On August 1, 2004, a huge fire broke out in the multilevel Ycua Bolanos shopping complex in the outskirts of Asunción, the capital of Paraguay. Possibly due to a chimney fire or propane gas canister explosion in an oven, the conflagration occurred when the mall was thronged with about a thousand midday Sunday shoppers buying groceries and lunching at the food court. The death toll rose to over 460 adults and children, with many hundreds more seriously injured. When the fire broke out, it was reported that the doors were ordered locked to prevent theft, thus impeding escape. The loss of life was reported to be the most tragic single incident in the history of Paraguay. President Nicanor Duarte visited the scene and declared that three days of national mourning would begin August 2.
Although some 5,000 miles away, the fire was hardly a remote catastrophe to us in Boston when we learned about it on the news that evening. As we had planned for months, on August 2 my wife, younger daughter, and I would be leaving for Paraguay to visit our older daughter, a Peace Corps Volunteer in a faraway village, about an eight-hour bus ride from Asunción. The timing of our trip suddenly seemed most unpropitious. In a country of about six million people, the death toll was more than proportionate to that of the 9/11 terrorist attack in New York City. Paraguay, moreover, has a history of national devastation and trauma. Perhaps most tragic of all was the 1865 conflict against Uruguay, Brazil, and Argentina in which Paraguay lost roughly half of its population and much of its territory.
For the out-of-the-way trip to this “island surrounded by land,” I had previously planned to meet José Arias, an adult and child psychiatrist who practices and teaches in Asunción. He would be my contact person in this third-world country where unusual things were reported to happen. We had been linked by Myron Belfer, an adult and child psychiatrist in the Department of Social Medicine at Harvard Medical School in Boston. Arias, who is on the psychiatric faculty of the University of Asunción, is the president of both the Paraguayan and the Latin American Associations of Psychiatry and Psychology for Infants and Adolescents (APPPIA and FLAPIA).
Given past Paraguayan tragedies, I wondered with them how the nation's history might affect the individual experience of trauma.
He received his psychiatric training at Johns Hopkins Medical School, had an analysis, and is both psychiatrically and psychoanalytically informed.
Upon arriving in Asunción, I called Arias on his cell phone. We soon met and talked about the horrific fire and what he and his colleagues were doing in its aftermath to try to help surviving victims, their families, and the bereaved. There were a few dozen psychiatrists and perhaps a hundred or so psychologists and more social workers in the city. They had begun working within schools and municipal office buildings to find and treat the multitude of those with posttraumatic shock and grief.
With many questions about how to proceed, they were hungry for input about psychic trauma. But Paraguay has no psychoanalytic institute or society, so Arias asked me to give a lecture on psychic trauma from a psychoanalytic perspective. Since he is fluent in English, he would translate.
Having left the morning after the conflagration, however, I had not imagined nor prepared for an impromptu invitation to lecture. Because the journey was to have been a pleasure trip, I certainly had brought along no notes. Under the circumstances, however, I could not refuse the possibility of trying to be helpful. Fortunately, I had just been editing and contributing to a volume on current psychoanalytic views on trauma (including severe trauma), fantasy, and reality since Freud's seduction hypothesis, so that some content was fresh in my thinking. [see “New Books by Members,” page 38]
After several days of touring the spectacular Iguazu Falls, Itapua Poty (my daughter's locale), and the nearby threatened forest and ecosystem reserve of the Cordillera de San Rafael (ProCoSaRa), we returned to Asunción. Meanwhile, Arias had printed colorful flyers with the lecture title, “El Trauma Psicologico Y Sus Effectos En La Subjectividad” (Psychological Trauma and Its Subjective Effects). The program was organized by the Prevention Program for High Risk Behavior and Mental Health of the Municipality of Asunción, APPPIA, and FLAPIA.
Some attending the conference spoke English; Arias translated admirably for the majority. I talked about the history and evolution of the psychoanalytic concept of trauma, as well as clinical and diagnostic issues. One issue was that since it was so soon after the tragedy, one had to be aware of the possibility that some of the immediate acute stress and grief reactions would become the more chronically debilitating posttraumatic stress disorder
Michael I. Good, M.D., is a faculty member of the Psychoanalytic Institute of New England, East, and an associate clinical professor of psychiatry at Harvard Medical School.
and some would not. In psychoanalytic terms, trauma is defined not by the event but by the intrapsychic effects.
A comparable disaster was the Cocoanut Grove nightclub fire in Boston some 60 years ago, which is a prototype in the study of trauma and bereavement due to conflagration. The human factor in causing a disaster is a troublesome contributor to traumatic outcome. In this case, the doors had been locked, and there was palpable rage as well as grief among survivors and families.
The audience was very receptive and responsive. Some shared their experiences with individuals and families. Among the issues we discussed were sleep problems, survivor guilt and grief, the possible need to wait for traumatized persons' readiness to talk about their overwhelming experience, longer-term therapeutic planning in the community at large, the notion of transmission of trauma through projective identification, and the countertransferential stresses on treaters and other helping persons. Given past Paraguayan tragedies, I wondered with them how the nation's history might affect the individual experience of trauma. After the gathering, which lasted over two hours, Arias expressed his wish for a return engagement.
In a related development a psychology trainee planned to travel to the U.S. to take a course on psychic trauma. Also, a link with another Peace Corps Volunteer led to the referral of a host family in a remote area whose daughter had come to Asunción to work as a cashier at the shopping complex and, sadly, had perished in the fire. Arias offered to see her family, who were overwhelmed with grief and could not sleep.
Meanwhile, Paraguay is now suffering further because of extreme drought and ruined crops. In the arid conditions at the reserve of Pro-CoSaRa, thousands of hectares of forest burned in February 2005. In the wake of all these great tragedies, it is heartening to know that there are Paraguayans who, like many others in our field in South America, have an interest in viewing the extreme range of human experience through a psychoanalytic lens.