Reflections On The Indigenisation Of Psychology In South Africa.

Abstract The indigenization of knowledge systems has resulted in many challenges, amongst others being the need to initiate and engage in a sustainable dialogue that captures African traditional understandings of mental health within the South African context. To this effect, departments of psychology throughout South Africa are being challenged to provide African frameworks of conceptualizing and understanding mental health issues and to develop curricular that integrate these in the training of their students. This landscape highlights the need to embrace a daring philosophical departure from the traditional Eurocentric/Western focus in order to heighten psychologys relevance within non-Western contexts. This further inspires the need to sensitize psychology intelligentsia to African perspectives of understanding and managing mental health an imperative for a multicultural society like South Africa. As an essential step towards this process, this paper aims to elicit scholarly input that will contribute towards a process of crafting a text that gives credence to indigenous African worldviews on mental health within the field of psychology training in South Africa. This will narrow the apparent gap that exists between training that is based on Western/Eurocentric models and the application of such skills in dealing with non-Western populations.

Introduction The wake of what is now referred to as the African Century, the century of the African Renaissance, provokes a re-examination of knowledge systems anew, by putting the indigenization of knowledge as an imperative on its agenda (Ntuli, 2002; Odora-Hoppers, 2002). As such, the Indigenous Knowledge Systems (IKS) movement generates debate and rhetoric that invokes African knowledge systems as a basis upon which to build new knowledge in order to contribute to the task of bringing about Africas re-birth. This has led to a revolution in thinking which has affected many quarters, amongst others, research and training institutions, including institutions of higher learning. These institutions are confronted with the challenge of investigating the 1

indigenization of knowledge acquisition and its conceptualization, as well as the challenge of designing a curricular that will embrace this knowledge into the local teaching programmes to ensure the promotion and sustainability of this framework. One of the many fields affected and challenged by the IKS movement is the psychology fraternity. Psychology teaching and practice in South Africa is largely based on the Western models of understanding and managing mental health. This is evidenced by the textbooks that are prescribed and curricular that is taught for such studies in institutions of higher learning across the country. While there are useful textbooks that are adapted for the South African context, an appraisal of these texts indicate that they are unsuitable to address the transformations that continue to take place in South Africa (Segalo, Kruger, Fourie, Nefale & Terre Blanche, 2004). An in-depth analysis further unveils a reliance on concepts that are Western in origin, as opposed to those that are Indigenous to Africa. Therefore, Departments of psychology throughout South Africa are being challenged to find indigenous ways of defining, contextualizing and managing mental health issues from a perspective that is unique to the South African context. This requires the transformation of foreign models and frameworks that are currently employed in the training of psychologists in order to make them and ultimately psychology, suitable to local cultural contexts (Gobodo 1990; Mkhize 2004).

Given the above scenario, it therefore becomes imperative for the psychology fraternity to revolutionize their thinking and begin to tap into the world of indigenous knowledge of health. This should extend to designing programmes that will endeavour to teach indigenous knowledge within the discipline in a manner that embraces traditional African worldviews on mental health. Re-thinking training models in psychology Heeding the IKS call. In any growing and transforming society, knowledge traditions develops and changes, and new traditions that are more able and suitable to deal with incongruities that would likely provoke a crisis situation also emerge (Van Niekerk 1996; Kuhn 1970). Therefore whatever happens in any given society in a specific historical era directly influences not only the problems originating from that society but also the light in 2

which these problems are seen as well as the proposed solutions. The indigenisation of knowledge systems movement thus emerges during a context of increasing appreciation for retrieving and developing indigenous systems of thought that challenges traditionally western hegemonic social and political orders. The history of psychology will be mapped through this Kuhnian lens emphasising the social historical concerns particular to the South African context. This approach recognises and acknowledges that Indigenous frameworks that were historically deplored universally were actively informing the creation of different forms of knowledge systems for African and other indigenous people in pre-colonial times. While this does not attempt to ratify African frameworks, it acknowledges the call to engage in critical dialogue with theoretical frameworks that explain local peoples understandings and conceptualisations of their own life experiences (Mkhize 2004; Ntsoane 2003). A starting point in the process of revolutionizing thinking within the psychology fraternity, like in any other form of revolution, is to acknowledge the need for such a revolution - for as long as psychology accepts as true that it is relevant and effective, it will not recognize the need for transformation and change. Following this logic, it becomes necessary to comprehend the long standing, dominant social and political forces that shaped and fuelled the revolution in thinking within the discipline of psychology in South Africa. Psychology in South Africa: A historical stance It has become an undisputed common knowledge that orthodox psychology is based on western frameworks that reflect western ideals which propound individually focussed and deterministic understandings of human functioning. Within this framework, people are viewed as self-contained individuals that are differentiated from each other according to internal personal attributes (Foster 2004, Mkhize 2004). The commitment to individualism was ushered in by the cognitive revolution of the 16th and 17 centuries. This timeline locates the source of knowledge in the scientific orientation that emphasised naturalistic and empirical cause and effect. This view has proliferated in psychology teachings on mental health and illness and has served as the foundation for psychotherapeutic theory, research and practice. The perpetuation of this trend that is predicated on one worldview and one set of values concerning mental health and illness thrived as a result of the characterisation of Africas pre-colonial indigenous cultures as significantly primitive. This false ahistorical stereotype had profound consequences for 3

the status of African indigenous knowledges for philosophy and consequently psychology as international enterprises. According to (Hallen 2002) pre-colonial human societies were unfairly not thought to have developed the capacity for the intellectual reflection definitive of these supposedly sophisticated disciplines. Therefore Africas indigenous cultures were, as a matter of principle, prohibited from occupying a place in the philosophical arena. A cursory look at equity demographics in postgraduate psychology training programs, 10 years into democracy in South Africa, confirm that transformation of prior subjectivities is painfully slow. (Naidoo 1996). To this effect, the psychology intelligentsia (African psychologists in particular) have been criticised for contributing to the oppression of traditional African knowledge (Bodibe 1993; Gobodo 1990). Masoga (2002) refers to this as a discourse of the absence of presence and the presence of the absence in which African intellectuals were trained within a context that does not take their cultural background into account which then led to a clash between the perceived to be an intellectual thought for Africa and the ought to be intellectual thought for the continent (ibid 2002:304). Forster (2004) argues that even though there are always possibilities of resistance and challenge of prevailing social orders, the outcome of this resistance carry traces of draconian repressions and thus still contain traces of former oppressions and dispossessions even when they are successful. The anomalies within mainstream psychological theory and practice has thus sparked concerted criticism for being culturally encapsulated and lacking in cross-cultural relevance (Sue 1981; Naidoo 1996). Researchers and critics such as Prinsloo (1992), Bodibe (1993), Dawes (1986), Naidoo (1996, 2000) and Forster (1991) amongst others have raised questions relating to the relevance and Africanization of psychology. As a result psychology has been charged to be reductionistic and irrelevant in non-western contexts. Argueing that psychology is dominated by Western paradigms which are then applied indiscriminately to the African context; raised concerns about the quality of service being offered to the African clients. These criticisms stem from the acknowledgement that indigenous populations were since engaged in creating different forms of knowledge during pre-colonial times; indicating that that they had a system in place that reflects their own practices and conceptual frameworks to deal with everyday problems that they were encountering (Mkhize, 2004). 4

Post 1994, most institutions of higher learning in South Africa made attempts to participate in the Africanization of psychology. One way in which they did this was to introduce community psychology as part of their curricular (Lazarus 2004). Community psychology thus came into being as a critique to mainstream psychology which was seen as addressing the needs of the elite few who could afford the services of psychologists while not being accessible to the many people who probably needed it, but could not afford it (Naidoo, 1996). This is because mainstream psychology believes in one-to-one psychotherapy, which is often seen as a luxury, particularly in this country. Thus, community psychology made attempts at embracing the communalistic aspect inherent within most African communities (Nefale, 1999) aspiring to become contextual and relevant. Although there have been some shifts in the psychology curricula, other central themes in the disciple such as personality theories, theories of psychopathology and models of psychotherapy are still largely Eurocentric/American based and seem to be based on the principles of individualism (which are Western based) as opposed to principles of collectivism (which are largely African based), just to cite one example. This forms part of the challenges which Masoga (2002) believes are facing African intellectuals the issues of location or context and content which are both seen to be addressing relevance. This results in a skewed presentation of psychology as it seems to imply that the Western way of understanding the world is the only way of constructing reality the product of counselling and psychotherapy training in South Africa that has been traditionally conceptualized in Western terms. Nekhwevha (2004) refers to this discourse as Western cultural hegemony in which ideas serve to promote relationships of domination. It therefore becomes important to incorporate other (unheard) voices within the discipline of psychology especially in a multicultural society of South Africa. Failure to do this will result in, what is already happening, where, because of lack of sufficient cultural understandings, non-Western clients who present with certain psychological issues are labelled abnormal by the Western conceptualizations of such issues which, at times, might not necessarily be abnormal. Naidoo (1996) labels this a myth of sameness or universality, which represents obstacles rather than solutions since people 5

that function outside the norm of the dominant viewpoint are liable to be treated as others: deviant, dangerous, different, inferior and at best, to be regarded as serviceable others This, to some extent, is a devaluation of others culture and can result in a process of demeaning peoples self-definition and self-respect leading to secondary trauma. Inevitably, this process leads to the provision of ineffective treatment since clients are advised using foreign tools to deal with their problems based on foreign understandings of their problems. Therefore to illustrate the core thesis of this paper, the authors describe their therapeutic encounters whilst undergoing training in becoming psychologists/psychotherapists. Below are vignettes to reflect the discrepancies that sometimes exist when Western/Eurocentric theories are applied to African clients.

Case illustrations: Case 1: The case of D

D was a 23 year old female who was admitted to an academic psychiatric institution. Her presenting problem was characterised by a belief that her family and friends indulged in satanic rituals and also claimed that God had informed her that her parents were Satanists. She laughed and talked incoherently to herself and prior to admission she was reported to be seen wandering aimlessly around her neighbourhood. Translated into clinical language which relied on the Diagnostic and Statistical Manual (DSM-IV) classification system, a norm in psychiatric institutions, her clinical picture thus consisted of impaired judgement, lack of insight and her affect was noted to be constricted. There were disturbances in content of thought, displaying paranoid ideations as well as auditory hallucinations. D is the youngest child in the family of four children. She was raised in actively Christian family homes - first by her mother and then her grandmother. She gave birth to a baby boy in 1988 at the age of seventeen while she was still in grade 10. Along with other children from her school, she was reported to have been raped by her school principal in 1991. Her behaviour consequently started changing after this incident and she could no longer concentrate at school. Furthermore, she was described as easily irritable and thus became unreasonable at home. After the rape incident in 1991, she became a born again Christian. Two years later (1993) she enrolled for a theological course at a Bible School. Three months later D started wandering aimlessly and became ambivalent about her career choice, therefore considering a switch to a career in Electronics. It was at this point that she began to experience pervasive thoughts of naked bodies which later became intense and caused mental confusion. She also started hearing a voice asking her what she was doing at home. She subsequently started talking and laughing to herself. Nevertheless, despite her erratic behaviour and preoccupied thought patterns, D managed to pass the first year of her theological course. She unsuccessfully tried to resist hospitalisation. Upon admission, D was diagnosed by the Psychiatric Registrar as suffering from Paranoid Schizophrenia. However, when she was transferred to a psychotherapeutic 7

unit, the diagnosis given during admission was reviewed in favour of the Brief Reactive Psychosis, the now Brief Psychotic Disorder according to the DSM-IV. During her stay and eventual discharge at the psychotherapeutic unit, D received another provisional diagnosis of Schizophreniform disorder. From the above presentation of the clients history and diagnosis, it is evident that some complexities with regards to diagnosis and therefore management of the client arose. Some assumptions can be made from the above case illustration: Some of Ds presenting symptoms included the belief that her family indulged in Satanic rituals and also claiming that God had told her that her parents were satanists. An exclusive, traditional, psychopathological perspective would, undoubtedly, label the above symptoms delusional. This perhaps, explains the initial Paranoid Schizophrenia diagnosis which was made on admission. Realising that the symptoms did not fit in well with the diagnosis, the diagnosis was then reviewed in favour of the Brief Psychotic Disorder. However, as already illustrated, the symptoms also, did not fit in with the diagnosis. The inclusion of culture sensitive features into the diagnosis of Schizophrenia illustrates that: In some cultures, visual or auditory hallucinations with a religious content may be a normal part of religious experience (DSM IV, 1994:281). However, at the time this case was managed, the classification system being used was the DSM-III-R, which did not cover culturally sensitive features as part of the diagnostic procedure and consideration. This led to a dearth of vital information to assist in the proper management of the case, hence the complications encountered with Ds diagnosis. The above case illustrates how applying western models of understanding disease and illness to non-western clients come into conflict with traditional understandings of mental health and illness and as such fail to provide all the answers at times.

Case 2

The case of Gentleman

The following case study illustrates the importance of worldviews and the need to be culturally sensitive in therapy. As a young and ambitious initiate Black student I was faced with the dilemma of seeing all the black clients supposedly for language purposes. The client was presented at an academic psychiatric institution which provides internships to students from local universities. He was tossed from one institution to the next as an attempt to make sense of his psychosis. Thus he was not making satisfactory progress; in fact his psychosis was seemingly getting worse. His real name and particulars have been altered to ensure confidentiality. Gentleman is a single black male in his middle twenties. He resides in a township around a major urban city with his mother and siblings a brother and two sisters all older than him. They all live with their mother, who is a Sangoma and make a living from healing local people who consult her for different problems. All his siblings were unemployed and depended entirely on their mother. He was referred to the psychiatric institution by his employer for management of a psychotic disorder. An investigation of the presenting problem revealed that at some point during the progression of his illness he had auditory hallucinations. Gentleman was a trainee at a local military institution at the time of his admission. According to him he experienced this change in behaviour about eight months prior to admission to this particular institution. He reported seeing fire on numerous occasions while riding in a taxi. For him and his family it was interpreted as a sign that he has to undergo initiation as a sangoma. Being obstinate, he refused to oblige and as a consequence, the fires eventually became progressively worse and unbearable. One day while he was commuting in a taxi, he saw fire engulfing it and as a result he shot out of the taxi which was still in motion, but had slowed down to approach a red robot and ran wildly as fast as his legs could carry him. He became very sick afterwards and his family took him to a traditional healer to undergo the long putoff thwasa: initiation and training. Thwasa is a Zulu word that refers to the process of self-discovery and recognising of ones spiritual links and destiny involved in training to be a Sangoma. As can be expected, he was unable to report for duty until he was well enough to request Leave of Absence (LOA) from his trainer to explain the reasons for his absence from work to his employer. He was eventually granted permission to go and sort this 9

out. Upon arrival at the barracks his immediate superior would not hear anything of what he had to say and told him that he had been dismissed as he went AWOL (Absence Without Leave) from work for six months. He persisted to explain that he did not have full control of the situation and demanded to have his problem sorted out. As a result he was sent from pillar to post moving up the hierarchical ladder of authorities to repeat himself over and again. This proved to be a frustrating exercise and he eventually became angry and lashed out verbally as help was not forthcoming. This aggressiveness, coupled with his story about his whereabouts for six months earned him a place in a military psychiatric hospital where he was diagnosed with a psychotic disorder not otherwise specified. He refused to comply with the set out treatment and was thus referred to abovementioned institution for further management, where he was immediately admitted in a closed male ward. Gentleman came to the psychiatric institution against his will and retorted that traditional, cultural issues were not understood nor given consideration. As part of training, the client was assessed and presented at a multi-disciplinary ward conference. The psychological evaluation (Mini- Mental Status Examination) at that time failed to reveal any psychopathology as set out by the diagnostic nomenclature of the DSM IV. The conflict for me was not knowing how to proceed from that point. I had no doubt that there was no justification for the clients continued hospitalisation since at the time of the evaluation (and admission) there were no significant signs and symptoms from the DSM IV that could be identified in order to arrive at a diagnosis. Instead a choice was made by the admitting registrar (as it is sometimes the tradition) to trust the referring colleagues judgement. The institution in which I was training espoused a rigid medical model which alienated cultural dimensions discernible in clients manifest behaviour. Furthermore, the unspoken emphasis on the obligation to categorise all behaviour according to conventional western cultural norms made it difficult for any psychologist in training to go against the grain of the dominant training approach of the people who are to write your final progress report. I started thinking critically about my credibility as a mere trainee and the traditional issues that were silent in the medical discourse. This case study is cited to show that the worldview that the client relied on espouses a different theory of illness. Illness causality was viewed to be linked to metaphysical 10

origins in African traditional culture, hence traditional means of ameliorating and treating his illness were sought. The case study reflects the ills of relying completely on the medical model and therefore to make sense of and to do justice to the client one needs to understand the nature of human relationships in traditional African societies and the role of the African metaphysical system. This case study further illustrates that there is no worldview better or superior to the other. The case again further proves that the most popular and publicized worldview may not necessarily be correct or have answers and solutions to everything. Furthermore, the case teaches that different views need to learn from others experiences. Since this worldview is not part of formal psychological training in many institutions students find themselves ill-prepared to deal with such cases and referring African clients either to someone who can speak the language or understand their traditional beliefs becomes the option. Therefore it is imperative that the training of psychologists incorporates indigenous worldviews of understanding mental health and illness. From the above two cases it is apparent that western frameworks of understanding illness can sometimes collide with non-western frameworks of understanding illness, especially when applied indiscriminately thus impacting on the management of such illnesses. It is also evident from the cases cited above that for South African psychologists to provide relevant and effective service to their clients, they need some element of sensitivity towards their clients roots and culture, hence reference to indigenous knowledge regarding the development and management of mental health within South Africa. Towards an Indigenous Knowledge Systems of Psychology The brief historical overview of the training of psychologists in South Africa that has been presented above indicates that counselling and psychotherapy training in South Africa has traditionally (and perhaps still the case today, to a large extent) been conceptualized in western ways. The implications of this kind of training when indiscriminately applied to non-western clients have also been outlined. In the light of this, it therefore becomes imperative for the psychology fraternity to begin a process of reviewing their psychology curricula. Mkhize (2004) posits that a reflection on the oppression of Traditional African Knowledge Systems cannot be complete without a 11

brief overview of the complicity of the educational system and the African elite. Adoption of this form of training psychologists, for example, will initiate (indigenous) students into new ways of thinking about the self and the world. Therefore this creates specific subjects who do things in a particular way, as mapped out by their discipline. This paper, therefore, is aimed at rising to the challenge of incorporating health IKS into the psychology curriculum by introducing a text, in South African institutions of higher learning, which gives impetus to African worldviews on mental health and the incorporation of this into the training of mental health practitioners. This is important as South Africa is a multicultural society that is comprised of people who are influenced by and practice African culture. Furthermore, the introduction of an African worldview on mental health within the field of psychology training in South Africa will narrow the gap that exists between training that is based on Western models and application of such skills in dealing with non-western clients. The text that the authors are in the process of co-creating, as highlighted in the abstract will therefore consist of sections that address the following: A historical overview of mental health management in South Africa this section will explore the models that are used in South Africa in the management of mental health. African traditions and methodological considerations this section will focus on methodological issues relating to African traditions, specifically related to how these are preserved and transmitted from one culture to the next African worldviews an in-depth exploration of the various understandings of what constitutes African worldviews will be presented Approaches to the management of mental health in South Africa this section will cover specific psychotherapeutic approaches that are currently being used to address (treat) with mental health problems in South Africa. Towards a working model one that incorporates IKS in this section the authors will propose a model of managing mental ill-health in South Africa, embracing Indigenous Knowledge Systems.

12

This text may constitute a module at any level of undergraduate training in psychology and can also be offered in depth, at a postgraduate level. This move will be an attempt to participate in NEPAD and the African Renaissances initiatives of acknowledging both thought and practice in the indigenization of knowledge.

In conclusion This paper was aimed at provoking critical and rigorous consideration of the relevance of psychology theory and practice to present day South Africa and was designed to generate scholarly input at a conference that addresses the indigenization of knowledge systems.

13

References Bodibe, R.C. (1993). What is the truth? Being more than a jesting Pilate. South African Psychology, 23, 53-58. Dawes, A.R.L. (1986) The notion of relevant psychology with particular reference to Africanist pragmatic initiatives. Psychology in Society, 5, 28 48. Foster, D. (2004). Liberation psychology. In Ratele, K. Duncan, N., Hook, D. Mkhize, N., Kiguwa, P. & Collins, A., (Eds.). Self, Community & Psychology, p1 44, chapter 1. Lansdowne: South Africa: UCT Press. Gobodo, P. (1990). Notions about culture in understanding black psychopathology: Are we trying to raise the dead? South African Journal of Psychology, 20(2), 93-98. Hallen, B. (2002). A short history of African philosophy. USA: Indiana University Press. Kuhn, T. S. (1970). The structure of scientific revolutions. Chicago: University of Chicago Press. Lazarus, S. (2004). Psychology post 1994 The relevance debate revisited. Key note address at the 10th Anniversary Psyssa Congress held in Durban, South Africa in September.

Masoga, M. (2002). The role of African Intellectuals in the reconstruction of the African social fabric (The quest for nation building). Alternation, 9 (2), 300 315.

Mkhize, N. (2004). Psychology: An African perspective. In Ratele, K. Duncan, N., Hook, D. Mkhize, N., Kiguwa, P. & Collins, A., (Eds.). Self, Community & Psychology, Chapter 4, p 4-1 to 4-29. Lansdowne: South Africa: UCT Press.

14

Naidoo, A. V. (1996). Challenging the hegemony of Eurocentric psychology. Journal of Community and Health Sciences, 2(2), 9-16.

Naidoo, A. V. (2000). Community psychology: Constructing community, reconstructing psychology in South Africa. Inaugural lecture. University of Stellenbosch.

Ntuli, P. P. (2002). Indigenous Knowledge Systems and the African Renaissance: Laying the Foundation for the Creation of Counter-Hegemonic Discourses. In Odora Hoppers, C.A. (Ed.). Indigenous knowledge and the integration of knowledge systems: Towards a philosophy of articulation, p 53 66. Clairmont, South Africa: New Africa Books.

Nefale, MC (1999) Western therapists African patients: Can it work? A poster presented at the 2nd World Congress for Psychotherapy held in Vienna, Austria in July. Nekhwevha, F. (2004). A discourse on the Africanisation of curriculum in South African Higher Education Modules. A paper delivered at the University of South Africa, South Africa in June. Ntsoane, O. (2003). Knowledge production and challenges for the academy: An indigenous knowledge systems perspective. Paper presented at the conference on Perspectives on African Indigenous Knowledge Systems, University of South Africa, 19-19 September 2003.

Odora Hoppers, C. A. (2002). Indegenous knowledge and the integration of knowledge systems, p. 2 22. Clairmont, South Africa: New Africa Books.

Prinsloo, R. (1992) The rethorical reconstruction of psychology in South Africa today. Psychology Quarterly, 2, 36 46.

15

Segalo, P., Kruger, D.J., Fourie, E., Nefale, M. Terre Blanche, M. (2004). Introduction. In Ratele, K. Duncan, N., Hook, D. Mkhize, N., Kiguwa, P. & Collins, A., (Eds.). Self, Community &Psychology, p xiii xv. Lansdowne: South Africa: UCT Press. Sue, D.W. (1981). Counselling the culturally different. New York: John Wiley & Sons.

Van Niekerk, E. (1996). Paradigms of mind: Personality perspectives in context. South Africa: International Thomson Publishing.

16