A brief sociological sketch of our current understanding of the social structure among Blacks is presented, with a decided emphasis on its historical link with pre-industrial Black ontology, a concept to be explained later in this discussion. A serious attempt is made through phenomenological analysis to deal with the now well-known resilience of traditional ideas in the areas of health and disease.S. Afr. Med. J., 48, 922 (1974)

Manganyi, N.C.

English

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922 S.-A. MEDIESE TYDSKRIFHealth and Disease4 Mei 1974SOME TOPICAL PROBLEMS OF SOCIOCULTURAL TRANSITIONN. C. MANGANYISUMMARYA brief sociological sketch of our current understandingof the social structure among Blacks is presented, with adecided emphasis on its historical link with pre-industrialBlack ontology, a concept to be explained later in thisdiscussion. A serious attempt is made through pheno-menological analysis to deal with the now well-knownresilience of traditional ideas in the areas of health anddisease.S. Afr. Med. l., 48, 922 (1974).The peculiarities of Black societies as distinct from thoseof Western European descent have been a stock themeof cultural anthropologists, novelists, explorer-adventurers,missionaries and others. As late as the last decade, we findin South Africa such devout cultural propagandists asBryant' and Silberbauer.' Regrettably we find on examina-tion that the innocent conceit of the early observers of thelast and early 20th centuries are still present in the 7thdecade of the present century, in spite of the unprecedent-ed sociocultural changes which have been witnessed onthe African continent.Silberbauer and others are guilty of a strange misconcep-tion, namely that they write and talk as though the socio-cultural status of Blacks is static. This last issue is ofconsiderable ·importance and is one which requires themost dispassionate type of analysis. The areas of concernof this paper may be described as follows.THE DESCENT OF TRIBAL MANThe present century is possibly seeing the last vestiges ofso-called traditional societies in Africa. One of the symp-toms of the wide-ranging changes of the times is the dis-repute into which the concept of the tribe has fallen.'According to Uchendu' several varieties of man in Africahave been described in the literature ('primitive man', 'de-tribalised man', 'the attention-getting elites' and the 'tran-sitional or developing man'). In the light of the generaltransformation of African societies, what may be saidabout the transformation of the Black man in SouthAfrica?Baragwanath Hospital, JohannesburgJ. C. MANGAl Yr, D.LITT. ET PIllL., Clinical PsychologistPaper presented at the 1st South African International Conference onEpilepsy, Johannesburg, 24 April 1972.Pre-industrial African OntologyIn view of our concern with ideas relating to health anddisease we have to introduce our discussion of the kindsof changes which have occurred in South Africa's Blacks byconsidering, however briefly, pre-industrial Black ontology.An understanding of Black ontology - the Black man'sphilosophy of being, his philosophy of existence (life) -is fundamental to a fuller appreciation of his ideas in theareas of health and disease. This philosophy of existence(ontology) has been forcefully documented by Tempels:In a later statement, Senghor" gives the following brief butcomprehensive description of the Black man's world view;'Like others, more than others, he distinguishes thepebble from the plant, the plant from the animal, theanimal from man; but, once again, the accidents andappearances that differentiate these kingdoms only illus-trate different aspects of the same reality. This reality isbeing in the ontological sense of the word, and it is lifeforce. For the African, matter in the sense the Europeanunderstands it, is only a system of signs which translatesthe single reality of the universe: being which is spirit,which is life force. Thus, the whole universe appears as aninfinitely small, and at the same time an' infinitely large,network of life forces which emanate from God and endin God, who is the source of all life forces. It is He whovitalises and devitalises all other beings, all other lifeforces.'African ontology, therefore, conceives of reality as con-sisting of interdependent, interacting life forces. These lifeforces, which are not of the same magnitude or potency,are organised according to a principle of hierarchy ofprepotency. Depending on an individual's social and othercircumstances, his life force (vital force) could be vitalisedor devitalised, increased or decreased. He could, as it were,be healthy or ill. The aetiology of his decreased vital forceis to be searched for and understood in relation to hisexistential relations with other vital (life) forces in hisphysicosocial environment. Is this ontology still valid? Anattempt will be made at a later stage to deal with thisquestion more fully.Sociological PerspectiveIn order to answer our question relating to the currentvalidity of African ontology, it is necessary to addressourselves to some of the current sociological evidence re-lating to the urbanisation and industrialisation of Blacksin South Africa.According to current historical evidence, the first re-corded historical contact between Blacks and Whites was4 May 1974 S.A. MEDICAL JOURNAL 923URBANISED POPULATION IN SOUTH AFRICA(PERCENTAGE)Year Whites Blacks*during the year 1770 on the banks of the Great Fish River.Since that year, closer contact has been brought about byindustrialisation and urbanisation. The trend in urbanisa-tion may be observed in figures provided by Moolman'in the following table.Moolman's figures reveal that 55% of the Black popu-lation was in South Africa's urban areas in 1970. If oneconcedes that the Black population is much larger than theWhite population, it is immediately evid~nt that there is asignificant Black population in the urban areas.It is not sufficient to observe that these Blacks have beenexposed to urbanisation and industrialisation since theturn of the century. We need to have more systematic for-mulations of the kinds of psychosocial changes whichhave taken place since the turn of the present century. Anumber of outstanding observers have made contributionsrelevant to the problem of social change among Blacks.s ,.,What insight can we gain from these contributions? Letus examine some of the more important formulations inthis respect.We begin with the reports of Wilson. 14 Her studies inthe Cape Peninsula led her to the conclusion that thepeople of Langa (a Black residential area) classifiedthemselves into the following categories: (a) townsmen('decent people' and 'tsotsis'); (b) Migrants (amagoduka,amaqaba); (c) libari (usually residing and working inflats). She also found that there were several distinctsocial groups: families, home-boy cliques, church groupsand various clubs (sport clubs; savings circles, erc).Mayer: in his comprehensive studies of East London,found the following basic social categories: 'real towns-people', 'red migrants' and 'school migrants'. Houghton,"in his contribution, recognises the existence of three cate-gories of workers from traditional societies. These are the'emigrant breadwinners' who are in the urban areas towork and make money so as to be able to support theirfamilies in the rural areas. The 'emigrant families' arecomposed of those workers who have migrated to thetowns lock, stock and barrel. The third group, the 'abscon-ders' (makholwa) are those who have no commitment toanybody either in the rural areas or in the town.Regional urban differences are always to be expectedin view of the differences in ethnic group composition. Inthis respect, for example, Soweto (Johannesburg) woulddiffer markedly from the East London residential areasstudied by Mayer. In spite of this consideration, it isprobably true to say that the findings relating to social• Note that Moolman used the term 'Bantu'.categories and social groups have a wide area of generality.To complete our brief sociological review, it is neces-sary to pay attention to two additional aspects. First thereexists the general question of the status of Black intensivepopulation areas in the cities. Any urban area of reason-able size in South Africa has a White city area and aBlack residential area (location or township) as part ofits ecological structure. The basic characteristic of thesesatellite communities is that in important respects they areneither urban nor industrial, since their economic viabilityis entirely dependent on the White cities. Neither couldthey, strictly speaking, be compared with suburbia. Lambo"has pointed out that in their psychosocial characteristicsthese communities are to be identified with (a) an unusual-ly high morbidity rate (social pathology); (b) 'non-tradi-tional' and 'non-supportive' child-rearing practices; and(c) the absence of community support during periods ofstress. Referring to Soweto, Helleman13 has also madesome observations relating to changes in social structure.In her view, the main changes have been in the areas ofthe extended kinship system, the patriarchal family struc-ture and the emergence of the nuclear family, The scopeof the present paper does not permit an extended treat-ment of Black urban and other sociology, although itcould be interesting, for example, to look at social mobilityin these groups, but that is another matter. We planned tolimit our analysis to those aspects of Black urban sociolo-gy which were considered to be related to the centraltheme of this paper, namely ideas of health and disease.TRIBAL AND WESTERN MEDICINECONFUCT OR SYNTHESIS?The study of ideas of health and disease among Blackshas since passed the stage of satisfying the curiosity offoreign observers to more well-formulated and seriousattempts such as those of Maclean1s and Read.'" Significantrecent efforts in this country are those of Fisher andHurst" and Hurst et al." Anecdotal evidence abounds tosuggest that traditional methods of dealing with illness inthe Black urban areas are still the rule rather than theexception, For example, Hurst et al." have suggested thatthey recognised a shift in their sample from magical ex-planations and witchcraft towards Western ideas of causa-tion and treatment.Blacks here and elsewhere may be classified into threecategories on the basis of their response to the introductionof Western medical services. Firstly, there is a group oftraditionalists, possibly now the smallest group, whowill only use traditional medical services. The secondgroup consists of those who will use Western services tothe total exclusion of all other services. The third group,possibly the biggest group, consists of those who will usea combination of traditional and Western services.Our analysis may now be crystallised to lead to tworelated observations. The first of these observationsamounts to saying that available sociological evidence fromstudies in various urban areas in South Africa reveals thatthere are several recognisable social categories (townsmen,unschooled migrants and schooled migrants) or, morebriefly, emigrants and migrants. The evidence also sug-gests that the migrants such as the 'red' migrants of East1013141924283255536068777984-+-86(?)19041911192119361946195119601970924 S.-A. MEDIESE TYDSKRIF 4 Mei 1974London or the amaqaba of Langa, Cape Town, may re-main 'encapsulated', insulated from the more significanturban and industrial influences. In this respect, it shouldbe noted that an increasing number of Blacks are beingexposed to urban industrial environments for varyingperiods of time (55% in 1970).The second observation: what accounts for the obser-ved resilience of traditional views and practices in theareas of health and disease? This question, importantthough it is, has not been treated with the seriousness thatit deserves. It is my submission that this question mayonly be adequately understood and formulated through aphenomenological frame of reference. This means that wemust attempt to understand the Black man's perception ofbeing-in-society (being-in-the-world); his mode of ex-periencing his phenomenal field; his experience.A phenomenological exercise of the type suggested willlead us first to a recognition of the current validity ofAfrican ontology (the theory of forces) as an organisingprinciple in the lives of the 'red' migrants (the amaqaba),the /ibm'i, the home-boy cliques and other urban non-kinship-orientated associations.In the case of these groups who constitute the bulk ofour urban Black proletariat, no other subjective experienceof being-in-the-world, no other organising principle hasovertaken that of the theory of forces. No competingworld-view exists for these people. If and when Westernideas are opportunistically utilised, they are subjectivelybeing experienced within the framework of the theory ofvital forces; of African ontology. No contradiction orconflict is involved, but only a situation synthesis.What of the townsmen? Why is it that even in theircase we invariably find a sporadic return to Africanontology - the usual combination of Western medicineand traditional remedies? In my view, this socioculturalregression is proportionately related to the degree of stressexperienced by the individual or his family. Phenomenolo-gical analysis tells us that in these cases, too, we are proba-bly dealing with a competition of world-views, of ontolo-gies. It is not difficult to see that African ontology has adecided historicocultural advantage in terms of formativeinfluence over Western conceptions derived from a domi-nant White culture.Our analysis tells us further that the theory of theresilience of traditional beliefs, which is based entirely on adefence mechanism hypothesis - which understands theBlack man's behaviour to constitute a security operation -does not constitute the whole story. It seems to me thatwhile the principle of situational relevance accounts fora considerable part of the behaviour, it is necessary tosuggest that African ontology as an organising principlein certain classes of urban Blacks (townsmen) has becomedissociated (not repressed) from the self-system, and re-mains latent as long as stress is subliminal, only to beactivated the moment the stress is beyond a certainthreshold.On following the phenomenological line of analysisI arrive at the conclusion that Mayer's concept of 'encap-'sulation' in respect of the East London 'red' migrants doesnot do justice to the psychosocial reality to which it is areference. It seems to me that the current structure ofSouth African society or that of the history' of any con-tact situation between White and Black has had deliberate,planned and religiously guarded encapsulation as its domi-nant characteristic. This fact is one which is subject toeasy demonstration by invoking the limitations on culturaldiffusion created by legislation and the resultant categoricaltypes of sociocultural interaction characterised by stereo-typing as well as the existence of religiously graduatedopportunities for assimilation of other sociocultural alter-natives.IMPLICATIONSThere are several implications which flow from this analy-sis. These will be briefly stated.Current evidence suggests that what we are witnessingin the area of health is not a conflict between Westernmedical practices and traditional ones. Analysis favours aview which suggests a psychosocial synthesis which is un-derstandable and not to be scoffed at.Health programmes of whatever description are rele-vant to the extent that they are related to the needs of thepatient-community they serve and not otherwise. Sincethis is not controversial, it should come as no surprise thathealth programmes should be based on a solid and soundpsychosociological knowledge of the specific communitiesinvolved.As I have said elsewhere, a solid sociology is mandatoryin the planning of training programmes for health per-sonnel and will determine to a large extent the degree towhich treatment modalities became relevant to specifichuman situations.Finally, I would like to say with all the conviction atmy command, that the witchcraft extravagance which hascharacterised the many contributions of some competentobservers, is quickly becoming museum material and mustbe replaced by a relevant and enlightened sociology,anthropology and sociopsychology.REFERENCESI. Bryant, A. T. (1966): Zulu Medicine and Medicine-men. Cape Town:Struik.2. Silberbauer, E. R. (1968): Understanding and Motivating the BantuWorker. Johannesburg: Personnel Management Advisory Service.3. Gutkmd, P. C. W., ed. (1970): The Passing of Tribal Man in Africa.Leiden: E. J. Bril!.4. Idem 1970): Op. cit.,' pp. 51 - 65.5. Tempels, P. (1959): Bantu Philosophy (trans!. into English by King,C.). Paris: Presence Africaine.6. Senghor, L. S. (1966): 'Negritude: A humanism of the 20th century',Optima, March 1966, p. 4.7. Moolman, J. H. (1971): 'Urbanisation of the Bantu in South Africa',USSALEP Conference, 1971.8. Mayer, P. (1971): Townsmen and Tribesmen: Conservation and theProcess 0/ Urbanisation in a Sowh A/rican City. Cape Town: OxfordUniversity Press.9. Idem in Holleman, J. F. ed. (1964): Problems of Transition, pp. 21-51. Pietermaritzburg: ata} University Press.10. Idem (1972): Urban Africans and the Bantllstans. Johannesburg:SAIRR. .11. Glass, Y. (1964): Op. cit.,' pp. 52 - 80.12. Idem (1963): S. Afr. J. Sci., 59, 386.13. Helleman, E. (1971): Soweto. Johannesburg: SAIRR.14. Wilson, M. (1964): Op. cit.,' pp. 1 - 20.15. Biesheuvel, S. (1964): Op. cit.,' pp. 81 - 102.16. Houghron, H. in Smith, P., ed. (1958): Africa in Transition, pp. 39-46. London: Max Reinhardt.17. Lambo, T. A. in Wolstenholme. G. E. W. and O'Connor, M., eds(19 ): Man and Africa (Ciba Foundation Symposium). London: J.& A. Churchill. .18. Madean, U. (1971): Magical Medicine: A Nigerian Case-Swdy.London: Alien Lane - The Penguin Press.19. Read, M. (1966): Culwre, Health and Disease: Social and CulturalInfluences on Health Programmes in Developing Countries. London:Tavistock Publications. 120. Fisher, C. and Hurst, L. A. (1967): Topical Probl. Psychiat. Neurol.,5, 179.21. Hurst, L. A., Hall, R. S. and Fisher, C. (1970): Brit. J. Soc.Psychial.

Health and disease

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Health and Disease

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