Mandela and Mental Health

As the accolades roll in for Nelson Mandela on his death, lost among his astonishing accomplishments may be his relevance to mental health. If we reflect on this on December 8, the day officials in South Africa have deemed the a day of reflection, the relevance may become apparent, not only for South Africa, but for the USA. Certainly, the end of apartheid was conducive to the mental well-being of so many black South Africans, even as the economic advances still lagged well behind the political ones.

In the USA, despite our first black President and other related political advances, the mental well-being of black Americans also seems to be lagging behind. We still have significant disparities in mental healthcare for Black-Americans. We still have frequent misdiagnoses. We still have poorer access. We still have less psychotherapy and more medicating.

On the other side of the mental health coin, young black American men are very much overrepresented in our jails and prisons. This is not necessarily due to more untreated mental disorders per se, but to ramifications of our national drug policy. Nevertheless, if one serves as a clinician in our prisons, as I did, one often can discover unrecognized and unresolved PTSD at the root of much substance abuse and crime. Elsewhere, I’ve deemed this as aparttime- a reference to so much time spent out of society.

If there is a group-and there is-that is even more segregated in our society than young black American men, it is our native American Indians. Whether still separated on reservations or not, the prevalence of PTSD and alcoholism is extremely high. Moreover, even though Canada has established a Truth & Reconciliation Commission for their historical abuse of the aboriginals in their country, nothing remotely resembling this has occurred in the USA. Only the economic jackpot from Indian-owned casinos seems to be helping.

A lesser known contribution of Mandela was his establishment in 2007 of The Elders, an independent group of elder global leaders. It was led for the first 6 years by Desmond Tutu, Mandela’s partner in South Africa’s Truth & Reconciliation Commission. Among many of the projects devoted to peace and human rights, many have mental health implications. One is the advocacy for a new global drug policy that emphasizes prevention, harm reduction, and treatment instead of punishment and repression. Another addresses violence against women- surely a precursor of PTSD.

Mandela himself seemed to be able to avoid trauma and PTSD despite his 27 years of brutal life in prison. Instead of wanting retaliation, he emphasized not only obtaining the truth and some reconciliation, but also the need for forgiveness-both for himself and for his country. This model could be relevant not only to many who are incarcerated, but to all who have suffered severe trauma. Processing trauma, whether personally or in psychotherapy, is the first crucial step toward recovery. What can help complete that recovery is forgiveness of the perpetrators, just as Mandela apparently did.

We can use Mandela's life as an inspiration to bring back all of those who been set apart in our society: those with mental disorders, some minority groups, the poor, and immigrants, among them. As we continue to address these challenges, we might remind ourselves to ask, what would Mandela do?