On the morning of the 29th February 1998, Dr. Seape, Therry, Zane and myself headed off to Rustenburg. Instead of the gambling halls of Sun City, we were destined for less alluring places. Our first stop was Mogwase Prison – situated fifty kilometres from Rustenburg. Dr. Seape and Therry disembarked there to meet with prison doctors, social workers and wardens.
Dr. Seape and Therry were warmly welcomed by Mr. Sekgatle, and 20 professionals (doctors, psychiatric nurses, social workers and guidance teachers) who were already waiting for the talk.
After a short introduction by Mr. Sekgatle (Area Manager of Prison’s Department), Dr. Seape gave a talk on Anxiety Disorders. She started off by explaining the difference between normal anxiety and pathological anxiety, and went on to explain the 5 different disorders under the Anxiety Disorders umbrella. She gave the clinical picture of all 5 disorders, going into greater detail with Panic Attacks and Panic Disorder. She pointed out the difficulty in diagnosing Panic Disorder because it mimics a myriad of symptoms and syndromes ranging from heart attacks, gastrointestinal problems to neurological problems. She also pointed out the number of specialists that patients often go through before getting help for the “great pretender”. She also touched on psychosocial implications of Anxiety Disorders such as marital discord, loss of working time, job loss, financial loss and drug and alcohol dependency.
Dr. Seape explained the different medications that are usually used for the treatment of Panic and other Anxiety disorders and emphasised that a thorough physical examination should be done in order to eliminate physical ailments. The doctor must discuss with the patient the medication he is going to be given and the side effects they can expect.
She closed the session with questions from the audience, who were interested in knowing how best they can help the prisoners in the absence of psychiatrists and psychologists. The prison doctor, Dr. Joe Kabugujjo was very interested in side effects and medication, and asked if the group can influence the Government to change the curriculum at medical schools to include more training for general practitioners on psychiatric illnesses. A lot of questions were asked on the different medical side effects and how they can be tolerated by patients. The visiting doctor, Dr. Kabugujjo wanted to know how, in a prison where depression is so rife, he can differentiate genuine cases from attention seeking malingerers.
Therry Nhlapo then explained the role that the support group plays in helping to identify these disorders. The different nationwide campaigns undertaken by the group to educate people about these disorders and the help that people can get from the group were all discussed. The main aims of the group being to destigmatise mental health so that people can come forward to get help.
Dr. Seape and Therry were very impressed with the enthusiasm of all the professionals who work within the prison. They wanted to know how the group can be started, what needs to be done to keep it going, who should run the group and what help they can expect from us. One guidance teacher pointed out the need of such services in schools as well, not for pupils only, but for teachers too. A psychiatric nurse from the local clinic wanted to know if she can start a support group in her residential area.
After wrapping up the questions, Dr. Seape and Therry immediately went to talk to the inmates, who were eagerly waiting for them.
Meanwhile, Zane and I returned to the city centre and addressed new members of the Rustenburg Support Group at the local library. Zane’s speech briefly covered the history and make-up of The Depression and Anxiety Support Group, definitions and explanations of the five anxiety disorders and discussion of the various types of medications used to treat the disorders.
The audience was very enthusiastic and asked a large number of medication-related questions. Some of the more interesting questions involved the role that serotonin plays in anxiety and the kind of functioning level one can expect from a good medication. Zane stressed that effective medication should make one function to at least 80 – 90% level of your previous lifestyle.
The Rustenburg Support Group is a recent development and is headed by Tertia van der Bank - Zane’s talk was instrumental in providing the members with a comprehensive background to the disorders and laying the basis for further development of the group.
The talk to the inmates of Mogwase Prison was the highlight of the Rustenburg trip for me in that it was such a unique and interesting accomplishment. Dr. Seape and Therry addressed about 20 inmates who suspected that they might be suffering from anxiety or depressive illness.
Therry described the formation and activities of our support group and gave a brief description of the five anxiety disorders. Dr. Seape discussed the anxiety disorders in greater depth specifying all possible symptoms that could accompany a panic attack or depression.
There were a few inmates who identified with only one symptom from the list, that they were suffering from, e.g. insomnia. This prompted Dr. Seape to stress that an individual has to be experiencing at least 4 symptoms at a time in order for Panic Disorder to be diagnosed. She also mentioned the frequent connection of anxiety with depression.
The inmates questioned whether the justice system is obligated by law to supply them with psychologists. They mentioned the lack of help that was available for psychological disorders in the prison and were worried about the support from the officials in this regard.
In response, Therry stressed the importance of proactive behaviour. She suggested that the formation of a support group in the prison by themselves would be very helpful, and offered to supply the group with any materials (audio tapes, reading matter, etc.) that would be of use in combating anxiety. But she also warned any potential malingerers not to abuse the information as it would be to the detriment of the project in prisons countrywide.
It was nice to see that there was a lot of support and interest from the wardens and educational officers. The social workers, Mr. Nchoe and Mr. Disitshwene, were particularly supportive and Ms. Mothupi, the local social worker expressed keen interest. The success of the visit was clearly evident in the enthusiastic manner with which the inmates discussed forming their own support group after the talk. The prison setting brings a new perspective to anxiety disorders, and prompts one to consider the role that institutionalisation may play in the development of these disorders.
Our thanks to Mr. Sekgatle, Area Manager of Mogwase Correctional Services Centre, and to Thabo Sekano particularly, an inmate who bought this project to our attention and has pursued it vigorously since September 1997.