Mental Health, PTSD and the Crisis in Nicaragua

Anxiety, depression, and suicidal thoughts are the most common disorders that specialists in mental health have been seeing.

Por Julian Navarrete  (La Prensa)

HAVANA TIMES – The body of Josue Sandigo Reyes, 22, was discovered last June 16, in the community paradoxically known as Desamparados [“The Defenseless”] outside of San Jose, Costa Rica. An empty bottle of poison lay beside it.  Sandigo had been one of those in the occupation of the Nicaraguan National Autonomous University (UNAN) in Managua during the protests against Daniel Ortega’s government. On July 21, it would have been a year from the date he left for exile in Costa Rica.

The forced exile, the separation from his sister –  the only family member he had – and the lack of opportunity to work or study could have been the factors that pushed him to take his life, according to the friends with which he shared a small house in precarious economic conditions. “He felt very bad, and at times he would cry and relieve his feelings that way,” stated one of his friends.

Sandigo’s case isn’t an isolated one. This week, the death of Jasson Lopez, 22, was also being posted on social media. Lopez, another of the former demonstrators, hung himself as a result of the depression he had been suffering for months, according to statements from his family.

These cases reflect the most severe damages to mental health that Nicaraguans are suffering as the result of the political crisis. However, specialists warn that given the magnitude of the repression that they’re living and the ever more prolonged period of instability, the psychological and physical problems are affecting all Nicaraguan citizens.

“It would be abnormal for people to feel normal in this context,” says psychiatrist Gioconda Cajina, who has attended patients that run from the family members of those killed during the repression, to released political prisoners and citizens suffering nervous crises within the context of current events.

The most common mental disorders that people suffer are anxiety and depression, but they can also include other serious disorders. Nicaraguans may also be suffering general illnesses like head and muscle aches, blood pressure alterations, or high levels of sugar in the blood due to stress.

“We tell ourselves that it’s mental, and we hold on, we bear up, but everything in the brain is reflected in our body, and this can lead to hormonal and metabolic disorders and thus alterations in the entire central nervous system,” explains Cajina, specialist in mental health.

No information from the Ministry of Health

Political crises, like the one Nicaraguans are experiencing, produce a social and organic decomposition in the entire country. Citizens have lost their basic rights to be able to survive in society because the authorities charged with overseeing their health, family sustenance and security have lost all credibility.

According to specialists, the citizens now fear the police, army members, doctors in the public hospitals, and judges in the court system.

The Ministry of Health, for example, the institution that is responsible for the health of Nicaraguans, has no data about attention offered for psychiatric problems. La Prensa’s Sunday magazine (Domingo) sent an e-mail requesting information regarding this, but as of press time the Ministry hadn’t responded.

On the other hand, the only specialized attention that the state offers for these problems is in Managua’s Psycho-Social Hospital and another three smaller centers in the entire country. Nevertheless, the political lens through which all this is viewed causes distrust in perspective patients in need of this attention.

A doctor who purchases medications from this hospital, and who asked to remain anonymous, stated that before handing him the pills, the nurses from the center subject him to a political speech in favor “of Daniel Ortega’s government”.  This center also displays different posters with propaganda from the Sandinista Front.

“Patients who aren’t Sandinistas don’t feel enough trust to open up, in order to relieve their mental problems,” the doctor says.

The Ministry of Health has also failed to issue any report on the consultations in the hospitals and health centers for illnesses that could be related to stress and depression. Such data could serve to measure the real impact of the crisis on mental health.

A collective of independent psychologists called Sanar (Recover) has offered over 850 consultations during the entire crisis period. The eight specialists offer confidential attention via social media, by telephone, and occasionally in person.

The majority of those who reach out to Sanar are suffering from anxiety, or symptoms of mood disorders such as depression, suicidal thoughts or other things.

Psychiatrist Gioconda Cajina believes that instead of an increased volume of consultations in her clinic, these have decreased due to the economic crisis that the country is suffering.

Open wounds

Fear has enveloped the citizens when they walk down the streets in Nicaragua; they take more precautions that they did months ago, and they’re even more cautious about speaking on certain topics, even those that aren’t strictly political. To the specialists consulted, this is due to accumulated post-traumatic stress from the wars that were waged during the last 40 years. The current crisis has revived these traumas.

The adults that lived through the wars tend to remember those conflicts and they relate them to the current moment. “These people worry when their family members leave work, the university, or school. This leaves them in great tension due to the insecurity that exists in the streets,” says psychologist Roger Martinez.

Political prisoners from La Modelo

In the eyes of the Sanar collective, the burden from the many armed conflicts in Nicaraguan society has still not been cured and this has been magnified by the latest months of violence that the country has experienced. “This has generated both physical and mental destabilization in all Nicaraguans, this being the natural response to an abnormal context,” this team of specialists added.

In the last 40 years, there haven’t been any processes of reparations in Nicaragua for the victims of violence. Psychiatrist Gioconda Cajina feels that this has caused an accumulation of traumas. “Psychological health has never been treated, and there are certain truths that we don’t want to examine,” she added.

Nevertheless, history is a continuum. The greatest consequence of the wars, specialists agree, is the damage done to the consciousness, so as to avoid repeating the experience of war. “We don’t want the history of the struggle for power to repeat itself,” Cajina says.

The prison psychologist

In the El Modelo prison, Roger Martinez did laps around his cell and breathing exercises to calm himself after situations that caused an overload of emotions.

Martinez, 35, is a psychologist who for two years has been writing for the newspaper Hoy. During the political crisis he was jailed for participating in the protests and was released after eight months.  “The other prisoners called me “the psychologist” and that’s how they got to know me,” Martinez says.

Some prisoners would come to Martinez in prison seeking psychological attention. He gave several of them books to read so that they could “find themselves”. Others were reluctant to express themselves. “Little by little they began gaining trust to express how they were feeling: they managed to overcome their mental barriers and approach me.  Others never managed to,” affirms Martinez.

Gioconda Cajina explains that due to their machismo, many prisoners don’t accept that they have mental problems. “There are people that suffer panic attacks and don’t accept it. They say that they’re heart problems, but when they have tests, the heart is normal. This lack of acceptance is normal, because there’s resistance to feeling vulnerable,” she adds.

In the cells of the La Modelo prison, Martinez perceived that the most common illnesses were anxiety, stress and depression. What he saw most often was the political prisoners crying for long periods of time due to this emotional suppression “in order not to seem weak.”

“Many left prison without having had the opportunity to express those emotions, and today they’re suffering the consequences in symptoms such as aggression and explosive tempers,” the psychologist sustains.

Cajina feels that direct victims like the tortured, the exiled, and the released prisoners need specialized attention. However, she sees how it’s now more common for people to be buying pain pills or sleeping pills in the pharmacies. “People are self-medicating, and that poses an enormous risk because it keeps them from fully grasping reality,” the specialist warns.

At home, the released prisoner Martinez has had trouble sleeping. Others of the released political prisoners suffer from night terrors, nightmares, excessive hunger or loss of appetite. In jail, the meal hours were different; some, like Martinez, have still not adapted.

Others of the released prisoners suffer from episodes of paranoia or delusions of persecutions when they’re near a uniformed police officer.

What to do?

Psychiatrist Gioconda Cajina says that we should pay attention to the opportunities that arise out of great difficulties. As such, she advises us to look for the positive side of every situation. For example, she has counseled a released prisoner who has two small children to use this time to be with them, because previously he couldn’t.

Another released prisoner who lost his permit to make fireworks and rockets, was counseled to make hammocks, since he could also do that.

For released prisoners who don’t know how to read, Cajina has instructed them to use this time at home to progress out of illiteracy.

The psychiatrist affirms that loss can cut people down, reduce their self-esteem and cause them to be revictimized or made to feel inferior. As such, they should transform their circumstances.

Physical ailments can be generated by mental exhaustion. There are defense mechanisms to maintain mental stability such as adrenaline and the corticosteroids, but when these run out, the body begins to fail.

The abuse of stimulants, can cause depression, personality disturbances and suicidal thoughts. Specialists consulted considered that there are no pills that “remove the urge to kill yourself” and that collective treatment is the best.

Am I experiencing a psychological crisis?

Here are a few tips from the psychologists at Sanar and other specialists to know if you’re going through a mental crisis.

• Identify a recent problem that has affected your mood and physical state.
• Identify the frequency and intensity of what you feel.
• Identify who else is affected by this situation
• If you’ve experienced these sensations for more than a month, you should see a professional.
• If you go to a doctor, you should describe your immediate environment to identify the symptom
• Muscular aches, irregularities in blood pressure, nervousness or any health upset can be related to stress.