This article examines the social relationships involved in the production of a Xhosa version of the Beck Depression Inventory (BDI). The South African sociopolitical context and the imperatives of the biomedical context are discussed. These play an important role in how the problem of semantic equivalence between translations, and the issue of the imposition of a colonialist, Western psychiatric framework are addressed. After a brief but critical outline of recommended translation techniques, the particular combination of back-translation and committee method employed in this study is presented. An analysis of the social relationships revealed a complex set of interrelated factors affecting the process. The power differential between researcher and back-translators, compounded by their different perceptions of the task, impeded discussion about the instrument. Translators had ostensibly markedly opposed claims to competence to speak for the "true Xhosa language". At a deeper level however, these claims, and indeed the entire translation enterprise, could be seen to be reproducing apartheid structures, regardless of the intention of the participants. The dynamics we describe are particularly salient in the South African context but may also be operative in other contexts.
The Truth and Reconciliation Commission (TRC) has been widely hailed by mental health practitioners and others as a source of psychological healing. In this article we consider this claim and its relevance to clinical practice. Recent research in anthropology and related disciplines in South Africa and elsewhere raises questions about the cultural construction of traumatic memory and healing. We argue that these questions have bearing on how we understand the role of mental health practitioners and mental health institutions in the post-TRC period. Case material is be used to illustrate our view that it is important to distinguish between individual and collective healing.
South Africa’s political history has led to a marginalizing of all languages except for English and Afrikaans. Many clinicians cannot speak the languages spoken by patients. We attempt to understand the slow progress towards achieving greater access to mental health services on the basis of language. The administrative constraints of an overburdened and bureaucratized health system lead to language and communication playing a relatively small part in clinical practice. Resistance to learning other languages may relate to the emotional risks involved in this learning. A psychological understanding of the barriers to linguistic change may help us develop further changes.
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