Sometime in 2015, the government of Gauteng Province (which surrounds Johannesburg and is home to over 25% of South Africa’s population) decided to save money by deinstitutionalizing a substantial portion of the inpatient psychiatric population in its care.  As testified by the Director of Mental Health Services, the plan was to reduce annually the number of patients in the Province’s care by 20%. This was intended as a cost‑cutting measure.  It was surely also a measure that was expected to bring political kudos to the Province’s Executive Council and specifically to the Council’s Member responsible for Health, as well as the Head of the Health Department and the Director of Mental Health Services, who were tasked with implementing the project.  Accordingly, between March and June 2016, a “high‑level decision” was made to immediately relocate 1,700 patients from Life Esidimeni Hospital and to place them in 27 private facilities and nongovernmental organizations. In the course of this “programme of action,” 144 patients died and an additional 12 individuals are still missing presumed dead.

As details of the events of those fateful months emerged, the full extent of a horrifying instance of mass murder became apparent.  A decision, unquestionably flawed from a medical standpoint, was precipitously implemented in a chaotic manner without regard for the wellbeing, let alone the rights, of the patients and their families.  Neither the patients nor their families were informed in advance of the relocation.  Moreover, it frequently occurred that, when the families of a patient inquired about the whereabouts of their relative, the authorities claimed they were without information as to where the patient had been sent.  Many of the nongovernmental facilities to which patients were relocated were far away from the patients’ homes and communities.  None were properly prepared.  Many were unlicensed, some only established just prior to the programme.  The facilities often lacked adequate accommodation for the patients they received, and were usually without sufficient staffing (let alone medical personnel).  Of those facilities that were licensed, many received far more patients than their license permitted.  For example, one nongovernmental organization, licensed to care for three patients, actually received seventeen.

As the public learned more about how the government had implemented this “programme of action,” it transpired that most of the relocated patients were bundled into the back of trucks, often tied down, and sent to one of the 27 facilities.  Medication and medical records were usually not relocated with them.  Deaths occurred within days and weeks of the relocation.  Some patients died of dehydration, some of starvation.  Some patients were found on autopsy to have eaten plastic in their desperation.  Many corpses were hastily buried so that autopsies could not be performed.  Some bodies went unidentified for weeks or months; some were stored in a makeshift area that had been previously used by a butcher.

As many commentators have concluded, the government’s crime was not only mass murder but torture of those relocated patients who survived.  Even now, some aspects of this tragedy are unknown.  Bodies are still missing and causes of many deaths have not been ascertained.

Section 27, which is a public interest law centre that seeks to achieve substantive equality and social justice in South Africa, took up the cause of the bereaved families.  An arbitration process was established under a distinguished retired judge, Justice Dikgang Moseneke.  Its purpose was not only to bring the dimensions of the crime into the public record, but also to determine what the government should be required to do for the suffering of the bereaved.  Significantly, the government hired one of the most expensive law firms in the country to make its case; it admitted “errors” had been made, but argued for only a very limited liability.  The hearings ended this past month, February 2018, and we await Justice Moseneke’s conclusions as to what the bereaved are entitled to receive from the government in terms of professional support and financial compensation.

In relation to a monstrous violation of human rights such as this, there can be no positives.  However, the valorous work of Section 27 must be mentioned.  Moreover, the arbitration process was the occasion for an instance of exemplary social activism on the part of a group of psychoanalytically oriented professionals.  Section 27 asked Ms. Coralie Trotter, a practicing psychoanalyst who is perhaps South Africa’s most distinguished teacher of psychoanalytic theory, to provide expert testimony about the psychological suffering involved, both that inflicted on the relocated patients and that endured by the bereaved families.  Ms. Trotter recruited a team of nineteen mental health professionals who interviewed and provided support for the bereaved.  On the basis of these data, Ms. Trotter wrote a report on the psychological magnitude of all the suffering involved.  The report was submitted to Justice Moseneke and entered into the public record.  Ms. Trotter then gave powerful oral testimony at the arbitration proceedings, in the face of hostile efforts by the government’s attorneys to discredit her findings.  It was clear that her impressive use of psychoanalytic wisdom to explain, in a public forum, the inner dimensions of suffering experienced by the victims of human rights’ abuses, made a profound impact on all involved at the arbitration process.

In an epoch in which psychoanalytic insights about the dynamics of the human condition are all too often dismissed as somehow obsolete, the dedication and commitment of Ms. Trotter and her colleagues stand as a sterling example of the way in which psychoanalytic sophistication can contribute significantly to fighting even the suffering that accompanies the atrocities of torture and mass murder.

[Dr. Barratt would like to thank Ms. Vossie Goosen for her assistance during the preparation of this commentary.  Also, it should be noted that Ms. Coralie Trotter is currently a doctoral Candidate at the Parkmore Institute.]