What Comforts us during this time?

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

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

Then Carl R. Rogers came and said:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Written by Thembisile Masondo

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

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

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

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

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

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

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

Written by Amina Mwaikambo

 

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

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

3 questions formed the basis of the discussion, namely:

Do children get covid19?

Are children covid19 super spreaders?

How can we make schools relatively safe?

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

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

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

-sore or red throat

-runny nose

-diarrheoa

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

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

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

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

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

Written by Sumaiya Mohamed (Senior Psychosocial Trauma Professional)

 

 

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

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

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

Self-quarantine /isolation/Social distancing

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

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

Enforcement of Covid regulations

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

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

Dropping the ball.

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

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

The spotlight on mental health

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

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

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

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

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

 

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

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

Written by Charlotte Motsoari

 

 

 

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

 

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

 

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

 

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

 

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

 

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

The intrapsychic pandemonium of a global pandemic

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

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

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

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

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

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

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

Written by Amina Mwaikambo