Post-traumatic stress disorder is a syndrome that affects the entire South African society. After being raped by a gang of four police officers 10 years ago, Thandi Shezi (26) could not even look at a man without shaking. She jumped at loud noises and the smell of a man's sweat made her sick to her stomach. A once well- adjusted woman had become consumed by her fear. After years of emotional suffering, Shezi went for counselling to Khulumani, a support group for survivors of apartheid. Shezi was suffering from post-traumatic stress disorder as a result of her attack. She first told her story of suffering to Khulumani co-ordinator Ntombi Mosikare, and now, years later, is counselling other victims of violence.
Mary Robertson, co-ordinator of the trauma clinic for the Centre for the Study of Violence and Reconciliation, argues that the whole country is being traumatised by violence. "We're living in a culture of violence, and we're dealing with an entire society that is traumatised. Dealing with post-traumatic stress disorder is a very effective way to break the cycle of violence," she says.
Robertson describes the effect of violence on society as "the ripple effect. Let's say a father is hijacked.His children will often experience symptoms of post-traumatic stress, worrying whether their father will come home, and having nightmares. The violence does not just affect him, it affects his whole family." She says violence also affects police officers, nurses and other professionals who are "exposed to incredible levels of violence every day". For many patients, the threat of violence is never-ending. "We find that in many of our patients, the chances of being re-victimised are very high," she said. "We're helping some people almost to prepare for when it happens again."
Mosikare says that she sees post-traumatic stress disorder in relatives whose loved ones have disappeared. "In African customs, it is important to know where a person died, and to bury them properly," she said. "Not knowing what happened contributes a lot to the stress disorder." Robertson says that violent crime is the most common cause of post-traumatic stress "reactions" in patients at the trauma clinic, which served more than 650 patients, without charge, last year. Armed robbery was the most common traumatic trigger, followed by car hijacking, traumatic bereavement over the loss of a loved one, sexual child abuse, rape and political violence. No national figures are available on post-traumatic stress disorder, but Robertson says South Africa's high violent crime rate would suggest that many victims currently suffer its symptoms.
The disorder was controversial for its role in the Truth and Reconciliation Commission hearings. Hlengiwe Mkhize, a commissioner on the rehabilitation and reparation committee, says that the legislation which created it did not include any strategy for addressing the disorder. "We really didn't have the capacity to deal with the symptoms of the trauma," Mkhize said. "A victim would testify before the committee and then come back to us and say, `All the symptoms are back [because I told my story]. What can you do for me?' People really fell between the cracks." As for the victimisers, like police Captain Jeff Benzien, Mkhize says the truth commission should have scrutinised such testimony with the aid of an expert psychologist. "The perpetrators were often the ones to use the symptoms of post-traumatic stress disorder to benefit themselves. It was clear that in some instances people could relate clearly, but then at a key point [in the testimony], they would have difficulty in remembering," she said.
The national Department of Welfare and the Institute for Security Studies launched the Victim Empowerment Programme in December 1998 that includes policy on addressing the disorder. But Robertson says the programme comes up short in actually helping victims cope with trauma. "There needs to be a lot more focus on service delivery," she says, noting that there are "massive gaps" in delivery, especially in rural areas. A recent tender by the national Ministry of Health, which will train hospital nurses in trauma counselling, is a good first step, Robertson says. Such efforts need to be taken further, she argues. "In rural areas, the first person a victim might talk to would be a traditional healer or the church. We need to provide training for them, and also give them information on referral services for victims who need professional counselling," she says.
Says Mkhize: "Victims of political violence and victims of criminal violence have the same reaction to an event: it is shattering, and it is beyond their comprehension. It's important for South Africa to come to terms with the violent acts we live with on a daily basis."