South African Psychiatry - February 2019

FEATURE
DEADLY MEDICINE:
PAYING THE PIPER
- THE PERVERSE PROTOPSYCHOTIC
NATURE OF LIFE ESIDIMENI THROUGH
A CONTEMPORARY FREUDIAN LENS
Coralie Trotter
“
Psychoanalysis begins in wonder that the
unintelligibility of the events that surround
one do not cause more wonder” writes
Jonathan Lear (1998, p. 28). This paper is
about such an event: the Life Esidimeni tragedy in
South Africa.
In October 2015 the Gauteng Health Department or,
as retired Deputy Chief Justice Dikgang Moseneke
(Moseneke, 2018) put it, ‘an admittedly delinquent
provincial government’ embarked on an avoidable
mass relocation of psychiatric patients. This
Gauteng Mental Health Marathon Project (GMHMP),
supposedly in line with South Africa’s policy of
deinstitutionalisation, imploded into a bitter humaninduced
trauma. Over one and a half thousand
mental health care users were unlawfully, irrationally,
and hurriedly dispatched from psychiatric institutions
mostly without their identity documents, medical files
and support systems and sometimes with changed
names. The relocation process left human wreckage
in its wake.
THE GAUTENG HEALTH DEPARTMENT
OR, THE DEPARTMENT, AS THE FAMILIES
REFERRED TO IT, ALSO CALLED IT
THE DECANTING. IRONICALLY AND
TRAGICALLY, ONE MEANING OF THE
WORD DECANTING IS TO TEMPORARILY
TRANSFER PEOPLE FROM ONE PLACE
TO ANOTHER. THIS PROVED TO BE
PERVERSELY TRUE.
One hundred and forty four
patients died silently soon after the
shambolic and reckless endeavour
from dehydration, starvation,
exposure, injury and medical
neglect rendering their transfers
truly temporary. Patients were
moved from place to place: from
one unlicensed non-governmental
organisation (NGO) to another or
Coralie Trotter
to hospitals or to morgues forcing
concerned family members to engage in a perverse
process of ‘hide and seek’ in order to locate their
loved ones while alive and then their actual bodies
after death. The whereabouts of some mental health
care users are still unknown and unidentified bodies
remain in limbo - or ‘decanted’. The survivors have
been, again ironically, returned to the original facility.
The implication of this is sobering: The Department
used a term to describe a range of temporary
human transfers before the Marathon Project had
even been set in motion.
On 22 nd August 2017 I received an email from a public
interest law firm, Section27, requesting assistance to
assess the impact of the Life Esidimeni relocation on
a group of, at that stage, fifty five families who had
lost a family member due to the project. The aim
was to produce a report that could be presented as
evidence for an Alternative Dispute Resolution (ADR)
or arbitration process under Justice Moseneke. This
was done with the assistance of a team (LETEAM)
of twenty registered mental health professionals
with diverse clinical qualifications and a range
SOUTH AFRICAN PSYCHIATRY ISSUE 18 2019 * 17