Information, loss, and the complex work of reclamation

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Aspects of culture in South African psychiatry

Bibliography: pages 351-389.A review of the South African psychiatric literature reveals that the concept of culture is commonly reified. It is also used by the South African state to legitimate apartheid. The concept of cultural relativism, though often associated with liberal views internationally, is linked with state policies in South Africa. Some South African social scientists, therefore, strongly question the notion of relativism. This reaction unfortunately does not engage with the social reality of the widespread perception of cultural differences, in psychiatric settings and elsewhere. Issues of race and culture in psychiatric practice were explored in a psychiatry department of a liberal South African university. Observation of ward-rounds in a psychiatric casualty (emergency) facility over six months revealed that, as elsewhere in the world, a major cultural factor influencing clinicians is the relationship between psychiatry and general medicine. A cultural understanding of South African psychiatry must take account of this relationship. Ward-rounds in a facility treating Black psychiatric patients were observed over fifteen months. Black and white clinicians in these rounds were often in conflict over constructions of the concept of culture. Some appeared deeply ambivalent about cultural relativism. Psychiatric registrars (residents) attached to the department under study participated in loosely structured interviews exploring issues of race and culture in their work. They also responded to vignettes dealing with white, coloured and Black patients. Registrars felt uncomfortable about the role of the concept of cultural difference in affecting the welfare of Black patients, and in maintaining discrimination. Their own socialisation as practitioners in an individualising and medicalising discipline seems a major factor contributing to their ongoing reproduction of this discrimination. The study reveals the importance of exploring the views and experiences of practitioners. South African work focussing on the need for fundamental change in mental health care has generally glossed over details of extant practice. This dissertation shows, however, that a major site for mobilisation for change in South African mental health-care must be the psychiatric institution itself

Behind the scenes

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Books

CULTURE AND COMMON MENTAL DISORDERS IN SUB-SAHARAN AFRICAMaudsley Monographs #4. By Vikram Pate!. Pp.xv + 128. GBP24.95. Psychology Press. 1998. ISBN 0-86377-516-

IMPLEMENTATION OF ADOPTION IN SOUTH AFRICA: PERSPECTIVES FROM PRACTITIONERS IN THE WESTERN CAPE

In South Africa adoption as a form of alternative care had decreased despite a supportive legal and policy environment. This qualitative exploratory study explored adoption policy implementation. Semi-structured interviews were conducted with four social workers and two magistrates implementing adoption in the Western Cape. Data were thematically analysed using Lipsky’s theory of street-level bureaucracy. Results indicate significant problems in implementation, including lack of adoption services by the Department of Social Development (DSD) social workers; overuse of foster care; and difficulties in registration of the birth of abandoned babies and babies assumed to be foreign. Recommendations for practice are provided

POSTTRAUMATIC STRESS SYMPTOMS IN EMERGENCY SERVICE AMBULANCE PERSONNEL

A diversity of research has demonstrated that, although all people will present with a reaction after a traumatic incident, only a minority will develop posttraumatic stress disorder PTSD (Allan, La Grange, Niehaus, Scheurkogel & Stein, 1998). A complex interaction of multiple pre- and post-trauma factors determines the response. Numerous studies have attempted to assess variables that make an individual more susceptible to developing PTSD. A number of factors were investigated including genetic (Eisen, Goldberg, Heath, Lyons, Nowak & Rise, 1993), family history (Breslau, Davis, Andreski & Peterson, 1991), individual personality (Schurr, Friedman & Rosenberg, 1993), past history of trauma (Zaidi & Foy, 1994) and life events (McFarlane, 1989). A number of studies have identified posttraumatic stress disorder (PTSD) as an important issue in various South African groups (Kaminer, Seedat, Lockhat & Stein 2000; Marais, De Villiers, Möller & Stein, 1999)

Therapeutic pluralism and the politics of disclosure: breast cancer patients’ experiences in public healthcare

Background: Despite the widespread utilisation of complementary and or alternative medicine (CAM) by breast cancer patients in low-and-middle-income countries, few disclose CAM use to their physicians. Objective: This study examines disclosure CAM use among a small sample of women attending a breast cancer clinic in a public health hospital in the Western Cape, South Africa. Methods: An Interpretative Phenomenological Analysis (IPA) approach was utilised in this study. Semi-structured in-depth interviews were conducted with a convenience sample of 17 women attending a breast clinic in a public hospital. Results: Non-disclosure of CAM use was attributed to minimal time for patient-doctor interactions due to resource constraints in public health facilities and the superior status accorded to biomedical doctors’ superior knowledge, associated with paternalism, leading to patients’ fear of reproach for using CAM. Consequently, disclosure of CAM only occurred in instances where it was deemed an absolute necessity. Conclusion: Considering the reality of an overstretched public healthcare system, what may be possible is an active attempt to communicate to patients that doctors are aware that patients may use a range of resources (such as CAM), which is their right, and further, recommend patient disclosure of CAM use to their doctors, because of the possibility of drug interactions and other potentially negative effects. Keywords: Breast cancer; alternative medicine; South Africa

Barriers to the participation of people with psychosocial disability in mental health policy development in South Africa: a qualitative study of perspectives of policy makers, professionals, religious leaders and academics

BACKGROUND: This paper outlines stakeholder views on environmental barriers that prevent people who live with psychosocial disability from participating in mental health policy development in South Africa.METHOD:Fifty-six semi-structured interviews with national, provincial and local South African mental health stakeholders were conducted between August 2006 and August 2009. Respondents included public sector policy makers, professional regulatory council representatives, and representatives from non-profit organisations (NPOs), disabled people's organisations (DPOs), mental health interest groups, religious organisations, professional associations, universities and research institutions. RESULTS: Respondents identified three main environmental barriers to participation in policy development: (a) stigmatization and low priority of mental health, (b) poverty, and (c) ineffective recovery and community supports. CONCLUSION: A number of attitudes, practices and structures undermine the equal participation of South Africans with psychosocial disability in society. A human rights paradigm and multi-system approach is required to enable full social engagement by people with psychosocial disability, including their involvement in policy development