Includes bibliographical references. / This dissertation explores the use of qualitative methods to research community health workers' (CHWs) perceptions of mental health problems in Khayelitsha and Nyanga, two peri-urban Black townships in the Cape Town area. Since the historic WHO-UNICEF meeting at Alma-Ata in 1978, there has been widespread interest in the concept of CHW s as the ideal work force for advancing the principles of the primary health care (PH C) approach. In seeking to transform the structure and delivery of mental health care in South Africa within the confines of limited financial and human resources, policy makers are shifting attention to the integration of mental health care within a PHC framework. Fundamental to the PHC agenda, as conceptualised at Alma-Ata, is health care that is based on appropriate technologies and that encourages effective community participation in making decisions about health issues. In the past few decades, anthropological perspectives gained from cross-cultural research into health beliefs and practices have made valuable contributions to the planning and implementation ofPHC programmes. In the field of medical anthropology, hermeneutically orientated approaches play an important role in advocacy, whereby the patient's perspective on illness and the meaning of illness is brought to the fore in an attempt to provide more patient-centred care. In this research, CHW s were interviewed to gain insight into the scope of primary mental health care, as perceived by them, and prevailing beliefs and practices surrounding mental health problems. Unstructured individual interviews were conducted with 20 CHW s working in community-based PHC projects in Khayelitsha and Nyanga to elicit their personal accounts of mental health problems in their geographical communities. This material was used to construct five vignette descriptions of mental health problems in the CHWs' own words. Kleinman's explanatory model approach was used in structured individual interviews to access CHW s' understandings of mental illness. Questions related to naming the problem; theories of illness causation; coping with the problem; and decision-making as regards treatment options. Focus group interviews were held with the participants of two of the CHW projects to explore their feelings about involvement in mental health care. This micro-level analysis was accompanied by the perspectives of critically-interpretive medical anthropology which shifts attention beyond the individual cultural construction of illness to the political and economic factors affecting the social organisation of health care. Within the PHC setting, the critical perspective entails challenging constraints to the attainment of health for all as a result of inequities in the distribution of power and wealth; barriers to achieving community participation in health issues; and inequitable access to basic primary health needs by the most disadvantaged.

Despite the fact that some of the highest rates of fetal alcohol spectrum disorders (FASDs) in the world have been reported in the Western Cape of South Africa, little research looks at the experiences of pregnant women who consume alcohol and what influences their alcohol use. Gaining insight into the social, psychological and contextual processes that contribute to risky drinking during pregnancy will help in guiding interventions that aim to prevent prenatal alcohol use, thereby preventing the occurrence of FASDs. Using both social representation theory and a discourse analytic approach, fourteen narrative episodic interviews were conducted in a Western Cape community with women who consumed alcohol during their pregnancy, and two focus group discussions with 13 members of the pregnant women’s community. Data collection aimed to elicit how these women and community members constructed and made sense of alcohol use. The interview and focus group data was analysed using thematic decomposition analysis. Alcohol use was represented by many participants as a social activity which was heavily influenced by their peers. Implicit in this representation was the notion that heavy drinking was a norm within this study community and offered one of the only ways in which to socialise. However, some participants also represented alcohol use as an individualised activity by constructing a clear boundary between drinking socially with friends and drinking to become inebriated. Although drinking during pregnancy was represented as a stigmatised activity, it was also understood by the pregnant women and community members as a way of dealing and coping with difficult domestic problems, such as infidelity. Furthermore, it was also represented as contributing to problems in the participants’ lives as well as unwanted changes in their behaviour. For some interview participants the problems they faced, reservations they held about their pregnancy and becoming a mother, and the social nature of drinking in their community may have inhibited their ability to stop drinking during their pregnancy. For other participants access to some form of social support, a level of responsibility-taking and a desire to protect the fetus from harm as well as care for and look after their children seemed to contribute to their ability to give up drinking while pregnant. Future interventions should take the social context of alcohol use into account, and rather than ignoring it – as most interventions do – use it to not only shift the social norms that surround heavy alcohol use, but also to support pregnant women to stop drinking. Prevention and intervention initiatives should also take a non-judgemental and supportive approach that focuses on capitalising on the moment of pregnancy and on teaching psychosocial skills that enable pregnant women to manage their problems effectively.

Bibliography: leaves 96-103. / The purpose of this study was to explore definitions of an illness condition amafunyane and the subsequent help-seeking behaviour amongst Black Psychiatric patients who were attending a psychiatric community clinic in Guguletu, a residential area for Blacks in Cape Town). Psychiatrists have always been faced with the problem of having to deal with patients who present with this condition. The concern was to do an exploratory research in this area using the Explanatory Model framework as a method of enquiry in studying the condition of amafunyane. Within the parameters of this model, Black psychiatric patients presenting at the psychiatric clinic, were studied in order to explore the context of illness definitions regarding the condition of amafunyane. Of importance also was to explore the patterns of help-seeking behaviour employed by these patients, and the effect that the psychiatric orientation adopted at the clinic had on such patterns.

Recent case reports have shown that global loss of dreaming can result from medial occipitotemporal lesions. These findings have cast doubt on Solms's reformulation of Charcot-Wilbrand Syndrome (CWS) into two distinct disorders of dreaming, and caused substantial confusion in dream research as far as the neurological correlates of dreaming are concerned. This study attempted to confirm these case reports and determine whether there were any characteristics unique to the lesions among patients who had lost the ability to dream following damage to medial occipito-temporal cortex. Nine participants (three non-dreamers and six dreamers) who had suffered non-hemorrhagic infarction in the territory of the posterior cerebral artery were recruited in this study. Case histories and neuroradiological data were used to compare the lesion sites of non-dreamers with dreamers. It was confirmed that complete loss of dreaming could result from lesions in medial occipito-temporal cortex. It was found that non-dreamers always suffered bilateral cortical damage as opposed to dreamers who all suffered unilateral damage. The lesions in the non-dreamers tended to be more posterior than the dreamers. It was further speculated that concomitant damage to the thalamus or parietal areas played a role in the causation of heteromodal loss of dreaming. The implications of these findings were discussed in relation to CWS, Solms's dream system, and dream-function research. Finally, future directions were considered.

Includes bibliographical references (leaves 143-158). / As UCT Child Guidance Clinic (CGC) practice and policy shifted markedly in response to the political turmoil and parallel crisis in South African psychology during the 1980s, this study investigates the effects of the ""new"" South Africa on CGC practice and clientele during the 1990s.

Bibliography: leaves 117-128. / Woman abuse is a pervasive social problem and there is a paucity of South African research exploring women's experiences of violence. This study focused on how women endure abusive relationships by examining how women construct and give meaning to their experiences, within a particular socio-cultural context. Interviews were conducted with 15 participants who volunteered participation in response to advertisements. All research participants resided in Mitchell's Plain or surrounding areas. In-depth, narrative interviews were used to investigate women's experiences of violence from their partners. The interview topics included women's daily concerns and problems, their experiences of and responses to their partners' violence, and their feelings toward their partners and staying in the relationships. The interviews lasted approximately one to two hours and were tape-recorded and transcribed. The interview data was analysed by utilising a narrative approach, taking the content of women's stories into account. A close attention to language and discourse also shaped the analysis of women's narratives. In their narratives, women named their experiences of violation and abuse, explored the impact of abuse, and discussed their help-seeking attempts. Women also constructed particular gendered identities for themselves and their partners. Hegemonic gendered identities were sometimes adopted or resisted and reflected contradictory subjective experiences. This study showed how women in abusive relationships utilised a variety of strategies to end the violence in their lives and challenged constructions of women as passive victims of abuse. The meanings women attached to their experiences of abuse were filtered through the particular socio-cultural context (characterised by poverty and deprivation) within which their experiences occurred. An important contribution of this study was the acknowledgement that change occurred as a result of the abuse. Women named their experiences of abuse, questioned a husband's violence against his wife, and made connections between their experiences and those of other women, thereby shifting toward a gendered consciousness.

Includes bibliographical references (leaves 101-115). / [Background] The effects of a traumatic brain injury (TBI) can be devastating not only for the child that sustains the injury but also for his or her family. A TBI can negatively affect a child cognitively, emotionally, and behaviourally. In developing countries such as South Africa these negative effects of TBI are often compounded by the impact of other health crises such as HIV / AIDS, as well as by the existence of relatively few economic resources and a lack of rehabilitation services. Injury-related consequences, further compounded by developing world contexts, seem to suggest that families of children with TBI have many stressors and strains that need to be addressed. Aims. The current study sought to explore the needs and stressors of caregivers of children with TBI, and how local contextual factors contribute to those needs and stressors. [Methods] The sample consisted of four groups (n = 18 caregivers in each). These four groups included parents/caregivers who cared for a child with either a mild head injury, a moderate/severe head injury, or an orthopaedic injury, and a control group of caregivers with healthy children. The Parenting Stress Index, Family Burden of Injury Interview, and Family Needs Questionnaire were administered to each participant. [Results] South African caregivers of children with TBIs are critically stressed. Much of their stress is related to the child's behaviour and ways of relating to their caregiver. Caregivers in the Moderate/Severe TBI group reported experiencing particular difficulty with their own reactions to the injury, and reported feeling depressed and incompetent, as well as isolated and restricted by their role as parent. Caregivers also reported experiencing a need for health information, professional support, community support, involvement in the child's care, and emotional support. They reported, however, that few of these needs were being met. Results also showed that South African caregivers of children with TBI displayed more stressors and needs than similar samples in developed countries. [Conclusions] We suggest that a better understanding of the experience of families of children with TBIs is needed amongst TBI service providers. It is hoped that this study's results will aid that understanding, and that they will provide information for policy makers who can set into motion a sequence of services that more adequately aid both the child with TBI and his/her family.

Bibliography: leaves 131-136. / This dissertation investigates the application of Multicriteria Decision Making (MCDM) methodologies to the area of scenario based policy planning. We examine how the tools of MCDM can be used to develop a Decision Support System (DSS) that would allow management or policy planners to resolve conflicting goals and interests. Ideally, the resolution would be obtained by the various decision makers (DMs) in such a manner, that it satisfies all the relevant interest groupings at a maximum level of achievement for all concerned. This is not always possible and compromises need to be made that are fair and equitable to all the relevant interests. Stewart et al. (1993), in a report entitled: "Scenario Based Multicriteria Policy Planning for Water Management in South Africa", develop the principles of a procedure for implementing scenario based multicriteria policy planning. Their iterative procedure is illustrated in figure 2.1, chapter 2, of this paper. In this dissertation, we refine certain parts of this procedure and the two areas in particular that we have looked at are: (1) filtering a large set of policy scenarios (Background Set), that could be a continuum, to form a smaller set (Foreground Set), and (2) further reducing the smaller set to form a solution set of policy scenarios. (The generic terms "Background Set" and "Foreground Set" are defined in section 2.1 of chapter 2.) The main objectives of this study were therefore mainly twofold and are as follows: (1) to determine what MCDM methods are relevant to natural resources management (using water as a case study), and (2) to investigate how these methods need to be adopted for use in an interactive DSS. We address the first objective by surveying the literature in an attempt to identify potential MCDM approaches that are suitable to (i) reduce a large set of alternatives, analogous to the Background Set, to a more manageable smaller set, analogous to the Foreground Set of alternatives, and (ii) refine this Foreground Set in order to present the DMs with a solution set of alternatives from which University of Cape Town they will make their final selection. The literature has until now not dealt explicitly with these two issues and we had to adapt certain MCDM approaches, many of which have been developed in a linear programming context, to suit our purposes.

Includes bibliographical references. / The ethos behind the psychodynamic approach is that past experiences influence and shape present experiences. The past is seen as playing a pivotal role in life outcomes. This study attempts to trace and explore the factors that shape the current motivations of six volunteer counsellors based at an established counselling organisation. The psychodynamic theory is adopted as the framework to interpret the life stories of the participants. Working within a retrospective and narrative framework the life histories of the volunteers could be explored as the narrative approach emphasises the links that individuals make in describing their life histories. The central focus of the study is on the participants' subjective accounts of their life histories and how they interpret these through their narrative.

Includes bibliographical references (leaves 61-65). / This study examined the attitudes and perceptions of directors and treatment staff towards organizational functioning within substance abuse treatment facilities across South Africa. In South Africa a history of socio-political factors have hindered substance abuse treatment. Large disparities existed between racially defined population groups and the quality and allocation of resources to substance abuse treatment services across South Africa have not been equitable. Understanding organizational functioning within substance abuse treatment facilities is essential to identifying and prioritizing treatment facility issues that both directors and staff believe need attention. The identification and examination of these issues facilitate the development of appropriate strategies to promote treatment facility improvements and the adoption of evidence-based treatment practices. Cross-sectional surveys of substance abuse treatment facilities were conducted in the Western Cape (2005) and in the Eastern Cape, Gauteng, and Kwa-Zulu Natal (2006). Forty-four treatment facilities participated in this study from a population of 89 facilities. The Texas Christian University survey of Organizational Functioning (TCU ORC) was used to assess directors' and staff's attitudes and perceptions towards organizational functioning within their treatment facilities. One-way analysis of variance tests were used to examine whether certain contextual and demographic variables influenced directors' and staff's attitudes and perceptions. Results indicated that directors and staff displayed favorable attitudes and perceptions towards the TCU ORC domains organizational climate and staff attributes, and indecisive attitudes and perceptions towards the motivation for change domain. Demographic variables including: ethnicity, levels of education, amount of work experience, and provincial location were found to influence directors' and staff's attitudes and perceptions towards organizational functioning.