Traumatic Stress in South Africa

Gillian Eagle, Debbie Kaminer

Description

Traumatic Stress in South Africa deals with the topic of traumatic stress from a number of angles. Traumatic stress, and posttraumatic stress more particularly, has gained international prominence as a condition or disorder that affects people across the globe in the wake of exposure to extreme life events, be these collective or individual. Given the history of political violence in South Africa, extremely high levels of violence against women and children and the prevalence of violent crime, South Africa has the unfortunate distinction of being considered a real life laboratory in which to study traumatic stress. Taking both a historical and contemporary perspective, the book covers the extent of and manner in which traumatic stress manifests, including the way in which exposure to such extremely threatening events impacts on people’s meaning and belief systems. Therapeutic and community strategies for addressing and healing the effects of trauma exposure are comprehensively covered, as well as the particular needs of traumatised children and adolescents. Illustrative case material is used to render ideas accessible and engaging. The book also provides a comprehensive and up-to-date overview of theory and practice in the field of traumatic stress studies, incorporating both international and South African specific findings. The particular value of the text lies in the integration of global and local material and attention to context related challenges, such as how trauma presentation and intervention is coloured by cultural systems and class disparities. The book highlights both psychological and sociopolitical dimensions of traumatic stress.

Sujets

• Political Science
• General officer
• Psychology
• General

Informations

• Publié par: WITS University Press
• Date de parution: 01 octobre 2010
• Nombre de lectures: 0
• EAN13: 9781868148363
• Langue: English

Extrait

Traumatic Stress in South Africa
Traumatic Stress in South Africa
Debra Kaminer and Gillian Eagle
Wits University Press
1 Jan Smuts Avenue
Johannesburg
2001
South Africa
http://witspress.ac.za
Debra Kaminer and Gillian Eagle, 2010
First published 2010
ISBN (print) 978-1-86814-509-6
ISBN (EPUB - IPG) 978-1-86814-836-3
ISBN (EPUB - ROW) 978-1-86814-837-0
ISBN (PDF) 978-1-86814-682-6
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the written permission, except in accordance with the provisions of the Copyright Act, Act 98 of 1978.
Edited by Lara Jacob
Indexed by Ethn Clarke
Cover design by Hybridcreative
Layout by Manoj Sookai
Printed and bound by Creda Communications
Wits University Press has made every reasonable effort to locate, contact and acknowledge copyright owners. Please notify us should copyright not have been properly identified and acknowledged. Any corrections will be incorporated in subsequent editions of the book.
Cover: Blue Head, 1993 by William Kentridge
The authors are deeply grateful for the thoughtful and reflective comments provided by colleagues, friends and loved ones during the preparation of this book.
TABLE OF CONTENTS
LIST OF ABREVIATIONS AND ACRONYMS
1. INTRODUCTION
2. PATTERNS OF TRAUMA EXPOSURE IN SOUTH AFRICA
Violence
Non-intentional injury
Indirect traumatisation
Multiple traumatisation
Conclusion
3. POSTTRAUMATIC STRESS DISORDER AND OTHER TRAUMA SYNDROMES
Posttraumatic Stress Disorder
The effects of prolonged trauma exposure or abuse
The effects of community violence: a continuoustraumatic stress syndrome?
South African research on the psychiatric effectsof trauma
Conclusion
4. TRAUMA AS A CRISIS OF MEANING
Shattered assumptions and the search for comprehensibility
Beyond comprehensibility: the search for significance
Conclusion
5 . TRAUMA INTERVENTIONS FOR INDIVIDUALS, GROUPS AND COMUNITIES
Individual psychotherapy and counselling
Pharmacotherapy
Group psychotherapy
Common mechanisms and best practice
Treatment of multiple and continuous traumatic stress
Traditional / indigenous practices
Social alienation as a product of traumatisation
Community interventions, rituals and memorials
Conclusion
6. CHILDREN AND TRAUMA
Prevalence of trauma and posttraumatic stress in children
The impact of different forms of trauma on children
Developmental differences in trauma presentations
Familial, social and community dimensions
Treating childhood trauma
Conclusion
7. CONCLUSION
ENDNOTES
BIBLIOGRAPHY
ABOUT THE AUTHORS
INDEX
LIST OF ABREVIATIONS AND ACRONYMS ANC African National Congress ASD Acute Stress Disorder BPP Brief Psychodynamic Psychotherapy CBT Cognitive Behavioural Therapy CIDI Composite International Diagnostic Interview CISD Critical Incident Stress Debriefing CPT Cognitive Processing Therapy CSVR Centre for the Study of Violence and Reconciliation CT Cognitive Therapy DESNOS Disorders of extreme stress not otherwise specified EA Employee Assistance EMDR Eye Movement Desensitisation and Reprocessing IFP Inkatha Freedom Party IRCT International Rehabilitation Council for Torture Victims MVAs Motor vehicle accidents NGOs Non-governmental organisations NLP Neurolinguistic Programming NPAT National Peace Accord Trust PE Prolonged Exposure PIE Proximity, Immediacy and Expectancy POWA People Opposing Women Abuse PSTD Posttraumatic Stress Disorder PTGI Post Traumatic Growth Inventory SADF South African Defence Force SANDF South African National Defence Force SASH South African Stress and Health SIT Stress Inoculation Training SSRIs Selective serotonin reuptake inhibitors TFT Thought Field Therapy TIR Traumatic Incident Reduction TRC Truth and Reconciliation Commission VKD Visual Kinaesthetic Dissociation
Chapter 1
INTRODUCTION
T he aim of this book is to address the pressing and socially relevant topic of traumatic stress in South Africa. Given the high levels of exposure to trauma and violence of various kinds in this country, there is naturally serious concern about the mental health impact and implications of this exposure.
South African citizens are widely and commonly confronted with anecdotal accounts of traumatic events, both in the course of their everyday lives and in the mass media, often articulated in the discourse of living in a dangerous and traumatised society. Along with this awareness of the frequent occurrence of trauma is a preoccupation with its psychological consequences. The notion of posttraumatic stress has entered the public domain to the extent that this terminology is in common usage and is even used to describe the state of characters in popular local television dramas or soap operas . It is also noticeable that in media accounts of traumatic events there are frequently references to the fact that victims are receiving debriefing or counselling, suggesting that trauma intervention is offered by many practitioners of various levels of skill to large numbers of trauma survivors, with an assumption that such intervention should take place as a matter of course. The increasing awareness of and prominence given to posttraumatic stress conditions and related interventions has had benefits and costs. Although the public may be better informed about some aspects of traumatic stress and victims may more readily access and seek assistance, there are also misconceptions and problematic practices. Common sense or folkloric knowledge of traumatic stress can easily become dated, distorted or misinterpreted. Access to up-to-date, well substantiated and clearly presented information about traumatic stress is important at this point in time, both in terms of doing justice to the international advancements in traumatic stress knowledge and in terms of improving everyday practices in South Africa. In response to this need, this book presents an overview of aspects of trauma prevalence, impact and treatment that is intended to be both scholarly and accessible. This text aims to be mindful of the complexities of working with trauma survivors living within a context of multiple dangers.
Although the term trauma is often associated with medical conditions, as in physical trauma to the body, this book focuses on psychological trauma or trauma to the psyche. The origin of the word trauma lies in a Greek word meaning to tear or to puncture 1 . In the case of psychological trauma this understanding is reflected in a notion of psychological wounding and the penetration of unwanted thoughts, emotions and experiences into the psyche or being of the person. Traumatic experiences are usually unanticipated and by definition place excessive demands on people s existing coping strategies. Thus traumatic events create severe disruptions to many aspects of psychological functioning.
The term trauma has been used to refer both to stimuli of a catastrophic nature ( the assault was a trauma in her life ) and to the severe distress produced by such an event ( she experienced trauma as a consequence of the assault ), and in this book it is similarly used to refer to both events and responses. As will become clearer in the later discussion of the impact of trauma, this dual meaning perhaps makes sense when one appreciates that trauma is characterised by the coupling of a dreadful experience with a subjective experience of dread -  the outcome and its cause are inextricably intertwined. In this respect traumatic stress is a very specific type of stress, distinguishable from other forms of stress by the severity of both the stressor and the response. The study of traumatic stress is a distinct field of theory and research with some overlap with the stress field, but with a largely independent conceptual base and orientation. The field of traumatic stress (or traumatology as it is sometimes referred to) encompasses a broad range of issues and has generated a substantial body of psychological writing, particularly since the 1970s, with ever-widening interest.
In South Africa, psychological interest in traumatic stress has specific origins which have to some extent shaped the kinds of knowledge generated here. For many South Africans working as both researchers and interventionists in the traumatic stress field, interest in the phenomenon was generated out of a political investment. Whether this investment had its origins in anti-apartheid resistance politics or was informed by commitment to a general human rights agenda, many South African trauma researchers and practitioners have been drawn to the field out of moral, rather than purely academic, concerns. Much of the early work in the trauma field in South Africa, reflected in writing from the 1970s and 1980s, was not conceived of necessarily as falling under the umbrella of traumatic stress . For example, during this period traumatic stress terminology was not widely employed in discussions of the work of the volunteer-based Rape Crisis and People Opposing Women Abuse (POWA) organisations or the work of therapists providing support to ex-detainees and torture survivors. Nevertheless, in hindsight, it is apparent that the activist work engaged in by subgroups of psychologists, doctors, volunteer counsellors and other mental health practitioners was indeed traumatic stress intervention and contributed to the initial observation and documentation of traumatic stress phenomena in this country. As the diagnosis of posttraumatic stress and related conditions became popularised in the United States and internationally, the domain of traumatic stress studies became better defined and constructs from within this repertoire became more widely employed in South Africa. Also, with political change, the study of traumatic stress became open to more purely academic interests. However, the activist