A feminist phenomenological description of depression in low-income South African women

Dukas, Carla Justine (2014-04)

Thesis (PhD)--Stellenbosch University, 2014.

Thesis

ENGLISH ABSTRACT: A review of the past decade of literature on the subject of depression in South African women revealed a paucity of research that documents the perspectives of low-income women who have been diagnosed with depression. Informed by this and recent feminist critiques of the concept of depression, this study aimed to bring traditionally overlooked perspectives to the fore by providing rich descriptions of the subjectively lived experience of depression, as recounted by low-income women themselves. This feminist phenomenological study took place in a poor, rural community in the Western Cape Province of South Africa. Semi-structured in-depth interviews were conducted with ten low-income women who had been diagnosed with depression. The transcribed interviews were analysed using Interpretative Phenomenological Analysis. A number of important findings emerged. Firstly, participants were seen to express somatic complaints ahead of (and more frequently than) disclosures of sadness. Secondly, participants often described experiencing their psychological distress as anger, anxiety and a changed sense of self. Thirdly, participants generally attributed these experiences (and their overall distress) to a history of childhood trauma, the loss of important relationships, being physically, sexually or emotionally abused, feeling under supported and overburdened by multiple responsibilities, living in dangerous communities, and/or the various consequences of poverty. Finally, it was observed that while symptoms of suicidal ideation and intent were present in many of the women interviewed, strong religious and cultural norms existed and generally functioned to silence and deny the subject. Overall, the women’s subjective experiences, understandings and descriptions of depression allowed a more complex picture to emerge than that which is currently offered by mainstream biomedical models. Consequentially, the current conceptualisation of the term “depression” was deemed to be inadequate, specifically because it does not fully capture low-income women’s experiences of distress, and also because it tends to obscure the possible impact of socio-economic and political contexts on their mental health. Implications of these findings include firstly, that not only does the diagnosis of depression serve to medicalise women’s misery, but it may simultaneously serve to obscure their feelings of anger, anxiety, sadness, hopelessness and other symptoms of distress that are intrinsically linked to their disadvantageous social and living conditions. Secondly, the findings indicate that the use of traditional diagnostic and suicide assessment interviews may be unhelpful or even irresponsible in some South African contexts. Finally, many of the study findings warrant further investigation and psychological research. Recommendations to this end are thus included and stress the need to use theoretical perspectives and research methodologies that are sensitive to the multilayered, complex psychological experiences of depression in low-income women.

AFRIKAANSE OPSOMMING: ’n Oorsig van die afgelope dekade se literatuur oor depressie by Suid-Afrikaanse vroue dui op ’n gebrek aan navorsing oor die perspektiewe van vroue uit lae-inkomstegroepe wat met dié toestand gediagnoseer word. Na aanleiding hiervan sowel as onlangse feministiese kritiek op die konsep van depressie, was hierdie studie dus daarop toegespits om tradisioneel miskende perspektiewe na vore te bring deur middel van ’n ryke beskrywing van die subjektiewe ervaring van die lewe met depressie soos vroue uit lae-inkomstegroepe self daarvan vertel. Hierdie feministiese fenomenologiese studie is in ’n arm, landelike gemeenskap in die provinsie Wes-Kaap, Suid-Afrika, onderneem. Semigestruktureerde diepte-onderhoude is gevoer met tien vroue in die laeinkomstekategorie wat met depressie gediagnoseer is. Die getranskribeerde onderhoude is op vertolkende fenomenologiese wyse ontleed. ’n Aantal belangrike bevindinge is gemaak. Eerstens het die meeste deelnemers somatiese klagtes gehad voordat (en meer dikwels as wat) hulle oor hul neerslagtigheid en terneergedruktheid gepraat het. Tweedens het heelwat deelnemers hul sielkundige nood as woede, angs en ’n gewysigde selfbeskouing beskryf. Derdens het die vroue merendeels hul ervarings (en hul algehele nood) aan ’n geskiedenis van kindertrauma, die verlies van belangrike verhoudings, fisiese, seksuele of emosionele mishandeling, ’n gebrek aan ondersteuning tesame met ’n oormaat verantwoordelikhede, hul gevaarlike woonbuurte en/of die verskillende gevolge van armoede toegeskryf. Laastens is waargeneem dat hoewel die ideasie en voorneme van selfdood wél as simptome by baie van die respondente opgemerk is, daar terselfdertyd sterk godsdienstige en kulturele norme bestaan waarvolgens dié onderwerp oor die algemeen doodgeswyg en ontken word. In die geheel skets die vroue se subjektiewe ervarings, begrippe en beskrywings van depressie ’n meer komplekse prentjie as wat hoofstroom- biomediese modelle tot dusver gebied het. Dus blyk die huidige konseptualisering van die term ‘depressie’ onvoldoende te wees, veral omdat dit nie die ervarings en nood van vroue uit lae-inkomstegroepe ten volle vasvang nie, en ook geneig is om die moontlike impak van sosio-ekonomiese en politieke kontekste op dié vroue se geestesgesondheid te misken. Die implikasies van hierdie bevindinge sluit eerstens in dat die diagnose van depressie nie net hierdie vroue se nood ‘medikaliseer’ nie, maar terselfdertyd dalk ook hul gevoelens van woede, angs, hartseer, hopeloosheid en ander simptome van nood wat ten nouste met hul minderbevoorregte maatskaplike en lewensomstandighede verband hou, verberg. Tweedens dui die bevindinge daarop dat die gebruik van tradisionele diagnostiese en selfdoodevalueringsonderhoude in sekere Suid-Afrikaanse kontekste nutteloos en selfs onverantwoordelik kan wees. Laastens regverdig baie van die studie se bevindinge verdere ondersoek en sielkundige navorsing. Aanbevelings in hierdie verband word dus ingesluit, en beklemtoon onder meer die behoefte aan teoretiese perspektiewe en navorsingsmetodologieë wat gevoelig is vir die meervlakkige, komplekse sielkundige ervarings van depressie by vroue uit laeinkomstegroepe.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/86512
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