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Mental Health Matters Journal for Psychiatrists & GP's

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Literacy is a luxury that many of us take for granted.  We depend on written communication for information, guidance, and access to heath care information That is why SADAG created SPEAKING BOOKS and revolutionized the way information is delivered to low literacy communities. It's exactly what it sounds like.a book that talks to the reader in his or her local  language, delivering critical information in an interactive, and educational way.

The customizable 16-page book, accompanied by local celebrity audio recordings, ensures that vital health and social messages can be seen, heard, read and understood..

We started with books on Teen Suicide prevention , HIV, AIDS and Depression, Understanding Mental Health and have developed over 30 titles, such as TB, Malaria, Polio, Vaccines for over 30 countries.

suicide speaking book

The incidence of rape in South Africa has reached pandemic proportions. Despite all the social reforms and banding together of non-state organisations and the hard-line the legal system is taking against rape, the numbers per year are not decreasing. With 400 rapes a day, along with the mass of other violent crimes, we are a traumatised nation. It is estimated that approximately 70% of the people living in Soweto are suffering from PTSD.

In 1986, South Africa already had the highest rape figures in the western world. By 1994, this figure had increased, and about 300 000 women were being raped a year, which is about 400 rapes a day. In 1990/1, the Central Statistical Service Report indicated there had been 9 057 prosecutions for rape, for which only 4 661 had resulted in convictions. There is thus a huge discrepancy between those rapes occurring and those being prosecuted. This is explained by the fact that so few women actually report the rape, to avoid the pain and humiliation associated with exposing themselves to an insensitive society.

According to studies done in South Africa, the majority of victims fall into the 16 - 19 age group and they are female. Most victims are raped by acquaintances. The studies reported that the most common place for a rape to occur was in the victim's own house. Second was the rapist's home, then in a deserted public area, and then in a car.

South Africa is a country of diversity – a melting pot of cultures and ethnic groups. Each of these cultures has their own view of women and of sexuality. The black South African population makes up a majority, and in many cases there is still a fairly strong tie to the traditional gender roles. Most black cultures are patriarchal, in the sense that women are still the 'property' of their husbands / boyfriends etc. This attitude toward women is clearly shown in a study done by Soul City where we see men defining the strict moral codes, which young girls have to understand and live by. Soul City found that a contributory factor to the rape statistics is the belief that, once aroused, a man cannot control his sexual urges and is henceforth not responsible for his actions. In fact, rape is blamed almost entirely on the dress code of young girls who "ask for it" if they wear tight clothing. We are living in what is commonly known as a 'rape-supportive culture', where the blame for the rape is diverted away from the rapist and shifted to the victim.

A reason for this 'blaming of the victims', that is particularly relevant to South Africa, has also been explained by social psychologists as occurring as a result of fear and a form of denial that occurs in people. It is easier for them to believe that the victim did something to "bring it upon herself", rather that to believe she was entirely innocent and that the attack was entirely unwarranted. This would mean that they too are in danger and that there is nothing they can do to protect themselves from a similar fate. In a sense it is a coping mechanism, which allows people in South Africa to justify to themselves living here, and that their personal safety is not really in direct jeopardy. But it is also dangerous, especially in South Africa with its high crime rate, as it breeds complacency. People are not aware enough or alert enough to prevent these incidents, and also there is little support offered to the numerous victims. They have to live with the stigma of the rape as well as the direct trauma as a result of it.

Rape Trauma Syndrome is a specialized form of Post-Traumatic Stress Disorder, which is considered a normal reaction to abnormal stress. RTS can manifest in various ways. There are physical, behavioural and psychological symptoms to be considered. Rape victims may experience various combinations of these or none at all.

The physical symptoms of RTS include:

Ø Shock immediately after the rape which may manifest as feeling cold, faint, mentally confused (disoriented), trembling, feeling nauseous and sometimes vomiting.

Ø She may suffer from gynaecological problems like: irregular, painful periods, vaginal discharges, bladder infections, sexually transmitted diseases like syphilis, gonorrhea, and AIDS.

Ø A survivor may experience a soreness of the body, bleeding or infections from tears or cuts in the vagina or rectum, depending on what happened during the rape.

Ø A survivor may suffer from irritation and soreness of the throat due to forced oral sex.

Ø Tension headaches, pain in the lower back and the stomach are common, as are sleep disturbances, which include under- and oversleeping.

Ø Eating disturbances are also common - gaining or losing weight.

The behavioural symptoms include:

Ø Crying more often.

Ø Difficulty concentrating.

Ø Difficulty relaxing - feeling restless and agitated or moving very little.

Ø Socializing less or more than usual.

Ø Not wanting to be left alone.

Ø Stuttering or stammering more than usual.

Ø Avoiding things that remind them of the rape.

Ø Not wanting to talk about it for fear of reliving the trauma.

Ø Being easily frightened or startled.

Ø Being hypervigilant.

Ø Getting upset at minor things that didn't bother them before the rape.

Ø Losing interest in things that used to interest them.

Ø Problems in relationships - due to irritability or withdrawal from people.

Ø May become overly independent or dependent.

Ø May experience sexual problems - loss of interest, fear of sex, or loss of sexual pleasure.

Ø May stop working or show less commitment to their job.

Ø May begin abusing substances.

Ø Increased washing or bathing.

Ø May try to carry on their lives as if nothing has happened.

The emotional or psychological symptoms include:

Ø Having intrusive thoughts and feelings about the rape - known as obsessional thoughts.

Ø May experience flashbacks - sudden feelings that the rape is happening again.

Ø May develop phobias towards things that remind them of the rape.

Ø Many develop extreme fears of men.

Ø Some experience a loss of memory for all or part of the rape - called psychogenic amnesia.

Ø Some may be unable to experience feelings like happiness and may feel very flat.

Ø Others feel emotionally confused and have rapid mood swings.

Ø Some feel anxious, irritable, angry or fearful.

Ø Some may entertain thoughts of suicide.

Ø They often feel humiliated and shamed.

Ø Feelings of guilt and self-blame are common, as they are often made to believe they are somehow responsible for the rape.

Ø Many feel powerless and lose their self-respect and self-confidence.

Rape survivors tend to experience different symptoms over time. After the initial shock experienced in the first few days, some survivors try to act as if nothing has happened. They think if they let themselves remember what happened to them, they won't cope. This is known as denial or pseudo-adjustment. The effects of rape are long-term. The person will never forget being raped, but if the person is allowed to remember what happened to them in their own time, and slowly learns to cope with the feelings, they can learn to deal with the trauma. Rape survivors who had a strong self-esteem before the rape, who have good relationships with people, and who had few major life changes before the rape tend to recover more quickly from the effects of rape.

It needs to be made very clear that all victims of this crime will experience the rape differently. Culture, class, religion, sexual orientation and attribution styles are examples of the different characteristics that could influence how the person feels about being raped. Their symptoms will also depend on the type and amount of support they receive from their friends, families and communities.

If you know anyone who has been raped or have been raped yourself, contact the Depression and Anxiety Support Group, Monday to Friday, between 8am and 7pm, and on Saturdays from 8am to 5pm, for telephone counselling and referrals to appropriate mental health professionals and support groups, on (011) 783-1474/6.


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