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Conteúdo (article):

Violência urbana e sofrimento psicossocial: uma discussão clínico-política em torno da concepção de trauma coletivo

Urban Violence and Psycho-Social Suffering in Brazil: A clinical-political discussion of the concept of collective trauma

Violencia urbana y sufrimiento psicosocial: una discusión clínico-política en torno a la concepción de trauma colectivo

Lilian Miranda. ENSP/FIOCRUZ. Email: miranda78.lilian@gmail.com
Orcid: 0000-0002-8238-8111
Michael O’Loughlin. Adelphi University. Email: michaeloloughlinphd@gmail.com
Orcid: 0000-0001-9444-6174

Resumo
O ensaio apresenta uma abordagem clínico-política do trauma coletivo, com base em autores que fazem uma leitura intersubjetiva da psicanálise em diálogo com teóricas feministas, responsáveis pela leitura política do trauma. Esse material é dialogado com relatos de experiências de vítimas da violência urbana no Brasil. Admite-se que o trauma coletivo é um evento disruptivo, para o qual não há recursos de representação. Entre seus efeitos, encontra-se a corrosão dos laços de sociabilidade, sentimentos de impotência, medo e perda de orientação espaço-temporal. Geralmente assentado sobre contextos de exclusão e opressão social, o trauma coletivo tem sido abordado numa perspectiva medicalizante e reducionista, que desconsidera suas raízes estruturais. Em direção oposta, propõe-se que seja reconhecido seu caráter crônico, que exige uma discussão política, a partir da qual é importante legitimar as pessoas traumatizadas como especialistas na experiência vivida. Com o protagonismo delas, o enfrentamento do trauma deve envolver tanto estratégias políticas de criação de dispositivos coletivos, emancipação e luta por mudanças estruturais, como clínicas, sobretudo grupais, de escuta e oportunidades para reconstrução e compartilhamento de sentidos em torno do vivido.
Palavras-chave: Trauma Psicossocial; Traumas; Relações Interpessoais; Violência armada
Abstract
This article presents a clinical-political approach to collective trauma, based on authors who offer an intersubjective reading of psychoanalysis in dialogue with feminist theorists, responsible for the political interpretation of trauma. This material engages with accounts of victims’ experiences of urban violence in Brazil. Collective trauma is seen as a disruptive event, for which there are no representational resources. Among its effects are the corrosion of the sociability ties of the social group that experienced the trauma, feelings of impotence, fear, and loss of spatial and temporal orientation. Generally, based on contexts of exclusion and social oppression, collective trauma has been approached from a medicalizing, reductionist perspective, which disregards its structural roots. In contrast, it is proposed that its chronic nature be recognized, requiring political discussion, from which it would be important to legitimize traumatized people as specialists in the experience they have been through. With their protagonism, confronting trauma should involve both political strategies for creating collective mechanisms, emancipation and the struggle for structural changes, as well as clinical ones - especially group-based - of listening and opportunities for the reconstruction and sharing of meanings about what has been experienced.
Keywords: Psychological Trauma; Traumas; Interpersonal Relations; Gun Violence.

Resumen:
El ensayo presenta un enfoque clínico-político del trauma colectivo, basado en autores que ofrecen una lectura intersubjetiva del psicoanálisis en diálogo con teóricas feministas, responsables de la interpretación política del trauma. Este material dialoga con relatos de experiencias de víctimas de la violencia urbana en Brasil. Se admite que el trauma colectivo es un evento disruptivo, para el cual no hay recursos de representación. Entre sus efectos se encuentra la corrosión de los lazos de sociabilidad del grupo social que ha experimentado el trauma, sentimientos de impotencia, miedo y pérdida de orientación espacio-temporal. Generalmente asentado en contextos de exclusión y opresión social, el trauma colectivo ha sido abordado desde una perspectiva medicalizante y reduccionista, que desconsidera sus raíces estructurales. En dirección opuesta, se propone que se reconozca su carácter crónico, que exige un debate político, a partir del cual es importante legitimar a las personas traumatizadas como expertas en la experiencia vivida. Con su protagonismo, el afrontamiento del trauma implica tanto estrategias políticas para la creación de dispositivos colectivos, la emancipación y la lucha por cambios estructurales, como estrategias clínicas, especialmente grupales, que brinden espacios de escucha y oportunidades para la reconstrucción y el intercambio de significados en torno a la experiencia vivida.
Palabras clave: Trauma psicosocial; Traumas; Relaciones interpersonales; Violencia armada.

Introduction
Among the largest Brazilian social problems is armed urban violence, which kills thousands of people a year, mainly affecting the black population. According to the Institute of Economic and Applied Research (Ipea), in 2021, there were 47,847 homicides in Brazil, 77.1% of which had black victims. The number of young people killed is also notable: 24,217 in 2021, which corresponds to 50.6% of the homicides, and of every 100 young killed, 49 were due to homicide.1
In Rio de Janeiro State, the homicide rate in 2021 was 26.8 deaths per 100,000 inhabitants. This figure was higher than the homicide rate in Brazil as a whole, which was 21.261, while around the world there were 5.8.2 These data express the discrepancy and severity of the situation of armed violence in the country.
Most of these deaths happen in shantytowns, featuring complex, heterogeneous forms of social organization. Despite the diversity and specificities of each territory, the reality in Rio, for example, is that certain shantytowns are marked by the coexistence of opposites, such as some degree of State presence, schools and basic health units, and sewage systems that are poorly structured, deteriorated, neglected or non-existent. There is power and health among the thousands of inhabitants who are employed, but there is hardship and hunger among those who have neither access to employment nor to social benefits. There is creativity and strength in organizations and initiatives to strive for justice and improve living conditions, but there is a lot of death. In drug trafficking contexts, these deaths generally occur during armed conflicts between rival groups competing for leadership, or between traffickers and police. State-of-the-art weapons are used, capable of penetrating thick walls, which, in fact, often happens.3,4
Police, on the grounds of combating drug trafficking, usually enter the shantytowns in vehicles that look like military tanks, usually early in the morning, as adults are going to work and children are heading to school. It is also common for them to aggressively invade residents\' homes to search for drugs or some trafficker. In the exchange of fire, stray bullets hit homes and innocent people. In such a context, death is common, whether police officers, drug traffickers, or innocent citizens.
The tragedy shown by these data indicate the inevitable production of suffering of families who lose their children, siblings, cousins, and of neighbors who fear being the next victims, friends who survive, but are injured by shrapnel, as well as a range of physical and symbolic violence. Although indirectly affected, teachers and health professionals working in these areas are also involved, They learn protection techniques against stray bullets while performing their function of preserving the lives and future of the local populations they serve.5
Psycho-social suffering derived from this experience has been attributed a name and treated, predominantly in a medicalizing way6, categorized as mental disorders and syndromes7,8. It is certainly challenging to take care of public health services dealing with people undergoing intense psychic suffering, considering ethical and clinical problems derived from biomedical approaches guided by neoliberal values9,10. However, we urgently need to consider the traumatizing effects of armed violence on daily life. Effects that attribute suffering to some specificities are not yet sufficiently discussed in research on this theme11.
Traumas linked to racism, holocaust (and, we may add, to urban violence) have in common the fact that they are configured as collective trauma, or social trauma, a complex, controversial phenomenon among psychoanalysts and other scholars12–14. In this article, we assume collective trauma such as those originating from events that produce unique traumatic effects on each person involved, but form a set of people marked by horror and difficulty in processing15.
Considering the complexity of the concept and the vast use of the term in the common sense, we propose a synthesis between the contributions of a clinical reading of trauma and a political perspective. In other words, we outline a clinical-political interpretation of collective trauma, based on authors who carry out an intersubjective reading of psychoanalysis9,15-29. These shed light on discussions such as the transgenerational transmission of trauma, the non-verbal nature of traumatic communications, the disruptive effects of trauma on psyche and groups, as well as the power of group formations to favor narration and processing of trauma. In dialogue with this approach, we referred to Rachel Paim13 and Bonnie Burstow14, feminist theorists, responsible for political reading of trauma13,14,30.
Presenting himself as a social and political geographer, Paim13,30 focuses her research on violence, especially gender violence, as well as trauma and recovery, always prioritizing the point of view and protagonism of people exposed to traumatic events. Burstow14, in the 1960s, calling herself a radical feminist, undertook a research career on trauma, activism in favor of anti-psychiatry, and acting as a feminist therapist. From both authoresses, we revive criticism of the individualization and medicalization of trauma, the recovery of the role of culture as a beacon for the ways of feeling of the groups, and the idea of trauma as a response to the structural violence repeated throughout generations.
We thus present an understanding that associates psychic aspects and factors that encompass disputes of power and social inequalities. This material is dialogued with reports of victims’ experiences of urban violence, especially in Rio de Janeiro city. These are reports gathered from a leading newspaper31, on a website of a shantytown complex, and in scientific articles that have conducted empirical research on the theme3-5,11,32,33.

Collective trauma: some clinical concepts
Since the elaboration of the concept of traumatic neurosis, psychoanalysis has continued to develop its understanding of trauma in order to also conceive it in its collective dimension. Just as Penna16 systematizes, if initially research returned to the effects of wars on individuals, over the years, especially in the 1980s, it became possible to observe that trauma memory was encapsulated, not only in the subjects, generation to generation, but also in society. Mainly concerned about the effects of the Vietnam War and World War II (particularly the Holocaust), studies on collective trauma were developed.
Another phenomenon that inspired studies on the theme was environmental disasters, such as the one studied by Erikson17, the author who points out that collective trauma has as its main effect the dismantling of community ties and the sense of community. This is the case, for example, of the family members of young people murdered in Brazilian shantytowns. According to Rodrigues et al.32, these families live in fear and isolation, have a sense of imminent risk in the face of any interpersonal relationship, so that introspection has become the main resource, which compromises the experiences of sociability.
Among the reactions to trauma, Erikson17 highlights the demoralization (feeling that the world has come to an end, and there is no sense in making new investments in life); disorientation (feeling of loss of the place they occupy in the social field, which can last for months and even years); disconnection (people lose their sense of self when disconnected from the social place they occupy). Celeste\'s report, a fictitious name given by Schmid and Serpa11 to a woman whose son had been killed by a stray bullet during a conflict between police and traffickers, contributes to the understanding of this picture:
I feel hate, anger ... It\'s so strange. I had never felt it before; Nothing like this has ever happened to me. It\'s been two years, but I still feel like this ... It is a fear of going crazy ... I sought therapy because I spent almost two months locked in a room, angry, blaming everyone and not accepting it... 11 (p. 6).
A pioneer in studies on collective trauma, Caruth18 states that it temporarily destroys the mechanisms of consciousness and memory, literally mentally recorded, without representation, and repetitively returning in the form of flashbacks and nightmares, or as Reis19 proposes, repetition of sensations, incomprehensible synesthesias for the traumatized subject. Consequently, when trying to convey it, what is communicated is not knowledge about horror, but the horror itself. This is what we see in a passage of a report published on a Rio de Janeiro city shantytown complex website:
[...] This very nervous resident told us how he felt when he woke up and saw the news, the people rushing and shouting as they passed his house. Many scenes were repeated in his mind of what he might expect this day: banging of gunfire that wakes people with a fright, makes them fear leaving home to go to work, prevents children and adolescents from going to school, shouts of neighbors cornered in their homes, helicopter flying toward their homes, dead bodies and injured in the streets [...]34...
Volkan20 states that collective trauma affects the whole of society, as the subjects have the lost object incorporated, like a foreign body, with which they cannot identify and perform mourning processes. Consequently, they transmit this foreign body to several generations. According to Reis19, this transmission does not occur by verbal communication, but in corporal ways, habits and forms of existence. As Penglase3 observes, in Brazilian shantytowns, marked by violence, a kind of law of silence prevails, such that residents must not say anything about trafficking and the police, or even about bad aspects of life in the neighborhood. A stance of not knowing is assumed, whose silencing is transmitted from generation to generation, like an encased trauma.
Erikson35 classifies traumas as natural and technological. Although in most situations it is difficult to distinguish them objectively, the latter are those mainly caused by human action. Natural tragedies are those that invade and assail, whereas technological tragedies have a story, and one or more persons responsible. They are the ones that impact the most, because they arouse in people a feeling of loss of the basic belief that it is possible to trust human beings and the world. They are seen as forewarnings that other tragedies may happen, such as urban violence, as illustrated by the following excerpt about the reality of a shantytown complex in Rio de Janeiro city:
Twice in less than a week, on June 29th and July 4th, the silence of the morning was interrupted by the chopping sound of rotor blades. About 10 meters long with 12 people aboard pointing rifles downward, the helicopter was flying approximately 5 meters above the houses. Many of these aircraft used by the Rio de Janeiro police have been war equipment in other countries. [...] Dona Josefa was heading to work before sunrise and noticed, in the tranquility of the morning, that the day would be prosperous. But when she saw men in camouflaged uniforms prowling on the streets near her workplace, she soon thought her day would be shattered by shooting. Suddenly, she felt an overwhelming burning sensation in her leg. What despair! Dona Josefa realized she had been shot, and started to scream incessantly for help.36
Faced with technological trauma, it is common among those affected to feel that the story could have been different, and have a legitimate desire for the guilty party to be held responsible for the tragedy. It turns out that these parties often do not assume responsibility for damage and compensation, generating a deep sense of disrespect and anger among victims35. This is the leniency the Brazilian criminal justice usually has with police who commit acts of violent against innocent citizens37. Thus, the feeling of disrespect is deepened when society naturalizes the attempts to exempt those responsible for the disaster. Without basic belief in the world, traumatized people live in a state of vulnerability, predict the possibility of misfortunes based on their experience, not from the statistics, which generates a constant state of alert and anxiety35.
It is also important to make distinctions among the three types of trauma (acute, chronic and complex) proposed by Herman21. Acute trauma is that caused by a specific event, such as a natural disaster. Chronic trauma is caused by prolonged exposure to violence such as racism and male chauvinism, while complex trauma also results from exposure to prolonged violence, but is inflicted, for example, by a caregiver since a subject\'s childhood. From this perspective, trauma from armed violence in Rio de Janeiro\'s shantytowns can be considered chronic, as armed clashes have persisted in the world since the end of World War II, such as the rise of military regimes, and later the transition to democracy in Brazil, as well as the domination of neoliberalism3.
Regarding the collective memory of trauma, Hirschberger22 recalls that it persists for several generations, but becomes modified as it is transmitted, not only because the pain of trauma changes, but also because other forms of language are used. In any case, the author warns that, like individual trauma, collective trauma transforms the way survivors view themselves and their relationship with the group to which they belong and other groups. An important blow occurs in the sense of security, which lasts at least two more generations. These, at the collective level, present feelings of vulnerability, wounded pride, humiliation, identity crisis and predisposition to react with greater vigilance regarding new threats, so that the suffering of previous generations is mixed with the impositions of life of the present generation. In the following passage, a resident of a shantytown in Rio de Janeiro city, interviewed by Gonçalves, Queiroz and Delgado33 (p.19), helps us to visualize the process of perpetuation of collective trauma:
I was humiliated for living in the Maré shantytown [...] the police came in, searched me and asked why I was so nervous, and why, if I was worth something, would I be living there [...] I grew up seeing police hit people in the face and entering homes shooting [...], when my 2-year-old daughter sees a policeman, she runs away in fear.
Hirschberger22 points out that, at a first level, trauma memory helps victims protect themselves from danger and survive by avoiding the risks of repetition. It undergoes a mechanism of transgenerational psychic transmission, that is, unprocessed content (lacking sense, shame, repression, for example) are transmitted from one psychic space to another, without the possibility of processing38. At a second level, since it is transgeneratively transmitted, memory promotes a sense of continuity, control and security, as it facilitates cohesion of the group that, initially, due to the traumatic event, had been dismantled. Consequently, “[...] to abandon trauma is [...] highly aversive and costly; it is the same as abdicating collective meaning; and against this threat to meaning, societies mobilize to keep trauma alive as a lesson from the past for the future” (p. 3).
To justify the statement that it is difficult for a group to abandon its collective trauma, Hirschberger22 systematizes the process of meaning construction around collective trauma, pointing out an initial phase of transmission of teachings and cultural traditions that inform the threats to the group, and, once incorporated, enhance the tendency to assimilate trauma in a collective system of meanings. Next, the trauma favors the construction of a collective self that offers security and mitigates the risks of the existential threat. Thus, the memory of the trauma is perpetuated in such a way that it begins to inhabit the epicenter from which the group understands its world. It is important to emphasize, however, that this process of construction of traumatic memory is irregular and full of contradictions, as the collective meanings attributed to trauma result from “wars of memories” between victims and the perpetrator, and even between subgroups of these actors.
In the context of Rio de Janeiro city, some initiatives, such as the formation of a collective of mothers of children killed in armed clashes between police and traffickers - called Mães de Manguinhos1 [Mothers of Manguinhos shantytown], are essential in this war of memories. Grouped around the struggle for justice for the death of their children, these women strengthen the memory of the violence that befalls, above all, young blacks. In an interview with the newspaper, Jornal Brasil de Fato31, the leader of this group says that the struggle for justice for her son gave meaning to her life, and enabled her, in some way, to continue her motherhood.
Regarding the formation of collectives, it is noteworthy that, although recognizing that trauma is essentially destructive, Hirschberger22 argues that, once processed, it can allow construction of positive meaning for the group. This is because traumatic memory is not univocal and watertight - constantly, new sensations are coupled and new meanings can be constructed due to the demands of the present. Thus, although admitting that collective trauma commonly generates disruptive effects, as demonstrated by Erikson17, the author argues that it can arise from it greater feeling of community, an effect that increases as the time of the traumatic event passes by, given that the pain of the event is attenuated, allowing greater memory work.
Regarding the community effect arising from trauma, Erikson35 warns that even individual traumas have a common character, and admits that individuals\' wounds communicate, forming a traumatized ethos. This is not “easy camaraderie”, but a painful process from which shared experiences form a quite cohesive common culture. Thus, if the first effect of collective trauma is the corrosion of community ties, in a second moment, it can promote new bonds around itself, as with the aforementioned collective of mothers.

The political dimension of trauma
Fassin and Rechtman23 argue that the concept of trauma derives from collective processes by which society defines its introjected values and norms. Hierarchies and social inequalities involve trauma, whose concept can be understood and used to legitimize or exclude, compensate or condemn.
In the midst of this discussion, some authors13,14,34,35 draw attention to the common, widely disseminated use of the concept of post-traumatic stress disorder (PTSD) to classify those who suffer the consequences of trauma. They warn that, in addition to disregarding people\'s subjectivity, it is depoliticizing because it does not incorporate the historical conditions in which the traumatic experience occurred, individualizing, masking social problems and pathologizing traumatized people. These are treated as victims who require specialist attention30. In addition, by using PTSD, professionals disregard belonging to a particular social group and those who suffer transgenerational trauma14. Being universalized, PTSD is shown to be a powerful instrument for domination of the West23, disregarding the fact that every culture impacts the regulation and expression of emotions, establishes limits on tolerance of affective experience, and provides lay explanations for suffering24.
Schmid and Serpa11 interviewed women whose children or grandchildren had no relationship with drug trafficking, but were killed by stray bullets in a shantytown in Rio de Janeiro. Regarding the suffering of these subjects, the authors point to experiences of perplexity, invasion and excesses, which refer to trauma and prevent reduction“[...] and to the theme of the incidence of mental disorders” (p.15).
In the opposite direction to medicalization, Pain13 points out that decolonial studies show the political - and not essentially a clinical base - of the traumas, documenting long-term, transgenerational effects of collective experiences of racism, white supremacy, colonization, genocide, patriarchy. Thus, based on a political reading, it is understood that what characterizes collective trauma is that it is configured as responses to structural violence directed to marginalized places, there being a congruence between past violence and reiteration of trauma by related systemic actions.
If we consider trauma caused by urban violence, an unequal distribution of armed violence is observed, with most conflicts occurring in the shantytowns, where the poor, mostly black, population live.
Pain30 argues that trauma is related to psychological abuse, such as silencing, denial and betrayal, supported by cultural factors or political norms that erase violent acts, do not recognize the magnitude of damage or provide adequate reparation. Thus, in different magnitudes, collective traumas are always associated with political attempts to make them vanish.
Convergently, Burstow14 seeks a demedicalized definition of trauma, arguing that “[...] trauma is not a disturbance, but a reaction to a type of wound. It is a reaction to events and profoundly harmful situations in the real world and, in fact, to a world where people are routinely wounded [...]” (p. 1302). Therefore, the alleged disorders or mental health problems of people seeking health services may correspond to reactions to the situation of constant violence to which they are exposed.
In the wake of this reasoning, Pain13 criticizes the association of trauma with a single event that separates a "before" and "after", and that supposes the existence of a safe, reliable "before", which was shaken by the traumatic event. This may be true for acute traumas, as defined by Herman21, but it is not for chronic and complex traumas, whose violence in general has its roots in capitalism, colonialism, racism and chauvinism. In this regard, Burstow14 comments that, before the advent named as traumatic, the world was already violent for groups such as the blacks, survivors of psychiatry, among others. In this sense, supposing the interpenetration of the intimate and collective dimensions of collective trauma, Pain13 points out that it always happens in contexts of violence that drag on and are repeated over time and generations. This is the case of young blacks killed by stray bullets or in confrontations. Just like the case of their mothers and grandparents who bear the trauma of the conjunction of violence that culminated in the death of their children and grandchildren.
Another difference that decolonial theories mark in relation to Westerners, according to Pain13, is the emphasis on resilience, healing and activism of traumatized people. These are treated as active agents, specialists in traumatic experience. There is, then, a commitment to the demedicalization of the treatment and a rupture from the idea of trauma as the experience that is imprisoned in repetition of the past symptoms and experiences. In this regard, we can infer that the women interviewed by Schmid and Serpa11 sought treatment because they found themselves to be in deep suffering. However, they did not shy away from witnessing the injustices and violence suffered, in fact, actively positioning themselves in claims for justice.
Burstow14 follows this reasoning about the demedicalization of trauma, but does not fail to emphasize that traumatized communities are marked by insecurity, as well as feelings of terror, despair, hopelessness, uselessness, anger, and often guilt. It is common for people to be in states of numbness, spatial and temporally disoriented, as Erickson17 described. However, these states, often associated with psycho-pathological symptoms, are better defined as survival strategies. Consequently, traumatized people are seen as competent and not as passive victims.
Traumatized people, in most situations, develop qualities as an enhanced ability to understand each other, have respect for and from individuals and communities, compassion, interest in transforming the world, overcoming conditions of alienation, and developing profound survival skills14. An example of this can be extracted from an interview excerpt the leader of the Mães de Manguinhos group gave to Jornal Brasil de Fato:
In the process of the Mães de Manguinhos struggle, we began to understand the need to also help people’s political formation. They are often victims of State violence and violations, but they do not understand this. Cases of stray bullets, deaths in prisons. And we come to explain that their sons were under the tutelage of the State, that there exists responsibility, that there was no health care in the prison system. [...] And we are gaining knowledge that should not be restricted to us. We need to take it to the shantytowns. Also, knowledge of the shantytowns should be brought out.31
Therefore, it is necessary to think of the availability and type of framework on which the traumatized persons will rely to deal with their experiences. But, do we think of frames linked to a clinical or political perspective of trauma? We propose here a synthesis between both perspectives, or a clinical-political interpretation of collective trauma and of the clinical and political framework and strategies that could support people traumatized with a process decreasing suffering and increasing political empowerment. It is with this perspective that we outline some strategies to confront collective trauma. These are strategies that can contribute to the formulation of public policies aimed at providing care to people exposed to collective trauma, such as those arising from armed violence.

Accepting the trauma
The possibility of narrating traumatic experiences and elaborating them contributes to reduction of their effects on future generations26. In this regard, Baracat, Abraham and Martínez15, based on the work of Ferenczi, point out that, in situations of collective trauma, it is important to facilitate processes of sharing pain and lack of meaning, as, in this manner, it becomes possible to construct narratives. These, in turn, are usually able to generate empathy, contributing to the disruption of pathological lies that commonly accompany trauma. For the authors, narrative work does not aim to heal, but to alleviate pain and transform it into something with meaning and dignity.
However, every narration requires a listener capable of attesting to the truth of the traumatic event, and also its incomprehensibility, capable of searching the gaps between the speakable and the unspeakable, and enduring the terror of what is said, as well as the lack of responses as to the reasons that triggered the traumatic event27. Thus, the process of mourning inherent in the working through of trauma, requires at least one other person for the loss to be recognized, since it is often not incorporated by the self, and is not represented. It is only in the presence of a listener that the loss becomes real and can thus be historicized and then processed16,28,29.
Following Freudian paths, Sylla12 suggests that the elaboration of collective trauma tends to be more successful when traumatized subjects find a group with which they identify themselves (although groups can also experience processes of revenge and violence, delaying or preventing trauma processing). Regarding groups as a privileged place to deal with trauma, Penna16 argues that:
“[...] In the last twenty years, experience has shown that the processing of massive group mourning seems to be more palatable, probably because, in a group, the narrator-interlocutor relationship acquires greater space and holding. Furthermore, the experience of testimony, within a group setting, seems to be more amortized, albeit multiplied. [...]” (p. 17).
Sharing the valorization of groups, Pain13 warns that trauma processing require the conformation of collective, organized devices, which recognize trauma survivors as active agents, or specialists, and are shown as safe spaces for listening and social struggle. The author recalls that these spaces can neither be retraumatizing nor pathologizing, as well as not functioning to generate self-denial or disregard of structural violence.
Regarding interventions aimed at the treatment of trauma, Pain13 argues that they should be based on the strong points of the traumatized person, and criticizes the western healing model, based on the self-knowledge of the individual. In doing so, she cites non-western and indigenous perspectives, and their collective healing processes, as well as contemporary movements seeking social justice, which claim ancestral forms of treating trauma. Finally, she emphasizes that structural changes are fundamental to the healing of trauma.
In the same direction, Burstow14 proposes a radical practice based on the questioning of internalized oppression, as well as compassion and genuine interest in the complexity of the human being. She warns that it is essential not to privilege the psychological dimension of trauma to the detriment of the political dimension. It is also important to value the traumatized subjects’ view of the world, recognizing that its reality is really dangerous and oppressive. Thus, more than self-control, what is intended to achieve is action regarding the oppressive world. In addition, greater emphasis is needed on community, group work and testimony.
To develop work with trauma, Burstow14 proposes a kind of critical adult education, so that traumatized people and the professional attending them can exploit together the traumatizing oppressive structural situations and assume concrete tasks to confront them. Examples of actions that combat political alienation of traumatized people are narration activities of their own history, unmasking myths about the community to which they belong, creation of rituals and public ceremonies to express sadness and indignation, reconstruction of ties, traditions and community links, as well as reconnection with nature.
In the midst of these reflections, it is possible to point out that the trauma resulting from urban violence in Rio de Janeiro city is a complex problem that demands multiple solutions. In this article, we have highlighted those linked to health policies, which should guide actions that consider the connection between the psychic and social dimensions of the health system users, avoiding medicalizing practices. Treatment should involve clinical listening capable of addressing not only subjective aspects, but also social and structural ones. In addition to listening to suffering, it is important to address the degree of consciousness people have of the oppression suffered, and their possibilities to exert an active position in the face of social injustices. In this sense, group support is fundamental, but it is also necessary to consider that trauma attacks social bonds, as Erikson17 reminds, requiring the professional to stimulate, mediate or facilitate the formation of new groupings.

Final Considerations
The review of conceptions and discussions about collective trauma allows affirmation that it is a disruptive, unexpected event, for which a community and individuals do not possess resources for representation . Among its most common effects is the corrosion of the social group\'s bonds of sociability that underwent trauma, as well as feelings of impotence, fear and loss of spatial-temporal orientation of individuals. Generally based on contexts of exclusion and social oppression, collective trauma may be chronic, requiring political discussion. From this discussion, it would be important to recognize traumatized people as specialists in the experience undergone, capable of questioning their living conditions and the triggering factors of traumatic tragedy. Along with these specialists, facing trauma involves both political strategies for emancipation and struggles for structural changes, such as clinics, listening, and opportunities to reconstruct meanings regarding the experience.
In Brazil, armed violence, common in large urban centers, can be understood as a major source of technological and chronic trauma. The overlap of violence to which the shantytown population is exposed makes it difficult to delimit trauma, which tends to be approached from a medical and reductionist perspective. This can contribute to the perpetuation of the non-recognition of the structural conditions generating trauma and the silencing of it. In the opposite direction, to treat the suffering arising from phenomena such as armed violence from clinical and collective trauma conceptions, it would make it possible to deconstruct the tendency to individualize and pathologize the experiences of community members involved with the problem. It would induce the construction of group spaces for listening to these experiences, questioning their socio-historical determinants, reconstruction of meaning, building strategies for confrontation and projection of other possible futures.

* Article from research funded by the Print/CAPES program - Code 001

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