Virtual Therapy Helps Residents of a Shell-shocked Juarez

Adriana Zehbrauskas for The New York Times

A patient in Ciudad Juárez demonstrating treatment in which scenes related to a previous traumatic experience are viewed.

By KARLA ZABLUDOVSKY

NY TIMES

CIUDAD JUÁREZ, Mexico — Every time Erica González put the video goggles on, the details of her four days in captivity came rushing back to her. She could smell the sweaty T-shirt used to cover her head, taste the ash in the beer bottles that she was made to drink water from and hear her abductors’ muffled conversations.

“It was scary to go through it again,” Ms. González said, “but I said, ‘It’s good for me.’ ”

Ms. González, 18, is one of 25 patients who recently completed a virtual therapy program similar to the one used by the United States military to treat Iraq war veterans with post-traumatic stress disorder. Created by doctors and psychologists from the National Autonomous University of Mexico, the pilot project was aimed at filling a void in mental health services for Ciudad Juárez’s shellshocked residents.

The city, home to the powerful Juárez cartel and coveted by other criminal syndicates because of its strategic location within the drug trade, has been one of the front lines in President Felipe Calderón’s assault on organized crime.

The hair-raising virtual scenes that appear in the goggles were created for residents of this violence-racked city, which in recent years has had the highest murder rate in Mexico. The goggles show one of six scenes, including an armed robbery, a police checkpoint, a safe house for kidnappings and a shootout between cartel gunmen and army soldiers. Therapists show patients the scenes most closely related to their experience, and then further tailor the sessions to address their trauma more specifically, for instance by playing a song heard during their ordeal.

The program sharply reduced post-traumatic stress disorder symptoms, with a success rate of 80 percent, organizers said.

“There has been a lot of attention to the problem of violence, which is understood as public safety, drug trafficking and police,” said Hugo Almada, who does research on the psychological toll of violence at the Autonomous University of Ciudad Juárez. But the toll on mental health has been largely ignored, he said.

Even those directly affected by the city’s violence, which has claimed more than 10,000 lives in the past four and a half years, often do not know when they need help.

Another traumatized resident, Juan Carlos García, 29, stopped eating and sleeping and became withdrawn after his brother was killed and he had to identify the body at the morgue. After nearly a year, Mr. García’s wife and co-workers persuaded him to try the virtual reality treatment.

Wearing his goggles and headphones, he retold the series of traumatic events, from the last time he saw his brother alive to his burial. He worked through breathing exercises with his therapist afterward, techniques that were intended to help him lower his anxiety levels, which were monitored as he viewed the images through the goggles. And he did his homework between sessions, spending time in his brother’s room, visiting his grave and driving by the site where he was killed.

These exercises are especially important, the project’s therapists said, because unlike Iraq war veterans who eventually leave the battle zone, patients in Ciudad Juárez continue to live in danger. Because the patients have to drive by, or live near, the places where violent episodes occurred, the therapy is intended to help them stop avoiding these routes and routines.

But it is uncertain whether the program will continue, though, because the grant under which it was conceived ran out in December and no other financing has emerged, organizers said.

As emotionally draining as the process was, Mr. García said it was worth it. “I remember, but there isn’t as much pain,” he said.

The need for psychological services remains vast. A recent study by the university in Ciudad Juárez found that more than 70 percent of the city’s residents had passed by a cordoned-off murder site. The doctors leading the virtual reality treatment estimate that a quarter of the population in Ciudad Juárez suffers from post-traumatic stress disorder.

Maria Teresa Cerqueira, chief of the United States-Mexico border office of the Pan American Health Organization, said many residents in the city were dealing with the loss of loved ones, the disappearance of people around them or fears over their own security. “You need a lot of therapists that can support people,” she said.

Brisa Delgado is one of the victims of violence left adrift by the lack of a response network. Gang members burst into a house party that she was attending in January 2010, firing indiscriminately and leaving 15 people dead. Ms. Delgado’s head was grazed by a bullet in the attack, which the authorities said was a gang’s attempt to neutralize young people they mistakenly thought were rivals. Her government-subsidized psychologist discharged her after two months of therapy, but Ms. Delgado, a soft-spoken 18-year-old with auburn bangs swept to the side, was not feeling any better.

“Every day I dream that I get killed,” she said, looking down at her fidgety hands.

Neglect toward mental health is not exclusive to Ciudad Juárez. All across Mexico, institutions for the mentally ill are known for their decrepit conditions. On a recent afternoon, a dozen patients huddled in the shady end of a courtyard in one of the shelters for the mentally ill in Ciudad Juárez, off a dusty highway east of the city. They swatted off flies drawn to the smell of feces and dirty clothes.

Most of the money to operate the shelter comes from private donations. The government’s participation is negligible, said the shelter’s founder, the Rev. José Antonio Galván, who often salvages discarded and expired food for the patients.

“These are people that don’t exist,” Father Galván said. “They are invisible.”

For those whose lives have been turned upside down by criminals, psychological care can make the difference between self-imposed seclusion and guarded freedom. Ms. González, who stayed home for months after her kidnapping, has begun venturing out again. She goes to the movies with her boyfriend from time to time and is planning to return to school in August.

Ms. González is afraid that she may be kidnapped again, but she still feels as if she has come a long way.

“Before, I couldn’t talk about it without crying,” she said with a small, triumphant smile.