Lou-Marie Kruger

The other side of caring: abuse in a South African maternity ward

The abuse of women by nurses in maternity units of hospitals world‐wide has been documented in research conducted by universities, non‐governmental organisations and government agencies. In the current paper, patients and nurses of a maternity unit of one particular South African hospital are interviewed about their experiences of childbirth and their experiences of being nurses in a maternity unit. Interviews were analysed using social constructionist grounded theory and Foucauldian discourse analysis. It was found that in both sets of interviews, patient abuse (as experienced or witnessed) was a prominent theme. Accounts of satisfactory nursing were rare. Previous findings about abuse and ritualised abuse of patients by nurses were thus corroborated. In analysing how such problematic interactions constitute an integral part of medical care in a particular maternity ward, and, as such have become ritualised, sanctioned, normalised and ultimately institutionalised, it was found that nurses (who are typically disempowered in the hierarchy of the medical system) and patients (often considered to be docile passive bodies in the context of a medical ward) oscillate between being passive and active, powerless and powerful in the construction of the nurse–patient relationship. It is suggested that both nurses and patients feel frustrated, disappointed, resentful and even enraged in a context where they cannot be in control and cannot care or be cared for. The study seems to suggest that the empowerment of nurses and patients is necessary in order for the abuse to stop. It is further recommended that future research explore cases where nurses and patients are satisfied with the caring that they have given or received; such studies will illuminate the conditions which make good nursing possible in a different way.

Reflections on the sexual agency of young women in a low-income rural South African community

Reproductive health issues are pertinent in the mental health development of young women in South Africa, especially young women in low-income communities. The prevalence of problems such as HIV/AIDS and unplanned or unwanted pregnancies among South African female adolescents specifically warrants urgent attention. It is argued that inadequate theoretical frameworks and inadequate data on sexuality in different South African communities hamper effective preventative interventions in the female reproductive health arena. This article reports and discusses some of the findings of a larger study exploring female adolescent sexuality in one specific low-income South African community. Twenty-five adolescent women from low-income, ‘coloured’1 households in the Western Cape were interviewed about their first experiences of sexual intercourse. It was found that the participants demonstrated limited sexual agency in their first experiences of sexual intercourse. The authors conclude that a new discourse of female sexual agency may be needed.

Narrating Motherhood: The Transformative Potential of Individual Stories

In contemporary western society, motherhood has acquired a special significance for women: women are expected to find fulfilment and satisfaction in the role of the “ever-bountiful, ever-giving, self-sacrificing mother. Feminists, in attempts to problematise this ”myth of motherhood”, have emphasised the importance of focusing on the subjectivity of women by advocating that women themselves speak of, and reflect on their experiences of motherhood. In this article the narratives of two middle-class tertiary educated women were analysed to see to what extent the personal stories of individual women can serve to subvert such myths and change social realities. It was found that although both participants clearly articulated a profound ambivalence about their pregnancies and the possibility of becoming a mother, both women ended up addressing their ambivalence by simplifying their stories. Furthermore, in their quest for coherence and order, they reverted to reflecting and, in fact, reproducing dominant motherhood ideologies. It is argued that even the most individual stories are also shaped by political realities and that women will not be able to embrace the ambivalence in their stories in a context where such ambivalence is not yet tolerated within the dominant ideologies.

Masculinity, sexuality and vulnerability in ‘working’ with young men in South African contexts: ‘you feel like a fool and an idiot … a loser’

South Africa has seen a rapid increase in scholarship and programmatic interventions focusing on gender and sexuality, and more recently on boys, men and masculinities. In this paper, we argue that a deterministic discourse on mens sexuality and masculinity in general is inherent in many current understandings of adolescent male sexuality, which tend to assume that young women are vulnerable and powerless and young men are sexually powerful and inevitably also the perpetrators of sexual violence. Framed within a feminist, social constructionist the oretical perspective, the current research looked at how the masculinity and sexuality of South African young men is constructed, challenged or maintained. Focus groups were conducted with young men between the ages of 15 and 20 years from five different schools in two regions of South Africa, the Western and Eastern Cape. Data were analysed using Gilligans listening guide method. Findings suggest that participants in this study have internalised the notion of themselves as dangerous, but were also exploring other possible ways of being male and being sexual, demonstrating more complex experiences of manhood. We argue for the importance of documenting and highlighting the precariousness, vulnerability and uncertainty of young men in scholarly and programmatic work on masculinities.

The melancholy of murderous mothers: Depression and the medicalization of women’s anger

Informed by recent feminist critiques of the notion of depression, we explored how a group of South African low-income mothers who have been diagnosed with depression subjectively describe and explain their psychological distress. Working within a feminist materialist-discursive framework, we focused both on the explicit content of what the women were saying and on the implicit or underlying discourses that informed their narratives. Our findings suggest that respondents often subjectively experienced their psychological distress as anger, which was also articulated in violence directed at their children. This suggests that not only does the diagnosis of depression serve to medicalize the distress of participants, but it may simultaneously serve to obscure their anger at having to mother in adverse conditions. In exploring reasons for their anger, we found that participants were frustrated with trying to live up to idealized notions of motherhood in impoverished contexts.

Die subjektiewe ervaring van depressie onder Suid-Afrikaanse vroue in 'n lae-inkomste gemeenskap

In verskeie internasionale en Suid-Afrikaanse epidemiologiese studies is bevind dat vroue byna twee keer meer geneig is om aan depressie te ly as mans (Accort, Freeman & Allen, 2008; Kessler, 2003; Ngcobo & Pillay, 2008). Volgens die Wereldgesondheids-organisasie (2006) is depressie die grootste oorsaak van siekteverwante ongeskiktheid onder vroue wereldwyd (Dukas, 2009; Lafrance & Stoppard, 2006

Motherhood and the “Madness of Hunger”: “…Want Almal Vra vir My vir ‘n Stukkie Brood” (“…Because Everyone Asks Me for a Little Piece of Bread”)

It is widely assumed that the social and economic conditions of poverty can be linked to common mental disorders in low-, middle- and high-income countries. Despite the considerable increase in quantitative studies investigating the link between poverty and mental health, the nature of the connection between poverty and emotional well-being/distress is still not fully comprehended. In this qualitative study, exploring how one group of Coloured South African women, diagnosed with depression and residing in a semi-rural low-income South African community, subjectively understand and experience their emotional distress, data was collected by means of in-depth semi-structured interviews and social constructionist grounded theory was used to analyse the data. We will attempt to show (1) that the depressed women in this group of respondents frequently refer to the emotional distress caused by hungry children and (2) that the emotional distress described by the respondents included emotions typically associated with depression (such as sadness, hopelessness and guilt), but also included emotions not necessarily associated with depression (such as anxiety, anger and anomie). In our attempt to understand (both psychologically and politically) the complex emotional response of mothers to their children’s hunger, we argue that powerful gender and neo-liberal discourses within which mothers are interpellated to care for children, and more specifically, to make sure that children are not hungry, mean that the mothers of hungry children felt that they were not fulfilling their responsibilities and thus felt guilty and ashamed. This shame seemed, in turn, to lead to anger and/or anomie, informing acting out behaviours ranging from verbal and physical aggression to passive withdrawal. A vicious cycle of hunger, sadness and anxiety, shame, anger and anomie, aggression and withdrawal, negative judgement, and more shame, are thus maintained. As such, the unbearable rebukes of hungry children can be thought of as evoking a kind of “madness” in low-income mothers.

The stress of caring: The manifestation of stress in the nurse-patient relationship

Following global trends in health reforms, South Africa has followed a primary health care approach since the eighties (Petersen & Swartz, 2002; Van der Walt, 1998). The implementation of this approach at first was regarded as selective and piecemeal (Van der Walt, 1998), but with the emergence of a democratically elected government in 1994 a series of health reforms focused on equalising the coverage of service (Van Wyk, 2005). The South African health system can thus best be described as one that has been characterised by time-consuming restructuring processes aimed at the implementation of a comprehensive primary health care service. Within this system all health-care professionals have been exposed to stressful working conditions. However, mental health professionals (psychologists and social workers) agree that the impact of these conditions on nurses is specifically important as they form “…the largest cadre of frontline health providers in South Africa” (Van der Walt & Swartz, 2002:1002).

The Whales Beneath the Surface: The Muddled Story of Doing Research With Poor Mothers in a Developing Country

In this article I attempt to show how research ideals of social change and usefulness can lead to “research paralysis.” I also argue that if there is sufficient reflexivity about the research process itself, paralysis is not inevitable, and useful knowledge can indeed be generated. I substantiate this by illustrating how the same interview data can be analyzed on multiple levels, rendering it useful in different ways in different contexts. I thus argue that reflexivity is essential in the Community Psychologists struggle for usefulness: it is in reflecting on the complexity of the research task (the demands of different contexts and different communities) that the Community Psychologist can engage strategically and productively with the possibilities and the limits of her usefulness. The data that are the focus of this article were generated in a long-term qualitative research project focusing on low-income, Black mothers from a semirural community in South Africa.

An Exploration of German Subjectivity Three Generations after the End of World War Two

This qualitative study aimed to explore how grandchildren of Second-World-War-generation Germans talk about and make meaning of their national past. Operating from a social constructionist stance, semistructured individual narrative/biographical interviews were conducted to collect the data. These constructed narratives were analyzed drawing on intersubjective psychoanalytic theory to identify the relational affective investments (organizing principles) that implicitly influenced the discursive positions that seven third-generation post-War Germans—six participants and the researcher—assumed in conversation with one another. Four predominant positions emerged from the analytical process: the default German, the bad/ashamed German, the defensive German, and the good German. The results revealed a complex and layered German subjectivity. The nature of this self-structure indicates that the third-generation post-War Germans involved in this research experience significant adverse emotional effects in relatio...