Vaughan Bell, Beyond Boundaries column, The Psychologist, September 2011
Dr Ricardo de la Espriella’s office is surprisingly quiet. Buried deep within San Ignacio University Hospital, the growl of the chaotic Bogotá traffic is perceptibly absent. Despite the street-level pandemonium, the capital city of Colombia remains an oasis of relative calm in a troubled country. The five decade old conflict has been pushed back from the urban fringes and persists, unabated, in the rural areas where it continues to devastate the country’s diverse cultural landscape. Dr de la Espriella has long promoted an understanding of how psychological distress is filtered through cultural norms. “There are difficulties in recognising post-traumatic stress in certain populations which is why cultural psychiatry is so important” he stresses, highlighting the surprising variation in response to suffering. In this case, however, he is not talking about the culture of ethnic or racial groups, but the micro-culture of illegal paramilitary organisations.
While working on a project to rehabilitate ex-members of illegal armed groups, he noticed a striking absence of post-traumatic stress disorder in his patients, despite them having experienced extreme violence both as combatants and civilians. Many had taken part in massacres and selective assassinations, and many had lost companions to equally brutal treatment. There were high levels of substance abuse, aggression and social problems, but virtually none showed signs of anxiety. Intrigued, de la Espriella decided to investigate more closely and carefully interviewed the ex-paramilitary patients again, using the Clinician Administered PTSD Scale, which asks specific and detailed questions about post-trauma symptoms. After this more detailed examination, more than half could be diagnosed with the disorder.
The reason for why none of these symptoms presented in day-to-day life seemed to lie in paramilitary sub-culture. While aggression and drug abuse are tolerated, anxiety is taboo to the point where members showing signs of anxiety can be killed by their compatriots for being ‘weak’. This brutal emotional environment shapes the men to neither show nor spontaneously report any form of fear or nervousness. de la Espriella reported his remarkable findings in the Colombian Journal of Psychiatry where, as a clinician working to rehabilitate ex-paramilitaries, he discusses the difficulties in treating people who have been involved in violence and killing. His work also raises the uncomfortable of who we consider to be a victim of conflict. Can we extend our compassion to those who commit the atrocities or do we allow those who swim in the tides of war to drown in its powerful currents?