Vitalio Angula
GLOBALLY, trauma is under-rated, under-recognised and therefore under-treated.
Trauma can be defined as a deeply distressing and/or disturbing experience. These experiences can include but are not limited to a one-time event such as a car accident or the loss of a child which may lead to acute trauma and repeated and prolonged events such as domestic violence or sexual abuse which can lead to chronic trauma and complex trauma which are defined as the exposure to varied and multiple traumatic events often of an invasive, inter-personal nature.
Recognising the symptoms of trauma enables one to seek treatment which can be helpful in the healing process and ultimately recovery. Although there are schools of thought that acknowledge that one cannot be cured of trauma, there is a consensus among health practitioners that trauma counselling and treatment can help a patient live a whole, balanced, and healthy life whereby the trauma experienced no longer hinders personal growth and development. Eye-movement Desensitisation Reprocessing (EMDR) is the World Health Organisation’s (WHO) most recommended treatment for post-traumatic stress disorder (PTSD).
PTSD is a mental health disorder that manifests itself through several symptoms which include intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional reactions.
American psychologist, Dr Francine Shapiro discovered a link between eye movement and negative emotions.
“In 1987, Francine Shapiro was walking in a park when she realised that eye movements appeared to decrease the negative emotion associated with her own distressing memories. She assumed that eye movements had a desensitising effect, and when she experimented with this she found that others had the same response to eye movements.
It became apparent, however, that eye movements by themselves did not create comprehensive therapeutic effects so Shapiro added other treatment elements including a cognitive component and developed a standard procedure that she called eye movement desensitisation (EMD)”.
A Namibian-based psychologist, who is one of two EMDR specialists in the country that uses cognitive behaviour therapy (CBT), EMDR, as a treatment for trauma says although EMDR is a proven treatment for trauma it does not work for everyone.
“It can take up to 12 sessions for a patient with complex trauma and fewer sessions for patients with chronic and acute trauma,” she said.
“Because we come from a relatively disturbing history of violence like apartheid, these experiences have become part of our genetic memory. Epigenetics or rather genetic memory is the study of the trauma history we carry in our genes. It has been discovered in descendants of the survivors of Auschwitz, that even though they did not experience the horrors of the Nazi concentration camps directly, those negative emotions and experiences were passed on from generation to generation,” she explained.
Asked whether the OvaHerero of Namibia who had not experienced the 1904-1908 genocide actually carry the genetic history of the events that transpired in their genes, the psychologist said it is very likely that they do. She gave an example of the Afrikaners of South Africa who experienced collective trauma and ethnic humiliation at the hands of the British as a group that suffers collective and individual trauma which has been passed on from generation to generation.
“Globally trauma is under-rated, under-recognised and therefore under-treated and in post-apartheid Namibia unfortunately many people have undiagnosed and untreated PTSD,” she said.
“This is not only a result of our history but our country has a relatively high rate of crime, unemployment, substance abuse and domestic violence, which can lead to poor health outcomes such as PTSD which when left untreated can have a detrimental effect on the individual”, she suggested.
Namibia was found to have the fourth highest suicide rate on the continent; factors that contribute to this high suicide rate include high unemployment and substance abuse Deputy Minister of Health and Social Services, Esther Muinjangue, revealed at a Life Line International Forum held in the capital in June. The deputy minister, stated in an interview, that lack of access to mental health treatment leads to poor health outcomes for the country’s citizens. The psychologist agrees with the deputy minister's assertion and added that mental health treatment is inaccessible to most Namibians largely due to cost and the price patients have to pay for treatment.
“Medical aid funds misunderstand mental health disorders and even though they are covered by medical aid they are limited to an amount of sessions which are not enough for complete treatment. Unlike a broken arm which can be fixed and the patient heals and does not require further treatment, dealing with the brain is a much more complex, expensive and intensive undertaking,” the psychologist emphasised.
Medical aid consultant, Gabriel Emvula, however, disagrees with the psychologist’s assertion that medical aid funds misunderstand the intricacies of mental health treatment and lay the burden on the cost element of providing medical care to mental health patients.
“You should understand that medical aids are businesses, and unlike the government medical aid which is a scheme, private medical aids are driven by the need to make a profit to ensure sustainability, so from a commercial standpoint, one can understand why patients will only be limited to a certain amount of therapy visits in a given financial year,” Emvula explained.
Globally, trauma is under-rated, under-diagnosed and therefore under-treated. The same can be said in the context of Namibia where very few people have access to medical aid.
The government of South Africa recently legislated for the introduction of National Health Insurance for all its citizens. The benevolent gesture has its fair share of critics who question its practicality. The official opposition in South Africa, the Democratic Alliance (DA) warned that “the already over-burdened public health system would collapse if the Universal Health Coverage introduced in the country is implemented”.
Mental health is a critical component of holistic health and has gained traction in recent years as a priority area for global health outcomes.
The United Nations Sustainable Development Goal number three seeks to ensure healthy lives for all at all ages by reducing mortality from non-communicable diseases and promoting mental health. But this comes at a cost for governments and private health care providers alike.
These costs have made access to healthcare and especially access to mental health care inaccessible to a vast majority of Namibians even though healthcare is regarded as a human right, in Namibia like many African countries access to quality and affordable health care is a luxury that many cannot afford.
*Vitalio Angula is a socio-political commentator and independent columnist.
(NOTE: Psychologist prefers not to be mentioned by name for personal reasons.