Professional Documents
Culture Documents
Traumatic Stress in
South Africa
ISBN 978-1-86814-509-6
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1. INTRODUCTION.......................................................................................................................... 1
2. PATTERNS OF TRAUMA EXPOSURE IN SOUTH AFRICA................ 8
Violence. .................................................................................................................................................... 9
Non-intentional injury.................................................................................................................. 22
Indirect traumatisation. ................................................................................................................ 23
Multiple traumatisation. .............................................................................................................. 24
Conclusion. ........................................................................................................................................... 25
7. CONCLUSION. ...........................................................................................................................146
ENDNOTES. ..........................................................................................................................................155
BIBLIOGRAPHY..............................................................................................................................185
INDEX.........................................................................................................................................................207
List of Abbreviations and
Acronyms
ix
NPAT National Peace Accord Trust
PE Prolonged Exposure
PIE Proximity, Immediacy and Expectancy
POWA People Opposing Women Abuse
PSTD Posttraumatic Stress Disorder
PTGI Post Traumatic Growth Inventory
SADF South African Defence Force
SANDF South African National Defence Force
SASH South African Stress and Health
SIT Stress Inoculation Training
SSRIs Selective serotonin reuptake inhibitors
TFT Thought Field Therapy
TIR Traumatic Incident Reduction
TRC Truth and Reconciliation Commission
VKD Visual Kinaesthetic Dissociation
x
Chapter 1
Introduction
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Traumatic Stress in South Africa
stress conditions and related interventions has had benefits and costs.
Although the public may be better informed about some aspects
of traumatic stress and victims may more readily access and seek
assistance, there are also misconceptions and problematic practices.
Common sense or folkloric knowledge of traumatic stress can easily
become dated, distorted or misinterpreted. Access to up-to-date, well
substantiated and clearly presented information about traumatic stress
is important at this point in time, both in terms of doing justice to the
international advancements in traumatic stress knowledge and in terms
of improving everyday practices in South Africa. In response to this
need, this book presents an overview of aspects of trauma prevalence,
impact and treatment that is intended to be both scholarly and
accessible. This text aims to be mindful of the complexities of working
with trauma survivors living within a context of multiple dangers.
Although the term trauma is often associated with medical
conditions, as in physical trauma to the body, this book focuses on
psychological trauma or trauma to the psyche. The origin of the word
trauma lies in a Greek word meaning ‘to tear’ or ‘to puncture’1. In the
case of psychological trauma this understanding is reflected in a notion
of psychological wounding and the penetration of unwanted thoughts,
emotions and experiences into the psyche or being of the person.
Traumatic experiences are usually unanticipated and by definition
place excessive demands on people’s existing coping strategies.
Thus traumatic events create severe disruptions to many aspects of
psychological functioning.
The term ‘trauma’ has been used to refer both to stimuli of a
catastrophic nature (‘the assault was a trauma in her life’) and to the
severe distress produced by such an event (‘she experienced trauma
as a consequence of the assault’), and in this book it is similarly used
to refer to both events and responses. As will become clearer in the
later discussion of the impact of trauma, this dual meaning perhaps
makes sense when one appreciates that trauma is characterised by
the coupling of a dreadful experience with a subjective experience of
dread – the outcome and its cause are inextricably intertwined. In this
respect traumatic stress is a very specific type of stress, distinguishable
from other forms of stress by the severity of both the stressor and the
response. The study of traumatic stress is a distinct field of theory and
2
Introduction
research with some overlap with the stress field, but with a largely
independent conceptual base and orientation. The field of traumatic
stress (or traumatology as it is sometimes referred to) encompasses
a broad range of issues and has generated a substantial body of
psychological writing, particularly since the 1970s, with ever-widening
interest.
In South Africa, psychological interest in traumatic stress has
specific origins which have to some extent shaped the kinds of
knowledge generated here. For many South Africans working as both
researchers and interventionists in the traumatic stress field, interest in
the phenomenon was generated out of a ‘political’ investment. Whether
this investment had its origins in anti-apartheid resistance politics or
was informed by commitment to a general human rights agenda, many
South African trauma researchers and practitioners have been drawn to
the field out of moral, rather than purely academic, concerns. Much of
the early work in the trauma field in South Africa, reflected in writing
from the 1970s and 1980s, was not conceived of necessarily as falling
under the umbrella of ‘traumatic stress’. For example, during this period
traumatic stress terminology was not widely employed in discussions
of the work of the volunteer-based Rape Crisis and People Opposing
Women Abuse (POWA) organisations or the work of therapists
providing support to ex-detainees and torture survivors. Nevertheless,
in hindsight, it is apparent that the activist work engaged in by sub-
groups of psychologists, doctors, volunteer counsellors and other
mental health practitioners was indeed traumatic stress intervention
and contributed to the initial observation and documentation of
traumatic stress phenomena in this country. As the diagnosis of
posttraumatic stress and related conditions became popularised
in the United States and internationally, the domain of traumatic
stress studies became better defined and constructs from within this
repertoire became more widely employed in South Africa. Also, with
political change, the study of traumatic stress became open to more
purely academic interests. However, the activist origins that shaped the
early generation of knowledge in this field have been retained to some
extent. As much of the case material and empirical research cited in
this book reflects, looking at society through the lens of traumatic stress
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Traumatic Stress in South Africa
4
Introduction
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Traumatic Stress in South Africa
6
Introduction