Complexities of Mental Health

“At the root of this dilemma is the way we view mental health in this country. Whether an illness affects your heart, your leg or your brain, it’s still an illness, and there should be no distinction.” – Michelle Obama

South Africa has taught and has allowed me to experience more things than I could ever read in a textbook. It has also taught me that the unintentional conversations will have the greatest impact on you and will leave you thinking and analyzing for days and weeks following.

I was lucky enough to go paragliding while adventuring throughout Cape Town, and I was even luckier to gain knowledge and perspective from my instructor, Jacob, who grew up in Johannesburg during the peak of Apartheid. Jacob protested Apartheid, spoke against the government, and his actions led him to a fateful decision imposed by the government: join the military for two years or suffer in prison for six years. He chose to join the military and serve as an IT tech. As a technician, he got to see what was happening to the lives of South Africans and all the others fighting the People’s Liberation Army of Namibia (PLAN) during the Angolan Bush War. These people were suffering and fighting for a country that most of them didn’t believe in – a country they couldn’t even call home because of persecution and unjust laws based on race.

Jacob left the military at the end of war, and he went back to Johannesburg with a different perspective. After witnessing people fight countless battles and see his friends die in the field, Jacob also saw many of the people suffer from mental illnesses, especially PTSD. While several activist groups, especially students in United States are actively working to eliminate the mental health stigma, the opposite is true in South Africa; mental health is hardly discussed openly, formally, or even casually.

The importance of treating and learning about mental health isn’t only necessary for the war veterans, but also for the rest of South African citizens. Adults in South Africa have witnessed a violent transition between legal discrimination of Apartheid to continually unequal democratic South Africa. They have seen crimes, deaths, hatred, and other acts that are unimaginable. The children born after 1994 endured the suffering through their parents’ memories and actions. As soon as Nelson Mandela came into power, the oppressed were so-called “free.” Yet the unforeseen wounds of discriminatory acts were still fresh. How does a new country properly and efficiently treat an illness that is seen as taboo? – it doesn’t.

During its epidemiological transition, South Africa started to see a decrease in communicable diseases, and more noncommunicable diseases became prevalent, including mental illness. As a result, the government has incorporated mental health into primary health care recently (Burgess), but there are several barriers that need to be broken in order for mental illness to be fully understood and treated. One of the most obvious barriers is language. There are 11 national languages of South Africa, and it can be difficult to translate and interpret the model used for mental illness (Swartz and Kilian). Another problem with mental health is that some people view health care providers (as well as families and friends) as the reason for the stigma, and as a result, they will not receive treatment or even go as far as talking about it with someone else (Egbe et al.). The most basic level of treating an illness is completely lacking. By not even discussing their most pressing thoughts and memories, the disease cannot be understood and be broken down.

From an outsider’s perspective, one of the problems with acknowledging and diagnosing a mental illness is that the disease cannot be seen, so it is expressed in ways that we cannot understand or even know that the traumatic effects are taking course. One day when visiting one of the townships, we packed and handed out lunches to hundreds of children. Sometimes the parents would take the children’s lunches that we already gave them and would tell them to go sit back down and get more. As college students, we saw this as selfishness – they weren’t letting other children get their fair share, and they were possibly keeping it for themselves to make sure they were able to eat that day. But do we have the power to judge them for their actions? Can they truly be labeled as selfish when we don’t even know their situation? These were the people growing up during the heart of Apartheid. Their actions just might as well be the result of harm and food insecurity they have experienced throughout their lives. Depression, anxiety, PTSD, etc. have different ways of being displayed, and one of the ways to eliminate the stigma as visitors of South Africa is to treat everyone respectfully and understand that we don’t have the power to judge someone because we aren’t in their shoes.

In the United States, we are lucky enough to go to a university where most students and professors are progressively minded and do try to eliminate the mental health stigma, but one thing that I took away from this trip is that I personally need to research and understand the complexities of mental health in not only the United States, but also in South Africa and the rest of the world. We can work to eliminate the stigma, but it will take time. It will be the result of family, friends, and even strangers having difficult conversations. We will have to be vulnerable and open minded. And it starts with me.

Burgess, Rochelle Ann. “Policy, power, stigma, and silence: Exploring the complexities of a primary health care model in a rural South African setting.” Transcultural Psychiatry, vol. 53, no. 6, 2016, pp. 719-742.

Egbe, Catherine O, et al. “Psychiatric stigma and discrimination in South Africa: perspectives from key stakeholders.” BMC Psychiatry, vol. 14, no. 191, 2014.

Swartz, Leslie and Sanja Kilian. “The Invisibility of Informal Interpreting in Mental Health Care in South Africa: Notes Towards a Contextual Understanding.” Culture, Medicine, & Psychiatry, vol. 38, 2016, pp. 700-711.

  • Posted by: Lauren Schultz
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