#MentalHealthMatters

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

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

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

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

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

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

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

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

Written by: Sumaiya Mohamed

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

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

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

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

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

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

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

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

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

We are seeing devastating news in institutions of learning daily. Learners are killing each other and their teachers, there are high rates of teenage pregnancy and substance use and school drop outs. In the University of the Witwatersrand this year alone there are more than two cases of suicide with the most recent occurring on the 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

 

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

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

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

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

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

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

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

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

Written by Jacqui Chowles

[1] Eckhart Tolle A New Earth

She’s too small to think

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

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

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

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

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

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

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

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

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

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

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

Written by: Sumaiya Mohamed, Jacqui Chowles and Celeste Matross

Grief: It’s a journey

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

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

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

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

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

Written by: Thembisile Masondo

A Community Awaken

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

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

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

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

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

A Community Awaken

Give me  back my yesterday, I am today,

Standing still in the dusty areas of Mzansi!

Fighting for my freedom,

In the 9 Provinces!

Wakeup – Wakeup.

I am priceless, I might not look pretty

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

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

Wakeup – Wakeup.

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

Together we celebrate your breath

The Spirit of living and walking in the noisy street

I enjoy the enchantment of Ubuntu, Laughter and Love

A CommUnity Awaken!

Wakeup – Wakeup.

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

Service Protest, Killings are part of the daily living

But I don’t get discourage by these trivial events

We will heal in Time!

Wakeup – Wakeup.

The outcome of having life and joy,

Celebrations and ululations is the order of our days

I have drunk all your passion, devotion and Living unity

Move outside the tangle of Fear-thinking!

            Wakeup – Wakeup.

You who has produced lots of teachers

Doctors, nurses, community practitioners and lots of professions

You Making a Difference: Engage – Inspire – Empower!

        CommUnity Awaken…!

By Tsamme Mfundisi

Sitting with the wonderful and the tragic within us

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

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

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

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

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

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

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

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

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

Written by Sumaiya Mohamed

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

I recently attended the 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

 

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

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

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

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

Written by Jacqui Chowles

The power of the human spirit prevails

The Centre for the Study of Violence and Reconciliation (CSVR), well known for its research into violence and clinical and community intervention work, has in recent years become a learning organization. Moving towards developing our learnings and the learnings of others. This was evident at an event we had yesterday: a graduation ceremony for interpreters that provide interpretation to the clinical team in their therapeutic work with clients who speak French, Swahili, Kinyaruwandi, Lingala, Amaric and Somali. The event followed the interpreters completing an introductory course in interpreting skills at the WITS Language school.

I recall the beginning of this journey, as interpreters were filled with feelings of anxiety and concern. ‘im too old to go back to school’, ‘I don’t know if I can do this’, ‘if I fail I have to pay back the money, where will I get this money?’. Concerns around time commitments and being able to pass were noted.

This may seem like normal concerns and anxieties before one embarks on an academic venture, but what you need to understand is this is no ordinary group of individuals. These are individuals that come from war torn countries and have been able to survive in an environment often known for its xenophobic sentiments. They face many challenges as they navigate personal, family and communal life on a daily basis. So embarking on this journey was no easy task. Our Executive Director (Nomfundo Mogapi) captured the perseverance of their human spirit best by acknowledging their endurance in their home country, coming to South Africa which has given them good and bad experiences and making a life despite the bad experiences. Contributing to a country which has been unwelcoming at times and being a part of the change they want to see in the world and in South Africa.

As I watched them go through the course and there life journey, I marveled at their spirit. Their willingness and ability to engage with the content and be present and still do life. It made me reflect on my own resistance to re-entering the academic realm or creating change in my status quo, and yes I feel-‘l im too old’, ‘I got a lot on my plate’ (kids, family responsibilities, bills), ‘how will I manage to study and work at the same time’ and ‘I don’t know if I can do this now’. And then I think about these women and men, whom have been dealt a bad hand, not of their own choice and continue to persevere, continue to find meaning in life, continue to seize opportunities and work towards a better future. Continue to give life their all and all my reasons seem mundane. And so these words come to mind: The power of the human spirit prevails, it is self- doubt that keeps us stagnant.

Written by: Sumaiya Mohamed

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