Argument for Logotherapy in a Rural South African Setting
By Dr MA Kanda
This article first appeared in The International Forum for Logotherapy in 2015. This version has been reformatted and is published here without references.
The application of logotherapy in the rural African context is not well documented. Hence, questions about its applicability and appropriateness in rural Africa are often raised. The following paper argues that logotherapy is appropriate and applicable in the rural African clinical setting.
The Rural African Socio-Cultural Context
I have offered logotherapy sessions as a medical officer in a psychiatric clinic of a government district hospital located in a rural area of Limpopo Province, South Africa. Limpopo, the land of the world-renowned Kruger National Park, the Golden Rhino, and the Rain Queen Modjadji, is a beautiful province of South Africa.
The socio-cultural context of the clients and their families attending the psychiatric clinic is characterized by high rates of poverty, prevalence of HIV/AIDS, and a high mortality rate. The socio-cultural context is further characterized by the co-existence of both African traditional beliefs and Christian beliefs. Sepedi is the predominant language, and Zion Christian Church is the predominant religion among the population attending the psychiatric clinic.
In 2010 the report of the local municipal office stated that about 67.7% of its households had no income.12 This same report suggested that the low level of literacy was linked to a high rate of unemployment. The district hospital reported a monthly average of 30 deaths for the medical wards — most of these were related to HIV/AIDS.
Often, the patients and their families attending the psychiatric facilities consult traditional healers and also faith healers as well as medical health professionals during the course of the illness. Regarding this pattern of healthcare seeking, Herselman writes:
“In Southern African black societies, simultaneous consultation of a traditional healer and a medical practitioner, known as dual consultation or medical pluralism, often occurs.”
Ashforth also notes that in South Africa people generally consult traditional healers and prophets.
According to the clients and their families, psychiatric illnesses are viewed as the result of spirit possession or witchcraft. One can be possessed by good spirits (generally from one’s ancestors — “Moea” in Sepedi) or bad spirits unrelated to one’s family or kinship. Witchcraft or sorcery involves the manipulation of supernatural forces with the intention of causing harm or bad luck to others. The impact of traditional belief in witchcraft was illustrated by the loss of more than 600 people due to witchcraft-related violence in Limpopo province from 1996 to 2001.
In my experience, a common phenomenon attributed to witchcraft is the loss of schoolbooks or any other school items used by pupils. Some young clients believe that their lost schoolbooks or school items are magically used, by their schoolmates or other members of the community, in order to prevent them from performing well at school. These persons often present with depressed or manic mood with psychotic features and at times with anxiety symptoms.
According to the clients, the traditional healers are generally said to obtain their healing power from using natural and supernatural forces. The faith healers are believed to obtain their healing power through the use of prayers. However, the distinction between traditional healers and faith healers is not always clear.
The rural setting of the clinic where I offered logotherapy is also characterized by a limited number of healthcare professionals for a high number of clients attending the health facilities. In such context, like in most rural African areas, there is a very low number of psychiatrists, psychologists, and other professionals trained in mental health. Many clients who need mental health services live far from the health facilities. Because of these and other challenges, psychosocial intervention is very limited.
Logotherapy as an Appropriate Intervention in the Rural African Context
Since clients consult the traditional healer, the faith healer, and the medical professional for the same problem, clients come to the psychiatric clinic with a variety of questions, beliefs, and conflicting explanations of their health situation. Behind this, however, lies human values and meaning to be realized and fulfilled by the clients and their families. Meaning, according to logotherapy, is a universal phenomenon lived and experienced by all human beings. And logotherapy assists clients to search for each Meaning of the Moment as a calling in a culturally appropriate way.
Each human being fulfills the Meaning of the Moment through the actualization of values such as love and attitude in the face of suffering and guilt. Frankl categorized the ways of discovering meaning into creative, experiential, and attitudinal values. The South African logotherapist, P. Coetzer, called these Avenues to Meaning; and I like to call them Pathways to Meaning, given our rural setting.
Reasons why I think logotherapy is appropriate and applicable in the rural African setting include the position that meaning is unconditional for each individual and each moment. As such, each client has a life of meaning regardless of his or her cultural context. The socio-cultural context is an environment within which clients live that provides them a medium for communication and ways of interacting with the world, but the beliefs and context of the clients do not take away the meaning or calling of each moment in their life.
Further, the logotherapy concept of Self-Transcendence (the human ability to move beyond oneself and reach out for other beings or causes) . resonates well with rural African culture as it fits particularly with the African cultural concept of Ubuntu, which means: “A person is a person through other persons.” This concept calls each human being to be aware always of other beings in the world and to reach out to other fellow human beings. Thus, logotherapy’s concept of Self-Transcendence readily fits rural Africans in the process of the search for meaning.
Healing in logotherapy is facilitated through the personal search for meaning, which is individual, unconditional, personal, and unique for each person. The process of facilitating healing through the search for meaning in logotherapy sees meaning from the client’s point of view. This important position means that clients should find and fulfill their own, personal Meaning of each Moment. This empowers clients who otherwise feel helpless and hopeless in a context of poverty, HIV/AIDS, and death. In my experience in a psychiatric clinic of a government district hospital in rural South Africa, clients can actively engage in the healing process within their objective reality where meaning as a calling is located.