South African psychiatry — so important to national healing — is in dire straits, argues Dr Zanele Sidzumo Baqwa
‘PLEASE, Mr Gunman, may I have my new shoes back,” said my 11-year-old daughter, Nosizwe Lise, to the hijacker speeding off in the hired minibus he had taken from us at gunpoint. This happened outside the entrance to my sister’s house in Dobsonville, Soweto.
What did the feverish girl expect? That the gunman was some chivalrous highway robber who would charmingly throw her the shoes she longed for? She must have believed in his inherent humanity, despite his callous deed. She was shooed away by his partner, who also had a gun.
I will never forget the anger, frustration, self- pity, hopelessness and pain — all the emotions surging through me in the minutes and hours after the hijacking.
At the police station, there was seemingly no one who understood, nor cared to empathise with the traumatic experience I was going through. The policeman first ignored me as he lazily played with his teenage girlfriend, then proceeded to talk about his lost chances — how he would like to go to the Norway I had returned from after 30 years in exile. “You are lucky,” he said to me.
There I stood, a psychiatrist, seeking support from someone who did not comprehend the
Things did not improve when I phoned his senior the next morning. He listened to my demand for some action which would reassure me that something was being done to correct the state of affairs, and that there was a perception that a wrong had been committed. Instead, he drily told me to thank my gods that I had come away with my life.
The minute we returned to Norway, my daughter’s teacher asked her if they could take the matter up at school, to help her through the experience. She refused. In our own way we had managed to process the traumatic experience.
This story is not unique. It happened in June 1994, a link in the chain of violent events that has erupted into our consciousness and snowballed into a social monster.
But does it merely portray the current state of the world, or is there an additional factor — the crisis of change in the historical panorama? Is the young hijacker a psychopath – – a merciless, asocial character ruthlessly destroying in the path to gratify his own needs? Are all hijackers psychopaths? Are we observing some mass, primitive, projective catharsis from the dark years of having been denied humanity — the effects of colonisation and domination of the human spirit, from having been denied a sense of self?
Mental health is intrinsically related to society. All our lives we are in the process of accommodating ourselves to our environment; some call it coping, and it could be maladaptive or adaptive. A social analyst once said that the system of medicine (which includes mental health) is determined primarily by the same forces that determine the overall formation of society. So what forms of health service existed for the mentally suffering under the conditions of institutionalised violence, social and political, of apartheid?
Looking at the psychiatric health services in place today, I am painfully aware of the gulf between therapists and patients, between the ratio of white psychiatrists and black psychiatrists. I am aware, also, of the role of indigenous healers in preserving the mental health of the population at large.
The great majority of underprivileged mentally disturbed people, call them black if you like, are still at the tail-end when it comes to the delivery of services in psychiatry. The acutely ill have to travel long distances in order to be evaluated and, if necessary, admitted. Woe to them if a crisis occurs after 6pm, for then, if they live in Cape Town, there is no transport to take them from, say Khayelitsha, to Observatory where the tertiary institutions are.
There is a dire need for the development of secondary psychiatric services so this inequity can be removed. Most South African psychiatrists are in private practice. Those that are not are still staffing the “white” institutions in the old mode. It is definitely not enough to merely give a diagnosis, medicate and send a patient away.
The fact that the Health Department has failed to recognise the dire need to improve mental health services is a cause for concern: the hordes of children and mentally disturbed people living on the streets could be called a walking time bomb. The lack of a working tow- away system between society and the tertiary block means these vulnerable, weak people could revert to extreme measures to ease their mental torture. Research has shown an alarming rate of homicide among this group. Drug abuse compounds the problem.
Most of the mentally suffering need meaning and coherence in their lives. Psychiatrists need to have a tangible understanding of the social relationships in these people’s lives. Mental health is related to stable conditions in society, the family, the workplace; a reasonable degree of autonomy over one’s life, and a positive self image.
Psychiatric services first developed as a means of social control, but critics, such as French philosopher Michel Foucault, claimed that psychiatric services generally reflected the social and logical preoccupations of the time. Psychopathology was not independent of social history.
There followed a period where psychiatry was merely a care-giver. This care-giving was mostly in the form of asylums and moralisations rather than psychotherapeutic understandings and community-based structures; these evolved later and it is these that South Africa needs to develop extensively. Accessibility is the key word.
A sudden metamorphosis of therapists in South Africa along these lines would be welcome indeed. For example, post-World War II Britain welcomed psychiatrists, psychologists and educationists from Hitler-torn Europe for the enormous contribution they could make with their understanding and skills. They were used for the good of society, rather than marginalised by stagnant bureaucratic manoeuvres, because there was an understanding of the intimate connection between the social and individual.
Dr Baqwa is a rare phenomenon in South Africa: a black female psychiatrist. Trained in Oslo, she is currently working as a doctor in the Western Cape because of the freeze on recognition of foreign degrees