Connecting with South Africa
Cultural Communication and Understanding
By Astrid Berg
Texas A&M University Press Copyright © 2012 Astrid Berg
All rights reserved.
INFANTS AND PARENTS IN A CAPE TOWN COMMUNITY
In April 1994 we had our first democratic elections in South Africa, a triumphant event—active participation by all, and no violence. We were all heady with pride and enthusiasm. In January 1995 I was instrumental in organizing the first Infant Mental Health Conference in South Africa. The idea came from the Jungian child analyst Mara Sidoli: she planted the seed, and she helped me find colleagues to present papers. It was a huge success, and I realized only in retrospect that part of the reason for this success was the synchronicity of talking about real infants in the new, "infant" South Africa.
Beginning at the Beginning
This conference was the start of many creative endeavors in the country: it led to the establishment of associations in infant mental health in Cape Town and Johannesburg, both of which are affiliated with the World Association of Infant Mental Health; it led to a second Conference on Infant Mental Health in 2000, and it led to us being chosen as the hosts for the thirteenth conference of the world association in Cape Town in 2012. A large collaborative research project was set up during this period—looking at the prevalence of postpartum depression and the effect of this depression on the development of the infant—and other projects followed.
What is of relevance here (and close to my heart) is the clinical work with parents and infants to which all this gave rise. I was given the go-ahead by the University of Cape Town in Rondebosch and the head of the Department of Psychiatry to establish a parent-infant mental health service. I was advised by my professor of that time not to limit myself to working from my hospital, the academic base (tertiary health care), but to enter the community and start a service there, at a primary level. I objected to this—I considered myself ill-equipped to work in an unknown, for me "foreign" setting, when I was not at all sure what I was going to do with parents and their infants in a known setting. However, I took to heart his argument that we could not afford, in 1995, in the new South Africa, to be starting a new service that would have been seen to be providing help only to the well-to-do part of the city.
Thus, having accepted that I would have to do both—that is, start the service in a tertiary as well as a primary health care setting—I had to answer the question: what was I, as the person driving this alone, actually going to do? What would I offer and to whom? Infant mental health interventions have different levels and in order to be comprehensive, attention needs to be given to all of them. Prevention and treatment are intimately linked, and the younger the child, the more this holds true. If this intervention is to be done properly and according to the textbook, it requires quantitative research that can influence policy decisions; it then requires clinical trials that measure whether a particular intervention is working from the objective, scientific point of view. It requires different teams working in different settings and ascertaining whether a particular model is effective. And all of this means having almost unlimited resources, both financial and human—neither of which are at my disposal. The challenge for me has been: what can I do, given my constraints in terms of money and professional support?
I decided, or rather I was led to decide by forces outside of my conscious awareness, to be who I am, no matter where I work: that I am both a child psychiatrist and an analyst, and that I regard my basic role as that of a psychotherapist. As a child psychiatrist I center my attention on the infant—it is from him or her that I gather information. As a psychotherapist I do not merely want to gather information, but I want to provide alleviation of suffering—I need to do something with what I observe; and again, the younger the child, the less this is so via conventional medical psychiatry, where a diagnosis is made and medication prescribed. It requires a psychological intervention, an emotional intervention, and thus infant-parent psychotherapy is what I do.
But I am getting ahead of myself. Before one can do anything one has to have a base, a place from which to work. In my hospital clinic setting this was not a problem: I used my office in which to see parents and infants, and I made use of the infrastructure provided by the out-patient department. In the community I had no such base, and obtaining one was an adventure—at times a frightening one.
Entering the Unknown
The work in Rondebosch is much like I imagine work at any child psychiatry unit in Europe. There is a reception area with staff, consulting rooms, playrooms, and a steady team that fills the building. The patients are seen as per appointment, and the week is scheduled to the hour for every person working there. Regular team discussions are held where case material is presented in detail and where academic input is part of the course. The work is reliable, predictable, and known. It is embedded in the long history of similar units all over the western world. I knew that being in a primary health care clinic would offer me none of this, but what I did not know was that I would have to engage in a process, the complexity of which I had not envisioned.
When my professor suggested that I also work in the community I decided to go to a township called Khayelitsha. Black South African townships owe their origins to the Group Areas Act passed in 1950, assigning races to different residential and business sections in urban areas (its effects are summarized at http://www.africanaencyclopedia.com/apartheid/apartheid.html). Slowly but determinedly, all black people were moved out of "white areas"; those who were legally in the urban areas because of having the necessary work permits were then moved into townships adjoining the big cities. Khayelitsha, which means "new home," became an official township in the 1980s and is the third largest of such townships in South Africa. It lies eleven kilometers away from metropolitan Cape Town, adjacent to the international airport. Geographically it is situated in the Cape Flats—lowlands between the mountains of the Cape Peninsula and those of the lush interior wine lands. The Cape Flats offer spectacular views onto both sets of mountain ranges, but on the ground the soil is poor and sandy, growing water-logged because of winter rains or desertlike and dusty because of summer winds.
The inhabitants are Xhosa-speaking people who have moved to the city from their former "homeland," now the Eastern Cape, in search of employment, better education, and health care. Most members of the family, especially the elders, remain behind in the traditional homestead while the young people, young mothers, flock to the urban areas. Housing is in makeshift shelters, which may be turned into houses made of bricks as time passes; currently there are different stages of housing development evident as one drives through. But when one descends by plane from above to land, or when one drives by on the highway, all one sees are shacks: thousands of them, close to each other. They all seem the same, and one does not really want to look and is grateful for the concrete wall erected to prevent people from crossing the road. It is easier to ignore the obvious poverty and drive by swiftly. At this point something needs to be said about the color line that was so deftly drawn by the Apartheid government and that permeates the society to this day.
The Color Line
In the Apartheid days white people were not allowed into black townships such as Khayelitsha. The reasons for these laws were complex but were motivated psychologically by a drive for power, based in part on an unconscious sense of inferiority of the self that manifested in the fear of the other. The other, as a recipient of projections, became condensed into one undifferentiated mass of blackness. A dark skincolor became the signifier for a host of psychic attributes: mental inferiority and primitiveness in the widest possible senses of these words. Thus external laws had to be made to keep these perceived threats to "white civilization" at bay. The brutality and thoroughness of the laws of the Apartheid government were such that this split was successfully perpetuated externally as well as internally.
Only when I entered Khayelitsha in 1995 did I became fully aware of how much I had incorporated this racist split. Apartheid had been an effective system indeed. The withdrawal of projections has been an ongoing process for me, and with it strong emotions have come to the surface: emotions of fear, shame, and guilt. I have had to acknowledge these within myself and I am sure that this process is one that people in South Africa have had to go through and are still going through. Fear of otherness was manifested concretely in my complete unfamiliarity with the physical layout of Khayelitsha. Going into such an unknown area meant facing physical uncertainty on many levels, including about being violated in one way or another. It also involved having to face the poverty I had only read about in newspapers and had preferred to ignore. When, after a while, I came to know the area and some of the people living there, my fear soon gave way to shame that, as an educated person, I had been completely ignorant of my fellow citizens' lifestyle, customs, and values.
Finding a Space
During all my time in Khayelitsha—from 1995 to the present—I have been accompanied and led by two special women: Nosisana Nama and Nokwanda Mtoto. Nosisana and I have a particularly trusting, close relationship. She is Xhosa- speaking and deeply connected to her ancestors and traditional values, while at the same time living in the modern, urban world. She acts as my guide and mentor, and together we learn from each other. There is mutual respect and trust; we have had to go through some difficult times.
The most intense of these was our naïve attempt at setting up a community resource for mothers and their infants in a renovated shipping container. Structurally altered containers are a frequent sight in the township—they act as telephone houses, meeting places, offices. We bought one from a woman, called by her clan name of Magadebe, who was running a crèche—she had a container that was not in use and we thought it appropriate to be situated near a place designated for the care of handicapped children. The money used had come as a gift from my family abroad, and in our trust of Magadebe, we did not ask for a receipt. Initially all went well. After we had a nighttime burglary, we appointed a night guard and paid him as well as Magadebe a monthly sum, besides paying the municipal rates for using this piece of land. My daughter and her school friends painted the container with bright flowers. We had a colorful inaugural ceremony. We used the container as our office once a week, and during other times it was used by other organizations that wanted to inform mothers about various issues—such as the safe use of paraffin. It seemed ideal. We called it the Mdlezana Centre—using an indigenous word for the unity between mother and infant.
However, gradually it became clear to us that Magadebe was a woman with trickster traits who was exploiting our goodwill. She told people that the container was hers and denied that we had paid a large sum for it. Other unpleasant, plainly untruthful allegations were made, such as that we were withholding from the community funds we were thought to have. We felt increasingly fearful and vulnerable, so much so that one of the women who worked with us and who lived nearby started having bad dreams and started fearing bewitchment. After her house was gutted by fire in December 1998, I decided it was time to move. The feeling of paranoia that was evoked was real and came from deep layers of the unconscious, plus of course very real outer danger. Through all this, Nosisana and I worked as a team. We understood Magadebe to be greedy and exercising a sense of entitlement, and that she was prepared to tell lies in order to obtain whatever money and material possessions she could. The notion of bewitchment, though foreign to me, became a concept that needed to be taken seriously, because it could have been a real threat to life.
When I told the head of the Department of Psychiatry at the university, he advised me not to go into the area for the time being. Nosisana, who does not live in Khayelitsha, shared this view. In January 1999 she went back in alone to feel out the atmosphere. It was only when she reported to me that everything seemed to be fine that I returned. We decided the best way forward was to continue our work in one of the official well-baby clinics where infants are brought for weighing and immunization. These are mainly staffed by nursing sisters. We eventually settled down in a clinic called Empilisweni, meaning "good health." This was situated in a subsection of Khayelitsha called Harare. This place felt safe, protected by the community and larger municipal structures and, above all, staffed by nurses who were professionals and cared deeply for their people. As part of the development of infrastructure in the townships in general, Khayelitsha also obtained new buildings for clinics. We have since moved to such a new building in Kuyasa, together with the same clinic, and continue our regular visits.
Looking at this process from a deeper perspective, several issues arise. Often I asked myself why I continued to want to work in this area. According to many white people living in Cape Town, going into the township in the first place was asking for trouble. I had heard this often enough. When I was then confronted with all these difficulties, the fears and predictions of unrealistic idealism seemed to be confirmed. The opinion was that our western values—of right and wrong, of boundaries between professional life and personal life, between the individual and collective—were not compatible in a community where seemingly other values, other rules pertained.
What continued to motivate me on a conscious level were several factors: I regarded the preceding view as pejorative, one that was of the stereotyping kind reminiscent of the past. Cultural differences certainly do exist; the interaction with others, the dance one has with them, is in my experience much more complex, more differentiated than the western styles to which I am accustomed. Much more power lies in community relationships, in the interconnectedness between the people, than in the individualistic society of Europe and North America. What we experienced with Magadebe was an unfortunate incident, one we could have had in any society where there was so much poverty and deprivation.
Then there were the people I had come to know and respect—Nosisana as well as nursing staff and the mothers with their babies. They had become an integral and essential part of my life. I could not imagine being without them. At another level there was the wish to connect with the African culture, to be enriched and learn from age-old traditions, particularly those of ancestor reverence and the sharing spirit of ubuntu (discussed in chapter 6). In part this is making up for lost time—in the first half of my life I was prevented from engaging with African people on this level because of the political situation in the country and my own lack of awareness of what was happening. It is of course also about guilt and reparation, but there is more to it. In my European-ness I have lost my own connection to my ancestors, to a deeper universal rootedness. The separation anxiety that is so prevalent with western mothers and their babies seems to be almost nonexistent in traditional African culture. It is my impression that this might have to do with that linking to the clan and to the ancestors that is present for every individual from the very beginning of life. An individual person is part of a much larger whole—this notion is profoundly reassuring and accounts for the sense of equanimity that I come across, time and again. This is not resignation or depression, but a knowing of a greater order in which the individual is embedded.
I am mindful of the danger of romanticizing the other culture, of stereotyping and generalizing in an idealizing way. I do however have to stand by my very real experience over many years, namely that there is a special composure and acceptance among the black African people with whom I have come into contact; a sense of harmony that comes out of the knowing that one is part of a whole, a knowing deeply embedded in the collective psyche. This is of course not to deny or minimize the personal conflict, pain, and deprivation that exist in daily life. But it is humbling to be able to witness the life of so many brave parents and their children and to be able to help some of them. This is the reason for continuing. (Continues...)
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