An alternative point of view, reproduced from `Resister' magazine:
THE ABUSE OF PSYCHIATRY IN THE SADF
`I AM FIRST A SOLDIER
& THEN A PSYCHIATRIST'
In the late 1960s a new ward was created in the SADF's main military hospital at Voortrekkerhoogte near Pretoria. Ward 22 (later Ward 24) was set up ostensibly to cater for the needs of conscripts and members of the Permanent Force with psychological problems or disorders. The SADF's venture into psychiatry came at a time when the length of service was increasing and the size of the armed forces was expanding. Large groups of conscripts coming to terms with long periods of compulsory service and the experience of combat introduced new psychological problems into the military.
RESISTER has conducted a series of interviews with former notional servicemen who were either medical personnel or 'patients' in military psychiatric wards between 1 971 and July 1 985. It became clear that the practice of psychiatry in the SADF has been closely wedded to the preoccupation of the military authorities to eliminate patterns of behaviour which do not conform to SADF discipline and the apartheid war effort. Even conscripts who refused to be posted for active service or attempted to conscientiously object on grounds of their opposition to apartheid have been committed to the wards. Army psychologists have found their motivations incomprehensible and labelled them as potentially 'disturbed'.
An aside by a military psychologist to a serviceman in 1980 starkly illustrates the prevailing attitudes: 'I am first a soldier and then a psychiatrist'.
Few conscripts found an atmosphere which was supportive and conducive to working through their concerns. Most of the people we interviewed experienced their lime in the words as profoundly alienating and at times punitive. Phrases like 'It was the worst time of my life' and 'It is a period I want to put behind me', recurred in all their stories.
The procedure of admission to the wards, the composition of the patient population, their organisation along military lines, the attitude of the personnel working there and the types of treatment used, all included abuses of psychiatric and medical ethics.
A BRIEF HISTORY
The SADF's psychiatric units were largely the creation of Dr Aubrey Levine, whose career as a psychiatrist owed much to the SADF. He joined the army after qualifying for a medical degree and went on to study psychiatry on military bursaries. He worked under the supervision of Lt. General Cockcroft, the Surgeon General from 1969-1977. Upon his refirement Cockcroft become active in ultra-right organisations.
By the early 1970s Levine had been promoted to the rank of colonel and was chief military psychiatrist co-ordinating work in the army, navy and air force. Levine was solely responsible for the types of treatment used in Word 22. He was never accountable to a wider reference group of qualified personnel, and his approach could not have been cruder.
Levine was transferred at the end of the 1970s to Addington Hospital in Durban. In the same period Ward 22 was closed to be used as a physiotherapy unit for soldiers suffering limb injuries. Ward 24, further along the passage, was inaugurated as a new psychiatric centre.
The staff servicing the ward under Levine was small. He was assisted by only one part-time psychologist. Day to day supervision was carried out by medical students or interns doing their national service, and by medically untrained military orderlies. By the early 1980s the staff was larger. Colonel Weidemann co-ordinated services for the whole of the military, while Cdt. Potgieter was resident psychiatrist at Ward 24. Potgieter was assisted by a staff of trained clinical psychologists.
The organisation of the ward is along military lines. 'Patients' in 1985 were being subjected to military discipline. Regardless of their state of mind, they were forced to rise at five in the morning, make their beds and clean the wards in preparation for inspection at 6.30 a.m. Most of the patients regarded this as an extension of basic training. Until at least 1980 there was second inspection at 2 p.m., followed by a two-hour period of drilling in brown overalls. By1983, this appears to have been replaced by a compulsory game of volleyball.
Aside from the trained psychologists engaged in the treatment of the 'patients', none of the remaining personnel in 1985 were qualified. The daily running of the wards was entrusted to a ranking military officer, Captain Versluys. Failing under her were nurses - medical students and interns doing their military service - and orderlies seconded from the regular forces. Patients described Versluys as a 'fascist' who maintained a consistently hostile and unsympathetic attitude to her charges. Although she was trained as a psychiatrist in 1985, her main concern was the maintenance of discipline in the ward. She conducted inspections, turning out dustbins and upturning beds if she found anything out of place.
The orderlies were seconded from military units as part of their duties. Their attitudes varied - many were hostile, shouting orders at, and verbally abusing patients. Orderlies were armed with pistols at all times. One of the servicemen interviewed by RESISTER, who worked as an assistant to psychologists in 1983, said that there was continual tension between the qualified medical staff and military officers over the handling of patients in the wards, with the higher ranking military officials having considerable say.
Some of the patients found that the medical students on duty had little professional commitment to their work. They regarded it as part of their national service, to be got through as swiftly and painlessly as possible. In some cases this extended into a contempt for the `patients'.
A combination of these practices and attitudes was responsible for at least one death in Ward 22. It occurred in September 1980. The incident was related to RESISTER quite coincidentally, so it is possible that there may have been others.
A national servicemen was admitted to the ward, after having taken an overdose of disprins. Although his blood pressure was checked, no attempt was made to remove the poisons from his system. The following day he was forced to get up for inspection and, like the other patients, was not permitted to lie down during the daylight hours. Unable to stand, he was left out in the hospital garden for the day. He had fits of vomiting. In the evening his fellow patients informed the medic that his breathing had become abnormal. The medic took little notice and asked to be called only if there was a change in his condition. His breathing stopped at 2 a.m. There was no oxygen in the word and a qualified doctor called by the medic turned up an hour later. The other patients were instructed to keep silent about what they had seen.
National servicemen are admitted to Ward 24 on the advice of commanding officers, army doctors, social workers or chaplains. They appear before a panel of between seven and ten psychologists, whose object is to assess their case. In many cases patients experienced this process as an interrogation. The military authorities hold to the belief that servicemen try to get admitted to the ward to avoid basics or other commitments.
Three of the people we interviewed had been referred to the ward against their will for refusing to carry arms and for refusing transfer to an operational area.
Two were subjected to close questioning about their sexual habits and asked whether they used drugs, in the apparent belief that this would explain their opposition to the SADF's defence of apartheid.
One of the patients interviewed witnessed an incident in 1983 where a young serviceman was administered pethadine (a truth drug) to test if the explanations which he gave for his problems were true.
Once admitted to the wards patients' clothes are taken away from them. They are dressed in pyjamas and a dressing gown for the duration of their stay. These measures are taken partly to prevent 'patients' from escaping.
Bed space at Ward 22 and its successor Ward 24 has catered for around 40 patients. At any one time between 30 and 40 per cent of the occupants are - according to the definitions of the army - 'drug' users. The majority of these are dagga (marijuana) smokers. Another 10 - 15 per cent are gay. It is unlikely that in civilian life either category would find themselves in psychiatric care and their presence in the wards is solely a reflection of the SADF's attitudes.
The remaining patients (between 50 and 55 per cent) are more difficult to categorise. They include genuinely disturbed people (many of them fresh from traumatic combat experiences), alcoholics and people with clinical disorders. There have also been several conscripts who have vocally resisted aspects of military service - some for well-articulated political reasons - such as wearing uniforms or being sent to the border. They were referred to army doctors and social workers who took this as evidence of being disturbed.
Among this latter category there have also been several servicemen who went absent without leave (AWOL) and had been referred to the wards for observation. About 60 per cent of all the patients admitted to the wards are members of the Permanent Force - most of them with alcohol-related problems. Most of the PF members are over the age of 30 and have seen up to ten years of active service.
Different types of treatment have been applied to different categories of people. Some of the methodology has changed over time. More sophisticated methods of treatment have been introduced in the last ten years, reflecting greater concern about morale in the SADF.
30 per cent of the population in the words have been drug users, the single largest category. In 1985 the army conducted its own internal survey of what it defines as drug usage in its ranks. The findings, which were not made public, showed that 30 to 40 per cent of servicemen used drugs. Smoking dagga was most widespread, followed by the sniffing of various substances, such as ethyl nitrate, and the taking of various barbiturates and antidepressants. These included sodium seconal, valium and synthetic adrenalin. The latter substances were all obtained from army stores by medics who were involved in a brisk trade among the soldiers.
The findings show that although drug usage is widespread, strongly addictive and 'heavy' drugs do not appear among the substances used. It appears that servicemen use whatever is most easily obtainable. The most common reasons for the use of drugs are boredom and lock of morale.
A fair proportion of the people who land up in Ward 24 are therefore unlikely to have a serious drug problem. This becomes even more apparent when one looks at how most drug users came to be referred to the ward in the first place.
National servicemen caught smoking dagga, for example, are offered the alternative of referral to a civilian court for prosecution or a course of treatment in Ward 24. A sentence in court is added to the conscripts period of service, while a stint in Ward 22 is included as part of national service.
Currently drug users are allotted to sessions of group therapy for two to three weeks and are then returned to their units. They are subjected to surprise urine tests while in the Ward to monitor if they have been taking drugs illicitly.
In the 1970s and early 1980s habitual users - or people who were unfortunate enough to be caught more than once - were sent to Greefswald, a farm in the Northern Transvaal near the confluence of the Shashi and Limpopo Rivers on the Zimbabwe border. Greefswald was a project of Levine's. Conditions were particularly brutal. The idea was to isolate and keep the inmates perpetually on the move and through strenuous physical exercise exhaust them to keep their minds off drugs. The buildings and facilities at Greefswald were all constructed by the inmates themselves, as a form of hard labour. Every activity from rising to going to sleep at night was performed at the double, day in and day out, for several months at a time.
There was no resident psychiatrist at Greefswald. Levine used to visit the camp at monthly intervals. The farm was eventually closed as a rehabilitation camp and is now used as a launching pad for Special Forces Operations against Zimbabwe. Many of Greefswald's functions were taken over by a new work colony, Magaliesoord, in the Magaliesberg mountains, where military and civilian drug users were put to work in the fields. Magaliesoord, too, was closed in the mid 1980s. It is possible that the Klipdrift Personal Recovery Centre near Potchefstroom is now used for purposes of 'rehabilitation'.
If it was the objective of the wards and the work camps to curtail peoples' use of drugs, the projects must be regarded as failures. At Greefswald and at Magaliesoord many of the inmates were able to grow their own dagga in the surrounding fields and hills. In the wards, patients on medication tended to save their drugs and take them in single weekly doses or trade them with other soldiers.
The second largest group of people in the wards have been gays (10 to 15 per cent). No local surveys exist of South Africa's gay population. However, if the Statistics for European countries - where it is conservatively estimated that one in every ten males is gay - were applied to the white South African community, then at least ten per cent of the annual intake of conscripts - around 4 000 people a year - are entering an environment intensely hostile to the expression of their sexuality.
Gay men find themselves being admitted to the words in two main contexts: either because of trauma suffered as a result of victimisation by officers and fellow servicemen; or for refusing to be involved in the defence of apartheid. Only once confined to the ward was the sexuality of the latter group made into an issue by the resident psychologists. Under Levine's regime, homosexuality was regarded as an aberration and under his co-ordination gays were subjected to electroconvulsive aversion therapy - a practice which continued until at least 1978.
Aversion therapy involves the attempt to change a patient's behaviour patterns by imparting negative associations, such as pain or nausea, to them.
At Ward 22 electrodes were strapped to the arms of the subject. Wires leading from these were in turn connected to a machine operated by a dial calibrated from one to ten. The subject was then shown black and white pictures of a naked man and encouraged to fantasize.
While doing this the psychiatrist would gradually turn up the dial. The increase in the current would cause the muscles of the forearm to contract - an intensely painful sensation. When the subject was either screaming with pain or verbally requested that the dial be turned on, the current would be stopped and a colour Playboy centrefold substituted for the previous pictures. The psychiatrist (in most cases Levine) would then verbally describe the woman portrayed in glowing and positive terms. This process would be repeated three times in a single session. Sessions were held twice daily for three to four days. People subjected to this therapy experienced long periods of disorientation afterwards.
The servicemen subjected to this treatment had to agree to the therapy and their parents also had to give their consent, if they were under a certain age. But it is unlikely that many were able to make a rational choice. Most conscripts enter the army at the ages of between 1 8 and 24 when they are still coming to terms with their sexuality and it was easy for staff to manipulate their thinking. The decision to undergo therapy was always mode in an environment in which it was strongly stressed that homosexuality was an aberration. There was a total lack of anything approaching positive counselling. And given prevailing conservative attitudes few of the people who found themselves in this position could count ' on protection from their parents.
Aversion therapy has not been used medically in most countries for several years. In Britain it was stopped over thirty years ago. Its use has been confined mostly to military training programmes where professional units are trained to resist torture.
The application of aversion therapy in Ward 22 was a serious misuse of professional responsibility and a flagrant transgression of human rights.
None of the people interviewed who were Ward 24 in the 1980s had witnessed or heard about the use of aversion therapy. It is probable that it is no longer used. However, the shock machine was still kept in the stores in 1985.
Under current conditions the military continue to regard homosexuality as aberrant -behaviour and gays admitted to the ward are still expected to take part in group therapy.
'Conventional' shock therapy (applied to the temples of an unconscious patient) is still widely used to treat a range of clinical psychological disorders. According to a serviceman who was taken there in 1983, it was common for orderlies to threaten patients who refused to co-operate with this form of treatment.
Many of the people who found themselves on Words 22 and 24 were admitted after refusing to handle weapons, don uniforms or be transferred to operational areas. Expressing opposition to the SADF's role in upholding the apartheid system therefore carries with it the distinct risk of being characterised as disturbed by unscrupulous doctors or commanders.
All the patients affected in this way testified to a complete lack of comprehension on the part of the officers and many of the permanent medical staff as to the reasons for their refusal. One serviceman was fold that all he needed 'to sort him out' was a 'good stint on the border'.
The main method of treatment used in the wards in the 1980s has been group therapy, coupled with some occupational therapy and personal counselling. No attempt has been made in group therapy situations to separate people with similar problems. Everyone, irrespective of the severity of their condition or background, has been lumped together so that someone suffering trauma from a combat situation might be placed in the some group as a drug user. In some cases this has led to distressing confrontations. The group therapy sessions have been conducted in two languages, so that English speakers have had difficulty following Afrikaans and vice versa. No provisions for translating appear to have been made.
Patients with serious disorders have been heavily drugged for long periods of time. Medication and sedatives have been fairly freely dispensed among he patients. This has led to a feeling among some of the patients suffering from post-combat stress that it was more convenient for the staff to drug them than to confront their experiences.
All patients, irrespective of their problems, have been housed together. Many of the most unpleasant experiences of the men that we interviewed arose from incidents which occurred from being houses with severely disturbed patients.
There have been several instances of people having screaming fits or becoming violent at night and being physically suppressed by orderlies. Although there are special cubicles in the words for patients with serious disorders, these were not often used and were in any case within view and hearing of the other patients. On one occasion a psychopathic patient was held under 24 hour armed guard.
Unconscious or screaming patients could be brought in at all hours. People would be taken away for treatment and returned unconscious or heavily drugged without explanation to their colleagues. The atmosphere was tense and disturbing.
Over the fifteen year period we have surveyed, psychiatry in the SADF has never been geared to the patients individual and genuine needs. Rather it has been used to make servicemen conform to SADF notions of correct attitudes and behaviour. These are inextricably bound up with the defence of apartheid. At worst, the people confined there have been subjected to treatment constituting an abuse of accepted medical ethics and a danger to their sanity.
*The use of the term patient is merely technical and does not imply any acceptance of the SADF's criteria for the admission of individuals to their wards. The same applies to the term drug user.
RESISTER, magazine of the JOURNAL OF THE COMMITTEE ON SOUTH AFRICAN WAR RESISTANCE. DEC 1986 - JAN 1987, pp. Cover, 11 - 17.
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