Aspects of culture in South African psychiatry

Doctoral Thesis


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University of Cape Town

A review of the South African psychiatric literature reveals that the concept of culture is commonly reified. It is also used by the South African state to legitimate apartheid. The concept of cultural relativism, though often associated with liberal views internationally, is linked with state policies in South Africa. Some South African social scientists, therefore, strongly question the notion of relativism. This reaction unfortunately does not engage with the social reality of the widespread perception of cultural differences, in psychiatric settings and elsewhere. Issues of race and culture in psychiatric practice were explored in a psychiatry department of a liberal South African university. Observation of ward-rounds in a psychiatric casualty (emergency) facility over six months revealed that, as elsewhere in the world, a major cultural factor influencing clinicians is the relationship between psychiatry and general medicine. A cultural understanding of South African psychiatry must take account of this relationship. Ward-rounds in a facility treating Black psychiatric patients were observed over fifteen months. Black and white clinicians in these rounds were often in conflict over constructions of the concept of culture. Some appeared deeply ambivalent about cultural relativism. Psychiatric registrars (residents) attached to the department under study participated in loosely structured interviews exploring issues of race and culture in their work. They also responded to vignettes dealing with white, coloured and Black patients. Registrars felt uncomfortable about the role of the concept of cultural difference in affecting the welfare of Black patients, and in maintaining discrimination. Their own socialisation as practitioners in an individualising and medicalising discipline seems a major factor contributing to their ongoing reproduction of this discrimination. The study reveals the importance of exploring the views and experiences of practitioners. South African work focussing on the need for fundamental change in mental health care has generally glossed over details of extant practice. This dissertation shows, however, that a major site for mobilisation for change in South African mental health-care must be the psychiatric institution itself.

Bibliography: pages 351-389.