by Nunca Más is an international human rights and psychosocial response network that supports survivors of collective violence in the Global South, focusing on their mental health and political advocacy by applying the psychosocial approach. In this interview with Jan Ole Haagensen, founder and board member of the organisation, I delve into the psychosocial approach in practice, its cultural variety, and its limitations, as well as explore topics such as community empowerment and violence prevention.
Recently, in the academic world, numerous studies have demonstrated the high risk of mental health problems among populations which suffered potentially traumatic events such as torture, mass conflict, or natural disasters. Among others, the American Medical Association, in its research, highlights the high rate of post-traumatic stress disorder (PTSD) and depression, addressing those issues as “post-conflict mental health”.
The objective of focusing not only on the physical but also on the mental state of the victims of human rights violations gave rise to a so-called psychosocial approach to development work. Overall, the psychosocial approach is dedicated to communities that suffer mental health issues due to previous exposure to violence and highlights how social structure (political system, economy, health care, etc.) affects people’s mental well-being, underlining the need for social change.
The psychosocial approach in practice
Nunca Más is an organisation that supports survivors of collective violence in the Global South, focusing on their mental health and political advocacy for justice both in the individual and collective aspects. Its goal is to “accompany people in their ongoing societal struggles, and deal with the contemporary trauma without disregarding or neglecting the structural root causes for these traumas[…]”
For instance, Nunca Más conducted a project in Honduras where they were working with the Lencas indigenous community which was experiencing forced displacement, death threats, kidnappings and other forms of physical and psychological violence from part of the government and private landlords. Moreover, some of the organisation’s founders took part in a project in Cambodia assisting people who suffered persecution during the Khmer Rouge regime and a project in India which addressed the problem of power abuse by Indian police.
Noteworthy, Nunca Más’ psychosocial approach is based on the work of Ignacio Martín Baró, an XX-century Spanish-Salvadoran psychologist, philosopher and Jesuit priest, who was questioning the traditional psychology stream, highlighting the importance of including structural phenomena in the discussion. Nevertheless, the systemic perspective on mental health is still relatively recent in humanitarian assistance. Jan Ole Haagensen, Nunca Más’ founder and board member, who holds a PhD in Social Sciences from Roskilde University, explains the ongoing switch to a psychosocial approach in the development field:
“In Denmark, when we work with torture survivors, it is very much about having psychologists, psychiatrists, specialised nurses, physiotherapists and social workers. Formerly, the approach to mental health issues in development work was very medicalised, Northern, and based on many resources. However, in the Global South, the problem is much bigger and the resources are much smaller, so the question is how to deal with that?”
Overall, resources are an issue in development work, but it is not only about the lack of highly skilled professionals; according to Jan Ole Haagensen, the reality is more complex:
“Another issue is that people cannot come again and again [to mental health support sessions] because of lack of time, the political situation, money, and, in the poorest areas, also because of transportation. In the Global North context, people can come back next week and take part in long-term treatments with therapists, etc. And, for that reason, it becomes difficult to conduct research, compare patients, and, above all, assist them. You have to find a different way. That’s why we are looking for evidence-based methods which are not difficult in the sense that you don’t need highly skilled personnel but you can do some simple things to help people, and one of those methods is testimonial therapy.”
Testimonial therapy
Nunca Más focuses mainly on the testimonial therapy method, which was created by the two Chilean psychologists Ana Julia Cienfuegos and Cristina Monelli, in the times of the Pinochet dictatorship, when many people suffered torture by the regime. Testimonial therapy addresses the experience of collective violence, delving into its individual and collective dimensions. Originally, the method consists of two parts: firstly, victims tell their traumatic experience individually and the testimony is written down; and secondly, the public presentation of the testimony takes place, where the testimonies are read out loud with the participation of all the violence survivors. Jan Ole Haagensen states that testimonial therapy is about helping them write down and structure their story and accompanying them in the healing process while creating a safe space to share their experience.
“What is special about testimonial therapy is that it doesn’t require extensive training. Overall, it is the people themselves who have to be ready for the process and as an interlocutor, you only ask questions in relation to the story, you don’t give advice, and you don’t give therapy, because the majority of people who are trained to do it are not therapists,” he clarifies.
Moreover, Dr Inger Agger, psychologist and Nunca Más’ founding member, modified the method and added a third part to the process: a testimonial ceremony. It is relevant to highlight that the ceremonial part varies from region to region, based on culture, religion, ethnicity, etc. For instance, when working with the Lencas indigenous community in Honduras, the third part consisted of the Cosmic Ceremony which is embedded in the local beliefs, and in Cambodia, testimonial therapy finished with a traditional Buddhist ceremony.
“That is an added value to the message which was already there, and it is appreciated by the people we work with who are part of the testimonial therapy process. It is really important for many communities to include a spiritual aspect to a process that aims to help them heal psychologically,” Haagensen points out.
Essentially, implementing the testimonial therapy method in the organisation’s work was a way of finding a possibility for change in the complex social environment. As Haagensen claims: “Testimonial therapy is a possibility to, on the one hand, equip ordinary people with some tools to contribute to the healing from the trauma they have, and on the other hand, strengthen and empower them. In the end, hopefully, it could also provide some justice.”
Justice, political advocacy and prevention
The topic of justice, political advocacy, and prevention is also a significant part of the psychosocial approach. Jan Ole Haagensen emphasises: “It is not only about mental health; our perspective is broader and it’s more politically oriented. Because again, you can deal with mental health issues, but if the social environment is still the same, nothing will change and you will just continue healing people and new victims will be produced all the time, so there has to be some sort of prevention.”
In India, after the testimonial therapy process, many of the people who suffered police violence became community leaders and human rights defenders who started cooperating with an Indian organisation, the People’s Vigilance Committee on Human Rights (PVCHR):
“We have a film about it called ‘From Victim to Survivor to Activist’ on how they were healed and mobilised. There was a group of torture survivors who started to protest in front of a police station together and felt empowered by doing this and also by cooperating with the organisation,” Haagensen recalls. In other words, testimonial therapy contributes both to individual empowerment and community empowerment.
Besides the testimonial therapy method, Nunca Más conducts workshops on political advocacy, for example with the Lencas indigenous people who fight for their land and access to natural resources: “We do workshops on how they can strengthen their advocacy. It’s very much about finding issues and topics and then identifying them during workshops, prioritising them and evaluating how realistic they are in the short and long run.”
Concerning justice, written testimonies can also be used in court if a victim decides to testify against the perpetrator. Having a coherent story can support their cases and facilitate the legal process: “We also help them to structure the story because most people, when they are being interviewed, their mind goes to all different types of places and it makes the story contradictory at times, and from the perspective of a lawyer it’s beneficial to have witnesses who have a story which makes sense and is clear.”
Final reflections
In every project, Nunca Más collaborates with organisations from the regions they work in. For instance, in Honduras, they collaborate with an organisation called Centro de Prevención, Tratamiento y Rehabilitación de las Víctimas de la Tortura y sus Familiares (CPTRT), in Zimbabwe with Ukuthula Trust and Tree of Life, and in the Philippines Centre for Disaster Preparedness Foundation (CDP). In relation to this, I ask if testimonial therapy is a self-sustainable method in the sense that local communities and organisations can continue the work without Nunca Más’ assistance. Jan Ole Haagensen responds: “The main thing we do is to train people from local communities so they can conduct testimonial therapy themselves, and it’s often learning by doing it. And in fact, in Honduras, some of the people, and an organisation we cooperated with, continued doing it in other projects as well. So for us, this is very successful.”
However, the testimonial therapy method can, in certain situations, encounter some limitations and Nunca Más’ founder is aware of the scope of its capabilities:
“Of course, there are some limitations. If you work with people who have severe mental health issues like psychosis, etc., you will have to refer them to more professional assistance, which of course is a problem because it’s often not available. I don’t see it as a disadvantage of the method, it’s just a matter of accepting that all tools can’t solve all the problems. In this case, it’s a very rudimentary tool which can have a lot of positive effects and generally a positive impact but it can’t deal with severe mental health problems, which again, it’s not all people who have such problems.”
Conclusively, Haagensen reflects critically on psychosocial interventions: “Some people are really in need of treatment and the earlier you can give them the treatment, the better, while others can heal themselves with time. But how do you find those in need and those who will heal themselves? This is a challenge because intervening prematurely can also worsen the situation. And that’s the one million dollar question I have been posing for the last 15 years.”
