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Managing Suffering in War-Affected Pluricultural Contexts: Reflections on the Assistance to Victims in Colombia

Administración del sufrimiento en contextos pluriculturales vulnerados por la guerra: reflexiones sobre la atención a víctimas en Colombia
Administração do sofrimento em contextos pluriculturais vulnerados pela guerra: reflexões sobre a atenção a vítimas na Colômbia
Angélica Franco Gamboa and Laura Franco Cian
p. 109-121


Internal armed conflicts have generated plural and collective experiences of pain and suffering that challenge institutions. Based on the current consolidation of a public agenda that addresses the assistance to victims of the armed conflict provided in Colombia, and an ethnographic work with the indigenous Awa people of South-Western Colombia, we problematize the epistemes that inform two closely linked statutes that underlie the processes of transitional justice: law and science. The findings of the ethnographic research lay the foundations for an ethical-political reflection that suggests an action research agenda committed to recognizing the plurality of life within the structure of the longest conflict in America, and invites us to deconstruct notions, actions and institutions.

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Editor's notes

Received date: January 9, 2020 Acceptance date: April 1, 2020 Modification date: April 27, 2020

Author's notes

The empirical material presented in this article is a product of the first author´s doctoral dissertation “Reconstrucciones de la cotidianidad en el pueblo Awa: espacios minados, tiempo natural y sobrenatural” (2015). The research was carried out as part of the anthropology doctoral program at Universidad Nacional de Colombia, with the “Bicentenario” scholarship funding granted by COLCIENCIAS (528 de 2011). The School of Psychology at Universidad el Bosque, Colombia, supported us in preparing this article.

Full text

Article 7. The State recognizes and protects the ethnic and cultural diversity of the Colombian Nation.

Consejo Superior de la Judicatura and Corte Constitucional de la República de Colombia (1991; authors’ translation)

The Colombian Armed Conflict and the Juridical Framework for Reparation

  • 1 The Revolutionary Armed Forces of Colombia (FARC) were officially formed in 1964. The United Self-D (...)

1America’s longest armed conflict has taken place in Colombia, and has been influenced, from the beginning, by the presence/absence of the State in different parts of a geographically rugged territory, and by unequal access to land. Armed groups, such as the internationally known Fuerzas Armadas Revolucionarias de Colombia (FARC-EP) and Autodefensas Unidas de Colombia (AUC) among others, identified with both left and right political ideologies, and they emerged and demobilized in different historical periods.1

  • 2 Even if there are uncountable victims prior to this year, 1985 is the date that Law 1448 of 2011 es (...)

2From 19852 to 2018, there were eight million seven hundred ninety-four thousand five hundred forty-two (8,794,542) people registered as having been affected by victimizing events in the context of the armed conflict in Colombia. These events included forced abandonment or dispossession of land, terrorist acts, attacks, combats, harassment, crimes against sexual integrity and freedom, forced disappearance, forced displacement, murder, kidnapping, torture, forced recruitment of children and adolescents, and damage from landmines, unexploded ordnance, and improvised explosive devices (UARIV 2015a).

3As a response to these situations, the Colombian government created a legal framework: Law 1448 of 2011, known as the “Victims’ and Land Restitution Law” (Congreso de la República de Colombia 2011). Through measures of humanitarian aid, attention, assistance and comprehensive reparation for the victims, the purpose of the legislation is to “reclaim human dignity and allow victims to assume full citizenship” (2011, 9) by way of the implementation of juridical, administrative, social and economic mechanisms, both individual and collective, that are determined through the Victims’ Attention and Comprehensive Reparation Route foreseen by the Victims Unit (UARIV 2015b). This legal framework was integrated into the transitional justice system implemented in Colombia in the last decade, prioritizing the victims, by contrast to a previous process established by Law 975 (Congreso de la República de Colombia 2005) – “Justice and Peace Law” –, which prioritized disarmament, demobilization and reintegration of combatants into civilian life, leaving the promised justice for people harmed by the war as a secondary issue (Vera Lugo 2016).

4From a pluricultural context like the Colombian one, exposed to past and present colonialism and a conflict that seem endless, this work problematizes the epistemes that inform two closely linked statutes underlying the processes of transitional justice: law and science. The latter, of special interest in this work, is understood as a regime of truth (following Foucault 2011) that strengthens the content of rules, regulations and actions or forms of government that guide the former – Law – and institutions (Hansen and Stepputat 2001; Herzfeld 1992; Das 2000).

5In what follows, we will describe elements of the theoretical framework in which the key discussions of this work are inscribed. We then focus on the findings of an ethnographic investigation conducted between 2011 and 2014 with victims of antipersonnel mines planted by the indigenous Awa people in southwestern Colombia. Following this, we discuss the management of suffering in Colombia by way of providing, on the one hand, details about the bureaucratic routes in which law and science converge, guiding the action of professionals and the way in which reparation of the suffering of victims in Colombia is managed. On the other hand, we discuss the denunciations issued by victims’ organizations, scholars and public institutions, about the non-relevance of the reparation measures to the people affected by the conflict. Although the aim of this work is not to draw a comparative reading of the phenomenon, we wish to offer a critical look at the challenges of the implementation of reparation in transitional justice processes conducted in pluricultural contexts. As such, the discussion is supported by theoretical and empirical evidence about the management of suffering implemented in other countries of the continent. Finally, we articulate these arguments with an ethical-political reflection that suggest an action research agenda committed to the deconstruction of institutions, as a possible route to closing the extensive gaps that separate us from the situated understanding of our problems.

Theoretical Framework

6The discussions proposed in this article fall within the framework of the anthropology of violence and social suffering (Jimeno 2019; Ortega 2008; Das 1995 and 2000; Kleinman 2002; Kleinman, Das and Lock 1997; Scheper-Hughes 1992). From this perspective, suffering is defined as an “assemblage of human problems that have their origins and consequences in the devastating injuries that social force can inflict on human experience” (Kleinman, Das and Lock 1997, ix). This definition seeks to focus our attention on the network of power relations that shape the systematic logic of violence, and the people’s fields of possibilities and social action.

7Within this framework, two discussions are of our particular interest. On the one hand, the updates of the violence that take shape in what Ortega (2008), paraphrasing Veena Das, enunciates as the expropriation of the personal experience of suffering that the State exercises in the administration of suffering. According to the author, “through rhetorical and institutional mechanisms that substitute the authority of the victim over their pain and their condition of suffering, by the criteria of technical language” (2008, 37; authors’ translation), the State legitimizes its idea of social order, its interests and the epistemic violence that underlies the subalternizing power of specific social sectors. Multiple works have contributed to these particular discussions (Das 2000 and 1995 Kirmayer 1996; Kleinman 1986 and 2008; Pupavac 2001; Scheper-Hughs 1992; Summerfield 1999; Theidon 2004).

8On the other hand, from this theoretical framework, there are relevant discussions regarding the practices that, in the midst of pain and suffering, express the capacity of human beings, “to appropriate the pernicious marks of violence and re-signify them through the work of domestication, ritualization and re-narration” (Ortega 2008, 43; authors’ translation). Based on this theoretical sensitivity, different authors have coined categories to explain and visualize localized modes of the elaboration of pain, the restoration of dignity, the claim for justice, and political vindication (Jimeno, Castillo and Varela 2010; Theidon 2004; Burnyeat 2015; Acosta 2016; Vera Lugo 2016).

9Finally, this work sympathizes with the critical literature on transitional justice that questions the generalizations managed in conceiving reparation and more conscientiously details the different possible meanings of this conception in different parts of the world and from a local perspective (Nagy 2008; Pupavac 2001; Mc Evoy and McGregor 2008; Zolkos 2014).

Reconstructions of Daily Life among the Indigenous Awa People

10The Awa ethnic group, a population of around 37,000 inhabitants, is located in the department of Nariño in southwestern Colombia (see Figure 1). The area in which they have settled in the tropical rainforest of the Andean foothills is propitious for growing coca (the main asset of organized illegal armed groups) and has proven to be a strategic corridor for the transport of narcotics through the Pacific Ocean. The use of antipersonnel landmines by the guerrilla in the territory was a mechanism used to protect the illicit crops that the government has been trying to eradicate since the early 2000s. It is in this context that the main victimizing events against the Awa community occurred. In 2009, two massacres were perpetrated by the FARC guerrillas in their territory leading to their mass displacement. From the time of those events through to 2011, over fifty homicides, one more massacre and two other mass forced displacements were registered (ACNUR 2011). These events were added to the list of victimizations that the indigenous suffered, which also included crimes against sexual integrity and freedom, forced disappearance, forced recruitment of children and adolescents, and damage from landmines, unexploded ordnance, and improvised explosive devices, among others (ACIN 2017).

Figure 1. Maps of Tumaco in Nariño, Nariño in Colombia, and Colombia on the globe

Figure 1. Maps of Tumaco in Nariño, Nariño in Colombia, and Colombia on the globe

Source: Elaboration by the authors with data from​files/​images/​MunsNarino_Tumaco.jpg

  • 3 This research is based on the anthropology of war and social suffering. According to Tambiah, “the (...)

11The result of a multi-sited ethnography (Marcus 1995), the following empirical material seeks to show one of the local and plural expressions of suffering and the reconfiguration of life after a critical event in the context of the Colombian conflict.3 Based on the question of socio-culturally distinct forms of suffering and reconstruction of everyday life (Das 1995), local and trans-local narratives were explored in order to understand the link between dynamics expressed in the local territory and political, scientific, and cultural dimensions of larger magnitude (Sahlins, cited by Ortner 2006).

12During 2012 and 2013, participation in rituals, assemblies, mingas, moments of leisure, meetings with members of the indigenous government, school activities and long conversations –the kind you have in the kitchen–, took place in two of the Awa settlements (Inda Sabaleta indigenous reservation in Llorente District, municipality of Tumaco, and in the El Verde property, a district of El Diviso, municipality of Barbacoas). Fieldwork was also conducted in Bogotá, Tumaco, and Pasto.

  • 4 This research responds to a request made by the community with which the fieldwork was carried out (...)

13This work highlights the gaps between conventional codes of psychiatric and psychological nosology and local ways to experience and treat the damage caused by war. In what follows, we retrieve some ethnographic fragments of this research in order to describe the context of violence throughout the case of the Paí’s family belonging to the Awa people. In this family, such gaps had devastating effects, exposing them to situations of high vulnerability, which is why a close relationship and accompaniment was maintained.4 We will later discuss different issues associated with the management of suffering in Colombia, and concentrate on the ethical and political implications of the epistemic frameworks that inform the formulation and implementation of reparation measures in a pluricultural country such as this one.

The Case of José’s Mother and Sister

14José, a 16-year old young indigenous man, died on August 10, 2012, after he activated a highly destructive landmine as he walked to work, in an area where the FARC had recently caused an electricity pylon to collapse. The material and personal consequences of José’s disappearance for the Pai’s family were devastating. The thirteen members of the family group adjusted their domestic roles –according to age and gender– to restore their subsistence economy, which was mainly supported by the deceased young man. Nevertheless, a year after his death, the women of the family, Marta and Luz Mari, were suffering in a way that worried the rest of their relatives, especially because the treatment provided by the professionals at the township’s health center had no effect on the hielo de muerte (ice of death). As Miguel, 43 years old, Luz Mari’s husband and Marta’s son-in-law, said:

Marta, [José’s mother, 36 years old] was recently really sick, and we had to take her to the doctor. And she [Luz Mari, José’s sister, 18 years old] was sick as well and is currently taking drugs, but I took her elsewhere, now she is not taking medical drugs. She has been tormented by an hielo de muerte, […] like a bad air [mal aire], like a sickness of the spirit, because she suffers a lot because of her brother’s death […] Now, they (traditional doctors/shamans) are giving her a medicine and it did her good, because the medicine from the other doctors didn’t help her at all. I made them give her vitamins, physiological saline, but nothing happened! It made her worse. Right now, she is relaxed, she has been taking the remedy for two weeks. And she has a bottle of the remedy, which has to be mixed with aguardiente and she has to bathe in it for a whole afternoon and pray three Our Fathers, asking for forgiveness so that he [the deceased] would forget her. That really calmed her down, right now she is calm. (Interview with Miguel, Tumaco, August 2013; authors’ translation)

15José’s relatives reported that Luz Mari had been losing weight progressively for a year. According to José’s sister, she felt lazy, sleepy, sad, bored, her vision was blurred. In this context, the family reported that the treatment provided by the doctor did not work and that only two weeks before they found a “doctor” (shaman) who provided the diagnosis and effective medication to cure her sickness. According to the father of the deceased:

A woman arrived, she first saw her, touched her skin and said: “it’s sticky, something is killing her” and it was true. That day, it was as if she had just been taken out of the grave, pale. […] She gave her a pink cream in her little hand like this [she rubbed his hand with the fingers of the other hand] and she gives her a little mirror, with which she covers her hand and in the mirror everything emerged. In that mirror you can see all the lines of the hand and everything is there. She had an empty heart [corazón vacío] she said, because of the ice that was killing her. […] she gave her three bottles with the drops and a bottle of the remedy which had to be blessed. It had to be rubbed on her body in the afternoon... and some remedies with butter and aguardiente. The butter has to be rubbed, not drunk, the drops are to be swallowed; first she said “take 40” and then she said, 50. Those drops are strong, right now she is calmer […] Those herbal remedies that they make are really effective. A doctor [referring to allopathic doctors] does not know how to cure these sicknesses. Look, I have spent up to 100,000 pesos in medicines [overspending for his budget] and she gets sick again, I spent a lot and they have never worked. Doctors even took tests and the results are always normal. (Interview with Miguel, Tumaco, August 2013; authors’ translation)

16The texture of her skin and the projection of her hand in the mirror, constituted the diagnostic technique to reveal the problem: Luz Mari had an empty heart because of the ice of death, and that was killing her. It became clear that the treatment should include taking drops, cream to rub, blessed aguardiente, and remedy and baths with prayers at a certain times of the day, for the deceased to forget his living sister. Thus, the Luz Mari’s obvious improvement reaffirms, among her relatives, that herbal remedies and “their” [indigenous] diagnostic tests are more effective than the ones used by the colonos (as mestizos are pejoratively called by the indigenous of the region).

17Marta’s situation was different. His mother’s pain resulted in symptoms such as “stomach ache,” “dizziness,” “headache,” “drunkenness,” “oversights,” “suffering in thought,” remembering her son “torn to pieces,” “something burning inside,” “something burning in the belly.” This set of somatic, psychic, thermal and visceral simultaneous manifestations, according to Marta’s partner, the father of the deceased, were symptoms of a “scared heart” (corazón asustado): “A fear that has stayed inside her heart.” So, body experiences, memory, reverie, thoughts, weakness, and pain intermingle to express suffering among Awa women.

18In Marta’s case, there was no diagnostic technique or ancestral treatment due to their shortage of money, as shamanic interventions are expensive. Instead, other cultural and social responses appeared to help her deal with the grief. In her dreams, a flow of images and actions of her dead son, interpreted with the community’s help, allowed her and the deceased to fulfill wishes and expectations. These are, according to the ethnographic research, the oneiric narratives. As the mother explained, dreams allowed her to satisfy the dead boy’s hunger: “Three times I left him the dish [...] then he no longer asked me for food” (Interview with Marta, Tumaco, August 2013; authors’ translation); to know the place where he lives: “in dreams, he dreams of me and takes me along a nice pathway, wherever he lives” (Marta, Tumaco, August, 2013; authors’ translation); and through the father’s oneiric narratives to finally confirm his son’s deserved dignity: “His dad too dreamed of him [José], and he said to him, ‘I got a good job,’ ‘Come, let’s work here because I’m fine, I don’t go around treading on mud stomping mud, I’m quite at peace, with work, without suffering, I’m settled’” (Interview with Elkin, Tumaco, October 2012; authors’ translation).

  • 5 An extensive body of anthropological works about the indigenous people of America demonstrates the (...)

19The dreams constitute the time/space from which supernatural spirit acts are shown. Women’s narratives and symptoms allow a glimpse of particular notions of life and death. From these, suffering and dreaming of the relatives of the deceased externalize a continuity between the spiritual and the material, which gives the dead an important role in the management of the experience of grief.5

20What is the perspective of the professionals at the township’s health center of the health care of victims like Marta? The following ethnographic fragment corresponds to an interview which took place in 2017, with the head nurse of the nearest health center to Marta’s house, in Llorente (the closest health care point available to people impacted by victimizing events occurring in the indigenous reserves, and from which they are referred to Level II and Level III hospitals, depending on the severity of the damage). A question about the interactions between the indigenous people and health professionals revealed interethnic frontiers that not only involve stereotypes related to the “civilized and wild” according to the color of people’s skin, but the way in which human precariousness is increased by these frontiers:

Nurse: the doctor has to examine the patient based on the clinical manifestations; the clinical manifestations say it all. The signs and symptoms, whether the patient is distressed, has a fever, the symptoms, the clinical profile.

Researcher: And if the diagnosis is outside the regular codes of the clinic, for example, there are diseases like chutún, mal viento, mal aire, hielo de muerte...

Nurse: Actually, these diseases produce signs and symptoms, for example, fever, vomiting, diarrhea, stomach ache, so that is what is treated. We treat fever, diarrhea, so they are all sent for tests [...] sometimes it turns out that it is true, it exists. So it is. The doctors give them everything; they give them a thousand drugs but the patient only heals once they take him to the shaman. The indigenous still practice that a lot: the healers, the herbs [...] You’ve been there, right? For example, the indigenous who are already civilized are those who have kitchens. They [the “uncivilized/wild”] live in wooden houses; they make a single deck and they all live there. They do not care much about cleaning, being hygienic, that’s why they get sick, they are very unhygienic because they don’t know what it is to bathe, to use a perfume, deodorant. (Interview with Nurse, Tumaco, August 2017; authors’ translation).

21This expresses the distances between systems of knowledge, one Western, hegemonic, and another indigenous, non-hegemonic. The ineffectiveness of the former and the effectiveness of the latter (even if it is clearly delegitimized by the nurse), according to the experience of the Paí Family and the discourse of the nurse, question the “universality” of the human response to adversity and the notion that the experience of pain is likely to be addressed by clinical techniques that are based on the Western idea of human beings. This shows, on the one hand, the interconnections between the epistemic violence anchored in institutions and the worsening of suffering, and, on the other, the existence of mourning practices based on a very rich ethnic heritage.

22Far from any universalism, the validity of knowledge should always be contextual because it is produced and reproduced by the sociocultural experience (de Sousa Santos and Meneses 2017). In this sense, it is relevant to attend to the sociocultural elements that make viable oneiric narratives and the plural diagnostic and therapeutic systems of the aforementioned case. The Awa settlements are located in the jungles and mountains of the Colombian-Ecuadorian border area. Different anthropological works on this ethnic group (Cerón 1986; Parra 1989; Osborn 1991) affirm that important migratory processes towards places of very difficult access in the Andean foothills, motivated by dynamics of colonization, have caused the reproduction of material and symbolic logics of organization of life, underlying a spiritual syncretism. In it, converge codes of their worldview and of Catholic tradition.

23Understanding this syncretism from the perspective of members of the Awa people (or “mountain people,” as this Awapit language word is translated into Spanish) that remain in the territory and exercise their ethnic and territorial autonomy, implies a recognition of the fact that the mountain underlies the “origin,” the “raison d’etre,” the “identity,” the “wisdom” and the “autonomy” of the indigenous. For them, the relationship with the mountain or the territory is neither instrumental nor is it appropriation; the mountain and the Awa are one (UNIPA, CAMAWARI and ACIPAP [n. d.], 5).

24This defies the dualisms of Western modern thought. To say that the Awa and the mountain are one and the same, requires evidence that the use of words such as “imbrication” or “man-nature continuum,” would not be the most appropriate to assume this epistemological challenge and to explain that this is not about two exteriorities. For them, a single reality between the material and immaterial is configured through a territory that shapes a rich spiritual life (Cerón 1986; Parra 1989; Osborn 1991). According to the Awa People’s Ethnic Safeguard Plan, the mountain is made up of spiritual beings: “For us there are different and numerous sacred places within our territory. Within our worldview a sacred site is the place where spirits […] dwell, and with whom Awa must live daily, respecting and obeying their rules and protecting us from the diseases they can cause us when we fail to comply [...] Our spirituality is in the whole territory, because for us everything has a spirit” (UNIPA, CAMAWARI and ACIPAP [n. d.], 8-9; authors’ translation).

25According to Cadena and Paí Nastacuás (2006), when an Awa dies, his spirit leaves the underworld and begins to be part of the spiritual world, or the world above, a supernatural space from which incorporeal beings that inhabit the sacred places of the mountain, regulate the ways in which the natives act before their surroundings influencing their daily life. In the cases cited above, by way of dreams or diseases. Thus, from this “other” epistemology, there is no differentiation between spirit and nature and between the Awa and the territory (Cadena and Paí Nastacuás 2006; Franco 2016).

26That is the why somatic and spiritual ills, such as illness or grief, are expressed indistinctively in either the incarnate or psychological existence. The diagnostic and therapeutic system derived from their worldview names and treats the ills of the person as a whole, without cleaving the soul and the body: “empty heart” and “scared heart” are expressions of this conception. Among the Awa, both life and death, both the material and the spiritual, are levels of existence (Parra 1989). Death is not understood as the finiteness of life or existential disappearance. Life means being possessed of spirit, which is why “death” actually constitutes the transition to life in another existential world. To understand life, one has to understand death, as they are not two opposing states.

27This is the framework of meaning that enables oneiric narratives that affirm the existence of a life that follows death. What is more, the holistic experience of pain named under the categories of corazón vacío, corazón asustado and hielo de muerte, are expressions of a culturally-situated diagnostic and therapeutic coping system supported by a particular worldview which is at the heart of the psychosomatic uniqueness of suffering (not recognized by a Western medical standpoint). Both, dreams and sickness, exhibit notions and categories that express the various possibilities of time and space, of human life and death, of suffering and the re-composition of life following adversity.

  • 6 The context of violence in the Republic of Peru left approximately 69,280 fatalities. Of these, 79% (...)

28Other works on dreams in victims of violence, problematize singularities like these. In the process of transitional justice in the Republic of Peru, sleep experiences were witnessed by Quechua-speaking victims of the conflict that took place between 1980 and 2000, and were visible in the report of the Truth and Reconciliation Commission (Comisión de la Verdad y la Reconciliación 2003).6 These were documented by the anthropologist Arianna Cecconi (2011 and 2013) and linguist Luis Andrade (2005). On the one hand, Cecconi questions the dualisms of the Western context; rejects the general claims of such dichotomies in pluricultural contexts; challenges Western assumptions about body and mind; declares that dreams “seem to interact with the whole person” (2011, 411), and proposes that they should be used to go beyond the hegemonic view. On the other hand, Andrade underlines the therapeutic function of dreams through which dead relatives or divinities intervene on the dreamer’s ills by relieving them: “Years after the nightmare unleashed by the murderous project of Sendero Luminoso and the racist, violent and bewildered response of State institutions and the ruling class, in the dreams of the inhabitants of the Andes there is still a valuable space to comfort themselves from the sorrows, threats and fears of everyday life” (2005, 20; authors’ translation).

29In the next section, we describe the bureaucratic routes inserted in the apparatus of institutions involved in the management of suffering and we present, in order to support our arguments, some academic works that problematize the reparation processes.

The Bureaucratic Routes for Managing Suffering in Colombia

30According to de Sousa Santos and Meneses, “a vast institutional apparatus (universities, research centers, expert systems, technical opinions)” (2017, 9; authors’ translation) was configured in the South, supported by a capacity to confer intelligibility to one’s social experiences characterized by the “loss of a genuine self-reference” (2017, 8; authors’ translation), making it almost impossible to have a dialogue among diverse social groups. This category and its institutional anchoring constitute an interesting lens through which to analyze structural dimensions that are at the base of the reproduction of violence and suffering, even when in the legislation there is political will aimed at repairing the damages caused to particular groups of human beings by war. In this section, we describe the existing institutional, conceptual and technical provisions for the management of suffering in Colombia, the predominance of homogenizing, medicalizing and depoliticizing perspectives on suffering and the reception of these among communities of victims and social organizations. Following this, we deal with some ethical political reflections.

31The Colombian State’s acknowledgment of a victim begins with a registration of individual or collective victims in the RUV (Single Registry of Victims). Once registered, the UARIV (Unit for Comprehensive Care and Reparation for Victims) and the SNARIV (National System of Comprehensive Care and Reparation for Victims) execute the necessary actions for the victim to be able to access four of the five measures of comprehensive reparation contemplated by the Law (which may be individual, collective, material, moral or symbolic): administrative compensation; rehabilitation, which consists of medical, legal, psychological and social care­­; satisfaction through the “restoration of the dignity of the victim and dissemination of the truth about what happened; guarantees of non-repetition, and land or housing restitution. The victims access one or several of these measures, depending on the damages suffered and the type of victimizing event.

  • 7 In it, international humanitarian laws and human rights laws constitute the framework to “attempt t (...)
  • 8 “Starting from the recognition of human dignity, human rights and the damage caused during the arme (...)
  • 9 It considers that, the impacts of programs and projects –regardless of their good intentions– can e (...)
  • 10 Defined in the Art. 13 of the Law 1448 of 2011 as an approach that “recognizes that there are popul (...)

32To determine the severity of the damage caused and fulfill those measures, this Law gives prominence to the expert knowledge of law, medicine, psychology, social work, and social psychology. In this work, we are especially interested in the last three of these professions, as they were the ones called to guide the design and implementation of individual and collective actions aimed at rehabilitation; everything from a Rights-Based Approach,7 a Psychosocial Approach,8 a Do No Harm Approach,9 and a Differentiated Approach.10 The actions reported by this expert knowledge were systematized in the so-called Victims Psychosocial Assistance Program (Programa de Atención Psicosocial a Víctimas – PAPSIVI) designed by the Colombian Ministry of Health and Social Protection (2017).

33This document establishes three levels of care: counseling, therapeutic support and referral to specialized mental health services. In the last case, the care provided to the victim occurs in the context of the conventional Colombian health system, where criteria are based solely on broad principles of the ICD-10 (WHO 1992) and DSM 5 (APA 2013) nosology, which focus on the notion of trauma. Based on this notion as a hegemonic category for naming suffering, the main diagnostic manuals for mental disorders categorize symptoms from direct or indirect exposure to highly stressful events under different names of psychiatric disorders, which are thought to be subject to clinical and psychopharmacological intervention.

34Some scholars have introduced relevant debates about the re-victimization of people affected by war in Colombia after Law 1448 of 2011. The work of Colombian psychologist, Fredy Mora-Gómez (2016) discusses some significant elements about the technical particularities of the PAPSIVI. Specifically, Mora reveals how COLPSIC (Colombian College of Psychology) and academia have informed the construction of the interventions implemented through PAPSIVI. According to the author, some academic institutions propose the implementation of “models” and techniques to provide mental health care to victims that include: “the Narrative Exposition Technique (NET) and brief therapy models for managing PTSD, depression [and] anxiety” (Mora 2016, 137). Despite the ostensible precision of the techniques, the author adds that COLPSIC reported “weaknesses in the implementation of group and individual interventions that provide a full response to people’s particular needs (… with different regional origins, etc.)” (COLPSIC in Mora 2016, 138). In his thesis, “Reparation Beyond the Statehood,” the psychologist uses the expression “Repairing Betrayals” to refer to the practices of professionals and participants during psychosocial assistance interventions, which modify the protocols by recognizing themselves “as experts in the management of their own vital memories” beyond “the empirical validity of the device or the scientific knowledge […] and the empirically validated psychotherapies interested in referring symptoms, modifying ‘dysfunctional’ behaviors, or producing effectiveness indicators” (Mora 2016, 139). Mora concludes that reparation “cannot be designed” (2016, 199) because it emerges from each individual’s particular circumstances and own experiences.

35Public documents have also shown how these measures challenge the responsiveness of experts. Indeed, in 2015, the Colombian Ministry of Health and Social Protection showed that according to the allegations made by organizations of victims of violence: “There are currently practicing professionals who are untrained in the ethical-political, conceptual and best-practice foundations for the care of victims of the conflict” (Ministerio de Salud y Protección Social de la República de Colombia 2015; authors’ translation).

36In 2016, the Psychosocial technical committee, formed by civilian organizations and independent professionals, brought the following complaints to Colombian Congress after monitoring protocols and actions for psychosocial attention: “[there are] harmful actions, re-victimization and a deepening of the ways in which people are affected”; “inability to comprehensively approach the particular symptoms and effects manifested by the victims” and “conceptual setbacks […] in the current care guidelines from the Ministry of Health, where the focus of policy is limited to mental health” (Congreso de la República de Colombia 2016, 2; authors’ translation).

37There is an interesting cluster of academic works dating back to 2015, prepared by artists and professionals of social and legal fields that document individual and community emotional recovery practices, emerging outside the protocols and expert knowledge. These works describe concrete uses of the category of victim managed by local communities and performative practices that allow victims to resignify the critical event, update and dignify their vision of themselves, recognize ways of exercising citizenship, fuel the historical and intergenerational memory, mobilize social empathy and advance processes of political claim (Vera Lugo 2016; Acosta Sierra 2017; Rengifo Carpintero and Díaz Caicedo 2018; UARIV 2019; Delgado Barón 2015).

  • 11 Theidon identifies a range of critiques introduced by authors about responses from science and the (...)

38Many works criticize the lack of responsiveness in bureaucratic and scientific settings designed to deal with individual and collective harm in contexts of war and critical events (Das 2000 and 1995; Kirmayer 1996; Kleinman 1986 and 2008; Pupavac 2001; Scheper-Hughs 1992; Summerfield 1999; Theidon 2004; Zolkos 2008). In these, a number of concepts have been introduced to denominate the substitution of local categories of pain and damage for hegemonic medicalizing notions.11 Some of those concepts include, for instance, the category fallacy with which Arthur Kleinman name the “reification of one culture’s diagnostic categories and their projection onto patients in another culture, where those categories lack coherence and their validity has not been established” (2008, 14-15), or the spiritual failure, the term used by Veena Das (1995) to refer to the denial of other’s pain by the managerial logic of the State.

  • 12 From this frame of reference, the south is understood as a “field of epistemic challenges that seek (...)

39Undoubtedly, the evidence and indications presented in this paper reiterate these arguments and coincide with others associated with epistemic violence exercised by institutions, broadly conceptualized from a postcolonial perspective (Castro-Gómez 2010; Mignolo 2000; Escobar 2003) and from the epistemologies of the south12 (de Sousa Santos and Meneses 2017). Some of the papers that document pain management in multicultural contexts in Latin America during transitional justice processes coincide with the arguments introduced. The work of Diane Nelson (2015), Who Counts? The Mathematics of Death and Life After Genocide, on one hand, makes structural dimensions of epistemic violence explicit. In it, the author describes, the threats of physical and symbolic extermination exerted by the Guatemalan State on Mayan civilians during the post-conflict that followed the civil war and the genocide between 1960 and 1996. It also addresses the struggles that they undertook for the recognition of their systems of classification and categorization of the world, of their ways of naming and mathematically counting lives and deaths, and being counted as lives that matter.

40On the other hand, the work of Castellón and Laplante (2005) about mental health in people affected by the armed conflict in Peru, reveals cases of denunciation to the Peruvian State for the violation of the right to health protection, due to the lack of institutional structure; the lack of actual implementation and application; discrimination and stigma that make it impossible for victims to access their rights. In this same line, Theidon, in Entre Prójimos, denounces the ineffectiveness of the diagnosis of post-traumatic stress disorder to capture the meaning of the native and communal categories of suffering, such as “forgetful heart (qonqay sonqo)” (2004, 42), used to refer to the heart as the place where thoughts, emotions, and memory reside.

41These works echo the critical transitional justice studies that question the therapeutic nature of transitional policies that medicalize and depoliticize trauma and assume suffering as a condition that highlights the limits of dominant discourses on experiences after violence (Zolkos 2008). Everything seems to indicate that the processes of transitional justice open the structure of possibilities in which the vast apparatus of institutions (of law), informed by generalizing rationalities (and science), are stressed against the contradictions of the moral duty to repair, the non-capacity of response, the worsening of the damage, and the emergence of locally situated practices and performativities, outside the State. The ethnographic material exposed above highlights, on one hand, the great difficulties of self-referencing derived from the enormous apparatus of reproductive institutions of a mestizo subject (of which we –the authors– are part), which insists on univocal visions of human beings. On the other hand, they are contributions to the documented evidence of the practices that restore dignity that victims have been performing outside of the “official discourses of reparation” in Colombia. Experiences such as the ones described in this work (informed by people’s own knowledge and made possible by their sociocultural repertoires), located on the margins of “the official discourses of reparation,” are disseminated and witnessed as mechanisms that facilitated the elaboration of pain and the restoration of dignity.


42This paper problematizes the epistemes that inform two closely related statutes, underlying the processes of transitional justice: law and science. The loss of self-reference appears to be maintained by the “expert” knowledge dislocating the institutions from a situated social experience. The descriptions that show the voices of the victims added to the contributions of Colombian researchers shown in this paper, together with the ethnographical evidence of the technical impossibility of recognizing different meanings and particular ways of naming and healing suffering or pain in a war-affected pluricultural context, raise an ethical-political reflection about the validity of the criteria used to explain the other, that assumes the superiority of the mestizo.

43In Colombia, the facts suggest that perhaps the longest armed conflict in America, together with the victimization of almost 20% of the population, was a way to bring to public discourse an explicit awareness of the diversity that constitutes the territory, although it is not yet expressed in actions that effectively indicate the symmetry of such differences. Are not the clues, evidences and theoretical collections exposed in this work, sufficient elements to prioritize an action-research agenda that reorients our gaze towards higher education institutions, towards university-trained professionals and towards those who intervene in the life of others under the statutes of law and science? What happens if we shift the gaze from those others who are usually fragile, violated and marginalized, and we become the object of study? Is this loss of self-reference not an aspect associated with the reproduction of people’s unequal access to their rights, making them more precarious?

44We believe in the need to radicalize a research agenda capable of systematically objectifying the dialectic between the logics of production, reproduction, and consumption of knowledge and the modus operandi of the institutions through a sociology of science, an anthropology of knowledge and of institutions, and a social psychology that makes self-reflexivity a cultural code, capable of supporting the construction of policies sensitive to the multiplicity of forms of existence. We urge researchers and academics to question the training and emergency processes of professional groups; the formal and informal production of epistemes and sensitivities associated with one discipline or another; the production and reproduction of ideas of truth, of systems of interpretation that condition the ways in which we understand the world; the starting points of the thoughts; the exercise of professions in community and institutional, public and private spheres; the self-perception of the professional role in these contexts; the deconstruction of preconceptions and the construction of the so-called “good practices” located in the same contexts. We urge the reader to distrust the tendency to overturn the gaze on the vulnerable other. Standardized discourses on wellbeing, development and quality of life, that do not distance themselves from homogenized ideas of reality, and that ultimately have an impact on a modeling of the technique, the professions, and the institutions, are hidden behind this tendency.

  • 13 From this concept the plurality of the validity criteria is recognized, the horizontal dialogue amo (...)

45The findings presented in this paper reiterate the capacity of otherness to put under pressure established forms of knowledge by contesting the current epistemological regime, to challenge the epistemic violence and to expand political possibilities of ontology through an intercultural dialogue or ecology of knowledge.13 The challenge involves deconstructing notions, actions, and institutions. This allows for a moral and political practice, committed to the dignity and respect for the difference of those who, owing to historical inequities, have been exposed to physical violence in the name of war and to symbolic violence in the name of science.

46Acosta, Angélica. 2016. “Yo sabía que ser denunciante me iba a cambiar la vida.” In Etnografías contemporáneas III: las narrativas en la investigación antropológica, edited by Myriam Jimeno, Carolina Pabón, Daniel Varela and Ingrid Díaz, 299-326. Bogotá: Universidad Nacional de Colombia.

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1 The Revolutionary Armed Forces of Colombia (FARC) were officially formed in 1964. The United Self-Defense Forces of Colombia (AUC) was formally formed in 1997, supported by members of the public force, social elites and the Colombian business class. The actions of both groups involved drug trafficking, illegal mining, the use of anti-personnel mines, murder, kidnapping for political purposes or extortion, and terrorist attacks with bombs and unconventional weapons. The confrontation between the guerrillas and the Army and the self-defense groups led to the forced displacement of civilians, the recruitment of minors and the destruction of public infrastructure. The FARC demobilized in the framework of the Havana Agreements signed in 2016 under the government of Juan Manuel Santos. The demobilization of the AUC was part of a process characterized by high degrees of impunity guided by Law 975 of 2005, also known as the Justice and Peace Law, established during the government of Álvaro Uribe (Grupo de Memoria Histórica 2013).

2 Even if there are uncountable victims prior to this year, 1985 is the date that Law 1448 of 2011 establishes, in its third article, the starting point for victims to access to comprehensive care, assistance and repair measures: “Victims are considered, for the purposes of this law, those persons who individually or collectively have suffered damage due to events that occurred from January 1, 1985, as a consequence of violations of International Humanitarian Law or of serious and manifest violations of the Human Rights, which occurred on the occasion of the internal armed conflict.”

3 This research is based on the anthropology of war and social suffering. According to Tambiah, “the phenomena of ethnic and collective violence entail at least three large domains of inquiry” (1996, 27). These can be labeled as the anthropology of collective violence, the anthropology of displaced persons, and the anthropology of suffering. The research mentioned is located in this last domain of inquiry, which corresponds to the study of the suffering and coping at individual, familial, communal and collective levels (Das 1995 and 2000; Kleinman 2002; Kleinman, Das and Lock 1997; Scheper-Hughes 1992).

4 This research responds to a request made by the community with which the fieldwork was carried out (including leaders): to make visible the violations that currently threaten their physical and cultural existence. Although the study is broader than what is presented here, in this article we privilege this case as it allows us to elucidate the effects of the epistemic injustice expressed in reparation processes during the implementation of transitional policies. The research had the due approval of the Ethics Committee of the doctoral program to which it is attached.

5 An extensive body of anthropological works about the indigenous people of America demonstrates the function of dreams in social reproduction and maintenance of cultural order (Perrin 1990; Niño 2007; Descola 1989; Idogaya 1990; Losonczy 1990; Melis 1990). These ethnographic approaches have revealed some general principles that allow dreams to restore the characteristic values of their cultures. According to Perrin (1990) they include, first, the relationship between being asleep and being awake. This constitutes “the universal origin of the belief in the existence of soul as an entity that can be separated from the body” (1990, 7). This means that dreaming is an objective evidence of supernatural space/time; second, the connection among sleep, illness and death. The dream could be the announcement of a premonition, a symptom, or a therapeutic mechanism. And third, the relationship between the dreams and myths which reveal particular conceptions of a person and the way this idea of human being establishes relationships with the universe.

6 The context of violence in the Republic of Peru left approximately 69,280 fatalities. Of these, 79% lived in rural areas and lived in poverty and social exclusion, and 75% had Quechua or another indigenous language as their mother tongue. Data such as these showed “the seriousness of the ethnic-cultural inequalities that still prevail in the country” (CVR 2003, 53; authors’ translation).

7 In it, international humanitarian laws and human rights laws constitute the framework to “attempt to generate protection for people and goods that do not intervene in an armed conflict and has a binding effect on States and irregular groups” (Ministerio de Salud y Protección Social 2017, 40; authors’ translation).

8 “Starting from the recognition of human dignity, human rights and the damage caused during the armed conflict, we must begin to speak of psychosocial aspects, based on an integral conception of the person, which understands dignity as the inherent autonomy of every being human being, which is how one can understand people’s behavior in their ethical, legal, economic, political, religious, cultural, social and psychological context” (Ministerio de Salud y Protección Social 2017, 140; authors’ translation).

9 It considers that, the impacts of programs and projects –regardless of their good intentions– can exacerbate conflicts; so, “it proposes that, at the time of proposing the actions and evaluating their consequences, an ethical analysis of the actions should be included from the point of view of the values and principles that guide them, considering, in addition to other criteria, minimum principles –or minimum ethics– as agreements and desirable values of human coexistence in conditions of plurality and multiculturalism, based on the notions of dignity, autonomy and freedom” (Ministerio de Salud y Protección Social 2017, 32; authors’ translation).

10 Defined in the Art. 13 of the Law 1448 of 2011 as an approach that “recognizes that there are populations with particular characteristics due to their age, gender, sexual orientation, and disability situation” (authors’ translation).

11 Theidon identifies a range of critiques introduced by authors about responses from science and the State; they emphasize the centrality of the autonomous individual who exercises control over himself and his environment; the intrapsychic sphere is privileged over the socioeconomic or political context; the spiritual plane is relegated to a supplementary axis; the mental expression of distress is normalized and the corporal expression, known as somatization, is “pathologized”; supposes that there has been a defined traumatic event and that one can speak of a “post stress” state; assumes that there is a universal response to stressful events; the traumatic event was an event “outside the range of normal or everyday human experiences”; and the treatment takes the individual as the unit of analysis and intervention (2004, 41).

12 From this frame of reference, the south is understood as a “field of epistemic challenges that seeks to repair the damage caused”; “geographic south, subjected to European colonialism,” “the south in North America and the south in Europe” (de Sousa Santos and Meneses 2017, 10, authors’ translation).

13 From this concept the plurality of the validity criteria is recognized, the horizontal dialogue among knowledge is defended and a “critique commitment and an active awareness of the power relationships intertwined in the systems of knowledge to challenge the dominant orthodoxy of the academy” is claimed (de Sousa Santos and Meneses 2017, 13; authors’ translation). Considering the close relationship between law and science, as mechanisms underlying the maintenance of the regimes of truth, there is a particular interest in this work in problematizing an epistemological dimension. We consider that putting the starting point of interpretations into discussion is a powerful element to support structural transformations of reality, which enable ontology policies aimed at decolonizing thought (Holbraad, Pedersen and Viveiros de Castro 2014).

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List of illustrations

Title Figure 1. Maps of Tumaco in Nariño, Nariño in Colombia, and Colombia on the globe
Credits Source: Elaboration by the authors with data from​files/​images/​MunsNarino_Tumaco.jpg
File image/jpeg, 146k
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Bibliographical reference

Angélica Franco Gamboa and Laura Franco Cian, « Managing Suffering in War-Affected Pluricultural Contexts: Reflections on the Assistance to Victims in Colombia »,Revista de Estudios Sociales, 73 | 2020, 109-121.

Electronic reference

Angélica Franco Gamboa and Laura Franco Cian, « Managing Suffering in War-Affected Pluricultural Contexts: Reflections on the Assistance to Victims in Colombia », Revista de Estudios Sociales [Online], 73 | 01 julio 2020, Online since 01 July 2020, connection on 18 September 2020. URL :

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About the authors

Angélica Franco Gamboa

Ph.D. in Anthropology, Universidad Nacional de Colombia. Associate Professor at the School of Psychology at Universidad El Bosque, Colombia, and Assistant Professor at the Department of Anthropology at Universidad Nacional de Colombia. Latest publications: “En la lógica de la frontera: representaciones miopes, guerra y territorialidad en Tumaco (Colombia)” (co-author). Convergencias. Revista de Educación 1 (1): 25-44, 2018; “Fronteras simbólicas entre expertos y víctimas de la guerra en Colombia.” Antípoda. Revista de Antropología y Arqueología 24: 35-53, 2016. Anfrancoga[at]

Laura Franco Cian

Ph.D. student in Gender Studies: Culture, Societies and Policies, Universitat Rovira I Virgili, Spain. Assistant Professor at the School of Psychology at Universidad El Bosque, Colombia. Latest publications: “Los rostros de las mujeres víctimas del conflicto armado en Colombia: diferentes formas de violencias de género” (co-author). Revista Instituto Nacional de Medicina Legal y Ciencias Forenses 18 (1): 624-645, 2017; “La función de la piel y de las modificaciones corporales en la constitución del Yo” (co-author). Avances en Psicología Latinoamericana 30 (1): 159-169, 2012. Lfrancoci[at]

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