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Examining experiences of involuntary psychiatric treatment in South Africa: lived experience and care
Thesis (PhD)--Stellenbosch University, 2025.
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| Format: | Thesis |
| Language: | English |
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Stellenbosch : Stellenbosch University
2025
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| _version_ | 1867613845729574912 |
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| access_status_str | Open Access |
| author | Freeman, Alex Morung |
| author2 | Swartz, Leslie |
| author_browse | Freeman, Alex Morung Swartz, Leslie |
| author_facet | Swartz, Leslie Freeman, Alex Morung |
| author_sort | Freeman, Alex Morung |
| collection | Thesis |
| dc_rights_str_mv | Stellenbosch University |
| description | Thesis (PhD)--Stellenbosch University, 2025. |
| format | Thesis |
| id | oai:scholar.sun.ac.za:10019.1/134618 |
| institution | Stellenbosch University (South Africa) |
| language | English |
| last_indexed | 2026-06-10T12:42:37.450Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from SUNScholar — Stellenbosch University Repository |
| publishDate | 2025 |
| publishDateRange | 2025 |
| publishDateSort | 2025 |
| publisher | Stellenbosch : Stellenbosch University |
| publisherStr | Stellenbosch : Stellenbosch University |
| record_format | dspace |
| source_str | SUNScholar — Stellenbosch University Repository |
| spelling | oai:scholar.sun.ac.za:10019.1/134618 Examining experiences of involuntary psychiatric treatment in South Africa: lived experience and care Freeman, Alex Morung Swartz, Leslie Stellenbosch University. Faculty of Arts and Social Sciences. Department of Psychology. Involuntary treatment -- South Africa Mental health services -- South Africa Psychiatry -- Decision making Patients -- Legal status, laws, etc. -- South Africa Thesis (PhD)--Stellenbosch University, 2025. Freeman, A. M. 2025. Examining Experiences of Involuntary Psychiatric Treatment in South Africa: Lived Experience and Care. Unpublished doctoral dissertation. Stellenbosch: Stellenbosch University [online]. Available: https://scholar.sun.ac.za/items/4256324c-7407-4962-81d8-dc34818ca7df ENGLISH ABSTRACT: The issue of coercion in mental health care has been a longstanding and contentious issue, shaping legal, ethical, and human rights debates both historically and in the present. In this dissertation, I examine the lived experiences of involuntary psychiatric care in South Africa, centring the perspectives of people with psychosocial conditions, their families, and mental health professionals. Drawing on Carel’s phenomenology of illness, I critically engage with global debates on legal capacity, human rights, and mental health care, particularly in the context of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) Committee’s endorsement of General Comment 1 (GC1). These frameworks challenge conventional models of substituted decision-making and advocate for supported decision-making, raising complex ethical, legal, and practical questions about the nature of psychiatric care and the well-being of people with psychosocial conditions. Through a series of interrelated studies, I explore how people with psychosocial conditions, family members, and psychiatrists experience involuntary treatment, particularly in relation to systemic constraints, embodied disruptions associated with illness, and broader interactions with the healthcare system in the South African context. The first article examines the difficulties in defining legal capacity, highlighting how competing interpretations shape the lived experiences of people with psychosocial conditions and influence approaches to involuntary treatment. The second article foregrounds the voices of people with psychosocial conditions, detailing their experiences of coercion, agency, and the embodied impacts of involuntary treatment. The third article examines psychiatrists’ perspectives, revealing the dilemmas they face in balancing professional responsibilities, legal mandates, and ethical concerns. The fourth article investigates the experiences of family members, exploring the emotional burden, moral conflicts, and shifting relational dynamics that arose for participants in the process of involuntary hospitalisation. Finally, in a reflective piece, I consider my own position within these debates, using psychodynamic insights to explore the intersubjective complexities of studying coercion, care, and vulnerability based on my own experiences. My findings illustrate the ethical and practical complexities inherent in involuntary psychiatric care. While such interventions are often enacted with the intention of ensuring safety and providing necessary treatment, they can simultaneously involve experiences of coercion, disempowerment, and psychological distress for those subjected to them. Individuals with psychosocial conditions report varied responses to involuntary treatment, with some perceiving it as a necessary safeguard during periods of crisis, while others experience it as a violation of autonomy that undermines their sense of agency. Families similarly grapple with ambivalence, expressing both relief that intervention is available and distress over the relational strain and moral dilemmas it creates. Mental health professionals, in turn, must navigate the competing demands of legal mandates, clinical judgment, and ethical responsibility, often within resource-constrained systems that limit alternatives to coercive interventions. Rather than positioning involuntary treatment as either inherently oppressive or an unequivocal necessity, my findings highlight the ways in which its impacts are shaped by contextual, relational, and systemic factors. By critically examining these tensions, this research contributes to a deeper understanding of the lived experiences, ethical challenges, and policy implications surrounding involuntary psychiatric care in South Africa. AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar. Doctoral 2025-12-18T14:04:27Z 2025-12-18T14:04:27Z 2025-12 Thesis https://scholar.sun.ac.za/handle/10019.1/134618 en Stellenbosch University x, 127 pages application/pdf Stellenbosch : Stellenbosch University |
| spellingShingle | Involuntary treatment -- South Africa Mental health services -- South Africa Psychiatry -- Decision making Patients -- Legal status, laws, etc. -- South Africa Freeman, Alex Morung Examining experiences of involuntary psychiatric treatment in South Africa: lived experience and care |
| title | Examining experiences of involuntary psychiatric treatment in South Africa: lived experience and care |
| title_full | Examining experiences of involuntary psychiatric treatment in South Africa: lived experience and care |
| title_fullStr | Examining experiences of involuntary psychiatric treatment in South Africa: lived experience and care |
| title_full_unstemmed | Examining experiences of involuntary psychiatric treatment in South Africa: lived experience and care |
| title_short | Examining experiences of involuntary psychiatric treatment in South Africa: lived experience and care |
| title_sort | examining experiences of involuntary psychiatric treatment in south africa lived experience and care |
| topic | Involuntary treatment -- South Africa Mental health services -- South Africa Psychiatry -- Decision making Patients -- Legal status, laws, etc. -- South Africa |
| url | https://scholar.sun.ac.za/handle/10019.1/134618 |
| work_keys_str_mv | AT freemanalexmorung examiningexperiencesofinvoluntarypsychiatrictreatmentinsouthafricalivedexperienceandcare |