Resonances of childhood and circumcision in symbolic image

The prevalence of culturally familiar symbols in men suffering from psychotic disorders showed how their cognitive ability had become phenomenally orientated back into the ethnic and linguistic nexus that was intrinsic to their natal development (Edwards, 2005). In a psychotic state, men’s minds were in dissolution and this made them unable to navigate either their cultural and home domains or diversity in the world. Ayenda, on admission to

Circumcision, manhood and psychosis 127 the psychiatric ward just under a year after his circumcision, suffered from the delusion that “he was a dog”. Two explanations have relevance; the first refers to this being a ritual slur in the rite of passage and the second to the childhood abuse, he endured when growing up in the Eastern Cape (Vivian, 2011). Ayenda, disregarding secrecy, told me:

Circumcision ... afraid sometimes ... dreamt in school. I am a dog. One (blanket) that I got before I went home from the bush, from when I was leaving, and the father brings you another blanket to cover yourself when you go home and you keep that blanket for the rest of your life.

(Vivian, 2011, p. 141)

His tangential reply spoke to his confused state of mind, yet had symbolic logic in its representation of the status of boys and women; blankets as emblems of protection, the place of the father as a representative of the patriarchy and a distinctive memory of leaving the liminality of seclusion behind him. Whilst Ayenda’s memories of these symbolic representations were distinctive to his ritual process, they were out of context in the psychiatric ward. Quite distinctively, Ayenda’s disturbance brought the symbolic references in circumcision out of their metaphysical boundaries to manifest as hallucinatory and delusional experience in the psychiatric ward as “matter out of place” (Douglas, 1966, 1970). On many similar occasions in the clinic, this was representational of the distinctive psychotic emblems that marked Xhosa men’s cognitive disintegration.

Inner voices that inappropriately overwhelm

A disintegration in bodily and cognitive integrity during psychotic episodes manifests when people speak of “hearing voices” when no one or any sound system is present. Hearing internal voices that are not audible to others is a significant indicator of psychiatric disorders and essential in diagnostic criteria (Robertson, Allwood, & Gagiano, 2001; Katana & Robertson, 2005). In my study, when a man described “hearing voices”, I took these to stand as an explanation of the phenomenal in his life, the nature of his suffering, and his history as situational and cultural (Edwards, 2005). That said, although no one else could hear the voices they described, these phenomenally intruded amaXhosa patients’ contorted states of mind into that clinical space. As these took reality or manifested as symptoms of psychotic behaviour, for the clinical team the “voices" became an indicator of what had happened to the man. Frequently, the onset of “hearing voices” marked their gradual psychological disintegration and how circumcision had influenced this.

Men suffering from psychotic episodes related to circumcision described that when they listened for these “ voices”, they went away, or “they were scared by them”. Sadly, they did what their voices told them to do: in the worstcase scenarios, men stabbed people or slept with strange women. One Xhosaman described hearing a voice when he was talking, but it differed in volume and “he felt he was going mad”. Another put his suffering this way, “I know I am sick and that I hear voices, I think nothing but what I think is not what you want to hear”. “Voices” were about paranoia and leading men to imagine “holes in their head” or that “their mothers or police wanted to kill them”. These distorted reality in their homes and led to strife and conflict in their communities. Culturally circumscribed “voices” included those of healers and amaXhosa diviners, both benign and malevolent. These culturally notable figures became an essential part of men’s psychotic realms, urging those suffering to perform ritual slaughter or wear protective amulets. Amongst African autochthons, the incorporation of healers into delusional content forms part of a local isiXhosa lexicon around mental illness. This colloquially frames those perceived to be “mad" within this worldview (MacGregor, 2000). One psychiatrist used to say that beneath “the voices” and delusional psychotic content was a man’s unique, innate character. This held his propensity for resilient behaviour, but also aggression, violence, fear, and sexual promiscuity.

A threat to oneself and others

In this setting, the detention of a psychotic man required that psychiatrists could diagnostically prove that he was displaying abnormal, disordered behaviour and that his aggressive acts were not premeditated. Unequivocally, the threat of unpredictable violence, intrinsic to psychotic behaviour is hazardous for the sufferer and those drawn into its vortex. The communities of Xhosa patients were landscapes of erratic, impulsive violence. Some patients spoke of killing people; others were deceptively calm, non-confrontational, said they were unafraid, but then accused others of trying to poison them. Men would talk of violence matter-of-factly, then, a moment later, try to strangle a nearby patient. Sadly, stories of coming from circumcision and then running from people they could not see, being tied up, being beaten on the feet, or having scars were part of the discrimination and agony they endured. Others reacted violently because they believed they “were being bewitched” or were “affected by evil spirits”. Of peculiar noteworthiness was that all 75 men associated something that had happened in circumcision with their becoming ill, yet the circumcision ground was often safer than their day-to-day lives within their communities. In better circumstances, men complained about being mentally confused, afraid, and had suddenly lost all sense of themselves.

Dissolving cognitive kinship ties

The unravelling of a man’s cognition and disposition during psychotic episodes, inevitably mirrored his inability to remember and secure his family network and social relatedness. Most patients on admission to hospital struggled to recall the names of people in their family; this extended to any recall of their personal or familial history and where they lived. Against such poor recall of

Circumcision, manhood and psychosis 129 these day-to-day relationships and the mundane in daily life, the flamboyant symbols of circumcision stood out in stark contrast. This was extraordinary given that it was nested familial and community relations that had taken them for circumcision. In a clinical setting this begs the question of whether the patient does not want to remember family or is suffering from psychosis. Such conundrums warn of the disintegrating effect of psychotic disturbances on cognitive processes, loss of memory and a later deconstructing of social relatedness. In clinical practice, psychiatrists ask a person who is acutely psychotic to describe their home and with just one sentence, they find that the person’s description comes from their psychotic imagination. Inevitably, patients cannot describe the physicality surrounding them; instead they try to fabricate their internal delusions with words.

Death in symbolic image

Whilst psychotic images hide or misrepresent the truth, as in false claims of murder, it can also mask and distort reality. After listening to seemingly incoherent nonsense, I would find that this disguised the fact that a close Xhosa family member had died. The delusions acted as a protective shield for those who could not cope with the truth. Denying the death meant they sublimated their grief and instead the man worried that “incomplete rites of passage had been performed” for the deceased. Whilst the death of a close family member is a known, common stressor for the onset of mental illness, these Xhosa men differed in their cultural description of such traumatic memory. They appeared thwarted by the circumstances surrounding the death and were afraid for the journey of the ancestral spirit. This was because death must be contained in customary burial rites and practices but as they were detained in hospital, they could not participate. This has special relevance for circumcised men who must perform rituals for their patrilineal ancestors.