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Conferences as trauma-specific mentalising spaces: 2018 SAPC Couch and Country Conference.

The ordinary response to atrocities is to banish them from consciousness. Certain violations of the social compact are too terrible to utter aloud: this is the meaning of the word unspeakable... Atrocities, however, refuse to be buried. Equally as powerful as the desire to deny atrocities is the conviction that denial does not work. Folk wisdom is filled with ghosts who refuse to rest in their graves until their stories are told. Murder will out. Remembering and telling the truth about terrible events are prerequisites both for the restoration of the social order and for the healing of individual victims... The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma (Herman, 2015, p. 4).

Introduction

The South African Psychoanalytic Confederation (SAPC) is a broadly psychoanalytic organisation that serves as the umbrella body for various psychoanalytic groups of professionals nationwide. The Couch and Country focus of the SAPC conference, together with the invitation to the conference of people and organisations that are positioned outside of the fairly close-knit psychoanalytic world, allowed for much exploration of the role of psychoanalytically-oriented professionals in the realm of social change.

The conference organising committee is to be commended on a programme that gave voice to and initiated many important discussions about a variety of issues currently confronting our society and, in some instances, humanity as a whole. These included questions around acknowledgement of both hidden and overt forms of violence and neglect, healing from trauma, tolerance of difference, and how to find ways to move beyond the repetition of destructive patterns of interaction. The role of psychoanalytic practitioners in matters of advocacy was a burning query throughout the event. These are questions that require continuous attention in our society and are worth capturing for further thought.

Couch and Country: Trauma-specific mentalising

The conference began with the screening of the film Ellen Pakkies, the story of a mother driven to murder her substance-abusing son, and a panel discussion with the film producer, Paulo Areal and clinical psychologist, Martin Yodaiken. Setting the scene for the conference to come, the themes of violence, multi-level failures of care and lost youth, were highlighted. Astrid Berg, Professor of Psychiatry at both the University of Cape Town and Stellenbosch University, presented the opening plenary. Her reflections on the intergenerational transmission of trauma, importantly, provided a thinking space within which to reflect on the presentations to come, reminding us of the importance of Berthalot's (2015) trauma specific mentalisation--or the capacity to process traumatic experience--which is the construct identified as providing the necessary disruption of the intergenerational transmission of trauma.

There was a focus on policy and how psychoanalysis has much to offer in the thought processes around the development and implementation of policy and policy transformation. Simangele Mayisela, academic and educational psychologist, presented an object relational understanding of teachers' perspectives of corporal punishment. The paper demonstrated the strong pull of the repetition compulsion in the psyches of teachers, themselves recipients of corporal punishment, now left bereft by changes in law that no longer condone the use of corporal punishment in schools. This presentation respectfully explored the experiences of these teachers without judgement, which allowed for the highly useful illumination of the mechanisms by which this kind of trauma is repeated and policy change is resisted.

There was also a strong message about the importance of including psychotherapeutic work with infants and parents in policy. Presentations about infancy and the importance of beginnings and early intervention were delivered by psychologists Nicole Canin, Hayley-Haynes-Ronaldo, and Safiya Bobat. It was highlighted how the early environment sets up physiological processes that can remain throughout the course of life. Delegates were also reminded how challenging experiences during early infancy, such as premature birth, can set up a difficult parent-child relationship, setting in motion a developmental trajectory that could have been different and more psychologically adaptive, in the absence of such trauma in the family. Katherine Bain's (academic and clinical psychologist) presentation on the challenge to prioritise infant mental health in the national health system provoked thought around the importance of early intervention and proposed ideas about why infant mental health is struggling to find a foothold internationally, in policy and public health care. These reasons included the complexity of these interventions and the challenges involved in the measurement of their efficacy, along with our collective idealisation of motherhood and denial of infant sentience. The need to acknowledge our collective failure of infants in the health profession, in order to advocate for change, was emphasised.

It was heartening to see the number of presentations that highlighted the work of many community-based interventions. Dladlanathi's Ibhayi Lengane (Baby's Blanket) home-visiting project was represented (by social worker, Linda Smallbones and parenting programme co-ordinator, Nomagugu Mpembe), as was the Seven Passes Initiative, a parenting programme with an aim to change parenting styles in a community in George (by Wilmi Dippenaar, the Director of the Seven Passes Initiative). Nicki Dawson and Katharine Frost, psychologists from the Johannesburg NGO, Ububele, gave a poignant presentation on preventative infant mental health work that Ububele is conducting at Edenvale Hospital's neonatal intensive care ward. The presentation highlighted the national public health care crisis and the important ways that many NGOs are 'plugging the gaps' at primary and secondary health care facilities around South Africa.

Debbie Marais (professor in the Faculty of Medicine and Health Sciences at Stellenbosch University) and David Bilchitz (professor and director of the SA Institute for Advanced Constitutional, Public, Human Rights and International Law at the University of Johannesburg), highlighted the challenges in policy development in the areas of public health. Professor Marais stressed the need to design effective consultation processes that balance personal embodied knowledge, experience, and meaning-making processes in policy-making, which up to now have relied heavily on evidence-based models. Professor Bilchitz critiqued the 'General Comment' on Article 12 of the Convention on the Rights of Persons with Disabilities, which although intended to bring about positive change in the treatment of those with psychosocial disabilities, reinforces the notion that agency and autonomy determine value and rights. He questioned our adherence to this idea and our failure to recognise the value in dependency and passivity.

The conference was notably multidisciplinary and a session on possibilities and opportunities opened up conversations about how psychoanalytic intervention can be adapted for use in ways that are more contextually relevant. Carol Long (academic and clinical psychologist) presented on contextually sensitive approaches to brief term psychodynamic psychotherapy, while psychologists, Malan van der Walt and Dominique Ribeiro, demonstrated ways that psychodynamic therapy can be short-term and tailored to meet diverse needs in schools. Other creative presentations featured Uhambo--a creativity and literacy intervention from Lefika (by community art counsellor, Kamal Naran), equine-assisted psychotherapy (by psychologist, Pauline Mawson) and the use of boxing, yoga and mindfulness (by child protection and development specialist, Luke Lamprecht and social worker, Talia-Jade Magnes). Group work also featured with a presentation on group work in the South African context by group analyst, Anne Morgan and counsellor, Patricia Johnson-Peterson. Dialogue practitioner from Democracy Works, Busi Dlamini, discussed the role that group work can play in organisations. Anne Morgan and Nandi Mhlongo also facilitated 'Social Dreaming' sessions as pre-conference workshops which allowed delegates to experience the power of groups firsthand. The panel that explored ethics, media and technology included Sheri Hanson, the current Chair of the SAPC Ethics Advisory Committee, Laura Lopez-Gonzalez, a health journalist at the Mail and Guardian, and PsySSA Equity and Transformation Committee Chair, Suntosh Pillay. The possibilities of mutually beneficial relationships between journalists and mental health professionals was discussed. The possibilities of technology were also explored in presentations by psychologists Yael Kadish (online treatment) and Clinton van der Walt (gaming, social media and smart devices).

There was also a notable focus at the conference on more marginalised and vulnerable populations. Psychologists Fatima Abdullah and Thobile Sokhela presented their work with some of our most vulnerable youth, orphans, bringing attention to their socio-emotional development and psychosocial support needs. Tshidi Maseko, an educational psychologist from Khanya Family Centre, presented a paper about experiences of trauma and the development of violent and aggressive behaviours in the youth presenting at Khanya clinic in Johannesburg. With vivid video footage of adolescents using Nyope, her presentation both shocked and saddened the audience. In describing her work with these youths, she described the way in which blame involves the splitting and projection onto others of evil.

Executive Director of Lefika La Phodiso Community Art Counselling and Training Institute, Phumzile Rakosa and drama therapist, Rozanne Myburgh presented on Lefika La Phodiso's partering with the Department of Women in the National Dialogues on 'No violence against women and children'. This session highlighted the utility of psychoanalytic thinking in community intervention. With a presentation titled 'Witnessing the unheard', they reflected on the integrated use of art counselling and visual research methods in the capturing of stories and experiences of gender-based violence in communities in South Africa. The failure of our society to respect and protect the most vulnerable members, and the consequences of this, was again implicit in these presentations, alongside the need to understand the reasons for perpetration and failure.

Issues of diversity and difference were a focus. The need for transformation and change in the psychology world-view was a central theme running through the whole conference. A plenary session, entitled 'Dignity and equality', reflected on the paper: 'How do I live in this strange place?' (Vice, 2010), with panelists Samantha Vice (Professor of Philosophy at the University of the Witwatersrand), Lebogang Phaladi (attorney of the High Court of South Africa and senior legal counsel at the Competition Commission of South Africa) and clinical psychologist Zamo Mbele. Grant Andrews also provided much food for thought in his exploration of subject and image tensions in John Trengrove's film Inxeba. Other presentations on race explored the intersections between the psychoanalytic and the political (Ruby Patel and Tanya Graham: academics and psychologists) and racial ruptures and repairs in the therapy room (psychologists: Carol Long, Olwethu Zwili and Zinhle Vilakazi). Jonathan Percale and Anna Schmidt-Emke's (psychologists: Tara H. Moross Hospital) presentation served to emphasise the need for psychotherapists to consider their own difference and diversity. The Thinking Space Team (psychologists: Pierre Brouard, Yvette Esprey and Phethile Zitha) discussed transformation in schools. Children can sometimes carry burdens from their parents' and grandparents' past. They hold these 'ghosts' and the unresolved trauma and perpetrators from the past pull the children into roles where historical traumas are acted out by children in the present. Again, revenge attacks and racial incidents amongst children can be understood as the unconscious repetition of past historical injustices that have not been mourned. In this way, it is as though children are sent on an errand for the sake of their parents' unresolved experiences that are often a result of socio-political injustice. Teenage suicide and suicide in the universities was also highlighted as a significant concern that requires a thinking space and possibly collaboration and action.

In addition to transformation with regards to race, politics, land and socio-economics, there was also interesting debate around the need for transformation in other areas such as transgender issues. It was clear that transgender people can feel marginalised, pathologised and misunderstood by the psychology world. Psychologists Jonathan Bosworth and Sharon Cox discussed the introduction of LGBTIQ+ affirmative work and transformation in schools. During a plenary discussion entitled 'Sexual and gender diversity: How rather than Why', there was a powerful critique of psychoanalytic approaches to transgender issues and a plea for psychologists to do more listening and less diagnosing. Transgender people face judgement and scrutiny and their request to us, as psychologists, is that they would like us to offer them a space to think and process who they are in their minds and bodies. They do not want a psychologist to label, change or 'cure' them. More broadly, what emerged during the conference as a strong theme is a need for psychologists to listen to divergent voices, each with their own truth.

Mentally ill people can be marginalised in society and are particularly vulnerable to abuse. Reflections, responses, reactions and regret were expressed about the Life Esidimeni tragedy, involving a range of horrific abuses and the death of 144 mentally ill people. This painful and disturbing panel discussion was chaired by Zamo Mbele. On the panel were the operational director of SADAG, Cassey Chambers and Batetshi Matenge, one of the psychologists who worked closely with family members of those lost to the Life Esidimeni tragedy. There was a palpable feeling amongst those of us present of shame, horror, collective guilt and a realisation that although nobody in the room was actually responsible for or involved in the tragedy, we as custodians of mental health all need to take the blame and recognise that there are problems in mental health services, and in the Department of Health, that could possibly be addressed if we take a more socially and politically active and involved stance.

The fact that economically disadvantaged, mentally ill people died and suffered substantial injustices and human rights abuses during the Life Esidimeni disaster is part of a broader mental health crisis that we could and should be addressing more cohesively as South African mental health practitioners. Part of the reason for the Life Esidimeni crisis seems to have been extremely poor communication, poor organisation, and highly inadequate leadership. Silence in the psychology profession was noted, as it has been noted in many other situations when the profession should have been speaking out.

The panel discussion of dream analysis between Anne Morgan, Letta Mosue (psychologist, nun and traditional healer) and Joan Schon (psychologist) offered an excellent example of how different psychologists can hold different views about the psyche, with the interpretation of dreams providing a rich example. As in the decolonisation debate and process, there is a divergence of perspectives which brings great complexity and a real need to listen and to hold the discomfort of contrasting voices and experiences. A recurring theme throughout the conference was the need for mental health professionals to offer a holding space and a thinking space. But sometimes also, when needed, to move beyond the professional silence and neutrality that is so common in the psychology world, into a place of action and advocacy.

Although there were, at times, feelings of hopelessness and despair amongst conference delegates at the enormity of the challenges facing our profession, there was also discussion about the way forward. The importance of advocacy by psychologists and other mental health practitioners for marginalised or psychologically vulnerable members of society, and against social, political and other injustice, was discussed. The cooperative possibilities that emerged at the end of the conference are substantial. The People's Health Movement (represented by Sarah Davids) as well as various other mental health organisations including SAPC, PSYSSA, and SADAG need to work together to promote South African psychosocial health.

What psychoanalysis offers is a thinking space, first and foremost, and an appreciation of the fact that without deliberate and conscious attempts to remember the traumatic past, trauma will continue to beget trauma. Positive, rehabilitative and preventative work requires us as mental health professionals to listen, provide a thinking space, and speak out against injustice and abuse, particularly when it involves mentally ill and marginalised members of society. It was noted that competitiveness and rivalry between different groups of mental health practitioners hinders our ability to provide a collective response and action when it is needed. It was felt that collaboration and coming together as thinking groups is necessary and that the creation of action groups when it is needed, is essential.

During conference discussions, it emerged that when there has been an unfair and illegitimate distribution of power historically, what sometimes restores equilibrium is first for the positions of power to be swapped around, so that the victim gains a sense of agency. However, Cora Smith, professor in the University of the Witwatersrand Department of Psychiatry, in her presentation entitled 'The joy of revenge', warned of the costs of revenge--that the cruelty and human indifference required for revenge can leave a hollow emptiness. She reminded delegates that 'vengeance is a lazy form of grief' (Sylvia Broome in The Interpreter, in Hollander, 2006) and that revenge can be used to delay or defend against mourning. The socio-political application of this understanding, in South Africa and in the Middle East, provided rich discussion amongst delegates.

Overall, the themes that emerged from the conference reflected some of the central themes facing psychologists and South Africans during this decade, making it a relevant and worthwhile event. In addition to offering one of the very 'thinking spaces' advocated throughout the conference, it also offered some psychological insights into the social and political crisis facing our profession and the country as a whole.

Astrid Berg's introductory plenary spoke to the central theme of the conference and reminded us that intergenerational trauma repeats itself unless it is given a thinking space so that a process of mourning can take place. This process can sometimes only happen after a period of time has lapsed, in order for suffering to be metabolised. Resolving trauma can take a considerable length of time and may not be rushed. She emphasised that split-off past traumas need to be faced and confronted, and then mourned, in order for them not to be repeated. Our country, our profession, our patients, and ourselves as psychotherapists, are involved in a process of metabolising historical and current loss and injustice. Healing appears to involve mourning, fantasies of revenge and rescue, and lastly a conscious decision to move from a place of denial and silence, to a place of voice and action.

Van der Kolk (2015), writing on trauma reminds us that the restoration of relationships and community is vital to the restoration of well-being. Hope exists in the fact that we retain the ability to heal one another, alongside the capability to destroy one another. He reminds us that through communicating our experiences, we can find common meaning and change ourselves, to create safer environments. This conference highlighted the important role that the South African psychoanalytic community could play in this process.

References

Herman, J. L. (2015). Trauma and recovery: The aftermath of violence--From domestic abuse to political terror. New York: Basic Books.

Hollander, N. C. (2006). Trauma, ideology, and the future of democracy. International Journal of Applied Psychoanalytic Studies, 3(2), 156-167.

Van der Kolk, B. (2014). The body keeps the score: Mind, brain and body in the transformation of trauma. London: Penguin.

Jenny Perkel is a clinical psychologist working in private practice in Cape Town. In addition to clinical work, she is the author of Babies in Mind (Juta Books, 2007) and she writes for various public platforms, usually with a focus on child mental health. You will find her online at www.childreninmind.co.za and www.jennyperkel.com.Jenny@perkel.co.za

Katherine Bain has a PhD in psychology from the University of Pretoria and currently works as a clinical psychologist and senior lecturer at the University of the Witwatersrand. She teaches on the clinical psychology master's programme and supervises on the PhD by publications programme. She has research interests in the areas of developmental and psychoanalytic theory. She is the current editor of Psycho-Analytic Psychotherapy in South Africa. Katherine.bain@wits.ac.za

Jenny Perkel

Private Practice, Cape Town

Katherine Bain

University of the Witwatersrand
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Title Annotation:Forum; South African Psychoanalytic Confederation
Author:Perkel, Jenny; Bain, Katherine
Publication:Psycho-analytic Psychotherapy in South Africa
Article Type:Conference news
Geographic Code:6SOUT
Date:Dec 22, 2018
Words:3241
Previous Article:Editorial.
Next Article:Daughters and absent fathers: Triumph, loss and pain.
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