**All names have been changed.
During my time at Hospitalito Atitlán, I was surprised to find myself taking on the role of staff psychologist. While I was not specifically hired for this role, it was a natural fit based on my academic background and interests, as well as the great need for mental health services in this region. The community endured a civil war for 36 years, during which thousands of people were tortured and killed. In 2005, a mudslide caused by Hurricane Stan killed approximately 250 people and left more than 5,000 homeless. As a result of various factors, including these traumatic events, mental illness is widely prevalent in Santiago, especially PTSD and other severe anxiety disorders.
María arrived at the Hospital hoping to be seen by a plastic surgeon who could erase the prominent scar on her cheek. Our social worker Natalia informed her that unfortunately, the visiting surgical team had left the week before. Based on warning signs, Natalia identified María as a candidate for therapy and requested that I provide her with emotional support. In our borrowed clinic room, María explained that her aunt had given her the scar, slashing her face in an uncontrolled display of anger and jealousy. Her aunt, who abuses drugs and alcohol, had often lashed out at María based on conflict arising from their competing businesses. Both sell embroidery and souvenirs in the same location. María’s mother had always defended her sister in the past, rationalizing her behavior, but when she saw the most recent physical harm that her sister had inflicted on her daughter, she and María decided to take legal action to protect María’s safety. They filed a restraining order, but due to corruption and disorganization on the part of local authorities, are still waiting for it to be finalized.
María told me that she was afraid to leave her house, for fear of retaliation by her aunt. The paranoia curbed her appetite and afflicted her with insomnia. She was no longer selling her embroidery or earning an income, and felt guilty because her elderly mother took on additional work washing other families’ clothes in Lake Atitlán out of economic necessity, earning only 25 quetzales (the equivalent of $3.24) a day to support the two of them. She often complained to María that she was tired and did not want to continue like this, but María felt powerless to change the situation.
María struggled with many insecurities. In addition to her scar, she was born with one of her eyes closed and has never been able to see out of that eye. When I met her for the first time, she covered that eye with a curtain of side bangs. Her physical appearance is an additional source of shame for her that prevents her from leaving the house. She is afraid that people will make hurtful comments and judge her, as she was traumatized by bullying in school based on her appearance.
From our conversation, it became clear that María was searching for explanations for why she was born like this and why she ended up with such a terrible scar. Her instinctual response was to blame herself. I told her that none of these problems were her fault, something that she had never heard before. I also assured her that she is not deformed, that appearances are superficial and that what matters most is what she has on the inside--intelligence and a big, warm heart, evident from our first meeting. I emphasized that each time she leaves the house it will become easier, as she comes to realize that the majority of people will not make comments as she expects. Mostly I just listened, which I do best, while she recounted her traumatic experiences and poured her heart out, her mother sitting silently beside her. It was unclear how much of the conversation her mother understood, as we were speaking in Spanish and her mother speaks only Tz’utujil. But she occasionally nodded her head in acknowledgement, or a shadow of sadness and concern crossed her face, which made it clear that she registered fragments of our conversation and was empathizing with her daughter.
At the end of our session, María and her mother expressed their gratitude. Her mother was pleasantly surprised when I responded “Monaq xuban,” you’re welcome, in Tz’utujil. I emphasized that they are welcome to come to the Hospitalito to speak with me whenever María wishes to leave the house or is in need of emotional support, free of charge.
Two days later they returned. Both Natalia and I noticed a change in María. She had recently bathed and was wearing elegant clothing. She had woven her hair into a beautiful long braid behind her back, exposing her entire face, which revealed a radiant smile. She announced that she had come to talk to me. When we sat down with her mother in the same borrowed clinic room, she exuberantly shared her good news. She had eaten well for the past two days and slept well for the past two nights for the first time since the accident. She said she was finally starting to feel “normal.” She felt that a huge burden had been lifted off her shoulders, and was beginning to understand that her physical conditions were not her fault. She emphasized her gratitude for my support, as she lacks a confidante, and thus had never had the opportunity to express her emotions before. Although she knows implicitly that her mother loves her, she does not ask María how she is feeling or show her affection, not even in the form of a hug.
The main concern that María expressed was her economic situation. She wanted to continue to embroider and was able to do so from home. However, she still did not feel safe leaving the house to sell because there had been no further progress with the restraining order. I complimented María and her mother on their beautifully made huipiles (blouses). María told me that her mother had woven them, and that she had embroidered the intricate and colorful birds and flowers. It occurred to me to connect María with a local weaving cooperative run by a family of eleven with whom I had lived during my first month in Santiago. They taught me about the role of weaving in helping people overcome trauma; for example, it has played a vital role in healing the psychological wounds of women who have been sexually abused. My hope was for María to join their cooperative to increase her social support network and work opportunities. Her mother could weave for the cooperative as well, to alleviate the physical burden of washing clothes.
When I visited the cooperative a few days later, I asked the oldest daughter Ana about María’s visit, which I had coordinated with the family. She told me that for the past three days, María had embroidered from 8 am until 4 pm. I admired the work that she had completed, embroidering birds on a woven table runner, impressed that she had accomplished so much in so little time. Though María had expressed her goal to learn to embroider as beautifully and intricately as Ana, Ana joked that she couldn’t keep up with María, who embroiders two birds in the time that Ana embroiders only one. María had recounted her story to Ana and her mother, who both assured her that their house was a safe space and that she had already become part of their family.
The following week, María and her mother returned to the hospital. María was beaming. The motive of their visit was not for emotional support, but rather to thank me. María had received her first payment from the cooperative for her embroidery. They gave me a gift of five tangerines and invited me to have lunch at their house. They asked whether I like spicy food, which I assured them I love. María told me how much she enjoys embroidering at the cooperative--she had been going every day and planned to go the next, but wanted to take one day off to visit and thank me.
On Saturday María picked me up and welcomed me into her home, which I was surprised to discover is only two blocks from mine. She and her mother insisted that I sit down at the dining room table next to their bed, in a small room with religious decorations. They brought me limeade, grilled fish, rice, plentiful tortillas, and jalapeño salsa. María’s mother continuously filled my glass and served me more rice, even after I assured her that I was full. She was attentive to my every need and displayed immense generosity, hospitality, and warmth, despite the language barrier. I continuously repeated “Maltiox chawa,” thank you. At the end of the meal, filled with conversation and laughter, I told María that I needed to leave to begin cooking for my birthday dinner party that night. She graciously offered to help me cook, despite having never made or tasted lasagna before. I brought María to my house and she helped me clean and chop vegetables--even onions that made her cry--and wash mountains of dirty dishes. She conversed with Lidia, my landlady, in Tz’utujil, along with my friends at the dinner. When everyone had already sat down to eat and was absorbed in the food and conversation, María noticed that I didn’t have a chair and brought one upstairs for me. Her attentiveness and small act of generosity nearly brought me to tears.
María loved the lasagna, the culmination of our sharing of food from various generations and cultures--from her mother’s fish from Lake Atitlán to my grandmother’s tomato sauce, lasagna, and garlic bread from Italy. Although unfortunately one of the lasagnas exploded in the oven and was thus inedible, it was the process rather than the product that mattered. During the process María and I worked side by side towards a common goal, often in a companionable silence that connected us, given that words were not necessary.
María originally came to the Hospitalito looking for a plastic surgeon, and instead found a confidante and friend. She found an alternative form of therapy, her own embroidery, to help heal her psychological wounds, which cut deeper and leave more lasting marks than physical ones. I have learned that perhaps the most successful psychologists are not those who burden their patients with diagnoses and ink blots, but rather those who apply the principles of social work and connect their patients with community resources, so they can continue to improve their own well-being in a sustainable manner, outside and beyond therapy sessions. Perhaps the best payments are an uncovered smile, tangerines purchased with a patient’s first earnings, lunch and dinner dates, and the knowledge that the colorful birds that María embroiders have life far beyond the two-dimensional fabric on which they are crafted. They have liberated her and empowered her to fly.