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Psychology in Society

On-line version ISSN 2309-8708

Psychol. Soc.  n.44 Durban Jan. 2013

 

BOOK REVIEW

 

A call for a scientific approach to prevention

 

 

Mohamed Seedat

Institute for Social and Health Sciences. University of South Africa. Pretoria

 

 

Ward, C, van der Merwe, A & Dawes, A (eds) (2012) Youth violence. Sources and solutions in South Africa. Cape Town: UCT Press. ISBN 978-1-91989-587-1 pbk. Pages xv + 432.

In the introductory chapter the editors tell us that "the overall goal of this book is to provide a summary of the evidence to date, so that policymakers and those who implement programmes to prevent youth violence may be alerted to the critical need for interventions that are based on evidence for effectiveness and designed in a manner that takes the causes into account". Following this stated goal as well as the structure and contents of the book, one may surmise that the book is positioned as an intervention at several levels. At a conceptual level the book is constructed as a critique of the criminal justice approach to violence containment that stresses stringent retributive and punitive measures. The book categorically adopts an ecological model and so chapters two and three, constituting section one, represent a tightly crafted conceptual foundational framework for the rest of the edited volume. In describing the magnitude and patterns of violence, Don Foster, in chapter two, offers a critical reading of the gendered, class and race dimensions of violence. In chapter three, van der Merwe, Dawes and Ward systematically draw attention to the individual, familial, communal and societal risk factors and pathways to youth violence. The ecological framing of violence resonates throughout section two of the book, which comprises of ten chapters that focus on a range of topics, including youth violence in the early years, school-based youth violence, violence in out-of school contexts, gang violence, youthful sex offenders, media violence, youth offenders in the criminal justice system, and youth violence in cities. Each of these chapters methodically illustrates how violence may be prevented within specific sites, environments or developmental stages, consistent with their respective focus. The chapters in section two are primarily replete with high-income country examples of what works for youth violence prevention. For instance, chapter five written by Tomlinson, Dawes and the late Alan Fischer provide illustrative high-income country examples focused on infancy, toddlerhood and early childhood development stages. They also offer two South African examples implemented in Lavender Hill and Khayelitsha respectively. Given the gaps in the South African prevention science knowledge base, the editors and chapter authors in section two constantly and correctly make the point that these high-income country interventions would need to be tested for local cultural congruency and efficacy.

Whereas this edited volume derives its relevance from its focus on youth violence, a national and global public health and development priority, it also contains critical value. The book's critical value is best noted in its nuanced readings of race, class and masculinities (see chapter 2 by Foster) and adoption of ecological explanations of violence and violence prevention. The ecological framework provides a critical edge in that it situates individual violent behaviour within larger familial, communal and societal contexts and draws attention to the social determinants of violence. Unlike the criminal justice approach, which de-contextualises violence the ecological approach in this book takes a critical look at structural inequalities, poverty and corrosive ideologies in the perpetration of violence. This critical perspective is particularly evident in chapter four by Saadhna Panday and colleagues who carefully locate youth violence within a development approach, and South African historical and contemporary specificities. Panday and co-authors examine youth violence within South Africa's history of youth activism, and patterns of youth access to education, employment, health care and economic participation. These authors consider youth violence alongside teenage pregnancies, substance abuse and overall mental health, and point out the significance of civic participation as a trigger for youth identity and social development.

The reflective stance of the book is also apparent in the closing chapter wherein the editors draw on section two in particular to distill lessons and future directions for youth violence prevention in South Africa. Here they reiterate the call for theory-driven, evidence-based, multisystem programmes and creative ways of introducing and adapting high-income success for resource strapped contexts in South Africa. They stress several principles, including the value of intervening early, socio-cultural congruence, a focus on risks and resilience, and community embeddedness. Even though they note the importance of inter-institutional and inter-sectoral collaboration, perhaps the significant function of political will, institutional arrangements and leadership in youth violence prevention are insufficiently explored.

As a conceptual intervention, the book succeeds in providing a convincing case for an ecological approach that is mindful of the multi-level risks and determinants of youth violence and creates a foundation for multi-systemic interventions. The book is also an intervention intended to stimulate evidence-led prevention actions' perspective. So while prospective studies may help to reveal the extent to which this edited volume succeeds in its goal to encourage evidence-led policies and interventions, it may be instructive to be reminded that both policy and intervention development are complex processes and that the relationship between empirically generated evidence and decision-making is far from a linear one. Policy-making and intervention development are enabled and constrained by a range of vested political and economic interests, ideology, donor expectations, public demands and social actor values and orientations (see Landry, Amara & Lamari, 2001; Lavis, Robertson & Woodside, 2003).

So a question that one may ask: How does an edited book such as this one obtain maximum resonance and uptake among policy and intervention level decision makers? While several public launches served to place the book within the public arena and consciousness, the specific goal of the book raises questions about how academics working in the policy and development contexts may go about creating relevance and currency for their work in an ethical manner. The issue of relevance raises another set of questions: Who produces evidence in society? Who is the evidence produced for? What are the ideological functions of empirically produced data?

In considering such questions, I also wondered about the place of a science-based book in a society such as South Africa which continues to struggle to reconcile epistemological imperatives arising from its positioning as an African modernity committed to a knowledge-driven economy (see Posel, 2002), and its parallel pledge, albeit marginal, to support community embedded knowledge systems. While these are all rather troubling issues, that are unlikely to be resolved soon, all the chapter authors demonstrate empirical clarity, scientific independence and academic rigour in their review of the science base concerned with youth violence prevention. The reader is sensitised to the finer academic debates and gaps in the international and South African science base, and throughout the book there is no space to doubt its empirical veracity.

Given its academic quality it may be safe to suggest that the book will in all likelihood enjoy extensive citations and use in academic circles among researchers and postgraduate students alike. It is difficult to know how the book will be taken up in policy and practitioner circles. However, it must be stressed that all of the chapters, especially those in section two, contain pertinent key messages for policy and intervention development and that the book is a tightly packed resource for anyone committed to advance evidence-based youth violence prevention.

In reviewing the breadth of the topics covered in the book, I was aware that most of contributors are well-regarded and esteemed scholars whose academic records serve to bring credibility to the book as an intervention intended to stimulate and support policy-making and intervention development as rational decision-making processes. There can be no doubt that the book is a valuable resource containing empirical data on the magnitude and risks factors of violence and illustrations of successful youth violence prevention strategies. The editors have succeeded in marshalling the social and public health oriented sciences to make a persuasive case for evidence-led youth violence prevention.

 

REFERENCES

Landry, R, Amara, N & Lamari, M (2001) Climbing the ladder of research utilization. Science Communication, 22, 396-422.

Lavis, J N, Robertson, D & Woodside, J M (2003) How can research organizations more effectively transfer research knowledge to decision makers? The Milbank Quarterly, 81, 221248.

Posel, D (2002) A matter of life and death: Revisiting "modernity" from the vantage point of the "new" South Africa. Draft manuscript. Johannesburg: Wits Institute for Social and Economic Research.

 


 

Deconstructing "teenage pregnancy" / abortion

 

 

Rachelle Chadwick

Women's Health Research Unit. University of Cape Town. Cape Town rachellechadwick@yahoo.co.uk

 

 

Macleod, C (2011) 'Adolescence', pregnancy and abortion: Constructing a threat of degeneration. London: Routledge. ISBN 978-0-415-55338-4 pbk. Pages xi + 168.

 

 

Social anxiety regarding the "problem" of "teenage pregnancy" is rife in South Africa. Frequent media frenzies claim that "teenage pregnancy" is increasing and that young girls are deliberately becoming pregnant in order to access Child Support Grants. Questions ring out: why do teenagers become pregnant? And how can we stop teenage pregnancies? Amidst this volatile mix of public opinion and alarmist calls, 'Adolescence', pregnancy and abortion provides a much needed interrogation of representations of "teenage pregnancy" and abortion in the context of adolescent reproduction. Weaving together an impressive analysis of scholarly research, media/internet representations and public discourse, Macleod deconstructs the multiple ideological assumptions and discursive strands which underpin contemporary debate, public opinion, scholarly work and public health interventions pertaining to "teenage pregnancy"/abortion.

The book is divided into eight chapters. Chapter one situates the study as a social constructionist analysis of discourses of "teenage pregnancy"/abortion. Macleod moves away from the usual questions of cause, consequence and modes of prevention and signals her intent to focus instead on the ideologies which shape research questions, interventions and popular discourses regarding "teenage pregnancy"/abortion. Chapters two to seven provide a series of deconstructive analyses in which Macleod unpacks commonsense ideologies underpinning understandings of "adolescence", outlines the challenges posed to normative ideas of "adolescence" by the phenomena of "teenage pregnancy", sex education and adolescent abortion, traces the construction of "teenage pregnancy" and abortion as "social problems", interrogates the intersections between race and notions of "teenage pregnancy"/abortion and analyses the role of health service providers in calculating and managing risk in relation to the sexual/reproductive health of young people.

Chapter two contextualises the analysis of "teenage pregnancy/abortion" in relation to the broader idea of "adolescence", which is argued to be a recent historical invention. The chapter outlines three key ideologies of adolescence, namely: (1) the notion of adolescence as a transition, (2) the construction of an "imaginary wall" between adolescents and adults and (3) the definition of adolescence as an individual process divorced from social processes. According to Macleod, the notion of adolescence as transition maps onto broader notions of human development as a movement from primitive to civilized and is, as a result, haunted by anxieties of social decline or what Macleod calls the "threat of degeneration". The paradoxes and inconsistencies of the "adolescence as transition" ideology are unpacked more closely in chapter three.

Chapter four traces the invention of the idea of "teenage pregnancy" as a social problem dating back to the late 1960s. Macleod shows how the various ideologies of adolescence outlined in chapter two underpin constructions and discussions of "teenage pregnancy" within social science and public health research agendas. The idea that research practices are social practices is powerfully illustrated in this chapter. Through careful consideration of available research, Macleod shows that there is little clear-cut evidence supporting claims that "teenage pregnancy" results in a disruption of schooling and socio-economic disadvantage, automatically confers detrimental health risks to the mother, results in poor child outcomes or is linked to welfare dependency. Research on "teenage pregnancy" is shown to privilege age as key explanatory variable, rendering young women visible as "objects of scientific scrutiny" (p59) and rendering other factors (such as class and social situation) invisible.

Chapter five explores the construction of abortion in the context of adolescent pregnancy as a threat to personal and social decline and as a new "social problem". Similarly to research on "teenage pregnancy", Macleod finds no clear evidence of the detrimental effects of abortion for young women in particular. Once again the problems of relying on age as key explanatory variable (to the neglect of other factors) is exposed. In chapter six Macleod explores the ways in which discourses of "teenage pregnancy"/abortion are racialized, with black and ethnic minority young women (eg Hispanic, Coloured, Asian) usually emerging as particularly "problematic" in westernised public representations. Chapter seven explores the role of health service providers in calculating and managing risk in relation to the sexual/reproductive health of young people. Macleod draws on limited interviews with health service providers and shows how assumptions about young people and the imperative to manage risk infiltrates interventions relating to sex education and sexual/reproductive health.

In the final chapter Macleod summarizes the key arguments of the book and attempts to sketch a way forward. She argues chiefly for a shift in signification from "teenage pregnancy" to the notion of "unwanted pregnancies". The argument is that this shift will highlight contextual factors, avoid pathologizing young pregnant women, undo the "imaginary wall" separating adolescent women from adult women and allow the recognition that women in similar situations face similar difficulties around reproduction regardless of age. Macleod also makes recommendations regarding service provision, in particular the increased availability and accessibility of contraception, the acknowledgement of the importance of gender dynamics and power relations in relation to sex/reproduction (particularly in designing sex education interventions), increased accessibility and affordability of termination of pregnancy services and broader interventions aimed at improving women's access to education, health care and adequate childcare.

The strengths of the book lie in its superb deconstruction of dominant societal representations about "teenage pregnancy"/abortion, showing their reliance on problematic ideologies of adolescence and racialized threats of social decline. Chapter five is particularly excellent, and convincingly illustrates that much social science and public health research on "teenage pregnancy" is founded on problematic ideologies that shape research questions, methodologies and scientific interpretations. 'Adolescence', pregnancy and abortion provides an exemplary example of critical social constructionist work and its potential to shift research grounds / agendas and undo taken-for-granted assumptions. The limitations of the book lie in providing answers to the questions it opens up and in translating the implications of its powerful deconstructionist analysis into alternative visions and practical solutions. This is not unique to the book but is a common problem of critical deconstructionist analyses. What the book does do is succeed in unravelling ideological assumptions and revealing discourses of "teenage pregnancy"/abortion as mechanisms of social control which are raced, classed and gendered. For this it deserves to be widely read.

 


 

(Post)Apartheid dreamscapes

 

 

Derek Hook

Department of Psychosocial Studies. Birkbeck College. University of London. London

 

 

Kannemeyer, A (2010) Alphabet of democracy. Johannesburg: Jacana Media. ISBN 978-1-43140-077-5 pbk. Pages 72.

 

 

Anton Kannemeyer is perhaps the South African artist most adept at picturing the fantasmatic preoccupations and anxieties of the nation. His work often entails the dimension of political satire, as is clearly apparent in the various caricatured portraits and recontextualised newspaper cut-outs included in Alphabet of democracy. In this respect one might liken his work to other South African satirists - Zapiro's political cartoons immediately spring to mind, as do the antics of Loyiso Gola's Late Nite News, and - speaking historically - the impersonations of Pieter Dirk Uys. More controversially, one might include Brett Murray's work in this category also, although works like "Killed twice" (comprised of the bold inscription: "Biko is dead") and the notorious "The spear", seem ultimately to succeed more in intensifying racial animosities than in highlighting social contradictions in the way in the way in which Kannemeyer proves so adept.

In many respects Kannemeyer's work both goes further than that of many of the above satirists and yet proves also more refined in its critical sensibilities. That is to say, Alphabet of democracy affords more by way of nuance than does blunt political satire, certainly so when it comes to playing off many of the uncomfortable resonances between South Africa's past and present. The alphabet theme provides him with ample scope; key signifiers of the post-apartheid state, "R is for Rainbow Nation", "X is for xenophobia", "L is for lame duck president", "F is for foot-washing", and so on, enable him to arrange a series of recent works in different media, all of which comment on the current post-apartheid condition.

The "return of repressed" could be Kannemeyer's byline; he has a keen eye for resonances between apartheid and post-apartheid culture. Juxtaposing P W Botha's 1979 proclamation, "An irresponsible press is the greatest enemy of democracy" with Blade Nzimande's 2010 comment, "South African media is a serious threat to our democracy" makes for a wonderful case in point. The same is true of the book's cover. The front-piece, a well-chosen image for the collection as a whole, speaks of the (post)apartheid era as simultaneously a progression from and yet also a recapitulation of history. It features head-shot portraits of Eugene Terre'Blanche and Julius Malema in close proximity, and thus poses the question, despite the obvious gulf separating their declared political allegiances: mightn't these two populist firebrands play a curiously similar role in the psyche of the nation?

Kannemeyer's pictures call for the participation of an audience, and it works well in this respect that Alphabet of democracy includes purely text-based images - pencil on paper transcriptions of newspaper articles. What the use of duplicated newspaper texts makes clear is that what is being depicted is not necessarily the artist's own point of view - a point tellingly neglected in predictable critiques concerning the racist quality of the images that Kannemeyer re-cycles. Such images are themselves (re)transcriptions, and in a far more significant sense than stylistic pastiche. Let us take the golliwog-like portrayals of spear-wielding Africans and colonial servants that float across the depopulated suburban dreamscapes of Kannemeyer's "N is for nightmare" series. Here, as elsewhere, the offensive imagery Kannemeyer presents us with must be read as what it is: a conduit of fantasy. The (racist) fantasy in question is no doubt unpalatable, derogatory in nature. Nonetheless, it is a fantasy which continues to exert a powerful psychical and societal existence, an existence which should, as such, be made explicit rather than evaded.

Kannemeyer's chosen form, that is, the comic-book conventions of depiction so brilliantly exploited in his Bittercomix collaborations, has frequently been commented upon (Barnard, 2004; Tyson, 2012). He uses this visual idiom to great effect, setting up a type of internal dissonance between form and content, as in panels in which Tintin-esque characters play out scenes of colonial slaughter and brutality (see particularly his Pappa in Afrika, 2010). Such borrowings from earlier visual styles turn past historical forms jarringly against their former horizons of meaning. What is in question here is not only the contrast between form and content, but the lingering presence of apartheid sensibilities which cannot - or should not - be spoken (even thought) in the postapartheid present. Take "A black woman", a depiction of a job interview in which a white employer asks of his prospective employee, depicted in a typically over-the-top caricature of blackness, "I see from your résumé that you are a black woman".

While Alphabet of democracy dispenses in large part with the compositional conventions of comic-book illustration, the effectiveness of many of the images still pivots of Kannemeyer's manipulation of form. Take for example his compositional choices in the "N is for nightmare" series, perhaps the most arresting sequence of images in the book. The pallid colouring with which the safe environs of white suburbia are depicted - subdued tones of grey and brown - contrasts sharply with the saturated bright colours of a series of circular inlays. These circles, somewhat like the thought bubbles which hang over the heads of characters in comics informing us what they really think, include white South Africa's proverbial "worst nightmare": violent blacks on the rampage with knobkerries and pangas; a domestic worker serving up a white man's head on a platter; AK47-carrying African militia; a "native boy" in colonial garb issuing instructions to a prostrate white subordinate. These images float above the anxious white environs, existing at a level that cannot be adequately integrated into the fabric of the apparent (repressed) everyday reality of the situation. Nonetheless, they are the "most real" elements within the scene as a whole.

If we take seriously the thesis I am advancing in reference to Kannemeyer's work, namely the idea that he effectively gives form to, pictures fantasy, then we might reverse the politically-correct impetus to censor. If racist fantasy is sustained by existing precisely at a subliminal and/or disavowed level, then the attempt to condemn such images might be said to be suspect, for the simple reason that it allows them to persist unseen and unconfronted. It is when fantasy remains concealed that it is at its most virulent.

 

REFERENCES

Barnard, R (2004) Bitterkomix: Notes from the Post-Apartheid underground. The South Atlantic Quarterly, 103(4), 719-754.

Kannemeyer, A (2010) Pappa in Afrika. Auckland Park: Jacana.

Tyson, J (2012) Anton Kannemeyer's tactics of translation as critical lens. Synthesis, 4, 121148.

 


 

Engaging with trauma from a liberatory perspective

 

 

Gill Eagle

Department of Psychology. School of Human and Community Development. University of the Witwatersrand. Johannesburg. Gillian.eagle@wits.ac.za

 

 

Afuape, T (2011) Power, resistance and liberation in therapy with survivors of trauma: To have our hearts broken. London & New York: Routledge. ISBN 978-0-415-61189-3 pbk. Pages xii + 247.

 

 

The author of this engaging text, Taiwo Afuape, indicates that the book represents an attempt to convey something of her own journey as a psychotherapist specialising in working with oppression in its various forms. The journey has entailed not only integration of her personal life history, experiences and positions, but also the integration of a range of theoretical perspectives ranging from Buddhism to Liberation Psychology. She also acknowledges the input of past teachers and supervisors in influencing her thinking and the importance of the learning she has gained from working with clients, patients or users of the mental health system in the United Kingdom. The richness of the book lies primarily in this integration of a wide range of knowledge and clinical experience and Afuape's observation that working with complementary frameworks for intervention assists in compensating for gaps in any one particular approach, while simultaneously challenging the potential rigidification, or even reification, that often accompanies subscription to a single perspective, even if this is what might be considered a "progressive" perspective. Although Afuape is clearly respectful of a range of viewpoints, for her it is important that there are no holy cows. This actively critical stance is one of the strengths of the text.

Writing for a broad audience including "anyone in the mental health fields of therapy, counselling, social work or critical psychology" (cover page), Afuape seeks to share with the reader her integrative approach to working with survivors of trauma and/or what she terms "people who experience complex psycho-social difficulties" (p15). The integrative approach she adopts explicitly includes the following theoretical perspectives and approaches: narrative therapy, co-ordinated management of meaning (CMM), and liberation psychology. While many psychologists will be familiar with narrative therapy and liberation psychology, CMM is probably less well known. CMM is defined as "a social constructionist theory of communication developed by Cronen and Pearce (1985) which explores how meanings and actions emerge in context" (Afuape, 2011: 84). If I have grasped this correctly, while Afuape understands narrative therapy approaches also to be social constructionist in nature, she views them as more limited in their exploration of what contextual features shape how particular kinds of constructions operate or are derived. Thus she views CMM as bringing a stronger psychosocial focus to therapeutic work. For example, CMM explicitly focuses on the contributions of different levels and kinds of social forces, including the political, spiritual, cultural, familial and interpersonal, in exploring how clients come to understand their current difficulties. From narrative therapy Afuape emphasizes the egalitarian nature of the therapeutic relationship, the importance of language and how issues are framed, and the possibility of transformation through embracing different kinds of understandings of difficulties. Liberation psychology is conveyed as providing a lens through which to appreciate relations of dominance and submission, both structural and ideological, as well as the multiple forms that resistance to oppression can take. Afuape makes strong associations to resistance as associated with creativity, and reminiscent of some of the early anti-psychiatry writing by people such as Laing and Cooper, she insists on taking the meaningfulness of client's communications seriously and on recognising their (albeit often limited) agency in engaging with the mental health system, professionals and those who oppress them in various ways. In addition to the three perspectives that form the central pillars of her integrated approach, it is apparent that Afuape also draws upon feminist, black consciousness, Marxist and Buddhist ideas, amongst others. She is clearly a well read and very thoughtful person who seeks to live out a deeply committed ethico-political position in her every-day and professional practice. Reading the text one is convinced of her passion in this regard and this is part of what makes the book engaging.

Given her radical commitment to egalitarianism in counselling and psychotherapy and her emphasis on reflexivity and co-construction, Afuape offers a fair amount of personal commentary in her book. She indicates that she is a heterosexual, black woman, of Nigerian African descent, who grew up in a poor neighbourhood in the United Kingdom and trained as a clinical psychologist. She makes reference to historical and familial relationships and to the influence that her parents and other mentors have had on her thinking and practice. In this respect she aims to model the kind of self-reflexivity that she values in therapeutic work in her writing. At times this can be somewhat disconcerting, as in the very lengthy and personal dedications that preface the text, in juxtaposition with conventional expectations about how a "theoretical" text should be structured. While valuing the intention behind the practice, I felt that this fusion of personal disclosure and theoretical exposition did not always sit easily together in the text. Afuape has worked for the Medical Foundation in London, whose client base includes refugees and torture survivors, as well as in the various branches and trusts of the UK National Health System (NHS), where she was employed at the time that the book was published. Her professional experience is extensive and offers a valuable base from which to generate insights and illustrative case material. Particularly in the later part of the book devoted more explicitly to the implementation of her approach in practice, the case material is useful in highlighting the application of theory. Some cases are tracked through the text, although this approach is not true of most cases.

For mental health practitioners invested in adopting a critical stance in their work this is an inspiring text in many respects. Not only does it introduce a range of frameworks for thinking about intervention and suggestions about how to put these into practice (for example, through embracing irony), but there is also an implicit encouragement for the reader to perhaps develop his/her own take on the material presented. The book offers insights in the spirit of sharing something discovered and open to transformation. In this sense is not prescriptive and there is scope to think about how the subject matter might require some modification in application to different contexts.

Having indicated that the integration of theory and ideas is one of the key strengths I also felt that this represented something of an Achilles heel in reading the book. In the attempt to integrate across such a wide range not only of theoretical paradigms but also of different levels of explanation, I felt that the text became rather scattered and incoherent at times. The structuring of arguments and the links between sections are not always well sign-posted and there is some inconsistency in the coverage of theory. For example, some theorists within a particular approach are given much greater emphasis than others and some theoretical models are more clearly elaborated than others, without a clear justification for this unevenness. Although parts II and III of the book are ostensibly devoted to theory and practice respectively, the content belies this kind of division, in that, for example, new aspects of theory are introduced in the practice section. The text is also overly repetitive at points. For me, the book could have done with more coherent and rigorous structuring in order not to lose or frustrate the reader at points.

A further critical reflection concerns the manner in which "trauma" is interpreted in the book. The title suggests that the main focus of the text will be on "survivors of trauma". Despite myself having written critically on more narrow psychiatric and medico-legal framings of traumatic stress, I felt that the title was somewhat misleading in that the book seems to not only address a much broader patient population than those affected by "trauma", but also where it is explicitly focused on trauma survivors, to limit this to a relatively confined grouping. A lot of the case examples in the book concern immigrant populations struggling with adjustment difficulties in addition to what would more classically be understood as trauma exposure. In addition, there is a fair amount of coverage of the experiences of psychotic and in-patient clients, used to explicitly flesh out understandings of trauma. While I accept that institutionalization and associated practices may prove enormously stressful and even perhaps "traumatizing" to individuals I think the case needs to be better made, and also that it is somewhat peculiar to use this kind of material as a cardinal illustration of traumatic stress. A fairly wide range of trauma related stressors such as combat, criminal victimization. motor vehicle and other accidents, and even rape, are not addressed in any great detail within the text. Rather the trauma populations that are focused upon are victims of war and organized violence. Without suggesting that these populations are anything but significant in engaging with trauma, I think it is important to signal to potential readers that the focus of the text is primarily on survivors of organized repression and oppression, even if this is non-deliberate oppression in the form of the kind of institutional power laid bare by Foucault.

One further observation that may be of concern to potential readers is whether any empirical validation of Afuape's approach is offered. Given her allegiance to social constructionism Afuape herself is critical of the expectation that intervention approaches can only be validated by means of control based and qualitative evaluative studies and against these kinds of makers the approach remains unproven. However, the argumentation and illustrative case material are compelling. As an inspiring and thought provoking read, with some of the provisos mentioned above, I would recommend the book to a range of progressive mental health practitioners. In conclusion I believe it is instructive to offer a fairly lengthy quotation of the author's own summary of her intentions in writing the book:

"The book has focused mainly on restorative justice - restoring what was invalidated -rather than justice in the form of redress, which addresses more directly the structural or macro levels of oppression, such as in radical community psychology and political activism. This does not take away from the importance of fully integrating a liberatory ethic into therapeutic practice ... This means framing our theories and practice in terms of power, hegemony, colonialism, resistance, emancipation, oppression, deprivation, structural violence and privilege. Such a focus is more likely to lead us towards a concerted effort to change the causes of distress than towards a focus on evidence-based practice and technological approaches to treating the effects of trauma. My hope is that liberation will not become another empty discourse in the 'psy' literature, but rather a belief system, an attitude and a relational and political stance." (p190)

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