Disrupting Legacies of Trauma: Interdisciplinary Interventions for Health and Human Rights
Volume 23/1, June 2021, pp. 11-25
Joan Simalchik
Abstract
The devastation caused by war and atrocity extends beyond the battlefield and creates conditions with severe public health consequences in affected societies. The infliction of socially organized mass violence and the suppression of reporting of harms has an impact on multiple levels: the individual, the familial, and the social. Ignacio Martín Baró, a Jesuit priest and social psychologist, explored the impact of psychosocial trauma while living and dying in the 1980–1992 Salvadoran civil war. His depiction of the multilevel impact of atrocity provides insight into the connection between health and human rights. This article discusses how his analysis of the constituent parts of psychosocial trauma continues to hold relevance for understanding the legacy of historical events and points to possibilities for mitigating health harm in various contemporary contexts.
Introduction
No part of the world has been spared the experience of mass atrocity in the last century, and the early decades of the current one are continuing the trend. Following periods of intense mass violence, some regions have transitioned to democracy with varying degrees of success. Prolonged exposure to repression, organized violence, and war, however, have produced cultures of fear that present psychosocial obstacles to the establishment of good governance, healthy populations, and a human rights culture. How does the process of democratization frame power relations within a context of contested memory and meaning? How can the psychosocial consequences of mass atrocity be understood? How can they be mitigated?
If, as Sandra Bloom posits, “the twentieth century has become known as the Century of Megadeath,” there have also been attempts to codify and address its traumatic effects.[1] “A traumatic event is a shocking, frightening, or dangerous experience that can affect someone emotionally and physically.”[2] The duration of one’s reaction may be acute, chronic, or complex. Ignacio Martín Baró’s theory is significant in that it address both how individuals and the societies in which they live are harmed by traumatic events.
Speaking to the impact of violence beyond the battlefield, Devon Hinton and Alexander Hinton’s Genocide and Mass Violence: Memory, Symptom, and Recovery highlights “expressions and meaning of distress that are culturally specific.” The authors state clearly that “psychological and somatic manifestations will vary and so, diagnosis and understanding must also vary.” They then go on to explain that “trauma persists as a memory, forgetting and remembering affect the physical and social bodies and that through this process recovery can also begin.”[3] Each of these threads supplements Martín Baró’s theory, and its general application applies to other relevant traumatic contexts.
Andreas Hamburger, Camellia Hancheva, and Vamik Volkan’s Social Trauma: An Interdisciplinary Textbook provides a “bridging concept” for a multifaceted approach to post collective violence interventions.[4] The methodology is intended to collapse the distance between clinical, social, and cultural remedies. Additionally, Karin Carrington and Susan Griffin’s Transforming Terror: Remembering the Soul of the World takes a similar approach, arguing for an interdisciplinary understanding of trauma that incorporates spiritual and cultural perspectives.[5]
Lisa Butler, Filomena Critelli, and Janice Carello’s Trauma and Human Rights: Integrating Approaches to Address Human Suffering emphasizes the importance of context and recontextualization.[6] Their text offers an important intersectional examination of how race, gender, sexuality, age, health, and immigration status impact the experience of trauma. The concept is essential when constructing appropriate interventions in the aftermath of atrocity and demonstrates how and why essentialism should be avoided.
Taking into account the differences in the experience of trauma, others speak to the distinction by concentrating on specific case studies. Inger Agger and Soren Jensen’s Trauma and Healing under State Terrorism analyzes the specific trauma treatment developed by politically engaged health professionals working under the Pinochet dictatorship in Chile.[7] The treatments they devised and delivered clandestinely were relevant for those persecuted in their shared understanding of the root of the terror. Al Fuertes’s Community-based Warviews, Resiliency and Healing: The Internally Displaced Persons in Mindanao and the Karen Refugees on the Thai Burmese Border supplies nuanced contextual framings of community backgrounds and explains how, with support, communities are capable of defining their own experiences and shepherding their own healing.[8] Erica James’s Democratic Insecurities: Violence, Trauma, and Intervention in Haiti cites the specific obstacles, including chronic instability, that prevented the provision of assistance to women survivors during and after the country’s 1991 coup d’état.[9]
This particular set of contemporary theories recognizes and underscores the interdisciplinary nature of trauma. Many highlight the roles that anthropology, history, political science, medical and public health, law, art, and religion can play in a psychosocial framing of trauma and its possible amelioration. They point to the relationship between the social context of the traumatic event and the psychological impact on individuals and the wider community. Most importantly, they underscore the importance of social context by considering the experience, practice, and direction of the affected communities themselves.
Martín Baró developed an earlier iteration of this concept under conditions of war and repression in El Salvador. His theory of psychosocial trauma and destruction provides insight into how systems of organized violence impact individuals, their families, their communities, and their health. He signifies three elements inherent to the creation and endurance of psychosocial trauma: (1) organized violence, (2) institutionalized lies, and (3) social polarization.[10] All three serve as constituent elements that reinforce one another. When organized, systemic and institutional violence is practiced and then denied by the perpetrators, social schisms are created, and social polarization is intensified.[11] Under state terror, human rights crimes are inflicted but never acknowledged. During periods of democratic transitions, unless this problem is addressed, there remains a danger of leaving psychosocial trauma unabated.
Martín Baró describes how consequences of mass violence and atrocity create “circles of silence” that can persist past the violence itself.[12] Interrelated factors, personal, cultural, and social, can determine how persecuted individuals, their families and communities, and the wider society each constitute a closed circle that perpetuates denial. Circles of silence enclose the victims who have been rendered as the “other,” often without recourse to justice; the families who seek to protect; bystanders who fear repercussions; and the perpetrators who conceal the crimes. Each is entangled in interconnected webs that require propitiation.
This article discusses both the psychosocial consequences of “circles of silence” and the interventions that hold the possibility of creating “circles of support” as potential antidotes to circles of silence. These circles of support may create opportunities to mediate traumatic effects on the intersecting levels of private and public pain. Disrupting traumatic legacies and breaking the silences require intercessions for and from individuals, families, communities, and the state, as well as an interdisciplinary understanding of health and human rights.[13]
Health, human rights, and the social consequence of global atrocity
In contemporary times, civilians have always been casualties of war or disregarded as “collateral damage.” During the 20th and 21st centuries, however, an increased erasure of boundaries between combatants and civilians became evident.[14] “In the more than 100 civil wars between 1989 and 2010, nearly 50 percent of governments and 60 percent of rebel groups targeted civilians with severe forms of violence—massacring them, deliberately bombarding residential areas, burning homes and crops, or forcibly expelling people en masse from particular territories.”[15] Historically, civilians have always been injured when in the line of fire, but in modern versions of conflict, civilians increasingly have been deliberately targeted or used as human shields to mask movements of armed forces.[16]
International responses to atrocities have ranged from outright condemnation to the creation of new policy initiatives for both prevention and harm reduction. In regions where access to health care is limited or nonexistent, the Universal Declaration of Human Rights’ article 25 guarantees the right to “medical care and necessary social services.”[17] This right, however, has been proven inadequate in perception, development, and implementation. Senior scholar Leonard Rubenstein laments this lapse when conceptualizing care:
Yet even as the human rights community employed international humanitarian law in its work, it largely ignored the right to health in situations of political and armed conflict. This neglect extended beyond war, to situations of political volatility and violence, where international humanitarian law does not apply. In part, this neglect was a product of the general lack of attention to the power of the right to health to advance human well-being.[18]
The post-World War II international rights machinery created unintended separations between the various rights agendas.[19] While the right to health is affirmed as one of the 30 articles of the Universal Declaration of Human Rights, as Rubenstein maintains, “the right to health in situations of political and armed conflict” often remains unrecognized. If the right to health in these contexts is overlooked as a distinct right, then the role that public health can play is hindered.
Still, the concept of health, and that of its abrogation, is embedded in additional United Nations (UN) conventions that hold the potential to strengthen the nexus between health and human rights. In the aftermath of World War II and the recognition of the mass horror of the Holocaust, the UN Convention on the Prevention and Punishment of the Crime of Genocide was unanimously adopted in 1948 and included important language citing the infliction of serious mental harm. Although the final definition was limited by multistate negotiation of the term, the notion that the infliction of mental harm constituted an act of genocide remained.[20] In 1987, the UN Convention against Torture went further and included a provision for “full rehabilitation” for those so victimized.[21] Yet the chasm between established international mechanisms and their implementation on the ground can be difficult to traverse.
One casualty of the disconnect between the right to health and human rights claims is the often inadequate response, even for the temporary provision of immediate care, to incidents of organized violence. During the 2019–2020 eruptions of mass public protests in Chile, for example, police fired anti-riot shotguns into crowds that resulted in thousands of eye lacerations, fractured bones, and other injuries with little medical help available to meet these emergencies.[22] With public clinics and hospitals understaffed to meet crisis care on this scale, volunteer health professionals stepped in to provide cursory emergency medical attention amid the protests. This provisional support was frequently disrupted when the Carabineros, the national police force, directly attacked the makeshift but vital relief stations. A dialectical understanding of how the right to health is inextricably linked to human rights extends beyond service provision to the notion of prevention of health harms. The right to receive adequate health care is superseded only by the right not to be victimized. When human rights claims are met with violent suppression, individual and public health is undermined. Seen as an intrinsic right and not only as a by-product resulting from war and atrocity, the right to health can fundamentally be valued and, subsequently, be effective.
Outside of open warfare, the consequences of socially organized violence multiply when considering the ways in which dictatorships employ repressive measures against civilian populations. Examples of these types of human rights violations and crimes include imprisonment, torture, rape, and other sexualized violence and forced disappearance. These tactics are either executed alone or in concert, but all are devised to deter resistance against regimes that hold power through violence. When Amnesty International first started to document the “epidemic” prevalence of the practice of torture, the organization noted how human rights crimes were utilized as a means “to deter third parties” from challenging repressive systems.[23] Decades later, the evidence continues to confirm this assertion. Ezat Mossallanejed, senior policy director for the Canadian Centre for Victims of Torture, writes, “Torture should not be approached in isolation. It is part and parcel of a strategy of political repression … in order to paralyze the whole population … it acts as a sinister shortcut to maintaining power that has not been derived from the cross-section of the populace.”[24] Regimes that likely would not be democratically elected employ a continuum of repressive acts that also include threats against family members and fear of losing employment and status in the community. All of these repressive measures create cultures of fear and long-standing effects on individuals and the communities in which they live.[25]
Psychosocial trauma, circles of silence, and circles of support
One of the ways in which we talk about the long-standing health impacts of violence on individuals is through the lens of trauma. In his thinking about the context of El Salvador, Martín Baró parses psychological trauma and social trauma from the more complex phenomenon of psychosocial trauma. In the first case, harm exists within the individual as a consequence of “difficult” and “exceptional” experience. In the second, whole populations may share a common historical experience of harm, though, of course, the exact experience of individuals is shaped by their personal history and unique social location, especially their role in the conflict. Psychosocial trauma is more complex in that the origin of harm is social, “not something within the individual.” To Martín Baró, “psychosocial trauma [implies the] crystallization in individuals of the social relations of war that are experienced in a country.”[26] In particular, social relations are organized to cause alienation and harm and, over time, become less and less malleable, further stagnating the possibility of change and healing.
In the context of long-term and systemic oppression, Martín Baró cites three primary ways in which social relations become polarized and calcified. First, the experience, or even the threat, of violence seeds an embodied fear that can be documented in observable physical symptoms, such as trembling or stomach upset. At the level of individuals, this fear encourages an ardent denial of facts in the interest of self-preservation. One may deny having been victimized despite evidence to the contrary (for example, bullet holes in property or burned fields) out of fear of retribution. Added to this, “campaigns of polarization” keep a country in a state of heightened “psychological tension:”
[F]acts are ideologized, people are demonized, and the use of those very political spaces that have begun to open is criminalized—all of which leads to an apparent stagnation of social confrontation and to greater difficulty in trying to establish spaces for interaction of the various social groups with respect to objectives they share.[27]
Finally, an “‘official story’ [is created] which ignores crucial aspects of reality, distorts others, and even falsifies or invents still others.” The official story is propagated by intense propaganda, and further protected, as those that hazard to contradict the new “facts” are considered “subversive.” Though terrorism may be supplanted by military order, many of the actors remain the same, and the “militarization of order” demands that any public activity first receive institutional approval, thus preventing those that would challenge the status quo from interacting.
To Martín Baró, the primary psychosocial harm that individuals experience under such circumstances is this “alienation of social relations.” The individual experiences the stress that such social polarization lodges within the physical body (somatization), and those who are most at risk for polarization are likely to incur greater somatic harm. The climate of fear and silence shrinks one’s social world, limiting the potential to have one’s reality validated, which “corresponds to a sense of insecurity about what one thinks and to skepticism regarding the various social and political options.” The tension between what one has experienced and the lack of social validation may cause added stress, exemplified in the felt experience of very social emotions such as guilt and diminished self-worth. Finally, the militarization of social thought, feeling, and behavior is propagated by socialization such that it eventually becomes normalized:
People who are formed in this context (learn to) assume an inherent contempt for human life, adhere to the law of the strongest (or the most violent) as a social criterion, and accept corruption as a lifestyle, thus precipitating a vicious circle what tends to perpetuate the war objectively as well as subjectively.[28]
Martín Baró believed that under such circumstances, the original and continued harm to individuals can only truly be mitigated by first addressing the social context and the injury to social relations that otherwise will prevent the potential for sustained and widespread healing. Barring an approach that focuses on the social origin of trauma, and its perpetuation by a stagnated and normalized social order, any treatment of the individual (including the utility of psychotherapy) would remain “at best incomplete.”
If a solution is possible, Martín Baró suggests that it is
necessary to begin an intensive effort to depolarize, demilitarize, and deideologize the country, in order to heal social relations and allow people to work out their history in a better kind of interpersonal context. Stated in positive terms, it is necessary to work toward establishing a new framework for coexistence, a new “social contract” that would allow collective interaction without turning disagreement into mutual negation. There is an urgent need to work toward a process of greater social sincerity, in order to learn about realities before defining them, to accept facts before interpreting them. Finally, an effort must be made to educate by reason, not by force, so that coexistence can be based on mutually complementary efforts employed to resolve problems, not on violence used to impose one’s own alternative.[29]
This vision is foundational to the creation of what I call “circles of support.” Fundamentally, an environment must be made safe for individuals to share their experiences and to have that experience validated in the present, and it should be reflected in the building of the social order going forward. This process includes how the past is dealt with in the present and how it will be remembered. The challenge for the historian is to do this work without further alienating and harming the individuals involved, beyond what pain is necessary to heal. Thus, liberatory frames that allow the oppressed to design their own emancipation from previously imposed silences seem essential.
History, memory, and circles of silence
Beyond emergency health responses during conflict, war, or repression, the insufficiency of care extends to other areas of health concerns.[30] After the cessation of hostilities, physical and psychosocial complications remain. People who are scarred by physical and psychological torture, imprisonment, deprivation, and terror have a right to be recognized and treated.[31] In conditions of precarious transitions away from conflict and atrocity, however, delicate political compromise can forestall the establishment of a human rights agenda for long-term health needs. The task of collapsing the difference between public and private pain remains incomplete and difficult to surmount. Erna Paris entitled her study of postconflict, post-atrocity countries Long Shadows: Truth, Lies and History as a trenchant pronouncement on transition states. After an examination of contexts as varied as the antebellum United States, post-World War II Europe, the former Yugoslavia, and post-apartheid South Africa, Paris concludes that the prevention of national amnesia of cataclysmic events requires justice and accountability to move societies out of cycles of violence.[32] Impunity for perpetrators of atrocity can eclipse calls for justice and a righting of accounts. If there is institutional state failure to admit past wrongs and their impact, then there can be no consequent acknowledgment expressed for its victims.
In states of amnesia, little can be accomplished to discern the tasks needed to advance reconciliation under the image of a half-imagined history. Reconciliation, in this sense, would require all actors to shape a collectively understood past to prevent a conflicted future. Schisms can remain, wounds can fester, and propensity for division and conflict can remain alive. If it is said that Irish people have a memory as long as a rainy week, then Canada can also claim a stormy history. Contemporary Quebec automobile license plates read “Je me souviens” (“I remember”), in a direct gesture to an ostensibly unreconciled past. The mnemonic recounts the 1759 Battle for Quebec, when the British and French Empires fought for control of North America. Over two centuries later, the Canadian francophone province remembers the historic defeat of France and subsequent subjugation under British domination. This memory has strong resonance and contributes to contemporary secession debates. History’s shadows perpetuate unresolved loss and pain.
Individuals bear war wounds, but, in cases of mass atrocity crimes, the ultimate target of violence is the body politic. Regimes that cannot hold power through democratic means resort to systems of repression to seize and maintain power.[33] Nonstate actors often employ terror to establish and hold a geographical power base, as exemplified by the Islamic State.
Beyond the individual level, cultures and societies are transformed by the infliction of deliberate destabilizing senses of safety and security. Constructed cultures of fear do not evaporate without explicit endeavors to deconstruct and replace them with transparency and rule of law.[34] Traditional civic supports and familiar communal routines are eroded in times of war and repression, when powers usurp social protections.[35] Under dictatorships and in failed or repressive states, for example, the conventional notion that police are protectors of the rule of law is nullified when police become officially sanctioned perpetrators of violence and atrocity.[36]
The situation is exacerbated when censorship clouds reality and prevents the transparent transmission of fact-based information. Official denial of repression contributes to the diminishing of individual and collective psychosocial health. Under conditions of socially inflicted mass violence, human rights violations and atrocity crimes are integral to sustaining repressive power, but authorities most often deny their occurrence. Few regimes, or nonstate actors, admit to committing atrocity crimes. This denial contradicts the lived realty of the populace who know family or neighbors who have been disappeared and know that torture is inflicted. The disconnect between the official story and lived experience further undermines individual and public well-being.
People who recognize their own experience cannot find validation or understanding of their victimhood in the wider community. Individuals looking forward to finding recognition in the transitional state instead can find that their experiences remain theirs alone. The dialectical impact of damage done to individuals resonates in the impact of damage to the social fabric.
Institutional lies and social polarization
In Writings of a Liberation Psychology, Martín Baró posits that institutional violence has deleterious consequences by shrouding its impact in circles of silence. Atrocity crimes and violence are predicated on dividing communities into categories, separating groups into “us” and “them.” Here, the other is created, produced, and then denigrated to the point of dehumanization. Ethnic, class, gender, sexuality, religious, and political differences are purposefully intensified and inflamed. Historic grievances are recast to serve a contemporary political agenda. In different situations, the “other” may be described as “subversives” (Argentina) or “infidels” (Iran) or through further dehumanizing rhetoric, such as “cockroaches” (Rwanda). The schisms created are not easy to dismantle in the aftermath of war and repression. The resultant injuries may be borne by individuals, but these harms continue to wreak havoc on individuals as well as the res publica when official silence persists.
A notorious example of how social polarization operates is illustrated by the wars in the former Yugoslavia. Prior to the late-20th-century wars in the region, and before his presidency, Slobodan Milošević took advantage of the 600th anniversary of the Battle of Kosovo, when Serbs were brought under Ottoman rule, to exacerbate ethnic rivalry between Serbs and Muslims.[37] In a build-up to the 1989 anniversary, Milošević began a deliberate campaign that violated the tenuous ethnic equality pact (originally organized by the 1919 Treaty of Versailles) by provoking division among the country’s Southern Slavs. The 1389 Battle of Kosovo was used by Milošević in a “Serbian victimization narrative.”[38] Historic grievances were recast to serve a contemporary nationalist agenda.[39]
In the unstable contexts of transitioning from conditions of organized violence to some form of democratic governance, political compromises mitigate against official corroboration of past injustices. In Spain, between 1936 and 1939, an estimated 500,000 lives were lost, with approximately 135,000 more assassinated during the Franco dictatorship.[40] General Francisco Franco’s death in 1975 allowed for a new political reality to develop that was not possible in his lifetime. In 1977, an amnesty law was promulgated that entrenched the Civil War’s schisms. According to the law, prisoners of Franco’s fascist regime were freed, but the regime would not be held accountable.[41] The arrangement left little room for post-fascist governments to address the past. After the amnesty law’s promulgation, there were no prosecutions for executions, torture, or disappearances of civilians. Mass graves remained hidden and undisturbed. No truth commission was permitted. Only recently, decades after the cessation of hostilities, and only after persistent pressure from victims’ families, has the Spanish government begun undertaking exhumations in the more than 2,000 mass graves still being located in Spain.[42] Bodies of disappeared prisoners are being located on behalf of grandchildren and great grandchildren who are finally able to identify and give proper burials to their relatives.
In another example of a circumscribed transition to democratic rule, Chile’s 1991 Rettig Report (officially the National Commission for Truth and Reconciliation Report), was mandated to investigate only those violations that resulted in death and disappearance. It took another 13 years for the Valech Report to document the tens of thousands of torture cases incurred during the Pinochet dictatorship, and the report required two more iterations to account for even more cases of torture.[43] South Africa’s Truth and Reconciliation Commission had an amnesty provision embedded directly into its own operational protocol.[44] Typically, in transitional contexts, “truth” is circumscribed by circumstances, with the consequences being that reconciliation is measured out in small enough doses designed to be sufficient to placate the populace, or at least a part of the populace.[45]
Thus, victims suffer first the trauma of original harms, and second the retraumatization of transitional compromises aimed more at structural stability than individual and community well-being.
During transitions out of mass violence, provisions for health care, notably psychological services for victims, have been only sporadically established and are often inadequately funded. Memorial and commemorative practices are usually undertaken, even if grudgingly so.[46] Varying in degree from country to country is the establishment of public memorials, museums, officially sanctioned ephemera, sites of remembrance, and testimonial archives.[47] Yet, the perfunctory manner in which many of these memorials and commemorations are instituted tends to undermine a comprehensive reconciliatory purpose and frequently creates new schisms in the emergent culture. When he served as the Ford Foundation’s director of the Andes and Southern Cone, Alexander Wilde witnessed the “waning will for expressive politics” by Chile’s transition government toward memorials to the country’s victims of the Pinochet dictatorship. In 1994, when the memorial to the persons disappeared during the military regime was inaugurated in Santiago’s general cemetery during summer vacation, a sub-cabinet official was the highest-ranking representative of the new democratic government in attendance.[48]
In precarious political terrains, a reluctance to provoke perpetrators ultimately subverts the constitution of fundamental human rights regimes and the prevention of backsliding into mass violence and atrocity crimes. “The waning will” to memorialize renders social divisions intact and helps obscure past atrocity for the larger society.
Advancing circles of support
When the lived experience of individuals is at odds with the official record or narrative, it undermines the creation of healthy, forward-looking societies and serves as a barrier to progress. What had been known surreptitiously about past human rights crimes might be reluctantly exposed, but not always officially championed by states following war and atrocity. Ambiguity can shroud truth through covers of equivocation. Sola Sierra, who served as president of Chile’s Association of Relatives of the Disappeared in the years after the end of the military dictatorship, cogently expressed the transitional dilemma of speaking “half-truths, lies, [and] two-faced attitudes,” admitting that “no society can establish solid moral pillars under those conditions.”[49] Efforts, such as truth commissions, that set out the facts of past atrocities can begin to counter the legacy of institutional lies and help the past emerge into the national consciousness.
New realities continue to emerge that require a precise reading of the evolving political and social spheres after the cessation of hostilities and violence. Moving out from underneath the onus probandi (burden of proof) of past atrocity crimes is a complex negotiation between what is deemed politically and legally possible at any given time under existing jurisprudence, and what can ultimately lead to accommodation with impunity. For Martín Baró, context is key to understanding this process. A complicating problem affecting the notion of context is that circumstances surrounding atrocity crimes are dynamic, active and forceful—not static. They change, even if imperceptibly. New realities continue to appear, and the cessation of hostilities and violence does not automatically resolve the problem of contested memory.
Simultaneously, different sectors of society that ascribe separate and distinct meanings to lived experience perceive contradictorily the contours of any given context. Deeply held impressions may not correspond with the unstable landscape, and how these experiences are employed and deployed can pose barriers to newly constructed social and political projects.[50] Within a particular demarcated zone, societies continue to be divided, and these segments may be differently impacted. While society as a whole has been reshaped by atrocities, the past does not affect everyone uniformly or mechanistically.[51] Individuals assume different perspectives, with some choosing to forget what they know or what they experienced, and others starting to learn about the past only after official denial and censorship is lifted. Changing power dynamics dislocate the institutional practices of memory as well as the conditions that create and undo political and personal relationships.
Awareness of these contextual changes is critical to the forging of new pathways and to discerning how those pathways will be set. Determining possibilities for justice and accountability requires a clear understanding of new political and social terrain for successful remedies to be achieved. It also requires an understanding of human agency in its varied iterations.
Raul Hilberg’s influential trilogy of perpetrators, victims, and bystanders is a taxonomic framework that defines distinct participants and their roles in atrocity crimes.[52] But this formula can enmesh individuals in essentialist classifications when the changing landscape is not recognized as a nuanced space. The delineation of any transitional justice project provides possibilities for the agency of individuals to be engaged. Victims who organize for justice, provide testimonial evidence for human rights crimes, and create commemorative practices utilize their historic roles as active proponents of human rights. Marianne Hirsch explains how individuals considered vulnerable “can open up a space of interconnection as well as a platform for responsiveness and resistance.”[53] Efforts, both individual and collective, to transform traumatic experiences hold the capacity to transform social relations as well and enlarge the social space to be more receptive to human rights possibilities.
New political terrain established during political transitions exposes more relational divisions that can impede reconciliation or even possibilities for reconciliation. Barriers to transformation include the denial of human rights crimes by perpetrators who seek to escape punishment for their culpability. But beyond the perpetrator classification exists a dimension of accountability for all sectors. Holocaust and historical memory studies scholar Michael Rothberg provokes us to look more deeply into the complicated responsibilities among and between victims and bystanders along with those of perpetrators. In The Implicated Subject: Beyond Victims and Perpetrators, Rothberg claims that entanglements of persons living in conditions of extreme violence blur lines between categories, with no one left exempt from conscious or unconscious accountability. Complicity with atrocity is understood as a continuum among all actors in antithesis of Hilberg’s three-pronged rubric. Rothberg’s formulation demands consideration from all sectors so that trauma, individual and collective, can be allayed. “It both draws attention to responsibilities for violence and injustice greater than most of us want to embrace and shifts questions of accountability from a discourse of guilt to a less legally and emotionally charged terrain of historical and political responsibility.”[54] In this understanding of historic grievances, the legacies of atrocity crimes implicate future generations to take action against denial of complicity and to accept responsibility. This can then preclude the diffusion of intergenerational trauma by expanding social engagement and creating accountability, if not reconciliation, beyond the present.
Rothberg posits that “[s]ocially constituted ignorance and denial are essential components of implication; as such they are also potential starting points for those who want to transform implication and reconfigure it as the basis for a differentiated long-distance solidarity.”[55] Implicated subjects, and even their descendants, can transcend their confined roles by breaking through denial and acknowledging a more profound reading of social divisions. Rather than exchanging one role for another—perpetrator to victim, for instance—all individuals would be obligated to realize the complex multiplicity of culpability. Viewing histories with a nuanced perspective opens possibilities beyond a facile “black and white” reading. Failure to perceive, to admit, to act, for whatever reason, changes little and can keep in place cycles of violence.
Neglecting to dislodge the traumatic sequelae of atrocity condemns the past to remain as an open wound. Analyzing how context, power, and agency intersect can inform the forging of transitional possibilities toward healthy societies. Prioritizing analyses of context and power should not obscure the importance of human agency in the transition process. The ability of individuals and collectives to act is an essential element that can be at times discounted by the political powers of the day.
For the forging of strong democratic relations, processes committed to genuine reconciliation are required. A rush to foreclose the brutal past by preemptively demarcating the present may inadvertently impede opportunities for the (re)inclusion of victimized individuals into a society from which they were forcefully ejected. Despite demonstrated resilience and agency, survivors are too frequently rendered inconsequential. Even more, they can be seen as unwelcome reminders of past horrors who threaten to end social denial.
For example, Helen Bamber was a young social worker in Bergen Belsen after the liberation of the Nazi concentration camps. She recalled how Holocaust survivors were first met with shock and sympathy, but as time wore on they were recast as displaced persons. Few countries were prepared to accept them. Survivors were unwanted by their original homelands and not able or willing to return to them. Well into the 1950s, Bamber recalled, “[Survivors] changed from being creatures for compassion to being irritating people—displaced persons who had nowhere to go.”[56] They became embodied reminders of a genocidal past whose experience was not openly welcomed in postwar societies.
Similar treatment exists today for other survivors of genocide also deemed to be inconvenient for the politics of the present. A quarter of a century after the massacre of Srebrenica, where more than 8,000 Muslim Bosnians were murdered, thousands of survivors continue to live in refugee shelters set up as temporary facilities. Many more thousands are still internally displaced from their hometowns. Uprooted, unemployed, and depressed, families have seen their lives held in abeyance for generations.[57] Psychologists observe high levels of posttraumatic stress disorder not only in the original victims but also now in their children and grandchildren.[58] Avdo Hrustanovic, a second-generation survivor, grew up in these precarious conditions. He ruefully observed, “Every July, journalists go to Srebrenica for the anniversary of the genocide, but no one comes to Jezevac to see how the survivors of that genocide live now.”[59] The living have been expunged, not only from the past but also from the present. As embodied evidence of atrocity, they deserve the right to health, but their position on the margins of memory prevents its delivery.
In the state of official denial of atrocity pasts, there is often an innate desire to distance history and eclipse atrocity so that memory may be subsumed by the present. But remembrance of the past endures in new iterations of context. Trauma induced by repression can continue unabated unless the circles of silence can be transformed into “circles of support.”
One step to address institutional lies, organized violence, and social polarization is the pursuit of justice. Inherent in forging new social relations is the desire, by those victimized, for justice to be implemented and impunity to be ended for perpetrators.[60] If justice cannot altogether heal, acknowledgment of injustice restores notions of individual and collective security, especially for those whose rights have been violated. State interventions with criminal trials for human rights crimes establish official repudiation of past repression and can ease survivor suffering and allay intergenerational trauma. Given the multilayered dimension of psychosocial trauma, interventions on this scale, including human rights trials, can be seen as working on multiple levels beyond the institutional.
Psychiatrist and scholar Judith Stern’s The Eichmann Trial and Its Influence on Psychiatry and Psychology describes the crucial role that this trial played in recasting Holocaust survivors from silent victims to active witnesses in the promulgation of justice. Nazi officer Otto Adolf Eichmann was a major organizer of the Holocaust who was responsible for organizing the logistics of mass death. Following World War II, he fled to Argentina when, in 1960, Israeli agents captured him and brought him to Jerusalem. Indicted on 15 criminal charges, he was tried in a televised trial, convicted, and executed in 1962. The trial was much publicized and punctured the silence surrounding the Holocaust and those who survived it. Nearly 100 survivors provided first-person testimonies that formed much of the evidence against Eichmann. Prior to the trial, a “collusion of silence,” between health providers, society at large, and Holocaust survivors existed for those not prepared to comprehend Holocaust experiences.[61] The trial, however, offered the ability to provide a contextual understanding of the circumstances; there was a rationale for speaking, a meaning made of the atrocity, and an opportunity, at last, for society to witness survivor experiences.
“The Eichmann trial permitted the opening up of survivors’ experiences in public. Legal procedure enabled the witnesses to speak about what they had hidden until then. The judge’s presence gave legitimacy and power to the accusations, transforming the survivors from outlaws to partners in justice.”[62] Stern details how intersecting levels of private and public pain were revealed as legal processes influenced health outcomes. Indeed, she outlines how more appropriate professional trauma informed therapy developed side by side with the social awakening to the lived realities of survivors. Similar processes of testimonial evidence were undertaken in Chile, Cambodia, and South Africa, among others.[63]
The Eichmann trial punctured the circles of silence surrounding the Holocaust on multiple levels, both in Israel and internationally. On an individual level, survivors were given the opportunity to use their agency to testify about their traumatic experiences. Families and later descendants were able to amplify survivors’ voices. Society, in general and institutionally, was able to validate the experience and transform its traumatic impact by making meaning of the past. And as Stern documents, one important result was the mitigation of trauma, both individual and collective.
The outcomes of formal trials for perpetrators of human rights crimes are not uniform. Justice remedies that focus entirely on the legal aspect are insufficient as agents to meet the complex mental and public health needs of societies. While they may hold the propensity to precipitate a wider social response, courts alone are insufficient in this regard.
Alexander Hinton provides a salient example of how overreliance on legal remedies can limit comprehensive approaches to human rights development. In 2006, the Khmer Rouge Tribunal was convened to prosecute the senior members of Pol Pot’s genocidal regime in Cambodia (1975–1979). Hinton’s The Justice Facade: Trials of Transition in Cambodia is a sharp critique of instances where legal mechanisms fail to address the private dimension of pain.[64] Hinton argues that the tribunal was merely a “justice façade” that left unreconciled the divide between the formal legal proceedings and the social and cultural context of the country. He particularly suggests that attention must be paid to the inclusion of the “survivors’ voice,” which should be intrinsic to any human rights intervention. He cites the work performed by civil society actors who were able to render the court proceedings into terms that fit the cultural and religious meaning of the community.
Contrasted with the Eichmann trial, where the legal mechanism provoked the need for specialized health and counseling for survivors, in Chile the treatment offered to persecuted persons created legal evidence for the indictment of General Pinochet on an international warrant.[65] During his 18-year rule, Chile became notorious for the infliction of torture, imprisonment, and disappearances. The Chilean testimonial model of treatment stressed the significance of survivors’ narration of the traumatic event as a historical record.[66] The testimony was intended to make meaning of the experience and become a useful device for human rights complaints to international bodies. The documents were archived by human rights organizations, and teams of health and legal professionals worked along with historians and archivists facilitating the agency of survivors.
Another instance of historical reclamation took place in Peru, where a nongovernmental organization, REDINFA, constructed a collective history of trauma following the country’s decade of violence in the 1980s. Organized from the grassroots, its mission was to produce a more detailed accompaniment to the 2001 National Truth and Reconciliation Commission:
The central feature of the program was the development of community historical memory, an exercise that we thought would acknowledge the value of individual and collective experiences. This led us to carefully collect their testimonies, mitigate their pain, and support their emotional recovery, while at the same time opening the path toward dignity, a symbolic form of compensation. In this way, the development of historical memory went beyond the mere historical reconstruction of what was experienced and became a space for expression, acknowledgement of individual and collective capacities, resources and learning, for the joint and consensual construction of a different future for the participants.[67]
Beyond “the symbolic form of compensation,” the testimonies brought individual experience into a collective framing of how traumatic experiences could be understood and mitigated for individuals and the wider society.
The replacement of circles of silence with intentionally constructed circles of support has effectively addressed psychosocial traumas in more recent times. For example, psychologist and scholar M. Brinton Lykes is a founder of the Ignacio Martín Baró Fund, which supports community-based projects in global contexts. The fund has supported psychosocial community workshops, including those with Mayan women in Guatemala and with children survivors of war in the Philippines.[68] Based in the United States, the fund has a dual purpose: to assist the process of healthy community development after atrocity and to “infuse historical and academic knowledge with voices and action ‘on the ground.’”[69]
Repercussions of mass atrocity are global and extend past the borderlands of the affected geographical area. The creation of refugees is one example of how this operates. The Rohingya people who fled repressive onslaughts in Myanmar in 2016 have since been living in insecure refugee camps in Bangladesh. Both countries deny responsibility for them, and poor conditions have been exacerbated by COVID-19. Due to the pandemic, UNICEF has been forced to close schools for 460,000 Rohingya refugee children and, with a reduction of available camp workers, other services have also been reduced.[70] The right to health, in this context, is stymied by the opacity of responsibility (and thus agency) in such cases.
In another part of the world, refugees fleeing the Syrian conflict are being forcibly pushed out of countries. While Turkey encourages would-be asylum seekers to enter Greece, Greece is expelling them into the Mediterranean Sea.[71] Other European countries in proximity to escape routes are closing their borders. The United Nations High Commissioner for Refugees has commended Italy for being the exception in keeping its ports open through the pandemic and urges others to do the same.[72] The United States under the Trump administration reduced the numbers of refugees it was willing to accept to an all-time low.[73] When nations retreat from obligations embedded in international human rights conventions, severe public health consequences arise. Refugee fatigue is compounded by fear of illness, which creates even more obstacles to finding safe havens. When viewed in this light, people who have been victimized can be reduced to a sum of their victimization without any connection to the systemic oppression that created the conditions for flight.
Conclusion
Writing the commentary “Wresting with the Angels of History” in Genocide and Mass Violence: Memory, Symptom, and Recovery, Laurence Kirmayer identifies how whole populations face global atrocities. He posits:
[T]he remainders of violence can be seen at the levels of body, self, and society. The responses at each level have their own dynamics, involving physiological, psychological, and social processes that range from the intimate sphere of family systems to the wider arenas of neighborhood, community, nation, and the international networks of global society. These systems are deeply interconnected and we need interdisciplinary perspectives to trace the effects up and down these levels.[74]
Over the past century, understandings of the nature of trauma and its impact have continued to develop. Ignacio Martín Baró’s theory of psychosocial trauma and destruction, with its emphasis on the relationship between context, individual, and social well-being, is foundational to contemporary theory. He explains how trauma can be understood as having multiple impacts on individuals, families, and society and how, without intervention, circles of silence will continue to prevent recovery at each level. Pertinent for present and future work is the dynamic quality contained in his writing. He offers no rigid formula to follow but instead provides a theoretical model that requires a critical inquiry for each instance. An analysis of historical and existent cultural conditions and power relations will influence the creation of appropriate trauma care for the individual, familial, and social spheres.
Establishing foundations to build healthy societies following atrocity can be accomplished with greater international cooperation and recognition of the power of interdisciplinary engagement. Legal, health, humanitarian, philosophical, social, artistic, and political fields all hold the possibility to contribute to rupturing Martín Baró’s circles of silence and to construct circles of support as antidotes. Rothberg’s implicated subjects provide yet another type of opportunity to provide relief. The entanglements of those existing within and outside of global atrocity charge us to recognize how we all bear accountability for the creation of atrocity and, equally, for its amelioration and prevention.
Joan Simalchik, PhD, is Director of the Women and Gender Studies Program at the University of Toronto Mississauga, and the founding Executive Director of the Canadian Centre for Victims of Torture, Toronto, Canada.
Please address correspondence to the author. Email: joan.simalchik@utoronto.ca.
Competing interests: None declared.
Copyright © 2021 Simalchik. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.
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