Beyond PTSD : a study of distress and subject positions in rural KwaZulu-Natal.
The PTSD model of trauma encapsulated in the DSM has been subject to numerous challenges concerning the model's appropriateness and applicability in the South African context. These challenges relate specifically to specific nature of the traumatic stressors produced by the discriminatory policies of the Apartheid regime and the levels of political violence that permeated the entire country, especially entire rural communities in the KwaZulu-Natal (KZN) province. This form of endemic and incessant violence that traumatised entire communities has surpassed the DSM -IVTR's conceptualisation of trauma. This research study aims to open up a space for exploring alternate ways of conceptualising distress in the South African landscape of endemic violence and incessant trauma. This study draws attention to how men and women living in rural KZN experience and construct the meanings of their distressing experiences using the cultural resources available to them. Focus groups were conducted with six groups of first language isiZulu speakers from rural communities across KZN. Focus groups included a youth group, a male leaders group, a women's group, a group of traditional healers, a community health workers group, and a feedback session group. The groups were conducted in isiZulu, recorded, transcribed, and translated into English. The transcripts were interpreted using discourse analytic theory, analysing discursive constructions of distress and the subject positions contained within them. It was found that experiences of distress were interpreted through the lens of a socio-cultural African worldview which differed from that assumed by Western psychology. This worldview shaped the conceptualisation of distress and determined specific coping strategies. Distress was interpreted as a breakdown in the organisational matrix of life that systematically increases people's vulnerability to a range of interwoven complex stressors endowed with social, cultural and political meaning. These stressors perpetuate a cycle of distress that situates men and women in diverse and predominantly disempowering subject positions, shaping distinct experiences of trauma.