Includes abstract. / The Boston Naming Test (BNT) is a popular confrontation naming test that is frequently used in the detection of naming deficits in Alzheimer's disease (AD). However, the test may not be appropriate when used outside of North America due to the influence of varying word frequency and familiarity between different cultures and languages. This study investigated the diagnostic validity of a South African 15-item adaption of the BNT (the BNT-SA-SF) in a Cape Town memory clinic population of patients with dementia and healthy, community-dwelling control participants. Between-groups comparisons, receiver operating characteristic (ROC) analyses, and other diagnostic efficiency statistics were used to assess the test's discriminative capacity between patients with AD (n = 46), patients with other types of dementia (n = 23), and controls (n = 51), matched on key demographic variables. The AD group performed worse than patients with other types of dementia and controls on the BNT-SA-SF, and patients with other types of dementia scored more poorly than controls. The test showed the most significant discriminative capacity between patients with AD and controls, however. A general linear model examining the effects of socio-demographic variables on test performance found that BNT-SA-SF performance was not significantly affected by the socio-demographic characteristics of participants, including age, education, language, or socio-economic status, with the exception that men appear to achieve higher scores than women. Further, an item analysis identified a number of problematic items and suggestions are made concerning how to deal with these in future studies. Preliminary normative data stratified by sex and education are presented. Results support the clinical utility of the BNT-SA-SF as a screening test to aid in the diagnosis of AD from normal aging with older adults in South Africa. This study is a valuable step forward in the ongoing attempt to provide culturally appropriate and valid neuropsychological tests and norms for clinical and research purposes in South Africa. Future studies should examine the functioning of the test in larger samples, representative of the other major population and language groups in South Africa.

Includes bibliographical references (leaves 64-71). / An impressive collection of research has shown that mindfulness - described as a heightened awareness of the present moment - nurtures inner resources for reducing stress, and improving well-being. The aim of this study was to further validate, and add to these findings by illustrating the relationship between mindfulness and affect, cognition and physiological reactivity to stress.

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.

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 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.

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.

Includes bibliographical references (leaves 89-94). / Research into the reasons why sex workers enter and stay in sex work has largely viewed entry from perspectives of either choice or constraint. Choice perspectives attribute entry to reasons such as female agency and empowerment, and social and financial independence, while constraint perspectives attribute entry to reasons such as economic necessity, drug and alcohol abuse, childhood sexual abuse, lack of education and job opportunity, and homelessness and truancy.

Includes bibliographical references (leaves 146-170). / The aim of this study was to examine the complex issue of healing in relation to the TRC. More specifically, it addressed questions regarding retraumatisation through testimony as well as the immediate and also longer-term effects of providing public testimony by accessing the lived experiences of victims in their post-testimony lives. Semi-structured interviews were conducted with 10 individuals who had experienced a gross violation of human rights and who had provided public testimony to the TRC. Thematic analysis of the interview data reveal themes of traumatisation by human rights violations, presence of social support, testimonial significance and the influence of the post-traumalpost-TRC context.

Racial discrimination in mental health treatment in South Africa was well established by the 1890's. This study shows this discrimination was perpetuated through to the 1930's and 1940's. By means of a thorough review of racial and psychiatric literature pertaining to the period, this dissertation provides a rich context in to which to place the psychiatric practice of Valkenberg Mental Hospital for the period 1933-1943. Archival research was used to investigate official hospital records of, and case records for, Valkenberg for the years 1933; 1936; 1939; 1942 and 1943. Content analysis was used to analyse the case records and identify any discrimination across diagnosis, treatment, prognosis, criminal activity of patients, deaths in patients, and readmittance. Invidual case histories were also analyzed to ascertain psychiatric practice at a more individual level. Results showed that racial discrimination was still prevalent in the psychiatric practice of Valkenberg for the period. In Valkenberg 'non-European' patients received poorer care, were given inferior therapeutic treatment and often denied access to various effective treatments. European patients on the other hand superior care and had access to all the new and effective physical methods of treatment. Non-European patients were also subject to the racist attitudes of doctors and nurses, which in turn affected the level of care they received. The records also reveal the psychiatrists of the period not only purported the racist doctrines, they were involved in theories and studies that helped justify and confirm them. (154-163 pages missing).