Cultural constructions of the mentally ill in South Africa: A discourse analysis,part one

Abstract

This article analyses Zulu constructions of mental illness, as according to Zulu Psychology Masters Students from universities in KwaZulu-Natal, South Africa, by means of Foucauldian Discourse analysis. Analysis of qualitative interviews highlighted the complexity surrounding mental illness and psychology within the Zulu culture in South Africa, and revealed various cultural constructions of the mentally ill and psychopathology that have not previously been researched. Elucidated cultural constructions of the mentally ill included constructions of the ill as a contagious diseased state; a threat to peace; a deviant; a vagrant; and a non-social being and non-functional. These constructions placed the mentally ill at the lowest strata level within society. Historically rooted discourses of the black South African’s fight to be resilient, and the philosophical idea of ‘Ubuntu’, intersect with these constructions of the mentally ill. Furthermore, the constructions of the mentally ill are impacted by rural and urban geographic location. Also explored is the discourse of the Zulu mentally ill’s oppressed subject position as the ‘mad’ and black. These elicited constructions and discourses of the mentally ill within Zulu communities, in South Africa, provide a basis for vital future research into the cultural relativity and nosologies of mental illness within the South African context, and wider African context.

“Mental illness has its reality and its value qua illness only within a culture that recognises it as such” (Foucault, 1987, pp. 60–61)

The considerable impact of culture on psychopathology has long been established (American Psychiatric Association, 2013; Foucault, 1987). Despite knowledge of cultures’ influence on psychopathology, little research has explored alternate cultural nosologies of psychopathology, and there is a lack of research on the cultural relativity of psychopathology in both national and international research (Hassim, 2012; Matsunaga & Seedat, 2007; Stein et al., 2016). South African research on psychopathology is needed in order to more effectively help the mentally ill from different cultures within the country. The South African population has been shown to struggle with psychopathology, yet little research exists on psychopathology and the discourses surrounding it in the South African population (Jack et al., 2014; Stein, et al., 2016), and in specific more Zulu-focused models of psychopathology are needed (Hassim, 2012).

Due to the effects of both colonialism and neocolonialism (in South Africa and Africa as a whole) Indigenous Knowledge and resultant Discourses are elusive and difficult to trace (Nyamnjoh, 2012; Masuku, 2016). Therefore, discourses of colonial origin have taken centre stage in the realm of psychology, leaving indigenous discourses (such as that of Zulu culture) marginalized. This discourse analysis attempts to take a step toward voicing indigenous discourses and focuses on one Indigenous culture’s discourse in specific – Zulu culture. The elicited discourses of Zulu culture span beyond this one article, and form part of a wider original study.

A brief introduction to Zulu culture

Although this paper focuses on the Zulu Culture ¹ , it must be recognized that ‘Zulu’ is a dialect, culture, identity and ethnicity. Identification of an individual or collective group as being Zulu is marked according to the spoken language; geographical location; engagement in ceremonial activity and recognition of difference from other ethnicities. The Zulu culture is one of a handful of predominant cultural groups found in South Africa, stemming from the Nguni tribe, and have spread out across South Africa to become one of the largest cultural groups within the country (South African History Online, 2020).

Although many Zulu people converted to Christianity under colonization, most Zulu people still strongly believe in ancestral involvement, magic and other traditional beliefs. The word ‘Zulu’ translates to mean ‘Gods’ people’ (Washington, 2010, p. 25). Within the Zulu name itself is embedded the prominence of spirituality. Zulu culture’s axiology and cosmology are fundamentally spiritual and collectivistic. Nature as well as spiritual forces deeply impact upon Zulu notions of health, and psychological and spiritual realities are connected (Washington, 2010).

Within Zulu ways of being, healing and health are expressed within the ill individual, as well as the community (Hassim, 2012; Washington, 2010). The presence of illness within many Zulu communities is seen to mean that the ancestors have removed their protection, due to inharmonious action taken by an individual. As a result, this leaves the community vulnerable to the same illness (Washington, 2010). Within this culture, both the individual and community are responsible for bringing about healing and harmony (Hassim, 2012; Washington, 2010).

Illness in many Zulu communities ² is organized into three divisions as follows: animistic, magical and mystical (Edwards, 1983). Magical theories of illness are thought to be due to a human magical action, such as sorcery, to harm the victim (Edwards, 1983). Mystical theories of illness are due to a consequence of an experience, such as a lightning strike (Edwards, 1983). Animistic theories of illness are ascribed to a personal spirit, for instance the withdrawal of the ancestors’ protection, or chance spiritual action (Edwards, 1983).

Indigenous Knowledge Systems have had numerous scripts and oral practices for centuries; however, these have gone under-analysed and marginalised (Masuku, 2016; Zulu, 2006). Zulu people organized and shared social and cultural knowledge mainly through proverbs, oral poetry, myth and storytelling. It would be incorrect to assume that the culture does not have a wealth of constructed and shared knowledge, but the manner in which this cultural information was shared was not done in the same manner as the West. Further research by this researcher has studied the Zulu lexicon on psychopathology and emotion.

Research methodology and ethical considerations

The original research study aimed to elicit the discourses influencing Zulu Psychology masters’ students’ constructions and beliefs regarding psychopathology, as well as the students’ beliefs of their community’s norms and their beliefs of tertiary education norms. This original study gave primary source insight into the discourses informing Zulu Psychology masters students’ constructions of psychopathology and secondary source insight into Zulu culture’s and tertiary institution’s conceptualizations. The original study has been broken down into a few articles for ease of access and publication purposes.

The sampling criteria required the participants to speak English and Zulu, to self-identify as Zulu, and to be an enrolled masters student in Psychology at a University in South Africa. Interviewing in Zulu was not implemented, as the researcher, who was conducting the interviews, was unable to proficiently conduct the interviews in Zulu. Zulu Psychology masters students were chosen as participants for this research as these participants self-identified as members of the culture, and were able to understand and speak of both Zulu culture and Western ideas of psychopathology. These participants were able to understand the intersection and conflict between Indigenous knowledge systems (such as Zulu knowledge) and Western knowledge systems (such as taught in the masters degree), and as such had some insight into both Zulu and Western epistemologies ³ . Purposive and convenience sampling were used to locate participants. The Zulu Psychology Masters students were sampled from tertiary education facilities within KwaZulu-Natal, South Africa. Seven participants were chosen due to the time-consuming nature of transcription and discourse analysis, three of whom were male and four female. All participants were between the ages of 22 and 27. The sampled universities, from which the participants were sampled, were all located in urban areas.

The discussed confidentiality agreement with participants concluded that all personal names and identifying characteristics of the participants would be kept private and would not be published, and that participants would be referred to by pseudonyms. Participants were provided with the final research paper.

A semi-structured interview was conducted with each participant in a private room within their university setting. The sharing of mutual experiences or beliefs, and ‘off the cuff’ stories, about psychopathology was encouraged; however focus remained on the students’ discourse. The interviews were roughly 1 hour per participant. During the interviews, notes were written regarding non-verbal ques. All interviews were transcribed using a combination of reduced transcription and Jeffersonian Transcription. The interviews and transcripts were recorded and saved on a password protected application for transcription purposes (Potter, 2012). Interviews were transcribed word for word, without correction of punctuation, tense or sentence construction. In light of actively analysing macro-level Discursive practices, context of interaction could not be ignored (Alvesson, 2000). It was recognized that the accounts of the interviewees were created in interaction with the researcher, implicating a co-construction of discourse (Alvesson, 2000). Due to this, the researcher included her own speech in the transcriptions.

A combination of Parker and Willig’s Foucauldian Discourse Analysis techniques were utilized (Willig, 2013; Parker, 1992). With these techniques in mind, the researcher began the process of reading the transcripts multiple times; made relevant notes on the transcripts (in light of Foucauldian theory and the relevant literature); and began to pick out discourses noted in the transcripts. Discourses were then grouped together and narrowed down.

It is of ethical importance to note the researchers’ positionality when writing a paper that centres on culture, such as this article. The first researcher is a white English speaking South African researcher, who is not a member of the Zulu culture, and therefore writes as an outsider to the subject group. The second research is mixed-race (coloured) and English speaking, and like the first researcher, is not a member of the Zulu culture. Furthermore, as the proposed research works in the South African context with different cultures, an important ethical consideration is the respect for relativity of culture and its interaction with psychopathology. Additionally, the respect of participants’ race, culture, gender or education level was of paramount importance. In the creation of anything, the creation of something else is excluded. Care was taken to not create something that is not true to the Zulu participants or try create something with the known exclusion of another truth. Considering the political backdrop of South African history, the researcher was wary of the exercise of power over participants – both explicitly and implicitly during data collection and the writing up processes. Care was taken to ensure the voicing of the unheard Zulu students’ voices, as well as eliciting novel and critical information on Zulu culture, which may lead to positive changes in policy and education, thus ensuring beneficence.

Discourse analysis: Elicited discourses and themes

Zulu nosology of mental illness

Throughout the interviews with the participants, it was elicited that the mentally ill were othered and classified in a binaried manner within Zulu culture. Zulu people, according to the participants, were classified as extremes, healthy or mad. As participant six stated, ‘...that’s just...ya. Uhlanya. That’s all there is to it. Umm there is no... classification’. This is speculated to be due to the linguistic construction of uhlanya ⁴ (explored later in the article) as well as the lack of other linguistic terms in Zulu for other emotional and psychological states. It appears that no other psychological subject position existed other than ‘mad’ or ‘non-mad’.

During the interview with the participants, it became apparent that Zulu culture had developed a classification system for experiences which could be viewed as similar to madness. The participants spoke of uhlanya, ufufunyane ⁵ and ukuthwasa ⁶ , differentiating between these states and classifying them as distinctive experiences in Zulu culture, despite all having the same or similar symptom states. The states of ukuthwasa and ufufunyane would fall in the ‘non-mad’ category, as they are not psychological but rather understood as spiritual and cultural phenomena. While uhlanya would fall within the ‘mad’ category.

Indigenous Knowledge Systems have historically developed knowledge out of practical necessity for survival within Africa (Zulu, 2006). Unlike in Western culture, with our spectrum of states described within our own ‘mad’ category, it appears that Zulu Culture has not defined a detailed spectrum of mental illness, as it has not been practically necessary for the culture.

“…I think with mental illness it has (p) I think you look at it in a spectrum...but with UHLANYA, you just looking at one extreme, a person who is in an active stage of psychosis ... it’s either a mad person um or you’re not mad (raised inflection). There was no mentally ill, mentally stable person, no. We didn’t consider people that way... a person’s, just say mad, not mentally ill...” -Participant four

‘Uhlanya’, a linguistic recognition of ‘madness’, has been clearly defined within the Zulu culture as it has been deemed practically useful for stratification and identity purposes. Uhlanya can be recognized as a term for severe mental illness and a broad descriptor of ‘madness’ within Zulu culture.

“There’s a saying in Zulu ‘uhlanya aluqali ngokucosha amaphepha’ meaning (pause) uh, going mad or going crazy doesn’t start with (p) picking up paper...” -Participant one

This saying was well established as a Zulu cultural proverb, forming an oral text and oral pedagogy within the Indigenous Knowledge System. Every participant whom the researcher mentioned this saying to knew it well. A few participants recalled the statement with good humour and fondness; however, upon reflection of the statement, the participants began to question its heritage and meaning. The ‘paper’ mentioned was not necessarily writing paper, but food wrappers and scrap paper-based waste. The paper therefore had the connotation of ‘waste’, related to garbage, and created the image of the mentally ill as being vagrants.

The proverb recognizes that madness does not begin with the action of collecting waste, or picking up papers. Rather it acknowledges that something else has been causal in the creation of madness, but what the proverb believes is causal is not stated. Western models of thinking acknowledge a singular or linear causation of mental illness, unlike Indigenous epistemologies, which essentially recognise multiple non-linear causal factors. The acceptance non-linear aetiologies by the Indigenous Knowledge System may be due to its rooting in historically collective pools of knowledge, consisting of multiple beliefs and thoughts based upon a central philosophy of care, humanity or universality (Alao, 2004).

“...we’ve been so acculturated to thinking that a mad person, or someone who is (p) mentally disturbed, picks up papers.” – Participant five

“...that’s what happens in our community, once people they are mad they will have these like plastic bags um where they pick up papers...” – Participant four

Research displays that culture is pivotal in shaping psychopathological symptom expression (Matsunaga & Seedat, 2007; Sadock, 2015). Perhaps, this picking up of waste and paper has become a Zulu cultural signifier of severe mental illness or uhlanya. In line with the premises of social constructionism, Zulu culture’s creation of this proverb has in turn influenced the reality of the mentally ill’s activity.

The creation of such a proverb could plausibly have been based on observed instances of ‘mad’ individuals engaging in such behaviour. The mentally ill would plausibly ‘pick up papers’ due to the mentally ill’s occupied strata in society. Possibly, the ‘mad’ would be left vulnerable to poverty, required to find food and supplies amongst the leftovers from the ‘higher’ strata in society. As participant three stated, ‘...they’re looking for food...they mostly interested in takeaways and all that... that’s why, you mostly, you witness them in like in garbage bins...’

Constructions of normal and abnormal identity

Naming of the mentally ill

The first question the researcher posed to the participants was about the general understanding of mental illness that existed in their local communities. This elicited the discursive construction of madness equating identity.

“...it has to have been caused by something, doesn't just come from nowhere...And um... maybe (p) well a person is mad (elongation of word) ... you know its (pause) out of the norm. It's not something that should be happening, lets find the solution, what's going on? -Participant one

“When it walks in, like when the situation walks in, like when the patient walks in (p), the psychology that walks in there...” -Participant two

Participant one and two spoke of mental illness as an ‘it’. This is also reiterated throughout the interview with participant one. The use of non-descriptive ‘it’ distances the phenomenon, placing ‘it’ outside the community’s frame of reference and into the realm of the strange. Participant one, reflecting upon how her hometown may understand mental illness, immediately attributed its cause to a culturally problematic external factor. Another reading of these quotes is, as it was ‘out of the norm’ to the cultural community, the human being was assimilated into the abnormality, making the human being (not just the illness) abnormal to the norm. Further questioning could provide insight into whether this is due to Zulu culture’s belief that an illness in one individual may leave the rest of the community vulnerable to the same illness (Washington, 2010).

The participant’s statement ‘well a person is mad’ illustrates that the Zulu culture may define the person by their illness, making the mental illness the defining point of the human being who has a psychopathology. Thus, the individual does not merely have madness, but is madness. If madness is out of the norm, then so too is the individual.

Participants made mention of names that the communities gave some of the mentally ill, such as ‘Mad Sam’ or ‘Toysie’. What is clear is that the mentally ill individual, the ‘mad’, had no say in their naming. The community took the abnormality of madness and made it familiar through the process of renaming. As Participant one stated, ‘They give you a name based on (p) the mental illness that you have’. For instance, ‘Toysie’, was so named, as he would always have a toy with him. Toysie’s peculiarities were so normalised as being inherently abnormal via his renaming. It appears that the community would simultaneously identify the mentally ill by their name and thereby reject them due to it.

‘Uhlanya’

The participants spoke of ‘uhlanya’, the name that the mad are called in Zulu. The use of the pronoun ‘u’ in Zulu shows identity, in essence stating, ‘you are’. ‘Hlanya’ would be translated to mean crazy or mad, indicating severe psychopathology or psychosis. ‘uhlanya’ thus translates to ‘you are mad’ indicative of identity. This re-emphasizes that the human is defined by the mental illness in Zulu culture. As participant six stated, ‘...you are mad (p) that’s just...ya. Uhlanya. That’s all there is to it. Um, there is no classification’. Participant one held similar sentiments, correcting the researcher’s statement that one may be described as having uhlanya by stating that, ‘As BEING uhlanya, yes’.

Zulu culture is collectivistic, maintaining that the individual is less important than the importance of the community or the whole, following in accordance with Indigenous Knowledge Systems. One of the ways this manifests itself in Zulu culture is by the value placed on the functionality of an individual, which directly correlates to an individual’s usefulness to the community.

“...The first thing my grandparents would ask you, ‘Who are you?’ And when they ask ‘who are you?’ they don’t mean your name (p) they mean to ask you who you are in terms of your career (p) in terms of your capabilities...” -Participant six

In Zulu culture, function or activity is vital to identity. This is seen in the way that people are named according to their function in Zulu, ‘uthisha’ (you are teacher) or ‘udokotela’ (you are doctor). In Zulu conversation, one would often refer to the doctor as ‘udokotela’ and not by their given first or family name. This is hypothesized as purposeful and as having formed a vital function in decades past.

Participant six stated, ‘...The old struggle was always about being something...that may have been exactly what informed um the way we would kind of present ourselves because we need to be something. Um we’ve always been fighting to be something... because we are a movement going towards being something’. Amidst Colonial and Apartheid regimes in South Africa, black African people ⁷ were denigrated to the lowest sector of society and given a devalued public identity. In light of such devaluation, the black South African people had to fight for and create a valued identity of their own. Hence, movements such as the Black Consciousness Movement sought to redefine blackness; empowering and re-conceptualizing black identity. In a system where black people were seen as nothing, they had to fight to be something. This ‘something’ was possibly created and conceptually found in functions, such as careers or valued activities. Therefore, function and activity could have become to define identity.

Discourses of social stratification

As Zulu communities work toward being something they value, there must be a hierarchical strata of value implicitly found within the cultural communities, in order to place what is of value to be, and what is not valuable to be. This need to be something of value has paramount implications on the mentally ill. Through objectification, the mentally ill have been made a subject position as the abnormal mad and have been placed on the outskirts and constructed as the lowest lying sector within Zulu society.

Social stratification’s hierarchy has implications on the power, wealth and status allotted to different individuals in the hierarchical system. Social stratification, as according to Parsons, cited in Kerbo (2002), is driven by the need for status—a ranking determining how well the individual lives up to societies given standards or values. Parson noted wealth or power to be the secondary criterions of a society’s value system, with status and achievement as primary (Kerbo, 2002). Roles in the given society are implicitly ranked according to respected purpose or significance. The people who best live up to the value system in the given society will receive the most status and significance (Kerbo, 2002).

This stratification of society in Zulu communities is elucidated within the participants’ descriptions, and accounts of their communities’ descriptions, of the mentally ill. When discussing mental illness, and uhlanya, with the participants, a few recurring discourses arose. These discourses display the socially constructed subjectivities that the mentally ill occupy, and hence display the Discourse of the mentally ill’s low standing status within Zulu society:

The mentally ill as diseased

Mental illness, madness, or uhlanya, was thought to be contagious. As participant one stated, “everyone would run away, as if it’s contagious or something”. Participant three noted that their community saw mental illness as ‘some sort of disease’. The presence of illness within numerous Zulu communities is interpreted to possibly leave the community vulnerable to the same illness, and this would result in additional fear of contagiousness. The mentally ill individual would be seen as having done something to warrant their illness, causing the ancestors to look down upon them, and hence leaving the community vulnerable to the same illness.

The mentally ill as dangerous and threatening

Fear was a common feeling the participants associated to their communities’ reactions towards the mentally ill. Participant one stated, ‘you had to be careful around him. And then he would be a bit aggressive at times’ and participant four stated, ‘...people were afraid of him…we tend to associate him with danger’. The mentally ill were constructed to be associated with danger, violence and a threat to peace or harmony. This discursive construction correlates very strongly to the mentally ill’s construction as deviants in society.

The mentally ill as deviant

The places the mentally ill occupy were often described like that of a prison. Participant two spoke of a psychiatric hospital room, which ‘actually looked like a prison room’, and in reference to the mentally ill’s treatment by traditional healers, participant five sated that the mentally ill were often ‘bounded like a dog or an animal’. Notably, in both environments (Indigenous and Western) the mentally ill were treated very similarly.

Upon further enquiry with the participants, it was found that few of the mentally ill ever harmed anyone in the community yet were still treated as criminal. The construction and incarceration of the mentally ill as deviant continued even if the mentally ill had not committed a criminal offence or posed as a danger. It is therefore hypothesized that the confinement of the mentally ill was used as a means to protect the healthy in society not from harm, but from discomfort.

The mentally ill as the vagrant

The mentally ill were implicitly described as homeless, poor and or beggars. Despite not physically being homeless, as participants clarified that they did have homes, the mentally ill were nonetheless described as vagrants. This was likely due to both the stratification of the mentally ill, as well as cultural interpretation of the proverb ‘uhlanya aluqali ngokucosha amaphepha’. Participant two stated, ‘Person who is probably collecting rubbish or something...probably singing by himself...talking to himself” and participant six stated, “He would be boshed [drunk]...he had long hair, the had long nails, he was just always always always dirty”’.

The mentally ill as the non-social being

As a result of these Zulu constructions of the mentally ill, the mentally ill were disqualified from the community and hence occupied the lowest strata in the society. Participant three stated, ‘...they are isolated… most of them have their own world…[don’t] have like any sort of friends or social LIFE’. This disqualification meant that the mentally ill were not allowed respect, or access to ‘civilized’ social interactions and events, such as weddings. As participant six stated, ‘Can’t be around a decent place because the only thing they can do is distract or...offend or break something you know’. The mentally ill were, therefore, not socially involved in the community. Participant two reflected that community members would ‘They don’t pay [the mentally ill] any attention (p). They ignore [the mentally ill]. They disregard [the mentally ill]. [The mentally ill] don’t even (p) exist...’.

Participant three stated that the mentally ill would not be seen as a ‘social being’ and participant six stated that, ‘They are not part of the human being (pause) they are (pause) “the other”’.

The mentally ill are prescribed the subject position of “other”, non-human being, belonging to another world of their own, which was separated from the world of the mentally healthy. Due to this, they are isolated a-social beings. The mentally ill are objectified as an object of society’s critique, a study-object that Zulu society can disregard and disengage from due to their socially constructed abnormality. As an object, the mentally ill are not subscribed the ability to feel, understand, be understood or have friends. As participant six stated, ‘They don’t have feelings, they don’t even understand what you saying’.

Swartz, within a discussion on culture, stated that culture is ‘about the process of being and becoming a social being’ (Swartz, 1998, p. 7). If the mentally ill were defined as non-social beings, as according to participants’ elicited discourses, the mentally ill would therefore not be a part of a cultural group and would be a-cultural (Swartz, 1998). As a-cultural, the mentally ill individual is yet again set in a polar opposition to the rest of the socially determined ‘functioning’ cultural community. One could deduce that such a placement, outside of the cultural and social world, would deeply affect the identity or subjectivity of the mentally ill. Humans are social beings and process their identity in community with others. Without a community to reflect one’s identity off of, the mentally ill individual would be undefined and without a sense of identity. This lack of sense of self would further isolate the mentally ill from their community group, as they grow further away from social rules and norms.

“I think he also making a living by uh (p) cutting, collecting wood and then selling it (p)... I think he's is part of a community to a certain level. Cause he's, he has that interaction with the community. You pay me, I do this for you...But then, I wouldn't really say he's not part of a community … He is involved in the community, I wouldn't really say he is a social being, he is involved in the community..” – Participant Three

What is clear from the above quote is that although the mentally ill may interact with the community, this interaction is governed by utility. The mentally ill are socially isolated, yet physically utilized.

The mentally ill as non-functional

The mentally ill are positioned as being unable to fulfil an esteemed functional role within the society. As participant three stated (discussed above), the mentally ill were only positioned as able to perform inconsequential menial labour, such as cutting wood.

“Obviously they don’t keep that job...if I’m gonna hire the person, you know, it must be like keep it short...cause tomorrow they not gonna pitch (p) it’s a definite they not gonna pitch (slight laugh).” – Participant three

According to participant three, the community would assume that the mentally ill are incapable for commitment or occupation of a functional role. As already discussed, function or activity within Zulu society is vital to identity. If the mentally ill are deemed non-functional, they are not then given an identity more than that of ‘uhlanya’.

The above elicited discourses indicated that within Zulu communities the mentally ill are deemed diseased, dangerous, deviant, socially inept and non-functioning. ‘Uhlanya’ is a signifier of the above discursive constructions. ‘Uhlanya’ (or the individuals’ given name by their community) comes to embody Zulu society’s fears, beliefs and stereotyping of the mentally ill. The mentally ill therefore occupy the subject position at the bottom of the social ladder as they are deemed all that their name, ‘uhlanya’, embodies.

The resilience of black South Africans

Considering South Africa’s traumatic and oppressive history (with specific reference to Apartheid), black African people were required to maintain immense strength in light of immense pain. Black African people unified as a cohesive against oppressive white power. As participant six stated, ‘...black people have suffered with a lot of those things. And have been very resilient...’ Constructed as outsiders to white people, black South Africans formed their own social identity as the ‘powerful disempowered’. Black South Africans created a powerful group, inspired by the Black Consciousness Movement and leaders such as Steve Biko, despite the oppressive social isolation they faced. This formation and resultant resilience links itself to the fight of black South Africans, as participant six termed, to ‘be something’ something powerful and valued.

Historically, black South Africans were not given a voice to present their story, especially when in the context of the ‘outsider’ or white South African. Participant seven stated, ‘You see black people are not socialized to seek help (p) from outsiders, or tell their stories to outsiders’. This silencing of black Africans’ stories has likely continued into contemporary South African society.

A discourse of Indigenous Knowledge Systems is the ‘social and cultural expression of the quest for identity and participation in an as yet equitable society. It is thus an extension of the political liberation struggle’ (Hoppers, 2002, p. 105). Hoppers’s (2002) statement regarding Indigenous Knowledge’s discourse of liberation echoes Steve Biko’s sentiments, a vital leader of the political liberation struggle in South Africa, whereby black Africans were encouraged to redefine their identities. As revealed by the participants talk of resilience, black South Africans have fought to create their identity within the South African society. These discourses of resilience and the quest for identity are located within the wider Discourse of the subjugation of Indigenous Knowledge and indigenous people.

Participant six stated, in reference to black South Africans, ‘...we need to kind of endure, that’s what we are taught...we still thrive through these adverse encounters...’. The participant went on to comment that white people are granted a ‘freedom of expression’, that is not granted to black people, that enables white people to express their feelings and stand against abuse and violence. Whereas, participant six stated that this violence and abuse ‘[is] acceptable. It’s a way of life...’ for black South Africans who have experienced forms of abuse and violence for generations (the participant used the example of domestic violence). Participant six evoked the idea that black people’s resilience to abuse, hardship or violence was due to their lack of freedom of expression, historically, in comparison to white or ‘westernized’ citizens. This participant stated that she no longer had that ability (what the participant spoke of as a strength of sorts) to endure these hardships, as she had been educated to understand it as a weakness, stating ‘...that “strong-ness” for me is weakness at the same time’. This participant suggested that education had given her an awareness and a ‘freedom of expression’ that she had not had before, that now made the abuse and violence that was previously tolerable, intolerable.

Noteworthy is that participant six equates this resilience to hardship as a lack of freedom of speech. According to this participant’s interview, a resilient black community is unlikely to speak up against their oppressor, maintaining unequal social relations, such as the example participant six used of the dynamic between abusive husband and submissive wife. The equation of resilience to a lack of freedom is a concerning issue, one that echoes the past reality of Apartheid.

This resilience may have implications on social relations within local communities and within greater society. If resilience implicates endurance in the face of hardship it may involve a greater tolerance to hardships that other social groups are less able to endure. This may be a positive in some situations, such as that necessitated under Apartheid, as well as more adaptive. However, the normalization of hardship within black African communities, due to the oppressive history within such communities, may have led to the desensitization to hardship within black communities, impacting upon social relations. The concern behind this continued philosophy of resilience (which is supported by constructional beliefs and thoughts stemming from historic oppressive eras) is the impact this discourse may have upon those who make up the community, such as the mentally ill.

As previously discussed, resilience is tied to functionality in Zulu communities. The mentally ill individual, occupying a space within the resilient black African community, is potentially problematic as mental illness, or ‘uhlanya’, is equated with dysfunction, inability and deviance – what could reconceptualized as non-resilient. The non-resilient individual would likely be ostracized, as discussed previously. Additionally, such a discourse likely complicates help seeking behaviours in Zulu communities, as resilience and strength is valued over help seeking.

Geography and mental illness

Many of the participants spoke of the importance of environment and place, such as participant two, who stated, ‘...It’s amazing what (pause) an environment can do (p) to you and your thinking and your behaviour...to adapt to their current situation...to the societal norms of the (pause) the current environment’.

There is little research in South Africa showing detailed demographics of individuals living within rural or urban areas, and it is therefore difficult to state what percentage of rural areas Zulu individuals occupy. Andersson (2013) notes within her study (a study on depression based in the Eastern Cape, South Africa) that individuals were less likely to reach out for mental health care if they were from low-income sectors of society. The most substantial barriers to seeking mental health care were noted to be lack of knowledge, stigma and financial constraints (Andersson, 2013). Another study, conducted by Van der Hoeven et al. (2012) in her research within the North West province of South Africa, stated that individuals within urban sectors are more likely to be employed than their rural counterparts. Subsequently, individuals within rural sectors had a lower budget available to spend on their health care and access to these health care facilities than their urban counterparts (Van der Hoeven et al., 2012). Those individuals who make up the low-income sector living within rural areas are rendered disempowered and largely unable to attain the health care they or their families require.

Distinct geographic knowledge

There seem to be distinct, yet same-culture, knowledge systems in different geographic locations within South Africa. Culture may be inscribed at the level of the societal and individual, creating a complex web of unique descriptions of culture, which are subjectively and objectively inscribed. Indigenous Knowledge System Discourses are over-arching and extend beyond geographic boundaries, yet have unique cultural variations (Zulu, 2006). These cultural variations of Indigenous Knowledge are further dissected and varied geographically.

Zulu cultural distinctions were noted between participant’s descriptions of rural and urban places. Participant three emphasised the distinction between location and abundance of spiritual beliefs and traditions, ‘It’s a rural place, so those traditions are very like (p) uh held highly. Like you know that, okay, its not like HERE...’

Regarding this distinction between rural and urban areas and understandings of mental illness, participant seven stated, ‘I think because of the culture, you know, how people understand it’s the predominant language (p) in the township areas this is how we understand mental illness...’ This participant’s statements implied, in line with social constructionism, that language is constructional of reality (Burr, 2015). Therefore, despite being of the same cultural grouping, (e.g., Zulu) the language used in rural, township and urban areas would influence the people’s understanding of mental illness. Participant four spoke of the relativity of psychopathology to different geographic locations, stating ‘you go to rural areas, I can bet, you’ll never find um a person suffering from um an eating disorder...Uh, a black person who suffers from anorexia nervosa …will be highly educated to understand that um, there is something called anorexia...’ This participant evokes the idea of cultural relativity and the constructional power of language. The premise follows that without the awareness and language of and about anorexia nervosa, an individual would not suffer from the disorder. Especially within ‘rural areas’ in South Africa where there is limited access to knowledge resources. Subsequently, one could assume that there would be few or no individuals in these areas suffering from anorexia nervosa. Similarly, participant seven spoke of the cultural relevance of psychology and its connection with education, as they stated ‘I don’t see any black person (p) going to a therapist comfortably unless they know, unless they have been psycho-educated’.

Participant two realized a change within her family’s belief system upon relocation to an urbanized area. She stated, ‘in the more urban area it was more of a westernised (pause) approach, right? It was very westernised. Even, I realized with (p) my parents actually (p) their...their thinking changed, right...It’s amazing what (pause) an environment can do (p) to you and your thinking and your behaviour...’ The participant noted this change as due to a need to adapt to socio-cultural norms of the current environment, as well as due to exposure to new ways of thinking causing an awareness of alternative solutions to a problem.

Overlapping of knowledge – a counter discourse

Participant five noted that difference in place does not always equate to a difference regarding mental illness. Participant five stated, ‘Its strange how similar our … differences can be… in the shrine ⁸ I see a lot of the symptoms that um (p) I would see in the hospital, but they are purely traditional and I can cure them that way. In the hospital I see a lot of the symptoms I would see traditionally but they can be cured purely from a psychological perspective’. From this participant’s personal experience as both a sangoma (traditional healer) and a student psychologist, she noted an overlap in Western and Indigenous treatment and symptom expression. She likened the shrine to the hospital setting, both in terms of social treatment and stigmatization of the mentally ill, and saw an overlap between treatments and effectiveness in treating psychological or traditional illnesses.

‘Ubuntu’ and the mentally ill

Zulu culture emphasizes ‘Ubuntu’, translating to mean humaneness – implying empathy, oneness and unity (Washington, 2010). Many African communities have a fundamental culture of ‘being your brother’s keeper’, emphasizing the unity of all individuals within the Indigenous Knowledge System (Alao, 2004, p. 252).

However, the mentally ill are in some ways seemingly discarded from the normative social practice of the Indigenous Knowledge System’s valuing universality. The stratification and ostracisation of the mentally ill essentially states that ‘you are not us’. Participant six stated, ‘they are not part of the human being (pause) they are (pause) “the other”’. It could be argued that the mentally ill have been segregated from this ‘ubuntu’ or universality that is typically afforded to African people. This discourse of stratification is distinct from the known discourse of the Indigenous Knowledge System, which values universality and unity. Perhaps, the stratification present within Zulu culture is an embodiment of the Indigenous Knowledge system’s value for the larger collective body over that of the individual (Alao, 2004; Funteh, 2015). Therefore, the lowly stratification of the mentally ill is deemed advantageous to the collective, and hence implemented at the expense of the mentally ill individual.

However, simultaneously the participants presented a counter discourse and emphasized the care and support Zulu families show the mentally within the family system, thus showcasing the normative social practice of universality or ‘ubuntu’. As participant one stated, ‘...the family has tried everything...’ The family would, according to the participants, exhaust every option in attempting to help their mentally ill family member. Customarily, Zulu families would try traditional elements of healing before taking their ill family member to the hospital. As participant one further stated, taking a family member to the hospital is ‘probably a last resort’.

Participant two stated, ‘...they don’t understand what’s going on...so either [they] don’t want to face the situation or [they] don’t want to understand what’s actually going on cause [they’re] scared what’s on the other side’. Participant two provides three hypotheses for the family’s behaviour toward the mentally ill, either they dismiss the situation; do not understand; or are afraid to explore the illness. There is little support, considering the participants’ interviews, for the hypothesis that the family does not care and hence dismisses the mentally ill. Rather the family’s actions seem to stem from fear, confusion, and desperation.

As previously mentioned, many Zulu families do, as Alao stated (2004. p. 252), see themselves as their ‘brother’s keeper’, evidenced by the fact that the family will continually try and ‘get [the mentally ill family member] again’ as stated by Participant three. According to participants’ interviews, a Zulu family would identify themselves as the family of the mentally ill, while simultaneously trying to ‘contain the situation’, stated by participant three. This is since, as stated by participant seven, ‘it was embarrassing to have a family member who was mentally ill’ presumably due to the fact that they occupied the lowest strata in the community social system.

The confusion surrounding what course of treatment should be utilized may be due to Zulu families (as according to the participants) being conflicted by opposing polar Indigenous and Western Discourses surrounding mental illness. Alternatively, the confusion surrounding mental illness in Zulu families may be as many Zulu individuals are often placed in a disempowered position with regards to accessing and understanding mental health care within South Africa.

Western and Indigenous oppression of the mentally ill

This article argues that Freire’s and Fanon’s contemplations regarding the oppressed can be extended to address the state of the mentally ill. As per the previous elicited discourses, many mentally ill are regarded as one of, if not the lowest strata within Zulu communities. The rhetoric of many Zulu communities regarding the mentally ill reiterates a rhetoric used by colonial powers to assert power over black men and women. According to Freire’s writing, the oppressor never calls the oppressed such, but rather redefines them as subversives via terms such as ‘violent’, ‘savages’, ‘those people’ and so forth (Freire & Ramos, 1970, p. 56). Similar terminology is evoked in the participants’ discourses as the mentally ill are described as ‘the other’ (Participant six), ‘aggressive’ (Participant one) and ‘dirty’ (Participant six) among other descriptions.

This paper proposes that the ‘oppressed’ have morphed to include the mentally ill. If the mentally ill now form part of the ‘oppressed’ population, it must be asked whom the oppressor is. According to the explicated participant discourses, institutionalized models of health (western medicine) as well as traditional models of health (indigenous medicine) oppress the mentally ill. Participant two described a ‘western medicine’ psychiatric hospital room that ‘actually looked like a prison room’. While participant five stated that in indigenous traditional healers’ shrines where the mentally ill are often ‘bounded like a dog or an animal’.

Biopower ⁹ Discourses within such Western and Indigenous spheres have detention, or imprisonment, themes and subsequent actions attached. The discursive actions created out of biopower based Discourses render the mentally ill as dangerous objects, which need to be confined, studied, understood and sedated.

“...the door is locked because um they don’t want them roaming in and out everywhere... I know in some hospitals they have these seclusion rooms, and people have to be chained and whatever.... they did say if a patient comes in and they’re extremely psychotic then they have to be in seclusion...” - Participant two (speaking with regards to a psychiatric hospital)

As an object of enquiry, toward which dehumanizing actions are taken, the mentally ill individual is denied the space to express themselves. Upon expression of feelings or passions, the individual runs the risk of being deemed psychotic and subsequently treated as dangerous.

During interviews, participants were observed to note that patients’ opinions and beliefs about their own psychology are not centralized, but rather the health care professional’s (or traditional healers) beliefs dominate the relationship. It appears that within both western and indigenous models of health, the patient, the ‘mad’, have no or little say over their own healing process, being positioned as unable to make decisions about their own mind and being.

Discussion of analysis

Colonialism and Epistemological violence

The study bought to light various discourses and complexities surrounding indigenous knowledge systems, and elucidated the epistemically violent clash of Western and Indigenous knowledge systems in the medical and psychological fields.

The colonisation of South Africa bought with it a westernised diagnostic taxonomy for mental health, which aided colonial powers in maintaining their position of authority (Hassim, 2012). Mental illness served a function, as those who were deemed mentally ill were intellectually, socially and spatially segregated. During colonisation (which is both past and persistent) the ‘difference’ of African people to Colonial people resulted in the othering of African people. This aided colonial powers maintain their rule. Hassim (2012): stated that Africaness now became of more interest than madness. If the African was already deemed “normally abnormal”, then the mentally ill African was abnormally abnormal (Hassim, 2012; p. 31).

Given the power and voice attributed to colonial power over indigenous power, discourses of colonial origin have taken centre stage in the realm of psychology, leaving indigenous discourses to be silenced and marginalised. Western psychology took the forefront of study and practice within South Africa, a historically indigenous, or non-western, country. Practically, this looks like a lack of study and inquiry into indigenous discourses on psychology, as well as a lack of prioritization of indigenous epistemologies within the global psychology community. Hassim (2012, p. 103) explained ‘culture determines the definition, course, and treatment of illness’. Cultural discourse creates the reality and progression of psychopathology within a society.

Multifaceted is the relationship between the oppressed mentally ill and the oppressor, as Indigenous and Western health service providers are strained under existing binaries of black and white power, confounding the need to alter the pedagogy and epistemology relating to mental illness within South Africa, and Africa at large. South African and wider African society do not exist within a vacuum, void of past injustices and current injustices. Rather African society faces the challenge of confronting over-arching and engrained discourses regarding race and culture, while also confronting violent discourses of health and illness.

Marginalised subject positions – a double edged sword of oppression

It is evident that some black South Africans (and likely African people as a whole) who experience mental health issues are faced with two marginalised subject positions: ‘mad’ and black. These mentally ill black South Africans face a doubled edged sword of epistemological violence and oppression as they lie at the intersection of these two disadvantaged groups, and lie within two Discourses – the marginalisation of the mentally ill and the subjugation of indigenous people.

The oppressed intersectional subject position of the ‘mad black African’ has long been ignored within both research and social practice. This can be noted by: the absence of literature on the subject matter; lack of challenge to medical and psychological epistemological violence that continue to uphold the mistreatment of mentally ill black African people; as well as via this paper’s elicited participant discourses.

Enmeshed understandings

Notable within this paper is the inherent challenge and conflict of integrating Zulu and Western Knowledge. Effective and clear dialogue between these two knowledge systems is a challenge. The ongoing effects of historic injustices in South Africa, the prevalence of Western knowledge systems in the country (despite the majority of the South African population being from an indigenous origin), and the disregarding of indigenous epistemologies has resulted in an enmeshed understanding of mental illness with South African borders.

The analysis and elicited discourses in this paper display complex overlaps and counter-discourses, indicative of this enmeshed and at times ‘messy’ delineation of psychopathology within Zulu Culture. Due to the long standing history of colonisation and Western Knowledge dominance in South Africa, indigenous cultures have undoubtedly been influenced and altered in both the miniscule and macroscale. It became clear during analysis that participants held this enmeshed and dual subjectivity. They were at once both the Western educated individual and the Indigenous individual who was bought up with Indigenous ways of being.

A challenge for education

Education in Africa has led to what Nyamnjoh called an ‘epistemicide’ – the near complete replacement of Indigenous knowledge systems for the epistemological paradigm of the colonist (Nyamnjoh, 2012, p. 1). This has resulted in purely Western-based English education systems being implemented into schooling systems in Africa for decades past. The idea that Africans can contribute little that is worth learning about is implicitly stated through such education systems.

Paulo Freire theorized about the pedagogy of the oppressed and indicated that if education wishes to truly be liberating it cannot remain distant from the oppressed individuals within society. The oppressors within society must be willing to rethink their epistemological position (Freire & Ramos, 1970). If the oppressed and the mentally ill are equated, then according to Freire, the mentally ill need to have a voice surrounding their illnesses, subsequently having a voice regarding their treatment. More specifically, mentally ill black Zulu South Africans need to have more of a voice surrounding illness and treatment. The oppressor too is required to be open to rethinking their epistemological position, inferring that both Western-based and indigenous-based medicine needs to allow space for the voices of the oppressed indigenous mentally ill to be heard. Dei (2012, p. 102) suggests that there is a need ‘to replace our “cultural estrangement” with a “cultural engagement” in the pursuit and promotion of African/Black education…’, rooting education within Africa in the rich culture, history and heritage of indigenous people.

The act of Indigenous knowledge systems reclaiming their voice within education and health discourses is currently underway within South African society. Students at South African universities are speaking up about decolonizing institutional education systems, so as to no longer focalize the Western point of view within research and academia.

Limitations

Both researchers do not identify as members of the Zulu culture. This brings an inherent deficiency to the article, with both researchers not being members or insiders to Zulu culture. Although both the researchers have grown up in multi-cultural South Africa, the researchers are not Zulu in culture. Therefore, despite researcher reflexivity and best intentions, this research is vulnerable to cultural bias and the researcher was unable to communicate with the participants in their first language. Additionally, the sample of this study was small and non-representational to the general Zulu public (with all participants being enrolled in their masters degrees in urban areas). Further research with different samples from Zulu communities is needed to support the findings of this study.

In the interviewing and analysing of elucidated discourses, westernised terminology was used to describe and understand psychopathology whilst simultaneously and in contrast attempting to understand Zulu constructions of psychopathology, undoubtedly influencing results. Integration and effective communication of Indigenous and Western Knowledge Systems proves conflictive and difficult to navigate, indicative of wider ingrained Discourses and hurdles.

Literature regarding some factors relevant to this research was limited. Due to the inadequacy of literature on South African Zulu experiences, a portion of research was taken from international journals and applied to the South African context. The applied research was critically analysed before application, and it was ensured that only equivalent population groups were used when applying international literature. This does not nullify any of the findings, but rather points to the urgent need for more Quantitative and Qualitative research regarding the South African population to be conducted.

Conclusion

This paper functioned to elucidate the various discourses elicited during research on Zulu Culture. Common discursive constructions of the mentally ill arose from interviews with the sampled participants.

Within many Zulu communities, a binary of mental health existed – an individual is not mad, or is one with madness (‘uhlanya’) and hence is defined by it. Zulu communities were discovered to highly value functionality, and link identity closely to function. This was constructed as due to historical oppression which required Zulu individuals to fight for power and remain resilient. The mentally ill were subsequently constructed as non-functional and hence occupied one of the lowest strata, if not the lowest, within Zulu communities. The mentally ill were commonly discursively constructed as diseased; vagrants; aggressive; deviants and non-social beings.

The value placed by Zulu communities on functionality is linked to resilience, and the fight to be reconceptualised as valuable. Furthermore, the value of functionality is linked to the Indigenous Knowledge Systems’ value of practicality for aiding in survival. As the mentally ill are deemed non-functional, they are subsequently deemed non-resilient. Moreover, the research elicited that the importance of maintaining the perception of resilience may complicate help seeking behaviours, as strength and privacy are prioritized over help seeking. However, despite the importance of resilience and privacy, the premises of Ubuntu play a significant role in the family’s treatment of the mentally ill, in Zulu communities.

An interesting discourse regarding geographic knowledge arose during interviews. Noteworthy is the impact of geographic location on the understanding of mental illness. It is apparent that there are distinct, yet same-culture, knowledge systems in different geographic locations within South Africa. Rural and urban spaces’ impact on knowledge relating to mental illness warrants further attention.

Surrounding these discourses are a set over-arching deeply engrained wider Discourses. The oppressed mentally ill and the oppressor (indigenous and western health service providers) are strained under existing binaries of black and white power, as well as strained by prevailing Discourses of Biopower.

The constructions of psychopathology as according to the participants are shown to be complexly conducted by various historically rooted Discourses which still anchor themselves into the present South African Zulu individual and community. Subsequent to these historically rooted Discourses, Zulu individuals functioning within the mental health sphere (as patients or clinicians) face a doubled edged sword of epistemological violence and oppression as they try to effectively move through enmeshed and complicated waters. This results in a challenge for education providers if there is to be forward movement.

Elicited constructions and discourses point to the need for further research on indigenous communities and epistemologies within South Africa. Further quantitative and qualitative research on mental illness within Zulu, indigenous and other non-western communities is needed.