Role-Play as a Pedagogical Strategy to Assist Postgraduate Psychology Students Engage with the Social Embeddedness of Trauma

ABSTRACT

While it is now widely accepted that any understanding of PTSD needs to be contextualised within cultural parameters, there is a lack of pedagogical strategies to assist postgraduate psychology students engage with both the psychodynamic and socio-political aspects of trauma. To assist, role-play is put forward as a teaching strategy, enabling students to explore the impact of taken-for-granted attitudes, social norms and values on how traumatic stress is expressed and experienced. An illustration of a socio-politically rich role-play is used to demonstrate how, without engaging with trauma as socially embedded, comprehensive understanding, empathy, and care cannot be achieved.

KEYWORDS:

• Posttraumatic stress disorder (PTSD)
• role-play
• critical pedagogy
• drama pedagogy
• active learning
• postgraduate psychological training
• social embeddedness
• social unconscious

Introduction

Although a diagnosis of posttraumatic stress disorder (PTSD) has enabled many people to access psychiatric care globally, both diagnosis and treatment are deeply embedded in Western philosophical assumptions. These assumptions separate the individual from the social group, promote objectivity over subjectivity, and privilege rationality over emotionality. They bolster positivism and promote a view of people as objects acted on by provocative forces rather than agents engaging in meaningful action (Boyle 2022). Although positivism has contributed to the development of medical, scientific, and technological breakthroughs, its limitations are visible in its failure to fully understand psychological distress. Psychiatric diagnosis and intervention draw on theoretical models which highlight developmental, genetic, and neurological factors designed for understanding our physical bodies. It is unsound on both scientific and ethical grounds, then, to view psychological distress as purely a symptom of a physical disorder that is universal in nature, and independent of socio-political context (Thomas and Longden 2013).

While in the Global North psychiatric diagnosis and intervention are under criticism, the movement for Global Mental Health (GMH) and the World Health Organisation (WHO) have begun to increase access to psychiatric interventions and treatments, particularly within the Global South (Mills 2014). This move is based on the premiss that psychopathology is universal, and that Western psychiatric intervention is the treatment of choice. Recent research has, however, failed to find evidence to substantiate these claims, instead pointing to the impact of both relational and socio-political contexts on the expression and experience of trauma (Andermann 2002; Avissar 2016; Barglow 2012; Dimen 2011). For example, it has been noted that refugees from certain African and Asian countries experience trauma in ways that differ markedly from the Western narrative framework, with its links to Judaic-Christian notions such as catharsis, confession and redemption (Andermann 2002, 20). Further, in many non-Western cultures in the Global North and South, nonpsychiatric-based trauma recovery involves witnessing, testimony and reparation (ibid.). An example of this can be found in South Africa’s Truth and Reconciliation process. These findings highlight the need to explore the impact of taken-for-granted attitudes, norms, and values on how traumatic stress is expressed and experienced.

The decolonising of trauma-based psychology

From a critical and decolonial perspective, scholars such as Boyle (2022), Bracken, Giller, and Summerfield (2016), Mills (2014) and Summerfield (2008) argued that imposing Western models of psychopathology on other cultures is a damaging form of colonialism. Mills (2014), for example, highlights the irony in the GMH call to increase access to psychiatric treatments in the Global South, given the criticism psychiatry is receiving in the Global North. She reminds us that the market for psychiatric drugs is expanding in much the same way as colonialism expanded, by looking for new markets. Inevitably, the move to GMH influences decisions surrounding what is deemed “normal” and what is deemed “abnormal” in these cultures, as well as what kind of treatment is deemed “desirable”. This can lead to an undermining of local understandings of distress and ways of healing (Mills 2014). Similarly, the same process of medical imperialism occurs when indigenous populations are described as lacking mental healthcare literacy (Summerfield 2008). This marginalises traditional forms of healing and leads to the dismissal, or erasure, of local knowledge systems, which Summerfield (2008) regards as unethical and potentially harmful for these communities.

In her critique of objective analysis, Haraway (1988) argues against a disembodied subjectivity, removed from socio-political context, toward the embodied subjectivity and awareness of how knowledge is situated. Elaborating, Grosfoguel (2009, 13) points out, “No one escapes the class, sexual, gender, spiritual, linguistic, geographical, and racial hierarchies of the ‘modern/colonial capitalist/patriarchal world-system’”. Here, Grosfoguel suggests that we invariably speak from positions within the hierarchies of our available social narratives and discourses. According to Frosh, Phoenix, and Pattman (2002), our positioning within these hierarchies defines the kinds of experience available to us. There is a need, therefore, to consider an intersectional approach to knowledge systems in order to explore how “sociocultural power differentials” interweave with one another, and shape subjective reality (Lykke 2010, 67). We, as researchers and educators, must, therefore, be critically aware of our positioning in relation to each other, the theories and resources we draw from, and the knowledge production we engage in. Teaching and learning occur, not in a vacuum, but within particular socio-political institutions. Foregrounding this perspective enables us to understand how postgraduate psychological training, and the pedagogical strategies we employ (as with other courses, initiatives, and socialising institutions), are political and influential in the ways we train students to relate to the world around them. In taking a decolonial stance in education and knowledge production, therefore, it is important that I ground this paper, in order for you, the reader, to understand the socio-political context impacting me and the knowledge I produce:

Having my academic background in clinical psychology at a South African university, the call to decolonise resonates with me deeply. However, interwoven with my positioning within the taken-for-granted material, environmental, socio-economic, cultural, political, psychological, and ideological hierarchies of the Global South, is my position as an immigrant to South Africa, having been born and raised in Northern Ireland during the years of bloody unrest and religious rhetoric known as The Troubles. My own complex positioning within the socio-political norms and values within both the Global South and North, highlights the multiple sites I inhabit, rather than the illusion of some grand universal narrative that a Western perspective advances. My intertwined, complicated and, at times, contradictory positioning within these hierarchies made me question, from a young age, the multiple ways my socio-political context has shaped me (Auld 2022). In other words, I became aware of how socio-political narratives and discourses provide the context for subjectivity, while subjectivity focuses, poignantly illustrates, and contextualises socio-political narratives and discourses.

Decolonising GMH has important implications for teaching and learning, particularly in the Global South. In South Africa, positivism underpins higher education institutions with traditional psychological training programmes employing standard classification texts – such as the Diagnostic and Statistical Manual of Mental Disorders-V (DSM-V) (APA 2013) and the International Classification of Diseases-11th Revision (ICD-11) (WHO 2019) – in the teaching of psychopathology. Awareness needs to be developed of the ideological basis underlying all educational decisions – from choosing texts to setting learning objectives (Freire and Ramos 1970). Although these texts are presented as neutral and standardised, such psychiatric classification systems are invariably influenced by the dominant cultural attitudes, norms and values in which they were developed – in this case, those of affluent white Western men (Boyle 2022). The socio-political embeddedness of these texts can make psychiatric diagnosis prejudicial when applied to non-Western cultures in the Global South, as well subordinated cultures in the Global North. For instance, if we look at the DSM-V’s classification of PTSD, Criterion A stipulates that a person needs to be exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence. With this stipulation, psychic distress is seen as being caused by exposure to traumatic external events. While this brings attention to the essentially traumatogenic nature of certain experiences, the criterion helps obscure the role of the socio-political context on how traumatic stress is expressed and experienced (Andermann 2002; Barglow 2012; Eagle 2002; Foucault 2006). In other words, diagnosing social and political problems related to discrimination, violence, war or poverty as a psychiatric disorder medicalises social protest and suffering, potentially pathologizing victims of repressive regimes (Boyd et al. 2018). Given the needs of a multicultural population in South Africa – with our history of apartheid atrocities and post-apartheid strife – as well as the demand to provide culturally appropriate services to immigrants and refugees uprooted in armed conflict both in the Global North and South, a set of core principles that inform and support culturally competent practice for trauma recovery must be developed if we are not to perpetuate abuse and exploitation.

There have been some initial attempts at developing such a set of core principles. For example, trauma theory is an interdisciplinary field which emerged in the 1990s. It attempts to understand and respond ethically to all forms of human suffering. However, while trauma theory has yielded numerous insights into the relationship between psychic suffering and cultural representation, postcolonial critics such as Craps and Buelens (2008), Luckhurst (2013), and Rothberg (2008) have argued that it does not provide an ethical framework for engagement across cultures. In relation to the impact of racism and other forms of pervasive discrimination, Craps (2013, 32) points out that, “Understanding racism as a historical trauma, which can be worked through, would be to obscure the fact that it continues to cause damage in the present”. Craps concludes that, if trauma theory is to live up to its ethical aspirations, it must decolonise. In other words, any set of core principles must recognise the globalised contexts of traumatic events and acknowledge the specific forms traumatic suffering takes in these contexts.

Within postgraduate psychological training, we, as students, educators, and clinicians, need to become aware of our taken-for-granted understandings of trauma to realise the multiple layers of meaning that have been obscured by the process of psychiatric diagnosis. This critical stance is rooted in French historian and philosopher Michel Foucault’s (Foucault 2006; Foucault and Khalfa 2006) argument that mental illness is a social and historical problem rather than solely a medical one. There is a need, therefore, for a core set of principles to help us understand that the expression and experience of trauma is inseparable from our taken-for-granted material, environmental, socio-economic, cultural, political, psychological, and ideological context. These core principles also need to take into account that the stories we tell about our lives are derived from wider sociocultural narratives, and that, importantly, some perspectives and experiences of the world are more readily available and favoured than others (Denzin 1989; Layton 2007). Personal meaning is not solely a function of individual choice but arises in relationship to broader sociocultural resources and discourses. Furthermore, the unconscious also exerts an important influence on our understanding and experience of ourselves. Ultimately, therefore, we need core principles that empower us to see ourselves as active, purposeful agents, who create meaning and make choices in our lives, while at the same time being shaped by taken-for-granted environmental, socio-economic, cultural, political, psychological and ideological factors (Boyle 2022).

Fanon (1986) understands the complexity of human subjectivity, suggesting that as much as life is a private domain, it is also an embattled site of historical struggles and social contestation. Fanon, along with activists, clinicians, and academics such as Erich Fromm, Pierre Bourdieu, and Marie Langer, are among those who have called for a social psychoanalysis. In doing so, they advocate that psychoanalysis enlarge its project beyond private and personal subjectivity, and challenge longstanding therapeutic models that divorce the psychic from the social. In other words, these scholars see subjectivity as connected to the public processes and practices that contain and restrain it. In my attempt to decolonise postgraduate psychological training I draw from group psychoanalysis to view the unconscious as more than a reservoir of feelings, thoughts, urges, and memories that are outside of conscious awareness. The social unconscious (Foulkes 2018; Frosh 2018; Hopper 1996, 2002, 2003; Weinberg 2007) is an understanding of the unconscious that includes taken-for-granted attitudes, social norms, and values, born out of a particular time and place in history (Hopper 1996). The basis of the social unconscious is to be found in the conventions that we are born into but have not reflected upon (Dalal 1998). In other words, we absorb, replicate, and reinforce attitudes, norms, and values without knowing we are doing so. Our cultural milieu privileges particular ways of viewing and experiencing the world, while at the same time closes off other possibilities.

Weinberg (2007, 312) defines the social unconscious as “the co-constructed shared unconscious of members of a certain social system such as community, society, nation or culture”. He suggests that the social unconscious includes “shared anxieties, fantasies, defenses, myths and memories” (ibid.). He focuses on the traumogenic nature of the social unconscious and draws on Volkan’s (2001) idea that the social unconscious is largely shaped by the group’s chosen traumas and glories. Volkan describes chosen traumas as collectively held memories of suffering and devastation which have been handed down from one generation to the next. These traumas are shared mental representations of destruction the group’s ancestors suffered. They are often infused with annihilation anxiety, humiliation, and hatred, evoking desperate social and personal helplessness, powerlessness, and a sense of loss inextricably linked to identity. As chosen traumas are deeply disturbing, they are pushed into the social unconscious through repression and denial. Weinberg (2007) indicates that collectively held memories, perceptions, expectations, wishes, fears, and other emotions related to chosen traumas, and the defenses against them, may go on to become important identity markers of the group. As a result, if the group faces new conflict with new enemies, a reactivation of the group’s chosen traumas and associated defenses can occur to try to shore up the group’s battered identity.

Also focusing on trauma, Hopper (1996) draws a link between trauma and the social unconscious through the process of equivalence, whereby situations from another time and place are equated with a current situation. The process of equivalence enables Hopper to extend Malan’s therapeutic triangle to form a “therapeutic square” (Hopper 1996, 20). The therapeutic square includes four points: the “here and now”, “here and then”, “there and now”, and the “there and then”, with the latter referring to the social unconscious. In a similar vein to Hopper’s understanding of equivalence, Weinberg (2007) argues that the social unconscious is central to re-enactments of past trauma, through condensing past and present events in paranoid-schizoid ways.

Weinberg (2007), along with (Hopper 1996), consider the role of social defenses against shared anxieties caused by social trauma. From their perspective, social defense systems occur when a group unconsciously colludes to protect themselves against a shared anxiety at the expense of carrying out the group task. In this way, the group works to “turn a blind eye” (Steiner 1985) towards the conflicts and unbearable feelings that reality presents. In earlier research, Jaques et al. (1955) and Menzies-Lyth (1988) illustrate how social defense systems manifest at many levels in the group or organisational structure: in its procedures, information systems, roles, in its culture, and in the gap between what the group or organisation says it is doing and what it is actually doing. Fundamental to the nature of a social defense system, is the idea that individual anxieties can be projected, disowned, and given an independent existence in the social structure and culture of the group or organisation. As the social defense system develops slowly over time, externalisation and implicit collusion work to change group or organisational structures in self-serving ways in order to normalise the avoidance of core historical anxieties.

From yet another perspective, and influenced by a focus on intersectionality, Dalal’s (1998) work on the social unconscious questions the division between the social and the individual unconscious. Following Dalal, Layton (2007) has gone so far as to say that the split between psychic and social functioning is a false dichotomy that serves to perpetuate the individualistic, capitalistic status quo. Layton returns to Marxist thoughts on ideology, arguing that dominant ideologies work to present an idealised representation of society, while burying any disruptive effects in an unconscious element of the norm. In this way, unconscious ideals operate to produce and maintain political, social, and economic inequalities. Idealised cultural norms erect barriers to what can be thought, felt, and articulated. Layton argues that such occurrences are often enacted in the clinical setting in a way that recreates oppressive social systems, in turn, perpetuating on-going psychic pain.

The work of Hopper (1996), Weinberg (2007), Dalal (1998), Volkan (2001), Jaques et al. (1955), Menzies-Lyth (1988), and Layton (2007) suggest that all clinical work is framed by the historical, truamatogenic, defensive and political element of the social unconscious.

In this paper I argue that a critical and decolonial stance is an indispensable strategy within postgraduate psychological education to address the limitations of the hegemonic positivist model of training clinicians, by including awareness of the social unconscious, especially when working with psychic distress. I put forward role-play as a strategy within case-based learning which offers the chance for students to actively develop awareness of taken-for-granted socio-political attitudes, norms, and values, and their impact on the experience, expression, and understanding of trauma.

Role-play as a critical pedagogical strategy for developing awareness of the social embeddedness of trauma

It is clear from this discussion of the intertwined relationship between the psychic and the social, and their impact on the expression and experience of trauma, that dynamic pedagogical strategies are required to engage with the exploration of these complexities in the classroom. What is needed are pedagogical strategies which provoke students to, firstly, become aware of, and secondly, think critically about taken-for-granted socio-political realities such as race, class, gender, religion, economic status and sexual orientation, and the impact of such realities on the clinician, the patient, and the therapeutic encounter (Lobban 2013).

With this in mind, Brazilian educator and philosopher Paolo Freire’s (Freire and Ramos 1970) critical pedagogy may enable students to engage with the social embeddedness of trauma. At the heart of Freire’s (Freire and Ramos 1970) work lies the radical proposition that students must develop a critical consciousness. To elaborate, in traditional Western teaching and learning, Freire sees students as passive – being presented with information in lectures, where they “bank” knowledge without being given time to process or think about their learning. Passive learning – such as taking notes or listening to a lecture – does not require participation from the student (Tovani and Moje 2017). This makes it very difficult for students to interrogate the ideology underpinning the knowledge they are being presented with, reflect on the nature of knowledge, or to construct their own meaning from the information provided. Instead of banking knowledge, Freire challenges perceptions of the traditional teacher-pupil and expert-novice power dynamic, to envision educator and student learning and discovering together. In his reimagining of education, Freire sees students engaging in self-directed inquiry, being empowered to view themselves as agents, dispelling the perception that they are isolated from their socio-cultural communities, or are unable to effect change.

Critical pedagogy is rooted in a constructivist paradigm which draws on the theories of Dewey and Piaget, and sees learning as an active process of “meaning-making gained from experiences and interactions” (Miller-First and Ballard 2017, 25). Although Piaget and Dewey’s theories differ, they share a common focus on the active development of knowledge through engagement with complex real-world experiences (Gascon 2019). Piaget’s theory of cognitive development illustrates the advantage of indirect, rather than rote, learning (Ackermann 2001). With indirect learning, knowledge is understood as being constructed in the mind of the student when he or she is actively engaged in complex real-world experience (Dewey 1938). Piaget rejects the belief that education should focus on traditional positivist tenants of memorisation and repetition, in favour of learning as an active process of engaging with, and reflecting on, the world in which we live. Like Piaget, Dewey (1938) believes students should have complex real-world experiences to facilitate discovery, shifting the focus of education toward learning through inquiry. Dewey also appreciates that students learn better by “actively doing” rather than “passively receiving” information.

With an eye to developing clinicians who are responsive to marginalised and vulnerable communities, I consider how role-play, as a strategy that asks students to take on the role of a character within a scenario, may be an important step toward decolonising psychological training and practice, helping students understand distress and trauma as socially embedded, prior to their engaging in supervised clinical practice. To elaborate, drama pedagogy techniques move students from a traditional passive seat-based fixed desk environment to one focused on engagement, performance, and active participation. Techniques which can be employed with role-play include writing-in-role (a strategy that asks students to write from a character's perspective), improvised interview or hot-seating (a strategy in which the student, as the character they are portraying, is interviewed by their peers), and tableau (a strategy where students freeze in poses that create a picture of one important moment in the scene).

While teaching through role-play is often part of the training healthcare professionals (Harrison 2002; Negri et al. 2017; Pavey and Donoghue 2003), I believe that it can be particularly useful when the pedagogic aim is to get students to become aware of, and think critically about, the historical, traumatogenic, defensive, and political element of the social unconscious. This is because role-play provides students with a unique opportunity to explore meaning from an “inside” perspective, rather than reflecting on a case from the “outside”. Here, a student can learn by “stepping into” the complex and intertwined psychosocial reality of the character they are portraying. By taking on the “mantel” of the character (Heathcote and Herbert 1985) the student must become aware of, reflect on, and question, taken-for-granted ethnocentric worldviews. In other words, students must confront how the character both differs from, as well as is like, themselves. Through role-play students have the opportunity of making taken-for-granted (unconscious) socio-political norms and values, conscious. This transformative process is only possible because role-play does not bind the student to their own ethnocentric worldview. Instead, role-play enables student to experience the world through the eyes of the character they are portraying. Here, the student is given a voice that is not their own with which to interpret their character’s psychosocial reality. This opens the possibility of the student distancing themself from their own perspective enough to see the situation in a different way (Alkin and Christie 2002). By so doing, the student can contemplate a new point of view in a non-threatening way, facilitating a less defensive exploration of contentious socio-political realities such as race, class, gender, religion, economic status, and sexual orientation.

Other activities which can be used within role-play to encourage students to become aware of, and think critically about, ethnocentric world views include blind casting (casting performers without considering factors such as their ethnicity, skin colour, body shape, sex, or gender), conscious casting (casting performers where these factors are considered), and cross-cultural casting (casting performers in opposition to these factors) (Thompson and Turchi 2016). These activities can be used not only to cause students to slow down and contemplate their character deeply, but also to promote class discussion around taken-for-granted socio-political norms and values.

The active social interactions and conversations developed while preparing and participating in a role-play contribute to establishing a sense of community and support among students and educator, as they grapple with complex issues in a real-world context. This aids the development of culturally competent students who can understand the other performers’ socio-political attitudes, values, and opinions by drawing on their own embodied experience of portraying different characters, as well as the insights and support of their peer group (Arenas 2006; Hendry 2006; Monks, Barker, and Mhanachain 2001). In this way, role-play can enable students to listen to one another as well as to themselves, identifying and recording the impact of otherwise taken-for-granted socio-political norms and values, both within the character they are portraying as well as within themselves, while simultaneously drawing and building on their peer group’s knowledge and experience.

Given the link between psychiatric diagnosis and the medicalisation of social protest and suffering, the opportunity to engage with the social embeddedness of traumatic stress within the safety of the classroom and a community of peers, is of vital importance. For Winnicott (1964), supportive environments can function as transitional spaces, enabling children to engage, via play, with both fantasy and reality. Following Winnicott, it follows that, in postgraduate psychological training, role-play in the classroom can be used to create a supportive space where students can play, perform, and explore their own, and their character’s, ethnocentric worldviews. The space between student engagement with their own performance, and their interpretation of the performances of others, can also enable students to “look and see” as well as to be “looked at and seen” (Ma and Subbiondo 2022, 506) in terms of the impact of taken-for-granted ethnocentric world views. According to Winnicott (1964), being looked at and seen is essential for human development. Therefore, it is through the dynamic interplay of the individual student with the safe space of the classroom and the supportive community of their peers, which enables role-play to facilitate engagement with the social embeddedness of trauma.

Let us now look at a socio-politically rich role-play to illustrate how role-play, as a critical pedagogical strategy, can be employed in the classroom. The context of my use of role-play is as an educator in a postgraduate psychological training programme in an intuition of higher education in South Africa. The activity could also, however, be offered as a short course for qualified clinicians engaging in continuing professional development. It is recommended that 36 training hours are given to the activity.

Procedure

1. Role-play development – The educator selects case material rich in taken-for-granted socio-political realities such as race, class, gender, religion, economic status, and sexual orientation. Ethical clearance should be sought where necessary.

2. Role selection – Students are assigned to characters in the role-play using either blind casting, conscious casting, or cross-cultural casting. The aim here is to facilitate awareness of, and reflection on, taken-for-granted socio-political norms and values.

3. Background information – Character demographics, presenting problems, and personal histories are provided to the performers to set the scene for the role-play.

4. Research – Performers are given a week to research the role-play and improvise a clinical scenario. The students are given time to consult with the educator and their peers in order to discuss any queries or questions they may have.

5. Writing-in-role – Each performer is asked to write a short reflective essay about the trauma experienced from the point of view character they are portraying. These essays are shared with the class during the class discussion time.

6. Performance – A pair of students are chosen at random to present their role-play to the class.

7. Class discussion – After the role-play the performers are given an opportunity to reflect on their experience performing the role-play and to share their writing-in-role essays with the class. The floor is then opened for the class to discuss implicit socio-political factors students feel may be impacting the role-play, with the educator acting as facilitator.

8. Improvised interview or hot-seating – The student, as the character they are portraying, is interviewed by their peers to further explore, and make explicit, the impact of the psychosocial context on the trauma experienced.

9. Tableau – The students freeze in a pose that creates a picture of one important moment in the scenario which they feel expresses the impact of the socio-political norms and values.

10. Subsequent performances – The role-play is then repeated by the other groups of performers.

11. Further class discussion – After the final role-play some time should be spent looking at the variety of role-plays and psychosocial factors presented.

12. Reflective essays – All students are asked to write a one-page reflective essay on any insights they may have developed around the social embeddedness of trauma. These are then be brought to the classroom to share with class members for further discussion and reflection.

13. Next role-play – The procedure can then be repeated with other socio-politically rich role-plays.

Role-play illustration

1. Character demographics

Patient: Willem, a 49-year-old white, Afrikaans speaking South African Policeman whose career of 31-years spans both the apartheid and post-apartheid period. He is a Sergeant in the Search and Rescue Unit. He is married with no children.

Clinician: Newly qualified, white, English speaking female clinician working in a state hospital setting which is contracted into governmental medical aids and accepts injury-on-duty claims.

2. Presenting problem

Willem consults the clinician just before the Christmas holidays. He appears close to breaking point. He is very red in the face and grips the arms of the chair so tightly the clinician can see his knuckles going white. He speaks through clenched teeth and avoids eye contact. He feels like he is “going to explode”.

Willem’s symptoms are chronic. They include difficulty falling and staying asleep, night-sweats, nightmares, inexplicable outbursts of temper, hot flushes, poor memory, and avoidant behaviour. He has previously attempted suicide and is currently suicidal.

Willem feels his “whole world is crumbling” around him. He feels that work is “too much”, following his attendance at a motor vehicle accident in which a three-month-old child has been killed. After this incident he develops a “fear of driving”, avoiding sections of roads where he has attended fatal collisions. He can “no longer remember” how to do his job. Willem goes to his General Practitioner (GP) feeling like his head is “splitting open” and he cannot control his emotions. His GP refers him on to the clinician the same day.

3. Personal history

Willem is drawn to people who have suffered – his sister with Down’s Syndrome, his nephews and nieces, and the victims he rescues and cares for. However, he also describes himself as a loner. He feels ashamed of having to reach out for help and support for himself. This makes him feel inadequate, both as a man and as a policeman. Even his wife, whom he has been married to for 25 years, he wants to protect from the horrors he has witnessed. He does not want to “contaminate her with death”.

Willem is the second youngest in a family of six siblings. The family is working class: his father was a train driver for the state transport system, and died 3 years ago, while his mother worked as a secretary before her retirement. He mentions that his mother raised the family single-handed as his father was often absent, working a shift pattern and attending frequent compulsory military camps (a National Service requirement of all white adult men during apartheid). Willem says his mother coped by enforcing strict discipline and that she “drilled” it into him that he must do what he was told.

The family are also devoutly religious, belonging to a Calvinist form of Christianity, the Dutch Reformed Church. During apartheid it was important to his family that Willem attend church in his police uniform. His family and church congregation are very proud of his career and police service.

Willem has no clear memories of his childhood or schooling. The first thing he recalls is going to Police College when he was 18. He describes himself as having “a calling” to the South African Police. Being a police officer is all he has ever talked about or wanted to be.

Willem describes Police College as a “tough experience”. While he was busy with basic training, riots broke out, and his platoon was deployed to a township. Their orders were to drive through their assigned section of the township collecting dead bodies. Willem found this horrifying. However, while he felt at the time that this was just “part of the job”, currently he feels haunted by the experience. He often is unable to sleep at night for “seeing dead eyes staring back” at him. Willem is frustrated that, as the incident happened nearly 30 years ago, he should be “over it”.

Willem explains that, over the course of the past several years he has become more and more distressed at accident scenes. He tends to cope with his distress by distracting himself with jobs he feels good at and in control of. He often returns to his unit after office hours and works alone on dockets and vehicle maintenance. Although he feels he is caring and giving in his friendships and toward colleagues, Willem experiences his new black colleagues as vindictive, withholding, and capable of betrayal. He has become obsessed with correcting and controlling their behaviour. He has also lodged many grievances against them to commanding officers. He has become increasingly disliked at work. Willem has twice attempted suicide, trying to shoot himself in the head in his Search and Rescue Unit vehicle. On both occasions his firearm jammed. Willem feels that this was a sign from God. It was then made an appointment to see his GP.

Example of a student’s research into this role-play

During the early days of apartheid there was a job reservation policy aimed primarily at improving the lives of poor, Afrikaans speaking, white South Africans, implemented in all the state-owned enterprises as well as state departments such as the South African Police. In other words, being a policeman allowed impoverished rural Afrikaner men access into circles of power and privilege – in the form of employment, wages and skills development (Cawthra 1993). When the new majority government came to power in 1994, led by the African National Congress (ANC), they decided to implement an affirmative action policy to correct previous imbalances. The Employment Equity Act and the Broad Based Black Economic Empowerment Act aim to promote equality in the workplace, by advancing people from designated groups as a priority. By legal definition, the designated groups who are to be advanced in society include all people of colour, white women, people with disabilities and people from rural areas. However, the affirmative action policy may have the effect of not advancing people from previously favoured groups.

In so many ways the circle of power and privilege that had been open to white Afrikaner policemen during apartheid fell apart post-apartheid – they were not held in high esteem by the black society they now protected and served, promotions were no longer guaranteed, and they were no longer affirmed by the police sub-culture of the new post-apartheid police service.

Example of the use of tableau after the role-play

Figure 1

Figure 1. Tableau with cross-cultural casting.

Example of a student’s reflective essay

In her book Understanding trauma: A psychoanalytic approach, Garland (1998, 4) explains that, “the impact of trauma upon the human mind can only be understood through achieving with the patient a deep knowledge of the particular meaning of those events for that individual”. If we understand that what is apparently social and what is apparently psychological keep entwining with one another, then, as Frosh points out, “Deeply, passionately, unconsciously people are political – racialised, gendered and classed to the core of their identities. Equally deeply, erratically and bizarrely, social events are infused with phantasy – eroticised, exaggerated, full of fears and desires” (Frosh 1999, 387).

Embedding the role-play in its socio-political backdrop in apartheid South Africa, society was divided into good and bad, black, and white, separated by physical distance and structured by discriminatory laws. In terms of Dimen’s (2011) concept of the mind-society synapsis it could be said that the defensive operation of splitting, whereby the moral complexities of psychic and social life become reduced to good and bad polarities, was exacerbated during apartheid. Christian Nationalism, the ideology of the National Party (NP), was pitted against anarchic communist evil, symbolised by the ANC.

Willem was raised in a staunchly Dutch Reformed Afrikaner family. The operation of normative unconscious processes (Layton 2007) may have pushed Willem towards socio-culturally favoured ways of identifying himself – for example, through racism, militarism, machismo, patriarchy and nationalism. During apartheid “containing” external factors may have existed for Willem. The most obvious facilitating factor was the police sub-culture. It positioned Willem in affirming ways within sociocultural ideals. External influences of the police sub-culture may have been internalised by Willem in an ego-syntonic way. The police sub-culture confirmed that he was an authoritative, aggressive, heterosexual, able bodied, morally just, and physically brave man.

Before the demise of apartheid, Willem took it for granted that he was a respected and admired pillar of society. Under apartheid he worked with, and served under, colleagues who came from similar backgrounds and had undergone the same training that he had. They had a strong feeling of solidarity with each other and shared the same ideals. Under these socio-political circumstances Willem’s fears and anxieties appeared contained: he was seen as role model to family and friends, he was held in high esteem by colleagues and the church, he received promotion through the police ranks, and he felt he was essential to the country’s apartheid ethos. In many ways Willem embodied the apartheid sociocultural ideal.

Although Willem’s work in the apartheid police exposed him to traumatising experiences, his ability to reflect on and question the violence, devastation, and destruction he had witnessed and participated in appeared overlaid by a sense of fellowship and purpose. In addition, his emotional encounters and behaviour appeared to reflect a sub-culture entrenched in apartheid racialised and gendered ideologies (Auld and Cartwright 2018). The concept of the mind-society synapsis (Dimen 2011) may have bearing here: Willem’s psychic and social lives seemed to echo one another during apartheid. This may have helped him deal with the intricacies of life in a supported, direct, clear-cut, and dependable manner. Under such circumstances Willem appeared better able to cope with the distressing aspects of his job.

Life post-1994, however, brought with it a totally different police sub-culture. Here, Willem’s participation no longer seemed to fulfil his needs, or validate his self-worth as it had during apartheid. The transformation of the apartheid police to post-apartheid police may have undermined Willem’s taken for granted containing social structures, leaving his fears and anxieties uncontained. The apartheid police force had grown to reflect a new generation of South Africans and was no longer dominated by white Afrikaners; (formal) segregation ended. The parallel between the Willem’s psychic and social life seemed to gradually collapse, threatening, and undermining his mind-society synapsis and his taken-for-granted ways of affirming his identity (Auld and Cartwright 2018).

In this brief analysis we can see how the South African context “comes to pose a determining influence upon what counts as “pathological” within its parameters” (Hook and Parker 2002, 34). Thus, while the diagnosis of PTSD may be employed throughout the world as a basis for describing the impact of trauma, this role-play helps us see the need to understand the socio-cultural context and subjective meaning brought to the experience by individuals, such as Willem.

Conclusion

Many studies have explored the reasons why people experience PTSD. However, they tend to look at interaction between the individual and provocative external events to see their relative involvement. As Korber (1992) notes, they also tend to take for granted the idea of a rational subject who, after being exposed to various environmental influences, behaves in a manner which is out of character. In considering trauma from a sociocultural perspective, I in no way wish to reduce the significance of biological or neuropsychological considerations to this area of study. These considerations undoubtedly have important contributions to make in explaining how trauma exposure can affect an individual’s functioning. However, as students, educators, and clinicians we need to remain open to the impact of taken-for-granted attitudes, social norms, and values on how distress is expressed and experienced.

All too often in postgraduate training there is a preoccupation with individual genetic predisposition, biological factors, internal conflict, and on confronting maladaptive thoughts and behaviours, with the aim of symptom relief, at the expense of a concern for meaning and interpretation of lived experience. Given the positivist underpinnings of training, in this paper I have tried to illustrate how we can engage students in critical inquiry regarding the role of culture, race, gender, social class and the many other ways we live with inequality, on psychological distress as revealed in the role-play of a clinical encounter. This allows the student to grapple with the way in which identity is constructed from all the raw materials available – both internal and external – via the imaginative fabrications of the private and public, personal, and political, individual, and historical context as revealed in the therapeutic narrative. In this way, role-playing enables engagement with the lived experience of people interacting with one another, allowing the student to focus on the exploration of the multiple interpretations of how people live and give meaning to their lives at moments in the ongoing history of their culture. In sum, the multiple interpretations that can be engaged with through role-play enables students to engage with a lived experience of the interplay of the social and psychic that occurs in psychotherapy.

Role-play enables students to work with Layton’s (2007) idea that identities are built in relation to other identities, in terms of the mutual construction of meaning in the analytic dyad. It also enables students to engage with Dimen’s (2011, 4) idea of “mind-society synapse”, exploring how the dominant understandings of social categories such as race, gender, culture and religion are deeply rooted in our psyche. Such engagement in the classroom allows for social dialogue and exploration in an atmosphere of shared learning between students and educator. Thus, role-play allows students to engage with sensitive human issues and offers the potential for students to become aware of taken-for-granted sociocultural and political norms in preparation for clinical practice.

From a decolonial perspective, role-play provides us with a way to acknowledge the multiple sites we – as students, educators, patients, and clinicians – inhabit. As a critical pedagogical strategy role-play enables us to disrupt the perpetuation of the macro-narrative of Western domination and universality. It provides us with a means of liberating postgraduate psychological training and practice, causing us to become critically aware of our positioning in relation to each other, and the knowledge we draw on and produce. Role-play also informs and supports culturally competent training and practice by forcing us to realise that the experience and expression of trauma is inseparable from our taken-for-granted material, environmental, socio-economic, cultural, political, psychological, and ideological context. Ultimately, role-play develops our awareness of, and engagement with, the social unconscious. In doing so, it aids in the fight toward undoing and overcoming the colonial underpinnings that have shaped psychology’s knowledge practices in both the Global North and Global South. It offers us the hope of moving a step closer towards putting an end to medical imperialism and the perpetuation of abuse and exploitation.

Acknowledgements

This work is based on the research supported by the National Institute for The Humanities and Social Sciences.

Disclosure statement

No potential conflict of interest was reported by the author(s).