TRC Final Report

Volume 4

Chapter 5

Subsection 15

Abuse of diagnosis and treatment

86 The abuse of diagnostic tools by mental health professionals in collusion with the state must be regarded as a violation of human rights. Diagnosis was used to silence activists or opponents of the state, condemning them to institutions where they were under state control. This tendency increased the stigma attached to mental health institutions.

87 Health professionals also produced diagnoses that minimised illness or claimed that individuals were feigning illness, thus allowing the police to continue torturing and ill-treating political prisoners. Misdiagnosis also served to deny political prisoners and black people in general access to much needed mental health services. Yet, ironically, in an attempt to persuade the Commission’s Amnesty Committee to grant amnesty, a diagnosis of post-traumatic stress disorder was employed by security personnel.

88 The abuse of diagnosis is inextricably linked to that of treatment. Thus, individuals were given the wrong medication. As noted above, it was also claimed that detainees were used as guinea pigs to test new drugs.

Education, training and research

89 As with other health professionals, mental health professionals received very little under- or postgraduate training in ethics or human rights issues. At the time of reporting, psychologists were still not required to take an oath on graduation or registration and appeared to be acquiring knowledge about appropriate conduct by default rather than design.

90 Up until the time of the Commission, the training of mental health professionals adopted a largely Eurocentric paradigm, resulting in a style of mental health care that was inaccessible and inappropriate for many South Africans. While transformation was occurring in some academic sectors, change was still absent in others. Likewise, the types of psychometric tests used for assessment purposes (such as IQ tests) still tended to be appropriate only in a western culture. In South Africa, they were used as a way of excluding black candidates from, for example, educational institutions and employment opportunities.

91 In the same way, the types of research initiated and funded by tertiary academic institutions and organisations, such as the Human Sciences Research Council, remained esoteric and of little relevance to the mental health needs of the majority of South Africans.

Rural mental health

92 Most of the deponents who came from rural communities complained that they had no access to mental health services. Those who did experienced the services as alienating. They also spoke of the need for a culture that incorporated indigenous healing systems – for interventions informed both by the prevailing culture and by religious modes of healing.

The impact of trauma

93 At the time of the Commission, most South Africans were still experiencing the consequences of trauma. It was clear that mental health services were not yet geared to address this need. This point was discussed at a mental health workshop conducted by the Commission which dealt with the psychosocial and emotional needs of communities and individuals who had been identified by the Commission and other victim support agencies. The view was also expressed that mental health services historically received little or no resources and that the impact of poor mental health is far-reaching. In addition, the traditional paradigm used to understand trauma was Euro-American. The indigenous wisdom in South African cultures had been marginalised and its richness ignored. An aspect of trauma that also deserves attention is its impact on families and communities at a multigenerational level so that intervention strategies incorporate the family in its entirety.

Psychiatric patients remain a vulnerable group for discrimination and abuse of human rights. Both the mentally ill and the mentally handicapped are clearly stigmatised and thus discriminated against … In particular, there is a tendency to provide a differential level of care to different socio-economic groups, which is similar to the dehumanisation of other deprivations we have lived through.⁴⁰

94 The ‘sins’ of the mental health profession in South Africa were largely those of omission, although there is some evidence of more direct involvement in unethical conduct leading to human rights abuses. Unfortunately, because of the veil of secrecy surrounding the inner workings of the SADF and SAP and the invocation of the Official Secrets Act, it was not possible to perform an adequate assessment of the role that mental health professionals played in these institutions. Undoubtedly, like doctors and nurses with dual obligations, mental health professionals in these settings were vulnerable.