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International Journal of HealthPromotion and EducationPublication details including instructions for authors andsubscription informationhttpwwwtandfonlinecomloirhpe20

Understanding the causes of traumathe Indigenous African perspectiveAluwani Nevhutalu a amp Pilot Mudhovozi ba Department of Heath Seshego Hospital Limpopo Province South Africab Department of Psychology University of Venda Private BagX5050 Thohoyandou 0970 South AfricaPublished online 02 Aug 2012

To cite this article Aluwani Nevhutalu amp Pilot Mudhovozi (2012) Understanding the causes oftrauma the Indigenous African perspective International Journal of Health Promotion andEducation 504 178-193 DOI 101080146352402012702509

To link to this article httpdxdoiorg101080146352402012702509

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Understanding the causes of trauma the IndigenousAfrican perspective

Aluwani Nevhutalua and Pilot Mudhovozib

aDepartment of Heath Seshego Hospital Limpopo Province South Africa bDepartment ofPsychology University of Venda Private Bag X5050 Thohoyandou 0970 South Africa

We investigated the African Belief System on explanation of the causes of traumaThe study was conducted in the rural communities of the Vhembe District in SouthAfrica Seventy-five participants (female frac14 55 male frac14 20 age range frac14 25ndash60 yearsmean age frac14 356 years ethnicity Black African) were conveniently selected for thestudy Focus groupdiscussionswere conductedwith the participantsDatawere analysedusing thematic content analysis The African Belief System gives various causal reasonsof trauma The causes range fromnatural towitchcraft and lsquomazhuluzhulursquo Other causesinclude rape road accidents house or business breaking murder domestic violence andancestral spirits Future study with a larger sample is recommended to increase thetransferability of the findings to people in similar situations

Keywords African Belief System trauma culture traditional healing

Introduction

The cultural framework will be discussed below within the ecological theory of

Bronfenbrenner Bronfenbrenner proposed an ecological systems model of lifelong

progressive accommodations individuals make to the changing environment in which they

develop (Eamon 2001) He conceptualised a model that is referred to as a lsquobio-ecological

paradigmrsquo This model rests on two main assumptions that can be investigated within a

processndashpersonndashcontextndashtime model First he assumes that human development occurs

through a process of progressively more complex reciprocal interactions or proximal

processes which includes human beings objects and symbols in an environment

Proximal processes occur between a parent and a child and within peer school learning

and recreational activities These are the mechanisms by which genetic potential for

effective psychological functioning is realised

Second the effectiveness of proximal processes is determined by the biopsychological

characteristics of an individual the immediate and distant environments in which

proximal processes occur and the outcome being examined (Eamon 2001) According to

Bronfenbrenner development occurs in a set of nested structures Developmental

outcomes are influenced by the interactions within the microsystems or the immediate

settings that contain the developing person The remaining structures are according to the

order of the distance of their influence on the developing individual they include

mesosystems (processes between two or more microsystems both contain the developing

person) exosystems (processes between two or more settings) macrosystems (influences

of a broader culture and socio-economic environments) and chronosystems (effects of

ISSN 1463-5240 printISSN 2164-9545 online

q 2012 Institute of Health Promotion and Education

httpdxdoiorg101080146352402012702509

httpwwwtandfonlinecom

Corresponding author Email pilotmudhovoziunivenacza

International Journal of Health Promotion and Education

Vol 50 No 4 July 2012 178ndash193

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4

consistency and change over life course) The structures of the ecological environment

serve as a framework for the explanation of the Africansrsquo belief system

The microsystem

The microsystem consists of the immediate environment such as onersquos home friends

relatives school and society Proximal processes operate either to facilitate or to impede

development In this study the microsystem represents the everyday practical social and

collective life of people in Africa In an African environment the broader existence is

mostly influenced by the macrosystem and mesosystem However some illnesses are

believed to originate in the microsystem (Eamon 2001)

In an African environment not all illnesses are believed to be caused by the wrath of

ancestors There is a belief that pollution (or ritual impurities are usually associated with

death the reproductive system and the violation of sexual prohibitions) and germs can also

cause certain illnesses in the traditional African village For example it is believed that the

violation of sexual prohibitions like sexual intercourse with a woman during

menstruation with a widow before she is cleansed or with a woman who has had an

abortion or miscarriage can lead to a variety of health problems However in this case the

wrath of ancestors is believed to cause illness but it is also believed that witches

sometimes use sexual intercourse to cause illness Besides this belief about witches and

ancestors as causes of illnesses Africans also believe that some diseases like colds

influenza malaria and so forth are germ-related (van Dyk 2001)

The mesosystem

Mesosystems integrate the interrelations between two or more microsystems each of

which contains the developing person In an African view the mesosystem is the

intermediate universe It functions as a no-manrsquos land since it is believed to take place

where evil spirits witches and sorcerers dwell It is also called the lsquostructured collective

imaginaryrsquo a system that is highly respected for giving rise to all good and bad fortune as

well as giving of form to peoplersquos desires fears anxieties and hope for success It is also

believed to regulate the day-to-day psychological fate of individual human beings in

Africa (van Dyk 2001)

Traditionally Africans do not believe in chance bad luck or fate rather they believe

that every illness has an intention and a specific cause and in order to combat the illness

the cause must be found counteracted uprooted or punished This belief propels them to

ask questions like lsquowhorsquo and lsquowhyrsquo They recognise both an immediate cause and an

ultimate cause for disease or misfortune (Foulks et al 1977) An example in this case may

be a case of a patient with HIV who may fully understand that she was infected by her

partner and this is the immediate cause of her illness Despite this understanding she will

ask lsquowhy me and not another personrsquo the only answer that will really satisfy the person is

that someone by means of magical manipulation may have caused her husband to infect

her (the ultimate cause of the illness)

This belief in the cause of the illness makes many Africans consult both traditional

healers and biochemical professionals for the same condition The traditional healer is

consulted to diagnose the personal cause of the condition (eg bewitchment) or to prevent

recurrence (eg by performing a ritual) However the western doctor is consulted for

medication to treat the condition symptomatically (Scholten 2012)

International Journal of Health Promotion and Education 179

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The exosystem

The exosystemconsists of connections and processes between twoormore settings but only

one contains the developing person The home and the community in general are examples

of common settings for individuals Events that occur in a community have consequences on

individuals in the home For example a community may believe in witchcraft to the extent

that every member of that community might be forced to contribute money for consulting a

traditional healer if the community suspects that there is a witch who is bewitching its

members Failure by particular family members to co-operate with other community

members may lead those individuals to be suspects of witchcraft Instances have occurred

whereby families were punished by being burnt to death beaten or expelled from that

community following suspicions of being witches (van Dyk 2001)

The macrosystem

The macrosystem is referred to as the cultural lsquoblueprintrsquo that partially determines social

structures and activities that occur in the more immediate system levels Components of

the macrosystem include material resources opportunity structures alternatives available

throughout the life course lifestyles customs shared knowledge and cultural beliefs

(Eamon 2001) In an African context the macrosystem is regarded as the highest universe

that consists of God the ancestors and the spirits of the chosen dead In this context God is

seen as a Supreme Being or Creator who has withdrawn himself from human beings

Ancestors are believed to preserve the honour and traditions of tribes and usually protect

people against evil and destructive forces They can also punish their people by sending

illness and misfortune if social norms are violated or when culturally prescribed practices

are neglected or incorrectly performed (Kazarian and Evans 1998)

There is a belief that when a human being is about to enter the real world he forms an

agreement with God that determines how long he will live his profession the number of

wives he will have the number of children etc Failure to abide with the plan leads to

illness The traditional healer then intervenes by consulting the spirit to find out if the

patient needs to change his life to bring it into concordance with the life plan worked out in

the spirit world (Ebigbo 1987) Furthermore it is believed that illness might be caused by

failure to perform a cultural and religious ritual However it is assumed that peaceful

living with onersquos neighbours observing social norms and living in harmony with onersquos

environment and with God spirits and ancestors are all essential to protect oneself and

onersquos family from disease (Ebigbo 1987)

The above discussion indicates that culture is a determining factor in peoplesrsquo lives

influencing both decisions and understanding of the illnesses The health belief model

outlines how the belief system influences the perception of causes and treatment of

diseases In this study it is used to outline how Africans make their choice of treatment

based on what they believe to be the cause of their illness The ecological theory indicates

how onersquos development and the context within which individuals live contribute to the

development of psychological problems which include post-traumatic stress disorder

(PTSD) The next section focuses on the cultural conceptualisation of trauma

Cultural contextualisation of trauma

The effects of culture permeate the entire field of mental health Culture of a particular

society governs the social norms and provides explanation of how people become

mentally ill how they should be treated using acceptable treatment options and of the

180 A Nevhutalu and P Mudhovozi

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interaction of the roles of a patient and a healer (Foulks et al 1977) In the process of

development people imbibe the culture that is around them In a general sense people

grow up thinking believing and behaving in ways that are found in their culture adhering

to rules and conforming to its practices

Culture is defined by Matsumoto as lsquoa set of attitudes values beliefs and behaviours

shared by a group of people but different for each individual communicated from one

generation to the nextrsquo (1996 p 16) According to Gopaul-McNicol and Brice-Baker

(1998 p 5) lsquoculture is a way of living that encompasses the customs traditions attitudes

and overall socialization in which a group of people engage that are unique (not deficient)

to their cultural upbringingrsquo

lsquoCulture includes patterns of behaviour customs values beliefs attitudes implicit

rules of conduct patterns of family social organization taboos and sanctions-all which are

commonly shared in a group of people that have a common identity based in ethnic and

sometimes territorial unityrsquo (De Silva in Yule 1999 p 48) In support of the above idea

Triandis (1994 p 19) holds that lsquoculture is multifaceted in that it includes patterns of

dress methods of getting food economic activities patterns of social interaction patterns

of child rearing ways to educate the young ways to make decisions beliefs and patterns

of communication (language gestures) and so onrsquo

Trauma and social context

Trauma can in many ways be defined by an individualrsquos socio-cultural background both

directly and indirectly through the beliefs and attitudes heshe has acquired or

internalised Traumas resulting from the likes of death or severe injury in the war front

may be seen as catastrophic by almost everyone Other forms of trauma-inducing events

may be open to cultural construction making the reaction of individuals to traumatic

experience become influenced by their societyrsquos view or norms around the event In some

cases individuals may be seen as martyrs or unfortunate victims or mere mercenaries

For example a rape victim who can be made to feel that it was hisher fault that heshe was

attacked and instead of sympathy receive blame and even vilification

During acute trauma the social environment tends to respond with generosity Every

society seems to have evolved social and religious structures that aim at helping the

acutely distressed people until they resume self-care To prevent and treat post-traumatic

stress there should be external validation about the reality of a traumatic experience in a

safe and supportive context When there is persistence of a victimrsquos helplessness or when

the meaning of the trauma is secret forbidden or unacceptable trauma results in the

mobilisation of external resources or restitution Because of lack of validation and support

traumatic memories are more likely to continue prey on the victimsrsquo minds and will likely

be expressed as anger withdrawal or disruptive behaviour

The personal meaning of traumatic experience for individuals is influenced by the

social context in which it occurs This means that victims and significant people in their

surroundings may have different and fluctuating assessments of both the reality of what

happened and of the extent of the victimsrsquo suffering Therefore victims and bystanders

may have conflicting agendas to repair create forget or take revenge If memories of

trauma remain unprocessed traumatised individuals tend to re-experience the frightening

feelings and perceptions belonging to the past When there are actual injuries physical

pain and suffering are usually neglected Various forms of treatment on many disorders

including trauma-related disorders use western and traditional forms of treatment and this

occurs in different contexts across different cultures

International Journal of Health Promotion and Education 181

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The use of traditional healing in African culture

Though the use of western medicine is well spread in Africa most Africans still believe in

traditional healing methods This might be partly due to Africansrsquo belief of the causes of

illnesses Though most Africans are aware that some illnesses have natural or organic

causes there is still an overriding belief in the supernatural or spiritual causation of illness

that leads to the use of mystical and spiritual remedies for cure Africans tend to show

dissatisfaction with the scientific medicine that they see as undermining the religious and

ancestral aspects of the problem Because of this belief individuals wear a guard receive

spiritual baths (herbal bath with holy water) and also have a priest or minister to bless the

home or throw salt around the house to protect themselves from these evil forces In this

way the client goes to a faith healer while concurrently seeking medical or psychological

help (Gopaul-McNicol and Brice-Baker 1998)

When Christianity was established missionaries preached spiritual salvation based

on their own experiences Africans were accepted into the church upon receiving

baptism and making an oral confession of faith in Jesus Christ For many Africans

Christianity was only adopted outwardly and did not inspire them spiritually According

to Waruta and Kinoti (1994) many Africans still maintain their traditional beliefs and

practices during important or critical stages in life (like birth initiation marriage

death incurable sickness and other anxieties in daily living) while upholding their piety

as bequeathed to them in the missionary enterprise Waruta and Kinoti (1994)

furthermore hold that any kind of medical treatment which is unrelated to the

supernatural and to the community has limited chances of success in Africa even if

half the patients profess to be Christians

In most African societies healing combines herbal medication psychotherapy and

religion In a study conducted by Madu et al (1999) 80 of all psychic andor somatic

illnesses are treated by traditional healers in Africa and only 20 of the cases are

examined by a doctor of western medicine He furthermore states that traditional healers

and religious faith healers handle most of the cases in Nigeria

In his study to investigate the attitudes and knowledge of physicians towards

traditional healing faith healing and alternative medicine Peltzer (2001) found that on

the one hand the so-called non-biological methods were seen as quackery by 305

physicians for alternative medicine 467 for faith healing and 495 for traditional

healing The above discussion clearly indicates that Africans believe in their traditional

way of treatment It also became evident that even those who are Christians still believe in

traditional treatment One may argue that imposing western form of treatment even for

illnesses that are of western origin might not be regarded as being effective

Africans are not the only ones who hold special values around causation and

management of diseases for example the Vietnamese a nation on which most PTSD

diagnosis and research work was done following the Vietnamese war they also hold

certain beliefs around illness They were reported to follow Confician ancestral worship

wherein interpersonal relationships are carefully regulated Highly valued Confician and

Buddhist beliefs urge followers to be shy passive and modest and advocate restraint from

displaying strong emotions in public Thus a family a fundamental social unit frequently

gets involved in health care decisions that are seldom left for an individual During

suffering and conflict pain and unhappiness are initially endured in silence and privacy

and are generally only shared with family members and close friends when conditions

worsen and persist Because self-control is a traditional value emotions are considered

weaknesses expressed only by inferior people From this discussion one may argue that

182 A Nevhutalu and P Mudhovozi

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culture is predominantly vital in shaping peoplersquos lives Even when people are

traumatised it is important to consider how different cultures view trauma and peoplersquos

reactions to it

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) and the

International Statistical Classification of Diseases (ICD-10) are said to contain a particular

way of diagnosis to the world One may argue that different cultural contexts make it not

realistic that the diagnosis can suit all cultures across the world Collins (2004) argues that

the DSM-IV and ICD-10 contain information that is western orientated Thus the

psychiatric categories that are used to understand measure and classify mental distress are

specific to western culture and society

According to van Dyk (2001) the local concepts of suffering misfortune and

illness have been ignored and undermined It is maintained that the contextual factors

are critical in influencing and shaping how traumatic events are experienced

responded to and explained The society or individuals use these contextual factors to

experience what is considered traumatic Contextual factors include the social

political and cultural realities in which people exist and utilise to make sense of what

happens to them

Thus the PTSD model is said to have some shortcomings that include the fact that it

focuses on the individual while downplaying the effects of trauma on family friends and

other people in the traumatised personrsquos social world It also fails to acknowledge that

whole communities can experience trauma on a collective basis (Collins 2004) However

there are traditional methods that are available for the treatment of mental disorders

despite the psychological intervention which is of western origin

Method

Research design

This was an exploratory study whereby a qualitative method using focus group discussion

for data collection was utilised Neuman (2000) argues that an exploratory study is a study

into an area that has not been fully researched Much is not yet researched about on how

Africans understand PTSD especially in the Limpopo Province

Participants

Ten focus groups with a total of 75 participants (female frac14 55 male frac14 20 age

range frac14 25ndash60 years mean age frac14 356 years ethnicity Black African) were drawn using

convenience sampling method Participants were drawn from people who were involved in

traumatic incidents that include road accidents murder rape domestic violence and

housebreaking The sample was drawn from the rural communities of the Vhembe District

Each group consisted of 6ndash10 members from different villages in Thulamela and

Makhado municipalities For the purpose of this study the direct victims of violence

as well as their family members and relatives were found relevant as they were involved

in trauma-inducing events either directly or indirectly

Convenience sampling was used in this study This kind of sampling refers to a

haphazard selection of cases that conveniently suite the purpose of the study An example

of convenience sampling is like the street interview conducted by television interviewers

(Neuman 2000) A researcher selects those participants who are usually the nearest and

most easily available (de Vos 1998)

International Journal of Health Promotion and Education 183

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Research instrument

Focus group discussion method is defined by Struwig and Stead (2001) as a carefully

planned discussion designed to obtain individualsrsquo perceptions on a defined area of interest

in a permissive non-threatening environment The discussions between the research

participants enable the participants to discuss issues they consider to be important In focus

groups the groups are generally composed of 7ndash10 people who are unfamiliar to one

another They should be selected because they share certain characteristics relevant to the

questions in the study (Marshall and Rossman 1999)

During the interview the interviewer creates a supportive environment asks

focused questions so as to encourage discussion and the expression of differing

opinions and points of view Questions start from the general and the non-threatening

and progress gradually to the specific and that which may be threatening Tricky

questions are asked to promote participantsrsquo expression of their views through the

creation of a supportive environment The interviewer should make participants feel

that their contributions are worthwhile and also that they are free to disagree with

each other The facilitator must be attentive and willing to listen Heshe must also

show an interest in what is being said encourage a wide range of opinions

assist participants to explore their ideas further avoid belittling participants and

direct the conversation when people become repetitive or move away from the topic

(Struwig and Stead 2001)

The rationale for using focus groups was that these groups share a common

characteristic of having been involved in traumatic incidents either directly or

indirectly This encouraged them to speak more freely without fear of being judged

by others It is believed that people often need to listen to other peoplersquos opinion and

understanding to form their own The focus group method relies on group discussion

and for the discussion to be successful participants must be able to talk to each other

about the topic of interest This method assumes that an individualrsquos attitudes and

beliefs do not form in a vacuum Focus group method was found relevant in this

study for its excellence in obtaining information from illiterate communities and as a

way of discovering attitudes and opinions which might not be revealed in a survey

questionnaire

Procedure

Telephonic requests were made with some known members of the Thulamela and

Makhado Municipalities to contact people who were involved in traumatic incidents

These people those who were requested to contact traumatised people were told about the

purpose of the focus groups and the confidentiality involved Members of civic structures

and pastors were among other people who helped to organise group members from the

mentioned communities Appointment dates were organised for each focus group and

discussions took place as arranged

Two sessions were held per week for each focus group Each session lasted for an

hour and a half Some sessions were conducted in churches and others were held at the

victimsrsquo homes The focus groups were conducted in Venda which is the mother tongue

of the participants and the researcher It was explained to the participants that the

sessions will be confidential Participantsrsquo consent was sought for the use of a tape

recorder to keep record of the sessions Tape-recorded information was transcribed

immediately after the sessions and later translated from Venda to English and back-

translated for validation purposes

184 A Nevhutalu and P Mudhovozi

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Trustworthiness

Marshall and Rossman (1999) maintain that research should respond to canons that are

regarded as criteria in which trustworthiness can be evaluated These canons are viewed by

Lincoln and Guba (in Marshall and Rossman 1999) as classical contribution to the

methodology of qualitative research They are credibility transferability dependability

and confirmability These four constructs establish the lsquotruth-valuersquo of a study The truth-

value refers to the applicability consistency and neutrability One may argue that

credibility transferability dependability and confirmability may be matched with internal

validity external validity reliability and objectivity which are appropriate for the

positivist paradigm and inappropriate for qualitative inquiry (Marshall and Rossman

1999) The four constructs that are appropriate for qualitative inquiry are discussed next

Credibility

In qualitative research credibility is maintained by an inquiry that ensures that the subject

is accurately identified and described (de Vos 1998) In this study continuous interaction

with participants through focus groups ensured that the subjects were accurately identified

and described

Transferability

Transferability refers to the applicability of one set of findings to another context (de Vos

1998) de Vos (1998) further argues that the demonstration of applicability of one set of

findings to another depends on the investigator who should make the transfer than the

original investigator Interestingly there are researchers who regard transferability as a

weakness in the approach To counter-challenge this idea the researcher can refer back to

the original theoretical framework to show how data collection and their analysis will be

guided by concepts and models (Marshall and Rossman 1999) In this study the findings

might be useful in clinical setting to help traumatised people That is the findings can be

used by helping professionals in South Africa considering the fact that the study is

conceptualised from the African cultural perspective

Dependability

Dependability is the third construct It refers to an attempt by the researcher to change

conditions in the phenomena chosen for the study This applies to the changes in the design

created by a refined understanding of the setting However qualitative researchers can

assert that qualitative research cannot be replicated because of the changing world They

plan to keep notes or log that record each design decision and the rationale behind it Their

procedures protocols and decisions can thus be inspected (de Vos 1998) In this study the

protocols procedures and decisions have been recorded All collected data are well

organised in a retrievable form and are easily available to challenge the notion of the

changing world

Confirmability

This is the last construct Lincoln and Guba (in Marshall and Rossman 1999) emphasise

the need to ask whether or not the findings of the study could be confirmed by another

International Journal of Health Promotion and Education 185

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Because of the fact that the sample of this study was small the findings are less

generalisable

Data analysis

Thematic content analysis was used to analyse the data Tapes were transcribed from

Venda (the language of the interviewees) to English and back-translated to Venda for

validation purposes The data were coded analysed through reading and re-reading of

responses The rationale for reading and re-reading is that the researcher becomes familiar

with that data in intimate ways People events and quotations sift constantly through the

researcherrsquos mind (Marshall and Rossman 1999) The data were then analysed into four

steps as follows

Step 1 Analysis of individual transcripts

This step involves reading individual transcripts in several different ways First transcripts

were read as a whole noting general impressions Major opinions and attitudes that were

expressed by the groups were considered When transcripts were read for the second time

specific things that were looked for which were mainly from the objectives of the study

were noted Sections that were poorly transcribed and did not make sense were removed

Transcripts were coded sectioned and marked in the way that indicated what the

participants talked about The final step in reading the transcripts involved using the list of

required information and checking what information has been obtained

Step 2 The logbook

The logbook was used to keep all the responses together according to the topic of interest

Each response was entered unless it was exactly the same as another The main aim was to

retain the full range of responses

Step 3 Writing the results

Results were not only written from the logbook but also from the notes that were made

while reading transcripts as a whole As many reported results from the focus groups did

not indicate how many focus groups or participants discussed a certain issue results will

say lsquomany respondents said rsquo or lsquoonly a few groups discussions raised the issue of rsquo

Step 4 Interpretation

Throughout the study the researchers were thinking about the significance of the

information that was collected in terms of the problem or question that they wanted to

answer and to develop ideas about what the respondents said Results were looked at and

summaries were written

Ethical considerations

Participants in this study were informed about the nature and purpose of the study

Complete information about the study was explained for participants to comprehend the

purpose of the study This was done in order for participants to make a voluntary decision

about their participation (de Vos 1998) Participants were informed that they will be

186 A Nevhutalu and P Mudhovozi

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involved in focus groups and the study is for educational purposes It was clearly indicated

that each focus group would last approximately 45ndash90 minutes The researcher also

explained to the participants that freedom is respected and as such they had to participate

voluntarily without any physical or psychological force

Furthermore they were informed that they would benefit from the focus groups as

they would share their traumatic experiences among themselves Confidentiality and

privacy was assured so that participants were safe from exposure (Denzin and Lincoln

1998) Information from focus groups was given anonymously to ensure the privacy of

subjects However participants were informed that a tape recorder will be used so that

participantsrsquo privacy cannot be affected if the tape recorder is used as a hidden

apparatus

Results

Figure 1 shows that most of the participants attributed the cause of trauma to witchcraft

(60) followed bymazhuzhulu (panic reaction to frightening thought or event) (20) and

the belief that it just happened (20)

Interview responses on culture-related causes of trauma

It emerged from the study that some participants believed that trauma was caused by

culturally related causes They cited devil possession witchcraft and ancestral spirits as

the major causes of trauma These are presented next

Devil possession

There are instances wherein people tend to attribute violence like rape and murder to devil

possession Whenever such incidents occur and they lack an explanation concerning the

act they believe that it is because concerned people are possessed by the devil According

to some respondents incidents like these where people commit such crime that lack

Figure 1 Perceived traumatic events

International Journal of Health Promotion and Education 187

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4

explanation were not common in the olden days Eight per cent of the participants

perceived devil possession as a cause of violence This was reflected in the following

quotes

As far as rape is concerned I really do not know what is in the minds of men because theyeven rape babies of less than a year old In some cases one may think this may be influencedby Satanism (RP 32)

The other cause is that children these days are used by the devil or is like they have evil spiritsor possessed since they just kill as an end in itself and do not indicate why they killed or atleast show some hidden motive of wanting to steal that personrsquos money (RP 74)

Witchcraft

Though many respondents realised that they were living in a violent environment where

violent incidents occurred in their lives 8 attributed the causes of its trauma to

witchcraft Their explanations of the occurrence of traumatic incidents tended to suite their

held beliefs For example the interpretation of mishaps or misfortunes that befell

individuals was believed to be caused by witchcraft The belief that witchcraft is the cause

of violent incidents is reflected in the following

I think mine is obvious that there could be somebody who is after me because a person cannothave a series of accidents one after the other In Venda if incidents are happening like thiswe start to suspect that someone is bewitching you (RP 22)

I also felt the same way about the cause of my sonrsquos death I have a very strong suspicion thathe was bewitched (RP 51)

You may find that one of the people who were in the truck was bewitched and now it hasaffected all of us (RP 62)

When we are praying there are others who are working for Satanism so I cannot rule out that itmight be due to demons or witchcraft (RP 74)

Ancestral spirits

Even though most respondents believed in witchcraft as a cause of traumatic events

some respondents believed in ancestral causes It was interesting to note that the belief

in the connection of trauma to ancestral power was mostly held by older respondents

They mentioned that their ancestors talk to them and sometimes tend to understand

why some traumatic incidents happen to them For others it was an honour when their

ancestors talked to them because they were helping them with the type of intervention

that they must use for their problem Another point is that respondents showed that

they obey their ancestors and their instructions so that even understanding why

some mishaps are happening in their lives was not a concern The following extracts

reflect this

One day my father visited me in my sleep and told me to consult a traditional healerI consulted a traditional healer who told me that I have lsquotshilisorsquo (meaning something thatsomeone gives you without your awareness which ends up like a poison in your body)(RP 33)

To tell you the truth I think this is a punishment from my father because the cattle that I saiddied on one night were not given to me alone I took them forcefully from my half brother whowas my fatherrsquos favourite child From that time nothing went on smoothly in my life I am justworried that it seems as if even my following generation will suffer like what I did as a way ofpaying for what I did wrong (RP 68)

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Other causes of trauma

The study also revealed that trauma was caused by non-cultural factors Some participants

attributed traumatic experiences to the abuse of substances intimate partner violence

rape robbery road accidents and murder These are presented next

Substance abuse

Twelve per cent of the participants indicated that trauma was caused by the abuse of

substances They believed that when young people are under the influence of drugs they

involve themselves in violent acts which then affect the community as a whole They are

usually involved in housebreaking murder and rape This is reflected in the following

responses

The main cause of all this trouble is drugs and alcohol that the youth are using In mostinstances they are always at the bars drinking alcohol and smoking drugs After that they gowherever and cause all this troubles (RP 6)

I think that when the youths are involved in drugs they end up being involved in things likehousebreaking (RP 14)

I think the other cause is that young people use drugs that influence them to commit crimessuch as housebreaking and rape (RP 36)

As far as road accidents are concerned I think people sometimes drive when they are drunk ordrive recklessly which may also contribute to traumatic incidents (RP 65)

Road accidents may be caused by reckless driving and driving when people are drunk (RP 67)

Intimate partner violence

Some participants showed that intimate partner violence occurs among people though

very few report the incidents In almost all focus groups in this study very few responses

emerged around intimate partner violence as a form of a traumatic event This probably

happened because most people seem to consider domestic violence to be a normal way of

life in a family or in the community This is also regarded as something that is not

supposed to be disclosed This was reflected as follows

The other thing that people do not talk about is domestic violence (RP 33)

Domestic violence is also common but it is complicated because many women do not talkabout it even when they are being abused all the time (RP 36)

if he drinks he beats kicks and insults using vulgar words I mean those deep Vendawords that my children are not supposed to hear as these I think also affect them This hasbecome part of our life in this family that we just told ourselves that we should accept it assuch (RP 40)

Rape

Rape was mentioned in almost all focus group discussions Participants were concerned

about the fact that rape happens to people of all ages including children and it also makes

them feel unsafe Rape brings about fear in peoplersquos lives In these focus groups 21

reported having been raped and even those who were not subjected to this type of violence

showed concern that they were afraid of this act This is reflected by the following extracts

It is true because it is not safe to walk long distances alone where there is a small bush from 6pm onwards If you walk there alone you are just inviting trouble (RP 11)

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Rape is something that we cannot leave out as it is becoming the order of the day (RP 32)

The common traumatic events in our area include rape and housebreaking Usually we do notfeel safe anymore when we are away We are always fearful that anything bad can happen atany time (RP 40)

Robbery

Robbery appeared to be contributing to a fearful environment for most participants They

felt that house and business breaking was traumatic The finding s supported by the

following statements

Housebreaking is threatening because you do not know what will happen after the personenters the house (RP 53)

Besides rape other common incidents include housebreaking and theft These days even if youare asleep you do not even know what will happen as thieves and criminals rob at night(RP 58)

The other thing which we see as a problem is theft even during the day This also includeshousebreaking which makes people not to feel safe (RP 70)

Road accidents

Another form of violence that emerged from the focus group discussions was road

accidents It appeared that road accidents created situations that became traumatic and

violent to many respondents Seventeen per cent of the participants reported incidences of

having been involved or affected in road accidents Like rape road accidents became a

concern for many respondents as in the following responses

Road accidents are very common Some victims of road accidents are school childrenSometimes these accidents happen in succession and it becomes very painful (RP 32)

Now that we are going for holidays you will hear a number of road accidents reported evenhere at our place The problem is that in some cases other people die and it is very painful forthe relatives who are left behind (RP 61)

Murder

Twelve per cent of the participants reported incidences of a family member or relative who

was murdered There was a general feeling of concern that people no longer have respect

for life The finding is supported by the following statements

Another problem around here is killings Mostly boys do this They kill each other like fliesSome people are killed by guns and some by knives (RP 7)

From the place where I come from incidences of shooting are escalating It is now becomingthe way of life where thieves may even shoot you when you are inside your house (RP 16)

Discussion

Most of the participants attributed the cause of trauma to witchcraft (60) followed by

mazhuzhulu (panic reaction to frightening thought or event) (20) The finding supports

the notion that peoplersquo understanding of trauma and its causes anchors on their

macrosystem the cultural lsquoblueprintrsquo that partially determines social structures and

activities that occur (Eamon 2001) In the present study the Venda-speaking participants

190 A Nevhutalu and P Mudhovozi

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conceptualised trauma and its causes from their cultural beliefs Also the finding is in line

with Foulks et alrsquos (1977) assertion that Africans do not believe in chance bad luck or

fate They believe that every illness has an intention and a specific cause Their culture

includes customs values beliefs attitudes implicit rules of conduct patterns of family

social organisation taboos and sanctions which they shared (Triandis 1994 De Silva in

Yule 1999) Nonetheless 20 of the participants indicated that the trauma just happened

This view might have been put forward by participants who do not subscribe to the

traditional explanation of witchraft and mazhuluzhulu Another plausible explanation is

that the 20 may account for Black Africans who embraced the individualistic western

cultural values

Therefore the microsystems (immediate setting) mesosystems (processes between

two or more microsystems) exosystems (processes between two or more settings)

macrosystems (influences of a broader culture and socio-economic environments) and

chronosystems (effects of consistency and change over life course) among the Venda-

speaking participants influenced their understanding of the causes of trauma (Eamon

2001) Thus these structures of the ecological environment served as a framework for the

explanation of the Africansrsquo belief system among the Venda-speaking participants It is

therefore not surprising that most of them (60) attributed trauma to witchcraft

The above finding is in line with the notion that for many Africans Christianity was

only adopted outwardly and did not inspire them spiritually According to Waruta and

Kinoti (1994) many Africans still maintain their traditional beliefs and practices during

important or critical stages in life (like birth initiation marriage death incurable sickness

and other anxieties in daily living) while upholding their piety as bequeathed to them in the

missionary enterprise Waruta and Kinoti (1994) furthermore hold that any kind of

medical treatment which is unrelated to the supernatural and to the community has

limited chances of success in Africa even if half the patients profess to be Christians

Contrary to the above the western-oriented PTSD model fails to account for the cultural

pluralistic experience of trauma (Collins 2004)

Some participants cited devil possession and ancestral spirits as the major causes of

trauma The responses reflect the influence of the mesosystem on individual members The

mesosystem integrates the interrelations between two or more microsystems each of

which contains the developing person In an African view the mesosystem is the

intermediate universe It functions as a no-manrsquos land since it is believed to take place

where evil spirits witches and sorcerers dwell It is also called the lsquostructured collective

imaginaryrsquo a system that is highly respected for giving rise to all good and bad fortune as

well as giving of form to peoplersquos desires fears anxieties and hope for success It is also

believed to regulate the day-to-day psychological fate of individual human beings in

Africa (van Dyk 2001)

Contrary to expectation the study did lend support the notion that in an African

environment there is a belief that ritual impurities are usually associated with death the

reproductive system and the violation of sexual prohibitions (van Dyk 2001) It had been

argued that the violation of sexual prohibitions like sexual intercourse with a woman

during menstruation with a widow before she is cleansed or with a woman who has had

an abortion or miscarriage can lead to a variety of health problems However in this case

the wrath of ancestors is believed to cause illness but it is also believed that witches

sometimes use sexual intercourse to cause illness Besides this belief about witches and

ancestors as causes of illnesses (van Dyk 2001) events that occur in a community have

consequences on individuals in the home For example a community may believe in

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witchcraft Failure by particular family members to co-operate with other community

members may lead those individuals to be suspects of witchcraft (van Dyk 2001)

The above finding is compatible with Kazarian and Evansrsquos (1998) assertion that the

ancestors can punish their people by sending illness and misfortune if social norms are

violated or when culturally prescribed practices are neglected or incorrectly performed

The illness might be caused by failure to perform a cultural and religious ritual

Nevertheless it is assumed that peaceful living with onersquos neighbours observing social

norms and living in harmony with onersquos environment and with God spirits and ancestors

are all essential to protect oneself and onersquos family from disease (Ebigbo 1987)

It emerged from the study that trauma also results from non-cultural causes Some

participants attributed traumatic experiences to the abuse of substances intimate partner

violence rape robbery road accidents and murder This finding is in line with Gopaul-

McNicol and Brice-Bakerrsquos (1998) argument that the majority of Africans acknowledge

that some illnesses have natural or organic causes In the same vein Eamon (2001) opines

that certain illnesses are originated in the microsystem The microsystem consists of the

immediate environment such as onersquos home friends relatives school and society In this

study the microsystem represents the everyday practical social and collective life of

people in Africa (van Dyk 2001)

Conclusion

The DSM-IV-TR and the ICD-10 explain the western understanding of the causes of

trauma (Collins 2004) However the given explanations do not suit the traditional African

concept of trauma The psychiatric categories that are used to understand measure and

classify mental distress are specific to western culture and society They ignore and

undermine the African concepts of suffering misfortune and illness Africansrsquo

conceptualisation of trauma and its causes is influenced by several contextual factors

Contextual factors include their social political and cultural realities To a larger extent

the Venda-speaking participants attributed trauma to witchcraft angry ancestral spirits and

devil possession The study concludes that culture is a determining factor in peoplesrsquo lives

influencing both decisions and understanding of the illnesses

Limitations of the study

This study has some limitations All the participants were drawn from the Venda-speaking

ethnic group The study is short of the voices of the Tsonga Pedi Afrikaans and English-

speaking people in the Limpopo Province Considering the qualitative nature of the

present study the findings are not generalisable

References

Collins A 2004 Trauma in context advanced reader Durban University of Kwazulu NatalDenzin NK and Lincoln YS eds 1998 Collecting and interpreting qualitative materials

London Sagevan Dyk A 2001 Traditional African beliefs and customs Implications for AIDS education and

prevention in Africa South African Journal of Psychology 31 60ndash66Eamon MK 2001 The effects of poverty on childrenrsquos socioemotional development an ecological

systems analysis Social Work 46 256ndash266Ebigbo PE 1987 The mind body and society an African perspective International Journal for

the Advancement of Health 3 (4) 45ndash57Foulks EF et al 1977 Current perspectives in cultural psychiatry New York Spectrum

192 A Nevhutalu and P Mudhovozi

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4

Gopaul-McNicol S and Brice-Baker J 1998 Cross-cultural practice assessment treatment andtraining Canada Wiley

Kazarian SS and Evans DR 1998 Cultural clinical psychology theory research and practiceOxford Oxford University Press

Madu SN Baguma P and Pritz A 1999 Traditional healersrsquo approach to the schizophreniaFrankfurt IKO Verlag

Marshall C and Rossman GB 1999 Designing qualitative research 3rd ed New Delhi SageMatsumoto D 1996 Culture and psychology Pacific Grove CA BrooksColeNeuman WL 2000 Social research methods qualitative and quantitative approaches 4th ed

Boston MA Allyn amp BaconPeltzer K 2001 Exposure to violence and posttraumatic stress disorder in a rural adult population

in South Africa Acta Academica 32 73ndash84Struwig FW and Stead GB 2001 Planning designing and reporting research Pinelands

Cape Town Maskew Miller LongmanScholten A 2012 Bradycardia (Bradyarrythmia) [online] Available from httpcvimednyueduTriandis HC 1994 Culture and social behaviour New York McGraw-Hillde Vos AS ed 1998 Research at grassroots a prime for the caring professions Pretoria

Van SchaikWaruta DW and Kinoti HW 1994 Pastoral care in African Christianity essays in pastoral

theology Nairobi ActonYule W 1999 Post-traumatic stress disorders concepts and therapy Chichester Willey

International Journal of Health Promotion and Education 193

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4

The exosystem

The exosystemconsists of connections and processes between twoormore settings but only

one contains the developing person The home and the community in general are examples

of common settings for individuals Events that occur in a community have consequences on

individuals in the home For example a community may believe in witchcraft to the extent

that every member of that community might be forced to contribute money for consulting a

traditional healer if the community suspects that there is a witch who is bewitching its

members Failure by particular family members to co-operate with other community

members may lead those individuals to be suspects of witchcraft Instances have occurred

whereby families were punished by being burnt to death beaten or expelled from that

community following suspicions of being witches (van Dyk 2001)

The macrosystem

The macrosystem is referred to as the cultural lsquoblueprintrsquo that partially determines social

structures and activities that occur in the more immediate system levels Components of

the macrosystem include material resources opportunity structures alternatives available

throughout the life course lifestyles customs shared knowledge and cultural beliefs

(Eamon 2001) In an African context the macrosystem is regarded as the highest universe

that consists of God the ancestors and the spirits of the chosen dead In this context God is

seen as a Supreme Being or Creator who has withdrawn himself from human beings

Ancestors are believed to preserve the honour and traditions of tribes and usually protect

people against evil and destructive forces They can also punish their people by sending

illness and misfortune if social norms are violated or when culturally prescribed practices

are neglected or incorrectly performed (Kazarian and Evans 1998)

There is a belief that when a human being is about to enter the real world he forms an

agreement with God that determines how long he will live his profession the number of

wives he will have the number of children etc Failure to abide with the plan leads to

illness The traditional healer then intervenes by consulting the spirit to find out if the

patient needs to change his life to bring it into concordance with the life plan worked out in

the spirit world (Ebigbo 1987) Furthermore it is believed that illness might be caused by

failure to perform a cultural and religious ritual However it is assumed that peaceful

living with onersquos neighbours observing social norms and living in harmony with onersquos

environment and with God spirits and ancestors are all essential to protect oneself and

onersquos family from disease (Ebigbo 1987)

The above discussion indicates that culture is a determining factor in peoplesrsquo lives

influencing both decisions and understanding of the illnesses The health belief model

outlines how the belief system influences the perception of causes and treatment of

diseases In this study it is used to outline how Africans make their choice of treatment

based on what they believe to be the cause of their illness The ecological theory indicates

how onersquos development and the context within which individuals live contribute to the

development of psychological problems which include post-traumatic stress disorder

(PTSD) The next section focuses on the cultural conceptualisation of trauma

Cultural contextualisation of trauma

The effects of culture permeate the entire field of mental health Culture of a particular

society governs the social norms and provides explanation of how people become

mentally ill how they should be treated using acceptable treatment options and of the

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interaction of the roles of a patient and a healer (Foulks et al 1977) In the process of

development people imbibe the culture that is around them In a general sense people

grow up thinking believing and behaving in ways that are found in their culture adhering

to rules and conforming to its practices

Culture is defined by Matsumoto as lsquoa set of attitudes values beliefs and behaviours

shared by a group of people but different for each individual communicated from one

generation to the nextrsquo (1996 p 16) According to Gopaul-McNicol and Brice-Baker

(1998 p 5) lsquoculture is a way of living that encompasses the customs traditions attitudes

and overall socialization in which a group of people engage that are unique (not deficient)

to their cultural upbringingrsquo

lsquoCulture includes patterns of behaviour customs values beliefs attitudes implicit

rules of conduct patterns of family social organization taboos and sanctions-all which are

commonly shared in a group of people that have a common identity based in ethnic and

sometimes territorial unityrsquo (De Silva in Yule 1999 p 48) In support of the above idea

Triandis (1994 p 19) holds that lsquoculture is multifaceted in that it includes patterns of

dress methods of getting food economic activities patterns of social interaction patterns

of child rearing ways to educate the young ways to make decisions beliefs and patterns

of communication (language gestures) and so onrsquo

Trauma and social context

Trauma can in many ways be defined by an individualrsquos socio-cultural background both

directly and indirectly through the beliefs and attitudes heshe has acquired or

internalised Traumas resulting from the likes of death or severe injury in the war front

may be seen as catastrophic by almost everyone Other forms of trauma-inducing events

may be open to cultural construction making the reaction of individuals to traumatic

experience become influenced by their societyrsquos view or norms around the event In some

cases individuals may be seen as martyrs or unfortunate victims or mere mercenaries

For example a rape victim who can be made to feel that it was hisher fault that heshe was

attacked and instead of sympathy receive blame and even vilification

During acute trauma the social environment tends to respond with generosity Every

society seems to have evolved social and religious structures that aim at helping the

acutely distressed people until they resume self-care To prevent and treat post-traumatic

stress there should be external validation about the reality of a traumatic experience in a

safe and supportive context When there is persistence of a victimrsquos helplessness or when

the meaning of the trauma is secret forbidden or unacceptable trauma results in the

mobilisation of external resources or restitution Because of lack of validation and support

traumatic memories are more likely to continue prey on the victimsrsquo minds and will likely

be expressed as anger withdrawal or disruptive behaviour

The personal meaning of traumatic experience for individuals is influenced by the

social context in which it occurs This means that victims and significant people in their

surroundings may have different and fluctuating assessments of both the reality of what

happened and of the extent of the victimsrsquo suffering Therefore victims and bystanders

may have conflicting agendas to repair create forget or take revenge If memories of

trauma remain unprocessed traumatised individuals tend to re-experience the frightening

feelings and perceptions belonging to the past When there are actual injuries physical

pain and suffering are usually neglected Various forms of treatment on many disorders

including trauma-related disorders use western and traditional forms of treatment and this

occurs in different contexts across different cultures

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The use of traditional healing in African culture

Though the use of western medicine is well spread in Africa most Africans still believe in

traditional healing methods This might be partly due to Africansrsquo belief of the causes of

illnesses Though most Africans are aware that some illnesses have natural or organic

causes there is still an overriding belief in the supernatural or spiritual causation of illness

that leads to the use of mystical and spiritual remedies for cure Africans tend to show

dissatisfaction with the scientific medicine that they see as undermining the religious and

ancestral aspects of the problem Because of this belief individuals wear a guard receive

spiritual baths (herbal bath with holy water) and also have a priest or minister to bless the

home or throw salt around the house to protect themselves from these evil forces In this

way the client goes to a faith healer while concurrently seeking medical or psychological

help (Gopaul-McNicol and Brice-Baker 1998)

When Christianity was established missionaries preached spiritual salvation based

on their own experiences Africans were accepted into the church upon receiving

baptism and making an oral confession of faith in Jesus Christ For many Africans

Christianity was only adopted outwardly and did not inspire them spiritually According

to Waruta and Kinoti (1994) many Africans still maintain their traditional beliefs and

practices during important or critical stages in life (like birth initiation marriage

death incurable sickness and other anxieties in daily living) while upholding their piety

as bequeathed to them in the missionary enterprise Waruta and Kinoti (1994)

furthermore hold that any kind of medical treatment which is unrelated to the

supernatural and to the community has limited chances of success in Africa even if

half the patients profess to be Christians

In most African societies healing combines herbal medication psychotherapy and

religion In a study conducted by Madu et al (1999) 80 of all psychic andor somatic

illnesses are treated by traditional healers in Africa and only 20 of the cases are

examined by a doctor of western medicine He furthermore states that traditional healers

and religious faith healers handle most of the cases in Nigeria

In his study to investigate the attitudes and knowledge of physicians towards

traditional healing faith healing and alternative medicine Peltzer (2001) found that on

the one hand the so-called non-biological methods were seen as quackery by 305

physicians for alternative medicine 467 for faith healing and 495 for traditional

healing The above discussion clearly indicates that Africans believe in their traditional

way of treatment It also became evident that even those who are Christians still believe in

traditional treatment One may argue that imposing western form of treatment even for

illnesses that are of western origin might not be regarded as being effective

Africans are not the only ones who hold special values around causation and

management of diseases for example the Vietnamese a nation on which most PTSD

diagnosis and research work was done following the Vietnamese war they also hold

certain beliefs around illness They were reported to follow Confician ancestral worship

wherein interpersonal relationships are carefully regulated Highly valued Confician and

Buddhist beliefs urge followers to be shy passive and modest and advocate restraint from

displaying strong emotions in public Thus a family a fundamental social unit frequently

gets involved in health care decisions that are seldom left for an individual During

suffering and conflict pain and unhappiness are initially endured in silence and privacy

and are generally only shared with family members and close friends when conditions

worsen and persist Because self-control is a traditional value emotions are considered

weaknesses expressed only by inferior people From this discussion one may argue that

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culture is predominantly vital in shaping peoplersquos lives Even when people are

traumatised it is important to consider how different cultures view trauma and peoplersquos

reactions to it

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) and the

International Statistical Classification of Diseases (ICD-10) are said to contain a particular

way of diagnosis to the world One may argue that different cultural contexts make it not

realistic that the diagnosis can suit all cultures across the world Collins (2004) argues that

the DSM-IV and ICD-10 contain information that is western orientated Thus the

psychiatric categories that are used to understand measure and classify mental distress are

specific to western culture and society

According to van Dyk (2001) the local concepts of suffering misfortune and

illness have been ignored and undermined It is maintained that the contextual factors

are critical in influencing and shaping how traumatic events are experienced

responded to and explained The society or individuals use these contextual factors to

experience what is considered traumatic Contextual factors include the social

political and cultural realities in which people exist and utilise to make sense of what

happens to them

Thus the PTSD model is said to have some shortcomings that include the fact that it

focuses on the individual while downplaying the effects of trauma on family friends and

other people in the traumatised personrsquos social world It also fails to acknowledge that

whole communities can experience trauma on a collective basis (Collins 2004) However

there are traditional methods that are available for the treatment of mental disorders

despite the psychological intervention which is of western origin

Method

Research design

This was an exploratory study whereby a qualitative method using focus group discussion

for data collection was utilised Neuman (2000) argues that an exploratory study is a study

into an area that has not been fully researched Much is not yet researched about on how

Africans understand PTSD especially in the Limpopo Province

Participants

Ten focus groups with a total of 75 participants (female frac14 55 male frac14 20 age

range frac14 25ndash60 years mean age frac14 356 years ethnicity Black African) were drawn using

convenience sampling method Participants were drawn from people who were involved in

traumatic incidents that include road accidents murder rape domestic violence and

housebreaking The sample was drawn from the rural communities of the Vhembe District

Each group consisted of 6ndash10 members from different villages in Thulamela and

Makhado municipalities For the purpose of this study the direct victims of violence

as well as their family members and relatives were found relevant as they were involved

in trauma-inducing events either directly or indirectly

Convenience sampling was used in this study This kind of sampling refers to a

haphazard selection of cases that conveniently suite the purpose of the study An example

of convenience sampling is like the street interview conducted by television interviewers

(Neuman 2000) A researcher selects those participants who are usually the nearest and

most easily available (de Vos 1998)

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Research instrument

Focus group discussion method is defined by Struwig and Stead (2001) as a carefully

planned discussion designed to obtain individualsrsquo perceptions on a defined area of interest

in a permissive non-threatening environment The discussions between the research

participants enable the participants to discuss issues they consider to be important In focus

groups the groups are generally composed of 7ndash10 people who are unfamiliar to one

another They should be selected because they share certain characteristics relevant to the

questions in the study (Marshall and Rossman 1999)

During the interview the interviewer creates a supportive environment asks

focused questions so as to encourage discussion and the expression of differing

opinions and points of view Questions start from the general and the non-threatening

and progress gradually to the specific and that which may be threatening Tricky

questions are asked to promote participantsrsquo expression of their views through the

creation of a supportive environment The interviewer should make participants feel

that their contributions are worthwhile and also that they are free to disagree with

each other The facilitator must be attentive and willing to listen Heshe must also

show an interest in what is being said encourage a wide range of opinions

assist participants to explore their ideas further avoid belittling participants and

direct the conversation when people become repetitive or move away from the topic

(Struwig and Stead 2001)

The rationale for using focus groups was that these groups share a common

characteristic of having been involved in traumatic incidents either directly or

indirectly This encouraged them to speak more freely without fear of being judged

by others It is believed that people often need to listen to other peoplersquos opinion and

understanding to form their own The focus group method relies on group discussion

and for the discussion to be successful participants must be able to talk to each other

about the topic of interest This method assumes that an individualrsquos attitudes and

beliefs do not form in a vacuum Focus group method was found relevant in this

study for its excellence in obtaining information from illiterate communities and as a

way of discovering attitudes and opinions which might not be revealed in a survey

questionnaire

Procedure

Telephonic requests were made with some known members of the Thulamela and

Makhado Municipalities to contact people who were involved in traumatic incidents

These people those who were requested to contact traumatised people were told about the

purpose of the focus groups and the confidentiality involved Members of civic structures

and pastors were among other people who helped to organise group members from the

mentioned communities Appointment dates were organised for each focus group and

discussions took place as arranged

Two sessions were held per week for each focus group Each session lasted for an

hour and a half Some sessions were conducted in churches and others were held at the

victimsrsquo homes The focus groups were conducted in Venda which is the mother tongue

of the participants and the researcher It was explained to the participants that the

sessions will be confidential Participantsrsquo consent was sought for the use of a tape

recorder to keep record of the sessions Tape-recorded information was transcribed

immediately after the sessions and later translated from Venda to English and back-

translated for validation purposes

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Trustworthiness

Marshall and Rossman (1999) maintain that research should respond to canons that are

regarded as criteria in which trustworthiness can be evaluated These canons are viewed by

Lincoln and Guba (in Marshall and Rossman 1999) as classical contribution to the

methodology of qualitative research They are credibility transferability dependability

and confirmability These four constructs establish the lsquotruth-valuersquo of a study The truth-

value refers to the applicability consistency and neutrability One may argue that

credibility transferability dependability and confirmability may be matched with internal

validity external validity reliability and objectivity which are appropriate for the

positivist paradigm and inappropriate for qualitative inquiry (Marshall and Rossman

1999) The four constructs that are appropriate for qualitative inquiry are discussed next

Credibility

In qualitative research credibility is maintained by an inquiry that ensures that the subject

is accurately identified and described (de Vos 1998) In this study continuous interaction

with participants through focus groups ensured that the subjects were accurately identified

and described

Transferability

Transferability refers to the applicability of one set of findings to another context (de Vos

1998) de Vos (1998) further argues that the demonstration of applicability of one set of

findings to another depends on the investigator who should make the transfer than the

original investigator Interestingly there are researchers who regard transferability as a

weakness in the approach To counter-challenge this idea the researcher can refer back to

the original theoretical framework to show how data collection and their analysis will be

guided by concepts and models (Marshall and Rossman 1999) In this study the findings

might be useful in clinical setting to help traumatised people That is the findings can be

used by helping professionals in South Africa considering the fact that the study is

conceptualised from the African cultural perspective

Dependability

Dependability is the third construct It refers to an attempt by the researcher to change

conditions in the phenomena chosen for the study This applies to the changes in the design

created by a refined understanding of the setting However qualitative researchers can

assert that qualitative research cannot be replicated because of the changing world They

plan to keep notes or log that record each design decision and the rationale behind it Their

procedures protocols and decisions can thus be inspected (de Vos 1998) In this study the

protocols procedures and decisions have been recorded All collected data are well

organised in a retrievable form and are easily available to challenge the notion of the

changing world

Confirmability

This is the last construct Lincoln and Guba (in Marshall and Rossman 1999) emphasise

the need to ask whether or not the findings of the study could be confirmed by another

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Because of the fact that the sample of this study was small the findings are less

generalisable

Data analysis

Thematic content analysis was used to analyse the data Tapes were transcribed from

Venda (the language of the interviewees) to English and back-translated to Venda for

validation purposes The data were coded analysed through reading and re-reading of

responses The rationale for reading and re-reading is that the researcher becomes familiar

with that data in intimate ways People events and quotations sift constantly through the

researcherrsquos mind (Marshall and Rossman 1999) The data were then analysed into four

steps as follows

Step 1 Analysis of individual transcripts

This step involves reading individual transcripts in several different ways First transcripts

were read as a whole noting general impressions Major opinions and attitudes that were

expressed by the groups were considered When transcripts were read for the second time

specific things that were looked for which were mainly from the objectives of the study

were noted Sections that were poorly transcribed and did not make sense were removed

Transcripts were coded sectioned and marked in the way that indicated what the

participants talked about The final step in reading the transcripts involved using the list of

required information and checking what information has been obtained

Step 2 The logbook

The logbook was used to keep all the responses together according to the topic of interest

Each response was entered unless it was exactly the same as another The main aim was to

retain the full range of responses

Step 3 Writing the results

Results were not only written from the logbook but also from the notes that were made

while reading transcripts as a whole As many reported results from the focus groups did

not indicate how many focus groups or participants discussed a certain issue results will

say lsquomany respondents said rsquo or lsquoonly a few groups discussions raised the issue of rsquo

Step 4 Interpretation

Throughout the study the researchers were thinking about the significance of the

information that was collected in terms of the problem or question that they wanted to

answer and to develop ideas about what the respondents said Results were looked at and

summaries were written

Ethical considerations

Participants in this study were informed about the nature and purpose of the study

Complete information about the study was explained for participants to comprehend the

purpose of the study This was done in order for participants to make a voluntary decision

about their participation (de Vos 1998) Participants were informed that they will be

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involved in focus groups and the study is for educational purposes It was clearly indicated

that each focus group would last approximately 45ndash90 minutes The researcher also

explained to the participants that freedom is respected and as such they had to participate

voluntarily without any physical or psychological force

Furthermore they were informed that they would benefit from the focus groups as

they would share their traumatic experiences among themselves Confidentiality and

privacy was assured so that participants were safe from exposure (Denzin and Lincoln

1998) Information from focus groups was given anonymously to ensure the privacy of

subjects However participants were informed that a tape recorder will be used so that

participantsrsquo privacy cannot be affected if the tape recorder is used as a hidden

apparatus

Results

Figure 1 shows that most of the participants attributed the cause of trauma to witchcraft

(60) followed bymazhuzhulu (panic reaction to frightening thought or event) (20) and

the belief that it just happened (20)

Interview responses on culture-related causes of trauma

It emerged from the study that some participants believed that trauma was caused by

culturally related causes They cited devil possession witchcraft and ancestral spirits as

the major causes of trauma These are presented next

Devil possession

There are instances wherein people tend to attribute violence like rape and murder to devil

possession Whenever such incidents occur and they lack an explanation concerning the

act they believe that it is because concerned people are possessed by the devil According

to some respondents incidents like these where people commit such crime that lack

Figure 1 Perceived traumatic events

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explanation were not common in the olden days Eight per cent of the participants

perceived devil possession as a cause of violence This was reflected in the following

quotes

As far as rape is concerned I really do not know what is in the minds of men because theyeven rape babies of less than a year old In some cases one may think this may be influencedby Satanism (RP 32)

The other cause is that children these days are used by the devil or is like they have evil spiritsor possessed since they just kill as an end in itself and do not indicate why they killed or atleast show some hidden motive of wanting to steal that personrsquos money (RP 74)

Witchcraft

Though many respondents realised that they were living in a violent environment where

violent incidents occurred in their lives 8 attributed the causes of its trauma to

witchcraft Their explanations of the occurrence of traumatic incidents tended to suite their

held beliefs For example the interpretation of mishaps or misfortunes that befell

individuals was believed to be caused by witchcraft The belief that witchcraft is the cause

of violent incidents is reflected in the following

I think mine is obvious that there could be somebody who is after me because a person cannothave a series of accidents one after the other In Venda if incidents are happening like thiswe start to suspect that someone is bewitching you (RP 22)

I also felt the same way about the cause of my sonrsquos death I have a very strong suspicion thathe was bewitched (RP 51)

You may find that one of the people who were in the truck was bewitched and now it hasaffected all of us (RP 62)

When we are praying there are others who are working for Satanism so I cannot rule out that itmight be due to demons or witchcraft (RP 74)

Ancestral spirits

Even though most respondents believed in witchcraft as a cause of traumatic events

some respondents believed in ancestral causes It was interesting to note that the belief

in the connection of trauma to ancestral power was mostly held by older respondents

They mentioned that their ancestors talk to them and sometimes tend to understand

why some traumatic incidents happen to them For others it was an honour when their

ancestors talked to them because they were helping them with the type of intervention

that they must use for their problem Another point is that respondents showed that

they obey their ancestors and their instructions so that even understanding why

some mishaps are happening in their lives was not a concern The following extracts

reflect this

One day my father visited me in my sleep and told me to consult a traditional healerI consulted a traditional healer who told me that I have lsquotshilisorsquo (meaning something thatsomeone gives you without your awareness which ends up like a poison in your body)(RP 33)

To tell you the truth I think this is a punishment from my father because the cattle that I saiddied on one night were not given to me alone I took them forcefully from my half brother whowas my fatherrsquos favourite child From that time nothing went on smoothly in my life I am justworried that it seems as if even my following generation will suffer like what I did as a way ofpaying for what I did wrong (RP 68)

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Other causes of trauma

The study also revealed that trauma was caused by non-cultural factors Some participants

attributed traumatic experiences to the abuse of substances intimate partner violence

rape robbery road accidents and murder These are presented next

Substance abuse

Twelve per cent of the participants indicated that trauma was caused by the abuse of

substances They believed that when young people are under the influence of drugs they

involve themselves in violent acts which then affect the community as a whole They are

usually involved in housebreaking murder and rape This is reflected in the following

responses

The main cause of all this trouble is drugs and alcohol that the youth are using In mostinstances they are always at the bars drinking alcohol and smoking drugs After that they gowherever and cause all this troubles (RP 6)

I think that when the youths are involved in drugs they end up being involved in things likehousebreaking (RP 14)

I think the other cause is that young people use drugs that influence them to commit crimessuch as housebreaking and rape (RP 36)

As far as road accidents are concerned I think people sometimes drive when they are drunk ordrive recklessly which may also contribute to traumatic incidents (RP 65)

Road accidents may be caused by reckless driving and driving when people are drunk (RP 67)

Intimate partner violence

Some participants showed that intimate partner violence occurs among people though

very few report the incidents In almost all focus groups in this study very few responses

emerged around intimate partner violence as a form of a traumatic event This probably

happened because most people seem to consider domestic violence to be a normal way of

life in a family or in the community This is also regarded as something that is not

supposed to be disclosed This was reflected as follows

The other thing that people do not talk about is domestic violence (RP 33)

Domestic violence is also common but it is complicated because many women do not talkabout it even when they are being abused all the time (RP 36)

if he drinks he beats kicks and insults using vulgar words I mean those deep Vendawords that my children are not supposed to hear as these I think also affect them This hasbecome part of our life in this family that we just told ourselves that we should accept it assuch (RP 40)

Rape

Rape was mentioned in almost all focus group discussions Participants were concerned

about the fact that rape happens to people of all ages including children and it also makes

them feel unsafe Rape brings about fear in peoplersquos lives In these focus groups 21

reported having been raped and even those who were not subjected to this type of violence

showed concern that they were afraid of this act This is reflected by the following extracts

It is true because it is not safe to walk long distances alone where there is a small bush from 6pm onwards If you walk there alone you are just inviting trouble (RP 11)

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Rape is something that we cannot leave out as it is becoming the order of the day (RP 32)

The common traumatic events in our area include rape and housebreaking Usually we do notfeel safe anymore when we are away We are always fearful that anything bad can happen atany time (RP 40)

Robbery

Robbery appeared to be contributing to a fearful environment for most participants They

felt that house and business breaking was traumatic The finding s supported by the

following statements

Housebreaking is threatening because you do not know what will happen after the personenters the house (RP 53)

Besides rape other common incidents include housebreaking and theft These days even if youare asleep you do not even know what will happen as thieves and criminals rob at night(RP 58)

The other thing which we see as a problem is theft even during the day This also includeshousebreaking which makes people not to feel safe (RP 70)

Road accidents

Another form of violence that emerged from the focus group discussions was road

accidents It appeared that road accidents created situations that became traumatic and

violent to many respondents Seventeen per cent of the participants reported incidences of

having been involved or affected in road accidents Like rape road accidents became a

concern for many respondents as in the following responses

Road accidents are very common Some victims of road accidents are school childrenSometimes these accidents happen in succession and it becomes very painful (RP 32)

Now that we are going for holidays you will hear a number of road accidents reported evenhere at our place The problem is that in some cases other people die and it is very painful forthe relatives who are left behind (RP 61)

Murder

Twelve per cent of the participants reported incidences of a family member or relative who

was murdered There was a general feeling of concern that people no longer have respect

for life The finding is supported by the following statements

Another problem around here is killings Mostly boys do this They kill each other like fliesSome people are killed by guns and some by knives (RP 7)

From the place where I come from incidences of shooting are escalating It is now becomingthe way of life where thieves may even shoot you when you are inside your house (RP 16)

Discussion

Most of the participants attributed the cause of trauma to witchcraft (60) followed by

mazhuzhulu (panic reaction to frightening thought or event) (20) The finding supports

the notion that peoplersquo understanding of trauma and its causes anchors on their

macrosystem the cultural lsquoblueprintrsquo that partially determines social structures and

activities that occur (Eamon 2001) In the present study the Venda-speaking participants

190 A Nevhutalu and P Mudhovozi

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conceptualised trauma and its causes from their cultural beliefs Also the finding is in line

with Foulks et alrsquos (1977) assertion that Africans do not believe in chance bad luck or

fate They believe that every illness has an intention and a specific cause Their culture

includes customs values beliefs attitudes implicit rules of conduct patterns of family

social organisation taboos and sanctions which they shared (Triandis 1994 De Silva in

Yule 1999) Nonetheless 20 of the participants indicated that the trauma just happened

This view might have been put forward by participants who do not subscribe to the

traditional explanation of witchraft and mazhuluzhulu Another plausible explanation is

that the 20 may account for Black Africans who embraced the individualistic western

cultural values

Therefore the microsystems (immediate setting) mesosystems (processes between

two or more microsystems) exosystems (processes between two or more settings)

macrosystems (influences of a broader culture and socio-economic environments) and

chronosystems (effects of consistency and change over life course) among the Venda-

speaking participants influenced their understanding of the causes of trauma (Eamon

2001) Thus these structures of the ecological environment served as a framework for the

explanation of the Africansrsquo belief system among the Venda-speaking participants It is

therefore not surprising that most of them (60) attributed trauma to witchcraft

The above finding is in line with the notion that for many Africans Christianity was

only adopted outwardly and did not inspire them spiritually According to Waruta and

Kinoti (1994) many Africans still maintain their traditional beliefs and practices during

important or critical stages in life (like birth initiation marriage death incurable sickness

and other anxieties in daily living) while upholding their piety as bequeathed to them in the

missionary enterprise Waruta and Kinoti (1994) furthermore hold that any kind of

medical treatment which is unrelated to the supernatural and to the community has

limited chances of success in Africa even if half the patients profess to be Christians

Contrary to the above the western-oriented PTSD model fails to account for the cultural

pluralistic experience of trauma (Collins 2004)

Some participants cited devil possession and ancestral spirits as the major causes of

trauma The responses reflect the influence of the mesosystem on individual members The

mesosystem integrates the interrelations between two or more microsystems each of

which contains the developing person In an African view the mesosystem is the

intermediate universe It functions as a no-manrsquos land since it is believed to take place

where evil spirits witches and sorcerers dwell It is also called the lsquostructured collective

imaginaryrsquo a system that is highly respected for giving rise to all good and bad fortune as

well as giving of form to peoplersquos desires fears anxieties and hope for success It is also

believed to regulate the day-to-day psychological fate of individual human beings in

Africa (van Dyk 2001)

Contrary to expectation the study did lend support the notion that in an African

environment there is a belief that ritual impurities are usually associated with death the

reproductive system and the violation of sexual prohibitions (van Dyk 2001) It had been

argued that the violation of sexual prohibitions like sexual intercourse with a woman

during menstruation with a widow before she is cleansed or with a woman who has had

an abortion or miscarriage can lead to a variety of health problems However in this case

the wrath of ancestors is believed to cause illness but it is also believed that witches

sometimes use sexual intercourse to cause illness Besides this belief about witches and

ancestors as causes of illnesses (van Dyk 2001) events that occur in a community have

consequences on individuals in the home For example a community may believe in

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witchcraft Failure by particular family members to co-operate with other community

members may lead those individuals to be suspects of witchcraft (van Dyk 2001)

The above finding is compatible with Kazarian and Evansrsquos (1998) assertion that the

ancestors can punish their people by sending illness and misfortune if social norms are

violated or when culturally prescribed practices are neglected or incorrectly performed

The illness might be caused by failure to perform a cultural and religious ritual

Nevertheless it is assumed that peaceful living with onersquos neighbours observing social

norms and living in harmony with onersquos environment and with God spirits and ancestors

are all essential to protect oneself and onersquos family from disease (Ebigbo 1987)

It emerged from the study that trauma also results from non-cultural causes Some

participants attributed traumatic experiences to the abuse of substances intimate partner

violence rape robbery road accidents and murder This finding is in line with Gopaul-

McNicol and Brice-Bakerrsquos (1998) argument that the majority of Africans acknowledge

that some illnesses have natural or organic causes In the same vein Eamon (2001) opines

that certain illnesses are originated in the microsystem The microsystem consists of the

immediate environment such as onersquos home friends relatives school and society In this

study the microsystem represents the everyday practical social and collective life of

people in Africa (van Dyk 2001)

Conclusion

The DSM-IV-TR and the ICD-10 explain the western understanding of the causes of

trauma (Collins 2004) However the given explanations do not suit the traditional African

concept of trauma The psychiatric categories that are used to understand measure and

classify mental distress are specific to western culture and society They ignore and

undermine the African concepts of suffering misfortune and illness Africansrsquo

conceptualisation of trauma and its causes is influenced by several contextual factors

Contextual factors include their social political and cultural realities To a larger extent

the Venda-speaking participants attributed trauma to witchcraft angry ancestral spirits and

devil possession The study concludes that culture is a determining factor in peoplesrsquo lives

influencing both decisions and understanding of the illnesses

Limitations of the study

This study has some limitations All the participants were drawn from the Venda-speaking

ethnic group The study is short of the voices of the Tsonga Pedi Afrikaans and English-

speaking people in the Limpopo Province Considering the qualitative nature of the

present study the findings are not generalisable

References

Collins A 2004 Trauma in context advanced reader Durban University of Kwazulu NatalDenzin NK and Lincoln YS eds 1998 Collecting and interpreting qualitative materials

London Sagevan Dyk A 2001 Traditional African beliefs and customs Implications for AIDS education and

prevention in Africa South African Journal of Psychology 31 60ndash66Eamon MK 2001 The effects of poverty on childrenrsquos socioemotional development an ecological

systems analysis Social Work 46 256ndash266Ebigbo PE 1987 The mind body and society an African perspective International Journal for

the Advancement of Health 3 (4) 45ndash57Foulks EF et al 1977 Current perspectives in cultural psychiatry New York Spectrum

192 A Nevhutalu and P Mudhovozi

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4

Gopaul-McNicol S and Brice-Baker J 1998 Cross-cultural practice assessment treatment andtraining Canada Wiley

Kazarian SS and Evans DR 1998 Cultural clinical psychology theory research and practiceOxford Oxford University Press

Madu SN Baguma P and Pritz A 1999 Traditional healersrsquo approach to the schizophreniaFrankfurt IKO Verlag

Marshall C and Rossman GB 1999 Designing qualitative research 3rd ed New Delhi SageMatsumoto D 1996 Culture and psychology Pacific Grove CA BrooksColeNeuman WL 2000 Social research methods qualitative and quantitative approaches 4th ed

Boston MA Allyn amp BaconPeltzer K 2001 Exposure to violence and posttraumatic stress disorder in a rural adult population

in South Africa Acta Academica 32 73ndash84Struwig FW and Stead GB 2001 Planning designing and reporting research Pinelands

Cape Town Maskew Miller LongmanScholten A 2012 Bradycardia (Bradyarrythmia) [online] Available from httpcvimednyueduTriandis HC 1994 Culture and social behaviour New York McGraw-Hillde Vos AS ed 1998 Research at grassroots a prime for the caring professions Pretoria

Van SchaikWaruta DW and Kinoti HW 1994 Pastoral care in African Christianity essays in pastoral

theology Nairobi ActonYule W 1999 Post-traumatic stress disorders concepts and therapy Chichester Willey

International Journal of Health Promotion and Education 193

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interaction of the roles of a patient and a healer (Foulks et al 1977) In the process of

development people imbibe the culture that is around them In a general sense people

grow up thinking believing and behaving in ways that are found in their culture adhering

to rules and conforming to its practices

Culture is defined by Matsumoto as lsquoa set of attitudes values beliefs and behaviours

shared by a group of people but different for each individual communicated from one

generation to the nextrsquo (1996 p 16) According to Gopaul-McNicol and Brice-Baker

(1998 p 5) lsquoculture is a way of living that encompasses the customs traditions attitudes

and overall socialization in which a group of people engage that are unique (not deficient)

to their cultural upbringingrsquo

lsquoCulture includes patterns of behaviour customs values beliefs attitudes implicit

rules of conduct patterns of family social organization taboos and sanctions-all which are

commonly shared in a group of people that have a common identity based in ethnic and

sometimes territorial unityrsquo (De Silva in Yule 1999 p 48) In support of the above idea

Triandis (1994 p 19) holds that lsquoculture is multifaceted in that it includes patterns of

dress methods of getting food economic activities patterns of social interaction patterns

of child rearing ways to educate the young ways to make decisions beliefs and patterns

of communication (language gestures) and so onrsquo

Trauma and social context

Trauma can in many ways be defined by an individualrsquos socio-cultural background both

directly and indirectly through the beliefs and attitudes heshe has acquired or

internalised Traumas resulting from the likes of death or severe injury in the war front

may be seen as catastrophic by almost everyone Other forms of trauma-inducing events

may be open to cultural construction making the reaction of individuals to traumatic

experience become influenced by their societyrsquos view or norms around the event In some

cases individuals may be seen as martyrs or unfortunate victims or mere mercenaries

For example a rape victim who can be made to feel that it was hisher fault that heshe was

attacked and instead of sympathy receive blame and even vilification

During acute trauma the social environment tends to respond with generosity Every

society seems to have evolved social and religious structures that aim at helping the

acutely distressed people until they resume self-care To prevent and treat post-traumatic

stress there should be external validation about the reality of a traumatic experience in a

safe and supportive context When there is persistence of a victimrsquos helplessness or when

the meaning of the trauma is secret forbidden or unacceptable trauma results in the

mobilisation of external resources or restitution Because of lack of validation and support

traumatic memories are more likely to continue prey on the victimsrsquo minds and will likely

be expressed as anger withdrawal or disruptive behaviour

The personal meaning of traumatic experience for individuals is influenced by the

social context in which it occurs This means that victims and significant people in their

surroundings may have different and fluctuating assessments of both the reality of what

happened and of the extent of the victimsrsquo suffering Therefore victims and bystanders

may have conflicting agendas to repair create forget or take revenge If memories of

trauma remain unprocessed traumatised individuals tend to re-experience the frightening

feelings and perceptions belonging to the past When there are actual injuries physical

pain and suffering are usually neglected Various forms of treatment on many disorders

including trauma-related disorders use western and traditional forms of treatment and this

occurs in different contexts across different cultures

International Journal of Health Promotion and Education 181

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The use of traditional healing in African culture

Though the use of western medicine is well spread in Africa most Africans still believe in

traditional healing methods This might be partly due to Africansrsquo belief of the causes of

illnesses Though most Africans are aware that some illnesses have natural or organic

causes there is still an overriding belief in the supernatural or spiritual causation of illness

that leads to the use of mystical and spiritual remedies for cure Africans tend to show

dissatisfaction with the scientific medicine that they see as undermining the religious and

ancestral aspects of the problem Because of this belief individuals wear a guard receive

spiritual baths (herbal bath with holy water) and also have a priest or minister to bless the

home or throw salt around the house to protect themselves from these evil forces In this

way the client goes to a faith healer while concurrently seeking medical or psychological

help (Gopaul-McNicol and Brice-Baker 1998)

When Christianity was established missionaries preached spiritual salvation based

on their own experiences Africans were accepted into the church upon receiving

baptism and making an oral confession of faith in Jesus Christ For many Africans

Christianity was only adopted outwardly and did not inspire them spiritually According

to Waruta and Kinoti (1994) many Africans still maintain their traditional beliefs and

practices during important or critical stages in life (like birth initiation marriage

death incurable sickness and other anxieties in daily living) while upholding their piety

as bequeathed to them in the missionary enterprise Waruta and Kinoti (1994)

furthermore hold that any kind of medical treatment which is unrelated to the

supernatural and to the community has limited chances of success in Africa even if

half the patients profess to be Christians

In most African societies healing combines herbal medication psychotherapy and

religion In a study conducted by Madu et al (1999) 80 of all psychic andor somatic

illnesses are treated by traditional healers in Africa and only 20 of the cases are

examined by a doctor of western medicine He furthermore states that traditional healers

and religious faith healers handle most of the cases in Nigeria

In his study to investigate the attitudes and knowledge of physicians towards

traditional healing faith healing and alternative medicine Peltzer (2001) found that on

the one hand the so-called non-biological methods were seen as quackery by 305

physicians for alternative medicine 467 for faith healing and 495 for traditional

healing The above discussion clearly indicates that Africans believe in their traditional

way of treatment It also became evident that even those who are Christians still believe in

traditional treatment One may argue that imposing western form of treatment even for

illnesses that are of western origin might not be regarded as being effective

Africans are not the only ones who hold special values around causation and

management of diseases for example the Vietnamese a nation on which most PTSD

diagnosis and research work was done following the Vietnamese war they also hold

certain beliefs around illness They were reported to follow Confician ancestral worship

wherein interpersonal relationships are carefully regulated Highly valued Confician and

Buddhist beliefs urge followers to be shy passive and modest and advocate restraint from

displaying strong emotions in public Thus a family a fundamental social unit frequently

gets involved in health care decisions that are seldom left for an individual During

suffering and conflict pain and unhappiness are initially endured in silence and privacy

and are generally only shared with family members and close friends when conditions

worsen and persist Because self-control is a traditional value emotions are considered

weaknesses expressed only by inferior people From this discussion one may argue that

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culture is predominantly vital in shaping peoplersquos lives Even when people are

traumatised it is important to consider how different cultures view trauma and peoplersquos

reactions to it

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) and the

International Statistical Classification of Diseases (ICD-10) are said to contain a particular

way of diagnosis to the world One may argue that different cultural contexts make it not

realistic that the diagnosis can suit all cultures across the world Collins (2004) argues that

the DSM-IV and ICD-10 contain information that is western orientated Thus the

psychiatric categories that are used to understand measure and classify mental distress are

specific to western culture and society

According to van Dyk (2001) the local concepts of suffering misfortune and

illness have been ignored and undermined It is maintained that the contextual factors

are critical in influencing and shaping how traumatic events are experienced

responded to and explained The society or individuals use these contextual factors to

experience what is considered traumatic Contextual factors include the social

political and cultural realities in which people exist and utilise to make sense of what

happens to them

Thus the PTSD model is said to have some shortcomings that include the fact that it

focuses on the individual while downplaying the effects of trauma on family friends and

other people in the traumatised personrsquos social world It also fails to acknowledge that

whole communities can experience trauma on a collective basis (Collins 2004) However

there are traditional methods that are available for the treatment of mental disorders

despite the psychological intervention which is of western origin

Method

Research design

This was an exploratory study whereby a qualitative method using focus group discussion

for data collection was utilised Neuman (2000) argues that an exploratory study is a study

into an area that has not been fully researched Much is not yet researched about on how

Africans understand PTSD especially in the Limpopo Province

Participants

Ten focus groups with a total of 75 participants (female frac14 55 male frac14 20 age

range frac14 25ndash60 years mean age frac14 356 years ethnicity Black African) were drawn using

convenience sampling method Participants were drawn from people who were involved in

traumatic incidents that include road accidents murder rape domestic violence and

housebreaking The sample was drawn from the rural communities of the Vhembe District

Each group consisted of 6ndash10 members from different villages in Thulamela and

Makhado municipalities For the purpose of this study the direct victims of violence

as well as their family members and relatives were found relevant as they were involved

in trauma-inducing events either directly or indirectly

Convenience sampling was used in this study This kind of sampling refers to a

haphazard selection of cases that conveniently suite the purpose of the study An example

of convenience sampling is like the street interview conducted by television interviewers

(Neuman 2000) A researcher selects those participants who are usually the nearest and

most easily available (de Vos 1998)

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Research instrument

Focus group discussion method is defined by Struwig and Stead (2001) as a carefully

planned discussion designed to obtain individualsrsquo perceptions on a defined area of interest

in a permissive non-threatening environment The discussions between the research

participants enable the participants to discuss issues they consider to be important In focus

groups the groups are generally composed of 7ndash10 people who are unfamiliar to one

another They should be selected because they share certain characteristics relevant to the

questions in the study (Marshall and Rossman 1999)

During the interview the interviewer creates a supportive environment asks

focused questions so as to encourage discussion and the expression of differing

opinions and points of view Questions start from the general and the non-threatening

and progress gradually to the specific and that which may be threatening Tricky

questions are asked to promote participantsrsquo expression of their views through the

creation of a supportive environment The interviewer should make participants feel

that their contributions are worthwhile and also that they are free to disagree with

each other The facilitator must be attentive and willing to listen Heshe must also

show an interest in what is being said encourage a wide range of opinions

assist participants to explore their ideas further avoid belittling participants and

direct the conversation when people become repetitive or move away from the topic

(Struwig and Stead 2001)

The rationale for using focus groups was that these groups share a common

characteristic of having been involved in traumatic incidents either directly or

indirectly This encouraged them to speak more freely without fear of being judged

by others It is believed that people often need to listen to other peoplersquos opinion and

understanding to form their own The focus group method relies on group discussion

and for the discussion to be successful participants must be able to talk to each other

about the topic of interest This method assumes that an individualrsquos attitudes and

beliefs do not form in a vacuum Focus group method was found relevant in this

study for its excellence in obtaining information from illiterate communities and as a

way of discovering attitudes and opinions which might not be revealed in a survey

questionnaire

Procedure

Telephonic requests were made with some known members of the Thulamela and

Makhado Municipalities to contact people who were involved in traumatic incidents

These people those who were requested to contact traumatised people were told about the

purpose of the focus groups and the confidentiality involved Members of civic structures

and pastors were among other people who helped to organise group members from the

mentioned communities Appointment dates were organised for each focus group and

discussions took place as arranged

Two sessions were held per week for each focus group Each session lasted for an

hour and a half Some sessions were conducted in churches and others were held at the

victimsrsquo homes The focus groups were conducted in Venda which is the mother tongue

of the participants and the researcher It was explained to the participants that the

sessions will be confidential Participantsrsquo consent was sought for the use of a tape

recorder to keep record of the sessions Tape-recorded information was transcribed

immediately after the sessions and later translated from Venda to English and back-

translated for validation purposes

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Trustworthiness

Marshall and Rossman (1999) maintain that research should respond to canons that are

regarded as criteria in which trustworthiness can be evaluated These canons are viewed by

Lincoln and Guba (in Marshall and Rossman 1999) as classical contribution to the

methodology of qualitative research They are credibility transferability dependability

and confirmability These four constructs establish the lsquotruth-valuersquo of a study The truth-

value refers to the applicability consistency and neutrability One may argue that

credibility transferability dependability and confirmability may be matched with internal

validity external validity reliability and objectivity which are appropriate for the

positivist paradigm and inappropriate for qualitative inquiry (Marshall and Rossman

1999) The four constructs that are appropriate for qualitative inquiry are discussed next

Credibility

In qualitative research credibility is maintained by an inquiry that ensures that the subject

is accurately identified and described (de Vos 1998) In this study continuous interaction

with participants through focus groups ensured that the subjects were accurately identified

and described

Transferability

Transferability refers to the applicability of one set of findings to another context (de Vos

1998) de Vos (1998) further argues that the demonstration of applicability of one set of

findings to another depends on the investigator who should make the transfer than the

original investigator Interestingly there are researchers who regard transferability as a

weakness in the approach To counter-challenge this idea the researcher can refer back to

the original theoretical framework to show how data collection and their analysis will be

guided by concepts and models (Marshall and Rossman 1999) In this study the findings

might be useful in clinical setting to help traumatised people That is the findings can be

used by helping professionals in South Africa considering the fact that the study is

conceptualised from the African cultural perspective

Dependability

Dependability is the third construct It refers to an attempt by the researcher to change

conditions in the phenomena chosen for the study This applies to the changes in the design

created by a refined understanding of the setting However qualitative researchers can

assert that qualitative research cannot be replicated because of the changing world They

plan to keep notes or log that record each design decision and the rationale behind it Their

procedures protocols and decisions can thus be inspected (de Vos 1998) In this study the

protocols procedures and decisions have been recorded All collected data are well

organised in a retrievable form and are easily available to challenge the notion of the

changing world

Confirmability

This is the last construct Lincoln and Guba (in Marshall and Rossman 1999) emphasise

the need to ask whether or not the findings of the study could be confirmed by another

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Because of the fact that the sample of this study was small the findings are less

generalisable

Data analysis

Thematic content analysis was used to analyse the data Tapes were transcribed from

Venda (the language of the interviewees) to English and back-translated to Venda for

validation purposes The data were coded analysed through reading and re-reading of

responses The rationale for reading and re-reading is that the researcher becomes familiar

with that data in intimate ways People events and quotations sift constantly through the

researcherrsquos mind (Marshall and Rossman 1999) The data were then analysed into four

steps as follows

Step 1 Analysis of individual transcripts

This step involves reading individual transcripts in several different ways First transcripts

were read as a whole noting general impressions Major opinions and attitudes that were

expressed by the groups were considered When transcripts were read for the second time

specific things that were looked for which were mainly from the objectives of the study

were noted Sections that were poorly transcribed and did not make sense were removed

Transcripts were coded sectioned and marked in the way that indicated what the

participants talked about The final step in reading the transcripts involved using the list of

required information and checking what information has been obtained

Step 2 The logbook

The logbook was used to keep all the responses together according to the topic of interest

Each response was entered unless it was exactly the same as another The main aim was to

retain the full range of responses

Step 3 Writing the results

Results were not only written from the logbook but also from the notes that were made

while reading transcripts as a whole As many reported results from the focus groups did

not indicate how many focus groups or participants discussed a certain issue results will

say lsquomany respondents said rsquo or lsquoonly a few groups discussions raised the issue of rsquo

Step 4 Interpretation

Throughout the study the researchers were thinking about the significance of the

information that was collected in terms of the problem or question that they wanted to

answer and to develop ideas about what the respondents said Results were looked at and

summaries were written

Ethical considerations

Participants in this study were informed about the nature and purpose of the study

Complete information about the study was explained for participants to comprehend the

purpose of the study This was done in order for participants to make a voluntary decision

about their participation (de Vos 1998) Participants were informed that they will be

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involved in focus groups and the study is for educational purposes It was clearly indicated

that each focus group would last approximately 45ndash90 minutes The researcher also

explained to the participants that freedom is respected and as such they had to participate

voluntarily without any physical or psychological force

Furthermore they were informed that they would benefit from the focus groups as

they would share their traumatic experiences among themselves Confidentiality and

privacy was assured so that participants were safe from exposure (Denzin and Lincoln

1998) Information from focus groups was given anonymously to ensure the privacy of

subjects However participants were informed that a tape recorder will be used so that

participantsrsquo privacy cannot be affected if the tape recorder is used as a hidden

apparatus

Results

Figure 1 shows that most of the participants attributed the cause of trauma to witchcraft

(60) followed bymazhuzhulu (panic reaction to frightening thought or event) (20) and

the belief that it just happened (20)

Interview responses on culture-related causes of trauma

It emerged from the study that some participants believed that trauma was caused by

culturally related causes They cited devil possession witchcraft and ancestral spirits as

the major causes of trauma These are presented next

Devil possession

There are instances wherein people tend to attribute violence like rape and murder to devil

possession Whenever such incidents occur and they lack an explanation concerning the

act they believe that it is because concerned people are possessed by the devil According

to some respondents incidents like these where people commit such crime that lack

Figure 1 Perceived traumatic events

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explanation were not common in the olden days Eight per cent of the participants

perceived devil possession as a cause of violence This was reflected in the following

quotes

As far as rape is concerned I really do not know what is in the minds of men because theyeven rape babies of less than a year old In some cases one may think this may be influencedby Satanism (RP 32)

The other cause is that children these days are used by the devil or is like they have evil spiritsor possessed since they just kill as an end in itself and do not indicate why they killed or atleast show some hidden motive of wanting to steal that personrsquos money (RP 74)

Witchcraft

Though many respondents realised that they were living in a violent environment where

violent incidents occurred in their lives 8 attributed the causes of its trauma to

witchcraft Their explanations of the occurrence of traumatic incidents tended to suite their

held beliefs For example the interpretation of mishaps or misfortunes that befell

individuals was believed to be caused by witchcraft The belief that witchcraft is the cause

of violent incidents is reflected in the following

I think mine is obvious that there could be somebody who is after me because a person cannothave a series of accidents one after the other In Venda if incidents are happening like thiswe start to suspect that someone is bewitching you (RP 22)

I also felt the same way about the cause of my sonrsquos death I have a very strong suspicion thathe was bewitched (RP 51)

You may find that one of the people who were in the truck was bewitched and now it hasaffected all of us (RP 62)

When we are praying there are others who are working for Satanism so I cannot rule out that itmight be due to demons or witchcraft (RP 74)

Ancestral spirits

Even though most respondents believed in witchcraft as a cause of traumatic events

some respondents believed in ancestral causes It was interesting to note that the belief

in the connection of trauma to ancestral power was mostly held by older respondents

They mentioned that their ancestors talk to them and sometimes tend to understand

why some traumatic incidents happen to them For others it was an honour when their

ancestors talked to them because they were helping them with the type of intervention

that they must use for their problem Another point is that respondents showed that

they obey their ancestors and their instructions so that even understanding why

some mishaps are happening in their lives was not a concern The following extracts

reflect this

One day my father visited me in my sleep and told me to consult a traditional healerI consulted a traditional healer who told me that I have lsquotshilisorsquo (meaning something thatsomeone gives you without your awareness which ends up like a poison in your body)(RP 33)

To tell you the truth I think this is a punishment from my father because the cattle that I saiddied on one night were not given to me alone I took them forcefully from my half brother whowas my fatherrsquos favourite child From that time nothing went on smoothly in my life I am justworried that it seems as if even my following generation will suffer like what I did as a way ofpaying for what I did wrong (RP 68)

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Other causes of trauma

The study also revealed that trauma was caused by non-cultural factors Some participants

attributed traumatic experiences to the abuse of substances intimate partner violence

rape robbery road accidents and murder These are presented next

Substance abuse

Twelve per cent of the participants indicated that trauma was caused by the abuse of

substances They believed that when young people are under the influence of drugs they

involve themselves in violent acts which then affect the community as a whole They are

usually involved in housebreaking murder and rape This is reflected in the following

responses

The main cause of all this trouble is drugs and alcohol that the youth are using In mostinstances they are always at the bars drinking alcohol and smoking drugs After that they gowherever and cause all this troubles (RP 6)

I think that when the youths are involved in drugs they end up being involved in things likehousebreaking (RP 14)

I think the other cause is that young people use drugs that influence them to commit crimessuch as housebreaking and rape (RP 36)

As far as road accidents are concerned I think people sometimes drive when they are drunk ordrive recklessly which may also contribute to traumatic incidents (RP 65)

Road accidents may be caused by reckless driving and driving when people are drunk (RP 67)

Intimate partner violence

Some participants showed that intimate partner violence occurs among people though

very few report the incidents In almost all focus groups in this study very few responses

emerged around intimate partner violence as a form of a traumatic event This probably

happened because most people seem to consider domestic violence to be a normal way of

life in a family or in the community This is also regarded as something that is not

supposed to be disclosed This was reflected as follows

The other thing that people do not talk about is domestic violence (RP 33)

Domestic violence is also common but it is complicated because many women do not talkabout it even when they are being abused all the time (RP 36)

if he drinks he beats kicks and insults using vulgar words I mean those deep Vendawords that my children are not supposed to hear as these I think also affect them This hasbecome part of our life in this family that we just told ourselves that we should accept it assuch (RP 40)

Rape

Rape was mentioned in almost all focus group discussions Participants were concerned

about the fact that rape happens to people of all ages including children and it also makes

them feel unsafe Rape brings about fear in peoplersquos lives In these focus groups 21

reported having been raped and even those who were not subjected to this type of violence

showed concern that they were afraid of this act This is reflected by the following extracts

It is true because it is not safe to walk long distances alone where there is a small bush from 6pm onwards If you walk there alone you are just inviting trouble (RP 11)

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Rape is something that we cannot leave out as it is becoming the order of the day (RP 32)

The common traumatic events in our area include rape and housebreaking Usually we do notfeel safe anymore when we are away We are always fearful that anything bad can happen atany time (RP 40)

Robbery

Robbery appeared to be contributing to a fearful environment for most participants They

felt that house and business breaking was traumatic The finding s supported by the

following statements

Housebreaking is threatening because you do not know what will happen after the personenters the house (RP 53)

Besides rape other common incidents include housebreaking and theft These days even if youare asleep you do not even know what will happen as thieves and criminals rob at night(RP 58)

The other thing which we see as a problem is theft even during the day This also includeshousebreaking which makes people not to feel safe (RP 70)

Road accidents

Another form of violence that emerged from the focus group discussions was road

accidents It appeared that road accidents created situations that became traumatic and

violent to many respondents Seventeen per cent of the participants reported incidences of

having been involved or affected in road accidents Like rape road accidents became a

concern for many respondents as in the following responses

Road accidents are very common Some victims of road accidents are school childrenSometimes these accidents happen in succession and it becomes very painful (RP 32)

Now that we are going for holidays you will hear a number of road accidents reported evenhere at our place The problem is that in some cases other people die and it is very painful forthe relatives who are left behind (RP 61)

Murder

Twelve per cent of the participants reported incidences of a family member or relative who

was murdered There was a general feeling of concern that people no longer have respect

for life The finding is supported by the following statements

Another problem around here is killings Mostly boys do this They kill each other like fliesSome people are killed by guns and some by knives (RP 7)

From the place where I come from incidences of shooting are escalating It is now becomingthe way of life where thieves may even shoot you when you are inside your house (RP 16)

Discussion

Most of the participants attributed the cause of trauma to witchcraft (60) followed by

mazhuzhulu (panic reaction to frightening thought or event) (20) The finding supports

the notion that peoplersquo understanding of trauma and its causes anchors on their

macrosystem the cultural lsquoblueprintrsquo that partially determines social structures and

activities that occur (Eamon 2001) In the present study the Venda-speaking participants

190 A Nevhutalu and P Mudhovozi

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conceptualised trauma and its causes from their cultural beliefs Also the finding is in line

with Foulks et alrsquos (1977) assertion that Africans do not believe in chance bad luck or

fate They believe that every illness has an intention and a specific cause Their culture

includes customs values beliefs attitudes implicit rules of conduct patterns of family

social organisation taboos and sanctions which they shared (Triandis 1994 De Silva in

Yule 1999) Nonetheless 20 of the participants indicated that the trauma just happened

This view might have been put forward by participants who do not subscribe to the

traditional explanation of witchraft and mazhuluzhulu Another plausible explanation is

that the 20 may account for Black Africans who embraced the individualistic western

cultural values

Therefore the microsystems (immediate setting) mesosystems (processes between

two or more microsystems) exosystems (processes between two or more settings)

macrosystems (influences of a broader culture and socio-economic environments) and

chronosystems (effects of consistency and change over life course) among the Venda-

speaking participants influenced their understanding of the causes of trauma (Eamon

2001) Thus these structures of the ecological environment served as a framework for the

explanation of the Africansrsquo belief system among the Venda-speaking participants It is

therefore not surprising that most of them (60) attributed trauma to witchcraft

The above finding is in line with the notion that for many Africans Christianity was

only adopted outwardly and did not inspire them spiritually According to Waruta and

Kinoti (1994) many Africans still maintain their traditional beliefs and practices during

important or critical stages in life (like birth initiation marriage death incurable sickness

and other anxieties in daily living) while upholding their piety as bequeathed to them in the

missionary enterprise Waruta and Kinoti (1994) furthermore hold that any kind of

medical treatment which is unrelated to the supernatural and to the community has

limited chances of success in Africa even if half the patients profess to be Christians

Contrary to the above the western-oriented PTSD model fails to account for the cultural

pluralistic experience of trauma (Collins 2004)

Some participants cited devil possession and ancestral spirits as the major causes of

trauma The responses reflect the influence of the mesosystem on individual members The

mesosystem integrates the interrelations between two or more microsystems each of

which contains the developing person In an African view the mesosystem is the

intermediate universe It functions as a no-manrsquos land since it is believed to take place

where evil spirits witches and sorcerers dwell It is also called the lsquostructured collective

imaginaryrsquo a system that is highly respected for giving rise to all good and bad fortune as

well as giving of form to peoplersquos desires fears anxieties and hope for success It is also

believed to regulate the day-to-day psychological fate of individual human beings in

Africa (van Dyk 2001)

Contrary to expectation the study did lend support the notion that in an African

environment there is a belief that ritual impurities are usually associated with death the

reproductive system and the violation of sexual prohibitions (van Dyk 2001) It had been

argued that the violation of sexual prohibitions like sexual intercourse with a woman

during menstruation with a widow before she is cleansed or with a woman who has had

an abortion or miscarriage can lead to a variety of health problems However in this case

the wrath of ancestors is believed to cause illness but it is also believed that witches

sometimes use sexual intercourse to cause illness Besides this belief about witches and

ancestors as causes of illnesses (van Dyk 2001) events that occur in a community have

consequences on individuals in the home For example a community may believe in

International Journal of Health Promotion and Education 191

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witchcraft Failure by particular family members to co-operate with other community

members may lead those individuals to be suspects of witchcraft (van Dyk 2001)

The above finding is compatible with Kazarian and Evansrsquos (1998) assertion that the

ancestors can punish their people by sending illness and misfortune if social norms are

violated or when culturally prescribed practices are neglected or incorrectly performed

The illness might be caused by failure to perform a cultural and religious ritual

Nevertheless it is assumed that peaceful living with onersquos neighbours observing social

norms and living in harmony with onersquos environment and with God spirits and ancestors

are all essential to protect oneself and onersquos family from disease (Ebigbo 1987)

It emerged from the study that trauma also results from non-cultural causes Some

participants attributed traumatic experiences to the abuse of substances intimate partner

violence rape robbery road accidents and murder This finding is in line with Gopaul-

McNicol and Brice-Bakerrsquos (1998) argument that the majority of Africans acknowledge

that some illnesses have natural or organic causes In the same vein Eamon (2001) opines

that certain illnesses are originated in the microsystem The microsystem consists of the

immediate environment such as onersquos home friends relatives school and society In this

study the microsystem represents the everyday practical social and collective life of

people in Africa (van Dyk 2001)

Conclusion

The DSM-IV-TR and the ICD-10 explain the western understanding of the causes of

trauma (Collins 2004) However the given explanations do not suit the traditional African

concept of trauma The psychiatric categories that are used to understand measure and

classify mental distress are specific to western culture and society They ignore and

undermine the African concepts of suffering misfortune and illness Africansrsquo

conceptualisation of trauma and its causes is influenced by several contextual factors

Contextual factors include their social political and cultural realities To a larger extent

the Venda-speaking participants attributed trauma to witchcraft angry ancestral spirits and

devil possession The study concludes that culture is a determining factor in peoplesrsquo lives

influencing both decisions and understanding of the illnesses

Limitations of the study

This study has some limitations All the participants were drawn from the Venda-speaking

ethnic group The study is short of the voices of the Tsonga Pedi Afrikaans and English-

speaking people in the Limpopo Province Considering the qualitative nature of the

present study the findings are not generalisable

References

Collins A 2004 Trauma in context advanced reader Durban University of Kwazulu NatalDenzin NK and Lincoln YS eds 1998 Collecting and interpreting qualitative materials

London Sagevan Dyk A 2001 Traditional African beliefs and customs Implications for AIDS education and

prevention in Africa South African Journal of Psychology 31 60ndash66Eamon MK 2001 The effects of poverty on childrenrsquos socioemotional development an ecological

systems analysis Social Work 46 256ndash266Ebigbo PE 1987 The mind body and society an African perspective International Journal for

the Advancement of Health 3 (4) 45ndash57Foulks EF et al 1977 Current perspectives in cultural psychiatry New York Spectrum

192 A Nevhutalu and P Mudhovozi

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4

Gopaul-McNicol S and Brice-Baker J 1998 Cross-cultural practice assessment treatment andtraining Canada Wiley

Kazarian SS and Evans DR 1998 Cultural clinical psychology theory research and practiceOxford Oxford University Press

Madu SN Baguma P and Pritz A 1999 Traditional healersrsquo approach to the schizophreniaFrankfurt IKO Verlag

Marshall C and Rossman GB 1999 Designing qualitative research 3rd ed New Delhi SageMatsumoto D 1996 Culture and psychology Pacific Grove CA BrooksColeNeuman WL 2000 Social research methods qualitative and quantitative approaches 4th ed

Boston MA Allyn amp BaconPeltzer K 2001 Exposure to violence and posttraumatic stress disorder in a rural adult population

in South Africa Acta Academica 32 73ndash84Struwig FW and Stead GB 2001 Planning designing and reporting research Pinelands

Cape Town Maskew Miller LongmanScholten A 2012 Bradycardia (Bradyarrythmia) [online] Available from httpcvimednyueduTriandis HC 1994 Culture and social behaviour New York McGraw-Hillde Vos AS ed 1998 Research at grassroots a prime for the caring professions Pretoria

Van SchaikWaruta DW and Kinoti HW 1994 Pastoral care in African Christianity essays in pastoral

theology Nairobi ActonYule W 1999 Post-traumatic stress disorders concepts and therapy Chichester Willey

International Journal of Health Promotion and Education 193

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4

The use of traditional healing in African culture

Though the use of western medicine is well spread in Africa most Africans still believe in

traditional healing methods This might be partly due to Africansrsquo belief of the causes of

illnesses Though most Africans are aware that some illnesses have natural or organic

causes there is still an overriding belief in the supernatural or spiritual causation of illness

that leads to the use of mystical and spiritual remedies for cure Africans tend to show

dissatisfaction with the scientific medicine that they see as undermining the religious and

ancestral aspects of the problem Because of this belief individuals wear a guard receive

spiritual baths (herbal bath with holy water) and also have a priest or minister to bless the

home or throw salt around the house to protect themselves from these evil forces In this

way the client goes to a faith healer while concurrently seeking medical or psychological

help (Gopaul-McNicol and Brice-Baker 1998)

When Christianity was established missionaries preached spiritual salvation based

on their own experiences Africans were accepted into the church upon receiving

baptism and making an oral confession of faith in Jesus Christ For many Africans

Christianity was only adopted outwardly and did not inspire them spiritually According

to Waruta and Kinoti (1994) many Africans still maintain their traditional beliefs and

practices during important or critical stages in life (like birth initiation marriage

death incurable sickness and other anxieties in daily living) while upholding their piety

as bequeathed to them in the missionary enterprise Waruta and Kinoti (1994)

furthermore hold that any kind of medical treatment which is unrelated to the

supernatural and to the community has limited chances of success in Africa even if

half the patients profess to be Christians

In most African societies healing combines herbal medication psychotherapy and

religion In a study conducted by Madu et al (1999) 80 of all psychic andor somatic

illnesses are treated by traditional healers in Africa and only 20 of the cases are

examined by a doctor of western medicine He furthermore states that traditional healers

and religious faith healers handle most of the cases in Nigeria

In his study to investigate the attitudes and knowledge of physicians towards

traditional healing faith healing and alternative medicine Peltzer (2001) found that on

the one hand the so-called non-biological methods were seen as quackery by 305

physicians for alternative medicine 467 for faith healing and 495 for traditional

healing The above discussion clearly indicates that Africans believe in their traditional

way of treatment It also became evident that even those who are Christians still believe in

traditional treatment One may argue that imposing western form of treatment even for

illnesses that are of western origin might not be regarded as being effective

Africans are not the only ones who hold special values around causation and

management of diseases for example the Vietnamese a nation on which most PTSD

diagnosis and research work was done following the Vietnamese war they also hold

certain beliefs around illness They were reported to follow Confician ancestral worship

wherein interpersonal relationships are carefully regulated Highly valued Confician and

Buddhist beliefs urge followers to be shy passive and modest and advocate restraint from

displaying strong emotions in public Thus a family a fundamental social unit frequently

gets involved in health care decisions that are seldom left for an individual During

suffering and conflict pain and unhappiness are initially endured in silence and privacy

and are generally only shared with family members and close friends when conditions

worsen and persist Because self-control is a traditional value emotions are considered

weaknesses expressed only by inferior people From this discussion one may argue that

182 A Nevhutalu and P Mudhovozi

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culture is predominantly vital in shaping peoplersquos lives Even when people are

traumatised it is important to consider how different cultures view trauma and peoplersquos

reactions to it

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) and the

International Statistical Classification of Diseases (ICD-10) are said to contain a particular

way of diagnosis to the world One may argue that different cultural contexts make it not

realistic that the diagnosis can suit all cultures across the world Collins (2004) argues that

the DSM-IV and ICD-10 contain information that is western orientated Thus the

psychiatric categories that are used to understand measure and classify mental distress are

specific to western culture and society

According to van Dyk (2001) the local concepts of suffering misfortune and

illness have been ignored and undermined It is maintained that the contextual factors

are critical in influencing and shaping how traumatic events are experienced

responded to and explained The society or individuals use these contextual factors to

experience what is considered traumatic Contextual factors include the social

political and cultural realities in which people exist and utilise to make sense of what

happens to them

Thus the PTSD model is said to have some shortcomings that include the fact that it

focuses on the individual while downplaying the effects of trauma on family friends and

other people in the traumatised personrsquos social world It also fails to acknowledge that

whole communities can experience trauma on a collective basis (Collins 2004) However

there are traditional methods that are available for the treatment of mental disorders

despite the psychological intervention which is of western origin

Method

Research design

This was an exploratory study whereby a qualitative method using focus group discussion

for data collection was utilised Neuman (2000) argues that an exploratory study is a study

into an area that has not been fully researched Much is not yet researched about on how

Africans understand PTSD especially in the Limpopo Province

Participants

Ten focus groups with a total of 75 participants (female frac14 55 male frac14 20 age

range frac14 25ndash60 years mean age frac14 356 years ethnicity Black African) were drawn using

convenience sampling method Participants were drawn from people who were involved in

traumatic incidents that include road accidents murder rape domestic violence and

housebreaking The sample was drawn from the rural communities of the Vhembe District

Each group consisted of 6ndash10 members from different villages in Thulamela and

Makhado municipalities For the purpose of this study the direct victims of violence

as well as their family members and relatives were found relevant as they were involved

in trauma-inducing events either directly or indirectly

Convenience sampling was used in this study This kind of sampling refers to a

haphazard selection of cases that conveniently suite the purpose of the study An example

of convenience sampling is like the street interview conducted by television interviewers

(Neuman 2000) A researcher selects those participants who are usually the nearest and

most easily available (de Vos 1998)

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Research instrument

Focus group discussion method is defined by Struwig and Stead (2001) as a carefully

planned discussion designed to obtain individualsrsquo perceptions on a defined area of interest

in a permissive non-threatening environment The discussions between the research

participants enable the participants to discuss issues they consider to be important In focus

groups the groups are generally composed of 7ndash10 people who are unfamiliar to one

another They should be selected because they share certain characteristics relevant to the

questions in the study (Marshall and Rossman 1999)

During the interview the interviewer creates a supportive environment asks

focused questions so as to encourage discussion and the expression of differing

opinions and points of view Questions start from the general and the non-threatening

and progress gradually to the specific and that which may be threatening Tricky

questions are asked to promote participantsrsquo expression of their views through the

creation of a supportive environment The interviewer should make participants feel

that their contributions are worthwhile and also that they are free to disagree with

each other The facilitator must be attentive and willing to listen Heshe must also

show an interest in what is being said encourage a wide range of opinions

assist participants to explore their ideas further avoid belittling participants and

direct the conversation when people become repetitive or move away from the topic

(Struwig and Stead 2001)

The rationale for using focus groups was that these groups share a common

characteristic of having been involved in traumatic incidents either directly or

indirectly This encouraged them to speak more freely without fear of being judged

by others It is believed that people often need to listen to other peoplersquos opinion and

understanding to form their own The focus group method relies on group discussion

and for the discussion to be successful participants must be able to talk to each other

about the topic of interest This method assumes that an individualrsquos attitudes and

beliefs do not form in a vacuum Focus group method was found relevant in this

study for its excellence in obtaining information from illiterate communities and as a

way of discovering attitudes and opinions which might not be revealed in a survey

questionnaire

Procedure

Telephonic requests were made with some known members of the Thulamela and

Makhado Municipalities to contact people who were involved in traumatic incidents

These people those who were requested to contact traumatised people were told about the

purpose of the focus groups and the confidentiality involved Members of civic structures

and pastors were among other people who helped to organise group members from the

mentioned communities Appointment dates were organised for each focus group and

discussions took place as arranged

Two sessions were held per week for each focus group Each session lasted for an

hour and a half Some sessions were conducted in churches and others were held at the

victimsrsquo homes The focus groups were conducted in Venda which is the mother tongue

of the participants and the researcher It was explained to the participants that the

sessions will be confidential Participantsrsquo consent was sought for the use of a tape

recorder to keep record of the sessions Tape-recorded information was transcribed

immediately after the sessions and later translated from Venda to English and back-

translated for validation purposes

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Trustworthiness

Marshall and Rossman (1999) maintain that research should respond to canons that are

regarded as criteria in which trustworthiness can be evaluated These canons are viewed by

Lincoln and Guba (in Marshall and Rossman 1999) as classical contribution to the

methodology of qualitative research They are credibility transferability dependability

and confirmability These four constructs establish the lsquotruth-valuersquo of a study The truth-

value refers to the applicability consistency and neutrability One may argue that

credibility transferability dependability and confirmability may be matched with internal

validity external validity reliability and objectivity which are appropriate for the

positivist paradigm and inappropriate for qualitative inquiry (Marshall and Rossman

1999) The four constructs that are appropriate for qualitative inquiry are discussed next

Credibility

In qualitative research credibility is maintained by an inquiry that ensures that the subject

is accurately identified and described (de Vos 1998) In this study continuous interaction

with participants through focus groups ensured that the subjects were accurately identified

and described

Transferability

Transferability refers to the applicability of one set of findings to another context (de Vos

1998) de Vos (1998) further argues that the demonstration of applicability of one set of

findings to another depends on the investigator who should make the transfer than the

original investigator Interestingly there are researchers who regard transferability as a

weakness in the approach To counter-challenge this idea the researcher can refer back to

the original theoretical framework to show how data collection and their analysis will be

guided by concepts and models (Marshall and Rossman 1999) In this study the findings

might be useful in clinical setting to help traumatised people That is the findings can be

used by helping professionals in South Africa considering the fact that the study is

conceptualised from the African cultural perspective

Dependability

Dependability is the third construct It refers to an attempt by the researcher to change

conditions in the phenomena chosen for the study This applies to the changes in the design

created by a refined understanding of the setting However qualitative researchers can

assert that qualitative research cannot be replicated because of the changing world They

plan to keep notes or log that record each design decision and the rationale behind it Their

procedures protocols and decisions can thus be inspected (de Vos 1998) In this study the

protocols procedures and decisions have been recorded All collected data are well

organised in a retrievable form and are easily available to challenge the notion of the

changing world

Confirmability

This is the last construct Lincoln and Guba (in Marshall and Rossman 1999) emphasise

the need to ask whether or not the findings of the study could be confirmed by another

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Because of the fact that the sample of this study was small the findings are less

generalisable

Data analysis

Thematic content analysis was used to analyse the data Tapes were transcribed from

Venda (the language of the interviewees) to English and back-translated to Venda for

validation purposes The data were coded analysed through reading and re-reading of

responses The rationale for reading and re-reading is that the researcher becomes familiar

with that data in intimate ways People events and quotations sift constantly through the

researcherrsquos mind (Marshall and Rossman 1999) The data were then analysed into four

steps as follows

Step 1 Analysis of individual transcripts

This step involves reading individual transcripts in several different ways First transcripts

were read as a whole noting general impressions Major opinions and attitudes that were

expressed by the groups were considered When transcripts were read for the second time

specific things that were looked for which were mainly from the objectives of the study

were noted Sections that were poorly transcribed and did not make sense were removed

Transcripts were coded sectioned and marked in the way that indicated what the

participants talked about The final step in reading the transcripts involved using the list of

required information and checking what information has been obtained

Step 2 The logbook

The logbook was used to keep all the responses together according to the topic of interest

Each response was entered unless it was exactly the same as another The main aim was to

retain the full range of responses

Step 3 Writing the results

Results were not only written from the logbook but also from the notes that were made

while reading transcripts as a whole As many reported results from the focus groups did

not indicate how many focus groups or participants discussed a certain issue results will

say lsquomany respondents said rsquo or lsquoonly a few groups discussions raised the issue of rsquo

Step 4 Interpretation

Throughout the study the researchers were thinking about the significance of the

information that was collected in terms of the problem or question that they wanted to

answer and to develop ideas about what the respondents said Results were looked at and

summaries were written

Ethical considerations

Participants in this study were informed about the nature and purpose of the study

Complete information about the study was explained for participants to comprehend the

purpose of the study This was done in order for participants to make a voluntary decision

about their participation (de Vos 1998) Participants were informed that they will be

186 A Nevhutalu and P Mudhovozi

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involved in focus groups and the study is for educational purposes It was clearly indicated

that each focus group would last approximately 45ndash90 minutes The researcher also

explained to the participants that freedom is respected and as such they had to participate

voluntarily without any physical or psychological force

Furthermore they were informed that they would benefit from the focus groups as

they would share their traumatic experiences among themselves Confidentiality and

privacy was assured so that participants were safe from exposure (Denzin and Lincoln

1998) Information from focus groups was given anonymously to ensure the privacy of

subjects However participants were informed that a tape recorder will be used so that

participantsrsquo privacy cannot be affected if the tape recorder is used as a hidden

apparatus

Results

Figure 1 shows that most of the participants attributed the cause of trauma to witchcraft

(60) followed bymazhuzhulu (panic reaction to frightening thought or event) (20) and

the belief that it just happened (20)

Interview responses on culture-related causes of trauma

It emerged from the study that some participants believed that trauma was caused by

culturally related causes They cited devil possession witchcraft and ancestral spirits as

the major causes of trauma These are presented next

Devil possession

There are instances wherein people tend to attribute violence like rape and murder to devil

possession Whenever such incidents occur and they lack an explanation concerning the

act they believe that it is because concerned people are possessed by the devil According

to some respondents incidents like these where people commit such crime that lack

Figure 1 Perceived traumatic events

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explanation were not common in the olden days Eight per cent of the participants

perceived devil possession as a cause of violence This was reflected in the following

quotes

As far as rape is concerned I really do not know what is in the minds of men because theyeven rape babies of less than a year old In some cases one may think this may be influencedby Satanism (RP 32)

The other cause is that children these days are used by the devil or is like they have evil spiritsor possessed since they just kill as an end in itself and do not indicate why they killed or atleast show some hidden motive of wanting to steal that personrsquos money (RP 74)

Witchcraft

Though many respondents realised that they were living in a violent environment where

violent incidents occurred in their lives 8 attributed the causes of its trauma to

witchcraft Their explanations of the occurrence of traumatic incidents tended to suite their

held beliefs For example the interpretation of mishaps or misfortunes that befell

individuals was believed to be caused by witchcraft The belief that witchcraft is the cause

of violent incidents is reflected in the following

I think mine is obvious that there could be somebody who is after me because a person cannothave a series of accidents one after the other In Venda if incidents are happening like thiswe start to suspect that someone is bewitching you (RP 22)

I also felt the same way about the cause of my sonrsquos death I have a very strong suspicion thathe was bewitched (RP 51)

You may find that one of the people who were in the truck was bewitched and now it hasaffected all of us (RP 62)

When we are praying there are others who are working for Satanism so I cannot rule out that itmight be due to demons or witchcraft (RP 74)

Ancestral spirits

Even though most respondents believed in witchcraft as a cause of traumatic events

some respondents believed in ancestral causes It was interesting to note that the belief

in the connection of trauma to ancestral power was mostly held by older respondents

They mentioned that their ancestors talk to them and sometimes tend to understand

why some traumatic incidents happen to them For others it was an honour when their

ancestors talked to them because they were helping them with the type of intervention

that they must use for their problem Another point is that respondents showed that

they obey their ancestors and their instructions so that even understanding why

some mishaps are happening in their lives was not a concern The following extracts

reflect this

One day my father visited me in my sleep and told me to consult a traditional healerI consulted a traditional healer who told me that I have lsquotshilisorsquo (meaning something thatsomeone gives you without your awareness which ends up like a poison in your body)(RP 33)

To tell you the truth I think this is a punishment from my father because the cattle that I saiddied on one night were not given to me alone I took them forcefully from my half brother whowas my fatherrsquos favourite child From that time nothing went on smoothly in my life I am justworried that it seems as if even my following generation will suffer like what I did as a way ofpaying for what I did wrong (RP 68)

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Other causes of trauma

The study also revealed that trauma was caused by non-cultural factors Some participants

attributed traumatic experiences to the abuse of substances intimate partner violence

rape robbery road accidents and murder These are presented next

Substance abuse

Twelve per cent of the participants indicated that trauma was caused by the abuse of

substances They believed that when young people are under the influence of drugs they

involve themselves in violent acts which then affect the community as a whole They are

usually involved in housebreaking murder and rape This is reflected in the following

responses

The main cause of all this trouble is drugs and alcohol that the youth are using In mostinstances they are always at the bars drinking alcohol and smoking drugs After that they gowherever and cause all this troubles (RP 6)

I think that when the youths are involved in drugs they end up being involved in things likehousebreaking (RP 14)

I think the other cause is that young people use drugs that influence them to commit crimessuch as housebreaking and rape (RP 36)

As far as road accidents are concerned I think people sometimes drive when they are drunk ordrive recklessly which may also contribute to traumatic incidents (RP 65)

Road accidents may be caused by reckless driving and driving when people are drunk (RP 67)

Intimate partner violence

Some participants showed that intimate partner violence occurs among people though

very few report the incidents In almost all focus groups in this study very few responses

emerged around intimate partner violence as a form of a traumatic event This probably

happened because most people seem to consider domestic violence to be a normal way of

life in a family or in the community This is also regarded as something that is not

supposed to be disclosed This was reflected as follows

The other thing that people do not talk about is domestic violence (RP 33)

Domestic violence is also common but it is complicated because many women do not talkabout it even when they are being abused all the time (RP 36)

if he drinks he beats kicks and insults using vulgar words I mean those deep Vendawords that my children are not supposed to hear as these I think also affect them This hasbecome part of our life in this family that we just told ourselves that we should accept it assuch (RP 40)

Rape

Rape was mentioned in almost all focus group discussions Participants were concerned

about the fact that rape happens to people of all ages including children and it also makes

them feel unsafe Rape brings about fear in peoplersquos lives In these focus groups 21

reported having been raped and even those who were not subjected to this type of violence

showed concern that they were afraid of this act This is reflected by the following extracts

It is true because it is not safe to walk long distances alone where there is a small bush from 6pm onwards If you walk there alone you are just inviting trouble (RP 11)

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Rape is something that we cannot leave out as it is becoming the order of the day (RP 32)

The common traumatic events in our area include rape and housebreaking Usually we do notfeel safe anymore when we are away We are always fearful that anything bad can happen atany time (RP 40)

Robbery

Robbery appeared to be contributing to a fearful environment for most participants They

felt that house and business breaking was traumatic The finding s supported by the

following statements

Housebreaking is threatening because you do not know what will happen after the personenters the house (RP 53)

Besides rape other common incidents include housebreaking and theft These days even if youare asleep you do not even know what will happen as thieves and criminals rob at night(RP 58)

The other thing which we see as a problem is theft even during the day This also includeshousebreaking which makes people not to feel safe (RP 70)

Road accidents

Another form of violence that emerged from the focus group discussions was road

accidents It appeared that road accidents created situations that became traumatic and

violent to many respondents Seventeen per cent of the participants reported incidences of

having been involved or affected in road accidents Like rape road accidents became a

concern for many respondents as in the following responses

Road accidents are very common Some victims of road accidents are school childrenSometimes these accidents happen in succession and it becomes very painful (RP 32)

Now that we are going for holidays you will hear a number of road accidents reported evenhere at our place The problem is that in some cases other people die and it is very painful forthe relatives who are left behind (RP 61)

Murder

Twelve per cent of the participants reported incidences of a family member or relative who

was murdered There was a general feeling of concern that people no longer have respect

for life The finding is supported by the following statements

Another problem around here is killings Mostly boys do this They kill each other like fliesSome people are killed by guns and some by knives (RP 7)

From the place where I come from incidences of shooting are escalating It is now becomingthe way of life where thieves may even shoot you when you are inside your house (RP 16)

Discussion

Most of the participants attributed the cause of trauma to witchcraft (60) followed by

mazhuzhulu (panic reaction to frightening thought or event) (20) The finding supports

the notion that peoplersquo understanding of trauma and its causes anchors on their

macrosystem the cultural lsquoblueprintrsquo that partially determines social structures and

activities that occur (Eamon 2001) In the present study the Venda-speaking participants

190 A Nevhutalu and P Mudhovozi

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conceptualised trauma and its causes from their cultural beliefs Also the finding is in line

with Foulks et alrsquos (1977) assertion that Africans do not believe in chance bad luck or

fate They believe that every illness has an intention and a specific cause Their culture

includes customs values beliefs attitudes implicit rules of conduct patterns of family

social organisation taboos and sanctions which they shared (Triandis 1994 De Silva in

Yule 1999) Nonetheless 20 of the participants indicated that the trauma just happened

This view might have been put forward by participants who do not subscribe to the

traditional explanation of witchraft and mazhuluzhulu Another plausible explanation is

that the 20 may account for Black Africans who embraced the individualistic western

cultural values

Therefore the microsystems (immediate setting) mesosystems (processes between

two or more microsystems) exosystems (processes between two or more settings)

macrosystems (influences of a broader culture and socio-economic environments) and

chronosystems (effects of consistency and change over life course) among the Venda-

speaking participants influenced their understanding of the causes of trauma (Eamon

2001) Thus these structures of the ecological environment served as a framework for the

explanation of the Africansrsquo belief system among the Venda-speaking participants It is

therefore not surprising that most of them (60) attributed trauma to witchcraft

The above finding is in line with the notion that for many Africans Christianity was

only adopted outwardly and did not inspire them spiritually According to Waruta and

Kinoti (1994) many Africans still maintain their traditional beliefs and practices during

important or critical stages in life (like birth initiation marriage death incurable sickness

and other anxieties in daily living) while upholding their piety as bequeathed to them in the

missionary enterprise Waruta and Kinoti (1994) furthermore hold that any kind of

medical treatment which is unrelated to the supernatural and to the community has

limited chances of success in Africa even if half the patients profess to be Christians

Contrary to the above the western-oriented PTSD model fails to account for the cultural

pluralistic experience of trauma (Collins 2004)

Some participants cited devil possession and ancestral spirits as the major causes of

trauma The responses reflect the influence of the mesosystem on individual members The

mesosystem integrates the interrelations between two or more microsystems each of

which contains the developing person In an African view the mesosystem is the

intermediate universe It functions as a no-manrsquos land since it is believed to take place

where evil spirits witches and sorcerers dwell It is also called the lsquostructured collective

imaginaryrsquo a system that is highly respected for giving rise to all good and bad fortune as

well as giving of form to peoplersquos desires fears anxieties and hope for success It is also

believed to regulate the day-to-day psychological fate of individual human beings in

Africa (van Dyk 2001)

Contrary to expectation the study did lend support the notion that in an African

environment there is a belief that ritual impurities are usually associated with death the

reproductive system and the violation of sexual prohibitions (van Dyk 2001) It had been

argued that the violation of sexual prohibitions like sexual intercourse with a woman

during menstruation with a widow before she is cleansed or with a woman who has had

an abortion or miscarriage can lead to a variety of health problems However in this case

the wrath of ancestors is believed to cause illness but it is also believed that witches

sometimes use sexual intercourse to cause illness Besides this belief about witches and

ancestors as causes of illnesses (van Dyk 2001) events that occur in a community have

consequences on individuals in the home For example a community may believe in

International Journal of Health Promotion and Education 191

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witchcraft Failure by particular family members to co-operate with other community

members may lead those individuals to be suspects of witchcraft (van Dyk 2001)

The above finding is compatible with Kazarian and Evansrsquos (1998) assertion that the

ancestors can punish their people by sending illness and misfortune if social norms are

violated or when culturally prescribed practices are neglected or incorrectly performed

The illness might be caused by failure to perform a cultural and religious ritual

Nevertheless it is assumed that peaceful living with onersquos neighbours observing social

norms and living in harmony with onersquos environment and with God spirits and ancestors

are all essential to protect oneself and onersquos family from disease (Ebigbo 1987)

It emerged from the study that trauma also results from non-cultural causes Some

participants attributed traumatic experiences to the abuse of substances intimate partner

violence rape robbery road accidents and murder This finding is in line with Gopaul-

McNicol and Brice-Bakerrsquos (1998) argument that the majority of Africans acknowledge

that some illnesses have natural or organic causes In the same vein Eamon (2001) opines

that certain illnesses are originated in the microsystem The microsystem consists of the

immediate environment such as onersquos home friends relatives school and society In this

study the microsystem represents the everyday practical social and collective life of

people in Africa (van Dyk 2001)

Conclusion

The DSM-IV-TR and the ICD-10 explain the western understanding of the causes of

trauma (Collins 2004) However the given explanations do not suit the traditional African

concept of trauma The psychiatric categories that are used to understand measure and

classify mental distress are specific to western culture and society They ignore and

undermine the African concepts of suffering misfortune and illness Africansrsquo

conceptualisation of trauma and its causes is influenced by several contextual factors

Contextual factors include their social political and cultural realities To a larger extent

the Venda-speaking participants attributed trauma to witchcraft angry ancestral spirits and

devil possession The study concludes that culture is a determining factor in peoplesrsquo lives

influencing both decisions and understanding of the illnesses

Limitations of the study

This study has some limitations All the participants were drawn from the Venda-speaking

ethnic group The study is short of the voices of the Tsonga Pedi Afrikaans and English-

speaking people in the Limpopo Province Considering the qualitative nature of the

present study the findings are not generalisable

References

Collins A 2004 Trauma in context advanced reader Durban University of Kwazulu NatalDenzin NK and Lincoln YS eds 1998 Collecting and interpreting qualitative materials

London Sagevan Dyk A 2001 Traditional African beliefs and customs Implications for AIDS education and

prevention in Africa South African Journal of Psychology 31 60ndash66Eamon MK 2001 The effects of poverty on childrenrsquos socioemotional development an ecological

systems analysis Social Work 46 256ndash266Ebigbo PE 1987 The mind body and society an African perspective International Journal for

the Advancement of Health 3 (4) 45ndash57Foulks EF et al 1977 Current perspectives in cultural psychiatry New York Spectrum

192 A Nevhutalu and P Mudhovozi

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ober

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4

Gopaul-McNicol S and Brice-Baker J 1998 Cross-cultural practice assessment treatment andtraining Canada Wiley

Kazarian SS and Evans DR 1998 Cultural clinical psychology theory research and practiceOxford Oxford University Press

Madu SN Baguma P and Pritz A 1999 Traditional healersrsquo approach to the schizophreniaFrankfurt IKO Verlag

Marshall C and Rossman GB 1999 Designing qualitative research 3rd ed New Delhi SageMatsumoto D 1996 Culture and psychology Pacific Grove CA BrooksColeNeuman WL 2000 Social research methods qualitative and quantitative approaches 4th ed

Boston MA Allyn amp BaconPeltzer K 2001 Exposure to violence and posttraumatic stress disorder in a rural adult population

in South Africa Acta Academica 32 73ndash84Struwig FW and Stead GB 2001 Planning designing and reporting research Pinelands

Cape Town Maskew Miller LongmanScholten A 2012 Bradycardia (Bradyarrythmia) [online] Available from httpcvimednyueduTriandis HC 1994 Culture and social behaviour New York McGraw-Hillde Vos AS ed 1998 Research at grassroots a prime for the caring professions Pretoria

Van SchaikWaruta DW and Kinoti HW 1994 Pastoral care in African Christianity essays in pastoral

theology Nairobi ActonYule W 1999 Post-traumatic stress disorders concepts and therapy Chichester Willey

International Journal of Health Promotion and Education 193

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ober

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4

culture is predominantly vital in shaping peoplersquos lives Even when people are

traumatised it is important to consider how different cultures view trauma and peoplersquos

reactions to it

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) and the

International Statistical Classification of Diseases (ICD-10) are said to contain a particular

way of diagnosis to the world One may argue that different cultural contexts make it not

realistic that the diagnosis can suit all cultures across the world Collins (2004) argues that

the DSM-IV and ICD-10 contain information that is western orientated Thus the

psychiatric categories that are used to understand measure and classify mental distress are

specific to western culture and society

According to van Dyk (2001) the local concepts of suffering misfortune and

illness have been ignored and undermined It is maintained that the contextual factors

are critical in influencing and shaping how traumatic events are experienced

responded to and explained The society or individuals use these contextual factors to

experience what is considered traumatic Contextual factors include the social

political and cultural realities in which people exist and utilise to make sense of what

happens to them

Thus the PTSD model is said to have some shortcomings that include the fact that it

focuses on the individual while downplaying the effects of trauma on family friends and

other people in the traumatised personrsquos social world It also fails to acknowledge that

whole communities can experience trauma on a collective basis (Collins 2004) However

there are traditional methods that are available for the treatment of mental disorders

despite the psychological intervention which is of western origin

Method

Research design

This was an exploratory study whereby a qualitative method using focus group discussion

for data collection was utilised Neuman (2000) argues that an exploratory study is a study

into an area that has not been fully researched Much is not yet researched about on how

Africans understand PTSD especially in the Limpopo Province

Participants

Ten focus groups with a total of 75 participants (female frac14 55 male frac14 20 age

range frac14 25ndash60 years mean age frac14 356 years ethnicity Black African) were drawn using

convenience sampling method Participants were drawn from people who were involved in

traumatic incidents that include road accidents murder rape domestic violence and

housebreaking The sample was drawn from the rural communities of the Vhembe District

Each group consisted of 6ndash10 members from different villages in Thulamela and

Makhado municipalities For the purpose of this study the direct victims of violence

as well as their family members and relatives were found relevant as they were involved

in trauma-inducing events either directly or indirectly

Convenience sampling was used in this study This kind of sampling refers to a

haphazard selection of cases that conveniently suite the purpose of the study An example

of convenience sampling is like the street interview conducted by television interviewers

(Neuman 2000) A researcher selects those participants who are usually the nearest and

most easily available (de Vos 1998)

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Research instrument

Focus group discussion method is defined by Struwig and Stead (2001) as a carefully

planned discussion designed to obtain individualsrsquo perceptions on a defined area of interest

in a permissive non-threatening environment The discussions between the research

participants enable the participants to discuss issues they consider to be important In focus

groups the groups are generally composed of 7ndash10 people who are unfamiliar to one

another They should be selected because they share certain characteristics relevant to the

questions in the study (Marshall and Rossman 1999)

During the interview the interviewer creates a supportive environment asks

focused questions so as to encourage discussion and the expression of differing

opinions and points of view Questions start from the general and the non-threatening

and progress gradually to the specific and that which may be threatening Tricky

questions are asked to promote participantsrsquo expression of their views through the

creation of a supportive environment The interviewer should make participants feel

that their contributions are worthwhile and also that they are free to disagree with

each other The facilitator must be attentive and willing to listen Heshe must also

show an interest in what is being said encourage a wide range of opinions

assist participants to explore their ideas further avoid belittling participants and

direct the conversation when people become repetitive or move away from the topic

(Struwig and Stead 2001)

The rationale for using focus groups was that these groups share a common

characteristic of having been involved in traumatic incidents either directly or

indirectly This encouraged them to speak more freely without fear of being judged

by others It is believed that people often need to listen to other peoplersquos opinion and

understanding to form their own The focus group method relies on group discussion

and for the discussion to be successful participants must be able to talk to each other

about the topic of interest This method assumes that an individualrsquos attitudes and

beliefs do not form in a vacuum Focus group method was found relevant in this

study for its excellence in obtaining information from illiterate communities and as a

way of discovering attitudes and opinions which might not be revealed in a survey

questionnaire

Procedure

Telephonic requests were made with some known members of the Thulamela and

Makhado Municipalities to contact people who were involved in traumatic incidents

These people those who were requested to contact traumatised people were told about the

purpose of the focus groups and the confidentiality involved Members of civic structures

and pastors were among other people who helped to organise group members from the

mentioned communities Appointment dates were organised for each focus group and

discussions took place as arranged

Two sessions were held per week for each focus group Each session lasted for an

hour and a half Some sessions were conducted in churches and others were held at the

victimsrsquo homes The focus groups were conducted in Venda which is the mother tongue

of the participants and the researcher It was explained to the participants that the

sessions will be confidential Participantsrsquo consent was sought for the use of a tape

recorder to keep record of the sessions Tape-recorded information was transcribed

immediately after the sessions and later translated from Venda to English and back-

translated for validation purposes

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Trustworthiness

Marshall and Rossman (1999) maintain that research should respond to canons that are

regarded as criteria in which trustworthiness can be evaluated These canons are viewed by

Lincoln and Guba (in Marshall and Rossman 1999) as classical contribution to the

methodology of qualitative research They are credibility transferability dependability

and confirmability These four constructs establish the lsquotruth-valuersquo of a study The truth-

value refers to the applicability consistency and neutrability One may argue that

credibility transferability dependability and confirmability may be matched with internal

validity external validity reliability and objectivity which are appropriate for the

positivist paradigm and inappropriate for qualitative inquiry (Marshall and Rossman

1999) The four constructs that are appropriate for qualitative inquiry are discussed next

Credibility

In qualitative research credibility is maintained by an inquiry that ensures that the subject

is accurately identified and described (de Vos 1998) In this study continuous interaction

with participants through focus groups ensured that the subjects were accurately identified

and described

Transferability

Transferability refers to the applicability of one set of findings to another context (de Vos

1998) de Vos (1998) further argues that the demonstration of applicability of one set of

findings to another depends on the investigator who should make the transfer than the

original investigator Interestingly there are researchers who regard transferability as a

weakness in the approach To counter-challenge this idea the researcher can refer back to

the original theoretical framework to show how data collection and their analysis will be

guided by concepts and models (Marshall and Rossman 1999) In this study the findings

might be useful in clinical setting to help traumatised people That is the findings can be

used by helping professionals in South Africa considering the fact that the study is

conceptualised from the African cultural perspective

Dependability

Dependability is the third construct It refers to an attempt by the researcher to change

conditions in the phenomena chosen for the study This applies to the changes in the design

created by a refined understanding of the setting However qualitative researchers can

assert that qualitative research cannot be replicated because of the changing world They

plan to keep notes or log that record each design decision and the rationale behind it Their

procedures protocols and decisions can thus be inspected (de Vos 1998) In this study the

protocols procedures and decisions have been recorded All collected data are well

organised in a retrievable form and are easily available to challenge the notion of the

changing world

Confirmability

This is the last construct Lincoln and Guba (in Marshall and Rossman 1999) emphasise

the need to ask whether or not the findings of the study could be confirmed by another

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Because of the fact that the sample of this study was small the findings are less

generalisable

Data analysis

Thematic content analysis was used to analyse the data Tapes were transcribed from

Venda (the language of the interviewees) to English and back-translated to Venda for

validation purposes The data were coded analysed through reading and re-reading of

responses The rationale for reading and re-reading is that the researcher becomes familiar

with that data in intimate ways People events and quotations sift constantly through the

researcherrsquos mind (Marshall and Rossman 1999) The data were then analysed into four

steps as follows

Step 1 Analysis of individual transcripts

This step involves reading individual transcripts in several different ways First transcripts

were read as a whole noting general impressions Major opinions and attitudes that were

expressed by the groups were considered When transcripts were read for the second time

specific things that were looked for which were mainly from the objectives of the study

were noted Sections that were poorly transcribed and did not make sense were removed

Transcripts were coded sectioned and marked in the way that indicated what the

participants talked about The final step in reading the transcripts involved using the list of

required information and checking what information has been obtained

Step 2 The logbook

The logbook was used to keep all the responses together according to the topic of interest

Each response was entered unless it was exactly the same as another The main aim was to

retain the full range of responses

Step 3 Writing the results

Results were not only written from the logbook but also from the notes that were made

while reading transcripts as a whole As many reported results from the focus groups did

not indicate how many focus groups or participants discussed a certain issue results will

say lsquomany respondents said rsquo or lsquoonly a few groups discussions raised the issue of rsquo

Step 4 Interpretation

Throughout the study the researchers were thinking about the significance of the

information that was collected in terms of the problem or question that they wanted to

answer and to develop ideas about what the respondents said Results were looked at and

summaries were written

Ethical considerations

Participants in this study were informed about the nature and purpose of the study

Complete information about the study was explained for participants to comprehend the

purpose of the study This was done in order for participants to make a voluntary decision

about their participation (de Vos 1998) Participants were informed that they will be

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involved in focus groups and the study is for educational purposes It was clearly indicated

that each focus group would last approximately 45ndash90 minutes The researcher also

explained to the participants that freedom is respected and as such they had to participate

voluntarily without any physical or psychological force

Furthermore they were informed that they would benefit from the focus groups as

they would share their traumatic experiences among themselves Confidentiality and

privacy was assured so that participants were safe from exposure (Denzin and Lincoln

1998) Information from focus groups was given anonymously to ensure the privacy of

subjects However participants were informed that a tape recorder will be used so that

participantsrsquo privacy cannot be affected if the tape recorder is used as a hidden

apparatus

Results

Figure 1 shows that most of the participants attributed the cause of trauma to witchcraft

(60) followed bymazhuzhulu (panic reaction to frightening thought or event) (20) and

the belief that it just happened (20)

Interview responses on culture-related causes of trauma

It emerged from the study that some participants believed that trauma was caused by

culturally related causes They cited devil possession witchcraft and ancestral spirits as

the major causes of trauma These are presented next

Devil possession

There are instances wherein people tend to attribute violence like rape and murder to devil

possession Whenever such incidents occur and they lack an explanation concerning the

act they believe that it is because concerned people are possessed by the devil According

to some respondents incidents like these where people commit such crime that lack

Figure 1 Perceived traumatic events

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explanation were not common in the olden days Eight per cent of the participants

perceived devil possession as a cause of violence This was reflected in the following

quotes

As far as rape is concerned I really do not know what is in the minds of men because theyeven rape babies of less than a year old In some cases one may think this may be influencedby Satanism (RP 32)

The other cause is that children these days are used by the devil or is like they have evil spiritsor possessed since they just kill as an end in itself and do not indicate why they killed or atleast show some hidden motive of wanting to steal that personrsquos money (RP 74)

Witchcraft

Though many respondents realised that they were living in a violent environment where

violent incidents occurred in their lives 8 attributed the causes of its trauma to

witchcraft Their explanations of the occurrence of traumatic incidents tended to suite their

held beliefs For example the interpretation of mishaps or misfortunes that befell

individuals was believed to be caused by witchcraft The belief that witchcraft is the cause

of violent incidents is reflected in the following

I think mine is obvious that there could be somebody who is after me because a person cannothave a series of accidents one after the other In Venda if incidents are happening like thiswe start to suspect that someone is bewitching you (RP 22)

I also felt the same way about the cause of my sonrsquos death I have a very strong suspicion thathe was bewitched (RP 51)

You may find that one of the people who were in the truck was bewitched and now it hasaffected all of us (RP 62)

When we are praying there are others who are working for Satanism so I cannot rule out that itmight be due to demons or witchcraft (RP 74)

Ancestral spirits

Even though most respondents believed in witchcraft as a cause of traumatic events

some respondents believed in ancestral causes It was interesting to note that the belief

in the connection of trauma to ancestral power was mostly held by older respondents

They mentioned that their ancestors talk to them and sometimes tend to understand

why some traumatic incidents happen to them For others it was an honour when their

ancestors talked to them because they were helping them with the type of intervention

that they must use for their problem Another point is that respondents showed that

they obey their ancestors and their instructions so that even understanding why

some mishaps are happening in their lives was not a concern The following extracts

reflect this

One day my father visited me in my sleep and told me to consult a traditional healerI consulted a traditional healer who told me that I have lsquotshilisorsquo (meaning something thatsomeone gives you without your awareness which ends up like a poison in your body)(RP 33)

To tell you the truth I think this is a punishment from my father because the cattle that I saiddied on one night were not given to me alone I took them forcefully from my half brother whowas my fatherrsquos favourite child From that time nothing went on smoothly in my life I am justworried that it seems as if even my following generation will suffer like what I did as a way ofpaying for what I did wrong (RP 68)

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Other causes of trauma

The study also revealed that trauma was caused by non-cultural factors Some participants

attributed traumatic experiences to the abuse of substances intimate partner violence

rape robbery road accidents and murder These are presented next

Substance abuse

Twelve per cent of the participants indicated that trauma was caused by the abuse of

substances They believed that when young people are under the influence of drugs they

involve themselves in violent acts which then affect the community as a whole They are

usually involved in housebreaking murder and rape This is reflected in the following

responses

The main cause of all this trouble is drugs and alcohol that the youth are using In mostinstances they are always at the bars drinking alcohol and smoking drugs After that they gowherever and cause all this troubles (RP 6)

I think that when the youths are involved in drugs they end up being involved in things likehousebreaking (RP 14)

I think the other cause is that young people use drugs that influence them to commit crimessuch as housebreaking and rape (RP 36)

As far as road accidents are concerned I think people sometimes drive when they are drunk ordrive recklessly which may also contribute to traumatic incidents (RP 65)

Road accidents may be caused by reckless driving and driving when people are drunk (RP 67)

Intimate partner violence

Some participants showed that intimate partner violence occurs among people though

very few report the incidents In almost all focus groups in this study very few responses

emerged around intimate partner violence as a form of a traumatic event This probably

happened because most people seem to consider domestic violence to be a normal way of

life in a family or in the community This is also regarded as something that is not

supposed to be disclosed This was reflected as follows

The other thing that people do not talk about is domestic violence (RP 33)

Domestic violence is also common but it is complicated because many women do not talkabout it even when they are being abused all the time (RP 36)

if he drinks he beats kicks and insults using vulgar words I mean those deep Vendawords that my children are not supposed to hear as these I think also affect them This hasbecome part of our life in this family that we just told ourselves that we should accept it assuch (RP 40)

Rape

Rape was mentioned in almost all focus group discussions Participants were concerned

about the fact that rape happens to people of all ages including children and it also makes

them feel unsafe Rape brings about fear in peoplersquos lives In these focus groups 21

reported having been raped and even those who were not subjected to this type of violence

showed concern that they were afraid of this act This is reflected by the following extracts

It is true because it is not safe to walk long distances alone where there is a small bush from 6pm onwards If you walk there alone you are just inviting trouble (RP 11)

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Rape is something that we cannot leave out as it is becoming the order of the day (RP 32)

The common traumatic events in our area include rape and housebreaking Usually we do notfeel safe anymore when we are away We are always fearful that anything bad can happen atany time (RP 40)

Robbery

Robbery appeared to be contributing to a fearful environment for most participants They

felt that house and business breaking was traumatic The finding s supported by the

following statements

Housebreaking is threatening because you do not know what will happen after the personenters the house (RP 53)

Besides rape other common incidents include housebreaking and theft These days even if youare asleep you do not even know what will happen as thieves and criminals rob at night(RP 58)

The other thing which we see as a problem is theft even during the day This also includeshousebreaking which makes people not to feel safe (RP 70)

Road accidents

Another form of violence that emerged from the focus group discussions was road

accidents It appeared that road accidents created situations that became traumatic and

violent to many respondents Seventeen per cent of the participants reported incidences of

having been involved or affected in road accidents Like rape road accidents became a

concern for many respondents as in the following responses

Road accidents are very common Some victims of road accidents are school childrenSometimes these accidents happen in succession and it becomes very painful (RP 32)

Now that we are going for holidays you will hear a number of road accidents reported evenhere at our place The problem is that in some cases other people die and it is very painful forthe relatives who are left behind (RP 61)

Murder

Twelve per cent of the participants reported incidences of a family member or relative who

was murdered There was a general feeling of concern that people no longer have respect

for life The finding is supported by the following statements

Another problem around here is killings Mostly boys do this They kill each other like fliesSome people are killed by guns and some by knives (RP 7)

From the place where I come from incidences of shooting are escalating It is now becomingthe way of life where thieves may even shoot you when you are inside your house (RP 16)

Discussion

Most of the participants attributed the cause of trauma to witchcraft (60) followed by

mazhuzhulu (panic reaction to frightening thought or event) (20) The finding supports

the notion that peoplersquo understanding of trauma and its causes anchors on their

macrosystem the cultural lsquoblueprintrsquo that partially determines social structures and

activities that occur (Eamon 2001) In the present study the Venda-speaking participants

190 A Nevhutalu and P Mudhovozi

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conceptualised trauma and its causes from their cultural beliefs Also the finding is in line

with Foulks et alrsquos (1977) assertion that Africans do not believe in chance bad luck or

fate They believe that every illness has an intention and a specific cause Their culture

includes customs values beliefs attitudes implicit rules of conduct patterns of family

social organisation taboos and sanctions which they shared (Triandis 1994 De Silva in

Yule 1999) Nonetheless 20 of the participants indicated that the trauma just happened

This view might have been put forward by participants who do not subscribe to the

traditional explanation of witchraft and mazhuluzhulu Another plausible explanation is

that the 20 may account for Black Africans who embraced the individualistic western

cultural values

Therefore the microsystems (immediate setting) mesosystems (processes between

two or more microsystems) exosystems (processes between two or more settings)

macrosystems (influences of a broader culture and socio-economic environments) and

chronosystems (effects of consistency and change over life course) among the Venda-

speaking participants influenced their understanding of the causes of trauma (Eamon

2001) Thus these structures of the ecological environment served as a framework for the

explanation of the Africansrsquo belief system among the Venda-speaking participants It is

therefore not surprising that most of them (60) attributed trauma to witchcraft

The above finding is in line with the notion that for many Africans Christianity was

only adopted outwardly and did not inspire them spiritually According to Waruta and

Kinoti (1994) many Africans still maintain their traditional beliefs and practices during

important or critical stages in life (like birth initiation marriage death incurable sickness

and other anxieties in daily living) while upholding their piety as bequeathed to them in the

missionary enterprise Waruta and Kinoti (1994) furthermore hold that any kind of

medical treatment which is unrelated to the supernatural and to the community has

limited chances of success in Africa even if half the patients profess to be Christians

Contrary to the above the western-oriented PTSD model fails to account for the cultural

pluralistic experience of trauma (Collins 2004)

Some participants cited devil possession and ancestral spirits as the major causes of

trauma The responses reflect the influence of the mesosystem on individual members The

mesosystem integrates the interrelations between two or more microsystems each of

which contains the developing person In an African view the mesosystem is the

intermediate universe It functions as a no-manrsquos land since it is believed to take place

where evil spirits witches and sorcerers dwell It is also called the lsquostructured collective

imaginaryrsquo a system that is highly respected for giving rise to all good and bad fortune as

well as giving of form to peoplersquos desires fears anxieties and hope for success It is also

believed to regulate the day-to-day psychological fate of individual human beings in

Africa (van Dyk 2001)

Contrary to expectation the study did lend support the notion that in an African

environment there is a belief that ritual impurities are usually associated with death the

reproductive system and the violation of sexual prohibitions (van Dyk 2001) It had been

argued that the violation of sexual prohibitions like sexual intercourse with a woman

during menstruation with a widow before she is cleansed or with a woman who has had

an abortion or miscarriage can lead to a variety of health problems However in this case

the wrath of ancestors is believed to cause illness but it is also believed that witches

sometimes use sexual intercourse to cause illness Besides this belief about witches and

ancestors as causes of illnesses (van Dyk 2001) events that occur in a community have

consequences on individuals in the home For example a community may believe in

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witchcraft Failure by particular family members to co-operate with other community

members may lead those individuals to be suspects of witchcraft (van Dyk 2001)

The above finding is compatible with Kazarian and Evansrsquos (1998) assertion that the

ancestors can punish their people by sending illness and misfortune if social norms are

violated or when culturally prescribed practices are neglected or incorrectly performed

The illness might be caused by failure to perform a cultural and religious ritual

Nevertheless it is assumed that peaceful living with onersquos neighbours observing social

norms and living in harmony with onersquos environment and with God spirits and ancestors

are all essential to protect oneself and onersquos family from disease (Ebigbo 1987)

It emerged from the study that trauma also results from non-cultural causes Some

participants attributed traumatic experiences to the abuse of substances intimate partner

violence rape robbery road accidents and murder This finding is in line with Gopaul-

McNicol and Brice-Bakerrsquos (1998) argument that the majority of Africans acknowledge

that some illnesses have natural or organic causes In the same vein Eamon (2001) opines

that certain illnesses are originated in the microsystem The microsystem consists of the

immediate environment such as onersquos home friends relatives school and society In this

study the microsystem represents the everyday practical social and collective life of

people in Africa (van Dyk 2001)

Conclusion

The DSM-IV-TR and the ICD-10 explain the western understanding of the causes of

trauma (Collins 2004) However the given explanations do not suit the traditional African

concept of trauma The psychiatric categories that are used to understand measure and

classify mental distress are specific to western culture and society They ignore and

undermine the African concepts of suffering misfortune and illness Africansrsquo

conceptualisation of trauma and its causes is influenced by several contextual factors

Contextual factors include their social political and cultural realities To a larger extent

the Venda-speaking participants attributed trauma to witchcraft angry ancestral spirits and

devil possession The study concludes that culture is a determining factor in peoplesrsquo lives

influencing both decisions and understanding of the illnesses

Limitations of the study

This study has some limitations All the participants were drawn from the Venda-speaking

ethnic group The study is short of the voices of the Tsonga Pedi Afrikaans and English-

speaking people in the Limpopo Province Considering the qualitative nature of the

present study the findings are not generalisable

References

Collins A 2004 Trauma in context advanced reader Durban University of Kwazulu NatalDenzin NK and Lincoln YS eds 1998 Collecting and interpreting qualitative materials

London Sagevan Dyk A 2001 Traditional African beliefs and customs Implications for AIDS education and

prevention in Africa South African Journal of Psychology 31 60ndash66Eamon MK 2001 The effects of poverty on childrenrsquos socioemotional development an ecological

systems analysis Social Work 46 256ndash266Ebigbo PE 1987 The mind body and society an African perspective International Journal for

the Advancement of Health 3 (4) 45ndash57Foulks EF et al 1977 Current perspectives in cultural psychiatry New York Spectrum

192 A Nevhutalu and P Mudhovozi

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ober

201

4

Gopaul-McNicol S and Brice-Baker J 1998 Cross-cultural practice assessment treatment andtraining Canada Wiley

Kazarian SS and Evans DR 1998 Cultural clinical psychology theory research and practiceOxford Oxford University Press

Madu SN Baguma P and Pritz A 1999 Traditional healersrsquo approach to the schizophreniaFrankfurt IKO Verlag

Marshall C and Rossman GB 1999 Designing qualitative research 3rd ed New Delhi SageMatsumoto D 1996 Culture and psychology Pacific Grove CA BrooksColeNeuman WL 2000 Social research methods qualitative and quantitative approaches 4th ed

Boston MA Allyn amp BaconPeltzer K 2001 Exposure to violence and posttraumatic stress disorder in a rural adult population

in South Africa Acta Academica 32 73ndash84Struwig FW and Stead GB 2001 Planning designing and reporting research Pinelands

Cape Town Maskew Miller LongmanScholten A 2012 Bradycardia (Bradyarrythmia) [online] Available from httpcvimednyueduTriandis HC 1994 Culture and social behaviour New York McGraw-Hillde Vos AS ed 1998 Research at grassroots a prime for the caring professions Pretoria

Van SchaikWaruta DW and Kinoti HW 1994 Pastoral care in African Christianity essays in pastoral

theology Nairobi ActonYule W 1999 Post-traumatic stress disorders concepts and therapy Chichester Willey

International Journal of Health Promotion and Education 193

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ober

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4

Research instrument

Focus group discussion method is defined by Struwig and Stead (2001) as a carefully

planned discussion designed to obtain individualsrsquo perceptions on a defined area of interest

in a permissive non-threatening environment The discussions between the research

participants enable the participants to discuss issues they consider to be important In focus

groups the groups are generally composed of 7ndash10 people who are unfamiliar to one

another They should be selected because they share certain characteristics relevant to the

questions in the study (Marshall and Rossman 1999)

During the interview the interviewer creates a supportive environment asks

focused questions so as to encourage discussion and the expression of differing

opinions and points of view Questions start from the general and the non-threatening

and progress gradually to the specific and that which may be threatening Tricky

questions are asked to promote participantsrsquo expression of their views through the

creation of a supportive environment The interviewer should make participants feel

that their contributions are worthwhile and also that they are free to disagree with

each other The facilitator must be attentive and willing to listen Heshe must also

show an interest in what is being said encourage a wide range of opinions

assist participants to explore their ideas further avoid belittling participants and

direct the conversation when people become repetitive or move away from the topic

(Struwig and Stead 2001)

The rationale for using focus groups was that these groups share a common

characteristic of having been involved in traumatic incidents either directly or

indirectly This encouraged them to speak more freely without fear of being judged

by others It is believed that people often need to listen to other peoplersquos opinion and

understanding to form their own The focus group method relies on group discussion

and for the discussion to be successful participants must be able to talk to each other

about the topic of interest This method assumes that an individualrsquos attitudes and

beliefs do not form in a vacuum Focus group method was found relevant in this

study for its excellence in obtaining information from illiterate communities and as a

way of discovering attitudes and opinions which might not be revealed in a survey

questionnaire

Procedure

Telephonic requests were made with some known members of the Thulamela and

Makhado Municipalities to contact people who were involved in traumatic incidents

These people those who were requested to contact traumatised people were told about the

purpose of the focus groups and the confidentiality involved Members of civic structures

and pastors were among other people who helped to organise group members from the

mentioned communities Appointment dates were organised for each focus group and

discussions took place as arranged

Two sessions were held per week for each focus group Each session lasted for an

hour and a half Some sessions were conducted in churches and others were held at the

victimsrsquo homes The focus groups were conducted in Venda which is the mother tongue

of the participants and the researcher It was explained to the participants that the

sessions will be confidential Participantsrsquo consent was sought for the use of a tape

recorder to keep record of the sessions Tape-recorded information was transcribed

immediately after the sessions and later translated from Venda to English and back-

translated for validation purposes

184 A Nevhutalu and P Mudhovozi

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Oct

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4

Trustworthiness

Marshall and Rossman (1999) maintain that research should respond to canons that are

regarded as criteria in which trustworthiness can be evaluated These canons are viewed by

Lincoln and Guba (in Marshall and Rossman 1999) as classical contribution to the

methodology of qualitative research They are credibility transferability dependability

and confirmability These four constructs establish the lsquotruth-valuersquo of a study The truth-

value refers to the applicability consistency and neutrability One may argue that

credibility transferability dependability and confirmability may be matched with internal

validity external validity reliability and objectivity which are appropriate for the

positivist paradigm and inappropriate for qualitative inquiry (Marshall and Rossman

1999) The four constructs that are appropriate for qualitative inquiry are discussed next

Credibility

In qualitative research credibility is maintained by an inquiry that ensures that the subject

is accurately identified and described (de Vos 1998) In this study continuous interaction

with participants through focus groups ensured that the subjects were accurately identified

and described

Transferability

Transferability refers to the applicability of one set of findings to another context (de Vos

1998) de Vos (1998) further argues that the demonstration of applicability of one set of

findings to another depends on the investigator who should make the transfer than the

original investigator Interestingly there are researchers who regard transferability as a

weakness in the approach To counter-challenge this idea the researcher can refer back to

the original theoretical framework to show how data collection and their analysis will be

guided by concepts and models (Marshall and Rossman 1999) In this study the findings

might be useful in clinical setting to help traumatised people That is the findings can be

used by helping professionals in South Africa considering the fact that the study is

conceptualised from the African cultural perspective

Dependability

Dependability is the third construct It refers to an attempt by the researcher to change

conditions in the phenomena chosen for the study This applies to the changes in the design

created by a refined understanding of the setting However qualitative researchers can

assert that qualitative research cannot be replicated because of the changing world They

plan to keep notes or log that record each design decision and the rationale behind it Their

procedures protocols and decisions can thus be inspected (de Vos 1998) In this study the

protocols procedures and decisions have been recorded All collected data are well

organised in a retrievable form and are easily available to challenge the notion of the

changing world

Confirmability

This is the last construct Lincoln and Guba (in Marshall and Rossman 1999) emphasise

the need to ask whether or not the findings of the study could be confirmed by another

International Journal of Health Promotion and Education 185

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Because of the fact that the sample of this study was small the findings are less

generalisable

Data analysis

Thematic content analysis was used to analyse the data Tapes were transcribed from

Venda (the language of the interviewees) to English and back-translated to Venda for

validation purposes The data were coded analysed through reading and re-reading of

responses The rationale for reading and re-reading is that the researcher becomes familiar

with that data in intimate ways People events and quotations sift constantly through the

researcherrsquos mind (Marshall and Rossman 1999) The data were then analysed into four

steps as follows

Step 1 Analysis of individual transcripts

This step involves reading individual transcripts in several different ways First transcripts

were read as a whole noting general impressions Major opinions and attitudes that were

expressed by the groups were considered When transcripts were read for the second time

specific things that were looked for which were mainly from the objectives of the study

were noted Sections that were poorly transcribed and did not make sense were removed

Transcripts were coded sectioned and marked in the way that indicated what the

participants talked about The final step in reading the transcripts involved using the list of

required information and checking what information has been obtained

Step 2 The logbook

The logbook was used to keep all the responses together according to the topic of interest

Each response was entered unless it was exactly the same as another The main aim was to

retain the full range of responses

Step 3 Writing the results

Results were not only written from the logbook but also from the notes that were made

while reading transcripts as a whole As many reported results from the focus groups did

not indicate how many focus groups or participants discussed a certain issue results will

say lsquomany respondents said rsquo or lsquoonly a few groups discussions raised the issue of rsquo

Step 4 Interpretation

Throughout the study the researchers were thinking about the significance of the

information that was collected in terms of the problem or question that they wanted to

answer and to develop ideas about what the respondents said Results were looked at and

summaries were written

Ethical considerations

Participants in this study were informed about the nature and purpose of the study

Complete information about the study was explained for participants to comprehend the

purpose of the study This was done in order for participants to make a voluntary decision

about their participation (de Vos 1998) Participants were informed that they will be

186 A Nevhutalu and P Mudhovozi

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ober

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involved in focus groups and the study is for educational purposes It was clearly indicated

that each focus group would last approximately 45ndash90 minutes The researcher also

explained to the participants that freedom is respected and as such they had to participate

voluntarily without any physical or psychological force

Furthermore they were informed that they would benefit from the focus groups as

they would share their traumatic experiences among themselves Confidentiality and

privacy was assured so that participants were safe from exposure (Denzin and Lincoln

1998) Information from focus groups was given anonymously to ensure the privacy of

subjects However participants were informed that a tape recorder will be used so that

participantsrsquo privacy cannot be affected if the tape recorder is used as a hidden

apparatus

Results

Figure 1 shows that most of the participants attributed the cause of trauma to witchcraft

(60) followed bymazhuzhulu (panic reaction to frightening thought or event) (20) and

the belief that it just happened (20)

Interview responses on culture-related causes of trauma

It emerged from the study that some participants believed that trauma was caused by

culturally related causes They cited devil possession witchcraft and ancestral spirits as

the major causes of trauma These are presented next

Devil possession

There are instances wherein people tend to attribute violence like rape and murder to devil

possession Whenever such incidents occur and they lack an explanation concerning the

act they believe that it is because concerned people are possessed by the devil According

to some respondents incidents like these where people commit such crime that lack

Figure 1 Perceived traumatic events

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explanation were not common in the olden days Eight per cent of the participants

perceived devil possession as a cause of violence This was reflected in the following

quotes

As far as rape is concerned I really do not know what is in the minds of men because theyeven rape babies of less than a year old In some cases one may think this may be influencedby Satanism (RP 32)

The other cause is that children these days are used by the devil or is like they have evil spiritsor possessed since they just kill as an end in itself and do not indicate why they killed or atleast show some hidden motive of wanting to steal that personrsquos money (RP 74)

Witchcraft

Though many respondents realised that they were living in a violent environment where

violent incidents occurred in their lives 8 attributed the causes of its trauma to

witchcraft Their explanations of the occurrence of traumatic incidents tended to suite their

held beliefs For example the interpretation of mishaps or misfortunes that befell

individuals was believed to be caused by witchcraft The belief that witchcraft is the cause

of violent incidents is reflected in the following

I think mine is obvious that there could be somebody who is after me because a person cannothave a series of accidents one after the other In Venda if incidents are happening like thiswe start to suspect that someone is bewitching you (RP 22)

I also felt the same way about the cause of my sonrsquos death I have a very strong suspicion thathe was bewitched (RP 51)

You may find that one of the people who were in the truck was bewitched and now it hasaffected all of us (RP 62)

When we are praying there are others who are working for Satanism so I cannot rule out that itmight be due to demons or witchcraft (RP 74)

Ancestral spirits

Even though most respondents believed in witchcraft as a cause of traumatic events

some respondents believed in ancestral causes It was interesting to note that the belief

in the connection of trauma to ancestral power was mostly held by older respondents

They mentioned that their ancestors talk to them and sometimes tend to understand

why some traumatic incidents happen to them For others it was an honour when their

ancestors talked to them because they were helping them with the type of intervention

that they must use for their problem Another point is that respondents showed that

they obey their ancestors and their instructions so that even understanding why

some mishaps are happening in their lives was not a concern The following extracts

reflect this

One day my father visited me in my sleep and told me to consult a traditional healerI consulted a traditional healer who told me that I have lsquotshilisorsquo (meaning something thatsomeone gives you without your awareness which ends up like a poison in your body)(RP 33)

To tell you the truth I think this is a punishment from my father because the cattle that I saiddied on one night were not given to me alone I took them forcefully from my half brother whowas my fatherrsquos favourite child From that time nothing went on smoothly in my life I am justworried that it seems as if even my following generation will suffer like what I did as a way ofpaying for what I did wrong (RP 68)

188 A Nevhutalu and P Mudhovozi

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4

Other causes of trauma

The study also revealed that trauma was caused by non-cultural factors Some participants

attributed traumatic experiences to the abuse of substances intimate partner violence

rape robbery road accidents and murder These are presented next

Substance abuse

Twelve per cent of the participants indicated that trauma was caused by the abuse of

substances They believed that when young people are under the influence of drugs they

involve themselves in violent acts which then affect the community as a whole They are

usually involved in housebreaking murder and rape This is reflected in the following

responses

The main cause of all this trouble is drugs and alcohol that the youth are using In mostinstances they are always at the bars drinking alcohol and smoking drugs After that they gowherever and cause all this troubles (RP 6)

I think that when the youths are involved in drugs they end up being involved in things likehousebreaking (RP 14)

I think the other cause is that young people use drugs that influence them to commit crimessuch as housebreaking and rape (RP 36)

As far as road accidents are concerned I think people sometimes drive when they are drunk ordrive recklessly which may also contribute to traumatic incidents (RP 65)

Road accidents may be caused by reckless driving and driving when people are drunk (RP 67)

Intimate partner violence

Some participants showed that intimate partner violence occurs among people though

very few report the incidents In almost all focus groups in this study very few responses

emerged around intimate partner violence as a form of a traumatic event This probably

happened because most people seem to consider domestic violence to be a normal way of

life in a family or in the community This is also regarded as something that is not

supposed to be disclosed This was reflected as follows

The other thing that people do not talk about is domestic violence (RP 33)

Domestic violence is also common but it is complicated because many women do not talkabout it even when they are being abused all the time (RP 36)

if he drinks he beats kicks and insults using vulgar words I mean those deep Vendawords that my children are not supposed to hear as these I think also affect them This hasbecome part of our life in this family that we just told ourselves that we should accept it assuch (RP 40)

Rape

Rape was mentioned in almost all focus group discussions Participants were concerned

about the fact that rape happens to people of all ages including children and it also makes

them feel unsafe Rape brings about fear in peoplersquos lives In these focus groups 21

reported having been raped and even those who were not subjected to this type of violence

showed concern that they were afraid of this act This is reflected by the following extracts

It is true because it is not safe to walk long distances alone where there is a small bush from 6pm onwards If you walk there alone you are just inviting trouble (RP 11)

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Rape is something that we cannot leave out as it is becoming the order of the day (RP 32)

The common traumatic events in our area include rape and housebreaking Usually we do notfeel safe anymore when we are away We are always fearful that anything bad can happen atany time (RP 40)

Robbery

Robbery appeared to be contributing to a fearful environment for most participants They

felt that house and business breaking was traumatic The finding s supported by the

following statements

Housebreaking is threatening because you do not know what will happen after the personenters the house (RP 53)

Besides rape other common incidents include housebreaking and theft These days even if youare asleep you do not even know what will happen as thieves and criminals rob at night(RP 58)

The other thing which we see as a problem is theft even during the day This also includeshousebreaking which makes people not to feel safe (RP 70)

Road accidents

Another form of violence that emerged from the focus group discussions was road

accidents It appeared that road accidents created situations that became traumatic and

violent to many respondents Seventeen per cent of the participants reported incidences of

having been involved or affected in road accidents Like rape road accidents became a

concern for many respondents as in the following responses

Road accidents are very common Some victims of road accidents are school childrenSometimes these accidents happen in succession and it becomes very painful (RP 32)

Now that we are going for holidays you will hear a number of road accidents reported evenhere at our place The problem is that in some cases other people die and it is very painful forthe relatives who are left behind (RP 61)

Murder

Twelve per cent of the participants reported incidences of a family member or relative who

was murdered There was a general feeling of concern that people no longer have respect

for life The finding is supported by the following statements

Another problem around here is killings Mostly boys do this They kill each other like fliesSome people are killed by guns and some by knives (RP 7)

From the place where I come from incidences of shooting are escalating It is now becomingthe way of life where thieves may even shoot you when you are inside your house (RP 16)

Discussion

Most of the participants attributed the cause of trauma to witchcraft (60) followed by

mazhuzhulu (panic reaction to frightening thought or event) (20) The finding supports

the notion that peoplersquo understanding of trauma and its causes anchors on their

macrosystem the cultural lsquoblueprintrsquo that partially determines social structures and

activities that occur (Eamon 2001) In the present study the Venda-speaking participants

190 A Nevhutalu and P Mudhovozi

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4

conceptualised trauma and its causes from their cultural beliefs Also the finding is in line

with Foulks et alrsquos (1977) assertion that Africans do not believe in chance bad luck or

fate They believe that every illness has an intention and a specific cause Their culture

includes customs values beliefs attitudes implicit rules of conduct patterns of family

social organisation taboos and sanctions which they shared (Triandis 1994 De Silva in

Yule 1999) Nonetheless 20 of the participants indicated that the trauma just happened

This view might have been put forward by participants who do not subscribe to the

traditional explanation of witchraft and mazhuluzhulu Another plausible explanation is

that the 20 may account for Black Africans who embraced the individualistic western

cultural values

Therefore the microsystems (immediate setting) mesosystems (processes between

two or more microsystems) exosystems (processes between two or more settings)

macrosystems (influences of a broader culture and socio-economic environments) and

chronosystems (effects of consistency and change over life course) among the Venda-

speaking participants influenced their understanding of the causes of trauma (Eamon

2001) Thus these structures of the ecological environment served as a framework for the

explanation of the Africansrsquo belief system among the Venda-speaking participants It is

therefore not surprising that most of them (60) attributed trauma to witchcraft

The above finding is in line with the notion that for many Africans Christianity was

only adopted outwardly and did not inspire them spiritually According to Waruta and

Kinoti (1994) many Africans still maintain their traditional beliefs and practices during

important or critical stages in life (like birth initiation marriage death incurable sickness

and other anxieties in daily living) while upholding their piety as bequeathed to them in the

missionary enterprise Waruta and Kinoti (1994) furthermore hold that any kind of

medical treatment which is unrelated to the supernatural and to the community has

limited chances of success in Africa even if half the patients profess to be Christians

Contrary to the above the western-oriented PTSD model fails to account for the cultural

pluralistic experience of trauma (Collins 2004)

Some participants cited devil possession and ancestral spirits as the major causes of

trauma The responses reflect the influence of the mesosystem on individual members The

mesosystem integrates the interrelations between two or more microsystems each of

which contains the developing person In an African view the mesosystem is the

intermediate universe It functions as a no-manrsquos land since it is believed to take place

where evil spirits witches and sorcerers dwell It is also called the lsquostructured collective

imaginaryrsquo a system that is highly respected for giving rise to all good and bad fortune as

well as giving of form to peoplersquos desires fears anxieties and hope for success It is also

believed to regulate the day-to-day psychological fate of individual human beings in

Africa (van Dyk 2001)

Contrary to expectation the study did lend support the notion that in an African

environment there is a belief that ritual impurities are usually associated with death the

reproductive system and the violation of sexual prohibitions (van Dyk 2001) It had been

argued that the violation of sexual prohibitions like sexual intercourse with a woman

during menstruation with a widow before she is cleansed or with a woman who has had

an abortion or miscarriage can lead to a variety of health problems However in this case

the wrath of ancestors is believed to cause illness but it is also believed that witches

sometimes use sexual intercourse to cause illness Besides this belief about witches and

ancestors as causes of illnesses (van Dyk 2001) events that occur in a community have

consequences on individuals in the home For example a community may believe in

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witchcraft Failure by particular family members to co-operate with other community

members may lead those individuals to be suspects of witchcraft (van Dyk 2001)

The above finding is compatible with Kazarian and Evansrsquos (1998) assertion that the

ancestors can punish their people by sending illness and misfortune if social norms are

violated or when culturally prescribed practices are neglected or incorrectly performed

The illness might be caused by failure to perform a cultural and religious ritual

Nevertheless it is assumed that peaceful living with onersquos neighbours observing social

norms and living in harmony with onersquos environment and with God spirits and ancestors

are all essential to protect oneself and onersquos family from disease (Ebigbo 1987)

It emerged from the study that trauma also results from non-cultural causes Some

participants attributed traumatic experiences to the abuse of substances intimate partner

violence rape robbery road accidents and murder This finding is in line with Gopaul-

McNicol and Brice-Bakerrsquos (1998) argument that the majority of Africans acknowledge

that some illnesses have natural or organic causes In the same vein Eamon (2001) opines

that certain illnesses are originated in the microsystem The microsystem consists of the

immediate environment such as onersquos home friends relatives school and society In this

study the microsystem represents the everyday practical social and collective life of

people in Africa (van Dyk 2001)

Conclusion

The DSM-IV-TR and the ICD-10 explain the western understanding of the causes of

trauma (Collins 2004) However the given explanations do not suit the traditional African

concept of trauma The psychiatric categories that are used to understand measure and

classify mental distress are specific to western culture and society They ignore and

undermine the African concepts of suffering misfortune and illness Africansrsquo

conceptualisation of trauma and its causes is influenced by several contextual factors

Contextual factors include their social political and cultural realities To a larger extent

the Venda-speaking participants attributed trauma to witchcraft angry ancestral spirits and

devil possession The study concludes that culture is a determining factor in peoplesrsquo lives

influencing both decisions and understanding of the illnesses

Limitations of the study

This study has some limitations All the participants were drawn from the Venda-speaking

ethnic group The study is short of the voices of the Tsonga Pedi Afrikaans and English-

speaking people in the Limpopo Province Considering the qualitative nature of the

present study the findings are not generalisable

References

Collins A 2004 Trauma in context advanced reader Durban University of Kwazulu NatalDenzin NK and Lincoln YS eds 1998 Collecting and interpreting qualitative materials

London Sagevan Dyk A 2001 Traditional African beliefs and customs Implications for AIDS education and

prevention in Africa South African Journal of Psychology 31 60ndash66Eamon MK 2001 The effects of poverty on childrenrsquos socioemotional development an ecological

systems analysis Social Work 46 256ndash266Ebigbo PE 1987 The mind body and society an African perspective International Journal for

the Advancement of Health 3 (4) 45ndash57Foulks EF et al 1977 Current perspectives in cultural psychiatry New York Spectrum

192 A Nevhutalu and P Mudhovozi

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ober

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4

Gopaul-McNicol S and Brice-Baker J 1998 Cross-cultural practice assessment treatment andtraining Canada Wiley

Kazarian SS and Evans DR 1998 Cultural clinical psychology theory research and practiceOxford Oxford University Press

Madu SN Baguma P and Pritz A 1999 Traditional healersrsquo approach to the schizophreniaFrankfurt IKO Verlag

Marshall C and Rossman GB 1999 Designing qualitative research 3rd ed New Delhi SageMatsumoto D 1996 Culture and psychology Pacific Grove CA BrooksColeNeuman WL 2000 Social research methods qualitative and quantitative approaches 4th ed

Boston MA Allyn amp BaconPeltzer K 2001 Exposure to violence and posttraumatic stress disorder in a rural adult population

in South Africa Acta Academica 32 73ndash84Struwig FW and Stead GB 2001 Planning designing and reporting research Pinelands

Cape Town Maskew Miller LongmanScholten A 2012 Bradycardia (Bradyarrythmia) [online] Available from httpcvimednyueduTriandis HC 1994 Culture and social behaviour New York McGraw-Hillde Vos AS ed 1998 Research at grassroots a prime for the caring professions Pretoria

Van SchaikWaruta DW and Kinoti HW 1994 Pastoral care in African Christianity essays in pastoral

theology Nairobi ActonYule W 1999 Post-traumatic stress disorders concepts and therapy Chichester Willey

International Journal of Health Promotion and Education 193

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Trustworthiness

Marshall and Rossman (1999) maintain that research should respond to canons that are

regarded as criteria in which trustworthiness can be evaluated These canons are viewed by

Lincoln and Guba (in Marshall and Rossman 1999) as classical contribution to the

methodology of qualitative research They are credibility transferability dependability

and confirmability These four constructs establish the lsquotruth-valuersquo of a study The truth-

value refers to the applicability consistency and neutrability One may argue that

credibility transferability dependability and confirmability may be matched with internal

validity external validity reliability and objectivity which are appropriate for the

positivist paradigm and inappropriate for qualitative inquiry (Marshall and Rossman

1999) The four constructs that are appropriate for qualitative inquiry are discussed next

Credibility

In qualitative research credibility is maintained by an inquiry that ensures that the subject

is accurately identified and described (de Vos 1998) In this study continuous interaction

with participants through focus groups ensured that the subjects were accurately identified

and described

Transferability

Transferability refers to the applicability of one set of findings to another context (de Vos

1998) de Vos (1998) further argues that the demonstration of applicability of one set of

findings to another depends on the investigator who should make the transfer than the

original investigator Interestingly there are researchers who regard transferability as a

weakness in the approach To counter-challenge this idea the researcher can refer back to

the original theoretical framework to show how data collection and their analysis will be

guided by concepts and models (Marshall and Rossman 1999) In this study the findings

might be useful in clinical setting to help traumatised people That is the findings can be

used by helping professionals in South Africa considering the fact that the study is

conceptualised from the African cultural perspective

Dependability

Dependability is the third construct It refers to an attempt by the researcher to change

conditions in the phenomena chosen for the study This applies to the changes in the design

created by a refined understanding of the setting However qualitative researchers can

assert that qualitative research cannot be replicated because of the changing world They

plan to keep notes or log that record each design decision and the rationale behind it Their

procedures protocols and decisions can thus be inspected (de Vos 1998) In this study the

protocols procedures and decisions have been recorded All collected data are well

organised in a retrievable form and are easily available to challenge the notion of the

changing world

Confirmability

This is the last construct Lincoln and Guba (in Marshall and Rossman 1999) emphasise

the need to ask whether or not the findings of the study could be confirmed by another

International Journal of Health Promotion and Education 185

Dow

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ober

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4

Because of the fact that the sample of this study was small the findings are less

generalisable

Data analysis

Thematic content analysis was used to analyse the data Tapes were transcribed from

Venda (the language of the interviewees) to English and back-translated to Venda for

validation purposes The data were coded analysed through reading and re-reading of

responses The rationale for reading and re-reading is that the researcher becomes familiar

with that data in intimate ways People events and quotations sift constantly through the

researcherrsquos mind (Marshall and Rossman 1999) The data were then analysed into four

steps as follows

Step 1 Analysis of individual transcripts

This step involves reading individual transcripts in several different ways First transcripts

were read as a whole noting general impressions Major opinions and attitudes that were

expressed by the groups were considered When transcripts were read for the second time

specific things that were looked for which were mainly from the objectives of the study

were noted Sections that were poorly transcribed and did not make sense were removed

Transcripts were coded sectioned and marked in the way that indicated what the

participants talked about The final step in reading the transcripts involved using the list of

required information and checking what information has been obtained

Step 2 The logbook

The logbook was used to keep all the responses together according to the topic of interest

Each response was entered unless it was exactly the same as another The main aim was to

retain the full range of responses

Step 3 Writing the results

Results were not only written from the logbook but also from the notes that were made

while reading transcripts as a whole As many reported results from the focus groups did

not indicate how many focus groups or participants discussed a certain issue results will

say lsquomany respondents said rsquo or lsquoonly a few groups discussions raised the issue of rsquo

Step 4 Interpretation

Throughout the study the researchers were thinking about the significance of the

information that was collected in terms of the problem or question that they wanted to

answer and to develop ideas about what the respondents said Results were looked at and

summaries were written

Ethical considerations

Participants in this study were informed about the nature and purpose of the study

Complete information about the study was explained for participants to comprehend the

purpose of the study This was done in order for participants to make a voluntary decision

about their participation (de Vos 1998) Participants were informed that they will be

186 A Nevhutalu and P Mudhovozi

Dow

nloa

ded

by [

Uni

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f C

onne

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ut]

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10

Oct

ober

201

4

involved in focus groups and the study is for educational purposes It was clearly indicated

that each focus group would last approximately 45ndash90 minutes The researcher also

explained to the participants that freedom is respected and as such they had to participate

voluntarily without any physical or psychological force

Furthermore they were informed that they would benefit from the focus groups as

they would share their traumatic experiences among themselves Confidentiality and

privacy was assured so that participants were safe from exposure (Denzin and Lincoln

1998) Information from focus groups was given anonymously to ensure the privacy of

subjects However participants were informed that a tape recorder will be used so that

participantsrsquo privacy cannot be affected if the tape recorder is used as a hidden

apparatus

Results

Figure 1 shows that most of the participants attributed the cause of trauma to witchcraft

(60) followed bymazhuzhulu (panic reaction to frightening thought or event) (20) and

the belief that it just happened (20)

Interview responses on culture-related causes of trauma

It emerged from the study that some participants believed that trauma was caused by

culturally related causes They cited devil possession witchcraft and ancestral spirits as

the major causes of trauma These are presented next

Devil possession

There are instances wherein people tend to attribute violence like rape and murder to devil

possession Whenever such incidents occur and they lack an explanation concerning the

act they believe that it is because concerned people are possessed by the devil According

to some respondents incidents like these where people commit such crime that lack

Figure 1 Perceived traumatic events

International Journal of Health Promotion and Education 187

Dow

nloa

ded

by [

Uni

vers

ity o

f C

onne

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ut]

at 2

222

10

Oct

ober

201

4

explanation were not common in the olden days Eight per cent of the participants

perceived devil possession as a cause of violence This was reflected in the following

quotes

As far as rape is concerned I really do not know what is in the minds of men because theyeven rape babies of less than a year old In some cases one may think this may be influencedby Satanism (RP 32)

The other cause is that children these days are used by the devil or is like they have evil spiritsor possessed since they just kill as an end in itself and do not indicate why they killed or atleast show some hidden motive of wanting to steal that personrsquos money (RP 74)

Witchcraft

Though many respondents realised that they were living in a violent environment where

violent incidents occurred in their lives 8 attributed the causes of its trauma to

witchcraft Their explanations of the occurrence of traumatic incidents tended to suite their

held beliefs For example the interpretation of mishaps or misfortunes that befell

individuals was believed to be caused by witchcraft The belief that witchcraft is the cause

of violent incidents is reflected in the following

I think mine is obvious that there could be somebody who is after me because a person cannothave a series of accidents one after the other In Venda if incidents are happening like thiswe start to suspect that someone is bewitching you (RP 22)

I also felt the same way about the cause of my sonrsquos death I have a very strong suspicion thathe was bewitched (RP 51)

You may find that one of the people who were in the truck was bewitched and now it hasaffected all of us (RP 62)

When we are praying there are others who are working for Satanism so I cannot rule out that itmight be due to demons or witchcraft (RP 74)

Ancestral spirits

Even though most respondents believed in witchcraft as a cause of traumatic events

some respondents believed in ancestral causes It was interesting to note that the belief

in the connection of trauma to ancestral power was mostly held by older respondents

They mentioned that their ancestors talk to them and sometimes tend to understand

why some traumatic incidents happen to them For others it was an honour when their

ancestors talked to them because they were helping them with the type of intervention

that they must use for their problem Another point is that respondents showed that

they obey their ancestors and their instructions so that even understanding why

some mishaps are happening in their lives was not a concern The following extracts

reflect this

One day my father visited me in my sleep and told me to consult a traditional healerI consulted a traditional healer who told me that I have lsquotshilisorsquo (meaning something thatsomeone gives you without your awareness which ends up like a poison in your body)(RP 33)

To tell you the truth I think this is a punishment from my father because the cattle that I saiddied on one night were not given to me alone I took them forcefully from my half brother whowas my fatherrsquos favourite child From that time nothing went on smoothly in my life I am justworried that it seems as if even my following generation will suffer like what I did as a way ofpaying for what I did wrong (RP 68)

188 A Nevhutalu and P Mudhovozi

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Other causes of trauma

The study also revealed that trauma was caused by non-cultural factors Some participants

attributed traumatic experiences to the abuse of substances intimate partner violence

rape robbery road accidents and murder These are presented next

Substance abuse

Twelve per cent of the participants indicated that trauma was caused by the abuse of

substances They believed that when young people are under the influence of drugs they

involve themselves in violent acts which then affect the community as a whole They are

usually involved in housebreaking murder and rape This is reflected in the following

responses

The main cause of all this trouble is drugs and alcohol that the youth are using In mostinstances they are always at the bars drinking alcohol and smoking drugs After that they gowherever and cause all this troubles (RP 6)

I think that when the youths are involved in drugs they end up being involved in things likehousebreaking (RP 14)

I think the other cause is that young people use drugs that influence them to commit crimessuch as housebreaking and rape (RP 36)

As far as road accidents are concerned I think people sometimes drive when they are drunk ordrive recklessly which may also contribute to traumatic incidents (RP 65)

Road accidents may be caused by reckless driving and driving when people are drunk (RP 67)

Intimate partner violence

Some participants showed that intimate partner violence occurs among people though

very few report the incidents In almost all focus groups in this study very few responses

emerged around intimate partner violence as a form of a traumatic event This probably

happened because most people seem to consider domestic violence to be a normal way of

life in a family or in the community This is also regarded as something that is not

supposed to be disclosed This was reflected as follows

The other thing that people do not talk about is domestic violence (RP 33)

Domestic violence is also common but it is complicated because many women do not talkabout it even when they are being abused all the time (RP 36)

if he drinks he beats kicks and insults using vulgar words I mean those deep Vendawords that my children are not supposed to hear as these I think also affect them This hasbecome part of our life in this family that we just told ourselves that we should accept it assuch (RP 40)

Rape

Rape was mentioned in almost all focus group discussions Participants were concerned

about the fact that rape happens to people of all ages including children and it also makes

them feel unsafe Rape brings about fear in peoplersquos lives In these focus groups 21

reported having been raped and even those who were not subjected to this type of violence

showed concern that they were afraid of this act This is reflected by the following extracts

It is true because it is not safe to walk long distances alone where there is a small bush from 6pm onwards If you walk there alone you are just inviting trouble (RP 11)

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Rape is something that we cannot leave out as it is becoming the order of the day (RP 32)

The common traumatic events in our area include rape and housebreaking Usually we do notfeel safe anymore when we are away We are always fearful that anything bad can happen atany time (RP 40)

Robbery

Robbery appeared to be contributing to a fearful environment for most participants They

felt that house and business breaking was traumatic The finding s supported by the

following statements

Housebreaking is threatening because you do not know what will happen after the personenters the house (RP 53)

Besides rape other common incidents include housebreaking and theft These days even if youare asleep you do not even know what will happen as thieves and criminals rob at night(RP 58)

The other thing which we see as a problem is theft even during the day This also includeshousebreaking which makes people not to feel safe (RP 70)

Road accidents

Another form of violence that emerged from the focus group discussions was road

accidents It appeared that road accidents created situations that became traumatic and

violent to many respondents Seventeen per cent of the participants reported incidences of

having been involved or affected in road accidents Like rape road accidents became a

concern for many respondents as in the following responses

Road accidents are very common Some victims of road accidents are school childrenSometimes these accidents happen in succession and it becomes very painful (RP 32)

Now that we are going for holidays you will hear a number of road accidents reported evenhere at our place The problem is that in some cases other people die and it is very painful forthe relatives who are left behind (RP 61)

Murder

Twelve per cent of the participants reported incidences of a family member or relative who

was murdered There was a general feeling of concern that people no longer have respect

for life The finding is supported by the following statements

Another problem around here is killings Mostly boys do this They kill each other like fliesSome people are killed by guns and some by knives (RP 7)

From the place where I come from incidences of shooting are escalating It is now becomingthe way of life where thieves may even shoot you when you are inside your house (RP 16)

Discussion

Most of the participants attributed the cause of trauma to witchcraft (60) followed by

mazhuzhulu (panic reaction to frightening thought or event) (20) The finding supports

the notion that peoplersquo understanding of trauma and its causes anchors on their

macrosystem the cultural lsquoblueprintrsquo that partially determines social structures and

activities that occur (Eamon 2001) In the present study the Venda-speaking participants

190 A Nevhutalu and P Mudhovozi

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ober

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conceptualised trauma and its causes from their cultural beliefs Also the finding is in line

with Foulks et alrsquos (1977) assertion that Africans do not believe in chance bad luck or

fate They believe that every illness has an intention and a specific cause Their culture

includes customs values beliefs attitudes implicit rules of conduct patterns of family

social organisation taboos and sanctions which they shared (Triandis 1994 De Silva in

Yule 1999) Nonetheless 20 of the participants indicated that the trauma just happened

This view might have been put forward by participants who do not subscribe to the

traditional explanation of witchraft and mazhuluzhulu Another plausible explanation is

that the 20 may account for Black Africans who embraced the individualistic western

cultural values

Therefore the microsystems (immediate setting) mesosystems (processes between

two or more microsystems) exosystems (processes between two or more settings)

macrosystems (influences of a broader culture and socio-economic environments) and

chronosystems (effects of consistency and change over life course) among the Venda-

speaking participants influenced their understanding of the causes of trauma (Eamon

2001) Thus these structures of the ecological environment served as a framework for the

explanation of the Africansrsquo belief system among the Venda-speaking participants It is

therefore not surprising that most of them (60) attributed trauma to witchcraft

The above finding is in line with the notion that for many Africans Christianity was

only adopted outwardly and did not inspire them spiritually According to Waruta and

Kinoti (1994) many Africans still maintain their traditional beliefs and practices during

important or critical stages in life (like birth initiation marriage death incurable sickness

and other anxieties in daily living) while upholding their piety as bequeathed to them in the

missionary enterprise Waruta and Kinoti (1994) furthermore hold that any kind of

medical treatment which is unrelated to the supernatural and to the community has

limited chances of success in Africa even if half the patients profess to be Christians

Contrary to the above the western-oriented PTSD model fails to account for the cultural

pluralistic experience of trauma (Collins 2004)

Some participants cited devil possession and ancestral spirits as the major causes of

trauma The responses reflect the influence of the mesosystem on individual members The

mesosystem integrates the interrelations between two or more microsystems each of

which contains the developing person In an African view the mesosystem is the

intermediate universe It functions as a no-manrsquos land since it is believed to take place

where evil spirits witches and sorcerers dwell It is also called the lsquostructured collective

imaginaryrsquo a system that is highly respected for giving rise to all good and bad fortune as

well as giving of form to peoplersquos desires fears anxieties and hope for success It is also

believed to regulate the day-to-day psychological fate of individual human beings in

Africa (van Dyk 2001)

Contrary to expectation the study did lend support the notion that in an African

environment there is a belief that ritual impurities are usually associated with death the

reproductive system and the violation of sexual prohibitions (van Dyk 2001) It had been

argued that the violation of sexual prohibitions like sexual intercourse with a woman

during menstruation with a widow before she is cleansed or with a woman who has had

an abortion or miscarriage can lead to a variety of health problems However in this case

the wrath of ancestors is believed to cause illness but it is also believed that witches

sometimes use sexual intercourse to cause illness Besides this belief about witches and

ancestors as causes of illnesses (van Dyk 2001) events that occur in a community have

consequences on individuals in the home For example a community may believe in

International Journal of Health Promotion and Education 191

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witchcraft Failure by particular family members to co-operate with other community

members may lead those individuals to be suspects of witchcraft (van Dyk 2001)

The above finding is compatible with Kazarian and Evansrsquos (1998) assertion that the

ancestors can punish their people by sending illness and misfortune if social norms are

violated or when culturally prescribed practices are neglected or incorrectly performed

The illness might be caused by failure to perform a cultural and religious ritual

Nevertheless it is assumed that peaceful living with onersquos neighbours observing social

norms and living in harmony with onersquos environment and with God spirits and ancestors

are all essential to protect oneself and onersquos family from disease (Ebigbo 1987)

It emerged from the study that trauma also results from non-cultural causes Some

participants attributed traumatic experiences to the abuse of substances intimate partner

violence rape robbery road accidents and murder This finding is in line with Gopaul-

McNicol and Brice-Bakerrsquos (1998) argument that the majority of Africans acknowledge

that some illnesses have natural or organic causes In the same vein Eamon (2001) opines

that certain illnesses are originated in the microsystem The microsystem consists of the

immediate environment such as onersquos home friends relatives school and society In this

study the microsystem represents the everyday practical social and collective life of

people in Africa (van Dyk 2001)

Conclusion

The DSM-IV-TR and the ICD-10 explain the western understanding of the causes of

trauma (Collins 2004) However the given explanations do not suit the traditional African

concept of trauma The psychiatric categories that are used to understand measure and

classify mental distress are specific to western culture and society They ignore and

undermine the African concepts of suffering misfortune and illness Africansrsquo

conceptualisation of trauma and its causes is influenced by several contextual factors

Contextual factors include their social political and cultural realities To a larger extent

the Venda-speaking participants attributed trauma to witchcraft angry ancestral spirits and

devil possession The study concludes that culture is a determining factor in peoplesrsquo lives

influencing both decisions and understanding of the illnesses

Limitations of the study

This study has some limitations All the participants were drawn from the Venda-speaking

ethnic group The study is short of the voices of the Tsonga Pedi Afrikaans and English-

speaking people in the Limpopo Province Considering the qualitative nature of the

present study the findings are not generalisable

References

Collins A 2004 Trauma in context advanced reader Durban University of Kwazulu NatalDenzin NK and Lincoln YS eds 1998 Collecting and interpreting qualitative materials

London Sagevan Dyk A 2001 Traditional African beliefs and customs Implications for AIDS education and

prevention in Africa South African Journal of Psychology 31 60ndash66Eamon MK 2001 The effects of poverty on childrenrsquos socioemotional development an ecological

systems analysis Social Work 46 256ndash266Ebigbo PE 1987 The mind body and society an African perspective International Journal for

the Advancement of Health 3 (4) 45ndash57Foulks EF et al 1977 Current perspectives in cultural psychiatry New York Spectrum

192 A Nevhutalu and P Mudhovozi

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Gopaul-McNicol S and Brice-Baker J 1998 Cross-cultural practice assessment treatment andtraining Canada Wiley

Kazarian SS and Evans DR 1998 Cultural clinical psychology theory research and practiceOxford Oxford University Press

Madu SN Baguma P and Pritz A 1999 Traditional healersrsquo approach to the schizophreniaFrankfurt IKO Verlag

Marshall C and Rossman GB 1999 Designing qualitative research 3rd ed New Delhi SageMatsumoto D 1996 Culture and psychology Pacific Grove CA BrooksColeNeuman WL 2000 Social research methods qualitative and quantitative approaches 4th ed

Boston MA Allyn amp BaconPeltzer K 2001 Exposure to violence and posttraumatic stress disorder in a rural adult population

in South Africa Acta Academica 32 73ndash84Struwig FW and Stead GB 2001 Planning designing and reporting research Pinelands

Cape Town Maskew Miller LongmanScholten A 2012 Bradycardia (Bradyarrythmia) [online] Available from httpcvimednyueduTriandis HC 1994 Culture and social behaviour New York McGraw-Hillde Vos AS ed 1998 Research at grassroots a prime for the caring professions Pretoria

Van SchaikWaruta DW and Kinoti HW 1994 Pastoral care in African Christianity essays in pastoral

theology Nairobi ActonYule W 1999 Post-traumatic stress disorders concepts and therapy Chichester Willey

International Journal of Health Promotion and Education 193

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Because of the fact that the sample of this study was small the findings are less

generalisable

Data analysis

Thematic content analysis was used to analyse the data Tapes were transcribed from

Venda (the language of the interviewees) to English and back-translated to Venda for

validation purposes The data were coded analysed through reading and re-reading of

responses The rationale for reading and re-reading is that the researcher becomes familiar

with that data in intimate ways People events and quotations sift constantly through the

researcherrsquos mind (Marshall and Rossman 1999) The data were then analysed into four

steps as follows

Step 1 Analysis of individual transcripts

This step involves reading individual transcripts in several different ways First transcripts

were read as a whole noting general impressions Major opinions and attitudes that were

expressed by the groups were considered When transcripts were read for the second time

specific things that were looked for which were mainly from the objectives of the study

were noted Sections that were poorly transcribed and did not make sense were removed

Transcripts were coded sectioned and marked in the way that indicated what the

participants talked about The final step in reading the transcripts involved using the list of

required information and checking what information has been obtained

Step 2 The logbook

The logbook was used to keep all the responses together according to the topic of interest

Each response was entered unless it was exactly the same as another The main aim was to

retain the full range of responses

Step 3 Writing the results

Results were not only written from the logbook but also from the notes that were made

while reading transcripts as a whole As many reported results from the focus groups did

not indicate how many focus groups or participants discussed a certain issue results will

say lsquomany respondents said rsquo or lsquoonly a few groups discussions raised the issue of rsquo

Step 4 Interpretation

Throughout the study the researchers were thinking about the significance of the

information that was collected in terms of the problem or question that they wanted to

answer and to develop ideas about what the respondents said Results were looked at and

summaries were written

Ethical considerations

Participants in this study were informed about the nature and purpose of the study

Complete information about the study was explained for participants to comprehend the

purpose of the study This was done in order for participants to make a voluntary decision

about their participation (de Vos 1998) Participants were informed that they will be

186 A Nevhutalu and P Mudhovozi

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4

involved in focus groups and the study is for educational purposes It was clearly indicated

that each focus group would last approximately 45ndash90 minutes The researcher also

explained to the participants that freedom is respected and as such they had to participate

voluntarily without any physical or psychological force

Furthermore they were informed that they would benefit from the focus groups as

they would share their traumatic experiences among themselves Confidentiality and

privacy was assured so that participants were safe from exposure (Denzin and Lincoln

1998) Information from focus groups was given anonymously to ensure the privacy of

subjects However participants were informed that a tape recorder will be used so that

participantsrsquo privacy cannot be affected if the tape recorder is used as a hidden

apparatus

Results

Figure 1 shows that most of the participants attributed the cause of trauma to witchcraft

(60) followed bymazhuzhulu (panic reaction to frightening thought or event) (20) and

the belief that it just happened (20)

Interview responses on culture-related causes of trauma

It emerged from the study that some participants believed that trauma was caused by

culturally related causes They cited devil possession witchcraft and ancestral spirits as

the major causes of trauma These are presented next

Devil possession

There are instances wherein people tend to attribute violence like rape and murder to devil

possession Whenever such incidents occur and they lack an explanation concerning the

act they believe that it is because concerned people are possessed by the devil According

to some respondents incidents like these where people commit such crime that lack

Figure 1 Perceived traumatic events

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explanation were not common in the olden days Eight per cent of the participants

perceived devil possession as a cause of violence This was reflected in the following

quotes

As far as rape is concerned I really do not know what is in the minds of men because theyeven rape babies of less than a year old In some cases one may think this may be influencedby Satanism (RP 32)

The other cause is that children these days are used by the devil or is like they have evil spiritsor possessed since they just kill as an end in itself and do not indicate why they killed or atleast show some hidden motive of wanting to steal that personrsquos money (RP 74)

Witchcraft

Though many respondents realised that they were living in a violent environment where

violent incidents occurred in their lives 8 attributed the causes of its trauma to

witchcraft Their explanations of the occurrence of traumatic incidents tended to suite their

held beliefs For example the interpretation of mishaps or misfortunes that befell

individuals was believed to be caused by witchcraft The belief that witchcraft is the cause

of violent incidents is reflected in the following

I think mine is obvious that there could be somebody who is after me because a person cannothave a series of accidents one after the other In Venda if incidents are happening like thiswe start to suspect that someone is bewitching you (RP 22)

I also felt the same way about the cause of my sonrsquos death I have a very strong suspicion thathe was bewitched (RP 51)

You may find that one of the people who were in the truck was bewitched and now it hasaffected all of us (RP 62)

When we are praying there are others who are working for Satanism so I cannot rule out that itmight be due to demons or witchcraft (RP 74)

Ancestral spirits

Even though most respondents believed in witchcraft as a cause of traumatic events

some respondents believed in ancestral causes It was interesting to note that the belief

in the connection of trauma to ancestral power was mostly held by older respondents

They mentioned that their ancestors talk to them and sometimes tend to understand

why some traumatic incidents happen to them For others it was an honour when their

ancestors talked to them because they were helping them with the type of intervention

that they must use for their problem Another point is that respondents showed that

they obey their ancestors and their instructions so that even understanding why

some mishaps are happening in their lives was not a concern The following extracts

reflect this

One day my father visited me in my sleep and told me to consult a traditional healerI consulted a traditional healer who told me that I have lsquotshilisorsquo (meaning something thatsomeone gives you without your awareness which ends up like a poison in your body)(RP 33)

To tell you the truth I think this is a punishment from my father because the cattle that I saiddied on one night were not given to me alone I took them forcefully from my half brother whowas my fatherrsquos favourite child From that time nothing went on smoothly in my life I am justworried that it seems as if even my following generation will suffer like what I did as a way ofpaying for what I did wrong (RP 68)

188 A Nevhutalu and P Mudhovozi

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ober

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4

Other causes of trauma

The study also revealed that trauma was caused by non-cultural factors Some participants

attributed traumatic experiences to the abuse of substances intimate partner violence

rape robbery road accidents and murder These are presented next

Substance abuse

Twelve per cent of the participants indicated that trauma was caused by the abuse of

substances They believed that when young people are under the influence of drugs they

involve themselves in violent acts which then affect the community as a whole They are

usually involved in housebreaking murder and rape This is reflected in the following

responses

The main cause of all this trouble is drugs and alcohol that the youth are using In mostinstances they are always at the bars drinking alcohol and smoking drugs After that they gowherever and cause all this troubles (RP 6)

I think that when the youths are involved in drugs they end up being involved in things likehousebreaking (RP 14)

I think the other cause is that young people use drugs that influence them to commit crimessuch as housebreaking and rape (RP 36)

As far as road accidents are concerned I think people sometimes drive when they are drunk ordrive recklessly which may also contribute to traumatic incidents (RP 65)

Road accidents may be caused by reckless driving and driving when people are drunk (RP 67)

Intimate partner violence

Some participants showed that intimate partner violence occurs among people though

very few report the incidents In almost all focus groups in this study very few responses

emerged around intimate partner violence as a form of a traumatic event This probably

happened because most people seem to consider domestic violence to be a normal way of

life in a family or in the community This is also regarded as something that is not

supposed to be disclosed This was reflected as follows

The other thing that people do not talk about is domestic violence (RP 33)

Domestic violence is also common but it is complicated because many women do not talkabout it even when they are being abused all the time (RP 36)

if he drinks he beats kicks and insults using vulgar words I mean those deep Vendawords that my children are not supposed to hear as these I think also affect them This hasbecome part of our life in this family that we just told ourselves that we should accept it assuch (RP 40)

Rape

Rape was mentioned in almost all focus group discussions Participants were concerned

about the fact that rape happens to people of all ages including children and it also makes

them feel unsafe Rape brings about fear in peoplersquos lives In these focus groups 21

reported having been raped and even those who were not subjected to this type of violence

showed concern that they were afraid of this act This is reflected by the following extracts

It is true because it is not safe to walk long distances alone where there is a small bush from 6pm onwards If you walk there alone you are just inviting trouble (RP 11)

International Journal of Health Promotion and Education 189

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Rape is something that we cannot leave out as it is becoming the order of the day (RP 32)

The common traumatic events in our area include rape and housebreaking Usually we do notfeel safe anymore when we are away We are always fearful that anything bad can happen atany time (RP 40)

Robbery

Robbery appeared to be contributing to a fearful environment for most participants They

felt that house and business breaking was traumatic The finding s supported by the

following statements

Housebreaking is threatening because you do not know what will happen after the personenters the house (RP 53)

Besides rape other common incidents include housebreaking and theft These days even if youare asleep you do not even know what will happen as thieves and criminals rob at night(RP 58)

The other thing which we see as a problem is theft even during the day This also includeshousebreaking which makes people not to feel safe (RP 70)

Road accidents

Another form of violence that emerged from the focus group discussions was road

accidents It appeared that road accidents created situations that became traumatic and

violent to many respondents Seventeen per cent of the participants reported incidences of

having been involved or affected in road accidents Like rape road accidents became a

concern for many respondents as in the following responses

Road accidents are very common Some victims of road accidents are school childrenSometimes these accidents happen in succession and it becomes very painful (RP 32)

Now that we are going for holidays you will hear a number of road accidents reported evenhere at our place The problem is that in some cases other people die and it is very painful forthe relatives who are left behind (RP 61)

Murder

Twelve per cent of the participants reported incidences of a family member or relative who

was murdered There was a general feeling of concern that people no longer have respect

for life The finding is supported by the following statements

Another problem around here is killings Mostly boys do this They kill each other like fliesSome people are killed by guns and some by knives (RP 7)

From the place where I come from incidences of shooting are escalating It is now becomingthe way of life where thieves may even shoot you when you are inside your house (RP 16)

Discussion

Most of the participants attributed the cause of trauma to witchcraft (60) followed by

mazhuzhulu (panic reaction to frightening thought or event) (20) The finding supports

the notion that peoplersquo understanding of trauma and its causes anchors on their

macrosystem the cultural lsquoblueprintrsquo that partially determines social structures and

activities that occur (Eamon 2001) In the present study the Venda-speaking participants

190 A Nevhutalu and P Mudhovozi

Dow

nloa

ded

by [

Uni

vers

ity o

f C

onne

ctic

ut]

at 2

222

10

Oct

ober

201

4

conceptualised trauma and its causes from their cultural beliefs Also the finding is in line

with Foulks et alrsquos (1977) assertion that Africans do not believe in chance bad luck or

fate They believe that every illness has an intention and a specific cause Their culture

includes customs values beliefs attitudes implicit rules of conduct patterns of family

social organisation taboos and sanctions which they shared (Triandis 1994 De Silva in

Yule 1999) Nonetheless 20 of the participants indicated that the trauma just happened

This view might have been put forward by participants who do not subscribe to the

traditional explanation of witchraft and mazhuluzhulu Another plausible explanation is

that the 20 may account for Black Africans who embraced the individualistic western

cultural values

Therefore the microsystems (immediate setting) mesosystems (processes between

two or more microsystems) exosystems (processes between two or more settings)

macrosystems (influences of a broader culture and socio-economic environments) and

chronosystems (effects of consistency and change over life course) among the Venda-

speaking participants influenced their understanding of the causes of trauma (Eamon

2001) Thus these structures of the ecological environment served as a framework for the

explanation of the Africansrsquo belief system among the Venda-speaking participants It is

therefore not surprising that most of them (60) attributed trauma to witchcraft

The above finding is in line with the notion that for many Africans Christianity was

only adopted outwardly and did not inspire them spiritually According to Waruta and

Kinoti (1994) many Africans still maintain their traditional beliefs and practices during

important or critical stages in life (like birth initiation marriage death incurable sickness

and other anxieties in daily living) while upholding their piety as bequeathed to them in the

missionary enterprise Waruta and Kinoti (1994) furthermore hold that any kind of

medical treatment which is unrelated to the supernatural and to the community has

limited chances of success in Africa even if half the patients profess to be Christians

Contrary to the above the western-oriented PTSD model fails to account for the cultural

pluralistic experience of trauma (Collins 2004)

Some participants cited devil possession and ancestral spirits as the major causes of

trauma The responses reflect the influence of the mesosystem on individual members The

mesosystem integrates the interrelations between two or more microsystems each of

which contains the developing person In an African view the mesosystem is the

intermediate universe It functions as a no-manrsquos land since it is believed to take place

where evil spirits witches and sorcerers dwell It is also called the lsquostructured collective

imaginaryrsquo a system that is highly respected for giving rise to all good and bad fortune as

well as giving of form to peoplersquos desires fears anxieties and hope for success It is also

believed to regulate the day-to-day psychological fate of individual human beings in

Africa (van Dyk 2001)

Contrary to expectation the study did lend support the notion that in an African

environment there is a belief that ritual impurities are usually associated with death the

reproductive system and the violation of sexual prohibitions (van Dyk 2001) It had been

argued that the violation of sexual prohibitions like sexual intercourse with a woman

during menstruation with a widow before she is cleansed or with a woman who has had

an abortion or miscarriage can lead to a variety of health problems However in this case

the wrath of ancestors is believed to cause illness but it is also believed that witches

sometimes use sexual intercourse to cause illness Besides this belief about witches and

ancestors as causes of illnesses (van Dyk 2001) events that occur in a community have

consequences on individuals in the home For example a community may believe in

International Journal of Health Promotion and Education 191

Dow

nloa

ded

by [

Uni

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ity o

f C

onne

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ut]

at 2

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Oct

ober

201

4

witchcraft Failure by particular family members to co-operate with other community

members may lead those individuals to be suspects of witchcraft (van Dyk 2001)

The above finding is compatible with Kazarian and Evansrsquos (1998) assertion that the

ancestors can punish their people by sending illness and misfortune if social norms are

violated or when culturally prescribed practices are neglected or incorrectly performed

The illness might be caused by failure to perform a cultural and religious ritual

Nevertheless it is assumed that peaceful living with onersquos neighbours observing social

norms and living in harmony with onersquos environment and with God spirits and ancestors

are all essential to protect oneself and onersquos family from disease (Ebigbo 1987)

It emerged from the study that trauma also results from non-cultural causes Some

participants attributed traumatic experiences to the abuse of substances intimate partner

violence rape robbery road accidents and murder This finding is in line with Gopaul-

McNicol and Brice-Bakerrsquos (1998) argument that the majority of Africans acknowledge

that some illnesses have natural or organic causes In the same vein Eamon (2001) opines

that certain illnesses are originated in the microsystem The microsystem consists of the

immediate environment such as onersquos home friends relatives school and society In this

study the microsystem represents the everyday practical social and collective life of

people in Africa (van Dyk 2001)

Conclusion

The DSM-IV-TR and the ICD-10 explain the western understanding of the causes of

trauma (Collins 2004) However the given explanations do not suit the traditional African

concept of trauma The psychiatric categories that are used to understand measure and

classify mental distress are specific to western culture and society They ignore and

undermine the African concepts of suffering misfortune and illness Africansrsquo

conceptualisation of trauma and its causes is influenced by several contextual factors

Contextual factors include their social political and cultural realities To a larger extent

the Venda-speaking participants attributed trauma to witchcraft angry ancestral spirits and

devil possession The study concludes that culture is a determining factor in peoplesrsquo lives

influencing both decisions and understanding of the illnesses

Limitations of the study

This study has some limitations All the participants were drawn from the Venda-speaking

ethnic group The study is short of the voices of the Tsonga Pedi Afrikaans and English-

speaking people in the Limpopo Province Considering the qualitative nature of the

present study the findings are not generalisable

References

Collins A 2004 Trauma in context advanced reader Durban University of Kwazulu NatalDenzin NK and Lincoln YS eds 1998 Collecting and interpreting qualitative materials

London Sagevan Dyk A 2001 Traditional African beliefs and customs Implications for AIDS education and

prevention in Africa South African Journal of Psychology 31 60ndash66Eamon MK 2001 The effects of poverty on childrenrsquos socioemotional development an ecological

systems analysis Social Work 46 256ndash266Ebigbo PE 1987 The mind body and society an African perspective International Journal for

the Advancement of Health 3 (4) 45ndash57Foulks EF et al 1977 Current perspectives in cultural psychiatry New York Spectrum

192 A Nevhutalu and P Mudhovozi

Dow

nloa

ded

by [

Uni

vers

ity o

f C

onne

ctic

ut]

at 2

222

10

Oct

ober

201

4

Gopaul-McNicol S and Brice-Baker J 1998 Cross-cultural practice assessment treatment andtraining Canada Wiley

Kazarian SS and Evans DR 1998 Cultural clinical psychology theory research and practiceOxford Oxford University Press

Madu SN Baguma P and Pritz A 1999 Traditional healersrsquo approach to the schizophreniaFrankfurt IKO Verlag

Marshall C and Rossman GB 1999 Designing qualitative research 3rd ed New Delhi SageMatsumoto D 1996 Culture and psychology Pacific Grove CA BrooksColeNeuman WL 2000 Social research methods qualitative and quantitative approaches 4th ed

Boston MA Allyn amp BaconPeltzer K 2001 Exposure to violence and posttraumatic stress disorder in a rural adult population

in South Africa Acta Academica 32 73ndash84Struwig FW and Stead GB 2001 Planning designing and reporting research Pinelands

Cape Town Maskew Miller LongmanScholten A 2012 Bradycardia (Bradyarrythmia) [online] Available from httpcvimednyueduTriandis HC 1994 Culture and social behaviour New York McGraw-Hillde Vos AS ed 1998 Research at grassroots a prime for the caring professions Pretoria

Van SchaikWaruta DW and Kinoti HW 1994 Pastoral care in African Christianity essays in pastoral

theology Nairobi ActonYule W 1999 Post-traumatic stress disorders concepts and therapy Chichester Willey

International Journal of Health Promotion and Education 193

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4

involved in focus groups and the study is for educational purposes It was clearly indicated

that each focus group would last approximately 45ndash90 minutes The researcher also

explained to the participants that freedom is respected and as such they had to participate

voluntarily without any physical or psychological force

Furthermore they were informed that they would benefit from the focus groups as

they would share their traumatic experiences among themselves Confidentiality and

privacy was assured so that participants were safe from exposure (Denzin and Lincoln

1998) Information from focus groups was given anonymously to ensure the privacy of

subjects However participants were informed that a tape recorder will be used so that

participantsrsquo privacy cannot be affected if the tape recorder is used as a hidden

apparatus

Results

Figure 1 shows that most of the participants attributed the cause of trauma to witchcraft

(60) followed bymazhuzhulu (panic reaction to frightening thought or event) (20) and

the belief that it just happened (20)

Interview responses on culture-related causes of trauma

It emerged from the study that some participants believed that trauma was caused by

culturally related causes They cited devil possession witchcraft and ancestral spirits as

the major causes of trauma These are presented next

Devil possession

There are instances wherein people tend to attribute violence like rape and murder to devil

possession Whenever such incidents occur and they lack an explanation concerning the

act they believe that it is because concerned people are possessed by the devil According

to some respondents incidents like these where people commit such crime that lack

Figure 1 Perceived traumatic events

International Journal of Health Promotion and Education 187

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explanation were not common in the olden days Eight per cent of the participants

perceived devil possession as a cause of violence This was reflected in the following

quotes

As far as rape is concerned I really do not know what is in the minds of men because theyeven rape babies of less than a year old In some cases one may think this may be influencedby Satanism (RP 32)

The other cause is that children these days are used by the devil or is like they have evil spiritsor possessed since they just kill as an end in itself and do not indicate why they killed or atleast show some hidden motive of wanting to steal that personrsquos money (RP 74)

Witchcraft

Though many respondents realised that they were living in a violent environment where

violent incidents occurred in their lives 8 attributed the causes of its trauma to

witchcraft Their explanations of the occurrence of traumatic incidents tended to suite their

held beliefs For example the interpretation of mishaps or misfortunes that befell

individuals was believed to be caused by witchcraft The belief that witchcraft is the cause

of violent incidents is reflected in the following

I think mine is obvious that there could be somebody who is after me because a person cannothave a series of accidents one after the other In Venda if incidents are happening like thiswe start to suspect that someone is bewitching you (RP 22)

I also felt the same way about the cause of my sonrsquos death I have a very strong suspicion thathe was bewitched (RP 51)

You may find that one of the people who were in the truck was bewitched and now it hasaffected all of us (RP 62)

When we are praying there are others who are working for Satanism so I cannot rule out that itmight be due to demons or witchcraft (RP 74)

Ancestral spirits

Even though most respondents believed in witchcraft as a cause of traumatic events

some respondents believed in ancestral causes It was interesting to note that the belief

in the connection of trauma to ancestral power was mostly held by older respondents

They mentioned that their ancestors talk to them and sometimes tend to understand

why some traumatic incidents happen to them For others it was an honour when their

ancestors talked to them because they were helping them with the type of intervention

that they must use for their problem Another point is that respondents showed that

they obey their ancestors and their instructions so that even understanding why

some mishaps are happening in their lives was not a concern The following extracts

reflect this

One day my father visited me in my sleep and told me to consult a traditional healerI consulted a traditional healer who told me that I have lsquotshilisorsquo (meaning something thatsomeone gives you without your awareness which ends up like a poison in your body)(RP 33)

To tell you the truth I think this is a punishment from my father because the cattle that I saiddied on one night were not given to me alone I took them forcefully from my half brother whowas my fatherrsquos favourite child From that time nothing went on smoothly in my life I am justworried that it seems as if even my following generation will suffer like what I did as a way ofpaying for what I did wrong (RP 68)

188 A Nevhutalu and P Mudhovozi

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ober

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4

Other causes of trauma

The study also revealed that trauma was caused by non-cultural factors Some participants

attributed traumatic experiences to the abuse of substances intimate partner violence

rape robbery road accidents and murder These are presented next

Substance abuse

Twelve per cent of the participants indicated that trauma was caused by the abuse of

substances They believed that when young people are under the influence of drugs they

involve themselves in violent acts which then affect the community as a whole They are

usually involved in housebreaking murder and rape This is reflected in the following

responses

The main cause of all this trouble is drugs and alcohol that the youth are using In mostinstances they are always at the bars drinking alcohol and smoking drugs After that they gowherever and cause all this troubles (RP 6)

I think that when the youths are involved in drugs they end up being involved in things likehousebreaking (RP 14)

I think the other cause is that young people use drugs that influence them to commit crimessuch as housebreaking and rape (RP 36)

As far as road accidents are concerned I think people sometimes drive when they are drunk ordrive recklessly which may also contribute to traumatic incidents (RP 65)

Road accidents may be caused by reckless driving and driving when people are drunk (RP 67)

Intimate partner violence

Some participants showed that intimate partner violence occurs among people though

very few report the incidents In almost all focus groups in this study very few responses

emerged around intimate partner violence as a form of a traumatic event This probably

happened because most people seem to consider domestic violence to be a normal way of

life in a family or in the community This is also regarded as something that is not

supposed to be disclosed This was reflected as follows

The other thing that people do not talk about is domestic violence (RP 33)

Domestic violence is also common but it is complicated because many women do not talkabout it even when they are being abused all the time (RP 36)

if he drinks he beats kicks and insults using vulgar words I mean those deep Vendawords that my children are not supposed to hear as these I think also affect them This hasbecome part of our life in this family that we just told ourselves that we should accept it assuch (RP 40)

Rape

Rape was mentioned in almost all focus group discussions Participants were concerned

about the fact that rape happens to people of all ages including children and it also makes

them feel unsafe Rape brings about fear in peoplersquos lives In these focus groups 21

reported having been raped and even those who were not subjected to this type of violence

showed concern that they were afraid of this act This is reflected by the following extracts

It is true because it is not safe to walk long distances alone where there is a small bush from 6pm onwards If you walk there alone you are just inviting trouble (RP 11)

International Journal of Health Promotion and Education 189

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Rape is something that we cannot leave out as it is becoming the order of the day (RP 32)

The common traumatic events in our area include rape and housebreaking Usually we do notfeel safe anymore when we are away We are always fearful that anything bad can happen atany time (RP 40)

Robbery

Robbery appeared to be contributing to a fearful environment for most participants They

felt that house and business breaking was traumatic The finding s supported by the

following statements

Housebreaking is threatening because you do not know what will happen after the personenters the house (RP 53)

Besides rape other common incidents include housebreaking and theft These days even if youare asleep you do not even know what will happen as thieves and criminals rob at night(RP 58)

The other thing which we see as a problem is theft even during the day This also includeshousebreaking which makes people not to feel safe (RP 70)

Road accidents

Another form of violence that emerged from the focus group discussions was road

accidents It appeared that road accidents created situations that became traumatic and

violent to many respondents Seventeen per cent of the participants reported incidences of

having been involved or affected in road accidents Like rape road accidents became a

concern for many respondents as in the following responses

Road accidents are very common Some victims of road accidents are school childrenSometimes these accidents happen in succession and it becomes very painful (RP 32)

Now that we are going for holidays you will hear a number of road accidents reported evenhere at our place The problem is that in some cases other people die and it is very painful forthe relatives who are left behind (RP 61)

Murder

Twelve per cent of the participants reported incidences of a family member or relative who

was murdered There was a general feeling of concern that people no longer have respect

for life The finding is supported by the following statements

Another problem around here is killings Mostly boys do this They kill each other like fliesSome people are killed by guns and some by knives (RP 7)

From the place where I come from incidences of shooting are escalating It is now becomingthe way of life where thieves may even shoot you when you are inside your house (RP 16)

Discussion

Most of the participants attributed the cause of trauma to witchcraft (60) followed by

mazhuzhulu (panic reaction to frightening thought or event) (20) The finding supports

the notion that peoplersquo understanding of trauma and its causes anchors on their

macrosystem the cultural lsquoblueprintrsquo that partially determines social structures and

activities that occur (Eamon 2001) In the present study the Venda-speaking participants

190 A Nevhutalu and P Mudhovozi

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ober

201

4

conceptualised trauma and its causes from their cultural beliefs Also the finding is in line

with Foulks et alrsquos (1977) assertion that Africans do not believe in chance bad luck or

fate They believe that every illness has an intention and a specific cause Their culture

includes customs values beliefs attitudes implicit rules of conduct patterns of family

social organisation taboos and sanctions which they shared (Triandis 1994 De Silva in

Yule 1999) Nonetheless 20 of the participants indicated that the trauma just happened

This view might have been put forward by participants who do not subscribe to the

traditional explanation of witchraft and mazhuluzhulu Another plausible explanation is

that the 20 may account for Black Africans who embraced the individualistic western

cultural values

Therefore the microsystems (immediate setting) mesosystems (processes between

two or more microsystems) exosystems (processes between two or more settings)

macrosystems (influences of a broader culture and socio-economic environments) and

chronosystems (effects of consistency and change over life course) among the Venda-

speaking participants influenced their understanding of the causes of trauma (Eamon

2001) Thus these structures of the ecological environment served as a framework for the

explanation of the Africansrsquo belief system among the Venda-speaking participants It is

therefore not surprising that most of them (60) attributed trauma to witchcraft

The above finding is in line with the notion that for many Africans Christianity was

only adopted outwardly and did not inspire them spiritually According to Waruta and

Kinoti (1994) many Africans still maintain their traditional beliefs and practices during

important or critical stages in life (like birth initiation marriage death incurable sickness

and other anxieties in daily living) while upholding their piety as bequeathed to them in the

missionary enterprise Waruta and Kinoti (1994) furthermore hold that any kind of

medical treatment which is unrelated to the supernatural and to the community has

limited chances of success in Africa even if half the patients profess to be Christians

Contrary to the above the western-oriented PTSD model fails to account for the cultural

pluralistic experience of trauma (Collins 2004)

Some participants cited devil possession and ancestral spirits as the major causes of

trauma The responses reflect the influence of the mesosystem on individual members The

mesosystem integrates the interrelations between two or more microsystems each of

which contains the developing person In an African view the mesosystem is the

intermediate universe It functions as a no-manrsquos land since it is believed to take place

where evil spirits witches and sorcerers dwell It is also called the lsquostructured collective

imaginaryrsquo a system that is highly respected for giving rise to all good and bad fortune as

well as giving of form to peoplersquos desires fears anxieties and hope for success It is also

believed to regulate the day-to-day psychological fate of individual human beings in

Africa (van Dyk 2001)

Contrary to expectation the study did lend support the notion that in an African

environment there is a belief that ritual impurities are usually associated with death the

reproductive system and the violation of sexual prohibitions (van Dyk 2001) It had been

argued that the violation of sexual prohibitions like sexual intercourse with a woman

during menstruation with a widow before she is cleansed or with a woman who has had

an abortion or miscarriage can lead to a variety of health problems However in this case

the wrath of ancestors is believed to cause illness but it is also believed that witches

sometimes use sexual intercourse to cause illness Besides this belief about witches and

ancestors as causes of illnesses (van Dyk 2001) events that occur in a community have

consequences on individuals in the home For example a community may believe in

International Journal of Health Promotion and Education 191

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witchcraft Failure by particular family members to co-operate with other community

members may lead those individuals to be suspects of witchcraft (van Dyk 2001)

The above finding is compatible with Kazarian and Evansrsquos (1998) assertion that the

ancestors can punish their people by sending illness and misfortune if social norms are

violated or when culturally prescribed practices are neglected or incorrectly performed

The illness might be caused by failure to perform a cultural and religious ritual

Nevertheless it is assumed that peaceful living with onersquos neighbours observing social

norms and living in harmony with onersquos environment and with God spirits and ancestors

are all essential to protect oneself and onersquos family from disease (Ebigbo 1987)

It emerged from the study that trauma also results from non-cultural causes Some

participants attributed traumatic experiences to the abuse of substances intimate partner

violence rape robbery road accidents and murder This finding is in line with Gopaul-

McNicol and Brice-Bakerrsquos (1998) argument that the majority of Africans acknowledge

that some illnesses have natural or organic causes In the same vein Eamon (2001) opines

that certain illnesses are originated in the microsystem The microsystem consists of the

immediate environment such as onersquos home friends relatives school and society In this

study the microsystem represents the everyday practical social and collective life of

people in Africa (van Dyk 2001)

Conclusion

The DSM-IV-TR and the ICD-10 explain the western understanding of the causes of

trauma (Collins 2004) However the given explanations do not suit the traditional African

concept of trauma The psychiatric categories that are used to understand measure and

classify mental distress are specific to western culture and society They ignore and

undermine the African concepts of suffering misfortune and illness Africansrsquo

conceptualisation of trauma and its causes is influenced by several contextual factors

Contextual factors include their social political and cultural realities To a larger extent

the Venda-speaking participants attributed trauma to witchcraft angry ancestral spirits and

devil possession The study concludes that culture is a determining factor in peoplesrsquo lives

influencing both decisions and understanding of the illnesses

Limitations of the study

This study has some limitations All the participants were drawn from the Venda-speaking

ethnic group The study is short of the voices of the Tsonga Pedi Afrikaans and English-

speaking people in the Limpopo Province Considering the qualitative nature of the

present study the findings are not generalisable

References

Collins A 2004 Trauma in context advanced reader Durban University of Kwazulu NatalDenzin NK and Lincoln YS eds 1998 Collecting and interpreting qualitative materials

London Sagevan Dyk A 2001 Traditional African beliefs and customs Implications for AIDS education and

prevention in Africa South African Journal of Psychology 31 60ndash66Eamon MK 2001 The effects of poverty on childrenrsquos socioemotional development an ecological

systems analysis Social Work 46 256ndash266Ebigbo PE 1987 The mind body and society an African perspective International Journal for

the Advancement of Health 3 (4) 45ndash57Foulks EF et al 1977 Current perspectives in cultural psychiatry New York Spectrum

192 A Nevhutalu and P Mudhovozi

Dow

nloa

ded

by [

Uni

vers

ity o

f C

onne

ctic

ut]

at 2

222

10

Oct

ober

201

4

Gopaul-McNicol S and Brice-Baker J 1998 Cross-cultural practice assessment treatment andtraining Canada Wiley

Kazarian SS and Evans DR 1998 Cultural clinical psychology theory research and practiceOxford Oxford University Press

Madu SN Baguma P and Pritz A 1999 Traditional healersrsquo approach to the schizophreniaFrankfurt IKO Verlag

Marshall C and Rossman GB 1999 Designing qualitative research 3rd ed New Delhi SageMatsumoto D 1996 Culture and psychology Pacific Grove CA BrooksColeNeuman WL 2000 Social research methods qualitative and quantitative approaches 4th ed

Boston MA Allyn amp BaconPeltzer K 2001 Exposure to violence and posttraumatic stress disorder in a rural adult population

in South Africa Acta Academica 32 73ndash84Struwig FW and Stead GB 2001 Planning designing and reporting research Pinelands

Cape Town Maskew Miller LongmanScholten A 2012 Bradycardia (Bradyarrythmia) [online] Available from httpcvimednyueduTriandis HC 1994 Culture and social behaviour New York McGraw-Hillde Vos AS ed 1998 Research at grassroots a prime for the caring professions Pretoria

Van SchaikWaruta DW and Kinoti HW 1994 Pastoral care in African Christianity essays in pastoral

theology Nairobi ActonYule W 1999 Post-traumatic stress disorders concepts and therapy Chichester Willey

International Journal of Health Promotion and Education 193

Dow

nloa

ded

by [

Uni

vers

ity o

f C

onne

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ut]

at 2

222

10

Oct

ober

201

4

explanation were not common in the olden days Eight per cent of the participants

perceived devil possession as a cause of violence This was reflected in the following

quotes

As far as rape is concerned I really do not know what is in the minds of men because theyeven rape babies of less than a year old In some cases one may think this may be influencedby Satanism (RP 32)

The other cause is that children these days are used by the devil or is like they have evil spiritsor possessed since they just kill as an end in itself and do not indicate why they killed or atleast show some hidden motive of wanting to steal that personrsquos money (RP 74)

Witchcraft

Though many respondents realised that they were living in a violent environment where

violent incidents occurred in their lives 8 attributed the causes of its trauma to

witchcraft Their explanations of the occurrence of traumatic incidents tended to suite their

held beliefs For example the interpretation of mishaps or misfortunes that befell

individuals was believed to be caused by witchcraft The belief that witchcraft is the cause

of violent incidents is reflected in the following

I think mine is obvious that there could be somebody who is after me because a person cannothave a series of accidents one after the other In Venda if incidents are happening like thiswe start to suspect that someone is bewitching you (RP 22)

I also felt the same way about the cause of my sonrsquos death I have a very strong suspicion thathe was bewitched (RP 51)

You may find that one of the people who were in the truck was bewitched and now it hasaffected all of us (RP 62)

When we are praying there are others who are working for Satanism so I cannot rule out that itmight be due to demons or witchcraft (RP 74)

Ancestral spirits

Even though most respondents believed in witchcraft as a cause of traumatic events

some respondents believed in ancestral causes It was interesting to note that the belief

in the connection of trauma to ancestral power was mostly held by older respondents

They mentioned that their ancestors talk to them and sometimes tend to understand

why some traumatic incidents happen to them For others it was an honour when their

ancestors talked to them because they were helping them with the type of intervention

that they must use for their problem Another point is that respondents showed that

they obey their ancestors and their instructions so that even understanding why

some mishaps are happening in their lives was not a concern The following extracts

reflect this

One day my father visited me in my sleep and told me to consult a traditional healerI consulted a traditional healer who told me that I have lsquotshilisorsquo (meaning something thatsomeone gives you without your awareness which ends up like a poison in your body)(RP 33)

To tell you the truth I think this is a punishment from my father because the cattle that I saiddied on one night were not given to me alone I took them forcefully from my half brother whowas my fatherrsquos favourite child From that time nothing went on smoothly in my life I am justworried that it seems as if even my following generation will suffer like what I did as a way ofpaying for what I did wrong (RP 68)

188 A Nevhutalu and P Mudhovozi

Dow

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by [

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Oct

ober

201

4

Other causes of trauma

The study also revealed that trauma was caused by non-cultural factors Some participants

attributed traumatic experiences to the abuse of substances intimate partner violence

rape robbery road accidents and murder These are presented next

Substance abuse

Twelve per cent of the participants indicated that trauma was caused by the abuse of

substances They believed that when young people are under the influence of drugs they

involve themselves in violent acts which then affect the community as a whole They are

usually involved in housebreaking murder and rape This is reflected in the following

responses

The main cause of all this trouble is drugs and alcohol that the youth are using In mostinstances they are always at the bars drinking alcohol and smoking drugs After that they gowherever and cause all this troubles (RP 6)

I think that when the youths are involved in drugs they end up being involved in things likehousebreaking (RP 14)

I think the other cause is that young people use drugs that influence them to commit crimessuch as housebreaking and rape (RP 36)

As far as road accidents are concerned I think people sometimes drive when they are drunk ordrive recklessly which may also contribute to traumatic incidents (RP 65)

Road accidents may be caused by reckless driving and driving when people are drunk (RP 67)

Intimate partner violence

Some participants showed that intimate partner violence occurs among people though

very few report the incidents In almost all focus groups in this study very few responses

emerged around intimate partner violence as a form of a traumatic event This probably

happened because most people seem to consider domestic violence to be a normal way of

life in a family or in the community This is also regarded as something that is not

supposed to be disclosed This was reflected as follows

The other thing that people do not talk about is domestic violence (RP 33)

Domestic violence is also common but it is complicated because many women do not talkabout it even when they are being abused all the time (RP 36)

if he drinks he beats kicks and insults using vulgar words I mean those deep Vendawords that my children are not supposed to hear as these I think also affect them This hasbecome part of our life in this family that we just told ourselves that we should accept it assuch (RP 40)

Rape

Rape was mentioned in almost all focus group discussions Participants were concerned

about the fact that rape happens to people of all ages including children and it also makes

them feel unsafe Rape brings about fear in peoplersquos lives In these focus groups 21

reported having been raped and even those who were not subjected to this type of violence

showed concern that they were afraid of this act This is reflected by the following extracts

It is true because it is not safe to walk long distances alone where there is a small bush from 6pm onwards If you walk there alone you are just inviting trouble (RP 11)

International Journal of Health Promotion and Education 189

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ober

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4

Rape is something that we cannot leave out as it is becoming the order of the day (RP 32)

The common traumatic events in our area include rape and housebreaking Usually we do notfeel safe anymore when we are away We are always fearful that anything bad can happen atany time (RP 40)

Robbery

Robbery appeared to be contributing to a fearful environment for most participants They

felt that house and business breaking was traumatic The finding s supported by the

following statements

Housebreaking is threatening because you do not know what will happen after the personenters the house (RP 53)

Besides rape other common incidents include housebreaking and theft These days even if youare asleep you do not even know what will happen as thieves and criminals rob at night(RP 58)

The other thing which we see as a problem is theft even during the day This also includeshousebreaking which makes people not to feel safe (RP 70)

Road accidents

Another form of violence that emerged from the focus group discussions was road

accidents It appeared that road accidents created situations that became traumatic and

violent to many respondents Seventeen per cent of the participants reported incidences of

having been involved or affected in road accidents Like rape road accidents became a

concern for many respondents as in the following responses

Road accidents are very common Some victims of road accidents are school childrenSometimes these accidents happen in succession and it becomes very painful (RP 32)

Now that we are going for holidays you will hear a number of road accidents reported evenhere at our place The problem is that in some cases other people die and it is very painful forthe relatives who are left behind (RP 61)

Murder

Twelve per cent of the participants reported incidences of a family member or relative who

was murdered There was a general feeling of concern that people no longer have respect

for life The finding is supported by the following statements

Another problem around here is killings Mostly boys do this They kill each other like fliesSome people are killed by guns and some by knives (RP 7)

From the place where I come from incidences of shooting are escalating It is now becomingthe way of life where thieves may even shoot you when you are inside your house (RP 16)

Discussion

Most of the participants attributed the cause of trauma to witchcraft (60) followed by

mazhuzhulu (panic reaction to frightening thought or event) (20) The finding supports

the notion that peoplersquo understanding of trauma and its causes anchors on their

macrosystem the cultural lsquoblueprintrsquo that partially determines social structures and

activities that occur (Eamon 2001) In the present study the Venda-speaking participants

190 A Nevhutalu and P Mudhovozi

Dow

nloa

ded

by [

Uni

vers

ity o

f C

onne

ctic

ut]

at 2

222

10

Oct

ober

201

4

conceptualised trauma and its causes from their cultural beliefs Also the finding is in line

with Foulks et alrsquos (1977) assertion that Africans do not believe in chance bad luck or

fate They believe that every illness has an intention and a specific cause Their culture

includes customs values beliefs attitudes implicit rules of conduct patterns of family

social organisation taboos and sanctions which they shared (Triandis 1994 De Silva in

Yule 1999) Nonetheless 20 of the participants indicated that the trauma just happened

This view might have been put forward by participants who do not subscribe to the

traditional explanation of witchraft and mazhuluzhulu Another plausible explanation is

that the 20 may account for Black Africans who embraced the individualistic western

cultural values

Therefore the microsystems (immediate setting) mesosystems (processes between

two or more microsystems) exosystems (processes between two or more settings)

macrosystems (influences of a broader culture and socio-economic environments) and

chronosystems (effects of consistency and change over life course) among the Venda-

speaking participants influenced their understanding of the causes of trauma (Eamon

2001) Thus these structures of the ecological environment served as a framework for the

explanation of the Africansrsquo belief system among the Venda-speaking participants It is

therefore not surprising that most of them (60) attributed trauma to witchcraft

The above finding is in line with the notion that for many Africans Christianity was

only adopted outwardly and did not inspire them spiritually According to Waruta and

Kinoti (1994) many Africans still maintain their traditional beliefs and practices during

important or critical stages in life (like birth initiation marriage death incurable sickness

and other anxieties in daily living) while upholding their piety as bequeathed to them in the

missionary enterprise Waruta and Kinoti (1994) furthermore hold that any kind of

medical treatment which is unrelated to the supernatural and to the community has

limited chances of success in Africa even if half the patients profess to be Christians

Contrary to the above the western-oriented PTSD model fails to account for the cultural

pluralistic experience of trauma (Collins 2004)

Some participants cited devil possession and ancestral spirits as the major causes of

trauma The responses reflect the influence of the mesosystem on individual members The

mesosystem integrates the interrelations between two or more microsystems each of

which contains the developing person In an African view the mesosystem is the

intermediate universe It functions as a no-manrsquos land since it is believed to take place

where evil spirits witches and sorcerers dwell It is also called the lsquostructured collective

imaginaryrsquo a system that is highly respected for giving rise to all good and bad fortune as

well as giving of form to peoplersquos desires fears anxieties and hope for success It is also

believed to regulate the day-to-day psychological fate of individual human beings in

Africa (van Dyk 2001)

Contrary to expectation the study did lend support the notion that in an African

environment there is a belief that ritual impurities are usually associated with death the

reproductive system and the violation of sexual prohibitions (van Dyk 2001) It had been

argued that the violation of sexual prohibitions like sexual intercourse with a woman

during menstruation with a widow before she is cleansed or with a woman who has had

an abortion or miscarriage can lead to a variety of health problems However in this case

the wrath of ancestors is believed to cause illness but it is also believed that witches

sometimes use sexual intercourse to cause illness Besides this belief about witches and

ancestors as causes of illnesses (van Dyk 2001) events that occur in a community have

consequences on individuals in the home For example a community may believe in

International Journal of Health Promotion and Education 191

Dow

nloa

ded

by [

Uni

vers

ity o

f C

onne

ctic

ut]

at 2

222

10

Oct

ober

201

4

witchcraft Failure by particular family members to co-operate with other community

members may lead those individuals to be suspects of witchcraft (van Dyk 2001)

The above finding is compatible with Kazarian and Evansrsquos (1998) assertion that the

ancestors can punish their people by sending illness and misfortune if social norms are

violated or when culturally prescribed practices are neglected or incorrectly performed

The illness might be caused by failure to perform a cultural and religious ritual

Nevertheless it is assumed that peaceful living with onersquos neighbours observing social

norms and living in harmony with onersquos environment and with God spirits and ancestors

are all essential to protect oneself and onersquos family from disease (Ebigbo 1987)

It emerged from the study that trauma also results from non-cultural causes Some

participants attributed traumatic experiences to the abuse of substances intimate partner

violence rape robbery road accidents and murder This finding is in line with Gopaul-

McNicol and Brice-Bakerrsquos (1998) argument that the majority of Africans acknowledge

that some illnesses have natural or organic causes In the same vein Eamon (2001) opines

that certain illnesses are originated in the microsystem The microsystem consists of the

immediate environment such as onersquos home friends relatives school and society In this

study the microsystem represents the everyday practical social and collective life of

people in Africa (van Dyk 2001)

Conclusion

The DSM-IV-TR and the ICD-10 explain the western understanding of the causes of

trauma (Collins 2004) However the given explanations do not suit the traditional African

concept of trauma The psychiatric categories that are used to understand measure and

classify mental distress are specific to western culture and society They ignore and

undermine the African concepts of suffering misfortune and illness Africansrsquo

conceptualisation of trauma and its causes is influenced by several contextual factors

Contextual factors include their social political and cultural realities To a larger extent

the Venda-speaking participants attributed trauma to witchcraft angry ancestral spirits and

devil possession The study concludes that culture is a determining factor in peoplesrsquo lives

influencing both decisions and understanding of the illnesses

Limitations of the study

This study has some limitations All the participants were drawn from the Venda-speaking

ethnic group The study is short of the voices of the Tsonga Pedi Afrikaans and English-

speaking people in the Limpopo Province Considering the qualitative nature of the

present study the findings are not generalisable

References

Collins A 2004 Trauma in context advanced reader Durban University of Kwazulu NatalDenzin NK and Lincoln YS eds 1998 Collecting and interpreting qualitative materials

London Sagevan Dyk A 2001 Traditional African beliefs and customs Implications for AIDS education and

prevention in Africa South African Journal of Psychology 31 60ndash66Eamon MK 2001 The effects of poverty on childrenrsquos socioemotional development an ecological

systems analysis Social Work 46 256ndash266Ebigbo PE 1987 The mind body and society an African perspective International Journal for

the Advancement of Health 3 (4) 45ndash57Foulks EF et al 1977 Current perspectives in cultural psychiatry New York Spectrum

192 A Nevhutalu and P Mudhovozi

Dow

nloa

ded

by [

Uni

vers

ity o

f C

onne

ctic

ut]

at 2

222

10

Oct

ober

201

4

Gopaul-McNicol S and Brice-Baker J 1998 Cross-cultural practice assessment treatment andtraining Canada Wiley

Kazarian SS and Evans DR 1998 Cultural clinical psychology theory research and practiceOxford Oxford University Press

Madu SN Baguma P and Pritz A 1999 Traditional healersrsquo approach to the schizophreniaFrankfurt IKO Verlag

Marshall C and Rossman GB 1999 Designing qualitative research 3rd ed New Delhi SageMatsumoto D 1996 Culture and psychology Pacific Grove CA BrooksColeNeuman WL 2000 Social research methods qualitative and quantitative approaches 4th ed

Boston MA Allyn amp BaconPeltzer K 2001 Exposure to violence and posttraumatic stress disorder in a rural adult population

in South Africa Acta Academica 32 73ndash84Struwig FW and Stead GB 2001 Planning designing and reporting research Pinelands

Cape Town Maskew Miller LongmanScholten A 2012 Bradycardia (Bradyarrythmia) [online] Available from httpcvimednyueduTriandis HC 1994 Culture and social behaviour New York McGraw-Hillde Vos AS ed 1998 Research at grassroots a prime for the caring professions Pretoria

Van SchaikWaruta DW and Kinoti HW 1994 Pastoral care in African Christianity essays in pastoral

theology Nairobi ActonYule W 1999 Post-traumatic stress disorders concepts and therapy Chichester Willey

International Journal of Health Promotion and Education 193

Dow

nloa

ded

by [

Uni

vers

ity o

f C

onne

ctic

ut]

at 2

222

10

Oct

ober

201

4

Other causes of trauma

The study also revealed that trauma was caused by non-cultural factors Some participants

attributed traumatic experiences to the abuse of substances intimate partner violence

rape robbery road accidents and murder These are presented next

Substance abuse

Twelve per cent of the participants indicated that trauma was caused by the abuse of

substances They believed that when young people are under the influence of drugs they

involve themselves in violent acts which then affect the community as a whole They are

usually involved in housebreaking murder and rape This is reflected in the following

responses

The main cause of all this trouble is drugs and alcohol that the youth are using In mostinstances they are always at the bars drinking alcohol and smoking drugs After that they gowherever and cause all this troubles (RP 6)

I think that when the youths are involved in drugs they end up being involved in things likehousebreaking (RP 14)

I think the other cause is that young people use drugs that influence them to commit crimessuch as housebreaking and rape (RP 36)

As far as road accidents are concerned I think people sometimes drive when they are drunk ordrive recklessly which may also contribute to traumatic incidents (RP 65)

Road accidents may be caused by reckless driving and driving when people are drunk (RP 67)

Intimate partner violence

Some participants showed that intimate partner violence occurs among people though

very few report the incidents In almost all focus groups in this study very few responses

emerged around intimate partner violence as a form of a traumatic event This probably

happened because most people seem to consider domestic violence to be a normal way of

life in a family or in the community This is also regarded as something that is not

supposed to be disclosed This was reflected as follows

The other thing that people do not talk about is domestic violence (RP 33)

Domestic violence is also common but it is complicated because many women do not talkabout it even when they are being abused all the time (RP 36)

if he drinks he beats kicks and insults using vulgar words I mean those deep Vendawords that my children are not supposed to hear as these I think also affect them This hasbecome part of our life in this family that we just told ourselves that we should accept it assuch (RP 40)

Rape

Rape was mentioned in almost all focus group discussions Participants were concerned

about the fact that rape happens to people of all ages including children and it also makes

them feel unsafe Rape brings about fear in peoplersquos lives In these focus groups 21

reported having been raped and even those who were not subjected to this type of violence

showed concern that they were afraid of this act This is reflected by the following extracts

It is true because it is not safe to walk long distances alone where there is a small bush from 6pm onwards If you walk there alone you are just inviting trouble (RP 11)

International Journal of Health Promotion and Education 189

Dow

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ded

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ut]

at 2

222

10

Oct

ober

201

4

Rape is something that we cannot leave out as it is becoming the order of the day (RP 32)

The common traumatic events in our area include rape and housebreaking Usually we do notfeel safe anymore when we are away We are always fearful that anything bad can happen atany time (RP 40)

Robbery

Robbery appeared to be contributing to a fearful environment for most participants They

felt that house and business breaking was traumatic The finding s supported by the

following statements

Housebreaking is threatening because you do not know what will happen after the personenters the house (RP 53)

Besides rape other common incidents include housebreaking and theft These days even if youare asleep you do not even know what will happen as thieves and criminals rob at night(RP 58)

The other thing which we see as a problem is theft even during the day This also includeshousebreaking which makes people not to feel safe (RP 70)

Road accidents

Another form of violence that emerged from the focus group discussions was road

accidents It appeared that road accidents created situations that became traumatic and

violent to many respondents Seventeen per cent of the participants reported incidences of

having been involved or affected in road accidents Like rape road accidents became a

concern for many respondents as in the following responses

Road accidents are very common Some victims of road accidents are school childrenSometimes these accidents happen in succession and it becomes very painful (RP 32)

Now that we are going for holidays you will hear a number of road accidents reported evenhere at our place The problem is that in some cases other people die and it is very painful forthe relatives who are left behind (RP 61)

Murder

Twelve per cent of the participants reported incidences of a family member or relative who

was murdered There was a general feeling of concern that people no longer have respect

for life The finding is supported by the following statements

Another problem around here is killings Mostly boys do this They kill each other like fliesSome people are killed by guns and some by knives (RP 7)

From the place where I come from incidences of shooting are escalating It is now becomingthe way of life where thieves may even shoot you when you are inside your house (RP 16)

Discussion

Most of the participants attributed the cause of trauma to witchcraft (60) followed by

mazhuzhulu (panic reaction to frightening thought or event) (20) The finding supports

the notion that peoplersquo understanding of trauma and its causes anchors on their

macrosystem the cultural lsquoblueprintrsquo that partially determines social structures and

activities that occur (Eamon 2001) In the present study the Venda-speaking participants

190 A Nevhutalu and P Mudhovozi

Dow

nloa

ded

by [

Uni

vers

ity o

f C

onne

ctic

ut]

at 2

222

10

Oct

ober

201

4

conceptualised trauma and its causes from their cultural beliefs Also the finding is in line

with Foulks et alrsquos (1977) assertion that Africans do not believe in chance bad luck or

fate They believe that every illness has an intention and a specific cause Their culture

includes customs values beliefs attitudes implicit rules of conduct patterns of family

social organisation taboos and sanctions which they shared (Triandis 1994 De Silva in

Yule 1999) Nonetheless 20 of the participants indicated that the trauma just happened

This view might have been put forward by participants who do not subscribe to the

traditional explanation of witchraft and mazhuluzhulu Another plausible explanation is

that the 20 may account for Black Africans who embraced the individualistic western

cultural values

Therefore the microsystems (immediate setting) mesosystems (processes between

two or more microsystems) exosystems (processes between two or more settings)

macrosystems (influences of a broader culture and socio-economic environments) and

chronosystems (effects of consistency and change over life course) among the Venda-

speaking participants influenced their understanding of the causes of trauma (Eamon

2001) Thus these structures of the ecological environment served as a framework for the

explanation of the Africansrsquo belief system among the Venda-speaking participants It is

therefore not surprising that most of them (60) attributed trauma to witchcraft

The above finding is in line with the notion that for many Africans Christianity was

only adopted outwardly and did not inspire them spiritually According to Waruta and

Kinoti (1994) many Africans still maintain their traditional beliefs and practices during

important or critical stages in life (like birth initiation marriage death incurable sickness

and other anxieties in daily living) while upholding their piety as bequeathed to them in the

missionary enterprise Waruta and Kinoti (1994) furthermore hold that any kind of

medical treatment which is unrelated to the supernatural and to the community has

limited chances of success in Africa even if half the patients profess to be Christians

Contrary to the above the western-oriented PTSD model fails to account for the cultural

pluralistic experience of trauma (Collins 2004)

Some participants cited devil possession and ancestral spirits as the major causes of

trauma The responses reflect the influence of the mesosystem on individual members The

mesosystem integrates the interrelations between two or more microsystems each of

which contains the developing person In an African view the mesosystem is the

intermediate universe It functions as a no-manrsquos land since it is believed to take place

where evil spirits witches and sorcerers dwell It is also called the lsquostructured collective

imaginaryrsquo a system that is highly respected for giving rise to all good and bad fortune as

well as giving of form to peoplersquos desires fears anxieties and hope for success It is also

believed to regulate the day-to-day psychological fate of individual human beings in

Africa (van Dyk 2001)

Contrary to expectation the study did lend support the notion that in an African

environment there is a belief that ritual impurities are usually associated with death the

reproductive system and the violation of sexual prohibitions (van Dyk 2001) It had been

argued that the violation of sexual prohibitions like sexual intercourse with a woman

during menstruation with a widow before she is cleansed or with a woman who has had

an abortion or miscarriage can lead to a variety of health problems However in this case

the wrath of ancestors is believed to cause illness but it is also believed that witches

sometimes use sexual intercourse to cause illness Besides this belief about witches and

ancestors as causes of illnesses (van Dyk 2001) events that occur in a community have

consequences on individuals in the home For example a community may believe in

International Journal of Health Promotion and Education 191

Dow

nloa

ded

by [

Uni

vers

ity o

f C

onne

ctic

ut]

at 2

222

10

Oct

ober

201

4

witchcraft Failure by particular family members to co-operate with other community

members may lead those individuals to be suspects of witchcraft (van Dyk 2001)

The above finding is compatible with Kazarian and Evansrsquos (1998) assertion that the

ancestors can punish their people by sending illness and misfortune if social norms are

violated or when culturally prescribed practices are neglected or incorrectly performed

The illness might be caused by failure to perform a cultural and religious ritual

Nevertheless it is assumed that peaceful living with onersquos neighbours observing social

norms and living in harmony with onersquos environment and with God spirits and ancestors

are all essential to protect oneself and onersquos family from disease (Ebigbo 1987)

It emerged from the study that trauma also results from non-cultural causes Some

participants attributed traumatic experiences to the abuse of substances intimate partner

violence rape robbery road accidents and murder This finding is in line with Gopaul-

McNicol and Brice-Bakerrsquos (1998) argument that the majority of Africans acknowledge

that some illnesses have natural or organic causes In the same vein Eamon (2001) opines

that certain illnesses are originated in the microsystem The microsystem consists of the

immediate environment such as onersquos home friends relatives school and society In this

study the microsystem represents the everyday practical social and collective life of

people in Africa (van Dyk 2001)

Conclusion

The DSM-IV-TR and the ICD-10 explain the western understanding of the causes of

trauma (Collins 2004) However the given explanations do not suit the traditional African

concept of trauma The psychiatric categories that are used to understand measure and

classify mental distress are specific to western culture and society They ignore and

undermine the African concepts of suffering misfortune and illness Africansrsquo

conceptualisation of trauma and its causes is influenced by several contextual factors

Contextual factors include their social political and cultural realities To a larger extent

the Venda-speaking participants attributed trauma to witchcraft angry ancestral spirits and

devil possession The study concludes that culture is a determining factor in peoplesrsquo lives

influencing both decisions and understanding of the illnesses

Limitations of the study

This study has some limitations All the participants were drawn from the Venda-speaking

ethnic group The study is short of the voices of the Tsonga Pedi Afrikaans and English-

speaking people in the Limpopo Province Considering the qualitative nature of the

present study the findings are not generalisable

References

Collins A 2004 Trauma in context advanced reader Durban University of Kwazulu NatalDenzin NK and Lincoln YS eds 1998 Collecting and interpreting qualitative materials

London Sagevan Dyk A 2001 Traditional African beliefs and customs Implications for AIDS education and

prevention in Africa South African Journal of Psychology 31 60ndash66Eamon MK 2001 The effects of poverty on childrenrsquos socioemotional development an ecological

systems analysis Social Work 46 256ndash266Ebigbo PE 1987 The mind body and society an African perspective International Journal for

the Advancement of Health 3 (4) 45ndash57Foulks EF et al 1977 Current perspectives in cultural psychiatry New York Spectrum

192 A Nevhutalu and P Mudhovozi

Dow

nloa

ded

by [

Uni

vers

ity o

f C

onne

ctic

ut]

at 2

222

10

Oct

ober

201

4

Gopaul-McNicol S and Brice-Baker J 1998 Cross-cultural practice assessment treatment andtraining Canada Wiley

Kazarian SS and Evans DR 1998 Cultural clinical psychology theory research and practiceOxford Oxford University Press

Madu SN Baguma P and Pritz A 1999 Traditional healersrsquo approach to the schizophreniaFrankfurt IKO Verlag

Marshall C and Rossman GB 1999 Designing qualitative research 3rd ed New Delhi SageMatsumoto D 1996 Culture and psychology Pacific Grove CA BrooksColeNeuman WL 2000 Social research methods qualitative and quantitative approaches 4th ed

Boston MA Allyn amp BaconPeltzer K 2001 Exposure to violence and posttraumatic stress disorder in a rural adult population

in South Africa Acta Academica 32 73ndash84Struwig FW and Stead GB 2001 Planning designing and reporting research Pinelands

Cape Town Maskew Miller LongmanScholten A 2012 Bradycardia (Bradyarrythmia) [online] Available from httpcvimednyueduTriandis HC 1994 Culture and social behaviour New York McGraw-Hillde Vos AS ed 1998 Research at grassroots a prime for the caring professions Pretoria

Van SchaikWaruta DW and Kinoti HW 1994 Pastoral care in African Christianity essays in pastoral

theology Nairobi ActonYule W 1999 Post-traumatic stress disorders concepts and therapy Chichester Willey

International Journal of Health Promotion and Education 193

Dow

nloa

ded

by [

Uni

vers

ity o

f C

onne

ctic

ut]

at 2

222

10

Oct

ober

201

4

Rape is something that we cannot leave out as it is becoming the order of the day (RP 32)

The common traumatic events in our area include rape and housebreaking Usually we do notfeel safe anymore when we are away We are always fearful that anything bad can happen atany time (RP 40)

Robbery

Robbery appeared to be contributing to a fearful environment for most participants They

felt that house and business breaking was traumatic The finding s supported by the

following statements

Housebreaking is threatening because you do not know what will happen after the personenters the house (RP 53)

Besides rape other common incidents include housebreaking and theft These days even if youare asleep you do not even know what will happen as thieves and criminals rob at night(RP 58)

The other thing which we see as a problem is theft even during the day This also includeshousebreaking which makes people not to feel safe (RP 70)

Road accidents

Another form of violence that emerged from the focus group discussions was road

accidents It appeared that road accidents created situations that became traumatic and

violent to many respondents Seventeen per cent of the participants reported incidences of

having been involved or affected in road accidents Like rape road accidents became a

concern for many respondents as in the following responses

Road accidents are very common Some victims of road accidents are school childrenSometimes these accidents happen in succession and it becomes very painful (RP 32)

Now that we are going for holidays you will hear a number of road accidents reported evenhere at our place The problem is that in some cases other people die and it is very painful forthe relatives who are left behind (RP 61)

Murder

Twelve per cent of the participants reported incidences of a family member or relative who

was murdered There was a general feeling of concern that people no longer have respect

for life The finding is supported by the following statements

Another problem around here is killings Mostly boys do this They kill each other like fliesSome people are killed by guns and some by knives (RP 7)

From the place where I come from incidences of shooting are escalating It is now becomingthe way of life where thieves may even shoot you when you are inside your house (RP 16)

Discussion

Most of the participants attributed the cause of trauma to witchcraft (60) followed by

mazhuzhulu (panic reaction to frightening thought or event) (20) The finding supports

the notion that peoplersquo understanding of trauma and its causes anchors on their

macrosystem the cultural lsquoblueprintrsquo that partially determines social structures and

activities that occur (Eamon 2001) In the present study the Venda-speaking participants

190 A Nevhutalu and P Mudhovozi

Dow

nloa

ded

by [

Uni

vers

ity o

f C

onne

ctic

ut]

at 2

222

10

Oct

ober

201

4

conceptualised trauma and its causes from their cultural beliefs Also the finding is in line

with Foulks et alrsquos (1977) assertion that Africans do not believe in chance bad luck or

fate They believe that every illness has an intention and a specific cause Their culture

includes customs values beliefs attitudes implicit rules of conduct patterns of family

social organisation taboos and sanctions which they shared (Triandis 1994 De Silva in

Yule 1999) Nonetheless 20 of the participants indicated that the trauma just happened

This view might have been put forward by participants who do not subscribe to the

traditional explanation of witchraft and mazhuluzhulu Another plausible explanation is

that the 20 may account for Black Africans who embraced the individualistic western

cultural values

Therefore the microsystems (immediate setting) mesosystems (processes between

two or more microsystems) exosystems (processes between two or more settings)

macrosystems (influences of a broader culture and socio-economic environments) and

chronosystems (effects of consistency and change over life course) among the Venda-

speaking participants influenced their understanding of the causes of trauma (Eamon

2001) Thus these structures of the ecological environment served as a framework for the

explanation of the Africansrsquo belief system among the Venda-speaking participants It is

therefore not surprising that most of them (60) attributed trauma to witchcraft

The above finding is in line with the notion that for many Africans Christianity was

only adopted outwardly and did not inspire them spiritually According to Waruta and

Kinoti (1994) many Africans still maintain their traditional beliefs and practices during

important or critical stages in life (like birth initiation marriage death incurable sickness

and other anxieties in daily living) while upholding their piety as bequeathed to them in the

missionary enterprise Waruta and Kinoti (1994) furthermore hold that any kind of

medical treatment which is unrelated to the supernatural and to the community has

limited chances of success in Africa even if half the patients profess to be Christians

Contrary to the above the western-oriented PTSD model fails to account for the cultural

pluralistic experience of trauma (Collins 2004)

Some participants cited devil possession and ancestral spirits as the major causes of

trauma The responses reflect the influence of the mesosystem on individual members The

mesosystem integrates the interrelations between two or more microsystems each of

which contains the developing person In an African view the mesosystem is the

intermediate universe It functions as a no-manrsquos land since it is believed to take place

where evil spirits witches and sorcerers dwell It is also called the lsquostructured collective

imaginaryrsquo a system that is highly respected for giving rise to all good and bad fortune as

well as giving of form to peoplersquos desires fears anxieties and hope for success It is also

believed to regulate the day-to-day psychological fate of individual human beings in

Africa (van Dyk 2001)

Contrary to expectation the study did lend support the notion that in an African

environment there is a belief that ritual impurities are usually associated with death the

reproductive system and the violation of sexual prohibitions (van Dyk 2001) It had been

argued that the violation of sexual prohibitions like sexual intercourse with a woman

during menstruation with a widow before she is cleansed or with a woman who has had

an abortion or miscarriage can lead to a variety of health problems However in this case

the wrath of ancestors is believed to cause illness but it is also believed that witches

sometimes use sexual intercourse to cause illness Besides this belief about witches and

ancestors as causes of illnesses (van Dyk 2001) events that occur in a community have

consequences on individuals in the home For example a community may believe in

International Journal of Health Promotion and Education 191

Dow

nloa

ded

by [

Uni

vers

ity o

f C

onne

ctic

ut]

at 2

222

10

Oct

ober

201

4

witchcraft Failure by particular family members to co-operate with other community

members may lead those individuals to be suspects of witchcraft (van Dyk 2001)

The above finding is compatible with Kazarian and Evansrsquos (1998) assertion that the

ancestors can punish their people by sending illness and misfortune if social norms are

violated or when culturally prescribed practices are neglected or incorrectly performed

The illness might be caused by failure to perform a cultural and religious ritual

Nevertheless it is assumed that peaceful living with onersquos neighbours observing social

norms and living in harmony with onersquos environment and with God spirits and ancestors

are all essential to protect oneself and onersquos family from disease (Ebigbo 1987)

It emerged from the study that trauma also results from non-cultural causes Some

participants attributed traumatic experiences to the abuse of substances intimate partner

violence rape robbery road accidents and murder This finding is in line with Gopaul-

McNicol and Brice-Bakerrsquos (1998) argument that the majority of Africans acknowledge

that some illnesses have natural or organic causes In the same vein Eamon (2001) opines

that certain illnesses are originated in the microsystem The microsystem consists of the

immediate environment such as onersquos home friends relatives school and society In this

study the microsystem represents the everyday practical social and collective life of

people in Africa (van Dyk 2001)

Conclusion

The DSM-IV-TR and the ICD-10 explain the western understanding of the causes of

trauma (Collins 2004) However the given explanations do not suit the traditional African

concept of trauma The psychiatric categories that are used to understand measure and

classify mental distress are specific to western culture and society They ignore and

undermine the African concepts of suffering misfortune and illness Africansrsquo

conceptualisation of trauma and its causes is influenced by several contextual factors

Contextual factors include their social political and cultural realities To a larger extent

the Venda-speaking participants attributed trauma to witchcraft angry ancestral spirits and

devil possession The study concludes that culture is a determining factor in peoplesrsquo lives

influencing both decisions and understanding of the illnesses

Limitations of the study

This study has some limitations All the participants were drawn from the Venda-speaking

ethnic group The study is short of the voices of the Tsonga Pedi Afrikaans and English-

speaking people in the Limpopo Province Considering the qualitative nature of the

present study the findings are not generalisable

References

Collins A 2004 Trauma in context advanced reader Durban University of Kwazulu NatalDenzin NK and Lincoln YS eds 1998 Collecting and interpreting qualitative materials

London Sagevan Dyk A 2001 Traditional African beliefs and customs Implications for AIDS education and

prevention in Africa South African Journal of Psychology 31 60ndash66Eamon MK 2001 The effects of poverty on childrenrsquos socioemotional development an ecological

systems analysis Social Work 46 256ndash266Ebigbo PE 1987 The mind body and society an African perspective International Journal for

the Advancement of Health 3 (4) 45ndash57Foulks EF et al 1977 Current perspectives in cultural psychiatry New York Spectrum

192 A Nevhutalu and P Mudhovozi

Dow

nloa

ded

by [

Uni

vers

ity o

f C

onne

ctic

ut]

at 2

222

10

Oct

ober

201

4

Gopaul-McNicol S and Brice-Baker J 1998 Cross-cultural practice assessment treatment andtraining Canada Wiley

Kazarian SS and Evans DR 1998 Cultural clinical psychology theory research and practiceOxford Oxford University Press

Madu SN Baguma P and Pritz A 1999 Traditional healersrsquo approach to the schizophreniaFrankfurt IKO Verlag

Marshall C and Rossman GB 1999 Designing qualitative research 3rd ed New Delhi SageMatsumoto D 1996 Culture and psychology Pacific Grove CA BrooksColeNeuman WL 2000 Social research methods qualitative and quantitative approaches 4th ed

Boston MA Allyn amp BaconPeltzer K 2001 Exposure to violence and posttraumatic stress disorder in a rural adult population

in South Africa Acta Academica 32 73ndash84Struwig FW and Stead GB 2001 Planning designing and reporting research Pinelands

Cape Town Maskew Miller LongmanScholten A 2012 Bradycardia (Bradyarrythmia) [online] Available from httpcvimednyueduTriandis HC 1994 Culture and social behaviour New York McGraw-Hillde Vos AS ed 1998 Research at grassroots a prime for the caring professions Pretoria

Van SchaikWaruta DW and Kinoti HW 1994 Pastoral care in African Christianity essays in pastoral

theology Nairobi ActonYule W 1999 Post-traumatic stress disorders concepts and therapy Chichester Willey

International Journal of Health Promotion and Education 193

Dow

nloa

ded

by [

Uni

vers

ity o

f C

onne

ctic

ut]

at 2

222

10

Oct

ober

201

4

conceptualised trauma and its causes from their cultural beliefs Also the finding is in line

with Foulks et alrsquos (1977) assertion that Africans do not believe in chance bad luck or

fate They believe that every illness has an intention and a specific cause Their culture

includes customs values beliefs attitudes implicit rules of conduct patterns of family

social organisation taboos and sanctions which they shared (Triandis 1994 De Silva in

Yule 1999) Nonetheless 20 of the participants indicated that the trauma just happened

This view might have been put forward by participants who do not subscribe to the

traditional explanation of witchraft and mazhuluzhulu Another plausible explanation is

that the 20 may account for Black Africans who embraced the individualistic western

cultural values

Therefore the microsystems (immediate setting) mesosystems (processes between

two or more microsystems) exosystems (processes between two or more settings)

macrosystems (influences of a broader culture and socio-economic environments) and

chronosystems (effects of consistency and change over life course) among the Venda-

speaking participants influenced their understanding of the causes of trauma (Eamon

2001) Thus these structures of the ecological environment served as a framework for the

explanation of the Africansrsquo belief system among the Venda-speaking participants It is

therefore not surprising that most of them (60) attributed trauma to witchcraft

The above finding is in line with the notion that for many Africans Christianity was

only adopted outwardly and did not inspire them spiritually According to Waruta and

Kinoti (1994) many Africans still maintain their traditional beliefs and practices during

important or critical stages in life (like birth initiation marriage death incurable sickness

and other anxieties in daily living) while upholding their piety as bequeathed to them in the

missionary enterprise Waruta and Kinoti (1994) furthermore hold that any kind of

medical treatment which is unrelated to the supernatural and to the community has

limited chances of success in Africa even if half the patients profess to be Christians

Contrary to the above the western-oriented PTSD model fails to account for the cultural

pluralistic experience of trauma (Collins 2004)

Some participants cited devil possession and ancestral spirits as the major causes of

trauma The responses reflect the influence of the mesosystem on individual members The

mesosystem integrates the interrelations between two or more microsystems each of

which contains the developing person In an African view the mesosystem is the

intermediate universe It functions as a no-manrsquos land since it is believed to take place

where evil spirits witches and sorcerers dwell It is also called the lsquostructured collective

imaginaryrsquo a system that is highly respected for giving rise to all good and bad fortune as

well as giving of form to peoplersquos desires fears anxieties and hope for success It is also

believed to regulate the day-to-day psychological fate of individual human beings in

Africa (van Dyk 2001)

Contrary to expectation the study did lend support the notion that in an African

environment there is a belief that ritual impurities are usually associated with death the

reproductive system and the violation of sexual prohibitions (van Dyk 2001) It had been

argued that the violation of sexual prohibitions like sexual intercourse with a woman

during menstruation with a widow before she is cleansed or with a woman who has had

an abortion or miscarriage can lead to a variety of health problems However in this case

the wrath of ancestors is believed to cause illness but it is also believed that witches

sometimes use sexual intercourse to cause illness Besides this belief about witches and

ancestors as causes of illnesses (van Dyk 2001) events that occur in a community have

consequences on individuals in the home For example a community may believe in

International Journal of Health Promotion and Education 191

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witchcraft Failure by particular family members to co-operate with other community

members may lead those individuals to be suspects of witchcraft (van Dyk 2001)

The above finding is compatible with Kazarian and Evansrsquos (1998) assertion that the

ancestors can punish their people by sending illness and misfortune if social norms are

violated or when culturally prescribed practices are neglected or incorrectly performed

The illness might be caused by failure to perform a cultural and religious ritual

Nevertheless it is assumed that peaceful living with onersquos neighbours observing social

norms and living in harmony with onersquos environment and with God spirits and ancestors

are all essential to protect oneself and onersquos family from disease (Ebigbo 1987)

It emerged from the study that trauma also results from non-cultural causes Some

participants attributed traumatic experiences to the abuse of substances intimate partner

violence rape robbery road accidents and murder This finding is in line with Gopaul-

McNicol and Brice-Bakerrsquos (1998) argument that the majority of Africans acknowledge

that some illnesses have natural or organic causes In the same vein Eamon (2001) opines

that certain illnesses are originated in the microsystem The microsystem consists of the

immediate environment such as onersquos home friends relatives school and society In this

study the microsystem represents the everyday practical social and collective life of

people in Africa (van Dyk 2001)

Conclusion

The DSM-IV-TR and the ICD-10 explain the western understanding of the causes of

trauma (Collins 2004) However the given explanations do not suit the traditional African

concept of trauma The psychiatric categories that are used to understand measure and

classify mental distress are specific to western culture and society They ignore and

undermine the African concepts of suffering misfortune and illness Africansrsquo

conceptualisation of trauma and its causes is influenced by several contextual factors

Contextual factors include their social political and cultural realities To a larger extent

the Venda-speaking participants attributed trauma to witchcraft angry ancestral spirits and

devil possession The study concludes that culture is a determining factor in peoplesrsquo lives

influencing both decisions and understanding of the illnesses

Limitations of the study

This study has some limitations All the participants were drawn from the Venda-speaking

ethnic group The study is short of the voices of the Tsonga Pedi Afrikaans and English-

speaking people in the Limpopo Province Considering the qualitative nature of the

present study the findings are not generalisable

References

Collins A 2004 Trauma in context advanced reader Durban University of Kwazulu NatalDenzin NK and Lincoln YS eds 1998 Collecting and interpreting qualitative materials

London Sagevan Dyk A 2001 Traditional African beliefs and customs Implications for AIDS education and

prevention in Africa South African Journal of Psychology 31 60ndash66Eamon MK 2001 The effects of poverty on childrenrsquos socioemotional development an ecological

systems analysis Social Work 46 256ndash266Ebigbo PE 1987 The mind body and society an African perspective International Journal for

the Advancement of Health 3 (4) 45ndash57Foulks EF et al 1977 Current perspectives in cultural psychiatry New York Spectrum

192 A Nevhutalu and P Mudhovozi

Dow

nloa

ded

by [

Uni

vers

ity o

f C

onne

ctic

ut]

at 2

222

10

Oct

ober

201

4

Gopaul-McNicol S and Brice-Baker J 1998 Cross-cultural practice assessment treatment andtraining Canada Wiley

Kazarian SS and Evans DR 1998 Cultural clinical psychology theory research and practiceOxford Oxford University Press

Madu SN Baguma P and Pritz A 1999 Traditional healersrsquo approach to the schizophreniaFrankfurt IKO Verlag

Marshall C and Rossman GB 1999 Designing qualitative research 3rd ed New Delhi SageMatsumoto D 1996 Culture and psychology Pacific Grove CA BrooksColeNeuman WL 2000 Social research methods qualitative and quantitative approaches 4th ed

Boston MA Allyn amp BaconPeltzer K 2001 Exposure to violence and posttraumatic stress disorder in a rural adult population

in South Africa Acta Academica 32 73ndash84Struwig FW and Stead GB 2001 Planning designing and reporting research Pinelands

Cape Town Maskew Miller LongmanScholten A 2012 Bradycardia (Bradyarrythmia) [online] Available from httpcvimednyueduTriandis HC 1994 Culture and social behaviour New York McGraw-Hillde Vos AS ed 1998 Research at grassroots a prime for the caring professions Pretoria

Van SchaikWaruta DW and Kinoti HW 1994 Pastoral care in African Christianity essays in pastoral

theology Nairobi ActonYule W 1999 Post-traumatic stress disorders concepts and therapy Chichester Willey

International Journal of Health Promotion and Education 193

Dow

nloa

ded

by [

Uni

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ity o

f C

onne

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ut]

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222

10

Oct

ober

201

4

witchcraft Failure by particular family members to co-operate with other community

members may lead those individuals to be suspects of witchcraft (van Dyk 2001)

The above finding is compatible with Kazarian and Evansrsquos (1998) assertion that the

ancestors can punish their people by sending illness and misfortune if social norms are

violated or when culturally prescribed practices are neglected or incorrectly performed

The illness might be caused by failure to perform a cultural and religious ritual

Nevertheless it is assumed that peaceful living with onersquos neighbours observing social

norms and living in harmony with onersquos environment and with God spirits and ancestors

are all essential to protect oneself and onersquos family from disease (Ebigbo 1987)

It emerged from the study that trauma also results from non-cultural causes Some

participants attributed traumatic experiences to the abuse of substances intimate partner

violence rape robbery road accidents and murder This finding is in line with Gopaul-

McNicol and Brice-Bakerrsquos (1998) argument that the majority of Africans acknowledge

that some illnesses have natural or organic causes In the same vein Eamon (2001) opines

that certain illnesses are originated in the microsystem The microsystem consists of the

immediate environment such as onersquos home friends relatives school and society In this

study the microsystem represents the everyday practical social and collective life of

people in Africa (van Dyk 2001)

Conclusion

The DSM-IV-TR and the ICD-10 explain the western understanding of the causes of

trauma (Collins 2004) However the given explanations do not suit the traditional African

concept of trauma The psychiatric categories that are used to understand measure and

classify mental distress are specific to western culture and society They ignore and

undermine the African concepts of suffering misfortune and illness Africansrsquo

conceptualisation of trauma and its causes is influenced by several contextual factors

Contextual factors include their social political and cultural realities To a larger extent

the Venda-speaking participants attributed trauma to witchcraft angry ancestral spirits and

devil possession The study concludes that culture is a determining factor in peoplesrsquo lives

influencing both decisions and understanding of the illnesses

Limitations of the study

This study has some limitations All the participants were drawn from the Venda-speaking

ethnic group The study is short of the voices of the Tsonga Pedi Afrikaans and English-

speaking people in the Limpopo Province Considering the qualitative nature of the

present study the findings are not generalisable

References

Collins A 2004 Trauma in context advanced reader Durban University of Kwazulu NatalDenzin NK and Lincoln YS eds 1998 Collecting and interpreting qualitative materials

London Sagevan Dyk A 2001 Traditional African beliefs and customs Implications for AIDS education and

prevention in Africa South African Journal of Psychology 31 60ndash66Eamon MK 2001 The effects of poverty on childrenrsquos socioemotional development an ecological

systems analysis Social Work 46 256ndash266Ebigbo PE 1987 The mind body and society an African perspective International Journal for

the Advancement of Health 3 (4) 45ndash57Foulks EF et al 1977 Current perspectives in cultural psychiatry New York Spectrum

192 A Nevhutalu and P Mudhovozi

Dow

nloa

ded

by [

Uni

vers

ity o

f C

onne

ctic

ut]

at 2

222

10

Oct

ober

201

4

Gopaul-McNicol S and Brice-Baker J 1998 Cross-cultural practice assessment treatment andtraining Canada Wiley

Kazarian SS and Evans DR 1998 Cultural clinical psychology theory research and practiceOxford Oxford University Press

Madu SN Baguma P and Pritz A 1999 Traditional healersrsquo approach to the schizophreniaFrankfurt IKO Verlag

Marshall C and Rossman GB 1999 Designing qualitative research 3rd ed New Delhi SageMatsumoto D 1996 Culture and psychology Pacific Grove CA BrooksColeNeuman WL 2000 Social research methods qualitative and quantitative approaches 4th ed

Boston MA Allyn amp BaconPeltzer K 2001 Exposure to violence and posttraumatic stress disorder in a rural adult population

in South Africa Acta Academica 32 73ndash84Struwig FW and Stead GB 2001 Planning designing and reporting research Pinelands

Cape Town Maskew Miller LongmanScholten A 2012 Bradycardia (Bradyarrythmia) [online] Available from httpcvimednyueduTriandis HC 1994 Culture and social behaviour New York McGraw-Hillde Vos AS ed 1998 Research at grassroots a prime for the caring professions Pretoria

Van SchaikWaruta DW and Kinoti HW 1994 Pastoral care in African Christianity essays in pastoral

theology Nairobi ActonYule W 1999 Post-traumatic stress disorders concepts and therapy Chichester Willey

International Journal of Health Promotion and Education 193

Dow

nloa

ded

by [

Uni

vers

ity o

f C

onne

ctic

ut]

at 2

222

10

Oct

ober

201

4

Gopaul-McNicol S and Brice-Baker J 1998 Cross-cultural practice assessment treatment andtraining Canada Wiley

Kazarian SS and Evans DR 1998 Cultural clinical psychology theory research and practiceOxford Oxford University Press

Madu SN Baguma P and Pritz A 1999 Traditional healersrsquo approach to the schizophreniaFrankfurt IKO Verlag

Marshall C and Rossman GB 1999 Designing qualitative research 3rd ed New Delhi SageMatsumoto D 1996 Culture and psychology Pacific Grove CA BrooksColeNeuman WL 2000 Social research methods qualitative and quantitative approaches 4th ed

Boston MA Allyn amp BaconPeltzer K 2001 Exposure to violence and posttraumatic stress disorder in a rural adult population

in South Africa Acta Academica 32 73ndash84Struwig FW and Stead GB 2001 Planning designing and reporting research Pinelands

Cape Town Maskew Miller LongmanScholten A 2012 Bradycardia (Bradyarrythmia) [online] Available from httpcvimednyueduTriandis HC 1994 Culture and social behaviour New York McGraw-Hillde Vos AS ed 1998 Research at grassroots a prime for the caring professions Pretoria

Van SchaikWaruta DW and Kinoti HW 1994 Pastoral care in African Christianity essays in pastoral

theology Nairobi ActonYule W 1999 Post-traumatic stress disorders concepts and therapy Chichester Willey

International Journal of Health Promotion and Education 193

Dow

nloa

ded

by [

Uni

vers

ity o

f C

onne

ctic

ut]

at 2

222

10

Oct

ober

201

4