I first learned of plans for South Africa's first international psychoanalytic conference in the fall of 1996, shortly after beginning my psychoanalytic training in Seattle. I saw an announcement unobtrusively stuck to a bulletin board at Weskoppies Hospital, a psychiatric facility in Pretoria, South Africa.
At the time, I was part of an American Psychiatric Association delegation of visiting psychiatrists seeking to strengthen connections between psychiatry in post-apartheid South Africa and in America. Most of what I had seen was institutional, biological psychiatry. However, I had been privileged to meet with one of South Africa's Truth and Reconciliation Commissioners and found myself very curious about applications of psychoanalytic work in a beautiful country deeply traumatized by racial and political terrorism, oppression, and hatred. From the moment I saw the flyer, I felt a strong desire to return to South Africa to attend the conference. I intuitively felt that it would be important in the evolution of my identity as a community psychiatrist and psychoanalyst.
I had not anticipated the enriching company of Kimberlyn Leary and Paula Christian-Kliger, both candidates in Michigan. The chance to share the conference, Cape Town, and intense conversation into the small hours of the morning with two other black women with backgrounds and professional interests strikingly similar to my own was a rare treat. Collectively, I believe, we were able to experience and consider a great deal more than we might have done individually. The conference offered a great deal to experience and to process.
The conference, held in April 1998, was an event representative of many current tensions: between expatriates trained abroad and South Africans who stayed at home during apartheid, between psychoanalysts and analytically oriented psychotherapists, between analysis in the consulting room and analytic ideas applied in larger communities, between differing ideas of analytic authority, between Western and African cultures, between black and white.
Conference chair Fakhry Davids, a South African analyst of South Asian descent living in London and deputy chair of the South African Psychoanalysis Trust, gave the opening remarks. The trust, which co-sponsored the conference along with the International Psychoanalytical Association, aims to foster further development of psychoanalysis and psychoanalytic psychotherapy in South Africa. Davids introduced the opening speaker, South Africa's Director-General for Education, N. Chabani Manganyi, who spoke of the value of psychoanalytic thinking for the further development of education and sociopolitical life in the new South Africa.
As the conference unfolded, we heard about psychoanalytic ideas in many contexts. Richard J. Goldstone, justice of the Constitutional Court of South Africa and former chief prosecutor of the United Nations International Criminal Tribunals for the former Yugoslavia and Rwanda, spoke about the relevance of justice to victims of human rights abuses in situations where there are too many victims and too many perpetrators for an organized judiciary system to handle. In such situations, public recognition by society of what happened has been important to the delivery of justice and to a movement toward social reconciliation.
In two and a half years, South Africa's Truth and Reconciliation Commission has shed light on the deeds of thousands of people over the course of 34 years. For individual victims, public testimony about their experiences has brought psychological relief. Goldstone urged that psychoanalysts become involved in talking about the impact of these abuses on victims and on society and in helping the victims. Discussants from the audience elaborated that the commission has clothed facts with emotion, enabling an existential connection between victims, perpetrators, and the citizenry at large. Thus the commission acknowledges that all are “on the same map” and that all are victims. Psychoanalysts can and must write about the consequences of apartheid, which will continue in this and in future generations.
Irma Brenman Pick, a former South African and current president of the British Psycho-Analytical Society, presented the case of a middle-aged woman with an inability to love who sees her analyst's understanding as criticism.
Jennifer Johns (also from Britain), chair of the Winnicott Trust, formally discussed the case from the perspectives of Winnicott and Fair-bairn. Audience discussion addressed the metaphoric relevance of the case to South Africa, where one group may project unwanted parts of its collective self into the other group, fearing to know the other group and believing that the other does not want to know it.
The breadth of the conference was expressed in the 31 parallel presentations, which occurred over the course of three days. These presentations included such topics as preventive perinatal therapy, psychoanalysis and culture, stress-related disorders in black university students, application of psychoanalytic thinking to psychiatric practice, countertransference in the study of South African psychiatric institutions, positive countertransference as trap or tool in working with an adult patient, psychodynamic outreach work with traumatized township communities, and the symptom of “itchy eyes” as a defense in African children living in a violent community.
Lillian Nomathemba Cingo, an African nurse and psychological counselor trained in London, presented her work as manager of Transnet-Phelophepa, the world's first health care train. Transnet provides free or low-cost health care to thousands of rural South Africans. Services include counseling and psychological services through workshops with school and communities and referrals to local professionals. Health care providers come from many racial, social, and educational backgrounds and live and work together on the train, which operates for eight and a half months each year.
Sandra C. Walker, M.D., is the 1998–99 president of the Clinical and Academic Associates Organization of the Seattle Institute for Psychoanalysis, co-chair of The American's Committee on Public Information, and a member of the board of the American Psychoanalytic Foundation.
In a parallel session on the Truth Commission, Pumla Gobodo-Madikizela, a doctoral candidate in psychology at the University of Cape Town, talked about her interviews with Eugene DeKock, who is now serving two life sentences in prison for crimes, including murders, committed during apartheid. She described herself as unable to understand DeKock as solely an evil person. Rather, she found in him a split in personality that allowed him to experience remorse for his political crimes as well as anger at the African National Congress, whom he continues to see as the enemy. In interviewing DeKock, she discovered a countertransferential split in herself, more easily recognizing in DeKock those emotions she was able to recognize in herself, but possibly failing in conscious recognition of emotions she would find unbearable.
In discussing Gobodo-Madikizela's presentation, Marcus Johns, deputy director of the London Clinic of Psychoanalysis, identified a number of possible characteristics of perpetrators, including a high degree of shame and anal organization of the personality, which enables the perpetrator to experience the victim as “shit” and to evacuate his own shameful feelings in perverse, sadistic acts against the victim.
Melvin Glasser, Director of the London Clinic of Psychoanalysis, introduced similar concepts in a plenary presentation on psychoanalytic understanding of crime. In his view, apartheid as a social and political system has affected the development of the superego of South African children. Children who identify with a terrifying authority figure are likely to develop a brutal, proscriptive superego and a prescriptive superego beset with shame. In this way, a repressive regime can foster rather than prevent crime, as weak and helpless aspects of the self are identified with victims who have to be punished.
Tensions underlying the conference began to emerge early. South African participants expressed their frustration and dismay that plenary chairs from Britain seemed to favor participants whom they knew, primarily participants from Britain, when calling on people wishing to comment from the floor. When South African participants spoke from the floor, their comments were often quite pointed. In a plenary session entitled “Is Child Analysis Really Psychoanalysis?”, Anne-Marie Sandler, former director of the Anna Freud Centre in London, spoke about the differences between child and adult analysis, and the IPA's Latin America Vice President, Sara Zac de Filc, contributed her thoughts about analysis of adolescents. One audience participant responded, “Don't give us a bottle when we are ready for solids.”
His comment seemed to address the feeling of a number of South African participants that, in the absence of highly organized analytic institutions, therapists in their country had managed to organize effective study groups and had developed more than an elementary familiarity with analytic thinking. A black African analyst trained in Europe expressed the wish that he had had a child analysis because his white female analyst and the adult analytic setting had not allowed the expression of “the child in me.” A third audience participant declared, with some feeling, that “the child analytic movement is alive and well in Cape Town.” A fourth said of the question posed in the plenary, “Is child analysis really analysis?”—“Who cares? The question is what we can do to make a difference here.” Sandler responded that she had not had the courage not to present the paper that she had been asked to present. Zac de File said that had she been more aware of the sentiments and tone of the conference, she would have presented a paper on her work with “disappeared” parents and children in South America or the impacts of bombings on Jewish schoolchildren.
On the closing day of the conference, David Sachs, the IPA's Associate Secretary for North America, prefaced his paper “The Path to Tolerance” by saying that this was the first psychoanalytic conference he had attended that enacted the psychoanalytic process and also viewed psychoanalysis as a kind of colonialism. He challenged conventional notions of tolerance as good and intolerance as bad by noting that tolerance can be masochistic and that intolerance can sometimes carry with it a measure of social approbation, as in having an intolerance for smoking. He noted that intolerance seems to result from a wish to escape danger and that changing intolerance to tolerance requires an ability to tolerate feelings of unsafeness. Tolerance cannot neutralize intolerance, and tolerant people may have to give up some feelings of possessing the moral high ground in order to combat intolerance, he said.
At this point in Sachs' presentation, a female African academic psychiatrist stood up in the audience and announced, “This is intolerable. It makes me anxious. It is too cerebral. I must leave,” and departed, leaving the audience somewhat stunned. Later, in a closing session, which became a kind of “debriefing” for the conference as a whole, she was able to amplify her need, in her own life and in her work, to reconcile her intellectual experiences in the European world with her more affectively alive African experience. She had been the person who, at the conference party the night before, had stood up to urge us all to listen to the “African blues” performed by Sylvia Mdunyelwa, who sang of African women going from prison to prison in search of their husbands detained during apartheid. In focusing attention on the music, the psychiatrist had seemed to invite the audience to participate in an African experience, and many in the audience seemed to respond by getting up to dance.
Like a well-functioning analysis, the conference seemed to be able to contain these currents of conflict emerging to consciousness and to allow participants room to explore the multiple meanings in what came to the surface. This kind of fully engaged participation made this conference the most stimulating — on many levels of psychic organization — that I have experienced. I hope to return to South Africa in the future, as my own professional identity continues to evolve, so as to experience more of the evolution of psychoanalysis in this very fertile environment.