Men & Mental Health

The World Health Organization (WHO) defines mental health as a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community[1]. In other words mental health can be viewed as an essential constituent of health and well-being that cultivates our individual and collective abilities to make decisions, build relationships and be functional beings in the world.

Since time immemorial men have been gendered by traditional patriarchal norms that equate being a man with the following: Masculinity, Invincibility, Strength, Breadwinner and Powerfulness. Circumstances that typically off-set men’s mental health issues are those that challenge or oppose the gendered identity of the traditional male role, as men are most likely to experience stress if they feel like they are not matching the lofty expectations of adhering to traditional masculine gendered roles.

Stereotypes and misconceptions have proven to be a barrier for men to talk about Mental health; reading “men” and “mental health” in one sentence is inconceivable, if not incomprehensible, to some people. One could go so far as saying, stereotypically the concept of “men and mental health” conjures thoughts of men being ‘weaklings’ or subpar, relative to the patriarchal strong man.

How men have been socialised informs perceptions about men and their mental health. For example, we have sayings such as “indoda ayikhali” and “monna ga a lle,” Nguni and Sotho, respectively, for “a man should not cry” under any circumstances. Through different stages of development and socialisation, young boys are also encouraged not to cry or express their feelings as these are seen as more feminine traits. As a result, some men tend to suppress how they feel even when it is ”tough” for them.

The stigma surrounding mental illness is another reason why men may be reluctant to talk about their mental health challenges. Often, people in general, lessen the magnitude and gravity of mental health concerns — we often hear phrases such as “man up” or “get over it” to those that are suffering. The notion that men should be stoic, unfeeling and non-emotional beings creates the foundation for toxic masculinities and building blocks for problematic behaviour which feeds mental health issues.   

According to  Healthline¹, mental issues such as depression, anxiety, and suicide remain challenging for many men, yet they are reluctant to seek help because of stigma. In Healthcare Access – “New Threats, New Approaches”, Mxolisi Ngwenya and Gsakani Sumbane (2020) mentioned that: “In South Africa, the suicide rates are approximately five times in men than women. As of 2012, suicides rates ranged from 11.5 per 100,000 to as high as 23.5 per 100,000 in 2019, rendering South Africa being number tenth of countries with highest suicide rates”. Based on the recent data on suicides it is evident that Men’s mental health is plummeting.

The statistics are staggering and in order for our society to thrive, we need to destigmatise men and mental health. The ways in which we could do this include: Creating safe spaces and normalising dialogues around toxic masculinities and gendered roles and how they affect Men’s mental health; educating through campaign awareness; and platforms such as social media and media at large. A lot emphasis also needs to be put on Men speaking in public, seeking counselling and group therapies.

May is Mental Health Month, and during this period, it is imperative to drive home the critical matter of mental health and Men in particular.

Written by:

Percy Maimela (Senior Monitoring and Evaluation Officer at CSVR) and Modiegi Merafe (Senior Mental Health and Psychosocial Practitioner at CSVR)

If you are in need of counselling support, please reach out to following free counselling support services:

The Centre for the Study of Violence and Reconciliation (CSVR)

Counselling Helpline- 071 241 1831 (you can send a ‘please call me’, and we will call you back)

South African Depression and Anxiety Group (SADAG)

Helpline- 0800 456 789

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[1] https://encr.pw/FEYhp

Sidelined No More, Psychosocial Supports in Transitional Justice Processes

In 2021, in its capacity as a partner in the Global Initiative for Justice, Truth and Reconciliation (GIJTR), the Centre for Violence and Reconciliation (CSVR) facilitated a project to better understand the experiences of forced migrants as they relate to transitional justice (TJ). As part of the project, four case studies were conducted in Syria, Sudan, Bangladesh and Gambia, focusing specifically on the Mental Health and Psychosocial Support (MHPSS) needs of forced migrants in relation to TJ processes in these contexts. The following post highlights key takeaways and reflections from the studies.

Forced migration, its drivers and consequences, relate directly to  the practice and application of transitional justice processes, yet national governments and international actors largely use a humanitarian approach to responding to harms experienced by forced migrants. While this may meet immediate needs, humanitarian interventions do not address the structural and contextual factors that render forced migrants vulnerable to violations before, during and post migration, which continue to shape their experiences in the event of return or resettlement. This is particularly true with regards to MHPSS needs, which is inclusive of social, psychological and psychiatric needs. Since MHPSS needs are seen as the concern of mental health practitioners, they are often isolated from TJ processes altogether, leading to the further marginalization of forced migrants in conflict areas or transitional societies. This was highlighted throughout the four case studies, where MHPSS was noted as being inadequate and not prioritised within TJ processes.

All  case studies highlighted that conflict, human rights violations and abuses had an impact on forced migrants’ mental health and psychosocial wellbeing at the individual, family and community level. What was also highlighted was that access to MHPSS was scarce and in most cases became the responsibility of humanitarian aid institutions, as well as local and national NGOs. Furthermore, challenges in accessing MHPSS was noted as being linked to stigma and a lack of awareness regarding services. In the Gambian case it was stated that mental health issues were understood through cultural and religious lenses and consequently people with mental health needs are often seen as affected by supernatural forces and labelled as “crazy” and weak. These societal connotations of mental health issues were a routine deterrent to seeking help. In addition, the stigma attached to experiences of violations, especially in regard to torture and sexual and gender based violence, created further barriers to accessing support.

Normalising mental health issues was noted as important, especially in the case in Bangladesh, which highlighted that through awareness raising campaigns in camps, communities became more familiar with mental health concepts and started seeking support which contributed to a decrease in domestic violence, juvenile delinquency and mental instability.

As we think about the stigma in communities related to mental health issues, these are likely to resemble views shared within societal and governmental structures, which in turn impact the state’s willingness to invest in mental health generally, and certainly in the inclusion or exclusion of MHPSS in TJ processes.

Furthermore, mental health and psychosocial issues negatively impact forced migrants’ participation in TJ processes. As the Syrian case emphasised, forced migrants often must prioritize negotiating the daily challenges of displacement, leaving participation in Civil Society Organisation’s groundwork for post conflict restitution as a secondary goal.  This was further echoed in the Sudan case which identified that forced migrants’ preoccupation with continuous traumatic stress factors such as getting basic needs met constrained their ability to organise around TJ.

Conflict, violence and trauma have a tremendous impact on the mental and psychosocial wellbeing of individuals, families and communities. Forced migrants experiences of death, torture, family separation, physical insecurity, loss of livelihoods, social injustices,  inequality, discrimination, and lack of access to services contribute to an increased risk of mental health and psychosocial challenges. As a group, forced migrants are extremely relevant to the peacebuilding activities that transitional justice initiatives hope to promote, but their experiences often directly undermine the sense of belonging and co-ownership that are so essential to successful TJ processes.

It is important for those at the head of TJ processes to reflect on the MHPSS needs of this population and how to meet these needs within TJ mechanisms. And in process, leaders need to consider the many dimensions of wellness, including economic reform, structural reform, judicial reform, and social and psychological reform. Most often in rebuilding the focus is on economic, structural and judicial reform, with social and particularly psychological reform being anecdotal or adhoc. If we do not engage with all dimensions of societal wellness, a gap is left that has the potential to pull transitioning societies back into violence.

Thus, the integration of a MHPSS lens into all aspects and mechanisms of TJ is important, particularly when working with forced migrants. Transitional bodies must work in partnership with CSOs and informal support networks to create interventions and processes that are impactful and speak to all dimensions of societal wellness. It is also important that these investments are long term because MHPSS is crucial to building a sustainable post transitional society. As governments undertake TJ processes or peacebuilding initiatives, it is imperative that they acknowledge the psychosocial and mental health impacts on individuals and whole societies as they have the potential to undermine efforts in building a peaceful society.

Written by Sumaiya Mohamed (MHPSS Specialist)

Originally posted on the Global Initiative for Justice and Reconciliation https://gijtr.org/new-trends-in-transitional-justice-blog/migration-and-tj-blog/

Suicidality and mental health: a psychosocial lens

We live in a society where suicide is becoming increasingly common. The 10th of September was World Suicide Prevention Day which is a day aimed at promoting the worldwide commitment and action to prevent suicide. SADAG reports that there are 23 known cases of suicide in South Africa per day, and for every person that commits a suicide, 10 have attempted it.[1] To add to these statistics, one can imagine how many more people think about suicide or have considered it at some point in their lives. There is a lot to be said about the reasons suicide has become such a common occurrence, more devastatingly, amongst young people. We need to question the reasons why many people find themselves backed against the wall in this way where suicide becomes one of the ways or the only way to deal with the challenges they face. Is this learnt helplessness? The pressure of living in continuous stressful and challenging circumstances or a lack of access to resources and skills that promote mental health? Part of the answer is that many people are faced with emotional pain, feelings of hopelessness and helplessness and are often unable to access help and support, or skills on how to cope with life circumstances. All this can prove too much to bear to the extent of considering ending one’s life. Most suicidal thoughts are centred around a need to end some sort of psychological or physical pain and having or seeing no other option.

The prevalence of suicidality in our community points to the mental health crisis we are facing as a society. We cannot talk about suicide without talking about depression, which is one of the more common mental health issues in South Africa. The lifetime prevalence of depression in South Africa is 9.7 % or 4.5 million and 70% of people who attempted suicide have a mental health illness[2]. These are alarming figures that require a more active role in the prevention of mental health illnesses rather that a reactive one. The problem with the reactive approach is that for one, the individual has already died, and secondly, the devastating impact has already been put in motion: loss of loved ones, secondary trauma to those who witness or hear about the suicide, and the seed of suicide may be planted in the family or community. Where options are few in times of crisis, most people, particularly young people may feel as though suicide may relieve their pain or distress.  With the scarcity of school and community based programmes that deal with issues of mental health, these cycles then go one for generations, devastating entire communities.

It is important that we interrogate the factors that contribute to the prevalence of mental health issues in our society. I’ll only share 3 below :

A.       Our inherited traits

We deal with historical and continuous traumas that have impacted the way we have been wired to deal with or perceive distress through our nervous systems or by observing the adults around us. This could occur both on the nature -(epi)genetics- and nurture-socialization- levels (transgenerational transmissions of trauma)[3]. It is important to be not only be mindful but proactive around the contextual factors that predispose certain members of society more than others, to adverse childhood experiences and continuous distressing circumstances.

B.       Continuous stressful environments

This speaks to the prolonged exposure to distressing experiences that compromise people’s ability to lead healthy (physiological and psychological) lifestyles. This prolonged exposure to continuous traumatic stress (CTS)[4] can lead to feelings of helplessness and despair where people end up feeling alone and without the possibility of positive change. These speak to issues of where you live, what socio-economic challenges you face, how safe is your environment, how much quality time you are able to have with your loved ones, etc. These factors more directly confront the policy issues around access to basic needs, protections/freedoms, including access to mental health services.

C.       The attitudes and stigma around mental health

Most people will go through some form of mental health issue at some point in their lives. While other people may be able to cope with or manage their mental illnesses, some may not have the resources to do so. It is important that we engage in topics about mental health as an empowerment and preventative measure to ensure that people are well informed about the importance of mental health and how to prevent, cope and manage when faced with threats to our mental health. This then extends to the ways in which we talk about mental health and how we perceive and treat those faced with mental health challenges in our society. We need to take responsibility for the ways we may contribute, through our ignorance and negligent language and attitudes, towards exacerbating effects that mental distress can have on individuals and communities.

The promotion of mental health is a major factor in the prevention of suicide, depression and other mental health illnesses. Mental health should be prioritised. Not only on the micro level, but on meso and macro levels as well. There’s a need for increased community awareness and engagement around issues of mental health for the purposes of psychoeducation and to empower people with resources and skills to better manage with mental health challenges. Effort must be put towards creating education around mental health and mental illness as a skill acquisition approach and not only as a response to risks.

Many may find it difficult to support others who are dealing with depression and suicidality as one may feel stuck not knowing what to do. It is normal to feel at a loss to help friends and loved ones as and this alone may be distressing to you. It can be challenging to feel like you have to fix or find solutions to your loved one’s distress. However, what’s important to note is that suicidality is not a problem or situation to be fixed, rather, we need to remember the individual who is going through this difficult period. Remembering the individual helps us better connect with the person through listening to them, reaching out, acknowledging their feelings and normalising these within their context. And supporting them as they access mental health support and seek out professional help. For those who may be looking to support someone dealing with depression or suicidality and wanting to make a positive contribution towards preventing suicide in your own homes and communities a few ways you can do so involve:

• Taking the person seriously when they talk about wanting to kill themselves or feeling like suicide can be the answer to their pain.
• Trust: Be honest and sincere when you talk to people who may be suicidal. Do not make promises you can’t keep and respect them and not force them to do things they may not want to do.
• Refrain from trying to show them “The bright side” or cheering them up. Show empathy and see things from their point of view. This will allow you to be genuine and able to normalise their feelings within their context. Most times people need to be heard and understood.
• Tell them that you care and show this by being willing to listen to them in their distress. Acknowledge their pain and explore with them other options to alleviating their pain or distress( these should be safe and could include reaching out to professional services)

The message here is really that suicide can affect any of us or our loved ones. Each and every suicide is devastating and has a profound impact on those around us. It’s important that we raise awareness, to stop the stigma and promote mental health-which is not merely the absence of mental illness, but a lifestyle, a way of being where each one of us is able to feel authentically, become active members of society, manage, and cope with our daily challenges and reach our full potential.

Written by Charlotte Motsoari

For more information and support, Please reach out to any of the following organisations’ helplines, they are there to support you through your difficult time.

CSVR telephone line: 071 241 1831

People are Dr Reddy’s Help Line- 0800 21 22 23

Cipla 24hr Mental Health Helpline-0800 456 789

Pharmadynamics Police &Trauma Line: 0800 20 50 26

Adcock Ingram Depression and Anxiety Helpline:0800 70 80 90

ADHD Helpline:0800 55 44 33

Department of Social Development Substance Abuse Line 24hr helpline:0800 12 13 14 or SMS 32312

Suicide Crisis Line:0800 567 567

SADAG Mental Health Line:011 234 4837

Akeso Psychiatric Response Unit 24 Hour:0861 435 787

Cipla Whatsapp Chat Line:076 882 2775 (9am-4pm, 7 days a week)

24 hour Healthcare Workers Care Network Helpline:0800 21 21 21 or SMS 43001

NPOWERSA Helpline:0800 515 515 or SMS 43010

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[1] https://www.sadag.org/index.php?option=com_content&view=article&id=1877&Itemid=142

[2]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3195337/ ; https://www.mhanational.org/conditions/suicide

[3] Brave Heart, M. Y.H., Chase, J., Elkins, J., & Altschul, D.B. (2011). Historical trauma among Indigenous peoples of the Americas: Concepts, research, and clinical considerations. Journal of Psychoactive Drugs, 43(4), 282-290.

[4] Stevens, G., Eagle, G., Kaminer, D., & Higson-Smith, C. (2013). Continuous traumatic stress: Conceptual conversations in contexts of global conflict, violence and trauma. Peace and Conflict: Journal of Peace Psychology, 19(2), 75–84. https://doi.org/10.1037/a0032484

Blended Voices- Exploring challenges and opportunities for healing in Africa

CSVR hosted its first global symposium, titled, Blended Voices, which focused on building an understanding of torture, war trauma and violence through an African lens. The symposium took place virtually through a series of webinars starting in October 2020 and ending in March 2021. It brought together voices of African practitioners working on the ground to speak to narratives of trauma, healing and resilience. Over the years, there have been many actors that have contributed to the shared goal of a healed, thriving Africa and a healed, thriving planet. We cannot undo Africa’s traumatizing past shaped by colonialism and post-colonial conflicts, but we can learn from it and use the lessons learnt to shape the future.

The following is a brief summary of part 1 to 5 of the CSVR Symposium Webinar Series, sourced from observation notes written by Tasneem Van Der Biezen-Community Based Counselling Psychologist, who acted as an independent observer of the webinar series at CSVR’s request.

From the first webinar titled, “A traumatized Africa”, it became immediately clear that this was to be a space in which the traumas that the African continent has been exposed to would be dealt with in an honest, transparent, yet sensitive, safe and reflective way. This is important , as we acknowledge how sanitised the history of Africa had become, how stripped of emotion its retelling now is, if it is told at all and it really puts back the focus on the human experience. Hence, raising the awareness that real people, real communities had experienced these horrors, these atrocities, huge and complex losses, is important. These were the lived experiences of people from all over Africa, noted in the presentations reflecting the Gukurahundi genocide in Zimbabwe, impact of colonialism and dictatorship, state led violence and torture. Leaving one with a more holistic understanding of the width, breadth and depth of trauma and torture on the continent, but also the ways in which these atrocities have contributed to the state of Africa and her people, in more ways than just mental health.

A pivotal part of this webinar was the introduction of the concept: “woundedness” – which presented a rethinking of trauma and its effects. Insisting that trauma be understood in a collective way, in order for all its effects to be fully appreciated. The use of the word “woundedness”, offers an important way in which African and grass-root understandings of trauma can be adopted into clinical definitions. The term comes from the Xhosa understanding of trauma being a “wound of the heart”. The usefulness of this definition is that it allows for the effects of trauma to be understood as more than just a list of prescriptive and approved symptoms; but rather a marked impression left within an individual and a system.

The second webinar attempted to tackle the issue of, “Repetitive Cycles of Violence”, offering insights and critiques into some of the conundrums and stumbling blocks often faced when doing this work particularly when sitting with the gravity of the effects of trauma and the longevity of violence and trauma across time. It highlighted how we are often left with more questions than answers. A key observation was that trauma is not just epigenetically passed down over generations, but it is also intergenerationally shared through language, story-telling, and “works of memory” and so the trauma is inlaid across generations in multiple ways and re-performed generation after generation.

The third webinar, titled, “Torture and Trauma Rehabilitation” in Africa explored how conversations by African people can influence the narrative of violence on the continent so as to facilitate healing. This webinar offered reflections on the ways in which violence and transgenerational trauma can be disrupted so that rehabilitation strategies could be offered at multiple levels with the aim of collective healing.

Key take-aways from this webinar included the utility of traditional mental health methods of diagnosis and understanding. And that in an attempt to integrate indigenous ways of knowing, we do not need to proverbially throw out the baby with the bathwater. We can integrate our clinical expertise into our indigenous/cultural/spiritual ways of healing and that we must also caution ourselves to handing over all current ways of healing as “theirs” or “Western” as if we have not contributed to that knowledge or community of practice. This webinar restated the importance of psychotherapeutic work and its understandings, necessity in healing and helping individuals. Which has a place in society as less broken people, helps the collective. This webinar also emphasised that whilst indigenous and traditional healing may not be journaled and documented in conventional and traditionally Western ways, the healing is real nonetheless. The healing has a place in the world and certainly within Africa. 

While the previous webinars focus of interventions were on the individual, family and group level. The fourth webinar, titled, “In the Aftermath”, looked at the ways in which collective trauma interventions can be engaged with in post-conflict situations. Research and findings were presented depicting the ways in which various interventions are making progress in peace building and healing across the continent and that despite the various roadblocks and challenges, the work continues. An analogy that was useful throughout the webinar was that of the cracked cup, that despite the cup looking intact there are deep-rooted cracks that have been caused by violence and then further proliferated by systemic issues. As was usefully demonstrated, trauma in and of itself does not cause the cracks, but rather trauma is what prevents the cracks from being repaired. The symposium showed this over and over again in exploring the prevalence and pervasiveness of trauma across space and time and the ways in which it is produced and reproduced in so many spaces. The analogy of the cracked cup sits with one because it concretely demonstrates the inability of a cracked cup to be a useful and effective vessel. With the cracks it simply cannot be a productive entity and is usually something that we would just discard. However, through the work presented in this webinar glimmers of hopefulness emerged through seeing the ways in which repair is possible.

Lastly, the fifth webinar titled, “Unpacking Mental health in Africa”, allowed for African mental health workers to define and reflect on mental health on the continent. They discussed how pervasively mental health services continue to be under-resourced on the continent, yet due to high demands for care, is also simultaneously over-subscribed. The panellists demonstrated the ways in which healthcare practitioners, institutions and organisations attempt to fill these gaps. Suggestions were offered as to how research, advocacy, treatment and empowerment strategies can allow for the creation of a new way of thinking, engaging and co-creating a way forward. It was emphasised that the utilisation of an Afrocentric lens is pivotal. In order for healing to happen, respect has to be granted to grass-roots endeavours, interventions and to indigenous and African ways of knowing and healing.

#TowardsHealingAfrica

#MHPSSinAfrica

If you would like to watch the CSVR Symposium webinar series go to our website www.csvr.org.za or visit our Facebook page at The Centre for the Study of Violence and Reconciliation. Comment to let us know your thoughts on these issues.

Observation notes compiled by Tasneem van der Biezen (tasneem.psych@gmail.com ) and the CSVR MHPSS team

Can you hear me? Are you okay? ‘Tele-therapy’ during COVID19

COVID19 has brought about a new normal for many of us. As mental health professionals providing face to face counseling services to victims of violence and trauma, our new normal became tele-therapy. Some of us had done this in bits and pieces over our years of practice but never to this extent, never for a full hour or more and never for consecutive sessions. This blog post is the CSVR Trauma Clinic’s reflections of the process, to share with you what worked well and challenges that arose.

“I recall my first client call, I felt nervous, like an intern seeing her first client, which I found odd, as I have been providing counseling services for a good few years now and so the feeling of being nervous was rather interesting. But there it was, as I thought about it in hindsight, I realized that I relied a lot on my physical being in connecting with people and that a smile, a kind face, soft tone, even the way I dressed to see clients all communicated something that helped me build rapport with my clients from the first meeting. Over the phone, all I had was my voice” Sumaiya Mohamed

The way our operation works is that clients would call our emergency line, give their details to our receptionist who would then forward their details to a therapist. The therapist would then make contact. A few hiccups with this, clients may be called from an unknown number (dependent on a therapist willingness to share their contact details) or be called from a number they do not know. From our experience, they would either not answer the phone or when they do, they interrogate you, as they rightfully should, wondering who is calling me? Levels of mistrust are high in our society, thanks to high levels of violence and low levels of social capital, so these initial reactions are understandable. To manage this, you could:

• Contact the receptionist to essentially make an appointment for you. The receptionist would contact the client and inform the client that you (your name) would call at a particular time and that the number would show unknown or be this number xxxx. Alternatively, you can leave a voice message, informing the client who you are and stating that you will call again this time tomorrow.
• Once your call is answered, it is important to communicate who you are, what you do, where you are calling from and why you are calling them. One has to be mindful that this is not a social call and clients will be distant in the initial interaction. This is where the work starts for the tele-therapist, in terms of building rapport over the phone.
• What we found helpful, was being mindful of tone of voice and pace of speech. Being clear and concise is also very important. Through these elements, containment and holding are communicated.

“I think of clients I have called, who sounded suspicious in the beginning of our calls. Who are you? You said, you are calling from where? And by the end of the call, they are at ease, willing to make another appointment as they tell you about their routine, when they take their lunch break and when you can call again.’’- Charlotte Motsoari

“I have also had experiences where clients referred through the emergency line state it is urgent that a therapist contact them as soon as possible and when you call, the client states ‘I’m not able to talk, can we set another time?’ Be patient, hold in mind that you do not know their context, where they physically are at the time and so it is important to ask after you have introduced yourself, ‘are you able to talk at this time?’ This can give you some indication of the safety to have a therapeutic conversation.”-Gugu Shabalala

“Also very important is being in a quiet space when you make the call. You never know what you are going to get on the other side of the call. Similar to when you walk into a session with a new client for the first time, however, this time, so much is out of your control. You can’t see them, you don’t know where they are and reading body language and behavior is out of the equation. You rely on your hearing senses a lot more, listening for signals of distress, a sigh, a tone, something that can help you get a sense of what is happening for the other person is helpful.” Amina Mwaikambo

Once we move past the initial call, the counseling process starts. Below are a few tips to assist in navigating this process:

• Contracting is important, it helps set the perimeters of your work together:
• Consent forms. As we work with a population group in which not everyone has access to emails, we looked at obtaining verbal consent, written consent via email, WhatsApp or SMS.
• Informing them from the onset the steps you would take should they pose a risk to themselves or others. Getting information about emergency contacts, individuals that they live with or friends who you can contact should the client be at risk.
• What the process entails, what is therapy, what the service you provide is and the limitations to that service. Example: I provide counseling services and I do not provide social assistance. This sets the expectations of the space and limits the experience of frustration for the client and therapist down the line.
• Setting up the space for therapeutic conversations. Informing the client that they should find a space in which they will feel comfortable to talk, space where they will have limited interruptions and there will not be a lot of noise.
• Establish communication pathways, if you are sharing your contact details, can they WhatsApp you? What are your contact times? If you are not sharing your number, what are the avenues that they could use to contact you? If you are conducting therapy via WhatsApp or Zoom, what would be comfortable for you and the client (video on or not)?
• Maintaining some form of the frame:
• Be consistent in your appointment times. Consistency and structure is the foundation for a net of support and holding for the client.
• You are working from home so be mindful of what comes into view, finding a space where the background is neutral (no family photos etc) is recommended.

What we found helps clients engage well within the tele-therapy process:

• Basic counseling skills take you a long way. Being present and listening is your best tool
• Combined with psychoeducation and containment. Clients are really looking for a space to feel supported, heard and understood.
• Going at the clients pace. For example, going too fast can be overwhelming for them; going too deep may leave them uncontained in a situation that you have no control over; going too slow can be frustrating to them, especially if they have limited time to engage with you due to commitments in the home.
• Developing coping skills is very important, for us providing the tele-therapy intervention at this time is temporary, and is really our response to the pandemic. Working with individuals nationally, we are trying to help them create a basket of tools that they can draw on to cope during this time. However, for more in-depth, long-term assistance, we would encourage these clients to seek face to face counselling and therapy when these become available again.
• We found Dialectic Behavioural Therapy and Cognitive Behavioural Therapy homework tools effective to carry the work from call to call. When clients were given homework exercises, they felt like they were doing something and were keen to report on it when we spoke again
• Visuals are very helpful, when homework or psychoeducation was provided we would email or WhatsApp clients an infographic that they found helpful in understanding the exercise and it was executed more often than when information was only verbally relayed.

Referrals:

Tele-therapy allows for a wider reach. Based in Johannesburg we now have the opportunity to engage with people nationally. However, we have found it does have an impact on the referral process.

“Working in Johannesburg and networking has meant that when I make a referral I am aware of where my client is going, processes that they need to follow, even transport routes they need to get there and who they will find on the other side. Referring someone outside of Johannesburg is a lot of harder, as you rely on the internet, look for a resource closest to the client, give them the address and contact details and send them out. To assist this process, writing a referral letter and emailing it to the client may help (it looks official), as well as calling the place you referring them to, to ask about services and inform them of the referral.”-Thembisile Masondo

This journey has not been without its challenges. Below are a list of challenges to keep in mind:

• A common occurrence in our country is load shedding, which has an impact on the cellphone signal, making it hard to make calls. This has led to missed appointments, lack of consistency and when you have load shedding and your client does not, they wonder what has happened to you? Did you forget to call me? We have had to process clients feelings of rejection from a missed session due to load shedding one too many times. Looking at ways to manage this is important, when you know the load shedding schedule you are able to inform clients in advance and reschedule appointments. When it just springs on you, make a note of telling the client in the next appointment that this happened and that in the future if you don’t call, it is assumed to be a load shedding issue and you will make contact as soon as you are able.
• As highlighted before gaining consent is one of the first steps, in some cases clients did not have access to emails or WhatsApp or money to respond to an SMS. In these cases we relied on verbal consent. This is problematic in that there is nothing on record, no paper trail and in rare circumstances could pose an ethical challenge if the client felt you violated their privacy and does not recall giving verbal consent. Try to get written consent at all times and find creative ways to do this.
• Perceptions of the call: Clients may understand the emergency line as a space to off-load some steam and just have a listening ear. Others perceived the space as one where they could get advice and often asked, so tell me what I should do? Some told us their problems and waited for the answer, how can you fix it? Time was spent socializing clients into an understanding of mental health support and therapy services.
• Psychiatric cases and individuals that present as a high suicide risk: This is a challenge when working remotely, as your assessment is based on conversations you had with the client and possibly collateral information gained from conversations with family and friends, if the client allows. The rule of thumb, is to take action and refer if you are concerned. Getting clients to access the service is another challenge, as you have to get their buy-in and understanding of why this is needed. If you are not able to achieve this and the client poses a risk to themselves or others contacting the clients emergency contact to assist and get the client the help they need is worth trying.

Limitations to what you can do therapeutically:

• We found this especially true when doing trauma processing work. Trauma processing work in therapy is a complex and sensitive art when doing this in person, doing it over the phone/zoom etc presents its own challenges. Clients would start talking about their trauma but were not prepared for the intense emotions that it evoked and thus were not in the right space, physically or emotionally, to engage with this depth work.

“It was hard to contain them, as you hear the intense emotion over the phone. One client went silent for a long time and did not respond when I called her name, I was concerned she had dissociated and thus called her alternative contact from another line to check in on her. Fortunately, the client was okay.”- Celeste Matross

The fine line between supportive work and depth work has to be maintained, until the client is able to come into a therapy space in which all aspects of them can be observed and held.

• Another aspect of therapy is clients’ avoidance. When clients feel uncomfortable or want to remain in denial around certain issue, they avoid it. This strategy is easier done over the phone, as avoidance in tele-therapy is hanging up the call, I didn’t hear you, my signal went, I can’t talk right now, I have to go. This makes it hard to work with the client’s avoidance and make a breakthrough in therapy.

Self-care

Many therapists this year have had to adapt to this new way of providing counselling support –adapt the way they provide therapy, their skill set, their therapeutic approaches to meet the needs of clients during this pandemic. Feelings of being overwhelmed, anxious and helpless have been experienced. Furthermore, the pandemic is experienced by all and those offering support are not immune. It is important to be mindful of transferential issues that arise in the process and our own mental wellbeing. In addition, working from home and providing this service requires us to be aware of the cross pollination of home and work. Creating boundaries between the two in our own ways, such as, set work times, going outdoors during breaks, having lunch with family, stretch breaks during the day and most importantly switching the electronics off after a work day – symbolic of closing your office door.

Something that myself and colleagues have also found is the need to ground oneself before engaging with the family after working. The work we do is trauma focused and trauma has an impact on those hearing it too. In our role, we don’t only hear it but we try to connect to the clients’ experience of it and this does have an impact on us. We can all recall a feeling of heaviness after speaking to someone who has been through something difficult or is feeling a lot of pain and stress. That heaviness does not just leave us and we carry it for sometime. We can carry it with us into our private lives and in interactions with our loved ones. Grounding oneself through supervision support, peer support, mindfulness exercises can be helpful to make sense of the heaviness and experience emotional catharsis.

Those are our reflections and learnings thus far, we are sure as this journey progresses we will discover new insights and challenges. Hope you found this post helpful in the work that you do and wishing you all strength. Let us know what your lessons learned have been during this time.

Compiled by Mental Health Professionals from the CSVR Trauma Clinic

Trauma in the air: Catastrophe and/or transformation

The Covid-19 pandemic has revealed the often-masked reality that mental health is as much a societal issue as it is an individual one. In 2020, COVID19 has united South Africans and the Global community as we face a common enemy, resulting in a collective trauma experience. Our mental well-being as a society has been ‘shook’, with most people coping with an unprecedented crisis. Our normal coping techniques have been found inaccessible, wanting and insufficient.

During this pandemic, many are beginning to see that mental ill-health can emanate from and become exacerbated by socioeconomic and societal realities. Writers and mental health experts around the world have been emphasizing the importance of being mindful of people’s emotional wellbeing, normalizing and validating the waves and storms that many are struggling with during this time. It has been a period of incredible emotional support from the global community as everyone shares the collective experience and “holding” each other as we brace ourselves and breath through it all, together. There is no shortage of breathing and grounding exercises that help us stay calm and sane. We are encouraged to connect to loved ones as we go through this period of collective mourning. All this, so that we do not come out the other side as mere shells of our former selves, having mental breakdowns from failing to process all these experiences.

We can clearly see how mental wellbeing is slowly gaining priority during this period categorized by great loss, grief and bereavement; isolation, restrictions to movement and other liberties; excessive use of force and police brutality by state officials. In South Africa, one cannot help but get a sense that we’ve been here before. South Africa has had, and continues to have, periods where entire societies are held hostage by oppression, communities brought to their knees as they lose their loved ones weekly and fearful of setting foot outside as security forces clamped down on them. Periods of gruesome murders seen on a weekly basis, periods where domestic violence has become widespread, where substance abuse has ravaged through the youth population and infiltrated schools, where fathers are gunned down senselessly by criminals and those who have sworn to protect. Periods of not knowing what the future holds in store, and juggling hopefulness and helplessness. We have been through this collective trauma experience during the Apartheid regime, Xenophobic attacks, gangsterism, SGBV, Substance abuse, etc.

During these periods, that may be internally experienced as psychologically identical to what is happening right now with the pandemic. We were not getting constant reminders to be present and mindful, no videos or demonstrations of stress management and grounding exercises circulated. No toolkits of coping strategies or emotional regulation skills to ensure that we all come out the other side with our sanity intact and the ability to process and re-build. No debriefing sessions, no check in’s.  Essentially, no real acknowledgement of what impact these experiences have had on the mental health and the implementations of proper mental health programmes and facilities. The collective trauma experiences have been a part of the very fibre of South African history. Dare I say, the South Africa of today, was built on collective trauma and this has been left unprocessed, leaving our society fragmented.

Holding this in mind, it means that most people (resilience being a factor) came out of or lived through these periods as indeed, shells of their former selves. They have been living and walking the streets as beings with fragmented minds, broken hearts and lives in despair. The vulnerable in society are often labelled and disregarded and so too, individuals who struggle with their traumas have been labelled by society and stigmatised with no empathy for their lived experiences of trauma and systems fail to provide them with adequate rehabilitation and healing.

The reality is that our society is plagued by transgenerational transmissions of trauma caused by years of systemic, socioeconomic and cultural structures that have oppressed and dehumanised people through injustices and brutality. This has left communities with distorted psychological organisations where largely unhealthy coping and numbing strategies are passed on as a way of life, we see this in cases of alcoholism and lack of emotional regulation. People have been stuck in a perpetual state of fight, flight or freeze. And left to sort themselves out.

Mental healthcare has long been the “stepchild” of government interventions. Used either inadequately with stripped resources or not at all when it’s the very thing that could attempt to facilitate the reconstruction of individuals and societies at large. If we don’t learn anything from this period, I hope we learn this- Mental health is a social ill and should be prioritized and treated as such. People’s anxiety is exacerbated, maybe even caused by the lived experience of being in the middle of a pandemic. The environment is contributing to their mental ill-health. As it has for South Africans for years.  With the right support and treatment, people can learn healthy coping strategies, manage and process their distress. How many people have lived through and are still living through incredibly difficult periods and don’t have these services available?

At the same time, this era has presented an opportunity to reflect, pause and grow from the collective trauma that we have experienced. An opportunity to ‘be transformed’ by our experiences. There are talks of a new normal, as things will never be the same. A new way of being, living and treating each other. The Centre for the Study of Violence and Reconciliation (CSVR) in this month of October, being Mental Health Awareness Month, is launching a mental health campaign posing the following questions for reflection:

• Are we living through a catastrophe or is this an opportunity for transformation?
• Does this provide an opportunity for us to look at mental health and mental ill-health in ourselves and others?
• Are there adequate resources allocated to mental health needs in our society?
• Is mental health care accessible to all who require it?

As we ask these questions, we note that the pandemic has given mental health practitioners, especially those at CSVR an opportunity to reflect on their practice and change it to meet the changing global context, noted through the increased use of online therapy approaches that have made mental health support more accessible.  The transformation of mental health care is an opportunity that CSVR is hoping the world takes advantage of.

CSVR acknowledges the impact COVID19 has had on the transformation of self, families, communities, societies and the globe. And encourages us all to reflect on our society and be present and comfortable for the uncomfortable conversations that need to be had in order to create real transformation. As I invite you on this journey of reflection and insight gaining I am aware that this can feel catastrophic as it forces us to examine ourselves and our lives and may call on us to change.

We need to decide if this becomes the wound that we carry, that we continue to let our children carry. Or does this become the opportunity for transformation in how we deal with our pain and woundedness. To paraphrase a famous quote, “in the same way that trauma can be passed through intergenerational lines, so can healing”. We now have the opportunity to move from transgenerational trauma to transgenerational healing, from a trauma carrier to a trauma healer.

Which of these gifts do you want to give to yourself and your children?

Written by: Charlotte Motsoari, Celeste Matross, Jacqui Chowles and Gugu Shabalala.

SGBV and Healing:Intervention recommendations by CSVR practitioners

Following the previous blog, Don’t call me a ‘women’, in which reflections focused on SGBV in South Africa and its escalation, the CSVR Mental health and Psychosocial team set together to brainstorm ways of intervening. CSVR has for the past 30 years been offering mental health and psychosocial interventions for survivors of sexual and gender based violence (SGBV). Based on the experience of the Mental health and Psychosocial services (MHPSS) team the following recommendations are highlighted for addressing SGBV in South Africa:

• Interventions should incorporate the various other socio-political and economic issues that emerge in various contexts. Adopting the medical model, tends to focus on immediate causation, and ignore important aspects such as ideology which may provide deeper insight into the nature of violence and how it presents itself in different contexts.

• Interventions may include channeling funds towards the prevention of violence, and towards mental health interventions at primary health level (clinics). The role of multidisciplinary mental health and psychosocial practitioners is important for after care and support of family systems in cases of violence. At community level, workshops and psychoeducation would assist in re-shaping the beliefs of communities. Psychosocial interventions are not limited to individualised aspects of violence, they encompass ideology, identity, and context-specific understanding of misogyny and the drivers for violence against gendered bodies. These permit for the explication of violence at the source, approaching violence as part of human behaviour, approaching people in violent spaces as social and political beings.

• Police and other centres of care should be looking into these factors, and consider the broader implications of not bringing justice to families.

• Healthcare workers can invest in psychosocial support and not only focus on the biological/medical aspects of alleviating trauma.

• At present, most service providers and resources that have been commissioned to combat violence have been overwhelmed. There is a need for grass roots organisations to explore how to develop cost-effective initiatives that are co-created with community members to combat SGBV preferably utilising resources that are readily available.

• Responses to SGBV need to be multi-layered, as the root causes of violence such as SGBV are also multi-layered. They should therefore address issues such as cultural norms, inequality, poverty, socio-political, race relations, unresolved trauma and other mental health challenges. They should be long-term focused and not purely centred on crisis management. Short-term responses to violence often provide immediate relief, thus leaving victims in the same psychological state. The impacts of abuse and the subsequent displacement from their homes often cripples them socioeconomically. Many victims of IPV resolve to go back to the relationships that were abusive because there is no long-term plan.

• Services and initiatives that respond to SGBV should be community-focused, and should not only adopt an individual lens. Fostering a community perspective allows the organisation to target violence and inequality from multiple dimensions.

• Conversations about healing of society from SGBV involves the interrogation of psychosocial interventions and the unpacking of societal ideologies to shift consciousness about SGBV.

• Furthermore, responses should not be focused only a specific sector (e.g. the justice system) as there are multiple layers of violence that need to be tackled. For example, the justice system forces perpetrators to be accountable, but does not effectively enforce rehabilitation and reparation. A popular focus of campaigns and interventions has been on reporting acts of SGBV, whereas the problem does not rest solely in the criminal defence system. CBOs and community members also have a responsibility to create and maintain safe spaces. Culturally/traditionally, the focus has been on building and retaining the family unit, which is often accommodative of DV. As a result, society has become desensitised to IPV and DV remains under reported. Furthermore, there is an emerging distrust between communities and the justice system because the police force/personnel may not be attending to these cases adequately.

• Conversations about violence should not be disconnected from the history of violence – violence is often used by men as a tool for submission – to retain their sense of power and masculinity, and re-claim the power that systemic issues and feminist discourse have “stripped them of”. The interventions need to be conscious of harmful cultural practices and discourse that perpetuate violence that impacts upon gendered bodies. Why are our interventions not dealing with the history? They tend to focus on the issue in the moment – like the reason for referral, and not the other systemic issues that have contributed. Interventions typically are focused on specific aspects, including victims and not perpetrators.

• There needs to be a dialogue about key issues: violent culture has “resolved” a lot of societal issues in the past. This needs to be unlearned as a solution to problems. Culture is deeply entrenched and is the manner in which we have learned to manage conflicts and to bring about discipline, progress, and change. Have we noticed how violence has “worked” so that we can debunk the misconceptions of how violence “works”? Women are not saying that they don’t want to be mothers or wives or women – they just do not want to be assaulted and raped.

• Moving SGBV from the “woman vs men” issue, whereas it is a societal problem. We need to shift the reflection to what it does to society as a whole. It is important to re-build the nation as a whole, and not focus on women as the victims and the sole bearers of the violence. Explore what women empowerment means for society as social development, instead of as women empowerment for women

“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed it’s the only thing that ever has.” Margaret Mead

Recommendations compiled by the CSVR Mental Health and Psychosocial team

Don’t call me a ‘women’

….. if it means you think I’m weak, a sexual object or your punching bag

Violence against women continues to increase and the acts of violence continue to shock readers on media reports. Dare we say, the violence has become more brutal. Violence against women has been recognised as an international public health and human rights issue[1]. With prevention programs, awareness campaigns and various intervention strategies having been implemented for years. Why do we still see an increase in GBV and why is the violence so brutal, so demeaning?

This got me thinking about men and women and our relationship to each other as social beings. And I wondered how do men who violate women perceive women? This took me back to my sociology classes in which we learnt about concepts such as socialisation, briefly, defined as the process whereby we learn to be a person in our societies and of course this links to gender roles and how we are taught to be as male and female. One has to note that this process of socialisation and the teaching of these roles takes place through various institutions such as the family system, educational institutions, cultural and religious institutions etc. Going back into history and exploring the foundations of this system and how they were set up, the power structures that formed them come into focus, as we note that the power structures consisted mostly of men and so primarily the first learning’s so to say was dominated by a patriarchal underpinning. Patriarchy is defined as a system of social structures and practices in which men dominate, oppress and exploit women[2].

This system gave birth to gender norms and stereotypes, embedding these norms through the process of socialisation, in which women and men were perceived in a certain way and certain labels become associated with what it is to be women and men. Commonly women were perceived as weak, vulnerable, sexual objects so marital rape is not possible, nurturers, whose sole responsibility is taking care of the children etc and men were perceived as the providers (hunter/gatherers), physically stronger than women, alpha males, head of the household, men don’t cry, strong etc. Looking at these descriptions we see gender roles and placements for women and men in society. And this discourse/descriptions of men and women has been passed down and entrenched in our social and individual psyche. As evolved as we are, or think we are, we find ourselves at points in our life, going back to a default position. Acting on that default position, can be dependent on exposure to risk factors and protective factors, as well as being in the have or have not bracket of society.

Fast forwarding to the present, we acknowledge and are grateful for the various developments in women’s rights, gender equality movements, feminists movements which have delved into the deconstruction of gender discourse, highlighting the patriarchal underpinnings of our society that form the foundation of socialisation processes. These movements have contributed to redefining women as competent, equal, powerful and pretty much that women and men can stand along side each other and see each other as equals.

However, GBV stats is telling us something else. GBV is a “general term used to capture violence that occurs as a result of the normative role expectations associated with each gender, along with the unequal power relationships between […] genders, within the context of a specific society”[3]

This definition and GBV stats speaks to the reality of an unequal society that we continue to live in. One of the contributing factors to GBV is poverty and reports have spoken about the loss of employment by men impacting on GBV numbers increasing since the lockdown and COVID19[4]. I read another article that spoke about a loving father and husband who become abusive following the lost of his job[5]. As any person who has lost a job and now faces financial struggles and uncertainty and who is a provider for the family, I can understand the frustration, feelings of despair, stress and really an overwhelming anxiety and fear as I look at my children and wonder how will I take care of them. The part that I feel needs some getting into, is how that person then decides to take this anger, frustration, anxiety and fear out, specifically on a women or on children? And the thought that comes to mind is that women and children are perceived as weak and vulnerable in society, the same society which has in turn socialized this individual. The emotions inside, which are overwhelming, and dare I say ‘un-manly’ are in a way perhaps perceived as vulnerable and weak and thus suppressed and a more manly expression reveals itself through anger and through violence. I envision that to combat the vulnerability felt, the women who is perceived to be weak and vulnerable and incapable becomes a external representation of his internal self, becomes the object of violence, who is then beaten and abused, as an act of defeating his own internal vulnerable self. Through violence he enacts his power and regains a sense of power as his victims now fear him, can be controlled by him. And intra-psychically, it is the victim in him that is redeemed and empowered again.

The challenge I feel and what speaks to the brutality of GBV deaths that we have seen in recent years. Is that women are no longer only the nurturers, awaiting the provider, but have themselves become providers, empowered by society over the years. This in turn is threatening to the male gender socialised being. Beating you, abusing you, is not enough, as a employed women, who does not rely on her male counterpart has options available to her, has power that she too can enact. I assume this further angers the parts of the male who needs to dominate her, especially when the world has dominated him. In this im referring to high rates of unemployment amongst men, womens positions in employment circles. He cannot simply dominate and beat her down to regain power and deny his vulnerability, as she may not be in need of him, can leave him and this exacerbates his internal vulnerability and so he has to annihilate her, in turn, it is a representation of annihilating the vulnerable, weak parts of himself. With her death, it is symbolically gone.

The current climate of high unemployment, women empowerment and the redefining of women as competent, possessing agency, able and entitled is shifting the narrative previously layed down by the patriarchal forefathers and from what I reflected on above, would mean an escalation in GBV, as we are currently seeing in SA. The impact of this on women, men and future generations of our society is concerning. So what can be done?

For one, more can be done. A multi-layered response is needed, incorporating a lens that is bio-psychosocial, legal, economic and historical in nature. Institutional reform is needed, as systems reconvene and dissect their contribution to the state of GBV, gender norms and stereotypes and work towards providing systems that are sources of support and rehabilitation not only for the survivor but the perpetrator too. Not having these systems play out their own biases, contribute to the stigma, victim blaming and silencing-it’s a domestic issue Sisi, go home and sort it out. No, it’s a me, you, it’s a societal issue.

An increase in financial and human resources is needed to intervene and case manage beyond arrests being made, beyond women being placed in shelters for safety. Acknowledgement that there is no quick fix. Long term interventions are costly but they are an investment to building a society that we can live in, ideally, free of violence. A key part for me is the awareness that patriarchy and systems of old and their ideologies were filtered down into society and we see the remnants of that till today, undoing this, is our challenge and biggest battle. What we have learnt, we can unlearn and we can re-learn a new way of being as women and men, equal entities in society, both strong, both vulnerable, both weak, both empowered.

Written by Sumaiya Mohamed

Senior Psychosocial Trauma Professional at The Centre for the Study of Violence and Reconciliation (CSVR)

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[1] Giovetti, O. ‘3 Causes of Gender Based Violence.’ March, 5, 2019. Concernusa.org/story/3-causes-gender-based-violence/

[2] Sultana, A. ‘Patriarchy and Women’s Subordination: A Theoretical Analysis’, June 2010-June 2011, The Arts Faculty Journal.

[3] Bloom, Shelah S. 2008. “Violence Against Women and Girls: A Compendium of Monitoring and Evaluation Indicators.” Carolina Population Center, MEASURE Evaluation, Chapel Hill, North Carolina. https://www.measureevaluation.org/resources/publications/ms-08-30

[4] Lefafa, N. (2020). ‘Covid-19 lockdown provides ‘perfect storm’ for SA’s GBV crisis’, Health-e-news. health-e.org.za.

[5] Giovetti, O. ‘3 Causes of Gender Based Violence.’ March, 5, 2019. Concernusa.org/story/3-causes-gender-based-violence/

What Comforts us during this time?

Last year, when Covid-19 started making waves in the news, it was so far away from me and I was even arrogant enough to think it was not going to affect me. The day it reached South Africa I was out of the country, when I came back I had to be isolated and all of a sudden it became personal. Since then we have been under lockdown as South Africans and for the first time in many years I had to stop, I was so busy I did not realise that it was a while since I truly spent time with my family and more importantly myself. It is during this time that I was obligated to truly rediscover myself and my family members, it has been a trying time; I am not going to lie about that, but it has also been momentous in a sense because it has allowed me to appreciate my journey through life. In this blog I aim to share some of my life lessons from my favourite teachers that came in my life at a time when I was open to learn and have unknowingly helped me bear this dreadful time. I hope through their own words my dearest reader you find comfort and inspiration to push through to the next hour, next day and so on. C.G Jung once wrote:

“Until you make the unconscious conscious, it will direct your life and you will call it fate”.

Then Carl R. Rogers came and said:

“The curious paradox is that when I accept myself just as I am, then I can change.”

Briefly I will give you a description of where I come from, I was born and raised in Soweto, a township historically where blacks were segregated during the apartheid era. I was born in the 80s, I am that generation that has grown up in both the middle of apartheid and post-apartheid. I am black and female, meaning my potential in my youth was quite iffy, I could have ended up pregnant and holed up with an alcoholic boyfriend who would abuse me emotionally and physically every other day, or I could get NASFAS and go to university and make my way in the world. I don’t think my 17-year-old self would have believed how things turned out. In other words, Carl Rogers knew what he talking about, once I accepted myself, life took me places that I would not have dreamed of, and it still continues to do so.

My journey of acceptance did not come easy, it was about making the unconscious conscious, and the mind is very vast it’s like walking into a jungle. In fact, Elizabeth Gilbert described it very well when she said:

“When you are lost in those woods, it sometimes takes you a while to convince yourself that you’ve wondered off the path, that you’ll find your way back to the trailhead any moment now. Then night falls again and again and you still have no idea where you are, and its time to admit that you have bewildered yourself so far off the path that you don’t even know from which direction the sun rises anymore.”

It was during my bewilderment that I came across Iyanla Vanzant in a book called Yesterday. I cried and she egged me in her poem to cry because it was time to cry with an agenda. She taught me that in life we have to realise that we are learning and unlearning. Just then came Oriah Mountain Dreamer and said:

“My invitation, my challenge to you here, is to take the journey deeper, into intimacy with the world and your life without any promise of a safety guarantee of reward beyond the intrinsic value of full participation.”

There I was, deep in my journey to the self, whereupon I had travelled so deep that I was lost within myself, not knowing which way was which, when I found Oriah and she dared me to delve deeper into the woods and not only that, but to be in a relationship with them. At this point in time I had somehow made it to University and it was clear that I was on a path of sorts, Paolo Coelho says:

“When you find your path, you must not be afraid. You need to have sufficient courage to make mistakes. Disappointments, defeat and despair are tools God uses to show us the way.”

Believe me when I say I had plenty of those tools, luckily for me I also had sufficient courage, meaning that I was afraid for the most part but I pushed through some of the most difficult times in spite my fears. I experienced a lot of traumatic experiences growing up, and mostly there was not much I could do about it, mainly because I was born into my circumstances, and the more I learnt, the more I wanted to change my circumstances, but it’s not that easy, everyone is entitled to be who they want to because they are also travelling their own journeys. Now this is where Viktor Frankl came to teach me that:

“When we are no longer able to change a situation, we are challenged to change ourselves.”

This is the most difficult of lessons because it’s like what Oriah teaches:

“When we surrender we do not fight with life when it calls upon us we are lifted and the strength to do what needs to be done finds us.”

Over the years I have learnt to change myself to better suite my circumstances, and perhaps I was being prepared for this dark time. This epidemic somehow has shattered the illusion that we are safe, in a world where violence is a culture and faith is slowly losing its essence; security was indeed an illusion. It’s time to discover our humanness, the only way to do that is take a journey into ourselves and uncover our wounds so we can heal them, the journey is a terrifying one, but a journey worth taking believe me. One of the lessons that I keep with me during these times is the one Viktor Frankl imparted which is:

“Everything can be taken from a man but one thing: the last of human freedoms – to choose one’s attitude in any given set of circumstances, to choose one’s way.”

I tend to believe him, the man survived the holocaust.

In conclusion there is an old Cherokee story where a man is teaching his grandson about life. “A fight is going on inside me,” he said to the boy. “It is a terrible fight and it is between two wolves. One is evil – he is anger, envy, sorrow, regret, greed, arrogance, self-pity, guilt, resentment, inferiority, lies, false pride, superiority, and ego.” He continued, “The other is good – he is joy, peace, love, hope, serenity, humility, kindness, benevolence, empathy, generosity, truth, compassion, and faith. The same fight is going on inside you – and inside every other person, too.” The grandson thought about it for a minute and then asked his grandfather, “Which wolf will win?” The old Cherokee simply replied, “The one you feed.”

Written by Thembisile Masondo

Level 5, level 4, level 3….an introjective exploration of our COVID19 journey thus far

Approaching 23:59 on 31^st December 2019 (CAT, GMT, UTC, etc.), millions of people were waiting in anticipation of a new year. With resolutions in tow and hopes for a fruitful year, to many the start of a new calendar year is symbolic of the start of a new journey. While China’s medical personnel had identified an outbreak of illness and death that appeared to be caused by a type of pneumonia, most of global society was oblivious of what was happening to our fellow humans, and even more were unaware of what this meant for the rest of the world.

Fast forward all time zones to the detection of patient zero in different countries, the threat of this deadly virus became more real. This came with fear, panic and an uncertainty of what this meant for the rest of 2020 – physiologically, psychologically, economically, socially, academically…etc, etc, etc. People have had to learn how to cope with the repercussions – some of which have eased the pressure of life’s responsibilities, and others which have exacerbated them. Depending on who you are, what you have, and the format of life that has been ascribed to you, the process of adaptation has been vastly different. No single formula has eased this process as responsibilities, hashtags, challenges, and the 5^th industrial revolution may have triggered old wounds, soothed the inner child, or activated the inner critic.

There has been a need for mental health practitioners to provide services to people whose psychological wellbeing has been impacted as a result of the corona virus. While many may not have access to these resources, there is value in personal introspection. In an endeavour to move forward, it is always important to look inwards by taking strides down memory lane. Reflecting on one’s past serves as a tool through which one can make meaning of their past emotions, thoughts and behaviour. There is a predictive value in understanding the patterns that existed before in order to make sense of the present. So, yes…the COVID-19 pandemic has shaken, rattled, destroyed, and empowered…many have lost, and many have benefitted. The way in which this catastrophe has shifted one’s mental health status may be a reflection of the collective trauma caused by this pandemic. However, it may also be a reflection of pre-existing intrapsychic conflicts. Human beings do not “become” in the moment – we each have a history, a collection of experiences and beliefs that frame the identities that we embody, and are concurrently experienced by members of our communities, and the broader social world.

Many mental health practitioners are successfully assisting people to be optimistic, and latch onto a sense of hope for a “good enough” future. While the thoughts here are not intended to fragment those ideals, one needs to remain cognisant of the realities that existed pre-COVID-19. It is likely that the reality that you are experiencing now may be a reflection of your unconscious self – the bare id, the “self” that you are when your superego’s energy has been depleted and you have limited resources to remain politically correct, or socially desirable. There is a possibility that you not only felt uncontained when the threat of a virus or a lockdown was announced. Many of us had intrapsychic alarm bells resounding whenever our leaders, bosses, relatives (the institutional authority figures that society has awarded power over us) devalued our experiences, identities, and abilities. Remember that feeling of satisfaction as you expressed your distaste of the “other” in your tweet? Remember that feeling of uncertainty when you received that “we regret” letter? Remember the dread of waking up to start your day before the sun rose on a winter morning? Remember that “win” when you got the position that others rallied for? Remember that decision you made after pledging to never make that “mistake” again? Remember that choice to take 5 packets of toilet paper knowing quite well that other people might also need them? That’s all you (and your history)…before COVID-19. We can’t forget those people, and pretend as if we were not them before this virus pushed us all into our respective corners. So while we are engrossed in the psychological and socio-political impacts of this virus, we can’t give corona all the credit for the anxious, depressed, manic, aggressive, traumatised and unequal society that we are. We are all being fed this virus in a unique and precarious way. The traits that we possess (i.e. impulsivity, narcissism, mindfulness, avoidance, sociopathy, obsessive compulsivity, introversion, etc.) are being activated and deactivated as per our predispositions. The collective nature of this trauma makes it more complex because many of us don’t know whose feelings we’re actually feeling today, since we may not have been aware of our selves waaaay back in normalville.

As lockdown restrictions begin to ease, it becomes more important for us to reflect on how this affects each of us as individuals and as members of communities. While there is a collective need for either stricter or more lenient regulations, everyone who is reverting to the paths that they had embarked on when their minds struck 2020 will experience this differently. We will all have to kick-start the journey into a new “normal” because the world has changed, and there is a processing of loss which is akin to bereavement that may need to take place. Meanwhile, those who have been working as essential service providers may have to review what it means for them that the streets and buildings and modes of transportation are becoming more populated. There is a need for us to be honest with ourselves and mourn the 2020 we were expectant of more than five months ago. Granted, there is no need to throw the baby out with the bath water, but we definitely need to re-evaluate our plans and timelines with honesty and practicality.

In part, this process may include analysing our illusions of the “back-to-normal” internal and external worlds. How much of the pre-COVID19 world contributed positively to your mental wellbeing, and which components had a tendency to impact on you negatively? Our unconscious was active before the outbreak, yet may have been experienced more consciously due to the events that have made us more aware of our individual contexts. There is a lot that we can learn about our experience or ambivalence of ourselves through this ordeal. Life may have been more predictable when we knew our systems. It may take some time to recalibrate those systems, and it may be even more challenging depending on how this pandemic poked holes in our Pandora’s boxes. The psychological aspects of a global pandemic require that we are more patient with ourselves – when we have the privilege to do so. While some are hoping for restoration, there is a process of reparation that needs to take place in order to facilitate a smoother transition of our inner selves back into the less predictable and more communal external world. This is a journey that can be embarked on through introspection, and the process of being vulnerable with oneself. After all, can one ever truly see themselves except through a reflection…?

Written by Amina Mwaikambo

 

Back to school-back to reality (A COVID19 reality)

Today I attended an online webinar titled: Getting children back to school safely. Taking into account my own and other parents anxieties around whether or not to send children back to school, this was a very useful webinar, which answered many of my concerns. The webinar had a panel of experts who have done extensive research into the impact of COVID19 on children, drawing from global research, in areas in which the pandemic has hit and children continued to attend school or have resumed schooling after lockdown restrictions were lifted. As we have not reached this point yet as a country, it is valuable to look to those who have and learn from their experiences.

3 questions formed the basis of the discussion, namely:

Do children get covid19?

Are children covid19 super spreaders?

How can we make schools relatively safe?

The first speaker Professor Refiloe Masekela , Pediatric Pulmonologist and the Head of Department of Paediatrics and Child Health at the University of KZN, Durban, South Africa, answered the first question. In summary what I gathered from her discussion was that children aged between 0-19 years are less affected then the adult population. There is something specific in children which seems to protect them from the virus. She explained the virus, which is a respiratory virus, requires a certain receptor to break through our body and cause infection. She referred to a receptor called ACE2 (forgive me I’m not a doctor, so these terms were rather foreign to me, as I tried to keep up with the discussion), which is immature in children. From a very brief google search, I discovered that ACE2 is a specific protein that allows the virus to infect human cells. Called the angiotensin-converting enzyme 2 (or ACE2 receptor), the protein provides the entry point for the coronavirus to hook into and infect a wide range of human cells.

She further explained that children have fewer of these receptors in comparison to adults and may this contribute to understanding why the infection rate is lower in children in comparison to adults. She also explained that children’s immune system play a part, as it is considered to be more robust then adults aging immune system. If we think about it, it makes sense, our little ones are always putting their fingers in their mouths, fingers which have touched various surfaces, which contain various germs. Thus, she states that children have other viruses in their upper respiratory tract and COVID19 has to compete with these viruses in order to affect children. Furthermore, she highlighted that most children have fewer chronic diseases in comparison to adults, such as hypertension etc.

She then went on to discuss typical symptoms that may present in children. I found this interesting, as schools are getting ready to receive children and highlight as part of their preventative measure they will be having thermo-scanners. Prof. Masekela stated that the presentation of fever in children is rare, some may exhibit coughing, but key symptoms to look out for in children include:

-sore or red throat

-runny nose

-diarrheoa

She also emphasized that children may also present as asymptomatic (no symptoms) or with mild symptoms but majority are unlikely to require hospitalization. Among children, high risk groups were identified and included children under the age of 1 (possibly since their immune systems are still developing) and those with comorbid health conditions, those listed were: Chronic diseases in chest (lung disease); Chronic asthma (Mild or moderate asthma not at high risk, if well controlled); Cardiac disease and severe neurological disability; and Immunosuppression. Dr. Moherndran Archary (a panel expert who I will elaborate on later) added to this by stating that children who may get infected and do not have comorbid health issues may recover themselves, as children’s immune systems are robust. Recommending bed rest, hydration and nutritional needs are met.

Professor Sithembiso Velaphi, a Pediatrician, Associate Professor with the University of the Witwatersrand and Head of Pediatrics at the Chris Hani Baragwanath Academic Hospital in Johannesburg, South Africa, answered the second question, highlighting that the viral load in children is lower than in adults and yes they can affect others but are less likely to. Why you ask? Well firstly, because of the lower viral load, lower tidal volume (breathing lower) and coughing or sneezing less forcefully then an adult. He further stated prevention is better than cure and it is important to maintain social distancing, hand hygiene and screen for symptoms, as we need to remember that we are not isolated beings and children coming home from schools need to be educated about hand hygiene, especially if they have elderly at home or vulnerable individuals.

Doctor Moherndran Archary, a Pediatrician Infectious Disease Specialist in the Department of Pediatrics and Child Health at King Edward VIII Hospital affiliated to the Nelson R Mandela School of Medicine at the University of KZN, Durban, South Africa, than answered the third question: making schools relatively safe. He acknowledged that for parents the priority is keeping their children safe and acknowledged the confusion media and other reports may be giving: keep kids home when numbers were low versus send kids to school when numbers are high. How does this make sense? He explains that the pandemic will be with us for the next 1 to 2 or 3 years (if a vaccine does not materialize) and since we have not yet reached our peak, we have limited data and as time goes the data is evolving and developing further. Thus, they have learnt more about the virus over time and this has shown that children are not as severely affected. He draws on various research samples from various countries, as do the other speakers, to make this point. I will post the link to the webinar recording as soon as it is released so you can have a look at this and fill in any info gaps you may have after reading this post.

Dr. Archary also emphasized that the virus will hit us in waves and that the next wave is expected in the next 2 to 3 months. Thus, his presentation on a risk mitigation strategy was very useful for me, as I thought about the reality of keeping my child at home for 2 to 3 years or biting the bullet and finding a way to live with our new normal. His presentation looked at what schools needs to have in place for students return. I think all school heads should have a look at this as they prepare for the reopening of schools. I have attached pictures of his slides which explain these safety measures. It is our responsibility as mental health professionals, teachers, parents and citizens to ensure that the measures are put into place and help our schools to resume some form of educational normalcy, as this may be our new normal for the next 2 to 3 years.

Prof. Masekela also reflected on the impact of keeping children out of school on their mental wellbeing, as children are isolated, have limited peer support and structure is taken away, which could result in feelings of depression and anxiety. Mental health a key issue that is often forgotten as we focus on physical health during this pandemic. We need to be mindful that this is a difficult and anxiety provoking experience for our children too and finding helpful ways to engage with this is important for their mental wellbeing, as well as our own as the adults that are their caretakers.

Written by Sumaiya Mohamed (Senior Psychosocial Trauma Professional)

 

 

The need for a context-sensitive, trauma-informed response to Covid-19 pandemic: Inequality and opportunities for a transformed society

South Africa is a country with a history of state violence, structural discrimination and disempowerment. The arrival of the Covid-19 pandemic and its gradual increase in infections and deaths is more devastating for South Africa because we are still battling with inequality, poverty,  crime, and gender-based violence, to name a few. Granted, the pandemic did not bring these issues, however, it brought to light what thousands of activists have lamented since the dawn of democracy. If Covid-19 does not get to you, the aforementioned ills certainly will. This is the reality of many South Africans living on the wrong side of the inequality line and below the poverty belt. Unfortunately, the focus on flattening the curve, does not mean that these issues take a pause or seize to exist. If anything, they have gotten worse, and the people who were already vulnerable, are in a worse position now more than ever.

The swift and decisive response by our political leaders and their ability to mobilize resources is highly commendable. It gives hope for a new dawn of effective leadership that we have not seen in South Africa in many years. However, this is overshadowed by the lived experiences of those living under impoverished and dangerous circumstances as well as the state’s dark cloud – corruption –ever-present and lurking for its chance to pounce on opportunity. Left unattended, these existing and exacerbated issues, coupled with corruption, could see South Africans suffering devastating effects that far exceed the effects of the pandemic. Foresight and an effective response to the pandemic is required, in order to ensure that the future implications of decisions made today do not cause further damage to the lives of the people who are often left excluded. Thorough evaluation of policies and their implementation, and the newfound enthusiasm and dedication to serve the people, could mean a transformation and a real attempt to address the inequalities and injustices that continue to haunt South Africa.

Self-quarantine /isolation/Social distancing

Most of the regulations that have been put in place have proved more effective and realistic in upper-middle-class societies due to their inadequate consideration of the realities of the poor and vulnerable people in our society. Although the government has made great efforts towards providing supplies such as food, dignity aids, and funds for the unemployed, these are by no means long-term or sustainable interventions. Some issues such as inadequate housing, and unemployment, go deeper and need long-term approaches that aim to address inequalities. Historical and present day structural vulnerability limits underprivileged people’s ability to “access basic needs such as food, medical care and proper housing”.[i] The legacy of the apartheid regime still exists as the most disadvantaged people live in low income and densely populated communities[ii] . This means that people are often unable to comfortably fit their entire family under one roof without sleeping toe to head. Communities that are structurally built to squeeze as many people as possible and provide foot-to-gate space in the name of a yard, make it difficult to keep one’s “social” distance.

These challenges have meant that most people living in poverty have not been able to adequately comply with these regulations. They are unachievable due to densely populated communities, and could further pose more danger in the event that a family member contracts the virus. The spread could be devastating for a whole family that is forced to squeeze into a small house/shack. It is important to acknowledge the more long-term and sustainable responses such as taps to provide running water for communities and other infrastructure that have been built during this time. This indicates that there is the possibility for more transformative interventions that will not only save the day, but provide security for generations to come.

Enforcement of Covid regulations

We have seen the “law” enforcement of these regulations in poor communities, taking a quick turn for the worst. “Legitimized” state violence and humiliation has put an added strain on vulnerable communities. Most people in townships, for example Evaton in Sebokeng, where official state offices are often a distance away, the time it takes to go stand in line for a permit and then go stand in line for groceries or healthcare poses a challenge. People often opt to go straight to their store or clinic, also hoping to not be outside long enough to meet the police or the army. Should one encounter the SAPS or SANDF on their way, they risk punishment and humiliation.

This form of intervention that has been adopted by some SAPS and SANDF personnel is reminiscent of apartheid state violence and the civil and political wars experienced by many of our clients, at the CSVR trauma clinic. The trauma from the past gets re-experienced in a process called traumatization.[iii] This should by no means be taken lightly, because oftentimes, unprocessed trauma makes its way down generational lines and results in what we see today in South Africa. A country ailing with trauma from the head down. I imagine there isn’t adequate context-sensitive and trauma-informed briefing and debriefing before, and during the deployment. Which would be a big oversight by the government. In fact, trauma-informed approaches should span to all areas of government due to our country carrying the burden of half cooked processes of rehabilitation. Therein lies the opportunity to begin to understand, empathise and intervene appropriately.

Dropping the ball.

I have found it particularly alarming that 424(as of the day I’m writing this), schools have been vandalized during the pandemic since schools closed. I wonder how this is possible with increased police and military presence, but an old lady selling atchar in Dobsonville is arrested because she does not have a permit? This is a classic example of letting all other balls fall and focusing only on one.

Furthermore, families are losing their livelihoods and corruption comes to steal from those most affected by the close of businesses, when they have no other way of making a living during lockdown. Unfortunately, the government has the responsibility to have its eyes and ears everywhere, at all times. Things like corruption, (where we see reports of mismanagement and theft of food parcels meant for communities, confiscated alcohol and other prohibited goods during lockdown being kept by the police, money being stolen from roadblocks)  need to be rooted out, pandemic or not because they continue to undermine efforts of “moving the country forward”.

The spotlight on mental health

Mental health awareness has already been gaining momentum even before the country and the world, was hit by this pandemic.  Since the start of the pandemic, greater levels of awareness on mental health have risen. I cannot open my internet browser without seeing an article on self-care, mindfulness or meditation. And I love it! In light of being forced to be alone or without the distraction of the outside (with the exception of the internet of course), more people are becoming aware of the self and getting to know and understand, hopefully, what goes on in our minds and hearts when we are not stuck in traffic or queues, or bars or school and work.  I believe I speak for all when I say, it has not always been easy. For some, like myself, a very comfortable loner and introvert, the breaking point hit much later. For some, it has not hit as yet, and perhaps the lifting of the lockdown may bring emotions of anxiety as the comfort of being alone is taken away from us. So don’t worry, you’ll get your share! Jokes aside.

We should always spare a thought for those who are already dealing with mental health challenges from the past. Those in continuous traumatic situations. Those who have experienced past trauma and find themselves, in a way, “back at the scene of the crime”. Those faced with the power play of policing, being trapped in a house with your tormentor (as in the case of child abuse and neglect, and domestic violence), being triggered and re-traumatized by loss of personal space, uncertainty and seeing soldiers with guns, being overwhelmed by stress as you fail to put bread on the table for your family. Dare I say, we all, in one form or other, can find ourselves in this category.

I would like to draw attention to the realities of mental health, particularly in South Africa. It is still widely viewed as a privilege and something that only affluent people and those with resources can access. A number of reasons would support such sentiments. The under resourced mental health clinics and hospitals in rural areas and townships[iv] and the lack of mental health services in most schools, also in rural areas and townships, coupled with the stigma that surrounds mental health. All these undermine the efforts towards normalizing mental wellness and providing effective and quality mental health services. The point here is that, whilst some people have to make tough decisions with regards to starting online therapy or choosing between telephonic or video therapy with their current therapist, others have no idea that help exists. Many are not aware that their emotions are normal and valid, and that they can, with appropriate interventions, gain a better understanding of themselves, and perhaps, heal from their pain and trauma.

A lack of understanding and normalization of mental health, may lead to appropriate emotions in response to the pandemic such as anxiety, fear, helplessness and despair, being expressed inappropriately in the form of violence, neglect, self-harm. This may especially be the case where individuals or families have existing pathologies of transgenerational trauma or limited knowledge about emotional regulation, which is the case for many South Africans.

South Africa is a wounded country, led by wounded leaders[v]. This is a reality and we cannot continue tiptoeing around these issues because they threaten the dreams for healthy individuals and society, and a developed nation. What we need in these times, is empathy[vi]! Empathy provides the basis of human connections, which in return, informs human interactions. The lack of empathy means that human connections are based on a lack of compassion and understanding, and thus the interactions that follow are self-involved and lack the ability to see, acknowledge and feel with each other.

 

As we approach the lighter regulations of the lockdown, we should think more about what this period has taught us as a nation. We hope that the leaders will be able to reflect on their interventions and re-evaluate their approaches towards the betterment of people’s lives and the country as a whole. There are many texts that have been written during this period as many have shared their thoughts, experiences and considerations, to provide some light as to what the people are feeling and thinking.

South Africa cannot afford to take a hit on its road towards an equal and just society under the guise of swift interventions to flatten the curve. When handling or carrying out interventions and regulations in the South African context, it is not possible to roll out a blanket response. Due to the fact that South Africa is an unequal society and those on the wrong side of this inequality have found themselves fighting for their survival and dignity. Regulations should speak to the realities and context and have more foresight for the implications of such regulations and interventions, not only on the economy, but on the society’s physical and emotional wellbeing, post Covid-19.

Written by Charlotte Motsoari

 

 

 

[i] Quesada, J., Hart, L, Bourgois, P. (2012). Structural Vulnerability and Health: Latino Migrant Laborers in the United States. Medical Anthropology 30(4), 339-62. https://doi.org/10.1080/01459740.2011.576725.

 

[ii] Botes, T., CHOCHO, L.M.S., KELLOW, G., ENGELKING, E. B., KHOFI,  L., BOSIRE, E., COSSA, ., MALOPE, D. (2020). How A Pandemic Shapes The City: Ethnographic Voices From South Africa. Medical Anthropology at UCL. https://medanthucl.com/2020/04/10/how-a-pandemic-shapes-the-city-ethnographic-voices-from-south-africa/

 

[iii]  Retraumatization is a conscious or unconscious reminder of past trauma that results in a re-experiencing of the initial trauma event. It can be triggered by a situation, an attitude or expression, or by certain environments that replicate the dynamics (loss of power/control/safety) of the original trauma.

 

[iv] The South African Anxiety and Depression Group reports that there is only one psychiatrist for every 390,000 people in South Africa. Furthermore, two thirds of South Africa’s psychiatrists are employed in private practice.

 

[v] Mogapi. N. (2018). Cabinet Reshuffle: Wounded leaders, leading a wounded nation. Daily Maverick. https://www.dailymaverick.co.za/opinionista/2018-02-27-cabinet-reshuffle-wounded-leaders-leading-a-wounded-nation/

 

[vi] Empathy is the capacity to understand or feel what another person is experiencing from within their frame of reference, that is, the capacity to place oneself in another’s position.

The intrapsychic pandemonium of a global pandemic

Exploring the psychological impacts of the COVID-19 pandemic has dipped into both my intellectual and empathic reservoirs. It has challenged me to ponder upon my professional and personal journey with trauma. Firstly, it is important to acknowledge that the majority of global society has experienced at least one major trauma in their lives. That is the part of your being that I hope gets to read this – the part of your being that is able to connect with these words from a human perspective. Secondly, it is important to acknowledge the trauma that has been caused by the severe acute respiratory syndrome corona virus.

There isn’t a need to delve upon the physiological impact of contracting the virus. That has been discussed, and information has been widely disseminated. What seems to be the quieter conversation is the psychological impact of living (or dying) through the pandemic. Granted, our journeys will all be different, and how can they not be? There are people who have experienced complex trauma. There are people who have experienced trauma. There are people who have not experienced trauma. There are people who don’t know.

Reflecting on some of the conversations that have been shared with survivors of trauma, I am burdened, intrigued, and empowered. There is something about the corona virus and the subsequent lockdowns and restrictions that are akin to a political war. As we sit in our homes, we are reminded that our homes are no longer just homes. They are both our prisons and our places of refuge. They are now the structures that have been given the mandate to keep us safe from this plague. We sit in our homes, with the illusion of safety. But, are we really safe? What are we even staying safe from? There are no gun shots to remind us that there is a threat to humanity. There are no screams of fear and terror to be heard, but the dread is there. This equation does not balance. Have our autonomic responses been tampered with? Fight, flight, or freeze, right? What options do we really have? We are frozen, imprisoned by an invisible war that attacks us – not through bullets or grenades or machetes, but through contaminated respiratory droplets. Our quarantine partners, friends and family, those who we stay at home with may be the very people who could cause us the most harm, and vice versa. Our family systems have been threatened and our safety nets have been broken.

So as the calendar dates change every 24 hours, to many of us, they freeze in this war. In this intrapsychic conflict, we can’t fight, we can’t flee, so we freeze. Our limbic systems work in overdrive in response to this imminent threat, this ongoing trauma that is working precariously in our unconscious. Many are in survival mode, as the hypothalamus codes what it can. If you have experienced trauma in the past, your trauma response patterns may be recalibrating. This is why we are all responding differently. This is why even within ourselves we may not have the ability to contain our emotions consistently for a long period of time. We are unpredictable even to ourselves…and why not? The world’s predictability has been reframed into statistics of infection, death and recovery [repeat].

Institutions are closed and the streets are deserted. The roar of industry is a distant whisper. As we acknowledge both the collective, and individual trauma that this virus has inflicted, we begin the journey of healing. For the most part, we are uncertain of what it will look or feel like. There are so many dynamics and projections, that it is difficult to know what stage of trauma you are fighting with, fleeing from, or freezing in. It is a journey of knowing that the outside world may eventually reflect some semblance of “business as usual”, but we as human beings are forever changed.

For those of you who have embarked on a battle against complex trauma before COVID-19, I salute you. I salute you for existing and functioning in a traumatic space where you didn’t have the “comfort” of the entire world experiencing it with you. I salute you for receiving empathy, when even your words were never enough to express the fear, and the loss, and the grief. There are many whose trauma has been triggered and there are flashbacks, nightmares, and memories resurfacing of the wars and crimes against humanity, the outbreak of Ebola, the spread and stigma of HIV, the fight against hunger…… To some, this pandemic has a texture of normalcy. To some, there are wounds that have been re-infected. To some, their privilege will see them through.

There is something about working therapeutically with trauma that has been enlightening. Some of my recent existential moments have been inspired by the narratives of the precious and resilient people who have been violated by the injustices of the society that we all live in. I dedicate these words to those people. May their lives remain powerful enough to force us to stay human as we continue down the yellow brick road…

Written by Amina Mwaikambo

Healing the healer

We travel to unknown places – arid, devastated, or even dangerous – both physically and psychologically. We carry this big basket of hope, of life, of sanity. With this heavy basket, we jump through hoops, crawl up walls and are often met with hostility and suspicion, an uncertainty about this new form. We are met with resistance from the wolves in sheep’s skin who are nourished by the vulnerability of the flock.

In the basket, there are parcels of strength and empowerment. There are tools to clear the cobwebs from their dreams and hopes for a future better than this, and a quietening of the noise around to reach serenity within. With the basket in tow, we travel to meet those who are at the edge of their cliffs.

Upon receiving the honour, to trek through the ebbs and flows, to leap through the hoops, and crawl up the wall with this heavy basket, in order to touch those who have reached their limit, we present the parcels and lay out the tools. We seek not to impose, but to tread with caution approaching the lion with a thorn in its paw. We seek not to offend, but to acknowledge, reflect, validate and normalise.

We have swollen faces from turning the other cheek, and soiled lips from kissing “you-know-whats” in order to be allowed to leave an individual, well, Human. We return home. We kiss our loved ones “hello” as they celebrate our return, but we all know we haven’t really returned. We never do. We are never at the point of reclining and putting our feet up. We never allow ourselves. We all know that with bruises barely healed, the soil still grinding our teeth, we’ll be refilling this basket once more, for those we left at home. This healing business is not a part-time occupation, we do it in all corners of the world, including our own, at all levels of consciousness.

We walk into the office, normalised fatigue and all. “Take a self-care day” is the song on our lips and all shall be well. But we don’t know how to practice self-care for ourselves. We hardly do it. We assume that we are automatically attuned to our internal world, and inner peace because we work with others’ internal worlds and help them to stay attuned. Meanwhile, all along we’ve been ushering others to the river without ever stopping for a sip ourselves.

Lest we forget…“you cannot pour from an empty cup”. What makes us great healers, is our humanity, our ability to feel. Let’s be human, and feel.

Refill, restart, reset. Allow yourself to pause, even in chaos. Do not only focus on helping others to regain their equilibrium in a time of turmoil. It is okay to centre yourself. For your benefit, for their benefit. “Breathe beloved”. Heal the healer.

Dedicated to the millions of healers around the world.

By Charlotte Motsoari

 

When only a piece of paper might let you see me…. and even then you may decide that’s not good enough

The influx of displaced people the world over has increased in recent years, with more than 68.5 million displaced people globally and more than a million nationally (UNHCR Report 2017). Of course this number doesn’t capture the true reality of people on the ground as many displaced people are undocumented and so may not be included in the statistics. Individuals migrate for various reasons, some economic, others political. Whether economic or political they come seeking refuge, seeking a better life in another country.

In the past 2 years, listening to refugees and asylum seekers relate the stories of their lives in South Africa, there is a common thread of not being recognized, not being acknowledged and not belonging. Individuals speak about being in the country for 8 or more years and still falling under an asylum seeker permit, or worse receiving 1-3 month extensions. Or their legal documents expire and are not renewed, leaving them in a state of fear, as they fear being arrested for being undocumented and being detained and sent back to the very place they left for fear of death. Our clients live in a state of uncertainty, fear and confusion. They wake up every day and participate in a society that has not yet decided if they belong.

They do not possess the documents that allow them to fully participate in society, that allow them to receive health care, that allow them to have a stable job, that allow their children to get an education. They are the shadows in the dark. They do not want to be seen for fear that you will ask who they are and though they know who they are, they don’t have the right piece of paper to make you believe them or want them.

Taking into account xenophobic attacks in 2008, 2015 and most recently in Durban (2019), this communication of ‘you don’t belong’ is getting more direct, more aggressive and more violent. And though 2008 and 2015 are significant markers of xenophobic violence, the reality is that xenophobia occurs every day in our society: Through the way society engages with labels such as ‘makwerekwere’; perceptions that ‘you foreigners just come to have babies here’; and projections, ‘you come to take our jobs’. Does the othering defend against our own inadequacies as a nation? Can we and do we want to sit with those inadequacies? Realities that poverty, unemployment, corruption in government, poor service delivery and divisions still exist in our democratic, post-apartheid, rainbow nation South Africa? Is our Ubuntu only for those who possess a South African ID?

I have papers (dompas) officer

I am flesh, I am blood

I am emotions of pain, fear and sadness

I also possess the ability to laugh, smile and feel joy

I am human or have you forgot

Because the paper that I hold says refugee

Because the paper that I hold says seeking asylum

Because I hold no paper

Have you forgotten that my veins are blue and my blood is red

Have you forgotten that I too have a family and want the best for them

Have you forgotten that I too feel hunger pangs

And worse pain when I see my baby crying from the same hunger pangs 

Because my paper doesn’t allow me to work a stable job with benefits

Because my paper doesn’t allow me to think of a future beyond this week

Because I have no paper

You have forgotten my humanness 

You have forgotten we are one human race

You have forgotten I have the same human rights like you

You have forgotten your principles of Ubuntu

And so I lurk in the shadows with hopes that you don’t see me

Because even if you do, I don’t have the right paper for you to see me

Not as a refugee, asylum seeker

But as you see yourself: human, belonging, deserving, a mother, a father……

 

Written by Sumaiya Mohamed

Beginnings and premature endings: A therapist reflection on termination in therapy

The process of termination in therapy is often one fraught with intense emotions for both the client and the therapist. I find that this can become increasingly more intense when terminations are premature. As I therapist I feel incredibly guilty when I have to terminate with a client before we have done all the work together that we could have.

In the context in which I work where the majority of clients have experienced horrific losses and often feel unsupported, isolated and alone in their worlds, I always feel like I am playing into this dynamic and their sense of abandonment when the time for termination arises. But the reality is that as a therapist, we cannot be with our clients forever, we cannot assist our clients on their journey to healing to the extent that our minds and hopes desire. Nor do we have that control over things. But as a therapist, it is hard when I feel that I have not done what I could and that I am making their process of healing even more complicated. However, it is also all MY voice that feels that I am at the centre of the termination. As if I am letting the client down or that I am abandoning them. But the truth is that I am not the most important element of this process.

There are times when I have had to prematurely terminate with clients, but despite what I felt in the room, I allowed them to say they are fine and that they understand why this is happening and in doing so I facilitated their avoidance of what this ending may mean. This is particularly important based on how I work as a therapist within the context that I do. Due to all the contextual challenges clients face, we often sit in a space of crisis management and help in the avoidance of the difficult feelings and memories attached to traumatic events and the circumstances that have led them to therapy. Avoiding avoidance, so to say, is necessary to navigate the unfolding of the therapy process, which can lead to beautiful insights.  In doing this there is a relationship and trust that forms.

Furthermore, in the context of the work that I do where it can often be difficult to do pure therapeutic work, the foundation that I have worked from is trying to allow my clients to see that they can trust another human being. In doing that they can try and get the support they need to get through the difficulties and challenges they face. But trying to translate this into practices outside of the therapy room is a long process. So when I terminate before this point I feel like I have not finished what we started together.

And this is the position I find myself currently in. I have endured premature terminations before, but I have found that this time some of them are a lot more intense than previous ones. In reflecting on this, it is clear that it is the depth of where we have gone together in the therapeutic process, the level of trust created in the space together, the things that they have never explored with another before and those are the things I have taken and held but am handing back and leaving them with before they are entirely ready. So, in sitting with my feelings of guilt at having to tell my clients that we were ending and feeling the need to make it a pleasant and easy process for them, my supervisor pointed out something important: That through the process of therapy and in ending we cannot be the all good object but if the process of termination is handled properly I can hope to leave my clients with the ability to integrate good and bad in one object. That through this they will be able to hold onto the good parts after the termination and remember the things they need to when facing challenges. But that if I don’t and we don’t think and talk about the difficult parts then they will either shut that off and may see me as an entirely bad object and in doing so never access me (and the things done in therapy) for support in the future.

So in introducing the terminations this time around I was horribly aware of needing to do this for my clients. It was difficult sitting in the room being told I am ‘breaking a heart’, or that I am ‘loved and in leaving will create an emptiness’. The pain in this at times became almost unbearable and I wanted to run away, but sitting in it and tolerating it was what I needed to do. So for sessions we spoke about the imminent termination date and the difficulties related to it. But through this process we also spoke about the things that helped make sense of it and in speaking about it I could see the shifts in my clients. When my one incredibly emotionally avoidant client could articulate that he was sad about us ending I felt such happiness. Through difficult moments there can be moments of such intense beauty and growth.

I have reflected on this in relation to my own personal spaces, such as therapy and supervision, that have pushed me to spaces I have not wanted to go but places that I have needed to in order to grow. There is a sadness and beauty in ending something that has allowed a sharing of parts of you that are hidden to the rest of the world. What those spaces have shown me is that the hard, difficult and broken parts of me can be shared with and tolerated with another human being without them hurting me, judging me or running away. So a termination is like the end of a movie, there has been a story together and difficult choices made but that in the end the final decision is to leave and say good bye, the ending is inevitable. But in saying good bye, the memory does not leave. Through the difficulty of it there is a growth that occurs and there are parts of both of you that are changed forever.

Written by Jacqui Chowles

#MentalHealthMatters

1 in 3 South Africans will suffer from a mental illness in their lifetime (South African Depression and Anxiety Group)

Suicide is the second and “fastest growing” cause of death amongst 15-24 year olds (Mental Pressures can force youth into suicide-Karabo Ngoepe-Sunday Independent News).

Today marks World Mental Health Day, the theme for this year is ‘Young People and Mental Health in a changing world’. Reflecting on this theme, two thoughts come to mind: the increase of suicide rates amongst youth in universities across the country; and the stigma of mental health which continues to persist in our society. As a psychologist working with youth, depression is noted as a common feature, and as we hear more and more about youth suicides, there is a need to explore and understand the links between depression, youth and suicide in our society today.

Speaking to various mental health practitioners in the field working with youth, discussions have been around the societal pressures that youth face. The pressure to be smart, fabulous, a slay queen on social media, a real man, a successful academic. These pressures combined with financial pressures and limited social support structures has an impact on youth’s ability to navigate their social and personal world. Other practitioners have had conversations with youth, who have related their mental health struggles to issues of worth and purpose. As youth, feel they have no role to play in society today. In comparison to youth in the past that fought for Freedom. Highlighting an identity crisis where society cannot grasp what they are becoming or what is needed for them. They are referred to as the ‘millennials’, often thought of as lazy, not as robust as the generations before, having a sense of entitlement and lacking a hard work ethic. And the more connected they are through social media and other platforms of connection, the more isolated and disconnected they appear to be from their peers and even more so authority structures such as Universities, Government and even social support structures in society. Youth have found it hard to take their struggles to these platforms, feeling people don’t care, youth are seen as not doing enough, ‘the generation before did it why can’t you?’ And this often leaves them feeling alone and stuck. Reflecting on the incidents of suicide in this year amongst youth, many thoughts of why come to mind. Didn’t they have a friend to speak to? Someone to hear their cry? No one just decides to kill themselves, depression has a starting point and intervention can make a difference. So why is intervention happening too late or not at all.

The silence around mental illnesses is still a major problem in our society. And more so amongst our youth. As mental health issues in youth are often brushed aside (‘you will get over it’; it’s just a phase’), misunderstood and not received empathetically. As youth report that they are seen as weak if they are not coping, or pretending to cope. So they suffer in silence, attempt to manage their difficulties on their own and are not accessing support structures available to them. Raising awareness to decrease stigma is important and a starting point to get people to talk about mental illness. The more it’s talked about, the more it can be normalized and a part of conversation in society. Not seen as something that has to be kept a secret  and that if people do find out, will think you ‘crazy’, incompetent, not strong enough. How do we go about doing this? How to raise awareness and acknowledge mental health and illness as a part of the human experience and not something alien to us that has to be hidden, shunned and ignored?

I think it starts with each one of us, taking the time to educate ourselves, to understand mental illnesses and each other and not judge. To create safe spaces amongst ourselves, peers, families and communities to acknowledge the experiences of each, whatever that may be and engage with it, with empathy.

Today marks World Mental Health Day, this month marks World Mental Health Month, but the importance of mental health on us as individuals, families and communities is ongoing and requires ongoing attention, advocacy and support.

There is no health without mental health (World Health Organisation)

Written by: Sumaiya Mohamed

Not all pain is physical-Not all wounds are visible-Mental Illness is real

Growing up in South Africa, Swartruggens in the North West Province, my understanding of mental health was vague, I knew it related to the medical sphere and that medication could be used to treat it but I didn’t fully grasp the complex nature of its causes, symptoms and impact on mental health patients, their families and communities. I think this relates to a common stigma in our societies around mental health, where mental health patients are viewed or labelled as ‘ditsenwa’ in my language, which loosely translated means crazy. I feel this stigma comes from a lack of understanding of mental health. Physical illness is better understood. It is seen, it can be bandaged, and the healing process is visible. Whereas, mental illness is felt primarily by the mental health patient, it takes medication and something intangible like therapy to start the healing process. Thus, what has been a problem in many different societies is that there is limited knowledge on mental health and its detrimental effects on one’s functioning, health, wellbeing and increased stigma in seeking help.

In society today we are constantly see a lack of understanding and empathy with regards to mental illness itself through the gruesome events and human rights violations of the mentally ill, noted at Life Health Care Esidimeni. Facilities that are available are either not well equipped, service providers lack the knowledge in health care related to the field or just deliberately ignoring people’s rights to health care. We really need to re-evaluate ourselves as a nation because such neglect clearly shows the lack of respect for human life and the effects of that neglect on the vulnerable in our society such as mental health patients and their families.

October is mental health month and the aim of this month is to raise awareness on mental health in the country and to reduce the stigma attached to it. According to the South African Depression and Anxiety Group mental illness is on the rise countrywide with adults ranging from 16.5 % and children in the Western Cape alone ranging from 17% (SADAG, 2018). One in five people will suffer or are suffering from mental illness and the problem in the country is access to facilities that can assist in the treatment of mental disorders such as depression, anxiety, substance abuse and socio-economic stressors (SADAG, 2018).

A while back, I was listening to a radio program and the topic was based on an individual who had committed suicide due to debt, high stress levels and inability to cope. While listening to the show, the views on the person’s suicide caught the ear of many locals and everyone had a similar opinion that people who end up committing suicide are just lazy, not thankful for the life they have and they lack a “back bone” to face life. The assumption is that one is weak if they commit suicide, stress is not seen as something as important as physical illness. And many people lack the knowledge on what mental illness is, similarly to the concept of depression.

Coming to university in 2015, mental health was a topic from the first day of orientation. In their description of mental health they summed it up as one’s general wellbeing. Being well and balanced in the body, the mind and the spirit and in achieving this one has to understand and practice self-care. Students are one of the populations that are faced with mental breakdowns and mental health issues and as a result this has led to many students either using harmful substances as a coping mechanism or committing suicide.

I have proposed a question to my fellow colleagues and lecturers on how does one practice self-care and maintain balance when there are no support systems to guide them in that process? In my personal experience I’ve had to talk myself out of dropping out of school countless times, feeling like I do not belong in this prestigious university. I have had suicidal thoughts. Every time I was going through those phases and feelings I would wish for support from my family, and some sort of understanding from the University. I spent days explaining to my mother and siblings the importance of them checking on me. The importance of just sending an encouraging message or a message of love and care because countless times I felt alone in University and contact from them was what I needed to just get through the day.

We are all members of some system or another and the most primary of all is the family and the school environment and both of these systems are important as support systems. However the family systems in some communities or societies have the assumption that support is financial, neglecting the emotional aspect of it which is vital to one’s mental wellbeing.

The school is another primary system of socialisation where mental illness such as depression is prevalent. In South African schools, specifically with reference to public schools, I have recognised that there are limited support systems such as counselling services which are important to assist learners with the different issues they are facing in their developmental years. Anger is one emotion that they are unable to control, bullying is on the rise and many of our learners resort to violence or to committing suicide as a solution. There needs to be interventions to assist, educate and support learners, a place where they can feel free to talk about their issues without judgement.

We are seeing devastating news in institutions of learning daily. Learners are killing each other and their teachers, there are high rates of teenage pregnancy and substance use and school drop outs. In the University of the Witwatersrand this year alone there are more than two cases of suicide with the most recent occurring on the 19^th of September 2018. Many social issues need intervention from the government but there is neglect on children and the youth’s mental health and wellbeing because of the assumption that children are unable to feel stressed or overwhelmed or affected by any issues. Interventions have to be done from grass roots level from as early as primary school because depression is real, it is on the rise amongst our youth and taking from us on a daily basis.

At the same time we should not neglect that the workplace is another systems that people are a part of. There needs to be awareness and the need to understand that the workplace is one area or system that affects mental health as well. Companies have to provide wellbeing or wellness programs aimed at ensuring that people are functioning well because work can be stressful and at the same time employees do not exist in isolation, there are family related stressors that employees need to understand and be aware of, to empathise and provide services that will aid employees. A healthy and happy employee is a productive employee and therefore the company or business or any working environment will benefit also in ensuring good mental health for their employees.

It should be recognised that a month alone to raise awareness on such an important issue as mental health is not enough. Discussions and policies that will be implemented have to take place as a way forward and funding has to go into organisations that can assist not only in urban areas but in rural areas, villages, townships etc., that will focus on helping people country wide. We need to build a society that cares for the wellbeing of its people so that growth and development can occur.

Written by Julia Makganye (Social Work Intern at The Centre for the Study of Violence and Reconciliation)

Reference

South Afrcan Depression and Anxiety Group. (n.d.). Retrieved from A South African Depression and Anxiety Group web site: http://www.SADAG.org.za

 

Who has the right to fight for gender equality vs Who should fight for gender equality?

With the beginning of August came the beginning of women’s month in South Africa. As the month came closer one found oneself having more and more conversations, both personally and in work spaces, about the inequality that exists for women, particularly in our country. This year was also slightly different in that to initiate the start of the month there was the #totalshutdown march that aimed to highlight the challenges faced by women and gender non-conforming individuals and call an end to it. In relation to this there are two main elements that I have been thinking about,  the state of feminism in the country and across the globe, as well as the separation in both calling an end to and perpetuating the cycles of violence against minority groups.

I am a self-identified feminist (but by no means a theoretical expert on the topic) but in various ways have been told that I am not. I was told that what I actually am is an equalitarian and that I do not dress the part because of the fact that I wear feminine clothing, like the colour pink and shave my legs. This made me search further into the definition and understanding of feminism and if perhaps I was wrong and that perhaps it is not what I am. What it did highlight is how differently people understand the term and how many feminist schools of thought there are. Truly, as an introduction to this, the talk that resonated a lot with me in relation to how I make sense of it in my day to day life was Chimamanda Ngozi Adichies’ ted talk “We should all be feminists”. (https://www.ted.com/talks/chimamanda_ngozi_adichie_we_should_all_be_feminists/transcript?language=en)

But through all the discussions of what is feminism and how we define it, what is also particularly noticeable is the separation it creates. Because the very basic definition of it is, “The advocacy of women’s rights on the ground of the equality of the sexes.” But somehow we determined that men cannot be feminists and that they are very often excluded from the conversations around gender inequality and gender based violence.

This starts then perpetuating a hierarchical structure as to who is allowed to be part of the conversations and whose opinions in it matter more. As a privileged female, the assumption is that I face less/different challenges related to gender equality than someone from a different social class or sexual orientation. And based on this my contributions are limited and perhaps seen in a specific light. So even though I am a feminist, I am not as much of a feminist as another. What I would like to relate this to is what Eckhart Tolle[1] writes about as the current state of insanity of humanity and the elements that contribute to the perpetuation of violence within the world today. There are various factors that he speaks about in relation to this, but one is the need for us to create power dynamics and make ourselves feel superior by making someone else feel inferior. Furthermore, that if I feel inferior I will attempt to find something to make myself superior to another in order to feed my ego and feel a sense of power.

So how do we consider this in relation to gender equality and those involved for the fight for it? We exclude normative men from the conversation and tell them that it is something they have no right to speak about because as women this allows us to regain some sense of power that inherently we don’t have based on the patriarchal structures of society. Then within the remainder of us that are allowed to discuss it, we perpetuate this pattern by claiming, that as a certain group contributing to the movement, our challenges and contributions are worth more than another’s. So that even within an overarching movement that is fighting for equal rights we create separation and exclusion to find ways of regaining our power. I do not say this in a blasé manner that is aimed at taking away or diminishing the different experiences that individuals have experienced, but as a means of highlighting the separatism that we perpetuate to the exclusion of many whose involvement may be imperative in shifting the discourses and behaviours related to gender equality. I do not believe that by solely empowering women or minority groups we will end gender inequality. For women to gain power men also need to relinquish some of their power. They also need to be a part of the change so that the power differentials disappear and we can be equal. Because the other side is that it is determined that the only way of gaining this power from men is to take it by force, which then ultimately contributes to a further perpetuation of violence.

For me this separation was also highlighted in relation to the people in my life and society that participated in the #totalshutdown. My friends that work in corporate South Africa did not know about it until I told them about it nor did their companies support their participation in the march or requested activities of the day. This is challenging in that there is the growing awareness and attention to the  high levels of gender inequality, sexual harassment and perpetuate patriarchy in the work place across numerous sectors. They need to be involved in the change that is needed.

So the question I raise is, how does everyone become part of the change that is required to create a gender equal society?

Written by Jacqui Chowles

[1] Eckhart Tolle A New Earth

She’s too small to think

A common phrase I hear working with parents is, ‘she’s too small to think’, ‘they’re too small to understand what’s happening’, don’t worry about them, they don’t understand’. And because they don’t understand and are perceived as lacking the ability to think and understand what is happening around them, they are fine and we don’t need to worry about them. We don’t need to worry about the time I was attacked in our home and they sat by screaming for my attacker to leave me alone. We don’t have to worry about the time they walked in on me trying to commit suicide. We don’t have to worry because they too small to think and they will be fine. This often takes me back to the way I was raised, whereby “children should be seen and not heard”. These are the ways of thinking that I carry with me based on my upbringing and they only started shifting and changing as I studied psychology and got to understand more about the internal world of a child and their development. How so much of what happens in early life shapes and forms that child’s adult life.

Over the past 3 years the CSVR Trauma Clinic has evolved to include family interventions into the work that we do, based on the impact of the trauma on families and children specifically. Witnessing the impact of trauma and poverty on a parent’s ability to be emotionally available for their child, the ability to create a holding environment for a child: one in which they can be understood, emotionally nurtured and psychologically held has become more and more of a challenge in today’s times, which has further broadened my understanding of development especially in relation to the context in which children are raised.

So now as a therapist sitting with a parent and their 2, 3,4,5,6 year old child in a room. I see curiosity in the eyes of the child as mum talks, a glance towards mum as her voice softens and a caressing of mums face as tears fall. And I wonder, what is she thinking? What are the messages she is receiving from her world and how are they understood? When her ability to think, comprehend, have a mind and the impact of her context on that mind is questioned. And how do I try and translate my understanding, that what is happening around the child is having an impact on them, especially when the parents are sitting with numerous contextual challenges and their own traumas?

Looking at the current situation beyond the family, whereby immigrant children are detained in South Africa and the United States, it seems that this lack of concern for a mind of a child, a child as a being, is not only one that is held by families that are traumatized but by societies that are traumatized and is something that fits in with the historical legacy and societal norms of how we have thought about children that continue to be perpetuated. Holding in mind the importance of early childhood development, the nurture versus nature debate comes to mind. Reflecting on our current societies, and the processes of socialization that children are being exposed to at a very young age (detained migrant children, sexually abused children, cyber bullying, violence in the home and outside the home), as well as the limited parental and societal understandings of the impact of this on the child.

So when we have parents, societies and countries that unable to hold and contain children, how does the un-held, un-contained and wounded child develop? And what impact does that have on them in their adolescent and adult life and the ways in which they can contribute to society?

And this becomes the crux of the matter. Research done by CSVR on the drivers of violence which include structural and community level factors (socio economic inequality, gender and masculinity, lack of social cohesion, alcohol and firearms) helps make sense of the reason why providing an emotionally nurturing environment for children is a challenge. These ‘drivers’ which are predominantly evident amongst the most vulnerable and marginalized of our society, have an impact on family relationships, infant development and parenting. Thus, contributing to the cyclical nature of violence. As families in poverty, have mouths to feed, basic needs to meet and emotional bonding, psychological holding, nurturance through acknowledgement has to wait. There is no choice. We have undergone trainings, workshops and sat with many perspectives in relation to family interventions and one thing that stood out was, Attachment is Everything! Early attachment can be seen as the key to understanding many of the individual, familial and societal challenges we experience today and this links strongly to the continuous perpetuation of cycles of violence.

This was further highlighted in a talk by Dr. Clinton Van Der Walt, titled, ‘Formulating violence as a response to dysregulated and distressed mental states’ at EPASSA (Educational Psychology Association of South Africa) annual conference this year, where he highlighted the importance of attachment disruptions and trauma as major contributing factors to the development of violence, as he states that, ‘dysregulated children become dysregulated adults haunted by the ghosts in the nursery’. So as generations to come are exposed to violent, un-held and uncontained environments will they continue to express violence as an appropriate response to levels of despair, inequality and disempowerment? Reflecting on our youth, we find a generation riddled with feelings of hopelessness, helplessness and despair steered to crime and interpersonal and self-violence. And a society who looks upon this generation with judgement and vitriol, further othering them and entrenching their feelings of worthlessness and inferiority. Contributing unconsciously to the cyclical process of transgenerational trauma, poverty, mental health challenges and violence.

Taking this into consideration, I ask, is enough being done at an early intervention level to prevent violence?

These concepts are spoken in length about at academic and elite levels, yet are only trickling down in small ways to a grass roots level. Why? A lot of good work is being done in the field of early child development. Non-governmental organisations such as Ububele and Seven Passes Initiative, whom work with children, families and communities highlight the importance of attachment relationships with primary caregivers as the key to emotional development and provide this through various interventions. There are prenatal and post-natal classes offered to pregnant women. However, these early methods of intervention are only accessible to the minority of the population. Therefore, with some amazing interventions out there that have been shown to help and create the change that is needed in our current society, why are there still so many challenges to implementation on a larger scale? Why is this something that has not been prioritised by government?

So no, I don’t think enough is being done at an early intervention level in relation to the prevention of violence. Why are we not investing in our youth? Why are we not investing in our children? Helping them to create a violent free society by helping them to manage their own emotions and make sense of them.

Healthy individuals contribute to health families which contribute to health societies.

Written by: Sumaiya Mohamed, Jacqui Chowles and Celeste Matross

Grief: It’s a journey

Loss is a part of everyone’s life. It comes in different forms, such as, the passing on of a loved one, repossession of our material belongings, loss of status or relationships ending. How do these losses impact on us? How does the taking away of things we hold dear, things that function as extensions of ourselves affect our sense of self? Working in the field of trauma, loss has become a common concept that I grapple with each day. In trauma literature it is often said that trauma ‘shatters’. It shatters the way one looks at and thinks about the world, others and self. With that shattering, one can also argue comes an additional loss. A loss of a world known, loss of trust and faith in people and most significantly loss of self.

As I reflect, I have lost so much in my young life. Some things I found after many days of searching and some were never regained. The way in which I lost these belongings of mine has been different, as in some cases I did the losing and misplacement; and in other cases, things were taken from me by force, taken without my permission or me even knowing they had been taken. Each time I grieved and hid from the world, because it hurt too much. As a consequence I was not present and never got to be grateful for the people and things that were not gone. I have lost money to carelessness and theft; cell phones and laptop to muggers and burglary; I have lost friends to different locations and time; I have lost family members to life and death; and I have lost boyfriends to betrayals and unrequited love. Each time I thought I would not recover, but I would make more money and find a new boyfriend and so life would go on. For those things and people I have lost forever, slowly I would learn to live without them, even though I still feel the gaps in my life that their presence once filled.

Elisabeth Kubler-Ross in her book titled, ‘Life Lessons’ (2000, p.75) said that “we eventually lose everything we have, yet what ultimately matters can never be lost. Our houses, cars, jobs, and money, our youth and even our loved ones are not ours to keep. But realising this truth does not have to sadden us.” I struggled and still struggle with that statement and I read this book about 10 years ago when I had experienced a loss in which I felt overwhelmed with grief. Searching for some understanding of this feeling following my experience of loss, I searched through different books and came across a British novelist, Clive Staples Lewis, who for me captured that overwhelming feeling of my grief in this way “it feels like being mildly drunk or concussed. There is a sort of invisible blanket between the world and me.” I mean this author captured so much of the grief I felt. He says, “who knew that grief felt like fear”, he continues to talk about the spells where one convinces themselves that they don’t mind the loss; and moments when things make sense, when in the end what you prefer is the agony because it is authentic. The author describes the self-pity and wallowing and laziness that comes with grief and the shame.

When I came across these words, I had lost my grandmother, who was everything to me; my pain was so raw that nothing made sense at all. This loss had split me into thousands of tiny pieces and I did not know how to put myself together. I had lost a sense of self. I was still alive and yet this loss made me feel I had died too. All those emotions and behaviours described by Lewis is what I went through. I don’t know why I felt the sense to write on this subject after all these years, perhaps it was finding Lewis’ book and his words resonating with me, or perhaps it is seeing this kind of loss and grief in and out of my practice. And even though I provide ‘talk therapy’, I know that words cannot capture the loss and grief in the world, others and the self. The feeling of grief and loss is inevitably an experience that is felt and needs to be felt. Another author I came across during my search for comfort and understanding wrote, “It doesn’t interest me what planets are squaring your planet. I want to know if you have touched the centre of your own sorrow, if you have been opened by life’s betrayals or have become shrivelled and closed from fear of further pain. I want to know if you can sit with pain, mine or yours, without moving to hide it, or fade it or fix it.’’ Oriah Montain Dreamer (1995: 35).

It came to me 10 years later that people come and go and we should cherish the moments we have with them. Healing began when I started to remember the good and the bad times that I had with my grandmother, the songs we sang and how we danced to the tune that is life. I am what I am because of her and not only did I find comfort, but I found courage and strength to go on. However, there is something endearing about loss in whatever form it comes, one looks at the ‘what if’s’ or ‘I wish you were here’ moments and even in the ‘they’re not here moments’, still life goes on. I now know that we do not lose things and people all at once, we lose in degrees. I mean, 10 years later I still wish my grandmother’s wisdom on child rearing was around. I am quite certain that I will still lose a lot in my life, because loss is typical of life, but I will not go and hide. I also know that I will be saddened by it, but because of this grief, will in turn forever learn to strive to appreciate each moment I have with the people; time and possessions I have right now. What will you do when loss enters your life?

Written by: Thembisile Masondo

A Community Awaken

As a community practitioner working within previously disadvantaged communities and with vulnerable individuals, I reflect on the current status of the political arena in South Africa and the dependence on political leaders to heal us as a nation. And I wonder if we have forgotten our own power as people, as communities, as families.

I have been working in communities for the past 10 years in CSVR and have experienced a lot of love, laughter, heartache and tears but overall a lot of urge for change and togetherness, operating from a place of resilience.

I have been witness to the untold stories, some traumatising and some healing and this has inspired me to write the following poem: ‘A Community Awaken’, which I share with you below.

This poem touches on the idea of a rainbow nation Nelson Mandela once envisioned. Even though a lot of communities have not healed or received the help to heal from the apartheid era, they are still hopeful and working together for a means to healing.  As a community practitioner I don’t often engage in academic forms of writing, and thus I saw this space fit to at least try and capture the untold stories.

Life in South African communities have untold stories, powerful stories of resilience and perseverance, that we could look to, to find our power to create the change we want to see in years to come…

A Community Awaken

Give me  back my yesterday, I am today,

Standing still in the dusty areas of Mzansi!

Fighting for my freedom,

In the 9 Provinces!

Wakeup – Wakeup.

I am priceless, I might not look pretty

But I give life to the lifeless, hopeless and the forgotten

Looking at you from afar feels like I’m miles away from You!

Wakeup – Wakeup.

Mothers, Fathers, Children; South Africans and Non-Nationals

Together we celebrate your breath

The Spirit of living and walking in the noisy street

I enjoy the enchantment of Ubuntu, Laughter and Love

A CommUnity Awaken!

Wakeup – Wakeup.

Sorrow and Tears may come but they don’t stay forever

Service Protest, Killings are part of the daily living

But I don’t get discourage by these trivial events

We will heal in Time!

Wakeup – Wakeup.

The outcome of having life and joy,

Celebrations and ululations is the order of our days

I have drunk all your passion, devotion and Living unity

Move outside the tangle of Fear-thinking!

            Wakeup – Wakeup.

You who has produced lots of teachers

Doctors, nurses, community practitioners and lots of professions

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        CommUnity Awaken…!

By Tsamme Mfundisi

Sitting with the wonderful and the tragic within us

‘Strike the women and you strike the rock’-I recall hearing these words as a young girl when I accompanied my mother at marches against women abuse in the 90’s. I think back to those days surrounded by social workers chanting ‘strike the women and you strike the rock’, wondering what the statement meant and wondering where it came from. Years later I discovered that it was the words of female activists who marched to the Union Building in Pretoria on August, 9, 1956, calling for an end to the pass laws and advocating for women’s rights in South Africa. Winnie Madikizela Mandela, echoed these words in 1966 as she continued to fight for women’s rights. It is words that have become synonymous with the fight against women abuse. Growing up in post-apartheid, I didn’t know much about this South African icon and apartheid activist. All I knew was, she was the president’s wife, and amazed that she waited for him for 27 years to be released. They looked so happy to be reunited on the day of his release on February, 11, 1990. Like the nation I found myself in awe of their love story and commitment to one another. She was the First Lady, until she was no more.

Winnie Madikizela Mandela has been a controversial figure in South African history. With the release of her memoires, interviews, telling of her life story in film and book, we get a glimpse into this controversial figure, her career as a social worker, her marriage to Nelson Mandela, her own experiences of torture at the hands of officials during the apartheid regime and how that shaped and impacted the activist role she took on in the ANC. Quotes from her that come to mind with regard to this is:

“There is no longer anything I can fear. There is nothing the government has not done to me. There isn’t any pain I haven’t known.”
– 1987

“I am the product of the masses of my country and the product of my enemy.”
– 1996

The reason these quotes stick out for me is primarily related to the work that I do with torture survivors. Doing this work over the past 4 years has opened me to a new understanding of what pain, humiliation, isolation and torture can do to the human spirit. As we hold in mind Winnie the activist, the leader, the icon, the First Lady, we also need to hold in mind Winnie the person, the human being, who was tortured whilst imprisoned, the mother, who was separated from her children, unable to provide for them at times as she could not continue her work duties as a social worker. What did this do to the person, what hatred and pain did it ignite. I am by no means condoning the violence that she has been associated with, by no means minimizing the violent actions committed by her and in her name during the struggle, that have followed her through the years. I believe that violence is never the answer to our pain and our hatred, as violence begets violence and the pain and hatred continue in spaces, times and generations. This is evident as we reflect on our country and the manner in which violence continues to be a prominent feature to survive, exert power or simply be heard.

As I write this piece a few days after her death, I really felt compelled, compelled to reflect on this dynamic and rather complex women. And I urge the reader to understand these as my personal reflections and nothing more.

Over the years, as I learnt more about her, I always found myself holding two parts: one part, the strength of this women, the endurance, the love; the other part, is one of a leader that has lost her path, a women hurt, broken, angry. It is only in working with torture survivors that I have become able to hold the parts as a whole and not as polar opposites to each other. She was all the above and more. In conversations about her with people, I found it interesting that they either held the one part or the other, she was either praised or not. This made me think about how symbolic both Winnie and Mandela have been to us a nation.

Winnie is symbolic of the parts of us as a nation that may be uncomfortable, the parts of us that are hurt by injustices such as #LifeEsidimeni, unfairness such as social inequalities #feesmustfall #youthunemployment, poor service delivery #xenophobicattacks #violentprotests. The part of us that is not held, whose grievances and pain are not acknowledged and only through violence we feel impact is made, feel voices are heard. And as a society we shun the violence and ignore the pain. Make payments as a form of reparation then expect it to go away. As I reflect on Winnie being symbolic of the parts of ourselves as a nation that we may struggle to own. Mandela symbolizes the other part of us as a nation, a symbol of peace, forgiveness and hope. We held on to the idea of a rainbow nation, it was beautiful, it was inspirational. But what about those who were not ready, were too hurt, the memories of trauma too recent? Did we suppress those that didn’t agree, and in turn suppress feelings of anger and pain as a nation, until it reached a point of un-containment and spilling out. News headlines in the last few years in South Africa is testimony to this spilling.

As we end the era of Zuma and enter into a new era with Cyril Ramaphosa, I wonder if the leaders of our nation are ready to hold the nation as a whole, will the hopeful and the discontented be sitting at the same table and be heard and understood. Or do we once again, mark those who bring the uncomfortable sides of us out to the side, only to have the pain and discontent play out as it has been doing? Will we continue to suppress those that make us feel uncomfortable, because they force us to face the pain, or will we acknowledge that to heal pain must be felt?

Written by Sumaiya Mohamed

‘Mental health the Cinderella of health care’- President of the South African Federation for Mental Health

I recently attended the 5^th Global Mental Health Summit in Johannesburg, South Africa, which looked at mental health issues on a global scale. Many similarities across continents were noted, such as; the lack of awareness around mental health issues, the stigma that continues to surround mental illness, the increase of mental health concerns amongst the youth and the lack of resources.

It was truly an awe inspiring event, as professionals from various disciplines came together, echoing the World Health Organisation’s (WHO) slogan: “there is not health without mental health”. The presentation given by Crick Lund (Professor and Director at the Alan J Fisher Centre for Public Health, University of Cape Town) stands out for me in particular, as he highlighted the importance of including the role of persons with lived experience in shaping and informing mental health research, to in turn inform policy and strengthen mental health systems. To me this spoke not only to the formulation of policy but also to informing interventions and practices, as these voices are often lost, forgotten or dismissed. This rings true in the #LifeEsidimeniTragedy, with the deaths of mental health patients, who had no say in where they were going to be moved and whose family members could not advocate for them. What happened to human rights? What’s the purpose of having policies such as the Mental Health Policy if we fail to refer to it when implementing? As stated by Dr Lochandra Naidoo (President of the South African Federation for Mental Health), ‘Mental health is the Cinderella of health care’. The forgotten child? The imaginary friend? If not seen, does not matter and if they don’t matter, we can do what we want with them?

This de-valuing of individuals that have a mental illness can be explored in relation to how we have been socialized into understanding mentally ill individuals and mental illness as a whole. As my mother often would say to me, to understand the present you have to go back to the beginning. Pre 16^th Century, mental illness was attributed to the supernatural, witchcraft and insanity simply meant possession by the devil. By the 16^th Century, individuals with psychological disorders were seen as dangerous and needed to be locked away to protect society. By the 17^th Century, the mentally ill could participate with society but still needed to be understood as ‘mad’. With the term ‘lunatics’ becoming more common in reference to the mentally ill, who were also considered weak, in the 18^th Century. Thus, from this brief history, we can see how we may have been socialized to perceiving the mentally ill as less and mental illness as something that makes one incapable of participating in society and not the norm. If you have a mental illness, there must be something horribly wrong with you. By the 19^th and 20^th Century things started to change, as punitive treatments were abolished, an investment was made in understanding mental health as a health issue, which led to research being done to understand the causes of mental illness and in turn the establishment of more appropriate treatments and most importantly protecting the human rights of the mentally ill was emphasized.

So we have made progress over the years. Yet a stigma around mental illness still exist in the fabric of our societies. More needs to be done clearly, but what does this more look like? Dr Lochandra Naidoo calls for the creation of a ‘society in which mental health receives the attention it deserves’. I fully agree with this statement and to be honest I was shocked that mental health was not getting the attention it deserves. But as I reflected on this, I came to the realization that as a mental health practitioner, I engage with mental health issues on a daily basis, moreover, I studied it for 7 years, so I got a good base when it comes to understanding it in the context of myself, the family, community and broader society I live in. But, not everyone has this background. And even though in South Africa, we have been advocating, raising awareness and campaigning about mental health and illness, there’s a gap. And I say there’s a gap because I do believe that our government is a microcosm of the broader society. And the treatment by the government of mentally ill individuals in the Life Esidimeni tragedy speaks to an overall lack of understanding of mental health and mental health care. A disregard for the one of the most vulnerable groups in our society.  We have come a long way, but clearly, still have a long way to go.

I invite you to share your thoughts on the way forward, how do we create a society in which mental health receives the attention it needs?

Written by: Sumaiya Mohamed

 

‘An empty stomach has no ears’…..What do your ethics say?

‘An empty stomach has no ears’ is an African phrase commonly used by clients within our context. Referring to a hungry person not being able to concentrate on anything else, except their need to get their basic needs met. Many times as clinicians we sit and contemplate the contextual realities of many of our clients. My client has nowhere to live, another has no job, there’s no money for school fees and ones that can’t even afford food for their children. In sitting with these things an overwhelming sense of helplessness can become all consuming (which is often an echoing of the helplessness the individual is feeling about their situation). When I first started I used to have immense feelings of guilt and sadness, really just wanting to be able to give my client money to get food for her children. But that goes against two important aspects of my training, the first being to empower the individual to be able to do this for themselves and secondly that my professional ethical code of conduct prohibits it. Rationally being able to understand why I couldn’t did not help with the feelings. I eventually found myself switching off to it and constantly telling myself that that is not my role as a therapist. But my training also told me that you cannot do therapy with a hungry person and that can at times be so present in the therapy room that no amount of rationalisation can make it feel better.

Then we start coming towards the end of the year, which to me means Christmas time and holiday. Things that my socioeconomic status allows me to look forward to, but it is also a time where I reflect on the many things that I have in my life. So this year as the clinic we decided to try something a little bit different. We know that we cannot really give our clients things directly but technically that does not stop us from getting things donated. Some may have heard of the Santa shoe-box initiative whereby people can sponsor a child and pack a shoe-box with some essential toiletries, stationery, a toy and clothing. So we decided to do one for the children of the clients that we see at the trauma clinic. This was done specifically because many parents are often filled with sadness at not being able to give their children anything over the Christmas period and that the beginning of the year is often filled with such stress at getting basic stationery for the children old enough to go to school. Initially once we put together the list of children the task began to seem a bit overwhelming and I doubted the ability to get everything together and ensure that all the children got something. But truly sometimes the universe aligns itself and hears what is needed and the people that were approached began offering to help and helped in abundance of what was requested of them. And as a result 60 children’s Santa shoe-boxes were donated and given in December. Of course, this did not meet the greater basic needs of clients and perhaps it just met my own need to do something about my own levels of despair regarding client’s contextual realities.

What this also really speaks to the ethical dilemma that many individuals may face when working in impoverished settings, the professional ethics of what one is supposed to do and the human ethics of what one wants to do as a human being for another and this constant tug of war between the two. So before we begin to feel completely shut off to this aspect of others it was worthwhile seeing what could be done in the confines of what we could do. Being mindful of the reality that one small parcel does not solve the hunger that will be in the therapy room with me in the next session.

Written by Jacqui Chowles

The Cost of Black Tax – Mental Health and the Middle Class Crisis

The concept of mental health is often considered in clinical terms where focus relies on mental health difficulties that are individualised and related to a diagnostic criterion. While this stands true, mental health is often not considered from a biopsychosocial perspective where the individual may have mental health challenges but also exists in a context that can serve to exacerbate or relieve these mental health challenges.[1] In collectivistic societies like South Africa, people have a propensity to consider their lives in relation to the other. People are born and raised as part of a collective with collective support and through a lens where there is consciousness of their support systems and their various relationships[2]. These collectivistic systems of community interactions have been functional and have been the backdrop of society for centuries. 

Often when young people embark on their educational career, it stems from the perspective that they need to learn a science, a skill, a trade, but also develop for purposes of “becoming someone” – someone who can contribute to their various communities[3] for purposes of a collective wellbeing. This is understandable particularly due to the way many family members come together to raise and develop children and adolescents, into emerging adults. This brings to the fore one of South African society’s social conflicts – what is termed as “black tax”[4].

Black tax can be understood as money (and other resources) that employed black people are obligated to contribute to their families to support those who are unemployed, their children, and any other dependents within the family setting. It is centred on the expectation that when one is employed they will be able to support themselves and other family members with groceries, utility bills, school fees, rent, and various other necessities.

The reality of black tax starts to creep in anytime from matriculation to becoming employable. Some of South African youth are able to complete tertiary education, which is a great achievement, an achievement alive with possibilities. However, those realities will differ. Many young people walk towards the podium, on their graduation day to celebrate a victory and the beginning of new ventures into the work industry and their mapped-out career. For many African families, however, it is a celebration of completion, and also the celebration of a new breadwinner who is going to rescue the family, oftentimes from the harsh realities of poverty or low socioeconomic status.

Graduating is a milestone for the graduate to celebrate. In society, a graduate is also a potential role model for adolescents and emerging adults to look up to. Once again, emerges another expectation for a graduate, and being exemplary in one’s community is generally a big role to fill. These expectations can become overwhelming long before the graduate embarks on the job hunt.

The realities of job hunting emerge immediately after the graduation celebration. The graduate is seen to have finished the degree, got the certificate, wore the gown and now they need to “put it to good use”. This does not always happen in a linear manner as expected, much to the detriment of many graduates and their family members. The rate of unemployment in the country is significantly high, resulting in frustration, pressure and additional stress for the youth who are job hunting[5].

Some graduates are fortunate to find employment regardless of whether it is in their completed field of study, and that sense of stability and predictability is empowering and brings hope. Starting to earn a salary can also emerge with its own stress and anxiety based on one’s skillset and whether there are high expectations for financial support within their family. This may cause a dissonance as life as an independent young graduate needs to start, yet the responsibilities of being a breadwinner may delay the growth and progress of the individual[6]. Furthermore, the pressure to look like you have “made it” arises and the social life and innate desire to impress peers emerges with another dimension of strain. Understandably, many South African youth aspire to be admired due to their hard work and career achievements, however, due to family responsibilities they may not have the financial resources at their available disposal. Hence, one can be classified as the middle class because you earn within a certain financial bracket, which is merely indicative of a currency amount which states that you “qualify” – but in reality you cannot afford what you should be able to afford. There is an expectation to “have money” because you are employed, without the consideration that the money you earn is going to cover the expenses of not just yourself, your debt, but also the needs of your extended family too.

South Africa’s youth continue to bear the burden of an economy that is not favourable to their career development[7]. Discovering that the job market is saturated is something that no one could have realistically prepared the graduate for. There are people who are overqualified, underqualified and those who have no tertiary qualifications; and they are all in the same race for job security. The realisation of the “real world” can be overwhelming for a new graduate and often there is no psychosocial support structure to assist them to manage these realities. South Africa’s youth is normally met with the harsh expectation to make it through the complexities of socioeconomic stability because one is “a graduate”.

Where situations are more favourable, opportunity avails itself and a graduate finds employment. Entering the work industry emerges with its own realities, which often resemble a marathon that one is not prepared for, but must start running. It is important to keep in mind that the marathon comprises of skills and capabilities, but also systems and structures in the workspace where the needs of some people are prioritized over the needs of others. Many young people are employed in organisations which do not consider the intersections of their identities and can emerge as exclusionary, hence there is competition for opportunities which you may not be considered for because you are black, and young. Some opportunities bypass our black youth based on which institution one went to, and how one is considered to be of higher intellectual standing, than the other. Furthermore, there is often not enough insight into salary scales and most new graduates are under the guise that they are going to earn a particular salary, whereas there are levels: Entry levels, some of which are lower than their counterparts due to race, gender, and socioeconomic standing.

In an endeavour to graduate up the social class scale, many of South Africa’s youth incur debt early in their careers due to the need to fit in and be identified as middle class. At the same time, they also are required to provide for the family and support their siblings as they continue through their own schooling. Many youth form part of a system where they are required to assist family members who have children and cannot afford to support them, because their parents helped their own parents when they needed registration money to get into university. The black tax is seen as a way of clearing out an old debt.

Black tax is part of the dynamics that young South Africans have to navigate in order to achieve what they desire. Not many achieve their personal goals, even though they are determined and goal oriented. There is often limited emotional support from families and the workplace for young people embarking on a career with the shared burden of family responsibilities, and other psychosocial burdens. Somehow, they are expected to make it work. Workplace performance can be affected due to pressure of performing and navigating the systems that can be exclusionary and do not consider psychological demands beyond the work that needs to be delivered. Furthermore, the anxiety that is related to performance is not merely related to work performance, but also the understanding of what the work role actually is in relation to personal growth. This replicates the pressure to perform that is also experienced in home environments where the black tax is located. This feeds into the middle class crisis – a cycle of the workplace, black tax and mental health dilemma for South African youth.

Increasingly, young people are developing depression, anxiety and engaging in unhealthy coping mechanisms. These emerge in their lives as low work performance, substance use, impulsivity, and sometimes physiological health problems. There is a need for employee wellness programs to take into consideration the complex needs of South African youth who have high levels of family responsibility. These are conversations which should take place in boardrooms where interventions are developed to provide support for young candidates who have dreams, commitment, yet who still have a long journey in their career path.

Countless weekends across South Africa, young people engage in social activities which are associated with substance use and night life – while many are entertaining themselves, some also indulge to escape – to feel distracted from the heightened responsibility, emotional difficulties, and to avoid the demands from families. As such, mental health support should be accessible in work places in various forms to allow staff to develop in ways that their emotional wellbeing is not being left behind during the course of career development and the expectations of the black middle class.

As we commemorate youth month may we give ourselves time to reflect, check and support mental health initiatives for young people and entry level staff in workplaces to enhance the process of developmental wellbeing and their integration into workplace structures. This form of commemoration is admirable when considering South Africa’s history of youth who have laboured extensively for today’s youth to have the opportunities that were previously deprived of.

Written by: Mpfaraleni Mabidi and Amina Mwaikambo

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[1] Engel GL: The need for a new medical model: a challenge for biomedicine. Science 1977;196:129-136.

[2] https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response

[3] The diverse and multilayered systems which a person belongs to or identifies with e.g. family, place of residence, geographical location, religious group, cultures, societies etc.

[4] https://www.dailymaverick.co.za/article/2019-05-07-towards-an-understanding-of-black-tax-and-the-black-missing-middle/

Youth Day and The Day of the African Child — honouring the past, empowering the future

[5] https://www.statssa.gov.za/publications/P0211/P02111stQuarter2022.pdf

[6] https://www.iol.co.za/saturday-star/news/young-south-africans-mental-health-continues-to-worsen-latest-child-gauge-report-finds-cb84a0aa-e0b5-4538-b02a-f0fb35f44599

[7] https://www.statssa.gov.za/?p=15407

The Impact of Continuous Exposure to Trauma and Violence on School Learners

In 2021, CSVR embarked on a project that focuses on Sexual and Gender Based Violence (SGBV), sometimes referred to as the ‘Shadow Pandemic’ in South Africa. Under this project one of our interventions has been working with young people in schools to raise awareness and provide psychoeducation on SGBV. To date we have conducted dialogues with youth from high schools in Alexandra township, Inner City Johannesburg, and Orange Farm – areas which have been identified as GBV hotspots according to recent reports^[1]. Through our engagement, it was noted that continuous traumatic stress environments, characterized by high unemployment, poverty, exposure to femicide and crime contribute to SGBV in some communities.

Through dialogues the following perspectives were captured by learners:

One learner expressed that living in a home of 5 children, with only one parent employed, was financially burdening to the parent. The stress that comes with being the sole breadwinner and not knowing how to cope with financial expectations may lead to fears and frustrations, which manifest in the form of violence. In some situations, parents would become abusive (verbally and emotionally) to the children or spouse. This was further exacerbated by adopting unhealthy coping strategies to manage the stress – such as alcohol consumption – to silence the pressure, which in turn contributed to more aggressive behavior. It was noted that learners made meaning of this type of behavior based on the above reasoning i.e. the parent or caregiver is stressed.

This rationalization or meaning making, reflects learners’ socialization, as many learners become witnesses of the abuse and the victims of the hostile home environment. They are also prone to become trauma carriers in their communities. The schools that CSVR practitioners engaged with also reported high rates of bullying; drug abuse; sexual harassment among learners; teenage pregnancy; low pass rates in school; and learners becoming perpetrators of GBV, as they may perceive their violent responses as normal and accepted behavior.

It was also discussed that poverty and unemployment also contribute to ‘hustling’ to make sure there is food in the home. This was reported by female learners who reflected on single mothers having to have more than one romantic partner and pooling the money she gets from them to meet the basic needs of the home. They also spoke of older sisters engaging in sex work to get an income. Learners’ vigilance in what is happening in their community was noted, as they could identify the hotspots where ‘things went down’. It was also noted that female learners themselves were dating older men and had experienced physical abuse and emotional manipulation. This replicates what they have been exposed to within their own homes and alludes to the perception that abuse in a relationship is normal.

Exposure to violence in early childhood or adolescence has the potential to shape how learners perceive the world, others, and the self. Especially when that exposure to violence is within the setting of the family or an intimate partner relationship. It begins (consciously or unconsciously) to inform what we see as appropriate and inappropriate behaviors in a relationship. When exposed to domestic or intimate partner violence as a norm, that line can become blurred. For example, drawing on Erik Erikson’s Psychosocial Development Model^[2], during adolescence, individuals go through the developmental stage identity formation versus identity confusion, as they are discovering themselves, who they are etc. A relationship at this time that exposes them to intimate partner violence may impact on that development process in a negative way and can contribute to them forming unhealthy attachment styles in relationships. In addition, if the environment they find themselves in is one that does not offer the support they need during early childhood, it limits the opportunities that exist for developing trust, autonomy and initiative which are important characteristics for developing a sense of identity and coping with the demands of the external world^[3].

Learners who have been directly or indirectly exposed to continuous violence and trauma may experience the following:

• Feelings of anxiety, constantly being in a state of fear and worry of everyday events and potential events that might occur.
• May present with symptoms of depression: reported attempts of suicide; issues of concentration; lack of interest in participation in recreational activities such as sports;  irritability and anger; insomnia and low self-esteem.
• Behavioral difficulties- displays of aggressive behavior, reports of fighting with other learners especially at school, engage in bullying, and joining gangs that perpetuate violence at school and in the community. It can be understood that learners struggle with emotional regulation and develop unhealthy methods of expressing anger as they may not know how to cope with the difficult circumstances in their homes.
• Risky sexual behavior which are likely to get them in trouble with the law, i.e., learners who are alleged to have sexually coerced, harassed or assaulted other leaners at school.
• Drug abuse is another significant issue which seems to be a ‘coping mechanism’ that learners may engage in to escape their realities. Report that they would smoke weed/dagga because it makes them forget about the issues at home and make them feel happy. This is particularly dangerous because substance abuse at an early age has health implications such as developing kidney and respiratory issues, heart disease etc. which are often under looked.

However, like adults, learners can recover from their trauma with trauma informed care, these are individually, family and community structured interventions to identify and understand the causes of violence, acknowledge the impact and inform responses to the mental health and psychosocial needs. A school as a social institution plays a role in socialization and creating learning opportunities for learners, building the foundation for learner’s future in a way that shapes their mindset on life experiences. It is therefore essential that safety is ensured in the schools and the National School Safety Framework provides a systematic approach that helps us understand the role of each member of the school body in creating and maintaining safe school environment. It is an essential and useful guideline that can be reviewed and adapted to make it trauma-informed and to address the issues of violence in schools. Critical role players such as the Department of Education, Department of Social Development, Department of Health, NGOs, etc. could participate in the process and contribute to creating safe and violent free communities, and working in conjunction with Youth Initiatives, they can provide key recommendations based on their expertise. When there is an awareness of an area of concern there is opportunity to raise funds and prioritize the needs of young people who often are not adequately equipped to manage life’s psychosocial stressors and develop a safe quality of life.

Written by: Zanele Zondo (MHPSS practitioner) and Sumaiya Mohamed (MHPSS Specialist)

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[1] Maphanga, C. (2022, Sept 22). Cele reveals SA’s top 30 hotspots. News24. Retrieved from Cele reveals SA’s top 30 GBV hotspots | News24

[2] Rosenthal, D. A., Gurney, R. M., & Moore, S. M. (1981). From trust on intimacy: A new inventory for examining Erikson’s stages of psychosocial development. Journal of Youth and Adolescence, 10(6), 525-537.

[3] Makhubela, M. S. (2012). Exposure to Domestic Violence and Identity Development among Adolescent University Students in South Africa. Psychological Reports, 110(3), 791–800. https://doi.org/10.2466/16.13.17.PR0.110.3.791-800

Photo Cred: Mwesigwa Joel https://unsplash.com/photos/FXdIjVRFh24?utm_source=unsplash&utm_medium=referral&utm_content=creditShareLinkhttps://un

The Imposter Syndrome Experience of a Newly Qualified Social Worker

Imposter Syndrome (IS)…many of us have probably experienced it, either consciously or unconsciously and some of us probably did not even know that what we felt was a real experience, it exists and can be felt. The Imposter Syndrome refers to an internal experience of believing that you are not as competent as others perceive you to be.[1] However, the Imposter Syndrome can be defined from different perspectives given the different experiences by different individuals. Well, according to me, the imposter syndrome is a collection of feelings and thoughts of inadequacy, self-doubt, no confidence, and low self-esteem.

As I embarked on a new journey to experience the real world as a newly qualified social worker, I got an opportunity to work as a social work intern at The Centre for the Study of Violence and Reconciliation (CSVR). Like any other graduate, I had expectations that as I enter a workplace environment, for the first time, everything would fall into place. I thought I was prepared enough to give it my all, all I have learned and attained during the course of my study.

The transition from being a student social worker to being a qualified and registered social worker is a complex process whose success not only depends on one’s ability to integrate what was learnt during their studies with practical experience, but also requires an understanding of the role and confidence in one’s performance. What usually helps with this process is the induction and orientation period where you slowly get to know the people, the work, and the culture of the organization.

This is where my challenge began as I started my internship during the COVID-19 pandemic. As a newly qualified social worker I expected to undergo an induction or perhaps job shadowing process where I would get introduced to the people and work and get acquainted with the staff. However, due to restrictions imposed by the COVID-19 pandemic, the reality was that my experience would be different from what I expected. Working during the pandemic meant that the staff at CSVR were working remotely and I was also expected to work remotely, which meant learning a lot of new information about the work on my own. This experience was daunting as I had no experience on working remotely.

I was designated a supervisor, who also studied social work, who was then a senior practitioner at the organization. This was one person I knew I could relate with in many aspects, professionally, considering our qualification and my assumption of her experience transitioning from being a student to being a qualified social work practitioner. Being inducted remotely took away from my experience of feeling adequately equipped to start the work as I doubted that I could translate what I was learning through the virtual processes to practice with the clients. This is where the Imposter Syndrome crept in, and I struggled with trusting myself and my skills.

I felt I would not even be recognized, in terms of my energy, time and efforts because it almost felt impossible to experience a normal working environment, which I have always envisioned meeting my colleagues in the office, taking about the upcoming work and projects and have those mini de-briefing sessions about work and life in general. As if this was not enough, the feelings of inadequacy and self-doubt became intense, I got confused and that is when I realized I was experiencing the Imposter Syndrome. As a way of trying to know the organization better, I engaged more with my colleagues to learn what their roles were and their involvement in different projects. However, this did not help much as I began feeling overwhelmed, feeling like everyone was doing just perfectly and the manager would give those good remarks on the work they have done. I then started second-guessing my appointment as an intern. I felt that I was inadequate, and they did me a favor by hiring me.

As these feelings and thoughts became more intense, I would beat myself up over these negative feelings and thoughts for weeks because I didn’t experience these intensely in other areas of my life. During all of this I would still push myself to manage my tasks, meet deadlines and show up in meetings. As my feelings and thoughts intensified, I could no longer brush them off – they felt real. I just did not know at the time that the experience was conceptualized as the Imposter Syndrome. I knew and felt validated after I came across and read through a colleague’s post about the Imposter Syndrome. I related with the content of the post and felt I needed to know more about what the Imposter Syndrome was and how I could overcome it. I searched through the internet and read about the Imposter Syndrome as I also came across other people’s narrated experience of the Imposter Syndrome. I could relate to their shared experience, and I felt validated about my experience.

When I became aware of the source of these thoughts and feelings, I then focused more on why I was feeling and thinking in that way and how I could possibly overcome the Imposter Syndrome. As a result, I confided in someone who I knew could relate, had my best interest at heart, and was safe enough for me to be vulnerable with. I felt validated and supported even to this day.

Although I still experience that negative inner voice, it has become much better now that I know the source of my experience, and that the voice is not being truthful. My experience of Imposter Syndrome and the research I did on the topic has made me better informed and I have learnt to acknowledge and normalize my experience and not be too hard on myself. I have learnt to trust my skills; use the resources I have to do the best that I can, and ask for help when I need it. I am in a better space now. I realized that part of being an intern is observing and learning from those around you and sometimes that means feeling a bit lost and out of place but eventually you find your footing.

Written by Zanele Zondo

Social Work Intern at the CSVR

Key words: Imposter Syndrome, newly qualified social worker, working remotely, covid-19 pandemic

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[1] Imposter Syndrome: Definition, Symptoms, Traits, Causes, and Coping (verywellmind.com)