One of the advantages of being a psychology student is the emphasis on critical thinking not just on the disorders that are experienced by most South Africans but the profession we’re in and its relevance to the public. This is influenced by a number of topics and debates that we have been engaging on the entire year –psychology (psychotherapy) and the Diagnostic and Statistical Manual of mental disorders and whether or not they are relevant and applicable in South Africa.
It is really important that South Africans engage with these kinds of debates as they affect the majority that cannot speak for themselves. Some scholars and therapist will agree and some might disagree. However way one chooses to tackles this, my opinion may beg to differ and perhaps give different perspectives on something that we (as the general population of SA) have never thought about.
There are issues that are conferred within the task team compiling DSM. With the change of this manual – 5 times already, more and more debates are raised, and the veterans involved with the use of DSM do not agree with some of the disorders – be it they want them to be included or removed.
Most of the issues that are critically discussed are begging questions which are left unanswered. When we critically discuss DSM and evaluate the relevance and applicability of it in most countries, particularly in South Africa, some questions are raised. There has been controversy around the disorders that needs to be included or not included in the manual. Arguing about these things helps to clarify and understand DSM better. The answers to questions above infrequently you find them.
Is DSM applicable in the South African context? Yes and no. Yes in a sense that it serves as a guide to South African therapists and other practitioners that are in similar disciplines, working with patients that the society perceives them abnormal, to understand the situation of disorders better. At the same time, we need to be conscious that the patients might be different and as a result, nothing is wrong with them, they are merely dealing with things differently. It would help if there was South African DSM that caters for the needs of South African context. We need to bare in mind that context, culture, environment, race and countries differ. Which bring us to our ‘no’ answer.
No, DSM is not applicable in South African context because it is compiled in the States! With that being said, there has been inconsistency and critiques during the revisions of the manual. Now, if in the American context it is being questioned; how much more in South Africa. Personally, I do not own DSM-5 as per yet. However, I do not recall in the previous years when it talked and appreciated African culture and tradition of doing things and the context of which those are occurring. DSM is westernized and forgetting or rather being ignorant of the fact that South Africa is more diverse than most countries and what is considered as a disorder in Western countries it is not in South Africa.
For example, the process of ‘ukuthwasa’ – argued to be schizophrenia, bereavement in Xhosa way – depression in DSM, (lacking a better way of describing these) but when a child is neglected at home and his/her rightful traditional ceremonies have not been performed for her/him as a result experiencing some antisocial behaviours and not doing well at school – in DSM argued to be autism or ADD, etc. There are a lot of example that I may pick up to back the fact that DSM does not take into consideration the culture, diversity and the context of South Africa thus most people may doubt its applicability.
There are various issues that we may note when we refer to the shortcoming that psychotherapy had previously in South Africa. Psychotherapy traditionally accommodated for white middle class people. Language has also been one of the issues that has been experiencing by many people in this country. Accessibility to psychology psychotherapy services and affordability of those has also been an issue which has never been addressed previously. However, in recent years, there has been so much research and studies that has been conducted to explain and to a certain extent providing some solutions to these shortcomings.
There were other ways that traditionally South African people use to treat mental disorders and that accounts for sangomas and traditional healers. Most people of this country previously have never seen the need to attend psychotherapy or see a psychologist as it has been accommodating white middle class. However, in the recent, the arrival of Euro-American approaches has in a way neglected the way that previously the people of South Africa have been doing things. As a result, all those previous ways of treating mental disorders is somehow neglected and ignored. Many people find themselves caught in the middle of traditional way of doing things and the new approached that psychology brought about.
The majority of South African therapist are white middle class and can only speak Afrikaans and/or English. That becomes a problem because the majority of South Africans are native isiXhosa and IsiZulu. Often there are messages that are misinterpreted in the session because the therapist can only comprehend a language that is foreign to the one seeking treatment. Psychotherapeutic treatment takes time and cost money. This is of disadvantage to the majority of South African as they are poor and are unable to attend sessions which are situated in far areas from where they live.
My argument to all the readers is that we need to open a space in South Africa for DSM. However, at the same time we need to be conscious of how traditions, customs and other variables may play a part in individuals’ lives because these are long standing teaching and ways of dealing with disorders of which we may not run away from it. DSM does not offer a space for South African context and ways of dealing and doing things to play part. This is a problem because a lot could go wrong.
