Interview : Astrid Berg MD

Interview : Astrid Berg, M.D., Jungian Analyst
Cape Town, South Africa

Interviewed by Don Williams (IRSJA)

Astrid Berg, M.D., was born in Pretoria in 1950 of German immigrant parents. She studied medicine at the University of Pretoria, and Psychiatry and Child Psychiatry at the University of Cape Town. She was part of the first group of trainees in Jungian Analysis in Cape Town and was accepted as an inpidual member of the IAAP in 1992. Dr. Berg is one of the founding members of SAAJA (Southern African Association of Jungian Analysts) and its current president. She joined the IAAP Executive Committee as the representative of the Southern African Association of Jungian Analysts after SAAJA was elected to the Executive Committee at the 1998 IAAP Congress in Florence/Firenze. (Photo: Courtesy of Astrid Berg)
Astrid works as a Child Psychiatrist at the Red Cross Children's Hospital in Cape Town and is a senior consultant in the Department of Psychiatry at the University of Cape Town. She also has a part-time private practice for adult analysands. Her main interest is in Infant Mental Health, and she has established a Parent-Infant Mental Health Service under the auspices of the University of Cape Town.

The following interview began in late August with an exchange of e-mail which continued over two months and then concluded with two phone conversations. When we began, Astrid had just returned from a psychoanalytic workshop on racism.

DW: How did you find the workshop?

AB: The psychoanalytic workshop was racially mixed, with about one third people of colour, and the rest white. It was a disappointment that the group was not more representative of our general population, but the people that were there made an impact, so that we really all could learn from each other. As in the U.S. all the psychoanalytic groups are mostly of Caucasian origin. However, the University of Cape Town has a strong affirmative action policy, so, hopefully we will see more mixed groups in the future.

The fact that the different racial groups still live so apart is a real obstacle to true transformation. Unless we know the other, we will always project the shadow onto the unknown other. Because of my work situation I am fortunate to have the ongoing opportunity to get to know people of many cultures. Over the past four years I have established a Parent-Infant Mental Health Service at the Children's Hospital in Cape Town. As a part of this Service I go into an informal settlement just outside Cape Town on a weekly basis. I visit two clinics where mothers bring their infants for immunisation. The nursing staff knew about our interest in the emotional well-being of mothers and babies and they refer cases to us that are of concern to them. I work very closely with two mental health workers, who are part of the community. They act as translators as well as guides. It has been this regular encounter, with all the ups and downs that a new community service brings with it, that has made me confront many issues.

Initially I was frightened to go into such an unknown communityin the apartheid years it was forbidden for a white person to be driving into the black townships. Soon I realised that my fears were part of the collective paranoia which formed part of the previous government's rationalisationswe had the threat of the "black danger" hanging over us, together with that of the communist onslaught. I had not realised how deeply these attitudes had formed part of my psyche. It has been an enormous relief for me to have been able to withdraw these projections. After the fear came the guilt: why had I not known what was happening to people a few kilometers away from me, why had I not taken on a more active role in the liberation struggle, how can I justify my good education and my middle-class life-style in the face of so much deprivation and poverty? These are questions one struggles with all the time, and, while there may be plausible answers, the guilt is there and should be there, at least for those of us who grew up in the apartheid era. Having had the recent Truth and Reconciliation Commission in our country, the excuse of not-knowing is no longer valid. However, the guilt need not be paralising but can in fact be a motivating force to do something, to contribute actively to the transformation process. Those of us with a profession can find opportunities for doing so. It is humbling and deeply gratifying to see how one's contributions are received and valued.

But it is not a one-way process; it is not about those who apparently have to give to those who are perceived as not having. On the contrary, I find I am learning enormously about psychic processes from my black colleagues. I also have contact with traditional healers, of whom there are many in the townships and settlements. I am grateful for having had as my supervisor Dr. Vera Bührmann who was a pioneer in trans-cultural work, much ahead of her time. Because of her teaching, I am able to understand the world of the traditional belief systems. It is in this area that I find archetypal theory most useful and valuable. The traditional views on life, the reverence for the ancestors and the rituals which are performed to honour them, touch on deep psychic processes. I can appreciate why this research was so pivotal in Vera's life. There is something about the earnest way in which things are done, about the care and time taken, that we have lost in the Western world. Exposure to this kind of knowledge, this way of thinking and being, is a privilege for which I am profoundly grateful.

DW: Would you mind giving me an example of the kind of careful attention and respect you've witnessed?

AB: Not long ago I was invited to the funeral of the mother of one of my black colleagues. The funeral was an all-day ceremony, starting early in the morning at the deceased's house. The procession then moved to the church where a two hour service was held. Thereafter the coffin was taken to the cemetery and buried at a place where the family's ancestors were buried. Throughout the proceedings there was singing with a slow, rhythmic swaying of the bodiesit was very beautiful and moving. The day ended with a full meal, served at the deceased's house. The attention paid to every detail, from the setting up of the house, the provision of transport and food for almost 100 people, the presence of the priestsall this I found remarkable. I then realised that on that day the mother and grandmother had become an ancestor, someone who would be revered by her familyso, it made perfect sense that everything needed to be done properly. Western people have, on the whole, become so truncated in their belief systemswe do things like funerals in such a hurried way, fitting them in with our busy schedules. This was such a different experience.

DW: I'd be interested to hear more about your work with mothers and infants.

AB: The Parent-Infant Mental Health Service has two pillars, one at the Children's Hospital in Rondebosch, a middle-class suburb, and the other in Khayelitshaan informal settlement 11 km outside Cape Town. Here I visit two well-baby clinics once a week. While my referrals in Rondebosch are mostly healthy babies whose parents are struggling to get them to sleep, or where there are some behaviour problems with the toddlers, the situation in Khayelitsha is very different. Here mothers often have problems in feeding their children because of lack of resources. However, it is not just about food. Often mothers are depressed and angryparticularly with the fathers of the babies who have abandoned them. A depressed mother cannot be emotionally available to her infant, and this may manifest itself in failure to thrive.

Some time ago I had a particularly interesting and unusual case. The baby had been healthy until one particular time, when the weight started dropping. I had also noticed that the mother was wearing a necklace of animal hair. She was reluctant to talk about what it meant. When I asked her what happened at the time when the baby's weight went down, she told me of a dream she had had. In this dream her ancestors were calling her to become a healer. When she told her husband and his family about this, they were not in favour of her doing the training, which is an expensive and time-consuming process. In order to appease her ancestors, she went back to her family of origin's home, and performed a ritual--a so-called "blocking" ceremony. The necklace she wore originated in that ceremony. Despite having done this, she remained depressed, as she was not able to fulfill her calling. This then must have affected her relationship with her baby, and it manifested itself in failure to thrive.

In Khayelitsha I work with two women who act as my translators and mentors. We have been together for four years and have established a special relationship. I have begun to learn Xhosa, which is not that easy, as it is not related to any of the languages I know. However, the appreciation when one says even a few words, is enormous.

My work in Khayelitsha is very important to me. It is not easy, as the concept of mental health for infants is a new one and we have to think of ways of getting this across. I do not feel that we have to "teach" mothers how to be with their babiesthat would be Western arrogance. We in fact have a lot to learn from traditional ways of child rearing. What is important though is to tell mothers that if they are unhappy, their baby's development will be affected.

DW: I've wanted to ask, how did you decide upon child psychiatry?

AB: As a medical student I had wanted to become a pediatrician. When I was working in the Children's Hospital, I attended a meeting about a patient where the psychiatrist gave a diagnosis based on her observation of the child's play. This fascinated me and I went to the professor of Psychiatry, asking to become a Child Psychiatrist. He told me that this would be a long road, and that I would first have to become a general psychiatrist. This I did, and was fortunate that soon after my qualification, the University of Cape Town offered a higher degree in Child Psychiatry which I then registered for.

During my training in this field, I had the privilege of having as my supervisor Dr. Vera Bührmann. Vera has had a profound influence on my life. Through her I became involved in the training as a Jungian analyst. As you know, she was the force behind the establishment of the Jung Centre in Cape Town in the late 1980's. Out of this evolved our present Southern African Association of Jungian Analysts. Vera was also the first analyst to do cross-cultural research in our country. In this she was way ahead of her time, but sadly, was often misunderstood. During the apartheid years, talking about culture, especially African culture, was seen by liberal professionals as supporting the notion of "separate development." Cape Town has always been a liberal city. When Vera attended ward rounds in the mental hospital, she often met with resistance from the staff, who felt that her emphasis on culture was politically based. Today it is so differentthere is a pride in the cultural persity of all the people, and the rituals Vera researched in the 80's are now reported on often in our newspapers and are common knowledge.

[Note: To clarify just how perse South Africa is, it's useful to know that there are nine major black cultures representing 76% of the population with the British, Africaans, Indian, and Malaysian populations making up the rest of the country. There are also, of course, still many original cultures of the land which are not seen in Europe or the United States.]

DW: How would you describe the development of Jungian psychological interests in South Africa?

AB: The growth of interest in Jungian training is occurring in the larger cities of South Africa. Cape Town's Centre was founded in 1987 through the initiative of the late Dr. Vera Bührmann. SAAJA grew out of this and has now an established training programme. Our first group of trainees, who all started in 1995, are about to complete their training and we will start a new group in February 2000. Johannesburg is the other major centre. The group there has recently acquired Developing Group Status, and they are in the process of setting up regular seminars and supervision sessions with visiting analysts. The main problem is the need for resident analysts for the personal training analyses. In Johannesburg there is only one, Elizabeth Martiny, who is carrying many responsibilities and rolesnot an easy task for her but one she is doing admirably well. But she cannot do it all on her own.

There are also interested professionals who travel from Bloemfontein to Johannesburg whenever there is a seminarit is a five hour drive, but they do it, and I respect them greatly for their enthusiasm and commitment.

DW: Would you mind giving just a brief sketch of the differences between Johannesburg and Cape Town?

AB: Johannesburg is like I imagine your New York. Cape Town is a bit like San Francisco. Johannesburg has the gold mines, the stock market.... Life there is very hectic, frenetic, and it has a fast pace and it's busy. It's a huge city by our standards. Cape Town is by the sea, by the mountains, and it's far more laid back. Capetownians are said to be less sociable than the people of Johannesburg because the nature is so beautiful we are too eager to go hiking, for example.

DW: Thanks, I was curious since I knew that Johannesburg is larger than Cape Town, but has not been able to support analytic training without visiting analysts, travel, etc.

(After a pause)

DW: I'd like to return to the theme of apartheid for a moment. Having grown up in the southern U.S. during the Civil Rights movement, this subject holds an added interest for me. It is very disturbing to see that, despite vast social and economic changes here, the same prejudices and patterns of exploitation and scapegoating continue so relentlessly in the U.S. What is your experience of this in South Africa?

AB: I think in some ways it is actually easier for us in South Africa. Only about 11% of the population are white South Africans while 76% are black. White South Africans have to learn about the majority of their fellow citizens. Transformation is a real process herewe as whites have to look deeply into ourselves and the racist attitudes we have grown up with. I feel ashamed that I have never been to a funeral of a black person before, and I realise how much we as whites have also been deprived. We have not been able to get to know each other. What is very important is the fact that if you as a person are willing to make a contribution, are willing to go with the process of change in the country, you are welcomed and appreciated by the black leaders. To be African one does not have to be blackour President has made that very clear.

It's an enormously moving, sobering, and humbling experience to be working closely with black people. I am quite aware of my prejudice, and how it has changeda small example: on our news television one of the presenters is often black. It's striking how we've come to appreciate black beauty. Who is that exquisite woman! What an attractive man! And all that was so taboo 15 years ago!

DW: Our talk reminds me of a book by Michael Adams in New York.

AB: Yes, I have read that book, The Multicultural Imagination.

DW: Yes, and he argues persuasively that there's no such thing as race--we have different skin colors but only one race.

AB: Yes, I found that book very inspiring.

DW: I know that you are doing extraordinary things to transform old attitudes. Would you say more about your work with traditional healers?

AB: I always ask the mothers whether they have been to a healer and what he or she said to them. One of our concerns is that some healers advise the parents not to take their children to the hospital, sometimes with tragic consequences. We explain to the mothers that they can do both, but that if there is a physical problem, they must also bring their child to the hospital. Most of the mothers accept this. I have, however, had contact with healers because of my interest in their ways of working. This again is where I am so grateful to Vera. Because of her work, it is not difficult for me to understand the thinking of the healers.

A few weeks ago there was a meeting here in Cape Town of the Traditional Healers' Association. It was an exciting eventthe hall of the SA Museum was filled with traditionally dressed men and women. In the audience were two prominent professors from the University's Medical School. The one, the head of Pharmacology, is working closely with the healers in their use of traditional herbs. I feel it would be important for us as Jungian analysts to do something similar with the healers in their use of dream interpretation.

There is also much effort being made to get traditional healers working together with Western medicine to help prevent and treat diseases such as tuberculosis and AIDS. These are rampant in our communities. In KwaZulu-Natal the HIV infection rate is more than 30%. In some southern African states the life expectancy has been reduced by 15 years. These are horrific figures and HIV has reached epidemic proportions.

(After a pause)

AB: As I reflect on our interview, I realise there are a few points I would like to add to what I said about the negative aspects of South Africa. I need to say something about the crime and corruption here. These are the things that so many people here complain about, and which are a reality, but which for me are not the most important issues. However, I do feel I need to raise them, otherwise my account would be rather starry-eyed and one-sided.

With the crime, I also mean to include the high incidence of rape and murder. The level of aggression and violence is extremely high in our cities. In my view the reasons for this are multiple: the poverty and economic hardship of the great majority of the people, the disillusionment that the new government has not delivered as promised, the greed and sense of entitlement that has been constellated after years of suppression and subservience. But it goes deeper: we have come from a violent past.

As Jungians in particular I feel that we must bear in mind that collective forces, be they conscious or unconscious, inevitably will be enacted in some way. We cannot expect to have a completely peaceful transition from a very repressive government to a democratic one without some sort of backlash. Human life has become cheap here, and in a way, it always has beencertainly for a large sector of the population. Then there is another level, which I feel strongly about. During the apartheid years, family life was disrupted, social norms and values were disregarded, and people were torn apart and uprooted. We can only imagine how this must have impacted on the mother-infant relationship. Attachments could not develop, or were severed. Fathers were not allowed to live with their wives if they worked in "white" cities. Black women were employed by white families to help raise their children, while their own were taken care of by other people. What anxieties the mothers must have gone through, we will never know. I wonder in how far these early traumas could explain the ruthlessness of so many criminals, the utter contempt for life. I am certainly not wishing to explain away or make less the horror of the criminal violence we are living with; I am merely wanting to keep the broader perspective of its complicated origins in mind.

Crime and corruption are very much in the foreground today. The crime seems to have increased over the past 8-9 years. Of course one can't be exact. I think the white people, the privileged people are feeling it more. In the past it was more confined because of our separate development policy of the government so that things happened in black areas which one didn't know about. In a sense we had a false security. But I do think crime has increased and it's causing a lot of fear, a very understandable fear. It's causing a lot of people to leave the country because they fear for their own safety. What helps me personally to deal with it is to look at this in the broader context. You see, I grew up with this idea of the "black danger." I always had at the back of my mind as a child and an adolescent that one day, "the blacks would come" and overrun us or kill us or chase us out. That was the big fear and I'm sure I wasn't the only to have this fear. So when Mandela was released and we had such a peaceful transition to democracy, that "black fear" absolutely vanished. And what we have now is the crime, and for me the crime is much, much less than the "black danger" which I grew up with. The crime also hits everybody, it's not aimed at white people, it's aimed at those who have and that can be a black person in a BMW or a white person in a BMW. It's not against whites, per se.

DW: The wealthy, understandably, are targets for anger.

AB: It comes from poverty, it comes from deprivation, it comes from greed, you know, envy. All those things play a role. I see the crime in that perspective. We could have had a bloody revolution, we could have all been killed, and it hasn't happened. So what we have to deal with now is facing the crime, which the government is doing. The Mbeki government is much tougher on crime than the Mandela government. Mr. Mbeki is really trying to strengthen the police force and those kind of external controls.

DW: With any success?

AB: Well, he's just started, you know. He was elected into office this past June but his ministers are far more visible in the news and there seems to be more determination to do something about it. But also you can't do anything about it just by having outer discipline, you also have to have people in jobs that they value themselves. You have to have a middle class. Economic standards are going to play a crucial role also in this change.

So, I'm not denying the enormity of the problem here of crime ... and the corruption, also on the police force. That's one of the reasons why we haven't been able to get more of the crime under control because the police officers themselves accept bribes, for example, from gangsters and then don't follow them up. We have to remember however that the past government wasn't exactly exemplary in this regard either.

DW: The fact of police corruption made me wonder while you were talking if tougher laws would be effective.

AB: The commissioner of the national police force has for the past five years been a white man. Mandela chose him to bridge this period because, you know, the police force is predominantly white. That was a wise choice. But he's now retiring and being replaced by a black commissioner who seems more tough on crime and corruption. There's got to be transformation. Black people have to be in power; otherwise it's not going to work. So much damage has been done.

DW: What's happening in terms of reducing the divisions between rich and poor?

AB: I don't understand economics. On the one hand we have an inflation that's the lowest it's been in 51 years. The interest rates are really going down. But it seems that job creation is something else. I don't quite know how that works. So what we need really are jobs. The economy is steady. Despite the Asian market collapsing we were obviously affected here but we didn't go into a collapse, so the fiscal policies are very strict and are very well maintained. But what we need is job creation, especially from abroad. With South Africa being accepted into the European Market last week, that hopefully will open up exports to Europe, thereby creating job opportunities. There was a big debate about port and sherry because we make port and sherry and Portugal and Spain didn't like us using those names. So that was the hiccup at that point. They decided that over ten years they would phase out South Africa using those names. With that hurdle overcome they seem to have accepted us.

Otherwise, Cape Town has a strong affirmative action program. Previously disadvantaged people receive priority. Obviously it won't always work but outstanding people come to the fore in that way. There's so much talent in this country that got lost, that never came to the fore because of the disparity between the groups. But of course the danger is also that really good white people don't get a post or are pushed out. There's an enormous brain drain, enormous, especially in medicine. They leave the country. It's really dramatic in medicine. That's painful, painful for those who are leaving and for those who are staying behind. The leaving is so painful that often those who leave have to split at a very deep level, and then everything here gets rubbished with the idealization of the Other which is Europe. And it makes it difficult for those of us who stay behind not to feel left behind, not to doubt ourselves.

DW: It must be very important to have a sense of purpose.

AB: Oh, absolutely. Otherwise you just feel left behind. To be able to say I'm staying out of choice is essential.

DW: Is it difficult financially for analysts to practice in Cape Town or Johannesburg?

AB: No, although it is getting tougher. All of my colleagues work hard. The real difficulty is for the young people, the young psychologists. They struggle to have enough clients but once you're established as an analyst it's not difficult to stay busy.

DW: Historically people have to do well financially to go into analysis; even with a sliding fee scale, it's still expensive.

AB: Oh very. Some of our medical insurances are very good and pay and others pay very little. But there are always people here with lots of money.

DW: On the other hand, no one becomes an analyst because of the profession's economic potential.

AB: My life turns largely around the mental health profession. In that area there are so many exciting possibilities. Because I'm not just in private practice, I come into contact with other sections of the population and that's why I'm enthusiastic. There's a very different atmosphere in the public sector.

DW: I know that we have to stop this conversation now but I hope you know that it's been extremely interesting. I especially appreciate learning more about your work with mothers and children and about how you have managed to integrate Jungian analytic perspectives into the social, political and economic issues facing South Africans. Hearing your experience of working analytically and being socially engaged may help many of us. Thank you for your time, your openness and thoughtfulness.

The interviewer, Don Williams, is a diplomat of the C.G. Jung Institute-Zürich and is in private practice in Boulder, Colorado (USA). He is a member of the Inter-Regional Society of Jungian Analysts is the Assistant Editor of the IAAP Newsletter.