The Consequences of Truth: Post-traumatic Stress in New South Africa
By Lynn Burke
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JOHANNESBURG -- For years her sleep was plagued with visions of that night, and when she woke up in a cold sweat, she could still see the four white men, running toward her, grabbing for her, spreading her legs across the cold floor, reaching out, strangling her.
Thandi Shezi was 26 years old when a group of policemen barged into her home in the middle of the night, beat her and dragged her off to a jail cell over the screams of her six-year-old daughter and four-year-old son. Once at the cell, four white policemen covered her head with a thick, wet sack, attached electrodes to her body to shock her, chained her feet to a table and took turns raping her.
Ten years later in her Johannesburg office where she works as a counselor for a victims-rights group, Shezi stretches her arms out in front of her and examines the physical reminders of her torture, small black scars that have faded but not disappeared.
"You can see these marks, they are all over, my chest and my thighs," she says, peering out from behind large glasses.
Shezi says she was targeted by the police because she worked in the underground movement against apartheid as a secretary for the Soweto Youth Congress. Her task was to transport ammunition and help target government buildings for destruction.
"Somebody gave them the information that I'm a trained terrorist," she says, each syllable heavy with memory. She says they held her without trial for a year, and when she was released, she says she was a different person.
She was angry, withdrawn, jumpy. Her heart raced and her skin crawled when she stood too close to a man.
"I was a very angry person inside, and I was violent. I couldn't stand to see somebody standing next to me." Her voice breaks. "I was living somebody's life, it was not my own."
She told no one about her rape. She was too ashamed. And she says when the anger inside of her became too much to endure, she turned on the person closest to her, her little girl.
"My daughter is the victim of my trauma," she says. "I used to bang her (into) the walls." Shezi beat her daughter over a period of eight years.
Shezi suffers from post traumatic stress disorder.
She is not alone. Many people in this country have suffered great emotional and psychological harm because of apartheid. Many have developed post traumatic stress reactions, and they need counseling. But South Africa is a country with limited resources, and therapy is a luxury here.
The African National Congress, South Africa's ruling party which came to power after the first democratic elections were held in 1994, has done very little to directly address the problem of post traumatic stress. But it has not shut the door on the past.
Instead, it embarked on one of the world's most extraordinary experiments in truth-telling. In 1996, the ANC and the old National Party passed the Promotion of National Unity and Reconciliation Act, and created an official space to listen to the screams of a nation -- the Truth and Reconciliation Commission. The TRC, as it has come to be called, was established to "promote national unity and reconciliation in a spirit of understanding which transcends the conflicts and divisions of the past." President Nelson Mandela selected 16 commissioners to serve on the TRC from a list drawn up by nongovernmental organizations, and appointed Archbishop Desmond Tutu as chairman. Victims of past acts of political violence and torture were encouraged to come forward to document the human rights abuses they suffered between March 1, 1960, and May 10, 1994, within or outside South Africa, and perpetrators were invited to apply for amnesty, which would be only granted for full disclosure of crimes proven politically motivated.
Though the commission did appoint briefers (referred to also as Cry People) to assist survivors when they gave testimony at public hearings, and referred some deponents elsewhere for additional support, there were no direct psychological services for the victims. And the emotional responses of individuals who testified at the many hearings held in churches and halls throughout the country have been mixed. Many reported a tremendous sense of relief. Tim Ledgerwood, a former conscript in the defense force who attempted to escape and join the ANC, told the commission about his torture at the hands of the apartheid security police and said the TRC had changed his life.
Having gone to the (Commission) with my story, it is almost as if it is all right to talk about it now, he said at a Cape Town hearing. Slowly things are changing. As if I've been freed from a prison in which I have been for 18 years.
However, a worrying number of individuals found that in the weeks following their deposition, the symptoms associated with the original violations resurfaced and intensified from the retelling of their stories. Their experiences sharply contrast with the much-reported accounts of relief like Ledgerwood's. Their experiences are complicated, they ruin the easy narrative provided by the TRC. They reveal the degree of ambiguity inherent in reconciliation and the trauma involved in seeking the truth.
Post Traumatic Stress Disorder
PTSD is not a phenomenon that is new or unique to South Africa. Though the diagnosis of PTSD was only officially introduced to the Diagnostic and Statistical Manual of Mental Disorders and adopted by the American Psychiatric Association in 1980, the condition has been around for years under different names. In the American Civil War it was called "soldier's heart" or "melancholia," in World War I it was "shell shock" and in World War II it was called "combat neurosis." These labels were attached to soldiers returning home from combat, especially ones who saw catastrophic violence, who were withdrawn and depressed, and apt to leap for cover at the sound of a slammed door. Today the diagnosis of PTSD includes the after-effects of stressful events other than war, like rape and violent crime.
The National Center for PTSD estimates that 7.8 percent of adult Americans suffer from PTSD. For American veterans of the Vietnam War, those numbers are far higher - 31 percent. And in a recent review published in the PTSD Research Quarterly, researchers who reviewed 55 studies on children and PTSD found that children exposed to chronic community violence experience the disorder at a rate of 25 percent.
In 1997, the World Health Organization issued a study on the Global Burden of Disease, and found that mental disorders are second in burden only to infectious diseases. The most obvious consequences of mental disorders like PTSD are the cost in terms of human productivity and quality of life. Of the roughly 100,000 Vietnam veterans diagnosed with the disorder, 33 percent are alcoholic. Many are unable to work, and are only able to receive disability payments if they can "prove" the severity of their PTSD.
While there have been few epidemiological studies of trauma disorders in South Africa, existing research suggests South Africans, especially blacks struggling to make sense of the tragic tapestry of their country's past, may be suffering from the disorder in numbers far greater than average. In a 1997 study of 3,870 adults conducted by Market Research Africa and the Community Agency for Social Equality, 17 percent of people who had been exposed to trauma described their mental health as "poor", versus 2 percent of people who had not been exposed to trauma. Of the 23 percent of people exposed to violent events, 78 percent had one or more symptoms of PTSD. The study was conducted with face-to-face interviews.
Michael Simpson, a psychologist at the National Center for Psychosocial and Traumatic Stress in Pretoria, South Africa's capital, says PTSD isn't an accidental by-product of apartheid, particularly in the case of political prisoners. At a Mental Health Workshop held in November 1997, he said torturers deliberately traumatized their political prisoners.
(If) your cohesive and abusive interrogation (didn't) force somebody to tell you what you wanted to know, at least you could return them to the community...sitting shivering in the corner and awake with nightmares all night and no darn use to further the cause that he or she had been fighting for," he said.
Experts point out that while many people who lived through apartheid suffer from few if any symptoms today, there are others who are still so undone by yesterday's atrocities they are unable to work or have meaningful personal relationships. They suffer from nightmares, racing hearts, and frightening flashbacks. Their short-term memory is damaged, and their mood swings are severe. Some have turned to alcohol (South Africa has one of the highest rates of alcoholism in the world, according to a Health Department report released last year) and drugs to medicate themselves, some have embraced violence.
In July 1997, the TRC held a women's hearing in Johannesburg. The hearing began with mournful songs and poems that ended in a burst of applause. Archbishop Desmond Tutu, clad in his signature crimson robe, thanked the reader, saying we are grateful for whatever it is in our culture that has produced someone like you so that we can talk about our pain, share our laughter and our sadness as well. It was a sentiment Tutu would repeat often throughout the hearings, and revealed his underlying philosophy of reconciliation in South Africa. Blacks, Tutu believes, have a special capacity for love and forgiveness. Tutu then introduced Thandi Shezi. Mama, thank you for coming today, he said.
Shezi sat before the commission and an audience of listeners, leaned into the microphone in front of her, and told her story, including each horrible detail. When she was finished, Joyce Seroke, the briefer assigned to help Shezi with her testimony, asked her how the rape made her feel about her womanhood.
"I was very deeply hurt," Shezi answered. "As a result, there's nobody I've been able to relate the story to. My mom is hearing this for the first time."
Shezi says she thought making her story public might begin to heal her memories.
"When you lock your past inside your brain and mind, when this thing explodes, your life would be in tatters, like mine for the past ten years," she says. But her experience testifying before the TRC has left her feeling hollow. "You rip open the closed wounds and you are left with a gaping wound. The TRC was there just to get the information, not for the healing."
After her testimony, Shezi said her symptoms worsened, and she sought counseling at the trauma clinic at the Center for the Study of Violence and Reconciliation, a non-governmental organization funded primarily by foreign donations. Shezi was referred to clinic by Khulumani (Speak Out), a survivor's support group created in response to the TRC.
The counseling Shezi has received at the clinic, she believes, has helped her learn how to manage her rage. She admits she sometimes feels violent urges toward her children "when the trauma comes," but credits the self-care she learned at the clinic to help her through those periods. "Now I can manage," she says, offering a thin smile.
Mary Robertson, 34, is Shezi's psychologist and director of the trauma clinic, which offers free, short-term individual and group counseling to people who are having traumatic stress as a reaction to violence, both political and criminal. A total of 1264 new patients were referred to the clinic in 1997, and about 120 new referrals come to the clinic each month.
Robertson leans back on a puffy gray chair in one of the clinic's carpeted therapy rooms and runs her thin fingers through her cropped blond hair. She says the number of referrals has steadily increased since the TRC completed its human rights hearings in June 1998. Over 21,000 people submitted testimony, and 2,500 were invited to publicly testify in hearings held throughout the country.
A lot of people are starting to recognize that they are still dealing with the same post-traumatic stress, they still can't get along with people, they're still irritable, they're still having flashbacks, and they're not better even though the TRC has happened.
Counseling in South Africa, Robertson says, should be viewed as a necessity, and not a luxury.
"If people can get healing, and go for counseling, and work through their anger and work through their resentment, it's very likely to stop the chance of re-victimization happening and also to stop the victimized from becoming the perpetrator."
PTSD has no cure. There is no pill that can make all the symptoms go away. Sometimes tranquilizers are used to reduce anxiety and insomnia, though these medicines tend to be habit-forming and have potential for abuse. Some doctors try to limit mood changes and suppress angry outbursts with lithium, a drug frequently prescribed for bipolar disorder, an illness characterized by drastic mood swings. So far, therapists report the most success with anti-depressants. There is debate whether these drugs are specifically effective for PTSD symptoms, as some doctors claim they only relieve the secondary symptoms of depression exhibited by many patients. However, recent research out of the Veterans Administration Medical Center in Dallas has found that serzone (nefazodone hydrochloride), a drug used as an anti-depressant, specifically relieved PTSD symptoms by almost 30 percent in patients with PTSD. The drug is one of the newer anti-depressants that inhibits the brain's re-uptake of both serotonin and norepinephrine, neurochemical transmitters.
But here at the clinic and throughout South Africa, drugs are a luxury. The clinic cannot even afford to employ a psychiatrist to dispense medicine.
Another new clinical treatment, which has been scientifically evaluated primarily with trauma survivors in the United States, is Eye Movement Desensitization and Reprocessing (EMDR). The treatment has generated intense research and controversy in the United States and Britain in the past couple of years. In EMDR, a therapist guides the client in recalling distressing past experiences and helps her develop a new understanding of the traumatic events and the thoughts and self-images associated with them. The "eye movement" aspect of EMDR involves the client moving his/her eyes back-and-forth while recalling the traumatic events. The practice has proven effective in several recent scientific studies, and might be a relatively low-cost alternative to drug therapy in South Africa.
Robertson said it's time for corporations to step in and help fund programs like the clinic, because the reality of South Africa's resources prevents the government from offering financial assistance.
"Mental health is always at the bottom of the barrel," she said, "You always get the dregs."
There is a commitment on paper from the Departments of Welfare and Mental Health to a so-called victim empowerment program, but Robertson says the money has never followed. Besides, she says, "victims" are categorized as those who have suffered present-day crimes.
"I fear that victims of past human right abuses will fall through the cracks."
It was just weeks after Nelson Mandela was released from prison when Anglican priest Michael Lapsley opened his mail in his home in Zimbabwe on April 28, 1990. He was immediately blasted by a letter bomb hidden inside the pages of a religious magazine. The explosion took out the ceiling of three rooms of his house and ripped a huge hole in the floor. It was a bomb designed to kill. But Lapsley was sitting down when he opened it, and survived the blow, though his life would never be the same. Both his hands were blown off, one eye was permanently destroyed, and his eardrums were
Today he lifts a glass of lemonade to his lips easily, takes a long drink
and then sets the glass down on the carpeted floor of his modest home in a Cape Town suburb. A photograph of Fidel Castro hangs on his wall next to a door that is propped open to let a single beam of light enter the room. He crosses his hands and the shiny silver steel of the prosthetic claws makes a soft clicking sound.
Lapsley was expelled by the National Party from South Africa in 1976. He was a white priest ministering to black students at the University of Natal at the time, and became increasingly vocal in his opposition to apartheid after the killing of black schoolchildren during the Soweto uprising. Though he knew he would always be a potential target of the apartheid regime, he says it wasn't simply his affiliation with the ANC that placed him at risk.
"In my own view, in the end it was my theology which was a threat to the apartheid state, because my contention was that apartheid was a choice for death carried out in the name of the gospel of life, and therefore it was an issue of faith to oppose it," he says.
In 1992, two years after he received the letter bomb that nearly killed him, Lapsley left Zimbabwe to return to live in South Africa.
"It was a natural instinct to return and be part of a new phase of struggle, the phase of creating a different kind of society, and my particular contribution was to be a part of the healing of the country."
In 1993 he co-founded the Trauma Center for Victims of Violence in Cape Town, where he initiated a series of three-day memory workshops. In August 1998 he broke off from the center and found the Institute for the Healing of Memories, which offers workshops to any South African who wants to tell his story. Exposing people to the humanity of others, he says, creates room for people to change. He estimates that 1,500 people have been served directly by the Institute.
Small, grass-roots organizations like Lapsley's have been an integral part of the emotional clean-up process left by the legacy of apartheid, and in part, by the Truth and Reconciliation Commission.
"Whilst a limited number of people came before the commission," he says, "every South African has a story to tell about the apartheid years - the story of what we did, the story of what was done to us, the story of what we failed to do."
Lapsley told his own story to a packed audience at a TRC hearing in Cape Town in 1996.
I remember pain of a scale that I didn't think a human being could ever experience, he told the commission. I remember going into darkness - being thrown backwards by the force of the bomb."
He said he holds former President F. W. de Klerk responsible for his bombing , saying the bomb could not have been sent without his knowledge. He said he wanted an apology, wanted to hear about what the Nobel Peace Prize winner was doing for the healing of the nation.
"I have not heard from de Klerk one word of remorse," he said, the anger in his voice clearly detectable.
He pauses now, remembering his testimony.
"The truth commission was like a giant mirror put in front of the country. Like never before in history, the past of a nation was center stage," he says. But the mirror revealed a country whose wounds have yet to heal, and it revealed the complicated process of reconciliation and forgiveness.
A Specific Mandate
The Truth and Reconciliation Commission had several specific duties. The provision of counseling services was not among them.
"The Act (that created the TRC) is filled with simplistic assumptions," says Brandon Hamber, coordinator for the project on truth and reconciliation at the Center for the Study of Violence and Reconciliation, "like if we get the truth and we go this route and people speak out they'll feel better. And it just wasn't really that simple."
Hamber, 28, is a clinical psychologist and has written extensively about the emotional aspects of the TRC for survivors of violence. He readjusts his long legs and strokes his chin before he speaks.
"One of the problems with the process is that I think in the beginning we basically spoke the language in which the country had a psyche, and that a country is the same as an individual...in that the truth about the country will help heal in the same way we might say that dealing with your own personal truth in therapy might heal you," he says. "The real bottom line is it's very unlikely that your individual healing process, no matter how useful the testimony is to you, is going to correspond with the national process."
He agrees with the popular tenet of psychology that says repressed pain is likely to later cause adverse emotional and possibly physical consequences, but thinks the process of confronting the past is very important. He believes there are two ways of examining the commission and the part it has played in reshaping the country.
"On one level we can criticize the commission and say well, we opened up this trauma and there weren't adequate services and it's very problematic," he says. "A more positive way would be to say the trauma was there in the first place, it's going to come up at some point in time. We have zip, no services anyway, and perhaps by opening it up at least we've started the process. At least we've forced people to think they need to set up mental health services."
The mental health profession in South Africa is colored by deep hues of racism. During the apartheid years, people who were detained by the state went untreated or mistreated for psychological illness. In some cases, psychologists and psychiatrists assisted security police in developing torture methods and psychological warfare. Traditional psychoanalytic thought equated blacks with a rampaging id that threatened to spin out of control without the whites, the superego of South Africa.
Prime Minister Dr. Hendrik Verwoerd, a psychologist obsessed with the psychiatric eugenic theories developed in Nazi Germany, intensified the system of apartheid. In the 1960s he encouraged scientific societies like the South African Psychological Association to split along racial lines. The resulting segregated organization, the Psychological Institute of South Africa was an active proponent of apartheid until its dissolution in the early 1980s. Indeed, the horrible acts committed under apartheid were, except in rare cases, never part of the country's psychological agenda. Many, though not all, of the psychologists and counselors today are very young and without much experience. Many of the older generation, an all white group that has spent its professional life ignoring or harming blacks and treating only whites, have settled into lucrative private practices.
South Africa is dealing with conditions which are less than perfect.
"Mental health is still a second cousin to other types of health, and it still seems curative, it's not seen as a preventative strategy," Hamber says. In the Northern Province, where there are five million people, there is only one psychologist. People have had to do it themselves. "Forced with your back against the wall you might say it's better than nothing."
If treatment for traumatized individuals is different in South Africa, so is the nature of their condition. Hlengiwe Mkhize, formerly the national director of mental health and substance abuse, and now chair of the TRC's reparations committee, says the diagnosis of PTSD is not an easy one to make. Speaking at the TRC's Mental Health Workshop held in Cape Town in November 1997, she said, "We have had quite a number of people coming before us who had made statements but who had expressed difficult emotions like anger, depression, suffering, complicated grief and all those difficult emotions which go with the past... we are not too keen to diagnose those people because we know those are people who are people who were functioning at a high level, they were leaders."
Thulani Grenville-Grey, one of the few people left at the TRC's pared down headquarters in Cape Town, was in charge of the mental health needs of both the commission's staff and testifiers during the human rights hearings.
He is defensive about the commission's performance and the criticism that the commission didn't provide enough support for the victims. Rolling from side to side in his office chair and curtly excusing himself for the cigarette he is smoking in his office (It is supposed to be lunch, you know), he explains that the TRC was constrained by the Act which created it. It is a familiar argument. Given its resources, he says, the commission did all it could. The people who complain about the treatment of victims, he argues, are the ones who need to be acting.
My experience of mental health workers is a passive one, he says. They watch. They're not proactive. Things like trauma centers and counseling won't just materialize, he says. The mental health community needs to organize itself and lobby the government. I think they should get on board. It's got to be a loud voice.
Ntombi Mosikare vividly remembers the sight of her teenage brother's bloodied body the night of June 26, 1985. He was one of the executive members of COSAS, the Congress of South African Students. Eight of his co-members were to suffer the same fate at midnight that night in different townships throughout the country.
Mosikare says Solomon left their home in the black township of Duduza at 8:40 p.m. that night. A little over three hours later, he was blown apart by a hand grenade.
"He never came back, and we found his body lying in the street," she says softly. She was 28 years old. He was only 19. She crouched in the shadows, afraid to claim Solomon's corpse. His body was surrounded by police officers. She was scared to move any closer. "It was very scary," she said. "They were switching their lights on and off."
As soon as the sun began to burn through the sky the next morning she walked back down the dusty red road to get her brother. "His arm was in tatters," she says quietly, audibly sucking in her breath. She reaches for her face. "One eye, you know, came out," she says.
Mosikare felt responsible, wondered what she might have done to prevent his death, wondered what he might have done. She said some of her neighbors kept their distance from her family, and branded them terrorists. Her brother's death, they said, was his own fault. For years she had nightmares, couldn't get the vision of Solomon's body out of her mind. "I had problems but I knew nothing about counseling at the time," she whispers. As time passed, she managed to block out the images, sleep through the night, begin to forget.
It wasn't until two of her brother's killers applied to the TRC for
amnesty that the full trauma of his death really came back to haunt her. "It brought everything back," she says. "It was difficult, I couldn't take it." Solomon Mosikare's killers were among the approximately 7,000 people who have applied for amnesty. (Of the 5111 processed, 216 have been granted.) She started obsessing about the fact that she had advised him to repeat a year of school in order to bring up his grades. He wanted to be a doctor, so Mosikare encouraged him to stay in Duduza and keep studying. "If he didn't stay maybe he wouldn't have been killed," she remembers thinking.
Like many victims who submitted testimony to the TRC, Mosikare feels let down by the process. "I think that the first thing they should have done was take care of our mental needs, and they've done nothing." Khulumani, she says, is what saved her. Today she is the director of Khulumani, the support group that serves nearly 12,000 people throughout different townships.
The group has little money. It is not funded by the government, and the few full-time staff members who work at Khulumani find precious little time to do the kind of fund-raising necessary to keep the group running.
As a result, Dineo Nageng, at 27 years old, is the only professional counselor for Khulumani. "It's an almost impossible task," she admits. Khulumani does receive help from volunteer psychologists, but has problem staffing the areas of South Africa most in need of help, the "no-go terribly volatile areas where white psychologists won't go."
So Khulumani has created a network of survivor-counselors who spread out and hold workshops with the people who live in areas where there are no trauma clinics. Group therapy sessions, traditionally supposed to compose of ten people at most, burst with 50 or more victims. "We've actually had to go against what we've learned in school," Nageng says.
The Truth and Reconciliation Commission endeavored to link truth with reconciliation by sifting through a mountain of atrocities committed in the name of politics, picking out the worst ones, and allowing a national audience to learn about them.
This seeking of truth was in part a gift to those who had always been voiceless, the victims of the past, the survivors of the present. By formally recognizing the awful truth, the commission endorsed a culture of human rights and not abuses. By blasting its message throughout the country and the world, it forcefully ripped away the heavy cloak of denial that once shrouded many whites who sat down each night to dinner served on china plates while just a few miles away their black neighbors dodged bullets and burning tires.
During the truth commission hearings, no one could escape listening to a former security officer's extraordinary confession about burning the bodies of black men while he laughed and drank beer by the fire, no one could look away while a black mother held a clump of her dead son's hair in the air, no one could close his eyes when Desmond Tutu broke down and sobbed before his nation. No one could look at his neighbor in quite the same way.
But this truth came with a price. The Truth and Reconciliation Commission was created in December 1995 for political reasons, to bridge the sudden transition from a white, minority regime that reigned with brutality to a black majority democracy that wanted to avoid a massive civil war. And because the TRC was born from political needs, the individuals who spoke before the commission were caught in the gap that exists between the collective and the individual. In its attempt to scrub off the dust covering the past, the TRC exposed the thousands of tiny crevices of memory and pain that belong to each victim. In some cases, the airing of once silent memories helped break down the trauma sustained by each individual into manageable pieces. In others, the weight of memory only became heavier, more unmanageable.
South Africa is a developing nation. Its leaders are struggling with skyrocketing unemployment, one of the highest crime rates in the world, continuous political strife, and an AIDS epidemic that threatens to swallow the country's limited resources. So it isn't surprising that the government has not invested much in the mental health of its traumatized citizens. But ignoring the psychological well-being of so many disquieted people will inevitably prove more costly in the end, in terms of unemployment, crime, and the elusive goal of reconciliation.
There is no easy solution for a country in the midst of rebuilding its foundations, for the past is inextricably intertwined with the present. The very nature of post traumatic reactions is different here. The economic disparity between the whites and the blacks remains severe, and many of those who testified before the TRC have not seen their immediate circumstances improved since the end of apartheid. One of the challenges for those who attempt to heal the traumatized here is to recognize that stressful present, and integrate it into a treatment plan.
In fact, the very diagnosis of PTSD, according to clinical psychologist Brandon Hamber, mislabels the true experience and symptomology of many people here. In many cases, he says, it's hard to trace the direct origin of the stress-causing event, and it was usually not just one event but a cumulative process. "Using the word "post" is for me somehow not correct, he says, because people are living in a situation of continuous traumatic stress."