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Apartheid and the Making of a Black Psychologist. N. Chabani Manganyi
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isbn 9781868148639
Автор произведения N. Chabani Manganyi
Жанр Биографии и Мемуары
Издательство Ingram
My reading on brain–behaviour interactions and my study of and research into body image was given impetus by well-known figures such as Paul Schilder and Macdonald Critchley, among many others.13 Consequently, I found myself increasingly at home in the course of the daily professional discussions and activities that took place during ward rounds and consultations in other parts of the hospital.
The second learning opportunity arose during encounters, first in Ward 7 and later in other wards in the hospital, with patients who failed to make ‘neurological sense’ to the doctors. Significant numbers of female patients from Soweto and adjacent areas were being admitted to our medical wards complaining of symptoms that resembled known neurological and other illnesses. The complaints included paralysis of limbs and fainting spells, the sudden onset of an inability to walk, urinary incontinence, epilepsy-like convulsions, blackouts, fainting spells and palpitations – conditions that could easily be mistaken for diseases of the central nervous system. It was common for one to learn from such patients that the illness had been of sudden onset. The burden of explanation soon fell on me as the only psychologist in the team and the hospital. The question I was increasingly being asked both in our unit and in the adult medical departments was, what do these pseudo-neurological symptoms mean? Hidden within such questions was often an unstated assumption that the patient might be malingering – that is, playing at being ill.
I was consulted so often about patients in this class that the first paper I had published in South Africa’s premier medical publication, the South African Medical Journal, was on cases of hysteria among African women. The article appeared in May 1970. I had given the paper the title ‘Neurotic Compromise Solutions and Symptom Sophistication in Cases of Hysteria in the African’, but, without the courtesy of a discussion with me, apartheid gatekeepers at the journal’s headquarters had replaced the word ‘African’ with the derogatory term ‘Bantu’. I experienced this as a hostile and offhand rejection of the word ‘African’. Nonetheless, inexperienced as I was, in writing the paper I had put my finger on an important health issue which was developing under our noses.14
The history of hysteria, including its celebrated female patients and colourful healers in centuries gone by, remains a subject of continuing interest today. In 2011 I revisited the field of women and hysteria, and to my surprise I found that, although the diagnostic terminology has received a notable facelift, Asti Hustvedt, in her excellent study entitled Medical Muses: Hysteria in Nineteenth-Century Paris, could still report that
while modern medicine no longer talks about hysteria, it nonetheless continues to perpetuate the idea that the female body is far more vulnerable than its male counterpart. Premenstrual syndrome, postpartum depression, and ‘raging hormones’ are amongst the most recent additions.15
She adds that hysteria has assumed many ‘new incarnations’ and new diagnostic categories, among them chronic fatigue syndrome. What she found most remarkable was the degree to which new terminology had replaced the antiquated diagnostic system of the past. Here, then, is the story of an illness with a long and fascinating history in the West, an illness that intrigued me enough to have inspired the subject matter of my first publication as a clinical psychologist-in-training.
A third learning opportunity occurred during consultations conducted by psychiatrists working on a sessional basis in the hospital. Within the general hospital context in which I worked, outpatient work by part-time psychiatrists appeared peripheral to the work of the hospital. Although my role was largely that of a participating observer, I learnt a great deal in those years about the practices of psychiatrists in general hospital settings. Their consultations often took the form of a question-and-answer session between psychiatrist and patient, with the African nurse as an interpreter. I remember a certain dry matter-of-factness during the exchanges between psychiatrists and their patients. The practice was that I was permitted to observe their work during consultations at weekly outpatient clinics. Some of the patients would have been referred by me for psychiatric consultation, while others came directly on the strength of requests from doctors in the medical wards.
My relationships with consulting psychiatrists both at Baragwanath and at other Johannesburg-based teaching hospitals were the weakest link in my training. The patient histories that most psychiatrists solicited through poorly trained African interpreters were often shoddy and truncated. I sat through most of their sessions with patients only to hear the psychiatrists mention their treatment of choice, a predictable recourse to Valium, Stelazine or Largactil depending on whether the patient was believed to be neurotic or psychotic. It was as though the psychiatrists believed that all that was necessary in the treatment of those patients was pill-popping. The treatment interventions of psychiatrists in Johannesburg’s outpatient clinics in those years appeared to me to be disturbingly perfunctory.
One of the most striking features of life in a hospital such as Baragwanath at that time was the fact that, in the main, and in spite of apartheid laws, health professionals worked first and foremost as professionals in the execution of their duties. That is not to say that race and racism were consciously set aside; apartheid laws ensured that segregation was enforced with regard to residences, eating facilities and, of course, toilets and ablution facilities.
Over and above the opportunities sketched above, I benefited immensely from the fact that all the black doctors who were interns or registrars were engaged in further training as doctors and as specialists. Without planning on anyone’s part, I had landed in a hospital in which university-type activities such as teaching, learning, conducting research, publishing and studying for higher qualifications were part of everyday life. This was an unexpected but welcome bonus, with unintended consequences – a supportive learning environment that would have been non-existent in an ordinary psychiatric hospital in those days.
In this regard I remember the late Dr Benson Nghona, a University of the Witwatersrand graduate and a registrar in medicine during my time at Baragwanath. He, Dr Henry Smail and I were full-time residents in the black doctors’ quarters. Nghona, who was a few years older than I was, became my closest friend at the hospital. He neither smoked nor used alcohol. He was easy-going and friendly, but could be described as a bookworm. Remarkably, he was the most apolitical man I knew in those days.
I will always remember Nghona as the man who took me along to the medical school library in Hillbrow in his Mini and familiarised me with the workings of Index Medicus, a reference text that contributed enormously towards my literature searches in the course of my doctoral studies between June 1969 and December 1970. I also remember that close to the medical school library was a specialised bookshop that sold a wide range of medical and related books. Dr Nghona’s exemplary dedication to his field of study and profession did not escape the notice of the ambitious young man that I was in those days. He was one of my earliest role models.
I had started my internship at Baragwanath in the deep end of the pool at the beginning of January 1969. By 21 November there were definite signs that I was no longer out of my depth and was beginning to thrive – it was on that date that my paper on hysteria among African women was accepted for publication by the South African Medical Journal. Little did I know at the time that I would encounter a significant number of such patients within the teaching-hospital setting of the university as well as in the private practices of general practitioners in Soweto during the years that followed.
In the course of time, the prevalence of patients in our medical wards suffering from psychological rather than physical illnesses resulted in increased requests for my services outside the neurosurgery department. I inadvertently became the resident consulting psychologist for Baragwanath as a whole between 1970 and the first half of 1973.
During my three-and-a-half years at Baragwanath I was also drawn into the regular clinics conducted by a small group of highly dedicated female paediatric neurologists. Here I learnt a great deal about the neuropsychological illnesses of childhood, including childhood autism, a condition that was attracting a great deal of international attention at the time. I did not know then that years later this exposure to the work of paediatric neurologists would prove beneficial