Blended Voices- Exploring challenges and opportunities for healing in Africa

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

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

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

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

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

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

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

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

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

#TowardsHealingAfrica

#MHPSSinAfrica

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Referrals:

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

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

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

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

Limitations to what you can do therapeutically:

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

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

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

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

Self-care

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

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

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

Compiled by Mental Health Professionals from the CSVR Trauma Clinic

Trauma in the air: Catastrophe and/or transformation

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

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

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

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

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

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

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

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

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

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

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

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

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

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

SGBV and Healing:Intervention recommendations by CSVR practitioners

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Recommendations compiled by the CSVR Mental Health and Psychosocial team

Don’t call me a ‘women’

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

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

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

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

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

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

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

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

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

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

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

Written by Sumaiya Mohamed

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

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

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

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

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

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