31 Aug - 2 Sept 2004, ICC, Durban, South Africa

ABSTRACTS

Below are abstracts for the papers to be presented at Critical Methods Nine.

Critical Trauma Studies: setting and agenda
Anthony Collins
University of KwaZulu-Natal
anti at mweb.co.za / collinsa at ukzn.ac.za

Psychological responses to extremely distressing events are currently understood primarily with reference to the notion of Post-Traumatic Stress Disorder. This recent but pervasive category provides clear and specific definitions of stressors and symptoms, and functions as the yardstick for diagnosis and conceptualization within the field. Yet it was developed in social conditions fundamentally different from those in South Africa today. This paper explores the historical emergence of PTSD and briefly reviews a range of critiques that have been offered, attempting to draw out some of the specific problems in using PTSD as the foundational concept for developing interventions in the area of traumatic stress. This analysis is then used to propose a research framework and agenda for critical trauma studies in contemporary South Africa.

Reconciliation �� Capturing the Trauma in Context
Anna Pehrsson
Universidad del Salvador, Buenos Aires, Argentina
annapehrsson at hotmail.com / pehrsson.anna at home.se

Since contemporary conflicts tend to be internal, long lasting and mainly targeting civilians, social-cognitive processes such as victimization and dehumanization create hostile relations and identities based on the negation of the other. This adds an emotional, subjective and psychosocial dynamic that provides the base for self-perpetuating cycles of violence that escape traditional realist solutions. During the last decades, the concept of reconciliation has emerged as a response to this. It emphasizes the need to address the individual trauma, not only to reach individual healing but also to break the cycle of social violence leading to trauma leading to more social violence etc. On the other hand, it also emphasizes the need to (re-) construct social relations and institutions in order to facilitate the individual, communitarian and national healing but perhaps more importantly to address the structural and cultural violence that causes the direct violence as well as the trauma.

Trauma, narrative and memory:
The usefulness of the concept of trauma to work with refugees in South Africa
Ingrid Palmary
Manchester Metropolitan University
ipalmary at yahoo.co.uk

This paper will explore the usefulness of mainstream understandings of trauma for work in the African context. This will be done by considering how the different conceptualisations of trauma relate to a research project that was undertaken with refugee women living in Johannesburg, South Africa. In particular, I will discuss the relationship between memory, narrative and trauma and the limitations of some conceptualisations of trauma in relation to refugee women. I will consider the individualising consequences of the notion of trauma and how this might occlude a socio-political understanding of refugee��s experiences. The extent to which trauma has been central to service delivery and policy interventions with refugees will be discussed alongside the ways in which expectations among service providers of how trauma should be expressed work to construct some refugees as more deserving than others.

Gendered Subject Positions & Trauma:
A study amongst rural isiZulu speaking men and women in KwaZulu-Natal
Lucille Moodley
Psychology and Society Programme, University of KwaZulu-Natal
sopure at eastcoast.co.za

Trauma theorists have argued that the DSM conceptualisation of trauma is limited in capturing the traumatic stressors, symptomology and experiences of distress of people in non-Western cultural contexts such as South Africa (Giller, Summerfield & Bracken, 1995; Eagle, 2002). An aspect within the field of trauma study that has been unexplored is the role that gender plays in shaping the way that men and women subjectively understand and cope with their traumatic experiences. This study is grounded in a feminist poststructuralist framework (Weedon, 1987; Hollway, 1989; Root, 1992; Brown, 1995; & Mama, 1995) that aims to identify the discourses that rural isiZulu speaking men and women draw on in understanding their traumatic experiences. Discourses are systems of meaning that structure how individuals understand their experiences in the world. Secondly, this study aims to understand the way these discourses position the male and female participants in relation to their conceptualisation of trauma. Focus groups comprising a different category of isiZulu speakers were conducted in conjunction with Sinani (research collaborator). The data was translated into English and will be analysed using applied discourse analysis (Willig, 1999).

PTSR among clients at CSVR trauma clinic
Langa Malose
Wits University
mopetle at webmail.co.za

To discuss the post-traumatic stress reactions amongst the victims of sexual abuse in the inner city of Gauteng.

Sample in this study includes the clients who were seen for rape trauma counseling at the Centre for the Study of Violence and Reconciliation, Trauma Clinic.

Before counseling, clients are requested to fill an informed consent that they agree that their information and experiences as victims of sexual abuse will be used for research purposes to understand the prevalence, patterns and the effects of sexual abuse in South Africa.

Result shows that many victims of sexual abuse experience Post-traumatic stress reactions (PTSR) as a direct result of sexual abuse. This includes fear, anger, self-blame, guilty, feeling ashamed, feeling helpless or hopeless, fear of men and sexual problems.

Personal perspectives of women exposed to sexual assault
Bodil Pedersen
Denmark
bodilpe at ruc.dk

Women exposed to sexualised violence seek help at the ""Centre For Sexual Assault"" in Copenhagen. A research project aims at overcoming the problems e.g. abstract categorisations, decontextualisation, objectification, victimisation and the disappearance of the meanings of gender, of some approaches. The voices of women are often marginalised in dominant public discourses as well as in psychological research. In therapy this may also be the case, when abstract theoretical categorisations and/or therapy technologies engender severe limitations to the subjectivity of participants.The paper presents an alternative approach to research and therapeutic practice: Therapy-research is being developed as a method to explore the development of personal perspectives on sexualized violence by the abused. The research approach understands these perspectives as historical and local. The approach directs our attention to the aftermaths of the events in which the subjective meanings of sexual assault are being (re)contextualised.

Trauma, identity and Culture among rural isiZulu speakers
Siyanda Ndlovu
Psychology and Society Programme, University of KwaZulu-Natal
200270249 at ukzn.ac.za

The received view in psychology is that trauma is universal and experienced in the same way in all cultures. The criteria of Post-Traumatic Stress Disorder (PTSD) contained in the Diagnostic and Statistical Manual of Mental Disorders (DSMIV-R) provides the standard clinical description of trauma and its symptoms in individuals. However, this individualized notion of trauma is limited in the South African context where systemic factors such as poverty, HIV/Aids and violence combine to impact on whole communities. The study explores ways in which rural Zulu-speaking people interpret these phenomena and the cultural resources and explanations that are drawn upon in talking about what they consider to constitute trauma. Focus groups were conducted with women's, youth, traditional healers', traditional leaders', and community workers' groups. Their talk allows us to explore and understand trauma from a different, non-clinical perspective. For these participants, trauma is conceptualized as ukuhlukumezeka, entailing a disruption between the supernatural and natural domains of life. This disruption makes people vulnerable to specific traumatic events such as political violence, poverty, unemployment, HIV/AIDS, rape, that are understood to rupture social relations. Rather than an individual condition, trauma is thus conceptualized as connecting the supernatural and natural, social worlds.

A conceptualisation of traumatic stress
amongst rural Zulu-speakers in KwaZulu Natal
Helen McBride
Intern Psychologist, University of KwaZulu-Natal
mcbrideh at ukzn.ac.za

This paper explores the ways in which social, politico-historical and cultural factors influence the experience and understanding of traumatic stress amongst rural Zulu-speakers in KwaZulu Natal. A purposive sampling strategy was used to select the participants for four focus groups comprising, respectively, women, youth, traditional and faith healers and community health workers. A thematic analysis of the transcribed and translated data suggests that an explanatory system of illness, based on the African worldview, produces a tendency to conceptualise traumatic stress as a series of ��paths of distress�� with cultural and socio-political factors as the initial disruptive forces. Endowed with traumatic meaning, these ��paths of distress�� are an attempt to describe how the connection and relationship between events, which are to a large extent outside of one��s control, contribute to a concept of trauma or suffering that implies disruption and distress on an ongoing and wider scale that is captured in the Western concept of Post-Traumatic Stress Disorder (PTSD). A profound sense of failure and a breakdown of community relationships and processes are some of the effects of such paths.

Child sex workers in sub-saharn Africa and motivation for change
Theophilus Gokah
Cardiff University
Gokaht1 at cf.ac.uk / tkgo at hotmail.com

This paper considers the social condition of children traped in sex work and argues for strategies to motivate children out of such careers. Emotional and psychological consequences that go with such careers especially for children bonded into sex servitude have serious consequences for HIV and AIDS. Child sex workers will suffer traumatic conditions and at worse die if measures are not taken to ensure their protection and public health. The underlying principle here is that the many theories on poverty have not succeeded in alleviating family deprivation in sub-Saharan Africa, which sometimes forceschildren into risk activities such as sex work. There is the need therefore to consider alternative models such as motivation theory to change behaviour [adult and children]. The paper draws on children's own voices from field studies in four countries: South Africa, Ghana, Uganda and Ethiopia

Exploring the lived experience of rape survivors following the 1994 genocide in Rwanda
Donatilla Mukamana
School of Nursing, University of KwaZulu-Natal
donatillam at yahoo.fr

The study will take about the lived experienced of single, married and widows women who were raped during the 1994 Rwandan Genocide. Those women are 25 years old and above. As this moment I collect data through interviews I found that all women describe the feeling of indignity and shame from their experience of being raped. They didn��t feel guilt as they found that"" Rape was the price of their life"". They said that during the rape they lost conscious and have no detail of the sexual act but they describe pains on the back and legs when the rape was finished. However the women who have children deal easily with their experience of rape while the girls found that rape has destroy their life forever because they have no hope for marriage and have children. The reason could be that in Rwandan culture the value of a woman is associated by her role as a wife and a mother.

Fear of Crime and Indirect Victimisation
Claire Milne and Gary Steele
Rhodes University
casra at ru.ac.za

It is widely recognised that fear of crime is a pervasive feature of contemporary South African life. A recent study by the Institute for Security Studies suggests that nearly 50% of the South African population rate fear of crime as a significant factor in their lives. The current study focuses on women and investigates the broader impact of crime in society. More specifically, it studies the images that women have of crime in a particular social context, how it affects them and what their coping mechanisms are to deal with these images. To this end, the research project aimed to contribute to the understanding of the process of indirect victimisation and of the impact of fear of crime on women��s everyday life. A qualitative approach was adopted for the study, in which a series of focus groups were conducted with women from different socio-economic settings. The focus groups were analysed using a grounded theory approach and the findings are presented along the following three dimensions the participants�� perceptions of crime, the effects of crime at various levels, and the participants�� coping mechanisms.

Lay ontologies of victims of violent crime
Dee-Ann Smart
UNISA
dsmart at absamail.co.za

Although much research has been conducted in the area of post-traumatic stress disorder and trauma of victims of violent crime, little focus has been placed on the way in which an individual constructs and theorises their traumatic experiences and the impact that these lay ontologies have on their healing process/prognosis and view of reality. Given South Africa��s political history, crimes involving members of different races may reinforce and confirm pre-existing racist attitudes and stereotypes of a corrupt and inefficient government that allows criminals to rape and pillage without punishment.

The aim of this study is to investigate and describe the lay ontologies of crime victims in South Africa and to establish how they impact on the individuals�� view of reality, and our society as a whole. The primary aim and focus of this study is to investigate and describe the lay ontologies of crime victims, and a qualitative methodology, namely, social constructionism, would therefore be most appropriate. The type of data that will be collected will be in the form of words by means of Individual, semi-structured interviews. Consistent with this approach is the assumption that language helps to construct reality and therefore, the most applicable method of investigation is discourse analysis.

CRITIQUE, CULTURE AND THE COUCH:
EXAMINING CONCEPTUALISATIONS OF HEALING
Barnett, L. A.
Midrand Graduate Institute
LesleyAB at edu.co.za

If the discourse of trauma becomes commonplace in the fabric of social functioning and mental health is viewed as a sociocultural construction, an approach to healing should include a plethora of therapeutic strategies, drawing on various worldviews to ensure efficacy. The paper posits that interventions premised on the traditional healing practices of a particular culture ensure culturally competent models of helping. Critical analysis divulges that trauma interventions operating in the African context should take into account local understandings as well as indigenous capacity for dealing with ��social scars��. This challenges current, accepted Westernised models and further asserts that traditional healers, fulfilling the role of psychotherapists, may well be as effective as modern specialists. In opposition to accepted Western practices, the question has to be raised as to why psychotherapy refuses to incorporate indigenous healing systems, especially when failing to do so is so anti-therapeutic. Programmes that validate traditional beliefs around healing and provide services in a culturally acceptable fashion have the most chance for success - they mirror the culture of the group and are compatible with entrenched values.

THE TALKING CURE AND THE POLITICS OF THE PILL
de Chasteauneuf, B. & Barnett, L. A.
Midrand Support Centre
bonita at msc.org.za

The increased interest in pharmacological remedies in treating trauma symptomology has created a so-called gap in the usefulness of psychotherapy in healing trauma pathology. Studies on PTSD indicate that antidepressant medication can lessen PTSD symptoms. Significantly, vast resources have been allocated to the investigation of emerging neurobiological factors involved in trauma. The value of psychotherapeutic and pharmacotherapeutic approaches in the healing of trauma can be considered as empirically confirmed. However, overall effect sizes seem to be higher for psychotherapy as compared with pharmacology. This paper focuses on the debate ensuing around the effectiveness of specific pharmacological treatments, which challenge existing psychotherapeutic treatments. The psychiatric discourse, using pharmacology as a primary intervention, appears to be attempting to dominate the field, setting itself up against traditional psychological models of trauma intervention. This paper looks at the power relations between the opposing discourses and the consequences involved for psychotherapy in terms of its investment in the ��talking cure��.

Treating PTSD: A research model for investigating the transportability of evidence-based practice to local South African contexts
Rhodes University
D.Edwards at ru.ac.za

The last decade has seen the increasing refinement of treatments for post-traumatic stress disorder. In the United States and Britain programs such as Resick's cognitive processing therapy (Resick, Nishith, Weaver, Astin, & Feuer, 2002), Foa's exposure therapy (Hembree & Foa, 2003), Kubany's cognitive trauma therapy for battered women (Kubany et al., 2004), Shapiro's eye movement desensitization and reprocessing (Taylor, 2003) and a treatment manual based on David Clark's cognitive model of PTSD (Gillespie, Duffy, Hackmann, & Clark, 2002) have all reached the stage of being tested in randomised controlled trials. What can we learn in South Africa from such carefully structured and increasingly refined treatment models? To what extent are other transportable to our local contexts? Problems with transportability (Schoenwald & Hoagwood, 2001) arise from four sources: (1) insufficient training on the part of those delivering treatment, (2) insufficient resources at the delivery site, (3) offering a treatment to patient populations for whom it was not designed, and (4) failure to take into account local contextual and cultural factors. A case-based approach (Edwards, Dattilio, & Bromley, 2004) using contextually adapted treatment manuals and measurement methods provides the most appropriate research methodology for investigating transportability and developing evidence-based practice in the treatment of PTSD in South Africa.

Difficulties with HIV/AIDS patients in psychotherapy
Miranda Deonarian
University of KwaZulu-Natal
Deonarainm at ukzn.ac.za

This paper focuses on the challenges and difficulties the HIV/AIDS patients that is faced by the therapist when treating HIV/AIDS patients.  The paper will focus on 4 particular areas:

1.   KNOWLEDGE ABOUT  THE  ILLNESS
Therapists must be well informed about all aspects of HIV infection, and, know the latest developments in this rapidly developing and controversial field.  In addition, therapists need to understand laws to guide their pacticing and make the right decisions for patients living with HIV AIDS.

2.   THE  IMPORTANCE  OF  UNDERSTANDING  THE  WESTERN  AND  AFRICAN PARADIGMS  IN  TREATING  HIV/AIDS  PATIENTS
It is important to understand the difficulties therapists may experience working from a maintstream view to a traditional African world view, as this has far too long been ignored by the Western world.   No attempt has been made to understand and integrate the diverse cultural and belief systems of Africa and South Africa into such programmes.

3.  THE HEALTH  CARE  SYSTEM  AND  THE  LABELLING  AND  STIGMATIZING  OF  HIV/AIDS PATIENTS
Stigmatization of HIV/AIDS, central in the social construction of these illnesses and acts as an inhibiting factor in respect of seeking health care and individuals are stigmatised and discriminated against by the healthcare system.

4.   DIFFICULTIES  THERAPISTS  FACE WHEN  DEALING  WITHHIV/AIDS  PATIENTS  IN  PSYCHOTHERAPY,  INCLUDING
TRANSFERENCE  AND  COUNTER-INFERENCE  ISSUES
As this disease is relatively new and unfamiliar and complex treatment that alter frequently, therapists may naturally feel threatened or confused (Saunders, 1994) which may lead to distancing or distortions of the therapeutic relationship�. Transference and counter transference issues such as Anxiety, Fear and Failure, Vulnerability, Loss, Affects, helplessness, Defensive reactions, Withdrawals, Identification, Omnipotenece may occur.