Idioms of resilience among cancer patients in urban South Africa: An anthropological heuristic for the study of culture and resilience

Abstract

Despite the large body of research on idioms of distress in anthropology and transcultural psychiatry, few scholars have examined the concepts that people use to describe social and psychological resilience. The experience of social and psychological resilience is embedded in and shaped by social, political, and economic contexts—much like the factors that shape idioms of distress. As resilience literature more broadly has adopted a socio-ecological rather than trait-based approach, anthropology has much to contribute. This article investigates what idioms of resilience and cultural scripts emerge among low-income patients with cancer residing in Soweto, a peri-urban neighborhood in Johannesburg, South Africa. We conducted 80 life history interviews to better understand what social and psychological factors led some people to thrive more than others despite extraordinary adversity. We describe one idiom of resilience, acceptance ( ukwamukela in isiZulu), and three broader themes of resilience that emerged from life history narrative interviews (social support, religious support, and receiving medical care). We also present two examples from study participants that weave these concepts together. Our findings suggest that rarely is one form of resilience experienced in isolation. A focus on idioms of resilience can help chart the complex dimensions of acceptance and the dynamic social, religious, political, and temporal factors that mediate both suffering and resilience within individuals and communities.

Health system experiences of breast cancer survivors in urban South Africa

“…Many patients describe acceptance of their diagnosis through their religious beliefs to be fundamental to their breast cancer experiences. 27 Churches are significant communities of care not only through fostering strength people find through religion but also through a community of dialogue around cancer detection, diagnosis, and treatment. Fostering discussion of what types of treatment exist to religious communities may stymie fear after diagnosis; also promoting dynamic supportive groups for people living through treatment is possible through religious spaces.…”

Comorbid Suffering: Breast Cancer Survivors in South Africa

“…But the women who struggled the most were those whose social worlds had eroded along with their illnesses, such as Ntabiseng. We found that a culturally defined notion of resilience-in this case, acceptance of one's conditions-may function as a critical mediator of interpersonal suffering between an individual and their family, as was the case for Mpumi (also see Kim et al, 2019).…”

“…Finally, Mpumi was living with breast cancer and hypertension and revealed how her cancer had an enormous social impact on her family, in this case a misfortune to her daughter's life, although she eventually learned to accept her physical conditions. These cases convey key themes that emerged across the 50 interviews and highlight the range of comorbid suffering that arose (also see other related publications; Kim et al, 2019;Mendenhall et al, 2019).…”

“…If I take my pills, I feel normal, like other people who don’t have it.” In addition, her description of health as “feeling strong” or “I can do anything” illuminated how she related her physical health to social and emotional well-being. She often minimized her pain in reference to others, such as by stating, “You can heal—despite your pain—but others have it worse.” In this way, Mpumi normalized her personal suffering and thus managed to minimize the disruption of her illnesses in her life to some extent (see Kim et al, 2019). Yet her body had fundamentally changed, and she, like Ntabiseng, remained troubled by the transference of her suffering onto family members (through the rape of her daughter).…”

“…Mpumi’s transformation, on the contrary, was mostly located in her body as an internal process. Reckoning her illness as part of the body, and something physical—as opposed to social—may reflect a process of acceptance (reflecting a culturally scripted form of resilience) through which Mpumi was able to accept her situation despite feeling grieved by the physical pain (see Kim et al, 2019). By accepting the idea that her suffering was not as bad as some people’s, and focusing on her health in terms of how she physically felt, she moved beyond her personal suffering to focus more on the collective affliction of those who “have it worse.” These varied kinds of transformation reflected very different social experiences for each woman: Ntabiseng was socially ostracized, while Mpumi was strongly supported by her family and social networks.…”