It was as though the psychiatrists believed that all that was necessary in the treatment of those patients was pill-popping. The treatment interventions of psychiatrists in Johannesburg’s outpatient clinics in those years appeared to me to be disturbingly perfunctory.
One of the most striking features of life in a hospital such as Baragwanath at that time was the fact that, in the main, and in spite of apartheid laws, health professionals worked first and foremost as professionals in the execution of their duties. That is not to say that race and racism were consciously set aside; apartheid laws ensured that segregation was enforced with regard to residences, eating facilities and, of course, toilets and ablution facilities.
Over and above the opportunities sketched above, I benefited immensely from the fact that all the black doctors who were interns or registrars were engaged in further training as doctors and as specialists. Without planning on anyone’s part, I had landed in a hospital in which university-type activities such as teaching, learning, conducting research, publishing and studying for higher qualifications were part of everyday life. This was an unexpected but welcome bonus, with unintended consequences – a supportive learning environment that would have been non-existent in an ordinary psychiatric hospital in those days.
In this regard I remember the late Dr Benson Nghona, a University of the Witwatersrand graduate and a registrar in medicine during my time at Baragwanath. He, Dr Henry Smail and I were full-time residents in the black doctors’ quarters. Nghona, who was a few years older than I was, became my closest friend at the hospital. He neither smoked nor used alcohol. He was easy-going and friendly, but could be described as a bookworm. Remarkably, he was the most apolitical man I knew in those days.
I will always remember Nghona as the man who took me along to the medical school library in Hillbrow in his Mini and familiarised me with the workings of Index Medicus, a reference text that contributed enormously towards my literature searches in the course of my doctoral studies between June 1969 and December 1970. I also remember that close to the medical school library was a specialised bookshop that sold a wide range of medical and related books. Dr Nghona’s exemplary dedication to his field of study and profession did not escape the notice of the ambitious young man that I was in those days. He was one of my earliest role models.
I had started my internship at Baragwanath in the deep end of the pool at the beginning of January 1969. By 21 November there were definite signs that I was no longer out of my depth and was beginning to thrive – it was on that date that my paper on hysteria among African women was accepted for publication by the South African Medical Journal. Little did I know at the time that I would encounter a significant number of such patients within the teaching-hospital setting of the university as well as in the private practices of general practitioners in Soweto during the years that followed.
In the course of time, the prevalence of patients in our medical wards suffering from psychological rather than physical illnesses resulted in increased requests for my services outside the neurosurgery department. I inadvertently became the resident consulting psychologist for Baragwanath as a whole between 1970 and the first half of 1973.
During my three-and-a-half years at Baragwanath I was also drawn into the regular clinics conducted by a small group of highly dedicated female paediatric neurologists. Here I learnt a great deal about the neuropsychological illnesses of childhood, including childhood autism, a condition that was attracting a great deal of international attention at the time. I did not know then that years later this exposure to the work of paediatric neurologists would prove beneficial in my private practice and medico-legal work with children. In important respects, therefore, fate handed me a varied range of learning opportunities – more than I had bargained for, and most probably many more than I would have been exposed to in regular South African psychiatric hospitals in those days. However, I never had the privilege of learning what a typical clinical psychology internship in South Africa entailed. In my most generous moments I imagined that one would have learnt some of the basics of psychometric diagnostic testing as well as aspects of counselling and psychotherapy.
At Baragwanath my yearning for further study was difficult to ignore. Conditions were so auspicious that, in 1969, I was ready to register as a doctoral student under the supervision of Professor Roux. I did so with the full knowledge and active support of Professor Lipschitz and his senior colleagues. The theme of my doctoral research was body image in paraplegia.16 It was a daring move on my part to have decided on a research topic in a field that, in today’s terms, falls into the challenging and fascinating domain of neuropsychology. I am still heartened by the fact that no one expressed any uneasiness about the unusual research subject I had chosen. I can only assume that both Lipschitz and Roux believed that I could meet the challenge.
My research sample consisted of male paraplegics receiving treatment and rehabilitation in Ward 12, a unit under the direct supervision of Professor Lipschitz. Paraplegia, commonly the loss of regular use of the lower limbs, is a result of traumatic injury to the spine. In the course of individual development from childhood to adulthood, each of us develops a concept or image of his or her body. Such a body image is a psychological and mental representation of one’s identity as one experiences it in good health and in serious conditions such as paraplegia. The mental representation of one’s body may be distorted – that is, interfered with – by physical and psychological trauma such as the loss of the mobility of one’s legs following injuries to the spine.
My interest in disturbances of the body image was aroused by the noticeable attention such disturbances were receiving in the neuropsychological literature of the late 1960s and early 1970s. Fortunately, I encountered none of the difficulties I had experienced with my promoter in the course of my master’s research, and in November 1970 I was ready to submit my thesis for examination.
Although much has been said in recent times about racism in South African institutions such as the National Institute for Personnel Research (NIPR) and among the country’s leaders in the years of apartheid, I must admit that, as a young African psychologist who was working largely under conditions of professional isolation, I experienced the NIPR, with its substantial psychology and social science library and research atmosphere, as a welcome haven. My unrestricted access to the institute’s substantial book and journal collections, its reading areas and its earliest computer system contributed immeasurably to my doctoral research and development as a psychologist. I seized the opportunity to interact with and observe research psychologists at work outside a university and hospital setting.
Some of the researchers, such as Dr S Barran, who later left the country, offered me collegiality and friendship at a time when my professional identity was in its formative stages. During the closing stages of my doctoral studies my work was facilitated in no small measure by the installation of new computer facilities, which saved me from what would have turned out to be an unwelcome and time-consuming treatment of complex non-parametric statistical tests of significance during the analysis and discussion of my research results. In the winter of 1971 I was awarded the degree of DLitt et Phil at a graduation ceremony for black graduates of Unisa held in Ga-Rankuwa, an African residential area outside Pretoria.
By the time I began my first postdoctoral year at Baragwanath in 1971, I had started thinking and dreaming about academic work in a university as a prospective career. However, I soon found out that no black university was willing to employ me as a lecturer in psychology. I applied for a lectureship at my old university, but the fact that I was a former student who had completed his doctoral studies by the age of 30 failed even to secure a formal letter of rejection of my application.
What followed soon thereafter, however, was a windfall. I was invited to undertake an extensive coast-to-coast study tour of clinical psychology training centres at premier US universities. I term it a windfall for two reasons. One was that the invitation came as a surprise and at a time when I needed that kind of wide-ranging professional exposure. The second was that the trip included a visit that resulted in my subsequent return to Yale University as a postdoctoral fellow in July
