Guests of The Psychedelic Blog do not endorse, support, or otherwise advocate on behalf of any particular treatment approach for mental illnesses unless stated otherwise. The views expressed during this interview do not necessarily reflect the opinions or endorsement of The Psychedelic Blog. Readers should always consult with qualified healthcare professionals and conduct their own research before considering any treatment options. The blog and its authors are not responsible for any decisions made based on the information provided.
"TABANOK is the first and the last element: LOVE."
"We cannot forget the memory of the origin. It will always be very important to remember where we come from and where we are going, who we are. Let us remember that we are children FROM RIGHT HERE, KAMUENTSÁ, that we are children of TSBATSANAMAMA, Mother Earth. Let us remember that TSBATSANAMAMA is the whole planet Earth and when we say that we are FROM RIGHT HERE, we are not referring only to the true message of this word; KAMUENTSÁ, which our ancestors wisely crafted. It is for all humanity, because we are all FROM RIGHT HERE, from planet Earth, and everything that exists in the universe, is a fabric of millions of destinies, and TABANOK is the key."
-TABANOK, Camilo Jamioy
"TABANOK is the first and the last element: LOVE."
Dora María Hernández Holguín is a weaver. Like those who skillfully weave fibers into abstract representations of their interconnected natures, she understands the complex interplay between mental health and the collective dimensions of human existence. The difference, perhaps, resides only in the delicacy of the concepts she entwines.
Her insights stem from her early experiences in Medellín, where she tackled violence prevention in schools, families, and communities. Dora's approach transcends a traditional individualistic view of mental health, connecting it instead with broader social structures. She highlights the critical role women play in peace-building at the community level, blending traditions, care for new generations, and public advocacy against violence. Yet, she points out the stark realities: limited participation of women in national peace processes, prevalent stigma, misconceptions, and a healthcare system often ill-equipped to offer integrated and relevant mental health services. Dora's narrative is not just about understanding these issues; it's a call to action, especially for men and newer generations, to embrace alternative masculinities and renounce violent attitudes against women, thereby supporting women's mental health in a more meaningful way.
Dora's understanding of human behavior is equally groundbreaking and controversial. She posits that in the context of violence, behaviors cannot simply be labeled as 'good' or 'bad.' This perspective challenges the binary thinking prevalent in many social policies and interventions, advocating instead for nuanced and adaptive approaches that recognize the complexities of human experiences. Her work suggests that effective mental health interventions must tackle root causes embedded in systemic issues like poverty, education, and access to resources. Dora emphasizes the inextricable link between mental health, cultural practices, and community dynamics, advocating for culturally sensitive mental health care that respects and integrates these aspects. This approach aligns with postmodern critiques of binary oppositions and 'grand narratives,' advocating for a more fluid understanding of identities and experiences. Clinically, this translates to a holistic approach that considers an individual's life story, family dynamics, and wider social factors, instead of focusing solely on symptoms or diagnoses. The person-centered paradigm in mental health care prioritizes the individual's subjective experiences and their active role in their care, marking a significant shift from traditional methodologies. See Person-centered care and psychiatry: some key perspectives, (Boardman et al. 2020)
Her passion and dedication for the field of mental health care becomes evident in the shear volume of her published works, just a few of which include:
In essence, Dora María Hernández Holguín's work is a call for rethinking mental health care. Her advocacy for a holistic, culturally-sensitive approach that recognizes a complex interplay of individual, social, and systemic factors represents a significant advancement in our understanding of mental health. By challenging our traditional dichotomies and emphasizing the role of community and culture, Dora's work opens up new possibilities for more effective, compassionate, and inclusive mental health interventions. Her emphasis on the role of social justice and interpersonal relationships in mental health is not only a valuable contribution to the field but also a necessary step towards a more empathetic and understanding society.
I feel honored that she accepted my invitation to join me on The Psychedelic Blog. From the Mental Health Research Group at the University of Antioquia in Medellin, Colombia, please welcome Dora María Hernández Holguín.
Robert: Dora, your work is really very impressive. Can you talk about what led you to focus on the field of mental health in the first place, especially for women?
Dora: As a psychologist, I have always been interested in human behavior, and, since 2004, I have been working in the field of mental health from a public health perspective, in line with my interest in the relationship between mental health and the social macrostructure. At that time, post-crisis of violence due to drug trafficking in the 80s and 90s in Colombia, I participated in large-scale projects in the city of Medellín, focused on violence prevention in schools, families, and community contexts.
Later, with the intention of a more comprehensive view of mental health, we conducted several research projects with children and youth, focused on resilience and promoting coexistence; however, today we can say that this was a dichotomous view of mental health, expressed in this case in various ways, among others, as "aggressive behaviors vs. prosocial behaviors; violence vs. resilience." Based on the research results, we realized the importance of overcoming the preventive view, and mainly the traditional epidemiological* view of mental health; the multiple and historical social inequities faced by populations exposed to violence became evident, added to, for example, the importance of everyday life and parenting strategies. With this background, I wanted to approach from a more inductive type of research the multiple ways of peacebuilding in communities, and it was there where I encountered women, and from a broader perspective, peacebuilding in the feminine, in which fortunately many young people, men and women, are also now participating. I found that one thing is peace processes from the governmental level and another is the peacebuilding that communities do, often with an important role of women in strategies that involve the value of traditions, bonds, and the recognition of victims as political subjects.
*Epidemiological
Definition: Epidemiology is the branch of medicine that studies the occurrence, distribution, and potential control of diseases and health-related factors within populations. It is underpinned by the principle that disease and health conditions are not randomly distributed, and that social, economic, environmental, and biological factors determine the patterns of disease.
Explanation: Modern epidemiological studies and approaches extend beyond the mere statistical analysis of disease spread and control. They incorporate an ecosocial perspective that examines how societal structures and inequalities impact health outcomes. This field acknowledges the embodiment of social inequalities and environmental exposures, stressing the interconnectedness of individual and population health. Critical epidemiology, particularly emphasized in Latin American contexts, advocates for an ethical and courageous science, aimed at addressing the health needs of people in a way that challenges unhealthy civilizations and promotes social justice.
Example: Epidemiological research by Nancy Krieger and Latin American critical epidemiologists has been instrumental in highlighting how health disparities are rooted in social inequities and environmental injustices. Their work provides a comprehensive framework for understanding health phenomena, advocating for policy changes that address the root causes of health disparities.
Quote: "Epidemiologic theory is about explaining the people's health." Nancy Krieger. (It is about explaining the health status of populations in societal and ecological context, and is not about explaining why specific individuals become ill or stay healthy.)
Robert: Colombia has suffered 60 years of armed conflict and has been working towards peace. Should we understand mental health differently in a post-conflict society compared to relatively peaceful societies?
Dora: Although the Peace Agreement with the FARC-EP is a significant event in the present and for the history of Colombia, as a Colombian I understand that the signing of this does not necessarily represent the beginning of a perfect peace, rather, it indicates that significant conditions were given for us to dispose ourselves to the construction of peace and more dignified living conditions. In this sense, one of the conclusions we have reached is precisely what you say: in Colombia, we should understand mental health differently, moving from a "mental health" that only refers to the emotional consequences of the war, which is conceived as an experience and a responsibility of an individual nature, and that is essentially recovered with medications, to a more integral mental health, which without denying the convenience of medications in some cases, these are not the first option; it is based, rather, on a "mental health" that is cared for and produced in interpersonal relationships and with the territories; which is necessarily linked to peace, both as a right and in relation to social justice and dignified living conditions. Therefore, mental health must be considered in its political and collective dimension, one that allows us to transform - together - the realities that produce suffering.
Women make significant contributions to the construction of lasting peace and it's the men, with high positions in institutions, who are publicly recognized for fulfilling, as in this case, the functions that correspond to them.
-Dora María Hernández Holguín
Robert: You mentioned the 2016 peace agreement. How has the participation of women in the peace processes in Colombia differed from traditional peace-building methods?
Dora: Peace processes at the national level, at least in Colombia, have mainly been negotiations among men. An article from El Espectador newspaper on April 6, 2017, regarding the research "Negotiating from the Margins. The Political Participation of Women in Peace Processes in Colombia (1982-2016)" shows that of the 61 peace agreements signed between 1982 and 2016, only 4% of the signatories have been women. Even though a gender commission was created due to the demand of the feminist and women's movement in the peace agreement with the FARC-EP, the photo of the peace agreement's signing in 2016 shows it as an agreement between men. Women make significant contributions to the construction of lasting peace and it's the men with high positions in institutions, who are publicly recognized for fulfilling, as in this case, the functions that correspond to them.
This difference is not just numerical; the way of building peace in the territories, in the feminine, has been interwoven into everyday life, with the public denunciation of violence when they wanted it to be hidden, with the reclamation of traditions that were often forgotten: weavings, food, sewing, music; with the care and education of new generations of girls, boys, adolescents, and youth.
Robert: What is the relationship between women's participation in peacebuilding and the overall stability of post-conflict communities?
Dora: Many women have made the violence evident, have made calls for respect for life, they take care of raising girls and boys with a perspective of peacebuilding and care for victims, form groups, cooperatives, and work networks that encourage community life and have allowed many municipalities in Colombia to sustain themselves economically, have strengthened the public management capacities of some of them in localities; all these strategies towards lasting peace, which are not exhausted in the peace promises between armed groups, which although valuable in allowing life, do not tend towards transforming a reality that involves inequities, reification of human life, and disrespect for life in general.
Robert: Can you talk about how violence has impacted the mental health of Colombian women and how being exposed to armed conflict and violence uniquely affects their mental health?
Dora: Women in Colombia are generally exposed to many forms of violence, which is why most of us, and even more so those directly exposed to armed conflict, have seen their mental health affected in multiple ways, not only in emotional terms with fear, anxiety, sadness, or psychopathological issues, but in other forms of mental health expression as well. It seems to me that the courage of these women is a reflection of the strength of their mental health and its political dimension, for example, when: they left their homes to take to the streets to call for peace, met with commanders of armed groups to defend the value of life without this encounter being broadcast in the media, met in a veiled manner to provide mutual support, or when they have tirelessly searched for their children and the children of other women, among many other actions.
Robert: Strong women for sure. What cultural factors in Colombia influence how women perceive and seek help for mental health problems, and how do social attitudes towards gender and violence impact this perception?
Dora: Women in Colombia, more calmly than men, seek help for our mental health problems and those of our loved ones. Cultural aspects have a lot to do with this, as we are clear that help is sought among friends, family – and in contexts of armed conflict – in social organizations where they find a space where they can vent, express themselves, develop their capacities and be, while learning to listen to and care for others, and together (often not excluding men) they face the social rejection of the feminine from which weakness is acknowledged, the value of meeting, demonstrations of affection, and common projects.
Robert: What are the biggest barriers to accessing mental health care for women in Colombia, especially in areas affected by conflict?
Dora: Mental health in Colombia shares some barriers with health care in general, such as the geographical distance of health services and economic criteria for accessing certain services. However, there are particularities with respect to mental health and being a female victim of the armed conflict. The biggest barriers to accessing mental health care could be related to neglect and stigma against it, and to the gaps in its conception, because the health system in Colombia maintains a dichotomous perspective on mental health at all levels of care, which moves in pathologizing*, individualistic, and/or reductionist directions, that do not take into account the centrality of relationships for the production of mental health. Thus, devices based on these concepts are limited for an integrative view of mental health, which focuses on individuals, their relationships with themselves, with the social structure, and everything around them, their afflictions and their life journeys. Therefore, one of the barriers in mental health care services that female victims of the armed conflict have most referred to us is the lack of relevance and continuity of these services; professionals, almost always in psychology, come to the communities for 2-3 months, and in most cases, the women, who have assessment criteria because they have supported each other, feel that the service they receive is insufficient in time and not relevant to their condition as victims (this could be related to the individualistic, decontextualized, and pathologizing perspective of mental health).
*Pathologizing
Definition: Pathologizing refers to the process of viewing or treating a behavior, belief, or condition as indicative of a psychological or biological disease or disorder.
Explanation: It involves framing something that may be within the spectrum of normal human behavior or experience as abnormal or unhealthy, typically requiring medical attention or intervention. This can have significant implications, as it can stigmatize individuals and potentially lead to overdiagnosis or overtreatment. It is a term often discussed in mental health to critique how societal norms can influence what is considered "healthy" or "ill."
Example: If someone's intense grief over the loss of a loved one is labeled as clinical depression and treated as such without considering the natural process of mourning, this could be seen as pathologizing a normal human experience.
Quote: "The danger of pathologizing normal behaviors can lead to a society less tolerant of the diversity of human emotion and experience." - Dr. Allen Frances
Robert: What role do community organizations, like AMOR, play in addressing the mental health needs of women?
Dora: It can be said that AMOR, as well as other women's organizations in Antioquia and other regions of Colombia, has enabled women and society to understand, firstly, the impact of mental health on women due to structural, direct, and symbolic violence, crossed by patriarchal violence throughout their lives, of previous and new generations of women; and, secondly, with its model of steps and hugs and with its political training process for women, it has achieved through its peace-building practices and, in relation to mental health to harmonize elements such as: the body, the collective, the territory, the political, healing, the aesthetic, and the creative.
The role of AMOR and other women's organizations in Colombia has been that of caretakers of other women, their families, and communities, and as teachers in understanding mental health and the art of its care.
Robert: I love that. Along the same lines, is HOPE considered a key component in the therapeutic approach to managing mental illness?
Dora: Yes, hope is a key component in the therapeutic approach when supporting people with mental health problems. It is probably one of the elements that lead a person to seek support and accompaniment in experiencing their suffering, as hope constitutes the confidence that things can be better and that there are possibilities to feel and live differently, more satisfactorily. However, hope can be lost according to individual reality, hence, with it, it is important, among others, to favor the strengthening of the person's bonds, their sensitivity, and their political action in the spaces in which they operate, which could allow them to understand and seek ways to transform their reality beyond the symptoms of discomfort or suffering experienced.
Robert: Could you suggest ways in which men can be involved in supporting the mental health needs of women in Colombia?
Dora: This question seems very complex to me. I would dare say that in the first instance I would ask for respectful accompaniment from men, without imposing suggestions, however, in the face of such marked patriarchal violence, it is possible that this is not achieved by a simple suggestion. I am aware of men, mainly of new generations, who are working on alternative masculinities, which I believe, at least, sets the stage for them to start questioning and changing violent positions against women and femininity, and, of course, stigmatizing against mental health; it seems to me that this is a good way.
Robert: Can you talk about any ongoing research or project you are involved in related to the mental health of women in Colombia?
Dora: At this moment, the project "Affectations of the Infractions to the Medical Mission –IMM– on the women health workers, on the occasion of the armed conflict, the Colombian case", a research project in which I participated (research team in Colombia of Esperanza Echeverry, Yadira Borrero, Isabel Garcés, Carlos Iván Pacheco, Alejandra Marín, Dora Hernández) and whose articles are in the process of publication, is ending.
For the research, a qualitative study with a biographical method, thematic life stories, reconstructed from interviews with 26 health workers, after a documentary analysis on the context of the internal armed conflict in Colombia in three prioritized areas, the departments of Cauca and Chocó and the Catatumbo region in Norte de Santander, and 17 in-depth interviews with thematic experts. The objective was to understand the damages that the IMM have had on the life trajectories of health workers and the coping and resistance strategies that they, their families, health institutions, and their communities have deployed against them. The analysis led to three “type” life trajectories: “life in chronic adversity”, “lives reconstructed mainly by and for family care”, and “lives that are remade from and with organizational processes”, in which the importance of family, spirituality, and political organizational processes in the coping and resistance of IMM victim women was visible; and the insufficient response of the State (for example, mental health services) in the cases.
Robert: I look forward to seeing more about that. What message would you like to share with young Colombian women who aspire to get involved in peacebuilding and the defense of mental health?
Dora: I wouldn't dare to give recommendations for peacebuilding; I have suffered the armed conflict, as I believe all Colombians have, but I am not a direct victim; I can only say some things that I have learned from women who have been building peace for more than 20 years: They work for positive peace, beyond the signing of an agreement between armed groups and the government (largely commanded by men) and the ceasefire; they work for a peace that, although incomplete and imperfect, favors social and economic equity, quality basic education, the right to health, democratic participation, sustainable development, among others, because the lack of opportunities for personal development in Colombian society is what has made many young people be "used" in the war. In this same sense, peacebuilding is important for overcoming all forms of violence, intrafamilial, symbolic, sexual, and armed, all of them based on patriarchal violence. It is fundamental that as Colombian women, regardless of our professional, family, and social role, we understand our history and the violence we continue to face, bring these reflections to our homes, schools, municipal councils, universities, and organizations so that together we can build ways to confront and overcome them, appropriate to our culture.
I would tell young women who want to work in mental health in Colombia that there is much to be done, that we have been hinting at a path to overcome the individualistic, decontextualized, pathologizing, and reductionist paradigm in mental health that has been transmitted from universities without much critical position. It is not about denying or setting aside the contributions of the biomedical perspective of mental health, but about going beyond it. We need to research and document the experiences of psychic and social suffering in Colombia, the community and institutional responses to face them and thus create a paradigm more in line with our social, historical, and cultural reality.
Robert: What cultural tradition do you value or enjoy?
Dora: I love to have coffee in Colombia, on a sunny afternoon at the small tables on the sidewalk of a café or bakery on a busy street, or on a high mountain that allows me to see the panorama while I talk with loved ones. Additionally, I greatly admire the Carnaval de Negros y Blancos celebrated in Pasto, Nariño every January.
Robert: Who are your role models in life and what qualities do you admire in them?
Dora: My role models are located in the field of mental health, on one hand, people with psychic suffering – and in the case of Colombia, also with social suffering – who, with courage, humility, hope, and their own resources, and those of their communities and collectives have been able to see the value of life, cultivate bonds with others, recognize themselves in a demanding social and historical context and have been discovering, learning, and constructing ways to act in order not to stop living.
On the other hand, I am thankful for and admire authors from Italy, France, and Brazil who have been able to distance themselves from their time and culture and have dared to reconsider violent social practices in relation to people with mental health problems, practices that deny the subject and the expression of subjectivity. They understood from a humanitarian point of view what was happening and the damage that was caused in the name of formal knowledge.
I also admire and am grateful to my students for the questions and shared answers, not as a purely academic matter but as questions that touch our own lives.
Robert: This has been excellent, Dora! I've wanted to better understand mental health care in Colombia and this conversation has helped me immensely.
I think I share what may be a common sentiment with many who yearn for a decisive victory or some kind of groundbreaking progress in the battle against mental illness. Perhaps this perspective is just conditioned by the political rhetoric or propaganda that often surrounds various campaigns, where grandiose assertions are made with little regard for accountability beyond the tenure of those making them. With mental health care, incremental change is encouraging. And, so is knowing that smart and passionate people are on the case.
I hope that my readers will do what they can to support to mental health services in Colombia and/or wherever they may be.
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