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15 October 2020 | Story Angie Vorster | Photo Supplied
Angie Vorster is a Clinical Psychologist in the School of Clinical Medicine, University of the Free State

As a mental healthcare provider, I approach the end of every year with some trepidation. As soon as the August winds start to blow in Bloemfontein, we tend to see a distinct increase in our community’s psychological distress. The year 2020 has not spared us this increased burden of suffering.

This year has presented humanity with extreme challenges and our university community has felt this to our core. The latest research indicates that the South African population has been affected by the pandemic in various ways and on various levels but none less severe than our psychological health. One in three South Africans will present with a psychological disorder during our lifetime (and this was prior to the Covid-19 outbreak); and the effects of the pandemic have caused a significant rise in depression, anxiety and trauma symptoms among South Africans.

In mourning 

We are experiencing exceptionally high levels of financial stress due to the impact of the disease and lockdown on our economy. We have endured months of social distancing, fears surrounding our own health and the well-being of our loved ones, our financial safety, managing our children’s home-schooling, adapting to distance-learning and concerns about the academic year being salvaged. We have had to experience loss after loss. We mourn loved ones, colleagues and acquaintances that have become ill or passed away due to the pandemic. We have mourned the loss of our normal lives. The hugs, handshakes, casually touching someone’s arm, the shows, sporting events, weddings, graduations and braais we took as for granted. We grieve for a time before sanitising and masks and avoiding contact with our fellow humans was the daily norm. We miss our offices and tearoom banter. We miss being with our students. Amid all of these losses we know that our rates of gender-based violence, suicide and substance abuse have increased. When people are forced to spend time with others in confined spaces amid increasing financial, health and social stressors, frustration and fear may lead to damaging reactions and dysfunctional coping mechanisms. 

World Mental Health Awareness Day on 10 October could not have arrived at a better time. This year the World Health Organisation is encouraging investment into mental healthcare across the globe. While this is an essential step in increasing access to mental healthcare services, it is also only one aspect in the use of psychological treatment resources. One of our most important barriers to providing mental healthcare often lies within us. Mental illness remains one of the most stigmatised conditions in society; even though each one of us will be affected by our own, or our loved ones’ mental-health problems at some point during our lives. Some of the common problematic and erroneous beliefs society holds about people who struggle with mental illness is that they are somehow deviant, dangerous, weak or even faking it. Unfortunately, our healthcare workers are not immune to such prejudicial attitudes and neither are their patients. Self-stigmatisation occurs when we internalise these discriminatory generalisations and fail to access mental health care because we believe that we should be stronger, or just pull ourselves together or worry about the impact of receiving a psychiatric diagnosis on our career or our relationships. 

Silence is one of the most insidious barriers 

We fear being judged by our healthcare providers, our employers, colleagues, family and friends. This culminates in a situation where we lead lives of quiet desperation – numbing our distress with distractions and substances and perhaps even work. The silence surrounding mental health is one of the most insidious barriers to accessing treatment – because you cannot be helped if nobody knows you are suffering. This is the tragedy of suicide, which more frequently than we wish to believe, is the final symptom of depression and severe psychological illness. I have had to assist more patients than I care to recall to work through the trauma and grief of losing a loved one to suicide. Perhaps one of the most tragic aspects of this is that almost all would sit in utter shock recalling how their loved one had seemed fine. How this came out of the blue. How he or she had never told anyone how difficult life had become for them. How hard it was to get out of bed each morning. How much energy it took to go through the motions of a normal day. How ultimately they were so ill that they believed that they were a burden to their family and friends. How they could see no hope of relief from their pain other than to end their lives. And nobody knew. They were silent in their suffering because of fear of stigma, judgement, rejection or being viewed as a burden. 

The surprising gift of the pandemic

Mental illness does not discriminate against anyone. It affects professors, students, support staff and the greater university community equally. Nobody is spared these struggles. This is what we all share,   the human experience of life's seasons which we cannot do alone. When we need the help of more than our resilience, support structure and exercise routine. This is where the pandemic has brought some unexpected gifts. Prior to March of this year, it was very unusual for psychologists to provide online or telephonic therapy. In fact, many medical aids were uncomfortable covering teletherapy. Once we had no other alternative; however, we all had to adapt. Suddenly I no longer only saw patients who were able to attend sessions at my office. Now I could assist students and doctors who were in lockdown across the country. I could refer patients to the appropriate therapist, irrespective of where they were. Patients no longer had to negotiate the uncomfortable experience of waiting in a psychologist's waiting room or being seen leaving an office looking upset or need to take time off work to attend a session. Now patients can access their psychotherapist from the containment and confidentiality of their own space, and we in turn, are more freely available as we are not bound to a specific venue. 

Receiving psychological treatment is becoming as normal a part of well-being as going for a run, or eating healthily or spending time with our social support system. And this is what is going to save lives. The more we normalise the use of psychological services, the less stigma and silencing we will be subjected to.

We survived a pandemic 

As a clinical psychologist I proudly tell my students, colleagues and patients that I have my own psychotherapist without whom I would not be the therapist, colleague, friend and mom I am. There is no shame in owning our vulnerability and reaching out for assistance in order to make meaningful and even enjoyable the few journeys around the sun that we have left. So this October of 2020 should be the month when we start the conversation about our mental health. And by doing, so we permit those around us to do the same. We have survived a pandemic that changed the world and our daily lives. It's okay not to be okay.

Opinion article by Angie Vorster, Clinical Psychologist in the School of Clinical Medicine, University of the Free State

News Archive

Media: Sunday Times
2006-05-20

Sunday Times, 4 June 2006

True leadership may mean admitting disunity
 

In this edited extract from the inaugural King Moshoeshoe Memorial Lecture at the University of the Free State, Professor Njabulo S Ndebele explores the leadership challenges facing South Africa

RECENT events have created a sense that we are undergoing a serious crisis of leadership in our new democracy. An increasing number of highly intelligent, sensitive and committed South Africans, across class, racial and cultural spectrums, confess to feeling uncertain and vulnerable as never before since 1994.

When indomitable optimists confess to having a sense of things unhinging, the misery of anxiety spreads. We have the sense that events are spiralling out of control and that no one among the leadership of the country seems to have a definitive handle on things.

There can be nothing more debilitating than a generalised and undefined sense of anxiety in the body politic. It breeds conspiracies and fear.

There is an impression that a very complex society has developed, in the last few years, a rather simple, centralised governance mechanism in the hope that delivery can be better and more quickly driven. The complexity of governance then gets located within a single structure of authority rather than in the devolved structures envisaged in the Constitution, which should interact with one another continuously, and in response to their specific settings, to achieve defined goals. Collapse in a single structure of authority, because there is no robust backup, can be catastrophic.

The autonomy of devolved structures presents itself as an impediment only when visionary cohesion collapses. Where such cohesion is strong, the impediment is only illusory, particularly when it encourages healthy competition, for example, among the provinces, or where a province develops a character that is not necessarily autonomous politically but rather distinctive and a special source of regional pride. Such competition brings vibrancy to the country. It does not necessarily challenge the centre.

Devolved autonomy is vital in the interests of sustainable governance. The failure of various structures to actualise their constitutionally defined roles should not be attributed to the failure of the prescribed governance mechanism. It is too early to say that what we have has not worked. The only viable corrective will be in our ability to be robust in identifying the problems and dealing with them concertedly.

We have never had social cohesion in South Africa — certainly not since the Natives’ Land Act of 1913. What we definitely have had over the decades is a mobilising vision. Could it be that the mobilising vision, mistaken for social cohesion, is cracking under the weight of the reality and extent of social reconstruction, and that the legitimate framework for debating these problems is collapsing? If that is so, are we witnessing a cumulative failure of leadership?

I am making a descriptive rather than an evaluative inquiry. I do not believe that there is any single entity to be blamed. It is simply that we may be a country in search of another line of approach. What will it be?

I would like to suggest two avenues of approach — an inclusive model and a counter-intuitive model of leadership.

In an inclusive approach, leadership is exercised not only by those who have been put in some position of power to steer an organisation or institution. Leadership is what all of us do when we express, sincerely, our deepest feelings and thoughts; when we do our work, whatever it is, with passion and integrity.

Counter-intuitive leadership lies in the ability of leaders to read a problematic situation, assess probable outcomes and then recognise that those outcomes will only compound the problem. Genuine leadership, in this sense, requires going against probability in seeking unexpected outcomes. That’s what happened when we avoided a civil war and ended up with an “unexpected” democracy.

Right now, we may very well hear desperate calls for unity, when the counter-intuitive imperative would be to acknowledge disunity. A declaration of unity where it manifestly does not appear to exist will fail to reassure.

Many within the “broad alliance” might have the view that the mobilising vision of old may have transformed into a strategy of executive steering with a disposition towards an expectation of compliance. No matter how compelling the reasons for that tendency, it may be seen as part of a cumulative process in which popular notions of democratic governance are apparently undermined and devalued; and where public uncertainty in the midst of seeming crisis induces fear which could freeze public thinking at a time when more voices ought to be heard.

Could it be that part of the problem is that we are unable to deal with the notion of opposition? We are horrified that any of us could be seen to have become “the opposition”. The word has been demonised. In reality, it is time we began to anticipate the arrival of a moment when there is no longer a single, overwhelmingly dominant political force as is currently the case. Such is the course of history. The measure of the maturity of the current political environment will be in how it can create conditions that anticipate that moment rather than seek to prevent it. We see here once more the essential creativity of the counter-intuitive imperative.

This is the formidable challenge of a popular post-apartheid political movement. Can it conceptually anticipate a future when it is no longer overwhelmingly in control, in the form in which it is currently, and resist, counter-intuitively, the temptation to prevent such an eventuality? Successfully resisting such an option would enable its current vision and its ultimate legacy to our country to manifest in different articulations, which then contend for social influence. In this way, the vision never really dies; it simply evolves into higher, more complex forms of itself. Consider the metaphor of flying ants replicating the ant community by establishing new ones.

We may certainly experience the meaning of comradeship differently, where we will now have “comrades on the other side”.

Any political movement that imagines itself as a perpetual entity should look at the compelling evidence of history. Few movements have survived those defining moments when they should have been more elastic, and that because they were not, did not live to see the next day.

I believe we may have reached a moment not fundamentally different from the sobering, yet uplifting and vision-making, nation-building realities that led to Kempton Park in the early ’90s. The difference between then and now is that the black majority is not facing white compatriots across the negotiating table. Rather, it is facing itself: perhaps really for the first time since 1994. Could we apply to ourselves the same degree of inventiveness and rigorous negotiation we displayed leading up to the adoption or our Constitution?

This is not a time for repeating old platitudes. It is the time, once more, for vision.

In the total scheme of things, the outcome could be as disastrous as it could be formative and uplifting, setting in place the conditions for a true renaissance that could be sustained for generations to come.

Ndebele is Vice-Chancellor of the University of Cape Town and author of the novel The Cry of Winnie Mandela

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