Passive trauma | Revista Colombiana de Psiquiatría (English Edition)

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The stories from the following interviews were originally gathered as research by a playwright and theatre director with the intention of later producing a creative play. For the playwright and the women interviewed, the purpose was to make their experiences visible thereby turning them into told stories. On learning about this, we asked the director-researcher about the possibility of accessing the interviews in order to carry out a qualitative research secondary data analysis from both a clinical and family and couples psychotherapy perspective. After obtaining the consent of the people interviewed and that of the director, we proceeded to view all the interviews and conduct the research work which is the basis for this article.The aim of this work is to give a voice to the people who lived with soldiers during the armed conflict with the guerrillas in Colombia. These people were direct observers of the conflict, living alongside those directly involved in the fighting. As Gómez-Restrepo et al.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> show, from the National Mental Health Study, the repercussions of violence due to armed conflict not only affect the combatants, but also other sectors of the population which are not given enough attention. They had extremely shocking experiences which had significant effects on their lives. Making those voices heard is one way to vindicate other victims of the conflict who have lacked any mention in the country's medical and psychological literature.MethodsThis article is based on the secondary analysis of data on the narratives of military wives in a combat zone in Colombia. The information was gathered through semi-structured, video-recorded interviews with wives of Colombian soldiers of the rank of officers and chiefs who lived in barracks in combat zones during the armed conflict with the guerillas. The original research was carried out by a theatre director and playwright whose interest was to make the voices of these military wives heard. For this study, the original researcher used a sample of military wives who were invited to take part in individual interviews, after obtaining informed consent to videotape them, with the intention of writing a play and making a film and television documentary. The original sample consisted of 20 people. With the aforementioned input and the due informed consent of the original researcher and the participants, the authors of this article decided to carry out a second phase, which consisted of qualitative research with secondary discourse analysis,<a class="elsevierStyleCrossRef" href="#bib0010">2</a> using the videotaped interview information as material. The snowball sampling of 20 people is intentional for the sake of convenience. The instrument with which the secondary analysis was carried out was the video-recorded semi-structured interview with each of the participants, watched in its entirety by the investigators. The authors did not know the names of either the women or their soldier husbands.We established several categories to classify and analyse the information obtained from the interviews. The process of defining them was as follows. To start with, both investigators watched the first interview chosen at random. While watching the video, both investigators noted down a series of categories. At a subsequent meeting, through a process of analysis, reflection and theoretical-conceptual discussion, a consensus was reached on using the categories of experiences, emotions, feelings, family and symbols in the scheme to be applied while watching all the interviews. After the first 10 interviews, the investigators realised there was a degree of saturation with the categories chosen. Using the same procedure as previously to reach a consensus, they then added the new categories of morality, limits, self, reason for telling the stories, and absence of the father for the next 10 interviews.Analysis of the categoriesFirst phaseExperiencesIn this category, evident among those interviewed was the constant experience of loneliness due to the husbands’ prolonged absence. Expressions like, “not being able to see my partner, having limited time with my partner, living alone for 16 years, two years in which I only saw my husband for 2 weeks, up to seven months without seeing each other, being a single mother, being mother and father at the same time”, illustrate how the idea of being a couple with constant support in day-to-day life is distorted, being limited and curtailed by the lengthy and frequent absences of the partner. The idea of being a couple invokes the typical imagery where their presence, companionship and day-to-day life are the central axis of the relationship, a scenario which could not be further from reality in the lives of these women. Their key question is, “How can you be a couple with a person who's not here?”.Another experience has to do with constant transfers and the need to adapt to continuous changes, the experience of how difficult it is to always live on military bases and have to leave your pets behind with each transfer. This experience of continual mobility and instability lies behind the difficulties the women interviewed reported in making lasting friendships, which can be seen in the fragile relationships they have with others.War organises relationships and life. This phrase hides a multitude of acts and omissions in family life. For example, most agree that when the father comes home he spoils the children because he feels guilty about seeing them so little. Therefore, the mother has to take on the responsibilities that should be shared, such as guiding the education of the children. The absence of the fathers due to their military life makes it difficult for couples to work together to form the union which signifies them as parents and heads of family and home-makers.This distortion of family life generated an emotional experience of “living in a barracks directly connected to the war, as if we were one big family”. “We were all family”. As the nuclear family was fractured in a certain sense, they gathered together to form one large family with the soldiers, “considering them as our own children”. As women, they were aware that their children were experiencing the absence of their fathers, and they understood that, being sons, husbands or fathers, these soldiers were also creating voids in their families outside the barracks. The combination of absences experienced and absences generated gave rise to a great sense of solidarity among the people in the barracks, building strong bonds to look after each other which evoke family life.The continual insecurity, the constant uncertainty, “the constant risk, not being able to go out in the city or town freely for fear of attacks or kidnappings, always having to be careful on the street, always being prepared with a backpack in case there was an attack, learning to use weapons, combat training in case it was necessary to defend ourselves, getting used to gunshots and gunfights, bomb attacks, strict confinement to barracks because of threats”, is, as one of the women says, “living with your heart in your mouth”. Or as another says, “to constantly live with fear is to learn to be afraid”. All of this generates a deep feeling of fragility and vulnerability; living in constant fear.As a result, life is reduced and restricted to the barracks, which several of the women describe as “living in a bubble”; to the extent that “you forget the outside world exists”. This was made even worse when, under attack, you had to leave the house, not to leave the barracks, but to go into a bunker inside the barracks, which is an even deeper form of isolation.The continual witnessing of military friends dying brings the dead and wounded increasingly close to the family: “Will my husband come home alive?”, “Will my husband be wounded, have lost his legs, be dead, destroyed, etc?” Experiences such as that of one woman when a coffin arrived mistakenly labelled with the name of her husband; her husband had not actually died. In summary, continually observing war unfolding, daily life marked by the events of war, and the fears of children when seeing dead and wounded routinely arriving in helicopters, force these people “to learn to be brave”, as one woman says.Several of the women also agree on the need for the “vow of silence”, which they have to maintain as they cannot talk about many of the things they feel, experience and observe. They lack the direct experience of war, but they see the consequences of war. This means that when it comes to their children, in order to create a more or less happy and healthy family life, fathers get used to filtering the information to protect their wives and children from the reality.In this context of experiences of tension, insecurity, fear, absence and loneliness, psychological responses range from anxiety to spontaneous abortions due to stress, and clinical depression to hospital admissions for acute psychotic episodes.In the midst of all this, extraordinary acts emerge showing how these women in the midst of war manage to set up volunteer projects to help other people seeking compensation, with expressions such as “so as to feel like I’m doing something useful for others”; that is, those they call their extended military family.Emotions and feelingsIn the category of emotions, expressions such as, “How difficult it is to live with a hero, it's very hard”, or, “terrible stress”, are usually followed by phrases such as “constant fear of attacks, fear to leave the bubble of the base, continual fear for safety, fear of the outside world, locking myself in my fear, fear of being told that your husband has fallen or is injured, fear of being kidnapped, ever present fear of war”. All these feelings of fear are also accompanied by feelings of terror and panic seeing amputees and war injuries; they feel affected by the dead, the constant anxiety accompanied by the uncertainty of whether or not they will come home alive. This set of emotions and feelings drives them to “learn to be brave and be afraid simultaneously”. The fact of knowing that “we could lose them” keeps these women and their families in constant state of alert, for fear of the frequent mobilisations and of always being apart from civilisation.The husbands are out in the hills, meaning that, as the women agree, the experience of “not even being able to live with him”, generates a deep feeling of loneliness and a continuous dichotomy between union and death which means intimacy “is always hindered by distance”. The feeling of going from television spectacle straight to seeing dead soldiers off-loaded from the helicopter generates feelings of great confusion, difficult to describe; as one of the women says, “They should make a documentary about our feelings”.Other feelings also emerge, however, such as admiration for their husband, love for the country and for the armed forces, pride in the power of the husband and father, feelings of deep solidarity expressed by volunteering to help the wounded, amputees and families of soldiers, and “the non-fear of death”, something which becomes routine in the barracks. As one of the women says, all these difficult to metabolise feelings become illnesses that doctors cannot decipher; indefinite pain.FamilyIn terms of effects on family, there is a saturation index in the responses of those interviewed regarding the idea that war organises life and family, because the continual transfers of the military husband means the whole family transferring to the war front; this means that for most of these families, “Adapting to change is easy because you're constantly moving”. As one of the interviewees says, all relationships are subject to the nomadic military lifestyle, or according to another, “We haven’t lived a normal life”. For these families it is a constant that they identify as a “military family” serving the country, not just the soldier in the family, the whole family. This tacit mandate is so strong that one woman states, “We acquire the vocation to be part of them, and those who don't acquire it get divorced”. All of which translates into an idealisation of the military family. The woman or wife becomes the centre of day-to-day family life and becomes the organiser of that life. The continual absence of the father is a fact that impels the wife to be her husband’s support and carer of the children. A dual role that some recognise, “You have to be very strict as a mother because you have to serve God and the country”. This idealises the absence; “The absence is an honour.”The feeling of loneliness is deep-rooted in these women and their families; or as one of them says in great pain, “In so many of my husband’s absences, I was alone with my daughter”. But the most dramatic thing about these women's loneliness is what several of them expressed, “To be a military wife is to remain silent”. As a consequence of all the absence and loneliness, the military base becomes a large extended family, with one woman summing it up as, “Everyone on the base acted as if we were all brothers and sisters”. The way in which these mothers managed to justify the father's absence to their children was to, “Indoctrinate the children with stories of honour”, praising the father's absence as a sacrifice and act of extreme generosity, putting his life in danger to save the country.Children and their mothers live in an extreme dichotomy in which they fluctuate between the interest and concern of the day, observing the consequences of war when the helicopters arrive with dead and wounded, and the fear at night, when they have to process everything they have seen in order to rest and sleep.The most dramatic version of the experience is observing disabled soldiers, a by-product of war. Most of the women work as volunteers in helping these soldiers and comment that they are, in the words of one of them, struck by, “How they distance themselves from their families and prefer to isolate themselves from them”.From a structural perspective,<a class="elsevierStyleCrossRef" href="#bib0015">3</a> these are integrated families with fuzzy boundaries within the marriage (the wife goes where the husband goes) and with clear hierarchical boundaries between the members of the parental and filial subsystems. The women and children, being subjected to the professional demands of the father and an idealisation of his work, find their freedom to develop as individuals hindered to a certain extent.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> All family members are servants of the state. At the same time, the feeling of overprotecting the children is exacerbated, in view of the risks they are constantly exposed to. The woman has a dual role, she must act as a mother but, due to the man's long absences, she also has to take on the role of father. However, the masculine role is experienced as distant, idealised, absent for a greater good; the good of the country.Furthermore, these women stoically live the myth of Penelope, which involves extreme idealisation of the husband as a hero with whom she identifies. Moreover, what Boszormenyi-Nagy<a class="elsevierStyleCrossRef" href="#bib0025">5</a> would call “the invisible loyalties” is intensified, which these women experience in being loyal to their husband and in identifying with his ideology. “Why did I marry a soldier? One is their strength. Living in war is living with your heart on your sleeve. They give the country everything: themselves and their families! We are unpaid soldiers”.The subsystem of the couple is lived in an idealised way, composed of a hero, the husband, and the wife, who is a princess who meets him after long absences, made up for by the elimination of all conflict during the short coexistence. All the tensions inherent to life as a couple are therefore denied. An idealisation that is sustained by the denial of women and the concealment of husbands. The tensions in the environment lead these couples to merge, by hiding or denying feelings and events which may generate tension or anguish in their intimate exchange. When together, the personal efforts of each lead them to make efforts to maintain an emotional and intimate connection, free of topics and feelings that could alter the emotional and erotic harmony.SymbologyFrom the symbology of the daily life of these families, we can firstly state the experience of living in the family of a “hero”, a “hero of Colombia”, who sacrifices himself and gives his life for others and becomes a “saviour”. This makes them feel like a family, proud of their father's sacrifice, a sacrifice driven by “love of country”, which is the foundation of an idealisation of the sacrifice of the military father who fulfils a mission for the benefit of the entire country. This feeds a dichotomised and Manichaean vision of good guys (those who defend the State) and bad guys (those who attack the State). This dichotomisation in turn generates the idea of a divided country, of two homelands, one that is good, the one defended by the military, and another that is evil, the one fighting the State. With this perspective, the spirit of love for the military forces and the country emerges as the repository of all the implications related to individual and family efforts made by the family of a soldier in a war-torn land.The precarious nature of supplies, water, electricity, etc, become trivial next to the idealisation of the soldier, his honesty, the value of his word (a soldier's word), the soldier's faith; in short, the magnification of the father. Death, war, the wounded and the amputees become part of everyday life, to the point that the arrival of the helicopter from the combat zones with the wounded and dead becomes just another daily ritual in the barracks. In some barracks even the helicopter had a nickname, “the Russian”, which represents the life of the soldier and the death of the guerrilla. This experience of daily exposure to death is forcefully expressed in the statement of one of the women, “We make friends with death, so that we can bear the fear that something may happen to our husband”. In other words, manic denial was essential to survive the anxiety and anguish of what might happen day to day; “There's an invisible mantle that always accompanies you and protects you”. It is the omnipotent fantasy that, despite all the risks, no danger can touch you.From these symbols of military life in a war zone, the home emerges as the husband's destination, but he is constantly absent, which becomes the great paradox. The barracks, through the military ceremonies and protocols with its parades and showy and pompous rituals, is the place of emotions.During the day, the children's lives and emotions were focused on running to see the helicopter arrive with the wounded and dead. The noise of the helicopter, the clearing of the landing area, the soldiers running towards the helicopter, filled the children with emotion and expectation. Hours later, that emotion turned to fear and pain, and having to accompany friends and acquaintances in the sorrow of the funerals.It is important to highlight the labour of the mothers in their efforts to try to work though all these stresses suffered by their children with different resources. In one of the cases, as a resource to help stem the fear and dread in the father’s absence, a mother made up a story of the father as a magical being who appears and disappears from the children's lives as in a fairy tale through different things that he leaves them, provided by the mother. Sweets and other gifts would appear by surprise as a sign of love and of the presence of the father with an imaginary halo.Second phase of analysisOnce the first phase of analysis was completed with the categories defined for watching the interviews, we found that in the first 10 the repetition of content had saturated all the categories. The investigators therefore decided to create new categories for watching the 10 remaining interviews. The new categories agreed on were morality, boundaries, self, reason for telling the stories, and the father’s absence.MoralityIn this aspect, the experiences of war produced expressions such as, “Being afraid is a form of psychological violence”, “Learning to give out the message 'I'm not scared' is vital for the children's well-being”, “The need to maintain family unity as a reason for survival and parenthesis to cope with the impact of all the difficult and painful experiences that occur around us”, and “The normalisation of the bad and the risks in order to create calm for the children and the husband”. These are all expressions of the need to contain very stressful experiences under the appearance of normality, but for these women it involves a very strong psychological effort not to break down emotionally. This comes with a very high price, both on the mind and the body, since they have no way of working through all the stress caused by the risk situations which continually contaminate the environment.The difficulty is, “… not being able to gauge reality; fathers acted to hide the reality of the risks we were exposed to”, “Saying that everything is fine to give courage to the husband and children”, “the mother's love and love for the family was a force for survival”. These expressions show the enormous effort these women make to normalise the family's day-to-day life.One important moral component of the soldiers’ wives was their need for acts of solidarity with the wounded soldiers, which, “… started as maternal accompanying of these boys who came back wounded”; “That comes from the maternal instinct from being a woman, and these boys were like family”; “Thinking about the suffering of the soldiers' mothers fuelled the maternal instinct to care for and comfort the wounded”; “They taught you a lesson”; “They were always smiling despite what had happened. And you get back more than you give them”; “The presence of the wounded, having lost legs, having lost arms, disfigured, is an enormous pain that you can’t begin to comprehend”. Lastly, “God gave us the courage to have the strength to handle everything and give strength to our husbands”. With these comments, these women show the complementary side to their husbands' role. This brings to mind Gregory Bateson's description of the Naven phenomenon in a community in Melanesia in his book Steps to an Ecology of Mind,<a class="elsevierStyleCrossRef" href="#bib0030">6</a> when he delves into the concept of the social phenomenon of complementarities and the roles of the people who are part of a community. In this case, while the husbands, high-ranking soldiers, are working on military combat operations producing death and injury as a consequence, the wives are dedicated to caring for and rehabilitating the survivors. In this new role these women acquire, the maternal role of caregiver, protector and container is strengthened.LimitsThe experience of living in barracks in a war zone has implications in terms of mobility in the physical space and the environment of the barracks. For this reason, expressions such as “not being able to go out”, “not being able to go for a walk due to the risk of kidnapping”, “going out was dangerous” or “we lived in a ghetto” are common. Limits also include information: “We didn't know even 20% of the things and the operations”; “The children had to be taught about what they could and couldn't say; for example, they couldn't say their father's a soldier”. All of these expressions show the degree of constraint under which these women and their families lived in the midst of a context of risk and threat from outside, which they defended themselves from by confinement behind the walls of the barracks. Their lives in the barracks became about putting continual limits on their actions and words as a means of survival and protection.Limits on emotions, because, “You try not to pass on stress and anxiety to your children”; “We had to keep our children very busy with sports”; “The limits also affect the roles of the family members and especially that of the husband”; “You had to give your husband a place despite his absence, and support him”; “It's up to us to understand our husband's work”. With these phrases, the women highlight not only the restrictions of physical limits, but also of existential limits to the extent that the world became inaccessible in certain basic aspects, such as walking down the street alone, going for ice cream in town, etc.: “Closed families, we created a strong boundary between indoors and outdoors, even with the outside world”; “We lived in an idealised world in terms of safety”; “Continually constructing assurances”. In terms of Salvador Minuchin’s structural perspective, this contributed to the formation of an amalgamated family style, with very rigid external limits.SelfViolence and danger determine self: “Turning fear into strength to be able to visit dad”; “Adapting is a problem”; “Learning from other cultures and experiences due to moving”; “You get used to frequent changes with the transfers”; “You develop the capacity for social work”; “There's a lot of denial: everything is politically correct”; “We had to be careful when we were out, you develop other identities to protect yourself”; “For example, not saying who your husband is, because he's a soldier”; “The loneliness in the army was terrible”; “A lot of denial”; “Being a military wife is giving a little piece of myself to my country”; “One thing is what you think about military life and another is what you actually experience”; “A lot of fear, lots of scares concerning your husband”; “My identity is permeated by war issues”; “You become mother and father”. These are all expressions of the impact on self of the experience of living in barracks in a combat zone. Each of the expressions reveals the constant process of personal transformation that these women experience as observers of-participants in their husbands' work and of a much broader sociopolitical process which includes them as second-line protagonists and as a continual affective and emotional refuge for the combatants. Perhaps one of the most extraordinary developments of these women is that in their role they bring together psychological skills, putting into action what Bion<a class="elsevierStyleCrossRef" href="#bib0035">7</a> calls the alpha function of resignification and symbolisation of situations which are very difficult to work through, they function as good enough mothers, as Winicott<a class="elsevierStyleCrossRef" href="#bib0040">8</a> would say, showing a useful capacity for retention for their husbands, their families and the soldiers, and as Bowlby<a class="elsevierStyleCrossRef" href="#bib0045">9</a> would say, show a constant secure base attachment.Reason for tellingThe reason for talking about their life in the barracks in their interviews is to highlight that their husbands had a job to do and highlight that mission: “We take care of the children and the father takes care of the battalion”, “It is to tell a story from the shadows, from the perspective of providing accompaniment, the voice of the wounded, of the helpless”. As one of the wives says, “I told my son: we have to value life”, “It's recounting a life experience, having been able to be there”. These women give voice to the voiceless. “It's telling about the need to reintegrate soldiers into civilian life”; “It's telling how many soldiers were killed in cold blood”; “Being a perfect woman, creating a useful profession for myself and for the soldiers”. Through their accounts, these women show that the people are not alone, that all soldiers are part of a family network which continually supported them and that their value is sustained by the love of their families. Furthermore, they wanted to make their voices and experiences of affection, support and containment heard as a constructive contribution to life in the midst of war.Absence of father and family life“The constant worry about their father”, “We were never with him, very little time living together”, “The experience of their father's absence, sometimes six months away and three days at home”, “You become father and mother at the same time”, “You keep their father present through letters”, “He hardly slept, I don't know when he rested, I was worried he'd get sick”. From the above phrases, we see that, by assuming the dual role of father and mother due to the unavoidable absence of the father, these women maintained the structure of family limits and hierarchies described by Minuchin,<a class="elsevierStyleCrossRef" href="#bib0015">3</a> and also managed to avoid disruptions in the daily routines of family life and family organisation, none of which can have been easy running the family with an absent member. “Absence creates continual voids in information and misunderstandings”, “Family structure and relationships generate strengths and commitments”, in response to which some mention that they made efforts to “create survival narratives”.DiscussionReflective analysisIn the systemic family therapy clinic, secondary traumatic stress in the relatives of active military personnel is widely accepted.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> Our research focused not on the entire family, but on a particular member, the military wife, in relation to the impact, influence and transformation that observing traumatic experiences in her environment can generate. The accounts analysed from a systemic perspective show that in the background of their lives and their stories, discourses from the military and war context are present, which include actions, interactions, values, beliefs, feelings and the non-verbal signs of corporeality, clothes, objects, tools, technologies, times and places of life in the barracks. Listening to these women, it is clear that there are three different narratives that live within them. One corresponds to the formal discourse of the spouses, which responds to their belonging to an institutional structure which educates and trains them for a lifestyle and for a commitment that involves actions, thoughts, feelings and sacrifices which can result in loss of life.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> Another corresponds to the discourse of living the experience, of being part of the life of the soldier, which involves the absorption of events, episodes and circumstances that lead them in their own language to make sense of their reality. The third, typical of every couple, is the narrative of love, attachment, the idealisation of the other, which is very quickly distorted by the day-to-day effects of the unavoidable absence caused by the husband's type of work. As wives, these women make an idiosyncratic interpretation of the world of war which has remained invisible and unheard by society.We believe that when these women agreed to speak to the playwright and gave her permission to write a play with their stories lived and told, they found a suitable, safe place and medium to make their silenced voice heard. Gee<a class="elsevierStyleCrossRef" href="#bib0060">12</a> describes this use of invisible language as “lower-case” discourse, which corresponds to “language in personal use that is shared in conversations or stories”, which contrasts with “capitalised” discourse, which is part of the discourse typical of social institutions and includes other factors which identify the speaker as belonging to a group, association or significant social group, which in this case would be the military institution. These women are not soldiers, they are first-hand observers of the life of the soldier, and at the same time they participate in the life of the soldier, who end up introjecting, “…we are soldiers without a uniform”. These words connote the influence of the Discourse, with a capital D, of the military institution on the discourse, with a small d, of these wives. In the background of their lives, the lower-case discourse is sheltered by the umbrella of Discourse, which includes the narrative of the army, the narrative of war, the narrative of national politics.It is important for the reader to understand that these stories were shared with the playwright at a particular historical moment: during the peace negotiations between the Government and the guerrillas. Taking this situation into account, we again take the words of Gee,<a class="elsevierStyleCrossRef" href="#bib0060">12</a> who says that the key to the Discourses is recognition. When a person uses language, action, interaction, values, beliefs, symbols, objects, tools and places in such a way that others recognise a particular identity involved in a particular activity here and now, a Discourse has been uttered. Discourses are always embedded in a mixture of social institutions, often involving supports from these institutions (cultural, social, political, etc), such that people are not only talking and interacting with each other, but in their living and acting are the communicators, giving life to these Discourses.As researchers, in each story, in an exercise of deconstruction, we were extracting the different categories which, camouflaged in the narratives, allow us to understand the deep sense and meaning implicit in the experience of their lives in the barracks in the war zone. The categories used in the analysis do not come from the interest of the investigators, but were refined by the discourse of these women themselves.In each story told by each of these women, they create a discourse and a narrative which although it responds to their lived and observed experience, is reworked with the conditioning, restrictions and filtrations that come from military and war culture, which they incorporate through their relationship with their husbands. When they agree to be interviewed by the primary researcher, they hope that their voice conveys their lived history, aspects of which they want to highlight and give voice to so that they may be heard and recognised in the world beyond the institution.The institutional Discourse with the determination it exerts on the particular lives of these women shapes their lives in a way that cuts across individual, couple and family dimensions. At the individual level, daily life is punctuated by experiences that generate fears and dread, such as fear of leaving the barracks, fear of kidnapping, restrictions on movement, frequent changes of location, changing one's identity outside the barracks so as to avoid risky identification or submitting to security protection; all experiences which create a subtle but forceful mood of persecution and paranoia which over time generate cumulative, adaptive and social stress.In terms of the couple-related experience, the prolonged absence of the husband exacerbates the situation of loneliness, distance, lack of emotional support, the limitations on their sex life, and a prolonged internal dialogue in which they question themselves with the doubts and the unavoidable fears of whether they can or should share their inner thoughts with their husbands, their family and their barrack companions. In the couples’ relationship, the influence of the military institution is made visible with its unavoidable demands in the course of the building of the relationship as a third party, constantly eroding the autonomy of the couple.As for family life, it is affected by the constant absence of the father, who becomes a contradictory figure. He is an authority figure, but much of his role is assigned to the mother, who assumes a dual role as father and mother. As the absence of the soldier impacts the family balance, the wife reconstructs the image of the father in an idealised form as a hero figure by way of compensation, in order to fill the gaps in the absent father's duties with the all-encompassing presence of the heroic man, whose role is a supernatural task of protection, not only of the family, but also of the country. Given the importance of the men's role, the confidentiality of what they do, and the disturbing nature of war itself, they bring a significant silence into family life; there are things that cannot be talked about, cannot be said and cannot be named.Living in barracks in a war zone generates different emotional experiences, such as those described by these women: anxiety, fears and dread from a negative and threatening perspective. However, superimposed on these aspects, and despite the difficult experiences they have as front-line observers of the war, it is striking that emotions and feelings emerge which heighten their human sensitivity and make them feel solidarity with the soldiers and their families. Sharing the suffering of the combatants and their families erodes social distances and helps create an emotional bond, which then spurs them into action, prompting activities such as volunteering in support foundations for soldiers and their families; this then becomes very important for them and helps give meaning to their own lives.Last of all, life under these circumstances leads to consequences, such as the reformulation of the very conception of woman and couple and ordinary family life, the meaning of life, religion and the value of accompanying another and finding meaning in that, even with everything they have to give up themselves. One important aspect is that, in the midst of the destruction caused by the war, they manage to set up ventures such as kindergartens, schools, health centres and support foundations in the soldiers' environment.The idea of passive traumaWhen we talk about trauma, we are referring to the etymological origin of the term, which in Greek means “wound”, a physical injury caused by an external agent or also an emotional blow which causes lingering damage to the unconscious. Generally speaking, trauma is not life-threatening, but it can cause some type of disability in the person that alters or threatens their well-being. Trauma causes an imbalance in a person's mental state, in the area of their emotions, which to a certain extent can disrupt their existence. The Latin origin of the term passive means capable of suffering, sensitive, derived from the Latin term pati, meaning to suffer and endure. The concept of passive has the meaning of remaining inactive and letting things happen without your intervention; in other words, the affected person receives but does not act in a certain sense.When talking about the concept of passive trauma, developed from our analysis and the experience of this sample of women military wives, we are referring to the unavoidable, continual emotional experience that prevails and has to be lived through as part of ordinary life and affects existence, self and the ability to maintain an atmosphere of normality in their primary environment, with a psychological cost that is difficult to specify, but which may manifest with limitations or overcompensation. People who experience passive trauma live in a context of stress and threat that constitutes an existential background in which attention is hidden but is tacitly present and acts insidiously over time. Passive trauma is the experience of living in an atmosphere of uncertainty, tension and constant threat which cannot be avoided and which generate limitations and constraints on the one hand, as well as, on the other, a compensatory reaction which attempts to neutralise this atmosphere with idealisations such as heroism and obtain a greater good for others through acts of sacrifice and generosity.It is an emotional experience resulting from the partnership between someone who is exposed to direct trauma and someone who is simply an indirect observer. People live in an atmosphere of accumulating difficult, painful experiences, and this creates an environment of limitations in day-to-day life affecting movements, emotional, sexual and social life in a context of stoic seclusion which, on top of all that, is also wrapped in either real or imagined threats.As a result of this allostatic load of stress, people try to overcompensate for the stress burden with idealisation, generosity, identifications, which become transformed into supporting soldiers as substitute mothers, the development of a spirituality that gives assurances and meaning to the catastrophic, and continual educational activity in health and social matters.The characteristic defence mechanisms of passive trauma include: denial, by which events are seen through the protective bubble of the barracks or military institution (denial can also include the suffering of the enemies); the idealisation of military combatants, who are seen as heroes, with the omnipotence propelling frenetic aid activity in foundations, schools, rehabilitation institutions, etc; the separation of reality into good and evil according to Manichaean doctrine, whereby the enemies are some others, onto whom all defects or negative aspects can be projected; and regression, expressed in the experience of living in the barracks as a kind of bubble or a protective womb which protects from the dangerous outside world.These families live immersed in secrecy. Part of the husband's work is secret, all the traumatic and violent adversities of war become a repressed secret due to the nature of the work. As with all secrets, they become unspeakable and even unthinkable.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> Various theorists and family therapists have worked on the power this (something known but kept silent) has over family dynamics.<a class="elsevierStyleCrossRefs" href="#bib0065">13–15</a> We believe that one motivation in telling the stories lived by these women has a lot to do with what Penn<a class="elsevierStyleCrossRef" href="#bib0075">15</a> highlights about the effect that Bateson's “double description”<a class="elsevierStyleCrossRef" href="#bib0030">6</a> has on understanding the complexity of human experiences. Bateson would say that the testimony of the military wives speaking out broadens and enriches our understanding of the military context, as the opportunity to analyse a situation from various points of view takes us to a higher level of comprehension, to a wider and more complex understanding of lived reality.Differential diagnosisOnce our conceptualisation of passive trauma has been developed, other types of psychological trauma are defined to facilitate differential diagnosis.Post-traumatic stress disorder. A mental state triggered by a terrifying event, either experienced or witnessed, which is expressed in symptoms such as flashbacks, nightmares, severe anxiety and uncontrollable thoughts about the event.Collective trauma disorder.<a class="elsevierStyleCrossRef" href="#bib0080">16</a> “Collective trauma is defined as a tear in the social fabric, as well as an incident that, retrospectively, breaks with the usual mnemonic practices and in which no one narrative can be accepted by all members of the group”.Historical trauma. A trauma inflicted on a group of people who share an identity or affiliation (ethnicity, nationality, religion, etc), characterised by the transgenerational legacy of the traumatic events experienced and expressed through psychological and social responses.<a class="elsevierStyleCrossRef" href="#bib0085">17</a>Secondary trauma. Traumatic stress is a process by which an individual who observes the suffering of another simultaneously experiences the same emotional responses to the real or expected emotions of the other person.<a class="elsevierStyleCrossRef" href="#bib0090">18</a>TriangulationAs part of the research process and prior to completing it, we invited the wives interviewed by the playwright to a meeting to explain the process we had followed with their interviews and to read them the contents of the article written from our research.One of the investigators read the article and those present could interrupt to ask for clarification, expand explanations and, if they wished, express opinions, reflections and understandings raised by what we had written. After that stage, the feedback the women gave included various aspects. A first contribution was that the article accurately represented the psychological experiences that they had reported about their past. They then went on to say that the categories the investigators had used for the analysis and reflections on their experiences made them see themselves in a new light and broadened the spectrum of reflections on their experiences.One aspect emphasised by the women which had not been considered in the previous categories from the interviews was jealousy, an aspect that did not come up anywhere in the interviews. However, at this meeting they highlighted the importance of this feeling during their lives as military wives in conflict zones. They expressed that the long absences, the distances, the long periods with no communication and the lack of knowledge of where their husbands were during military operations all took its toll on their relationship as a couple when it came to their day-to-day lives, their conversations, tenderness, eroticism and sexuality. In these circumstances, the women reported that distrust, insecurity and in the end jealousy featured increasingly heavily in their thoughts and emotions.Thus, it is striking that in none of the interviews was there a single allusion to jealousy, something that also surprised the women who attended the meeting. None of them mentioned the subject. In trying to understand this, that they would leave out such a psychologically intense issue, the women explained that the reason for this omission may be that the interviews emphasised the issue of the family and their position as heads of the household in the absence of the husband, which meant that the issue of the couple had remained in the background, but emerges as an obvious omission when reading the article. With their comments they consolidated a latent idea in the interviews, the absence of the husband, no longer as a hero, but as someone who also represents the couple's conflict. Talking to these women, it becomes clear that their idealising of the military husband as a father and family member breaks down when looking at him as a partner. As the conversation deepened, the women agreed that life as a couple with a military husband is not easy and is full of many periods of loneliness and, above all, great personal and emotional uncertainty.<a class="elsevierStyleCrossRef" href="#bib0095">19</a>Another aspect which is only slightly hinted at in the interviews is certain psychosomatic symptoms<a class="elsevierStyleCrossRef" href="#bib0100">20</a> which some women talked about. However, in this new conversation, after listening to the contents of the article, the women stressed the importance of making specific reference to the consequences on their mental health throughout their years-long experience. They are explicit that they have not been immune to mental illnesses resulting in psychiatric diagnoses requiring drug therapy and, in some cases, admission to hospital for psychiatric problems. These aspects are mentioned with a certain wariness, as they expose a truth which cannot be idealised, with a clear emphasis on the cost this way of life has had on these women, which has never been made visible and nobody has taken into account.ConclusionsWith this study we wanted to make visible and externalise the existential discourse of a group of people who, living in a situation of constant underlying stress in the midst of armed conflict and war, not as direct actors, but as observers of the suffering of others, are repositories of a wide spectrum of experiences which all have an impact on their lives. These experiences affect both their physical and mental health, but they are seen from an individual perspective, and not as a group of women who, made invisible by institutions, by making their voices heard, show that the silence in which they live and the noise that arises from victims of both sides of the conflict turn them into a subtle form of victimisation: disconfirmation as subjects of suffering and pain. By sharing their experiences, both the personal ones and in the work they do to support and address the suffering experienced by soldiers in the battalions, they allow us to see another aspect of the conflict in which, surprisingly, solidarity and actions in support of human dignity are their counterpart to violence.Wars and soldiers will never go away. The aim of our contribution is to acknowledge that these women are silent, voiceless actors who require greater attention.Conflicts of interestThe authors declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres2042938" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1746765" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2042937" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1746766" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Analysis of the categories" "secciones" => array:1 [ 0 => array:3 [ "identificador" => "sec0020" "titulo" => "First phase" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Experiences" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Emotions and feelings" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Family" ] 3 => array:2 [ "identificador" => "sec0040" "titulo" => "Symbology" ] ] ] ] ] 7 => array:3 [ "identificador" => "sec0045" "titulo" => "Second phase of analysis" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Morality" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Limits" ] 2 => array:2 [ "identificador" => "sec0060" "titulo" => "Self" ] 3 => array:2 [ "identificador" => "sec0065" "titulo" => "Reason for telling" ] 4 => array:2 [ "identificador" => "sec0070" "titulo" => "Absence of father and family life" ] ] ] 8 => array:3 [ "identificador" => "sec0075" "titulo" => "Discussion" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0080" "titulo" => "Reflective analysis" ] 1 => array:2 [ "identificador" => "sec0085" "titulo" => "The idea of passive trauma" ] 2 => array:2 [ "identificador" => "sec0090" "titulo" => "Differential diagnosis" ] 3 => array:2 [ "identificador" => "sec0095" "titulo" => "Triangulation" ] ] ] 9 => array:2 [ "identificador" => "sec0100" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0105" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-07-17" "fechaAceptado" => "2021-09-28" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1746765" "palabras" => array:3 [ 0 => "Passive trauma" 1 => "Family" 2 => "Armed conflict" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1746766" "palabras" => array:3 [ 0 => "Trauma pasivo" 1 => "Familia" 2 => "Conflicto armado" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionWives of military personnel in action living on bases located in areas of armed conflict in Colombia before the peace negotiations with the Revolutionary Armed Forces of Colombia (FARC), were first-hand observers of the war, their husbands' participation in the war and the consequences and effects of the combat in which others participated. ObjectiveTo offer a hypothesis regarding these women's experience of direct trauma and characterise the dimensions of their experience as observers of the suffering of others. MethodsQualitative study and secondary discourse analysis in intentional snowball sampling of wives of military personnel (officers and chiefs) with whom semi-structured interviews were conducted. ConclusionsDirect trauma is not the sole cause of psychosomatic and psychopathological consequences; the experience of constantly observing the suffering and deaths of others also generates a cumulative effect that can affect physical and mental health. This experience is called passive trauma." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLas esposas de militares en acción, que vivían en cuarteles ubicados en zonas de conflicto armado en Colombia antes de las negociaciones de paz con las FARC, vivieron como observadoras de la guerra, de primera mano, la participación de sus esposos y las consecuencias y los efectos de los combates que otros vivieron. ObjetivoPlantear una hipótesis sobre el tipo de experiencia traumática vivida por ellas y caracterizar las diferentes dimensiones de la experiencia de observar el sufrimiento de otros. MétodosInvestigación cualitativa y análisis secundario de discurso en una muestra intencional en bola de nieve de esposas de militares (oficiales y jefes) con quienes se habían realizado entrevistas semiestructuradas. ConclusionesNo solo el trauma directo vivido en primera persona genera consecuencias psicopatológicas y psicosomáticas, sino que también las experiencias vividas al observar el sufrimiento y la muerte de otros de manera constante generan una experiencia acumulativa que puede afectar a la salud física y mental. A esta experiencia se la denomina trauma pasivo." 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Original article

Passive trauma

El trauma pasivo

José Antonio Garciandía Imaza,

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jose_garciandia@hotmail.com

Corresponding author.

, Jeannette Samper Alumb

a Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia

b TAOS Institute, Instituto de la Familia, Universidad de la Sabana, Bogotá, Colombia

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Understanding&#44; comprehending and reporting human experiences in their infinite variety arouses interest beyond the areas where they take place&#46; The stories from the following interviews were originally gathered as research by a playwright and theatre director with the intention of later producing a creative play&#46; For the playwright and the women interviewed&#44; the purpose was to make their experiences visible thereby turning them into told stories&#46; On learning about this&#44; we asked the director-researcher about the possibility of accessing the interviews in order to carry out a qualitative research secondary data analysis from both a clinical and family and couples psychotherapy perspective&#46; After obtaining the consent of the people interviewed and that of the director&#44; we proceeded to view all the interviews and conduct the research work which is the basis for this article&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The aim of this work is to give a voice to the people who lived with soldiers during the armed conflict with the guerrillas in Colombia&#46; These people were direct observers of the conflict&#44; living alongside those directly involved in the fighting&#46; As G&#243;mez-Restrepo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> show&#44; from the National Mental Health Study&#44; the repercussions of violence due to armed conflict not only affect the combatants&#44; but also other sectors of the population which are not given enough attention&#46; They had extremely shocking experiences which had significant effects on their lives&#46; Making those voices heard is one way to vindicate other victims of the conflict who have lacked any mention in the country&#39;s medical and psychological literature&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">This article is based on the secondary analysis of data on the narratives of military wives in a combat zone in Colombia&#46; The information was gathered through semi-structured&#44; video-recorded interviews with wives of Colombian soldiers of the rank of officers and chiefs who lived in barracks in combat zones during the armed conflict with the guerillas&#46; The original research was carried out by a theatre director and playwright whose interest was to make the voices of these military wives heard&#46; For this study&#44; the original researcher used a sample of military wives who were invited to take part in individual interviews&#44; after obtaining informed consent to videotape them&#44; with the intention of writing a play and making a film and television documentary&#46; The original sample consisted of 20 people&#46; With the aforementioned input and the due informed consent of the original researcher and the participants&#44; the authors of this article decided to carry out a second phase&#44; which consisted of qualitative research with secondary discourse analysis&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> using the videotaped interview information as material&#46; The snowball sampling of 20 people is intentional for the sake of convenience&#46; The instrument with which the secondary analysis was carried out was the video-recorded semi-structured interview with each of the participants&#44; watched in its entirety by the investigators&#46; The authors did not know the names of either the women or their soldier husbands&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">We established several categories to classify and analyse the information obtained from the interviews&#46; The process of defining them was as follows&#46; To start with&#44; both investigators watched the first interview chosen at random&#46; While watching the video&#44; both investigators noted down a series of categories&#46; At a subsequent meeting&#44; through a process of analysis&#44; reflection and theoretical-conceptual discussion&#44; a consensus was reached on using the categories of experiences&#44; emotions&#44; feelings&#44; family and symbols in the scheme to be applied while watching all the interviews&#46; After the first 10 interviews&#44; the investigators realised there was a degree of saturation with the categories chosen&#46; Using the same procedure as previously to reach a consensus&#44; they then added the new categories of morality&#44; limits&#44; self&#44; reason for telling the stories&#44; and absence of the father for the next 10 interviews&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Analysis of the categories</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">First phase</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Experiences</span><p id="par0025" class="elsevierStylePara elsevierViewall">In this category&#44; evident among those interviewed was the constant experience of loneliness due to the husbands&#8217; prolonged absence&#46; Expressions like&#44; &#8220;not being able to see my partner&#44; having limited time with my partner&#44; living alone for 16 years&#44; two years in which I only saw my husband for 2 weeks&#44; up to seven months without seeing each other&#44; being a single mother&#44; being mother and father at the same time&#8221;&#44; illustrate how the idea of being a couple with constant support in day-to-day life is distorted&#44; being limited and curtailed by the lengthy and frequent absences of the partner&#46; The idea of being a couple invokes the typical imagery where their presence&#44; companionship and day-to-day life are the central axis of the relationship&#44; a scenario which could not be further from reality in the lives of these women&#46; Their key question is&#44; &#8220;How can you be a couple with a person who&#39;s not here&#63;&#8221;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Another experience has to do with constant transfers and the need to adapt to continuous changes&#44; the experience of how difficult it is to always live on military bases and have to leave your pets behind with each transfer&#46; This experience of continual mobility and instability lies behind the difficulties the women interviewed reported in making lasting friendships&#44; which can be seen in the fragile relationships they have with others&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">War organises relationships and life&#46; This phrase hides a multitude of acts and omissions in family life&#46; For example&#44; most agree that when the father comes home he spoils the children because he feels guilty about seeing them so little&#46; Therefore&#44; the mother has to take on the responsibilities that should be shared&#44; such as guiding the education of the children&#46; The absence of the fathers due to their military life makes it difficult for couples to work together to form the union which signifies them as parents and heads of family and home-makers&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">This distortion of family life generated an emotional experience of &#8220;living in a barracks directly connected to the war&#44; as if we were one big family&#8221;&#46; &#8220;We were all family&#8221;&#46; As the nuclear family was fractured in a certain sense&#44; they gathered together to form one large family with the soldiers&#44; &#8220;considering them as our own children&#8221;&#46; As women&#44; they were aware that their children were experiencing the absence of their fathers&#44; and they understood that&#44; being sons&#44; husbands or fathers&#44; these soldiers were also creating voids in their families outside the barracks&#46; The combination of absences experienced and absences generated gave rise to a great sense of solidarity among the people in the barracks&#44; building strong bonds to look after each other which evoke family life&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The continual insecurity&#44; the constant uncertainty&#44; &#8220;the constant risk&#44; not being able to go out in the city or town freely for fear of attacks or kidnappings&#44; always having to be careful on the street&#44; always being prepared with a backpack in case there was an attack&#44; learning to use weapons&#44; combat training in case it was necessary to defend ourselves&#44; getting used to gunshots and gunfights&#44; bomb attacks&#44; strict confinement to barracks because of threats&#8221;&#44; is&#44; as one of the women says&#44; &#8220;living with your heart in your mouth&#8221;&#46; Or as another says&#44; &#8220;to constantly live with fear is to learn to be afraid&#8221;&#46; All of this generates a deep feeling of fragility and vulnerability&#59; living in constant fear&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">As a result&#44; life is reduced and restricted to the barracks&#44; which several of the women describe as &#8220;living in a bubble&#8221;&#59; to the extent that &#8220;you forget the outside world exists&#8221;&#46; This was made even worse when&#44; under attack&#44; you had to leave the house&#44; not to leave the barracks&#44; but to go into a bunker inside the barracks&#44; which is an even deeper form of isolation&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The continual witnessing of military friends dying brings the dead and wounded increasingly close to the family&#58; &#8220;Will my husband come home alive&#63;&#8221;&#44; &#8220;Will my husband be wounded&#44; have lost his legs&#44; be dead&#44; destroyed&#44; etc&#63;&#8221; Experiences such as that of one woman when a coffin arrived mistakenly labelled with the name of her husband&#59; her husband had not actually died&#46; In summary&#44; continually observing war unfolding&#44; daily life marked by the events of war&#44; and the fears of children when seeing dead and wounded routinely arriving in helicopters&#44; force these people &#8220;to learn to be brave&#8221;&#44; as one woman says&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Several of the women also agree on the need for the &#8220;vow of silence&#8221;&#44; which they have to maintain as they cannot talk about many of the things they feel&#44; experience and observe&#46; They lack the direct experience of war&#44; but they see the consequences of war&#46; This means that when it comes to their children&#44; in order to create a more or less happy and healthy family life&#44; fathers get used to filtering the information to protect their wives and children from the reality&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In this context of experiences of tension&#44; insecurity&#44; fear&#44; absence and loneliness&#44; psychological responses range from anxiety to spontaneous abortions due to stress&#44; and clinical depression to hospital admissions for acute psychotic episodes&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In the midst of all this&#44; extraordinary acts emerge showing how these women in the midst of war manage to set up volunteer projects to help other people seeking compensation&#44; with expressions such as &#8220;so as to feel like I&#8217;m doing something useful for others&#8221;&#59; that is&#44; those they call their extended military family&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Emotions and feelings</span><p id="par0075" class="elsevierStylePara elsevierViewall">In the category of emotions&#44; expressions such as&#44; &#8220;How difficult it is to live with a hero&#44; it&#39;s very hard&#8221;&#44; or&#44; &#8220;terrible stress&#8221;&#44; are usually followed by phrases such as &#8220;constant fear of attacks&#44; fear to leave the bubble of the base&#44; continual fear for safety&#44; fear of the outside world&#44; locking myself in my fear&#44; fear of being told that your husband has fallen or is injured&#44; fear of being kidnapped&#44; ever present fear of war&#8221;&#46; All these feelings of fear are also accompanied by feelings of terror and panic seeing amputees and war injuries&#59; they feel affected by the dead&#44; the constant anxiety accompanied by the uncertainty of whether or not they will come home alive&#46; This set of emotions and feelings drives them to &#8220;learn to be brave and be afraid simultaneously&#8221;&#46; The fact of knowing that &#8220;we could lose them&#8221; keeps these women and their families in constant state of alert&#44; for fear of the frequent mobilisations and of always being apart from civilisation&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The husbands are out in the hills&#44; meaning that&#44; as the women agree&#44; the experience of &#8220;not even being able to live with him&#8221;&#44; generates a deep feeling of loneliness and a continuous dichotomy between union and death which means intimacy &#8220;is always hindered by distance&#8221;&#46; The feeling of going from television spectacle straight to seeing dead soldiers off-loaded from the helicopter generates feelings of great confusion&#44; difficult to describe&#59; as one of the women says&#44; &#8220;They should make a documentary about our feelings&#8221;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Other feelings also emerge&#44; however&#44; such as admiration for their husband&#44; love for the country and for the armed forces&#44; pride in the power of the husband and father&#44; feelings of deep solidarity expressed by volunteering to help the wounded&#44; amputees and families of soldiers&#44; and &#8220;the non-fear of death&#8221;&#44; something which becomes routine in the barracks&#46; As one of the women says&#44; all these difficult to metabolise feelings become illnesses that doctors cannot decipher&#59; indefinite pain&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Family</span><p id="par0090" class="elsevierStylePara elsevierViewall">In terms of effects on family&#44; there is a saturation index in the responses of those interviewed regarding the idea that war organises life and family&#44; because the continual transfers of the military husband means the whole family transferring to the war front&#59; this means that for most of these families&#44; &#8220;Adapting to change is easy because you&#39;re constantly moving&#8221;&#46; As one of the interviewees says&#44; all relationships are subject to the nomadic military lifestyle&#44; or according to another&#44; &#8220;We haven&#8217;t lived a normal life&#8221;&#46; For these families it is a constant that they identify as a &#8220;military family&#8221; serving the country&#44; not just the soldier in the family&#44; the whole family&#46; This tacit mandate is so strong that one woman states&#44; &#8220;We acquire the vocation to be part of them&#44; and those who don&#39;t acquire it get divorced&#8221;&#46; All of which translates into an idealisation of the military family&#46; The woman or wife becomes the centre of day-to-day family life and becomes the organiser of that life&#46; The continual absence of the father is a fact that impels the wife to be her husband&#8217;s support and carer of the children&#46; A dual role that some recognise&#44; &#8220;You have to be very strict as a mother because you have to serve God and the country&#8221;&#46; This idealises the absence&#59; &#8220;The absence is an honour&#46;&#8221;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The feeling of loneliness is deep-rooted in these women and their families&#59; or as one of them says in great pain&#44; &#8220;In so many of my husband&#8217;s absences&#44; I was alone with my daughter&#8221;&#46; But the most dramatic thing about these women&#39;s loneliness is what several of them expressed&#44; &#8220;To be a military wife is to remain silent&#8221;&#46; As a consequence of all the absence and loneliness&#44; the military base becomes a large extended family&#44; with one woman summing it up as&#44; &#8220;Everyone on the base acted as if we were all brothers and sisters&#8221;&#46; The way in which these mothers managed to justify the father&#39;s absence to their children was to&#44; &#8220;Indoctrinate the children with stories of honour&#8221;&#44; praising the father&#39;s absence as a sacrifice and act of extreme generosity&#44; putting his life in danger to save the country&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Children and their mothers live in an extreme dichotomy in which they fluctuate between the interest and concern of the day&#44; observing the consequences of war when the helicopters arrive with dead and wounded&#44; and the fear at night&#44; when they have to process everything they have seen in order to rest and sleep&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The most dramatic version of the experience is observing disabled soldiers&#44; a by-product of war&#46; Most of the women work as volunteers in helping these soldiers and comment that they are&#44; in the words of one of them&#44; struck by&#44; &#8220;How they distance themselves from their families and prefer to isolate themselves from them&#8221;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">From a structural perspective&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> these are integrated families with fuzzy boundaries within the marriage &#40;the wife goes where the husband goes&#41; and with clear hierarchical boundaries between the members of the parental and filial subsystems&#46; The women and children&#44; being subjected to the professional demands of the father and an idealisation of his work&#44; find their freedom to develop as individuals hindered to a certain extent&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> All family members are servants of the state&#46; At the same time&#44; the feeling of overprotecting the children is exacerbated&#44; in view of the risks they are constantly exposed to&#46; The woman has a dual role&#44; she must act as a mother but&#44; due to the man&#39;s long absences&#44; she also has to take on the role of father&#46; However&#44; the masculine role is experienced as distant&#44; idealised&#44; absent for a greater good&#59; the good of the country&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Furthermore&#44; these women stoically live the myth of Penelope&#44; which involves extreme idealisation of the husband as a hero with whom she identifies&#46; Moreover&#44; what Boszormenyi-Nagy<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> would call &#8220;the invisible loyalties&#8221; is intensified&#44; which these women experience in being loyal to their husband and in identifying with his ideology&#46; &#8220;Why did I marry a soldier&#63; One is their strength&#46; Living in war is living with your heart on your sleeve&#46; They give the country everything&#58; themselves and their families&#33; We are unpaid soldiers&#8221;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The subsystem of the couple is lived in an idealised way&#44; composed of a hero&#44; the husband&#44; and the wife&#44; who is a princess who meets him after long absences&#44; made up for by the elimination of all conflict during the short coexistence&#46; All the tensions inherent to life as a couple are therefore denied&#46; An idealisation that is sustained by the denial of women and the concealment of husbands&#46; The tensions in the environment lead these couples to merge&#44; by hiding or denying feelings and events which may generate tension or anguish in their intimate exchange&#46; When together&#44; the personal efforts of each lead them to make efforts to maintain an emotional and intimate connection&#44; free of topics and feelings that could alter the emotional and erotic harmony&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Symbology</span><p id="par0125" class="elsevierStylePara elsevierViewall">From the symbology of the daily life of these families&#44; we can firstly state the experience of living in the family of a &#8220;hero&#8221;&#44; a &#8220;hero of Colombia&#8221;&#44; who sacrifices himself and gives his life for others and becomes a &#8220;saviour&#8221;&#46; This makes them feel like a family&#44; proud of their father&#39;s sacrifice&#44; a sacrifice driven by &#8220;love of country&#8221;&#44; which is the foundation of an idealisation of the sacrifice of the military father who fulfils a mission for the benefit of the entire country&#46; This feeds a dichotomised and Manichaean vision of good guys &#40;those who defend the State&#41; and bad guys &#40;those who attack the State&#41;&#46; This dichotomisation in turn generates the idea of a divided country&#44; of two homelands&#44; one that is good&#44; the one defended by the military&#44; and another that is evil&#44; the one fighting the State&#46; With this perspective&#44; the spirit of love for the military forces and the country emerges as the repository of all the implications related to individual and family efforts made by the family of a soldier in a war-torn land&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The precarious nature of supplies&#44; water&#44; electricity&#44; etc&#44; become trivial next to the idealisation of the soldier&#44; his honesty&#44; the value of his word &#40;a soldier&#39;s word&#41;&#44; the soldier&#39;s faith&#59; in short&#44; the magnification of the father&#46; Death&#44; war&#44; the wounded and the amputees become part of everyday life&#44; to the point that the arrival of the helicopter from the combat zones with the wounded and dead becomes just another daily ritual in the barracks&#46; In some barracks even the helicopter had a nickname&#44; &#8220;the Russian&#8221;&#44; which represents the life of the soldier and the death of the guerrilla&#46; This experience of daily exposure to death is forcefully expressed in the statement of one of the women&#44; &#8220;We make friends with death&#44; so that we can bear the fear that something may happen to our husband&#8221;&#46; In other words&#44; manic denial was essential to survive the anxiety and anguish of what might happen day to day&#59; &#8220;There&#39;s an invisible mantle that always accompanies you and protects you&#8221;&#46; It is the omnipotent fantasy that&#44; despite all the risks&#44; no danger can touch you&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">From these symbols of military life in a war zone&#44; the home emerges as the husband&#39;s destination&#44; but he is constantly absent&#44; which becomes the great paradox&#46; The barracks&#44; through the military ceremonies and protocols with its parades and showy and pompous rituals&#44; is the place of emotions&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">During the day&#44; the children&#39;s lives and emotions were focused on running to see the helicopter arrive with the wounded and dead&#46; The noise of the helicopter&#44; the clearing of the landing area&#44; the soldiers running towards the helicopter&#44; filled the children with emotion and expectation&#46; Hours later&#44; that emotion turned to fear and pain&#44; and having to accompany friends and acquaintances in the sorrow of the funerals&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">It is important to highlight the labour of the mothers in their efforts to try to work though all these stresses suffered by their children with different resources&#46; In one of the cases&#44; as a resource to help stem the fear and dread in the father&#8217;s absence&#44; a mother made up a story of the father as a magical being who appears and disappears from the children&#39;s lives as in a fairy tale through different things that he leaves them&#44; provided by the mother&#46; Sweets and other gifts would appear by surprise as a sign of love and of the presence of the father with an imaginary halo&#46;</p></span></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Second phase of analysis</span><p id="par0150" class="elsevierStylePara elsevierViewall">Once the first phase of analysis was completed with the categories defined for watching the interviews&#44; we found that in the first 10 the repetition of content had saturated all the categories&#46; The investigators therefore decided to create new categories for watching the 10 remaining interviews&#46; The new categories agreed on were morality&#44; boundaries&#44; self&#44; reason for telling the stories&#44; and the father&#8217;s absence&#46;</p><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Morality</span><p id="par0155" class="elsevierStylePara elsevierViewall">In this aspect&#44; the experiences of war produced expressions such as&#44; &#8220;Being afraid is a form of psychological violence&#8221;&#44; &#8220;Learning to give out the message &#39;I&#39;m not scared&#39; is vital for the children&#39;s well-being&#8221;&#44; &#8220;The need to maintain family unity as a reason for survival and parenthesis to cope with the impact of all the difficult and painful experiences that occur around us&#8221;&#44; and &#8220;The normalisation of the bad and the risks in order to create calm for the children and the husband&#8221;&#46; These are all expressions of the need to contain very stressful experiences under the appearance of normality&#44; but for these women it involves a very strong psychological effort not to break down emotionally&#46; This comes with a very high price&#44; both on the mind and the body&#44; since they have no way of working through all the stress caused by the risk situations which continually contaminate the environment&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The difficulty is&#44; &#8220;&#8230; not being able to gauge reality&#59; fathers acted to hide the reality of the risks we were exposed to&#8221;&#44; &#8220;Saying that everything is fine to give courage to the husband and children&#8221;&#44; &#8220;the mother&#39;s love and love for the family was a force for survival&#8221;&#46; These expressions show the enormous effort these women make to normalise the family&#39;s day-to-day life&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">One important moral component of the soldiers&#8217; wives was their need for acts of solidarity with the wounded soldiers&#44; which&#44; &#8220;&#8230; started as maternal accompanying of these boys who came back wounded&#8221;&#59; &#8220;That comes from the maternal instinct from being a woman&#44; and these boys were like family&#8221;&#59; &#8220;Thinking about the suffering of the soldiers&#39; mothers fuelled the maternal instinct to care for and comfort the wounded&#8221;&#59; &#8220;They taught you a lesson&#8221;&#59; &#8220;They were always smiling despite what had happened&#46; And you get back more than you give them&#8221;&#59; &#8220;The presence of the wounded&#44; having lost legs&#44; having lost arms&#44; disfigured&#44; is an enormous pain that you can&#8217;t begin to comprehend&#8221;&#46; Lastly&#44; &#8220;God gave us the courage to have the strength to handle everything and give strength to our husbands&#8221;&#46; With these comments&#44; these women show the complementary side to their husbands&#39; role&#46; This brings to mind Gregory Bateson&#39;s description of the Naven phenomenon in a community in Melanesia in his book <span class="elsevierStyleItalic">Steps to an Ecology of Mind</span>&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> when he delves into the concept of the social phenomenon of complementarities and the roles of the people who are part of a community&#46; In this case&#44; while the husbands&#44; high-ranking soldiers&#44; are working on military combat operations producing death and injury as a consequence&#44; the wives are dedicated to caring for and rehabilitating the survivors&#46; In this new role these women acquire&#44; the maternal role of caregiver&#44; protector and container is strengthened&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Limits</span><p id="par0170" class="elsevierStylePara elsevierViewall">The experience of living in barracks in a war zone has implications in terms of mobility in the physical space and the environment of the barracks&#46; For this reason&#44; expressions such as &#8220;not being able to go out&#8221;&#44; &#8220;not being able to go for a walk due to the risk of kidnapping&#8221;&#44; &#8220;going out was dangerous&#8221; or &#8220;we lived in a ghetto&#8221; are common&#46; Limits also include information&#58; &#8220;We didn&#39;t know even 20&#37; of the things and the operations&#8221;&#59; &#8220;The children had to be taught about what they could and couldn&#39;t say&#59; for example&#44; they couldn&#39;t say their father&#39;s a soldier&#8221;&#46; All of these expressions show the degree of constraint under which these women and their families lived in the midst of a context of risk and threat from outside&#44; which they defended themselves from by confinement behind the walls of the barracks&#46; Their lives in the barracks became about putting continual limits on their actions and words as a means of survival and protection&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Limits on emotions&#44; because&#44; &#8220;You try not to pass on stress and anxiety to your children&#8221;&#59; &#8220;We had to keep our children very busy with sports&#8221;&#59; &#8220;The limits also affect the roles of the family members and especially that of the husband&#8221;&#59; &#8220;You had to give your husband a place despite his absence&#44; and support him&#8221;&#59; &#8220;It&#39;s up to us to understand our husband&#39;s work&#8221;&#46; With these phrases&#44; the women highlight not only the restrictions of physical limits&#44; but also of existential limits to the extent that the world became inaccessible in certain basic aspects&#44; such as walking down the street alone&#44; going for ice cream in town&#44; etc&#46;&#58; &#8220;Closed families&#44; we created a strong boundary between indoors and outdoors&#44; even with the outside world&#8221;&#59; &#8220;We lived in an idealised world in terms of safety&#8221;&#59; &#8220;Continually constructing assurances&#8221;&#46; In terms of Salvador Minuchin&#8217;s structural perspective&#44; this contributed to the formation of an amalgamated family style&#44; with very rigid external limits&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Self</span><p id="par0180" class="elsevierStylePara elsevierViewall">Violence and danger determine self&#58; &#8220;Turning fear into strength to be able to visit dad&#8221;&#59; &#8220;Adapting is a problem&#8221;&#59; &#8220;Learning from other cultures and experiences due to moving&#8221;&#59; &#8220;You get used to frequent changes with the transfers&#8221;&#59; &#8220;You develop the capacity for social work&#8221;&#59; &#8220;There&#39;s a lot of denial&#58; everything is politically correct&#8221;&#59; &#8220;We had to be careful when we were out&#44; you develop other identities to protect yourself&#8221;&#59; &#8220;For example&#44; not saying who your husband is&#44; because he&#39;s a soldier&#8221;&#59; &#8220;The loneliness in the army was terrible&#8221;&#59; &#8220;A lot of denial&#8221;&#59; &#8220;Being a military wife is giving a little piece of myself to my country&#8221;&#59; &#8220;One thing is what you think about military life and another is what you actually experience&#8221;&#59; &#8220;A lot of fear&#44; lots of scares concerning your husband&#8221;&#59; &#8220;My identity is permeated by war issues&#8221;&#59; &#8220;You become mother and father&#8221;&#46; These are all expressions of the impact on self of the experience of living in barracks in a combat zone&#46; Each of the expressions reveals the constant process of personal transformation that these women experience as observers of-participants in their husbands&#39; work and of a much broader sociopolitical process which includes them as second-line protagonists and as a continual affective and emotional refuge for the combatants&#46; Perhaps one of the most extraordinary developments of these women is that in their role they bring together psychological skills&#44; putting into action what Bion<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> calls the alpha function of resignification and symbolisation of situations which are very difficult to work through&#44; they function as good enough mothers&#44; as Winicott<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> would say&#44; showing a useful capacity for retention for their husbands&#44; their families and the soldiers&#44; and as Bowlby<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> would say&#44; show a constant secure base attachment&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Reason for telling</span><p id="par0185" class="elsevierStylePara elsevierViewall">The reason for talking about their life in the barracks in their interviews is to highlight that their husbands had a job to do and highlight that mission&#58; &#8220;We take care of the children and the father takes care of the battalion&#8221;&#44; &#8220;It is to tell a story from the shadows&#44; from the perspective of providing accompaniment&#44; the voice of the wounded&#44; of the helpless&#8221;&#46; As one of the wives says&#44; &#8220;I told my son&#58; we have to value life&#8221;&#44; &#8220;It&#39;s recounting a life experience&#44; having been able to be there&#8221;&#46; These women give voice to the voiceless&#46; &#8220;It&#39;s telling about the need to reintegrate soldiers into civilian life&#8221;&#59; &#8220;It&#39;s telling how many soldiers were killed in cold blood&#8221;&#59; &#8220;Being a perfect woman&#44; creating a useful profession for myself and for the soldiers&#8221;&#46; Through their accounts&#44; these women show that the people are not alone&#44; that all soldiers are part of a family network which continually supported them and that their value is sustained by the love of their families&#46; Furthermore&#44; they wanted to make their voices and experiences of affection&#44; support and containment heard as a constructive contribution to life in the midst of war&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Absence of father and family life</span><p id="par0190" class="elsevierStylePara elsevierViewall">&#8220;The constant worry about their father&#8221;&#44; &#8220;We were never with him&#44; very little time living together&#8221;&#44; &#8220;The experience of their father&#39;s absence&#44; sometimes six months away and three days at home&#8221;&#44; &#8220;You become father and mother at the same time&#8221;&#44; &#8220;You keep their father present through letters&#8221;&#44; &#8220;He hardly slept&#44; I don&#39;t know when he rested&#44; I was worried he&#39;d get sick&#8221;&#46; From the above phrases&#44; we see that&#44; by assuming the dual role of father and mother due to the unavoidable absence of the father&#44; these women maintained the structure of family limits and hierarchies described by Minuchin&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and also managed to avoid disruptions in the daily routines of family life and family organisation&#44; none of which can have been easy running the family with an absent member&#46; &#8220;Absence creates continual voids in information and misunderstandings&#8221;&#44; &#8220;Family structure and relationships generate strengths and commitments&#8221;&#44; in response to which some mention that they made efforts to &#8220;create survival narratives&#8221;&#46;</p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Discussion</span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Reflective analysis</span><p id="par0195" class="elsevierStylePara elsevierViewall">In the systemic family therapy clinic&#44; secondary traumatic stress in the relatives of active military personnel is widely accepted&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Our research focused not on the entire family&#44; but on a particular member&#44; the military wife&#44; in relation to the impact&#44; influence and transformation that observing traumatic experiences in her environment can generate&#46; The accounts analysed from a systemic perspective show that in the background of their lives and their stories&#44; discourses from the military and war context are present&#44; which include actions&#44; interactions&#44; values&#44; beliefs&#44; feelings and the non-verbal signs of corporeality&#44; clothes&#44; objects&#44; tools&#44; technologies&#44; times and places of life in the barracks&#46; Listening to these women&#44; it is clear that there are three different narratives that live within them&#46; One corresponds to the formal discourse of the spouses&#44; which responds to their belonging to an institutional structure which educates and trains them for a lifestyle and for a commitment that involves actions&#44; thoughts&#44; feelings and sacrifices which can result in loss of life&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Another corresponds to the discourse of living the experience&#44; of being part of the life of the soldier&#44; which involves the absorption of events&#44; episodes and circumstances that lead them in their own language to make sense of their reality&#46; The third&#44; typical of every couple&#44; is the narrative of love&#44; attachment&#44; the idealisation of the other&#44; which is very quickly distorted by the day-to-day effects of the unavoidable absence caused by the husband&#39;s type of work&#46; As wives&#44; these women make an idiosyncratic interpretation of the world of war which has remained invisible and unheard by society&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">We believe that when these women agreed to speak to the playwright and gave her permission to write a play with their stories lived and told&#44; they found a suitable&#44; safe place and medium to make their silenced voice heard&#46; Gee<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> describes this use of invisible language as &#8220;lower-case&#8221; discourse&#44; which corresponds to &#8220;language in personal use that is shared in conversations or stories&#8221;&#44; which contrasts with &#8220;capitalised&#8221; discourse&#44; which is part of the discourse typical of social institutions and includes other factors which identify the speaker as belonging to a group&#44; association or significant social group&#44; which in this case would be the military institution&#46; These women are not soldiers&#44; they are first-hand observers of the life of the soldier&#44; and at the same time they participate in the life of the soldier&#44; who end up introjecting&#44; &#8220;&#8230;we are soldiers without a uniform&#8221;&#46; These words connote the influence of the Discourse&#44; with a capital D&#44; of the military institution on the discourse&#44; with a small d&#44; of these wives&#46; In the background of their lives&#44; the lower-case discourse is sheltered by the umbrella of Discourse&#44; which includes the narrative of the army&#44; the narrative of war&#44; the narrative of national politics&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">It is important for the reader to understand that these stories were shared with the playwright at a particular historical moment&#58; during the peace negotiations between the Government and the guerrillas&#46; Taking this situation into account&#44; we again take the words of Gee&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> who says that the key to the Discourses is recognition&#46; When a person uses language&#44; action&#44; interaction&#44; values&#44; beliefs&#44; symbols&#44; objects&#44; tools and places in such a way that others recognise a particular identity involved in a particular activity here and now&#44; a Discourse has been uttered&#46; Discourses are always embedded in a mixture of social institutions&#44; often involving supports from these institutions &#40;cultural&#44; social&#44; political&#44; etc&#41;&#44; such that people are not only talking and interacting with each other&#44; but in their living and acting are the communicators&#44; giving life to these Discourses&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">As researchers&#44; in each story&#44; in an exercise of deconstruction&#44; we were extracting the different categories which&#44; camouflaged in the narratives&#44; allow us to understand the deep sense and meaning implicit in the experience of their lives in the barracks in the war zone&#46; The categories used in the analysis do not come from the interest of the investigators&#44; but were refined by the discourse of these women themselves&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">In each story told by each of these women&#44; they create a discourse and a narrative which although it responds to their lived and observed experience&#44; is reworked with the conditioning&#44; restrictions and filtrations that come from military and war culture&#44; which they incorporate through their relationship with their husbands&#46; When they agree to be interviewed by the primary researcher&#44; they hope that their voice conveys their lived history&#44; aspects of which they want to highlight and give voice to so that they may be heard and recognised in the world beyond the institution&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">The institutional Discourse with the determination it exerts on the particular lives of these women shapes their lives in a way that cuts across individual&#44; couple and family dimensions&#46; At the individual level&#44; daily life is punctuated by experiences that generate fears and dread&#44; such as fear of leaving the barracks&#44; fear of kidnapping&#44; restrictions on movement&#44; frequent changes of location&#44; changing one&#39;s identity outside the barracks so as to avoid risky identification or submitting to security protection&#59; all experiences which create a subtle but forceful mood of persecution and paranoia which over time generate cumulative&#44; adaptive and social stress&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">In terms of the couple-related experience&#44; the prolonged absence of the husband exacerbates the situation of loneliness&#44; distance&#44; lack of emotional support&#44; the limitations on their sex life&#44; and a prolonged internal dialogue in which they question themselves with the doubts and the unavoidable fears of whether they can or should share their inner thoughts with their husbands&#44; their family and their barrack companions&#46; In the couples&#8217; relationship&#44; the influence of the military institution is made visible with its unavoidable demands in the course of the building of the relationship as a third party&#44; constantly eroding the autonomy of the couple&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">As for family life&#44; it is affected by the constant absence of the father&#44; who becomes a contradictory figure&#46; He is an authority figure&#44; but much of his role is assigned to the mother&#44; who assumes a dual role as father and mother&#46; As the absence of the soldier impacts the family balance&#44; the wife reconstructs the image of the father in an idealised form as a hero figure by way of compensation&#44; in order to fill the gaps in the absent father&#39;s duties with the all-encompassing presence of the heroic man&#44; whose role is a supernatural task of protection&#44; not only of the family&#44; but also of the country&#46; Given the importance of the men&#39;s role&#44; the confidentiality of what they do&#44; and the disturbing nature of war itself&#44; they bring a significant silence into family life&#59; there are things that cannot be talked about&#44; cannot be said and cannot be named&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Living in barracks in a war zone generates different emotional experiences&#44; such as those described by these women&#58; anxiety&#44; fears and dread from a negative and threatening perspective&#46; However&#44; superimposed on these aspects&#44; and despite the difficult experiences they have as front-line observers of the war&#44; it is striking that emotions and feelings emerge which heighten their human sensitivity and make them feel solidarity with the soldiers and their families&#46; Sharing the suffering of the combatants and their families erodes social distances and helps create an emotional bond&#44; which then spurs them into action&#44; prompting activities such as volunteering in support foundations for soldiers and their families&#59; this then becomes very important for them and helps give meaning to their own lives&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Last of all&#44; life under these circumstances leads to consequences&#44; such as the reformulation of the very conception of woman and couple and ordinary family life&#44; the meaning of life&#44; religion and the value of accompanying another and finding meaning in that&#44; even with everything they have to give up themselves&#46; One important aspect is that&#44; in the midst of the destruction caused by the war&#44; they manage to set up ventures such as kindergartens&#44; schools&#44; health centres and support foundations in the soldiers&#39; environment&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">The idea of passive trauma</span><p id="par0245" class="elsevierStylePara elsevierViewall">When we talk about trauma&#44; we are referring to the etymological origin of the term&#44; which in Greek means &#8220;wound&#8221;&#44; a physical injury caused by an external agent or also an emotional blow which causes lingering damage to the unconscious&#46; Generally speaking&#44; trauma is not life-threatening&#44; but it can cause some type of disability in the person that alters or threatens their well-being&#46; Trauma causes an imbalance in a person&#39;s mental state&#44; in the area of their emotions&#44; which to a certain extent can disrupt their existence&#46; The Latin origin of the term passive means capable of suffering&#44; sensitive&#44; derived from the Latin term <span class="elsevierStyleItalic">pati</span>&#44; meaning to suffer and endure&#46; The concept of passive has the meaning of remaining inactive and letting things happen without your intervention&#59; in other words&#44; the affected person receives but does not act in a certain sense&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">When talking about the concept of passive trauma&#44; developed from our analysis and the experience of this sample of women military wives&#44; we are referring to the unavoidable&#44; continual emotional experience that prevails and has to be lived through as part of ordinary life and affects existence&#44; self and the ability to maintain an atmosphere of normality in their primary environment&#44; with a psychological cost that is difficult to specify&#44; but which may manifest with limitations or overcompensation&#46; People who experience passive trauma live in a context of stress and threat that constitutes an existential background in which attention is hidden but is tacitly present and acts insidiously over time&#46; Passive trauma is the experience of living in an atmosphere of uncertainty&#44; tension and constant threat which cannot be avoided and which generate limitations and constraints on the one hand&#44; as well as&#44; on the other&#44; a compensatory reaction which attempts to neutralise this atmosphere with idealisations such as heroism and obtain a greater good for others through acts of sacrifice and generosity&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">It is an emotional experience resulting from the partnership between someone who is exposed to direct trauma and someone who is simply an indirect observer&#46; People live in an atmosphere of accumulating difficult&#44; painful experiences&#44; and this creates an environment of limitations in day-to-day life affecting movements&#44; emotional&#44; sexual and social life in a context of stoic seclusion which&#44; on top of all that&#44; is also wrapped in either real or imagined threats&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">As a result of this allostatic load of stress&#44; people try to overcompensate for the stress burden with idealisation&#44; generosity&#44; identifications&#44; which become transformed into supporting soldiers as substitute mothers&#44; the development of a spirituality that gives assurances and meaning to the catastrophic&#44; and continual educational activity in health and social matters&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">The characteristic defence mechanisms of passive trauma include&#58; denial&#44; by which events are seen through the protective bubble of the barracks or military institution &#40;denial can also include the suffering of the enemies&#41;&#59; the idealisation of military combatants&#44; who are seen as heroes&#44; with the omnipotence propelling frenetic aid activity in foundations&#44; schools&#44; rehabilitation institutions&#44; etc&#59; the separation of reality into good and evil according to Manichaean doctrine&#44; whereby the enemies are some others&#44; onto whom all defects or negative aspects can be projected&#59; and regression&#44; expressed in the experience of living in the barracks as a kind of bubble or a protective womb which protects from the dangerous outside world&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">These families live immersed in secrecy&#46; Part of the husband&#39;s work is secret&#44; all the traumatic and violent adversities of war become a repressed secret due to the nature of the work&#46; As with all secrets&#44; they become unspeakable and even unthinkable&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Various theorists and family therapists have worked on the power this &#40;something known but kept silent&#41; has over family dynamics&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#8211;15</span></a> We believe that one motivation in telling the stories lived by these women has a lot to do with what Penn<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> highlights about the effect that Bateson&#39;s &#8220;double description&#8221;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> has on understanding the complexity of human experiences&#46; Bateson would say that the testimony of the military wives speaking out broadens and enriches our understanding of the military context&#44; as the opportunity to analyse a situation from various points of view takes us to a higher level of comprehension&#44; to a wider and more complex understanding of lived reality&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Differential diagnosis</span><p id="par0275" class="elsevierStylePara elsevierViewall">Once our conceptualisation of passive trauma has been developed&#44; other types of psychological trauma are defined to facilitate differential diagnosis&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Post-traumatic stress disorder&#46;</span> A mental state triggered by a terrifying event&#44; either experienced or witnessed&#44; which is expressed in symptoms such as flashbacks&#44; nightmares&#44; severe anxiety and uncontrollable thoughts about the event&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Collective trauma disorder</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> &#8220;Collective trauma is defined as a tear in the social fabric&#44; as well as an incident that&#44; retrospectively&#44; breaks with the usual mnemonic practices and in which no one narrative can be accepted by all members of the group&#8221;&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Historical trauma&#46;</span> A trauma inflicted on a group of people who share an identity or affiliation &#40;ethnicity&#44; nationality&#44; religion&#44; etc&#41;&#44; characterised by the transgenerational legacy of the traumatic events experienced and expressed through psychological and social responses&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0295" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Secondary trauma</span>&#46; Traumatic stress is a process by which an individual who observes the suffering of another simultaneously experiences the same emotional responses to the real or expected emotions of the other person&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Triangulation</span><p id="par0300" class="elsevierStylePara elsevierViewall">As part of the research process and prior to completing it&#44; we invited the wives interviewed by the playwright to a meeting to explain the process we had followed with their interviews and to read them the contents of the article written from our research&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">One of the investigators read the article and those present could interrupt to ask for clarification&#44; expand explanations and&#44; if they wished&#44; express opinions&#44; reflections and understandings raised by what we had written&#46; After that stage&#44; the feedback the women gave included various aspects&#46; A first contribution was that the article accurately represented the psychological experiences that they had reported about their past&#46; They then went on to say that the categories the investigators had used for the analysis and reflections on their experiences made them see themselves in a new light and broadened the spectrum of reflections on their experiences&#46;</p><p id="par0310" class="elsevierStylePara elsevierViewall">One aspect emphasised by the women which had not been considered in the previous categories from the interviews was jealousy&#44; an aspect that did not come up anywhere in the interviews&#46; However&#44; at this meeting they highlighted the importance of this feeling during their lives as military wives in conflict zones&#46; They expressed that the long absences&#44; the distances&#44; the long periods with no communication and the lack of knowledge of where their husbands were during military operations all took its toll on their relationship as a couple when it came to their day-to-day lives&#44; their conversations&#44; tenderness&#44; eroticism and sexuality&#46; In these circumstances&#44; the women reported that distrust&#44; insecurity and in the end jealousy featured increasingly heavily in their thoughts and emotions&#46;</p><p id="par0315" class="elsevierStylePara elsevierViewall">Thus&#44; it is striking that in none of the interviews was there a single allusion to jealousy&#44; something that also surprised the women who attended the meeting&#46; None of them mentioned the subject&#46; In trying to understand this&#44; that they would leave out such a psychologically intense issue&#44; the women explained that the reason for this omission may be that the interviews emphasised the issue of the family and their position as heads of the household in the absence of the husband&#44; which meant that the issue of the couple had remained in the background&#44; but emerges as an obvious omission when reading the article&#46; With their comments they consolidated a latent idea in the interviews&#44; the absence of the husband&#44; no longer as a hero&#44; but as someone who also represents the couple&#39;s conflict&#46; Talking to these women&#44; it becomes clear that their idealising of the military husband as a father and family member breaks down when looking at him as a partner&#46; As the conversation deepened&#44; the women agreed that life as a couple with a military husband is not easy and is full of many periods of loneliness and&#44; above all&#44; great personal and emotional uncertainty&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0320" class="elsevierStylePara elsevierViewall">Another aspect which is only slightly hinted at in the interviews is certain psychosomatic symptoms<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> which some women talked about&#46; However&#44; in this new conversation&#44; after listening to the contents of the article&#44; the women stressed the importance of making specific reference to the consequences on their mental health throughout their years-long experience&#46; They are explicit that they have not been immune to mental illnesses resulting in psychiatric diagnoses requiring drug therapy and&#44; in some cases&#44; admission to hospital for psychiatric problems&#46; These aspects are mentioned with a certain wariness&#44; as they expose a truth which cannot be idealised&#44; with a clear emphasis on the cost this way of life has had on these women&#44; which has never been made visible and nobody has taken into account&#46;</p></span></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Conclusions</span><p id="par0325" class="elsevierStylePara elsevierViewall">With this study we wanted to make visible and externalise the existential discourse of a group of people who&#44; living in a situation of constant underlying stress in the midst of armed conflict and war&#44; not as direct actors&#44; but as observers of the suffering of others&#44; are repositories of a wide spectrum of experiences which all have an impact on their lives&#46; These experiences affect both their physical and mental health&#44; but they are seen from an individual perspective&#44; and not as a group of women who&#44; made invisible by institutions&#44; by making their voices heard&#44; show that the silence in which they live and the noise that arises from victims of both sides of the conflict turn them into a subtle form of victimisation&#58; disconfirmation as subjects of suffering and pain&#46; By sharing their experiences&#44; both the personal ones and in the work they do to support and address the suffering experienced by soldiers in the battalions&#44; they allow us to see another aspect of the conflict in which&#44; surprisingly&#44; solidarity and actions in support of human dignity are their counterpart to violence&#46;</p><p id="par0330" class="elsevierStylePara elsevierViewall">Wars and soldiers will never go away&#46; The aim of our contribution is to acknowledge that these women are silent&#44; voiceless actors who require greater attention&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conflicts of interest</span><p id="par0335" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Wives of military personnel in action living on bases located in areas of armed conflict in Colombia before the peace negotiations with the Revolutionary Armed Forces of Colombia &#40;FARC&#41;&#44; were first-hand observers of the war&#44; their husbands&#39; participation in the war and the consequences and effects of the combat in which others participated&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To offer a hypothesis regarding these women&#39;s experience of direct trauma and characterise the dimensions of their experience as observers of the suffering of others&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Qualitative study and secondary discourse analysis in intentional snowball sampling of wives of military personnel &#40;officers and chiefs&#41; with whom semi-structured interviews were conducted&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Direct trauma is not the sole cause of psychosomatic and psychopathological consequences&#59; the experience of constantly observing the suffering and deaths of others also generates a cumulative effect that can affect physical and mental health&#46; This experience is called passive trauma&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Las esposas de militares en acci&#243;n&#44; que viv&#237;an en cuarteles ubicados en zonas de conflicto armado en Colombia antes de las negociaciones de paz con las FARC&#44; vivieron como observadoras de la guerra&#44; de primera mano&#44; la participaci&#243;n de sus esposos y las consecuencias y los efectos de los combates que otros vivieron&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Plantear una hip&#243;tesis sobre el tipo de experiencia traum&#225;tica vivida por ellas y caracterizar las diferentes dimensiones de la experiencia de observar el sufrimiento de otros&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">M&#233;todos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Investigaci&#243;n cualitativa y an&#225;lisis secundario de discurso en una muestra intencional en bola de nieve de esposas de militares &#40;oficiales y jefes&#41; con quienes se hab&#237;an realizado entrevistas semiestructuradas&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">No solo el trauma directo vivido en primera persona genera consecuencias psicopatol&#243;gicas y psicosom&#225;ticas&#44; sino que tambi&#233;n las experiencias vividas al observar el sufrimiento y la muerte de otros de manera constante generan una experiencia acumulativa que puede afectar a la salud f&#237;sica y mental&#46; A esta experiencia se la denomina trauma pasivo&#46;</p></span>"
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                        0 => array:2 [
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                            0 => "C&#46; G&#243;mez-Restrepo"
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                            2 => "G&#46; Buitrago"
                            3 => "C&#46;C&#46; Guarnizo-Herre&#241;o"
                            4 => "N&#46; Garz&#243;n-Orjuela"
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                      "titulo" => "T&#233;cnicas de terapia familiar"
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                      "titulo" => "The systemic impact of traumatized children"
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Article information

ISSN: 25303120
Original language: English

DOI:10.1016/j.rcpeng.2021.09.003

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