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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

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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)


[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/

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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

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

Approaching 23:59 on 31st 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 5th 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

 

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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)

 

 

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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

Question marks

 

 

 

[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.

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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

yellowbrickroad

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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

silhouette photo of man with backpack standing in seashore during golden hour

 

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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

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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

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#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

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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 19th 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

 

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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

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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

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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

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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

You Making a Difference: Engage – Inspire – Empower!

        CommUnity Awaken…!

By Tsamme Mfundisi

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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

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

I recently attended the 5th 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 16th Century, mental illness was attributed to the supernatural, witchcraft and insanity simply meant possession by the devil. By the 16th Century, individuals with psychological disorders were seen as dangerous and needed to be locked away to protect society. By the 17th 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 18th 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 19th and 20th 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

 

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‘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

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