Gillian Eagle

Therapy at the Cultural Interface: Implications of African Cosmology for Traumatic Stress Intervention

The topic of intercultural or multicultural therapy continues to stimulate much debate in the field of psychotherapy. Intercultural counseling training emphasizes respect for cultural beliefs as a core dimension of appropriate intervention. This paper addresses the limitations of this perspective in guiding therapists when faced with a clinical situation in which the non-challenging of cultural belief systems seems counter-therapeutic. The discussion is focused around critical observations of circumstances in which conventional African wisdom, as understood by clients presenting for trauma counseling, appeared to be counterproductive for their recovery in terms of western intervention principles. In psychotherapy for traumatic stress and traumatic bereavement, such tensions appear to arise particularly strongly because of the inevitable search for meaning in the face of extraordinary life events. Focusing on meaning making, cognitive intervention, schema realignment and reframing within trauma therapy, the paper explores ethical considerations and areas of potential conflict with reference to theory and clinical case material. Some strategies for therapeutic engagement are proposed.

The intractability of militarised masculinity : a case study of former Self-Defence Unit members in the Kathorus area, South Africa

The study explores the struggle to maintain and transform a ‘masculine’ identity acquired primarily as a consequence of serving as part of a township-based paramilitary force in the pre-democratic South Africa. Based on accounts of former Self-Defence Unit (SDU) members from the Kathorus region (a group of townships on the perimeter of Johannesburg), the article explores some of the forces that influenced young men to become involved in political violence, the status this bestowed upon them, and how aspects of their ‘militarised identity have come into conflict with new constructs of masculinity in a post-apartheid South Africa’. Although the experiences of South African ex-combatants have been documented in a number of reports and articles (Gear, 2002; Marks, 2001; Mashike & Mokalobe, 2003; Xaba, 2001), this article seeks to highlight the intractability of a particular form of masculine identity attained during the pivotal stage of early and late adolescent development. The negative consequences of this weddedness to a militarised masculinity for both the men themselves and the broader society are explored, together with some of the dimensions that appear to make this identity so compelling and so difficult to transform. The article draws upon theoretical understandings that suggest that gender and masculinity are socially constructed, and is based on data collected by means of individual interviews and focus groups conducted, with former combatants. The interviews reveal that images of militarised masculinity were popularised and dominant during the liberation struggle against apartheid, particularly amongst urban youth who were recruited into resistance activities. Young combatants were expected to be strong, brave, tough, fearless, aggressive, and violent. In many urban townships, young boys who were not part of the liberation struggle and youth politics were constructed as lacking in masculinity. Post 1994, virtually overnight, young combatants were expected to relinquish their militarised roles and to adopt new forms of masculinity without the facilitation of any demilitarisation programme to address the complexities of this transformation in their social and personal identity. The interviews reveal that many of these former combatants feel betrayed, forgotten, and alienated in post-apartheid South Africa. Some have carried their militarised masculinities into the new democracy, continuing to be involved in violent activities and risk-taking behaviours. Although many of them appear to be suffering from symptoms of Post-Traumatic Stress Disorder (PTSD) and other aspects of war trauma, attending counselling is seen as a sign of weakness and as an insult to militarised masculinity. The article argues that interventions to assist with identity transformation and greater social integration of such marginalised young men need to take account of these dynamics.

The Shattering of the Stimulus Barrier: The Case for an Integrative Approach in Short-Term Treatment of Psychological Trauma

The paper argues that the integrative psychotherapy approach is ideally suited to the treatment of psychological trauma. A brief term intervention model, devised by psychotherapists working with trauma in the South African context, is presented to illustrate this premise. It is asserted that posttraumatic stress represents a disorder in which dysfunction occurs both internally and externally, according to Freud at the interface of these two aspects of psychological functioning, i.e., at the ego boundary. Disturbance manifests in recognizable cognitive, behavioral, and somatic symptoms and in addition carries unconscious associations and anxieties. The ideal approach to treatment thus appears to be to draw on the relative strengths of both the psychodynamic and cognitive-behavioral schools. Existing trauma intervention models reflect the centrality of integration in many respects, although this does not seem to be explicitly recognized. The five components of the model referred to above are outlined and each component is explored in terms of its efficacy within both a cognitive-behavioral and a psychodynamic framework. Illustrative case material is provided to demonstrate the mechanisms at work in each case. The paper argues that the clinical success of the model lies in its integrative perspective and that psychotherapy integration should be recognized as the approach of choice in the treatment of traumatized individuals.

Traumatic stress: established knowledge, current debates and new horizons

Traumatic stress studies is a well-established, vibrant and ever-growing cross-disciplinary area of research and practice to which psychologists have made a substantial contribution. This article presents an overview of the field, acknowledging the close relationship between the study of post-traumatic stress disorder more specifically and the field of traumatic stress studies in general. The authors focus on four key dimensions: historical and conceptual issues, diagnostic features and debates, aetiological research findings in relation to vulnerability to disorder and treatment approaches to post-traumatic stress disorder and related conditions. It is observed that there is both extension and deepening of knowledge based upon scientific advances such as neuroimaging and gene mapping technology, employment of meta-analyses, increased attention to randomized control studies and emphasis on more comparative research. Alongside such developments is the posing of important philosophical and psychosocial questions and increasing recognition of the need to contextualize both where and how established knowledge has been generated and how this may need to be expanded.

A Qualitative Study of the Multiple Impacts of External Workplace Violence in Two Western Cape Communities

We explore the individual, organisational, familial, and community impacts of external workplace violence in a South African telecommunications company, as perceived and experienced by victims of such violence and the members of management mandated to manage and prevent it. Exposure to violence while working dramatically and directly affected the lives of the individual victims. Moreover, its impacts were felt across and within the organisational, familial, and community settings in which these individuals are located daily. The use of conventional crisis management strategies that are traditionally directed at addressing the individual impacts of trauma through specialised psychological interventions were perceived to be ineffective by all of the research participants. Our findings therefore call into question current understandings of the psychologists role in managing violence in the workplace. Accordingly, ways of re-conceptualising the role and requisite skill set of psychologists working with or in organisations, where violence while working is an everyday reality, are suggested.

Bridging risk and enactment: the role of psychology in leading psychosocial research to augment the public health approach to violence in South Africa:

In the wake of apartheid, many in the South African health and social sciences shifted their orientation to understanding violence. Rather than approaching violence as a criminal problem, post-apartheid scholarship surfaced violence as a threat to national health. This re-orientation was well aligned with a global groundswell that culminated in the World Health Assembly’s 1996 declaration of violence as a public health problem. In response, researchers and other stakeholders have committed to the public health approach to violence in South Africa. Despite some unquestionable successes in applying this approach, violence remains a critical social issue and its recalcitrantly high rates signal that there is still much work to be done. One avenue for more focussed research concerns understanding the mechanisms by which upstream risk factors for violence are translated into actual enactments. We argue that South African psychology is well placed to provide greater resolution to this focus. We begin by providing a brief overview of the public health approach to violence. We then point to three specific areas in which the limits to our understanding of the way that downstream psychological and upstream social risk factors converge in situations of violence, compromise the theoretical and prevention traction promised by this approach and chart several basic psychosocial research coordinates for South African psychology. Steering future studies of violence by these coordinates would go some way to addressing these limits and, in so doing, extend on the substantial gains already yielded by the public health approach to violence in South Africa.

AIDS: Knowledge and Attitudes of a Group of South African Health Professionals

The results of a survey into attitudes to, and knowledge of, AIDS conducted on a group of 74 South African health professionals are described. Based on a similar British study by McManus and Morton, the authors sought to establish the degree to which attitudes to AIDS correlate with knowledge about AIDS, and the degree to which such attitudes correlate to attitudes towards the sexuality of ‘high-risk’ groups; homosexuals and blacks. Attitudes to AIDS appear to correlate significantly more highly with attitudes to high-risk groups than with knowledge concerning AIDS. The implications of these findings for educative intervention are briefly discussed.

Continuous traumatic stress as a mental and physical health challenge: Case studies from South Africa.

This article discusses the condition of continuous traumatic stress as common on the African continent and in other international settings characterised by very high levels of ongoing violence and threat of community, political or war-related origin. Through consideration of three case studies from South Africa, contexts of continuous traumatic stress are described, and the mental health and physical health effects of living in such contexts are elaborated. Cautions are raised about attempting to transpose existing posttraumatic stress models onto individuals exposed to situations of continuous traumatic stress, and guidelines for optimal interventions with such cases are proposed.

Posttraumatic Stress Disorder (PTSD): The Malleable Diagnosis?

The paper seeks to raise questions about the rigour of psychiatric diagnosis with specific reference to the diagnostic category of posttraumatic stress disorder (PTSD). It is argued that because of the inclusion of the stressor criterion (verifiable exposure to an external event) PTSD is very much located in consensual reality. In addition, because of its application to victims in extremity, the diagnosis cannot help but engage with people who are at the receiving end of abuses of power. Such characteristics shape PTSD as a somewhat uniquely socially-located diagnostic category and bring specific challenges to bear in the employment of the diagnosis. Not only is PTSD problematic in its location within a Western, medically-based system of classification, but it has also been drawn upon to serve explicitly political rather than purely clinical agendas. The political role of PTSD has tended to be most evident in the psycho-forensic domain where it has been cited in favour of both complainants and defendants, both perpetrators and victims. Examples of such evidence are discussed with particular emphasis on the role played by PTSD diagnosticians in the South African context. It is argued that the malleability of PTSD offers both problems and opportunities and that ultimately the integrity of the diagnosis may rest on moral as much as clinical principles. In this respect the paper seeks to illustrate that definitions of normality and abnormality in the psychiatric domain remain flawed and open to contestation and abuse. The importance of organizational and collegial support in grappling with these issues is also emphasized.

Self-Consciousness and Impression Management in the Authoring of Apartheid-Related Narratives

In taking a constructively critical view on the Apartheid Archive Project, an area that warrants consideration is the possible role of self-representation in the construction of the archive itself. Although narratives have and will continue to be collected through various channels, one of the primary means of submission is a Web-based portal. Thus far, many of the contributions have been offered by the research team and their associates, and to a lesser extent the general public. Contributors are able to submit anonymously or append their identities to the narratives if they so wish (see www.apartheidarchive.org). This means of participation suggests that self-representation is likely to be salient for many contributors. While it is evident that many of the analyses that have already been offered on different aspects of the contents of the archive have taken cognisance of discursive and performative elements of the kind identified as important in Potter and Wetherell’s (1987) and Butler’s (1999) work, there seems to be some merit in continuing to consider self-representation as implicated in a narrative-based archive in a focused way.