Circumcision can lead to mental illness

A 21-year-old Langa law student looked forward to his rite of passage to manhood but two weeks after his circumcision at an initiation school in the bush he had a psychotic episode and was admitted to a psychiatric hospital.

In another case, a 26-year-old man earned the money in Cape Town for his initiation and then returned to the Eastern Cape for the ceremony. But back in the city his life spiralled out of control.

He was dismissed from work for trying to stab a co-worker, and within a year of the rite was admitted to a psychiatric hospital and diagnosed with schizophrenia. These are two case studies taken from the PhD thesis of medical anthropologist Lauraine Vivian, titled Psychiatric Disorder in Xhosa-speaking Men following Circumcision.

Vivian explored the mental histories of five young men, who each suffered from acute psychotic episodes after initiation ceremonies.

She is based at  UCT medical school's Primary Health Care Directorate.

Her thesis examined how stress and anxiety related to personal, social and cultural factors, could possibly trigger the onset of a psychotic illness in vulnerable young men with a predisposition to such illness.

Circumcision and illegal initiation schools again made headlines in the news this month.

The circumcision death toll in the Eastern Cape has reached at least 20 so far this season, the  provincial health department said.

Another 72 initiates were admitted to hospitals in the region, suffering from dehydration or septic wounds.

Vivian said as an anthropologist she had great respect for the Xhosa custom but there was a need to ensure the rights of these young men were protected and the practice was carried out safely.

Our  Constitution protects the rights of all these young men. The onus is on the health system to ensure that cultural practices do not turn abusive.

She graduated this year after doing six years of research at a number of psychiatric institutions in the Western Cape, the Eastern Cape and the Northern Province.

She screened over 50 patients who had suffered from various psychiatric illnesses linked to their circumcision but focused on five men.

She interviewed traditional surgeons and community elders, and worked closely with a task team in the Eastern Cape.

At times it was distressing to hear what some of the young men had been through: how they were marginalised because they were mentally ill and received little care from their communities, who believed they were bewitched.

Adolescence and the pathway to manhood was tough enough in itself. In the cases she looked at, there was evidence that a lack of family support, especially the absence of a father, played a major role in exacerbating the patients' stress and anxiety.

Evidence illustrated that the most significant stressor was when fathers did not fulfill their roles as required for their sons' circumcision.

Because the father/son equation underpinned this patrilineal rite of passage, their psychological health and social relations were compromised, it highlighted the stresses, psychological harm, cultural dissonance, poverty and stigma they had suffered and indeed continued to endure.

Ironically, she said, there was a local idiom that warned of possible mental illness in youth who were not circumcised to their fathers' line of descent.

As much as it was a warning, it counselled that fathers, mothers and families needed to engage with their sons at this potentially turbulent time in their sons' lives. All five of the men in Vivian's study went through their initiation without the support of their fathers.

They also developed psychotic illnesses within one year of their circumcision. Two suffered brief episodes, which improved when their cultural experience had been addressed through therapy.

Her work argues that in the cases of the five men, stressors involved in their circumcisions precipitated stress-related anxiety, and because they were vulnerable, this contributed to the onset of psychotic illness.

They suffered from either schizophrenia, bipolar disorder or cultural bound syndrome (a disorder brought on by cultural pressures).

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