Circumcision, manhood and psychosis: Testimonies of engendered suffering

Introduction

The homes of the majority of poor, largely isiXhosa-speaking families lie in what has become known as “the townships”; Gugulethu, Khayelitsha, Langa, Nyanga and are situated, just outside the city. These are made up of thousands of small ‘backyard shacks’ and houses; some painted brightly, others ramshackle makeshift huts of tin, wood, oddments that have been found. It is of concern to know that people live there but at the same time they are coloured with convivial, familial activity. The roads are dirt tracks in a gridded system overseen by towering streetlights — one single reminder of apartheid’s watchful eye — beaming down, not on one road but a cluster of houses.

(Field notes, 1991)

This landscape has underscored my anthropological fieldwork amongst the amaXhosa since 1991, and I intimately know how an apartheid machinery in visible, and invisible boundaries confined ‘Black African’ people to impoverished ‘reserves’. Yet, despite the end of apartheid in 1994, poverty and victimisation, from violent crime and alcohol abuse, continue to increase the risk of mental illness across South Africa (Havenaar et al, 2008; Williams et al., 2008). A realisation of the genuine cost to amaXhosa people’s mental health came about when I began research on circumcision practices in 1995 in the closed malewards in Valkenberg Hospital for the Mentally Unwell. I attended weekly ward rounds and examined all the clinical files of amaXhosa men to find those cases where their psychosis was associated with circumcision. Subsequently, I interviewed many in the hospital and a few in their township homes. My original monograph described five case histories where Xhosa men suffered from a psychiatric disorder within one year of their circumcision (Vivian, 2011). Two men, Xolile and Mpumi, experienced brief psychotic breakdowns and recovered well. The remaining three, Ayenda, Lindelo, and Unathi had been diagnosed with schizophrenia or bi-polar disorder and remained chronically mentally ill (Vivian, 2011). Interestingly, the symbols in their psychotic imagery were remarkably similar and correlated

Circumcision, manhood and psychosis 119 with those I had gathered in earlier interviews and case histories. Despite the disturbance of mental illness, these vividly and quite distinctively described this cultural, ritualistic engendering experience in circumcision.

Dr David Kibel, a consultant psychiatrist, first described this phenomenal link to me. It was while sitting in and listening on his clinical ward round that 1 heard the chaotic, cultural symbolic references manifest in these unique, psychotic disorders. In biomedical terms, men suffering a psychotic episode meant they had some genetic vulnerability for its onset. Its pathological effect had embedded extensive damage into their innate abilities, cognitive processes, and physical dispositions. In diverse ways, psychosis reversed the engendering of resilience in men’s circumcisions. The effect of a psychotic episode warped notions of masculinity and adversely shaped these men’s lives. In general, their families concurred with the psychiatrists’ diagnosis for it was they who had brought them to hospital. Sadly, parents described how they had believed their sons were resilient, found out otherwise and wept in dismay. I watched Xolile’s grandfather hang his head in sorrow and wring his hands in disbelief. Yet, it is in unravelling how amaXhosa concepts of the liminal and metaphysical worked through these men’s lives, that an alternative perspective on psychosis opens up and this suggests that, in working through this, there is an opportunity for psychological and personal growth.

The substance with which I grapple in these Xhosa men’s stories is subliminated psychotic image and how this symbolic content can be linked, meaningfully and metaphysically, to their circumcisions. Despite the negative inferences associated with psychosis, I argue that, in an amaXhosa worldview, this connection was potentially productive of resilience. Symbolically, these narratives reveal a profound, elemental orthodox practice, in which women and men engage in reciprocity relations to circumcise youth. This happens in families across this cultural community where, quite simply, mothers and fathers advise their sons on their choosing to go, or not. I focus, though, on those vulnerable youth who suffered psychotic breakdowns. Diverse reasons lay behind their tragic circumstances; for example, sons had their circumcisions deferred but these never happened; anxiety then triggered their psychotic breakdowns. Other Xhosa men described feeling ambivalent about their gendered or sexual orientation and were either never taken or were pushed into circumcision. This is an insufficient explanation, because as Ntozini & Ngqangweni (2016) argue, older men choose youth more inclined towards being heterosexual. In contrast, were youth who went to circumcision, became Xhosa men, but were later diagnosed as being mentally ill. These were the majority in my interviews. Surprisingly, there were no cases on the psychiatric wards where men had disfigured, dysfunctional penises because of the circumcision cut.

In discussing a connection between circumcision and psychosis from a broad perspective, I explore patients’ intimate circumstances in their amaXhosa communities. I interrogate how mental illness arises in an interleaving of culture, circumcision practices, and poverty (Patel et al., 2005; Naidoo, 2013).

isiXhosa idioms of distress thereby incorporated and reflected a poverty of despair in this urban landscape (Havenaar et al., 2008). Idioms alluded to community doubt about whether circumcision was safe and if officials held to structure and function in the practice (Vincent, 2008b). While the Xhosa men I interviewed on the ward, who had presented with flamboyant psychoses received clinical care, predictably those suffering with chronic mental illness in these communities often did not. The Comaroffs’ (1987) Tswana “madman" is a case in point. They describe him as a bizarre character, who without proper care and medication suffered from the long-term effects of psychiatric disorder. His psychotic ramblings and disarray of artefacts revealed the latent symbols of his subliminal unconscious and how, a once culturally framed worldview had become his disordered world. My narratives describe the same desperation, illustrating the devastating consequences of mental illness in men’s homes.

These stories show amaXhosa life to be a rich tapestry. Whether Xhosa men were debilitated with mental illness, flamboyantly psychotic or, once again, strong, silent autochthons, they are as entrancing as the Tswana “madman’s”. Like his, these narratives elucidate how fragile resilience is; engendered in the rite of passage, it can become brokenness in manhood, but can also manifest as an ability to battle the demonic in psychosis (Vivian, 2011). My observations of this quality of broken masculinity gave me deeper insight into the metaphysical and enculturated dynamism in engendering. For instance, brokenness manifested in men who, suffering with psychosis, did not distinguish between the liminal in seclusion and their psychosis on the psychiatric ward. Their descriptions were vivid with the emblems in seclusion and this provided me with a window of insight into what they were going through. In addition, I learnt how ‘other’ Xhosa people understood and treated those suffering with mental illness; this contrasted with an unconditional acceptance of the newly circumcised. Thereby a link, between psychosis and circumcision, revealed the subliminal nature of the immensely complex and nuanced layers of culturally instantiated engendered meanings. I have portrayed this in the themes that draw on many men’s narratives firstly, by describing men whose psychotic breakdowns came before circumcision and secondly, those where this happened after their event. These circumstances were distinctively different because the second describes men’s psychotic phenomenon but the first in isiXhosa terminology stays a discourse on youth. I elaborate on this by discussing the peculiar, very particular, cultural events that so often triggered men’s psychosis and refer to related distinctive, pervasive symbolic images.