Rights) in Uruguay and is 4 Followed by: ‘Transgenerational Damage: Conse- professor of the School of Psychology at the quences of Political Repression in the Southern part of Universidad de la Repu¤blica, Uruguay. South America’ (EATIP et al., 2009). email: [email protected]