Encountering a biomedical patriarchy

As I walked the hospital wards with Dr Kibel, I found myself a stranger to the diverse social worlds inhabited by most South Africans. Meticulouslystructured by the rigorous racial divides of apartheid, this socio-cultural world had set in place, fixed but also false perceptions of bodily characteristics, gendered orientation, and ethnic difference. I came to realise that, inevitably, although an apartheid system had gone, it was not forgotten. Politically, it had been instantiated into the fabric of everything and most people who surrounded me. Indeed, in Valkenberg Hospital, importantly medical practices were involved in its institutionalisation.

I often felt that I was a lone British woman daring to discuss issues about manhood, which were uncomfortable - and taboo - in each of apartheid’s “Black”, “White”, “Coloured” or “Indian” racial groups. In contrast, in the psychiatric clinic I was confronted with the experiences of acutely psychotic abafana or new men and I determined to solve this ethical dilemma by conducting research in this field. Like other feminist ethnographers journeying into culturally bound issues of gender, sexuality, agency, and identity, I became fearful (McQueeney, 2013). Caught between patriarchies, I determined to focus not on the politics of this changing society but on how I perceived patriarchal relationships and each man’s agency (Strathern, 1972). Remembering my mentor Professor Kuper’s advice that, “Ethnography was the work of the anthropologist”, I chose to describe exactly how each Xhosa man perceived his manhood and, too, his psychotic illness. Pieced together these Xhosa stories drew a cultural and kinship map about engendering amongst them. Importantly, I tried not to presuppose a dominant gender group by inferring my own (intimate or political) gendered orientation and sexual preferences into theirs. Instead, I applied Strathern’s understanding of how women in patriarchies work into legal negotiations to secure their participation and protection. I sought out local mentorship from Dr Manton Hirst, Director of the Amathole Museum, knowing that he had a profound experience of the amaXhosa and had worked as a psychologist in a psychiatric hospital in the Eastern Cape, the rural home of the amaXhosa people (Amathole, 2016).

Inevitably, my ethnographic journey was about “the waiting time”, as ward rounds came regularly, phone calls interrupted other activities, and journeys to the psychiatric institution where I could enter at any time a privileged right (Mannay & Morgan, 2015). Irregularities in waiting for things to happen, infringed on my being able to immerse myself in one subject, i.e. circumcision and mental health within a bounded ethnographic field. This constantly caused me to question the anthropological authenticity of my research. My field of enquiry became my home. Added to this were significant limitations in language and transport difficulties, but also the health system had not trained health professionals to be culturally sensitive (London et al., 2002, Vivian et al., 2010). Whilst most autochthons spoke three languages, i.e. isiXhosa, Afrikaans and English, many doctors, like me, were monolingual or bilingual having Afrikaans. Regretfully, and said with shame because I had to work, lecture, and research in South Africa, a socio-economically less advantaged country, I never became fluent in isiXhosa. This challenged my psychological

Prologue 1 interpretation of psychotic symbols and, as few clinicians believed these had meaning, this remained unexplored. Yet, these culturally inscribed symbols, so clear in men’s accounts, persistently intruded into the heart of a very British, English-speaking academic institution. In comparison, my ethnographic approach was to remain, observe, and listen to a wealth of non-biomedical material. The pathology for me was an adjunct to these men’s narratives. Listening, in being non-participative, allowed me to embrace my feelings as a mature woman and mother and, being empathic, removed me from politics and idealism.

As Xhosa men’s hallucinatory images surfaced into reality, I became aware that my European notions of masculinity and femininity did not map onto an intricate, amaXhosa engendering process which embeds a deep sense of African being and morality (Ntombana, 2011). I determined to take an ethnographic journey into Xhosa men’s minds and out, into this body social, to understand their meaning of engendering processes and its link to mental illness. I came to interpret mental illness not as pathology but as an aspect of mind; a transitional state which many of us, especially those who are vulnerable, will encounter. In this book I understand psychotic illness as an aspect of people’s evolving, engendering natures; it is part of amaXhosa becoming as a person because, even when psychotic, these suffering men, like those who were resilient, engender the world. This considers that a person’s development and ability to change and mature in society is shaped by society; amongst the amaXhosa it is being wrought that brings resilience.