Yale RebPsych

Rethinking Addiction Recovery: Lessons from the Underground

Keynote Speaker: Dr. Angela Garcia, Ph.D.

Friday, October 9, 2020

Remote transcription services provided by:

TypeWell
P.O. Box 221, Patagonia, AZ 85624
(844) 897-3935
support@typewell.com

*** TypeWell transcription provides a meaning-for-meaning representation of spoken

conversation to facilitate real-time communication access. This rough-edited copy is provided
for reference and is not a verbatim record of the proceedings. ***
Yale RebPsych
Rethinking Addiction Recovery: Lessons from the Underground
Keynote Speaker: Dr. Angela Garcia, Ph.D.
Friday, October 9, 2020

Nientara Anderson: Good morning and welcome. We are so glad you're here today. The CME
credit number will be posted in chat. For those who don't know me, I'm Nientara Anderson and
a first year student. When I started I was an intern. None of us imagined the circumstances of
today.

It's only fitting I introduce in a mask, in scrubs, in a hospital, as this year’s RebPsych conference
is happening during a pandemic. We are generously supported by the Roberts Family.

A little bit about Dr. Roberts. He published Family and Class Dynamics. He was loved and
esteemed for his decency and sense of social justice.

This is an image of Dr. Roberts and Mrs. Frances Roberts. She had a master's degree. Who was a
public information officer and involved in the establishment of CMHC. Who was very involved in
public health and served in many capacities.

Here is the Roberts family when we could gather together in the same room without masks. I
want to thank the daughters of the Roberts' for their continued support.

So, RebPsych 2020. It's always based on a question that participants help us answer. We asked,
what are the intersections of mental health and social justice. We interrogated, in 2018, the
often hypocritical avoidance of racism in social justice and mental health.

This conference integrates this with global colonization and white supremacy. We ask how this
can be used as a platform for anti-racism and postcolonialism; what might this look like?

It's looking at concepts of ownership and space. Now, our relationships to space have been
disrupted. Perhaps we will be open to reclamation of physical space and others to decolonize
mental health and wellness.

We look forward to all our participants and we thank you for joining us. Also, just so you know,
the URL on the poster takes you to the 2020 event home page and a link to register. We look
forward to seeing you all here.

Marco Ramos: Thank you Nientara. The events are on Thursday evenings. You can find all the
information about what will happen.

I'm Marco Ramos and I'm delighted to introduce Professor Angela Garcia. I'm sorry, I skipped a
slide.
Nientara: I want to shout out to the organizing committee, listed on this slide. [Reading names:
Robert Rohrbaugh, Reena Kapoor, Maya Prabhu, Myra Mathui . . . we owe folks a giant thank
you.

Marco: Thank you so much. It wouldn't have been possible without Srija [sp?]

This is Professor Garcia. I came across her incredible work through her book. Get this book! The
Pastoral Clinic. It continues to challenge and shape how I approach addiction treatment. As far
as I'm concerned, it should be required reading for people working with substance use disorder
patients. I can't imagine a better keynote speaker for this event.

Professor Garcia is a professor in anthropology at Stanford. Currently, she engages with the
theme of addiction within Mexico City and its peripheral zones/underground.

Housekeeping. We'll hear Professor Garcia's talk. There will be time afterward for discussion.
Raise your hand in Zoom or put questions in the chat.

For the first time in Grand Rounds we have live and recorded closed captioning. If you're
interested in that, look in the chat.

Thank you.

Dr. Angela Garcia, Ph.D. : Thank you for inviting me. Let me see, I need to get my slides up. OK.
Can you see this everyone?

Tricia: Just change it to the "play" view like you did earlier. It's in the center, top center.

Dr. Angela Garcia, Ph.D. : I'm sorry about this. I'm learning, as are we all. Thank you.

This talk is based on a 7 year project I'm engaged in still, coercive treatment centers in Mexico.
These coercive centers are unregulated and developed by/for the working poor. They're wide
spread in Mexico and growing throughout Latin America. They are called anexos [sp?] They're
called granjas, or farms, particularly those in the provinces.

They're utilized by poor individuals who lack access to health care. Drug users and others with
mental health issues are usually taken by force.

In anexos, the patients are held for months to years even they stay until a relative claims them,
they can't pay, or they're considered rehabilitated.

Many have called for their replacement with evidence-based treatments, grounded in human
rights and professional conduct codes. While these discussions have shed light on the
disparities on the quality and availability of addiction treatment, they ignore the inequality that
shape addiction treatment and the struggles of poor families making decisions on how to care
for addicted kin.

There are reports of violence in the anexos, but it doesn't consider the violence that surrounds
them. This draws on my 7-year study in and around Mexico City. It provides documentation of
daily life and the influence of daily life.

It's not a presumed universal norm, but the complex environment and history they're immersed
in. I don't want to evaluate their effectiveness in treating addiction, but to examine the unequal
distribution of violence and addiction and how this shapes anexos.

Any attempt by authorities to regulate treatment must be grounded in the realities of those
who suffer in and around them.

What are these realities? In 2006, pres. Caldron deployed military in the war on drugs. Many
have died and disappeared. Many are young people. Mexico has the worst rate of femicide in
the world. But in 2020, the new president slashed federal spending for services for women and
children in danger from criminal violence.

93% of violent crime is unresolved.

Claims are that many of the people killed in this war are criminals in the drug trade. However,
many people and information show that these people are victims of the drug war. Children,
women, underemployed youth, etc.

The narrative of victim vs criminal is gaining traction with the public. It's NOT translated into
new policy approaches. Ongoing and worsening exposure to criminal violence impacts victims.
Incidents are widespread and worsening. The emotional wellbeing of citizens has deteriorated.

Journalists are also struggling as they cover this, and Mexico is the 2nd deadliest country for
journalists in the world. Only 2% of Mexico's budget is dedicated to mental and behavioral
health, however.

Violence and impunity has led to a complete lack of trust in the Mexican government and
responsibility for safety and wellbeing falls on the most vulnerable.

What is known about anexos comes from newspaper, television, and radio. There are some
government reports and articles in journals. The picture they paint is anexos are filthy,
overcrowded, and dangerous. This doesn't help us understand the conditions that fuel anexos.

Mexican authorities have a 2-fold approach, centering on the issue of violence. On the one
hand, government officials claim to shut down anexos yet also improve the conditions by
ridding them of violence through scale-up programs.
On the right of the slide, we see a headline about anexos. We also see the signing of a 2015
signing of a bill calling to close anexos and provide treatment. This is a troubling alliance
between public health and the Mexican military.

A quote: We are going to close the granjas or anexos where people are kidnapped. We've seen
violence and even murders inside. For this reason, they can no longer exist.

In both approaches of the government, the resolution of violence is unrealistic because criminal
violence saturates the communities where anexos are listed. I argue, the violence in anexos
can't be understood or addressed without understanding the violence around them.

We see anexo de Vida, or anexo from life. We had a mother work to keep her daughter in an
anexo to keep her safe. The daughter did not have a problem with addiction. I interviewed her
several times. Many people in anexos don't have addiction issues. Rather, many are young,
poor, female, and live in places saturated with violence and femicide.

The daughter wanted to get out of the anexo, but also understood why her mother wanted her
to stay.

The anexo I visited was small. They had between 10 and 20 anexados staying there. It was
crowded and filthy by western standards, but for people staying there, it was better than what
some people had lived in before.

Many talked about a fear of leaving; others talked about the desire to stay. There is no
professional healthcare oversite. Rather, the counselors were once anexados themselves. They
considered their efforts as a form of service and means of maintaining their own sobriety.

Many counselors stayed at the anexo after they went through treatment. They leave in search
of day labor and come back to eat, sleep, and lead meanings. Some are called padrinos, which
means godfather in the catholic term, but is also considered a male sponsor. A madrina is a
female sponsor, or godmother.

It is similar to this country where substance abuse counselors in programs have had addiction
issues they've worked with themselves. The families pay the anexos for their relative's
treatment. They may also contribute food and medicine.

The anexos I studied have weekly visitation hours. I saw some anexados receiving weekly visits,
usually from mothers, some had no visitors, and some had visitation suspended as punishment.

There are about 500 certified countries in Mexico, but 1500-4000 anexos. Certification has to
meet reform acts that were signed. The standards clinics must abide by include procedural
requirements, availability of treatment, and respect for the human rights and dignity of
patients.
In contrast to the small number of certified centers, there are far far more anexos. There are an
estimated 73000 anexos throughout the country. One person said, we will never know how
many anexos exist because they're under the radar.

What is known about anexos is they're concentrated in poor neighborhoods, settlements, and
rural areas. These areas have seen an increase in criminal violence. They lack public
infrastructure, schools, legal protection, etc. they carry the burden of their own protection and
survival, and I argue anexos are the response to this burden.

These are three of the areas I focused on in blue. The first phase of my research was simply
locating anexos. I worked with a group of researches to do this. The dots in the image on the
right represent the number of anexos located in a neighborhood, usually a six block radius.

The blue dots show anywhere between 11 and 20 anexos in any given neighborhood. These are
only the ones we could identify, keep in mind.

I'm going to focus on one neighborhood for the rest of my talk. It had 20 anexos and is 16
kilometers west of Mexico City.

This is Grupo San Rafael. It's on a dirt road. The neighborhood reflects the inequality. The
neighborhood has dirt roads, self-built houses. Most of the cinderblock houses are one or two
rooms in size. Water is delivered in 55 gallon drums once or twice a week. Electricity is stolen.
Garbage service comes from mule-drawn wagons.

The image on the left shows where Grupo San Rafael is located. It's dressed with a colorful
banner showing they're a rehabilitation center. They offer vocational training, cardio, and yoga.

Up the hill, residents have landslides every year. This is concentrated in the slopes of the
mountain ranges. There are dangerous from landslides and femicide. You can see the faces of
women. They are local disappeared and murdered women.

Daily life in the anexos is highly regimented. Anexados wake, eat, participate in programs, cook,
clean, all at the same time every day. All activities unfold in one room. There is another room
where the padrinos can be, but the anexados are in one room.

14 men and 1 woman shared this one room. Some had been there for many months, one for a
few years, and the woman had been there for 10 years. Most anexados where in their late
teens or early 20s. You see here people during the cleaning periods.

One anexado was placed by his father when he was 12 years old. He was sniffing solvents and
drinking beer. He then was in over 20 anexos. His last admission was here and it was voluntary.
He sought shelter from violent conditions and was seeking protection for his own life. This was
a kind of refuge for him.
This is not an unusual story for anexados and counselors. Five years after arriving here, he was
promoted to counselor. On the wall are religious photos, inspirational quotes, duties, and
recognition of good work of anexados to other anexados.

The windows were barred and covered. The furniture was folding tables and chairs. These are
put away and mats are unrolled to sleep. Anexados spend a lot of time putting things up and
down and cleaning.

Exercise was part of the daily treatment. In anexos, exercise is generally running around in
circles and holding their body in challenging poses for a long time. If they can't run or hold a
pose, they are likely subjected to kicking or verbal abuse so they try harder.

Most anexados arrive very thin and can't do this. Others gained weight and said they had
regular meals for the first time in a long time. So some got healthy and strong, and some
languished and had illness.

This is yoga, but the value I saw was non-violent touching between men. For some it was
entirely new and I saw men struggle with this, not just physically, but emotionally and
psychically. This stirred up distrust, fear, and memories of abuse. It also led to the realization of
the possibility of non-violent touch, however. This is an exciting possibility.

So many arrive in distress. This doesn't end with admittance. Some are kidnapped, blindfolded,
wrapped in a blanket, beaten, and tossed into an anexo, much like cartel actions. When I asked
about this, some padrinos said it was because people didn't want to get help they needed.
Some said, it's just the way it is, mirroring the violence in the area.

But for some, they said the fear of death through the abdication helps them when they
understand that they are not going to be killed and instead are given a chance to live clean and
sober. When this happens, they are more likely to want and achieve sobriety.

Physical violence is prevalent in anexos. Mano dura, or strong hand. This is a form of "hard
therapy." It can be a form of punishment and also a means of introspection and a pathway to
humility and sobriety.

Other practices can include kneeling on hard substances, with arms outstretched, can be called
an intersection of punishment, treatment, and religious experience. There is an attempt to give
meaning to the pain as a transformative recovery.

Many of these treatments are similar to or the same as religious punishments and want to
distinguish between the destructive suffering before becoming an anexado and the
transformative suffering that leads to sobriety.

Many anexados made it to the 4th or 5th grade before leaving school, and the same was true
for many counselors. Each day, anexados and counselors sit and read either the Big Book or the
Bible. Some don't know how to read and they are taught. Some are so withdrawn they seem to
forget how to read.

An anexado is called on to read aloud, and it was painful to observe the struggle. The stigma
and shame about not being able to read was sometimes more acute than the stigma around
anexado life.

In this case, the counselor was kind and encouraging. Other counselors were incredibly cruel
and demeaning during this practice and made the struggle of reading and education harder.

One activity that often takes up most of the day and into the night is testimony. This is the
distinction between useless suffering and redemptive suffering becomes apparent. They listen
to other's experience of violence and assault and almost always identify as victims of it.

This is gut-wrenching to witness and include screaming, weeping, smoking, and so on. Feelings
of hopelessness, having loved ones disappear, nearly being killed or of killing others, and the
horror fear and loss that comes with these experiences and areas.

Here we see a boy, called Catorce, which means 14 in Spanish. That's how old he was at
admittance.

The person testifying is at the front, and the audience must maintain perfect posture. If they
don't, they're hit or made to sleep near the toilet at night. Perfect posture is seen as part of
that hard therapy.

Meal time. There are routines but there was little evidence of work training here. I always
thought, of course there isn't vocational training. There's a scarcity of work in these areas,
which makes such training irrelevant.

Many report that the anexos share the worst possible food, if they share it at all. Maggoty
beans and moldy tortillas. But my observation was different. Because mothers provided food,
often as a form of payment. They tried to make it delicious and healthy for their family member
and so that the anexo would accept their family member.

People often bartered for treatment by providing food or services, or sharing the phone
number of the padrino for future anexados. Many women did this to have their abusive
husbands taken in to be taught and punished for abusing them.

Other people called on future favors, the nature of which I did not know or inquire about
because some places could be quite shady. There were forms of labor and business on the side
that I didn't want to engage with, for safety issues.

Why can't I move forward?

Tricia: Angela, you're muted.

Let's go back to Catorce. His mother put him there because she feared for his life after
experiencing violence to/murder of her other children.

When I asked her if she was worried about how this might affect him, she said, "of course I'm
concerned. But what is the alternative? There isn't one." When I asked Catorce about his
mother and how he felt about her decision, he shrugged his shoulders. Later he said, he wished
his mother had put his brother and sister there, too.

In this slide we see nighttime sleeping, about six hours a night. Everyone sleeps on the same
floor where all activities occurred.

I want to end with the slide and ask questions. How can the forcible or compulsory detention
and violence to anexados serve or enrich the world where the anexo is situated?

At times, the answer to the question was unclear to me. But some of the practices are
conceived as moving the anexado away from the violence of the community and Mexico at
large and toward sobriety and survival.

This is linked to one's movements and feelings of shame of fear as well as the sharing of
suffering and fear. Over time, this sharing, I think, enables a new means of violence that is
latent with the possibility of something more than violence.

Nevertheless, not all anexos are the same and not all people in anexos suffer the same.
Anexados do attempt to escape and are sometimes successful. Those who leave and are
captured or return freely, are sometimes chained to walls.

I want to draw attention to how anexos strategies utilize the indeterminate nature of violence
to secure recovery and safety, which is also indeterminate in this world.

Grupo San Rafael shares all of the characteristics I observed throughout Mexico City. Namely, it
exists in poor and violent neighborhoods. It uses coercion and deprives anexados of what we
call here liberty. But the actual experiences within anexos varies a lot. Casting all anexos as hell,
labor farms, etc. obscures the realty.

From the point of view of many Mexican families who use them and padrinos who run them, it
does not protect them necessarily. It can make them more vulnerable to addiction and violent
crime. The rehabilitation potential is unclear.

The centers are sub-standard compared to American treatment centers. But the fact that some
anexados voluntarily come to receive food, shelter, safety, or addiction help is another thing to
consider. We don't downplay the situations of anexos. But it can function more as a shelter
than a clinic and a refuge from violence, rather than a vehicle for it.
Many parents were relieved their children were in anexos based on the local realities. So this is
complex - what does addiction recovery require and consist of, and what should it look like in
this milieu.

Anexos have been coming to the attention of Mexican authorities as well as national groups. In
2010, a program was launched for uncertified residential treatment centers. This project was
led by the OAS's drug committee.

They were systematically locating the anexos and conducting a needs assessment survey to
develop a more empirically based training program for counselors to provide better services.

These were piloted in six states and I was able to observe. I want to highlight a few points about
this program and the surveys.

Many municipalities were inaccessible to field workers because they were so unstable, and this
is exactly where anexos where more likely to be located. Some states had no certified programs
at all, including Oaxaca. These violated requirements of NOAM 28.

Some situations were revealed to be terrible. There's also the epidemiology of addiction itself.
They found that crack cocaine and meth was used much more prevalently than reported.

Finally, when the data from the initiative was written up, the Mexican government and public
health agencies refused to publish the findings. They prohibited it. They effectively reinforced
the illegality of the system they sought to reform.

I asked the padrino what he thought about NOAM 28 and he said it caused more problems than
it helped. He talked about visits from enforcers, and he said the sanitation committee extorted
anexos for money.

Meanwhile, some anexos said the government couldn't shut down anexos because there aren't
any alternatives. This reflected the concerns of the families I spoke to.

One anexo was shut down and anexados were forced to work packaging products. Families
rioted and closed the streets, demanding that the anexos be opened again because there was
nowhere to take their children to keep them safe. So this reflects the challenges with improving
anexos.

The challenge of addiction and recovery in Mexico make clear how embodied addiction and
violence are. Much research is essential for bringing the suffering and challenges into focus
while making sense of the narratives and how they relate to the situations that casued the
suffering.

We must assess the forces being used. As problems with addiction grown and criminal violence
worsens, this is especially necessary.

This is the end of my official part of this. I will stop sharing, somehow.

Marco: I'm interested in your questions. Thank you, Professor Garcia. You can raise your hand
or put questions in the chat. Please do that.

Question; What is the average length of stay?

Professor Garcia: the average length of stay is 3-10 months, but some people were there for
years. They can cycle from one anexo to another and another, so a good deal of their life can be
spent there. Every counselor or padrino I talked to had been in anexos for 20 or 30 years before
become a professional worker, in a sense.

How much time did they get outside? Only counselors were allowed out. They searched for
work during the day. The only other opportunity to go outside was the weekly visits with
families.

They took place outside, many of them, and were observed heavily so anexados didn't escape.
There were also yearly celebrations on the day of the anexos' establishment. There was music
and food. The establishment of the anexo was considered a celebration.

Marco: Dr. Diaz has a question about financial support, and have there been initiatives to
regulate them?

Professor Garcia: families would pay a monthly fee if they could, that helped with function. This
was between $30 and $50 US dollars/month. The counselors who left during the day were
expected to tithe some of their earnings for their room and board.

There was a sense that, like in many mutual aid groups, the family, the community, and the
anexados who became counselors supported the anexo.

I did see exchanges of other monetary support. It seemed unrelated to the treatment or
upkeep of a particular person. I tended to not ask about these, due to safety concerns. But they
were clearly visible to me. Not all, but particularly those in Mexico City proper.

In terms of official initiatives to regulate anexos, there is the initiative of closing all of them.
That's the key initiative in place utilizing the Mexican military to close these policies, often
violently, forcing them to become even more underground to remain open.

There are some up-scaling initiatives funded by the sort of local governments that essentially
seek to improve the physical conditions of the anexo.

Community residents also participate when there is an issue with flooding or cracks in the wall
for example, leaking, which is a yearly occurrence during the rainy season. People from the
community help repair the structure.

The other way the community helped with upkeep or upscaling the anexo was through
donations of furniture, food. These were considered within the community as being as
important as some of the things the reform bill (passed in 2009) insisted on. Making sure there
is a bathroom for men and women. Separating genders at night, keeping files, etc. These are
the procedural requirements officially demanded. They were simply never instituted in the
anexos I visited. It fell to the community.

Tricia: Someone wants to know how you were received.

Professor Garcia: It took a good two years for me to get in there. One of the reasons was
because of my previous work and my own personal experience of coming from a family that
struggled for generations with opioid addiction. It was my personal relationship to
intergenerational drug use and poverty. I was seen as a goddaughter, or ahijada.

The relationship I had with anexos was very strong. I have ex-pat journalist friends in Mexico
City. They asked me to get them in. I tried, and they were refused. I was very lucky to get the
access I was given.

Nobody cared I taught at Stanford [laughing.] What made a difference was my personal
connection to the issues.

Tricia: Is there a group that benefits financially from this system?

Professor Garcia: Yes, ultimately this is a job for padrinos and counselors. They get a salary they
can depend on. There are likely other beneficiaries. I didn't ask about this.

If there are profits, I would say they are very meager. I visited padrinos in their homes. They
were humble. No fancy cars or gates on houses. They lived within the community.

But I can say with some certainty that there are likely others. Because of the nature of the
informal economy in Mexico, people are working multiple jobs to make ends meet. This form of
work was one of many forms the people working there were part of.

Marco: I'm going to group questions because we have a lot coming in. There are two questions
about religion, and I see a raised hand. We'll go there next.

How is religion utilized in an environment where anexados are not allowed ownership of their
bodies?

Also, is there any connection to local connections, and is there faith-based teaching in the
anexos.
Professor Garcia: The question of bodily ownership is interesting, I'm writing about it now.
Most of the anexos I worked in were oriented to Catholicism and not evangelism, which has
been in Guatemala, for example, the primary identification. But in Mexico it was Catholicism.

Bodily ownership, there's a question about whether one has ownership of their own bodies,
particular within the pop strain of Catholicism. There are traditions where part of religiosity,
faithfulness, is to give up one's bodily ownership. Like I said, this tradition goes back centuries.
St. Augustin and penitents would go into cells or practice self-flagellation to show devotion.

But in anexos it was different. They weren't able to express their religion or faithfulness outside
of that space. They were forced to do so within at different times throughout the day. There
were prayers at different times, multiple times, throughout the day. It was a huge part of the
experience being there.

The names of anexos tend to be the names of saints. San Rafael, San Cristobal for examples.
They had altars too. Virgin of Guadalupe, etc. There were practices as well as iconography.

I mentioned the yearly celebrations. The founding day of anexos. Sometimes those took place
in a church yard or near a church. A priest would come and speak. There were connections
between churches and anexos.

I saw this more frequently in the municipalities on the urban periphery. I saw it less frequently
in Mexico City. Although there where similar practices of abusing the body. Images of saints,
and everything.

As I mentioned, during the yearly celebration local churches were often involved. That typically
happened in the urban periphery. I did study some anexos in Oaxaca, deep in the mountains.
And there, church was much more involved. In the rural areas.

Dr. Jordan: Professor Garcia, I truly enjoyed your talk today. You did an amazing job being
neutral and culturally affirming. Kudos to you, I don't think that's easy. I deeply appreciate that.

I had so many visceral responses to the information. I felt angry, heartened, saddened. When
there is a lack of public health infrastructure or a real way for government to take addiction
seriously, the community does what it can to take care of people. Within my anger, I felt really
grateful that the community did what they needed to do to take care of people.

I've thought about historically marginalized populations, how their humanity is often ignored.
So while this is a tough way of treating people with substance use disorders, I felt grateful as
well for the efforts.

What would you like the government to do? And how are you sharing your findings with the
community you study?
Professor Garcia: I also have strong responses. Working within these spaces was very difficult
and I often left feeling really disheartened. Not just because of what I saw, but because of what
I didn't see.

I only saw condemnation of these Places and I think it builds on a history of condemnation of
the poor. I wasn't able to get into aid and government neglect. It's historical, but also increasing
with the cutting of healthcare and services for women and children. The community does do its
best to help.

One of the things I try to do is, I saw a lot of illness. I worked with a physician and psychologist
who did field work with me. There were people with epilepsy, for example. I did work trying to
destigmatize seizures and to differentiate between seizures and alcohol withdrawal.

There was basic medical instruction that I and my colleagues tried to offer. I brought medicines
for diarrhea and asthma, diabetes. There were other issues I felt I could address by sharing
medicine.

For me, the takeaway is that the violence that is highlighted in these spaces by the Mexican
government, the narratives drawn upon to condemn these policies, this is a form of violence
itself.

I have been publishing findings in Mexico, in Spanish, and have been largely condemned. I've
been told I'm unethical, that they need the police and not an anthropologist.

At the same time, I've met other researchers who want to do this research but they don't have
the support. It takes someone from the outside. Some people appreciate this work and want to
have reforms that keep in mind the realities of the people who depend on these places. They've
also become activists.

There are the peace and non-violence movements. A lot of women at risk of violence become
activists. Women anexados sometimes leave and become part of the movement against
violence toward women.

I often felt incredibly overwhelmed by the amount of work that needs to take place, the
understanding that needs to be had, and the feeling of frustration where everything seems
impossible.

There are very few studies on these places. I wonder sometimes if there is anything to be done,
and it can be very disheartening.

Tricia: Do anexados ever age out of the system? What happens as they age and have more
medical needs?
Professor Garcia: that's A great question too. Some anexados didn't know their age. They didn't
remember how old they were. That could have been because of mental health conditions, as
well as the disorientation of being in one room for so many years.

Old, in this population - because 20% of the people killed are minors, "old" can mean 30. Age is
different in this context. But for people who had been there for many years, there was wear
and tear on the body. From sleeping on the floor, for example. It was obvious.

At one point, an architect came in to figure out how to make it more hospitable to the bodies of
people who were clearly wearing from having to sleep on these floors and practice this kind of
exercise.

The mental health conditions seemed most acute within the very young and very old, which
again is between the ages of 30-mid 50s.

These ages appeared to be in better condition. They did have the hope of leaving. Very young
people had the hope of escape, or not escaping - being maintained in the space for safety
reasons. The people there for long periods didn't talk about leaving. They were often people
who didn't get weekly visits.

I met with the family of some people of anexados in their 40s and 50s. The family said they got
tired of the visits but they just kept their kin there because they couldn't handle the conditions
members were dealing with.

Prof. Inhorn: Hello, thank you for being here. I wanted to insert some anthropological
discussion here. I'm thinking of a famous study in Brazil. He describes a zone of social
abandonment.

Many of these young people aren't abandoned by their families; in some instances, it's there to
keep them safe. I'd love to hear information on that. Can you talk about the differences
between other anthropological work and your own? I also see you play the cello!

[End of transcript, but conversation continued. Transcriber scheduled until 11:30 [EST]. Signed
off at 11:40 AM [EST.]