Journal of Child and Family Studies

, Volume 21, Issue 6, pp 1018–1027

Disempowerment and Psychological Distress in the Lives of Young People in Eastern Cape, South Africa


    • Department of PsychologyUniversity of Witwatersrand
  • Rachel Jewkes
    • Gender and Health Research Unit, Medical Research Council
Original Paper

DOI: 10.1007/s10826-011-9564-y

Cite this article as:
Nduna, M. & Jewkes, R. J Child Fam Stud (2012) 21: 1018. doi:10.1007/s10826-011-9564-y


A qualitative study was conducted in Butterworth, in the rural Eastern Cape Province of South Africa, to explore sources of distress for young people. Semi-structured, individual in-depth interviews were conducted with 16 men and 24 women aged 16–22 years. The findings revealed interconnections between structural factors such as death, poverty, unemployment and gender injustices to cause distress. Negative home dynamics such as disinheritance, financial hardships, undisclosed paternal identity, substance abuse, child abuse and unpredictable informal adoption circumstances were worries of the participants. Worries over their inability to complete school dominated the narratives of orphaned participants. Lack of communication and consultation within families on important matters contributed to distress. Distress related to sexual relationships, such as infidelity, an unacknowledged pregnancy, intimate partner violence, transactional sex and sexual orientation were evident only in women’s narratives. Strengthening of families, improving financial security, extension of social grants and no-fee school policies are needed to alleviate distress in young people in this area. These findings are a call for the monitoring of policy delivery imperatives for child protection.


DistressFamily economic hardshipsParental deathPaternitySouth AfricaYouth


Research from South Africa shows that young people experience considerable emotional distress (Nduna et al. 2010; van Renen and Wild 2008). In a survey of 2,800 participants in the rural Eastern Cape Province, Jewkes et al. (2010) found that 16% of women and 7% of men reported depressive symptoms severe enough to require clinical attention. Distress among young people is important in its own right, but also because of the associated risks of alcohol abuse, risky sexual behaviours, sexual violence, HIV and suicide (Blore et al. 2004; Nduna et al. 2010; Wild et al. 2004).

The causes of distress are manifold. Forms of adversity such as severe poverty, parental absence and large dysfunctional families are endemic (Department of Health, Medical Research Council and OrcMacro 2007; Eddy 2009). In the Eastern Cape, children living with neither of their biological parents outnumber those living with both (Holborn and Eddy 2011; Kane-Berman 2009). Parental loss is rife and many, but by no means all, are attributable to AIDS. Following death, siblings are often separated, family structures and resource availability often changes, and those left behind often find themselves isolated from kinship networks, financially insecure and unable to afford schooling (Cluver and Gardner 2007; Låftman 2010). Stigma, bullying, lack of access to basic needs such as food and the inability to complete school are rife among orphaned youth (Cluver and Orkin 2009; Operario et al. 2008). Violent conflict and sexual and physical violence perpetrated by relatives against children is common within some families (Berry and Guthrie 2003; Cluver and Gardner 2006; Phakathi 2009). These reduce family functioning and cohesiveness and contributes to distress for youth (Freeman and Nkomo 2006; McLoyd 1990; Pillay and Wassenaar 1997).

This study aims to contribute to our understanding of psychological distress among young South African men and women. In this study, we work with the definition of distress as a ‘…unique discomforting, emotional state experienced by an individual in response to a specific stressor or demand that results in harm, either temporary or permanent, to the person’ (Ridner 2004, p. 539).


The study was phenomenological and sought to investigate young people’s experiences of distress. This approach was chosen because the research was exploratory and we sought to capture the perceptions and narratives of this subjective phenomenon. There are complexities in defining a young person (Arnett 2007; Blum 2007) and in this paper the terms ‘youth’ ‘young people’ ‘young adults’ and ‘adolescents’ are used interchangeably.

The study was located in the former Transkei area of the Eastern Cape Province of the Republic of South Africa. Transkei is a former internally self-governing Black African homeland, in the southeast of South Africa on the Indian Ocean coast. It was reintegrated into South Africa at the end of Apartheid in 1994. Economically Butterworth was the fastest growing town in the former Transkei in the early 1990s, but this has since changed. It is now economically depressed and has been subject to very rapid growth, far outstripping its infrastructure. For example, between 1989 and 1995 the number of shacks (informal homes) in Butterworth increased from about 700 to over 5,000 (The Fort Hare Institute of Social and Economic Research (FHISER) 2006). Butterworth has a variety of settlements: three middle class suburbs near town, seven formal townships outside town where most working class people reside, eight informal settlements and twenty-five rural villages. The selection of the district was based on convenience.

The data was collected in September 2007 and April 2008. Participants were volunteers, recruited by a research assistant from a high school through circulating an information sheet and through community radio announcements. Volunteers were invited to participate in a study on ‘issues bothering youth’. They had to be older than sixteen and with no known clinical diagnosis of any mental illness. At the point of recruitment the orphanhood status of some was not known. Interviews took place either at school or in homes, where visual and auditory privacy was ensured. The author conducted digitally recorded one-on-one, face-to-face, in-depth interviews in isiXhosa. Referral to social workers was offered to any participant who became very distressed during the interview and one interview was stopped because the participant was too distressed to continue.

Forty narratives were sought and most were undertaken over a period of 2 weeks. The majority of participants who came forward for interview were women. This may reflect men’s greater reluctance to talk about their emotional difficulties, or possibly that the female interviewer and her female assistant appeared more accessible to women. Interviewees came from rural and township communities. Ethics approval for the study was obtained from the University of the Witwatersrand’s non-medical committee. All participants were asked to sign informed consent. An incentive of R20.00 (US $2.70 in 2010) was provided.

Twenty-four women and sixteen men aged 16–22 were interviewed. Sixteen of the 40 participants reported that they lived in homes where the primary caregiver was not a biological parent. Twenty-one of the participants reported that they were orphaned with five having lost both parents, 10 were paternal orphans and six maternal. The longest period of orphanhood was 10 years and the shortest was 2 years. Three participants had finished grade 12 and were not studying, 10 were in tertiary education and 27 were in high school at the time of the interview.

Interviews took about an hour and followed a semi-structured guide. They were structured around the question ‘is there anything in your life that you can talk about thatis/wasa source of distress to you?’ with subject-appropriate follow-up probing. The phrase ‘made your heart painful’ understood to mean ‘emotionally affected’ or ‘greatly bothered’ was used. This question resulted in accounts of selected events in the interviewee’s life, they did not seek an account of the whole life, nor did the interviewing strategy seek to collect information from other sources on their lives. The interviews were transcribed and translated into English. Data were translated to convey meaning but it was not ‘cleaned up’ during transcription to keep the expressions of the participants as close as possible to the original. Analysis followed recommendations for exploratory qualitative work and used a content analysis approach (Babbie 2008; Speziale and Carpenter 2007). Transcripts were read over and over again for data exploration. All descriptions of experiences and functional relations that potentially could contribute to distress were labelled in open coding. Similar events and happenings described by different participants were grouped together, for example, death, unacknowledged pregnancies by putative fathers, undisclosed paternal identity, financial hardships and abuse. We explored the data for patterns of relationships between events, participant reactions, significant others’ responses and the structural context of occurrences in order to present plausible explanations of distress from these relationships. The table presented below aims to show these interrelated elements. Problems experienced in sexual relations were reported as a source of distress by women whilst family factors were a concern for both men and women.


A summary of the main sources of distress is shown in the figure below. This figure illustrates how the lives of young people were conducted within a context shaped by structural factors, notably loss, poverty and gender inequalities, that profoundly and negatively contributed to distress. The interviews, which mainly discussed the immediate home and relationship environment, illustrated that these groups of factors interacted in different constellations at different times to cause participant distress. Some of the accounts were of young people’s struggle with orphanhood, parental absence and informal adoption by relatives which left them economically disempowered in the face of little or no household income. Informal adoption here refers to care arrangements with kin that do not involve social welfare services. Parental alienation was often discussed, particularly where paternal identity was undisclosed. Poverty amplified the impact of loss, or absence of a parent. In many instances silence in families profoundly contributed to distress and amplified this for participants who did not feel they had the power to talk. Dating relationship problems, raised in the interviews mainly by women, were dominated by worries about partner’s infidelity and denied pregnancies, both problems that reflected endemic gender inequity. Dating violence and transactional sex (i.e. sex, or sexual relationships, motivated by the receipt of cash or services such as transport or accommodation (Dunkle et al. 2004) were features of relationships conducted in circumstances of poverty and dependence and reflected the vulnerable and subordinate status of young women (Fig. 1).
Fig. 1

Framework explaining causes of distress for participants

Structural Factors

Loss and the Resultant Insecurity

Participants, many of whom felt the devastating effects of parental death as a result of AIDS, felt powerless. The devastation AIDS brought to families was construed as misfortune and as illustrated by Manelisi (17, male) when he gave a chronology of events in his family starting when “…my mother passed away in 2005 due to AIDSI was thirteen when my father passed awaymy two aunts also passed onit was AIDS also…”. Post-death events left him, like others, losing material and other support.

For many informants, poverty compounded the impact of the loss. Nomhle (20, female), did not have the money to attend the funeral of her estranged father after she heard about it on the radio. She was one of several participants who were severely financially affected by bereavement. She described how her family watched their father’s estate being inherited by his girlfriend, with whom he cohabited in Cape Town. After this her mother could no longer afford to rent in the township and they moved to the village, a sign of lowered social status. Desperately short of money, her vulnerability was starkly highlighted when she and her older sister received sexual advances from an old man in their village who offered ‘…something to help my mother…’ in exchange for sex. She did not tell her mother but rejected this with disgust, seeing it as a sign that her family was not ‘respected’ because they were so poor.

Several participants described the distressing impact of disinheritance after parental death. It was perceived as being ‘cheated’ out of their rightful inheritance, although in terms of South African law it is possible that some of the parents were not legally married and so it may not have been strictly illegal. For example, following the death of her father, Nosizwe’s (17, female) paternal family told his former employer that he was unmarried and so excluded her mother from his estate. Similarly for Nompumelelo (21, female), a painful family conflict over inheritance ensued her father’s death threatening her ability to further her education. She said

… (Shivering low voice) our father passed away in 2002…my mother had no money to send me to University but she was going to sell my father’s cattle to finance his children’s education. My grandmother was claiming the livestock; my aunts were also claiming their brother’s cattle…so there was conflict (crying)…

Evidence of hardships following parental death was conveyed in other participants’ narratives. Several described family-based violence, lack of trust, exploitation, exclusion and abuse. Bongani (22, male) lost his mother when he was 12 years old. He did not know how she died. Since he thought that his sisters knew, he felt excluded from the family by this. Silence on issues related to death and inheritance were typical in the narratives. Although many of the research participants were legally regarded as adults and had rights in law, families used the tradition of strong age hierarchy to accord them a subordinate status and expected their consent and compliance because of culturally important rules of respect. Thus Bulelwa (22, female), a maternal orphan, did not like “…important decisions [being] made without me being told She lived in her late mother’s house with her maternal grandmother and aunts and worried that her aunts were conspiring to change ownership of the house; a move that would disinherit her and her brother. Yet she was constrained in addressing this by rules of respect. Not wanting to sound as if she was making a claim on the house, she used appropriate linguistic forms of deference and politeness and phrased her concern as lack of consultation and being unfairly excluded from this decision-making. She said “… not that I am old or I have a rightbut as a member of the family I should be told…” (22, female). Tensions over property after bereavement made her, and several others, feel that social support diminished in their homes. Others described being reminded of their orphanhood and being destitute. Their vulnerability was worsened by the absence of someone who would defend their interests in the family. For instance, at times of conflict with cousins, guardians were perceived to side with the stronger party (the non-orphaned).


Parental unemployment, absence of fathers and large families resulted in financial insecurity, conflict in family relationships and vulnerability, causing distress among participants. Poor rural families often sent their children to be cared for by relatives in the township where resources were believed to be better. Phathiswa (17, female) remembered that when she was young her mother “…said she could not afford to look after her. Her hardship started at an early age and at five she had been raped by her older cousin when her mother left her under his care to go and look for a job. When her grandfather’s sister offered to take care of her, she felt a relief because back in the village “… life was really difficult and she would not “… even have shoes to wear All the same, she was distressed as she felt like I am not their child [parents in the village]…” She cried for most of the interview as she narrated her multiple experiences of ‘misfortune’. Although living in town, she remained very poor. She braided hair for a pittance and sent some money to her family but it worried her that “…when I ask my mother for money she is like “no but you have money”, it’s like I am parenting myselfI do not know [why] I feel so lonely inside (crying)…” She was also very worried about her older brother who did not go to school as he had epilepsy and they were too poor to get proper healthcare for him. She cried most of the time during the interview and said “…I act as two people, one side will be stressed and crying the other will speak to the other one that is distressed and comfort ittell myself that I am strong…” Over and over again participants presented their family as inadequate, which was conveyed by an often recurring expression that one did not “…come fromthe right family…” Whilst some were raised by a single unemployed mother, it was not household structure alone that influenced what a ‘rightfamily’ was because others lived with two parents but struggled.

Home Environment Factors

Narratives of homes made unhappy by alcoholic parents, family violence, undisclosed paternal identity, and indifferences to children’s needs were shared by some. One of the participants, Babalwa, described how her mother “…makes the home feel cold, if she is drunk then no one should be happy(16, female). She would shout about their estranged [subsequently late] father’s lack of support and this made her feel guilty. Phakama, a maternal orphan who moved in with her father because her maternal family was too poor to look after her described a similar scenario. Even though materially her circumstances were better, she found her father’s philandering despicable, especially when he propositioned her school friend who visited their house. She felt embarrassed, confused and angry but could not talk to him about his conduct. Although when her father did the same to her stepbrother’s female friend, her stepbrother confronted him, but as for Phakama, she said “…I don’t have the guts to do so lest I appear disrespectful (18, female) Phakama also knew her father was living with HIV and she worried about the impact of his excessive drinking on his deteriorating health. She was worried about her future, possible homelessness and having no one to see her through school if he died.

It was typical in this sample that participants were raised in different homesteads and rarely in nuclear family structures. To further illustrate negative family dynamics, Chuma (17, male) was raised by his mother and step-father but at the time of the interview he lived with his mother’s friend having survived years of severe battering from his stepfather. His biological father had denied paternity when his mother was pregnant. He thought that his stepfather deprived his mother financial support because he resented his presence in their house and Chuma believed that this contributed to his difficult childhood. He was forced to be self-reliant and sold perishable food after school as a street vendor. He, and others, who earned money to support themselves and their families felt overburdened and robbed of their childhood.


Participants, not all of whom were orphans, commonly lived with maternal relatives and some spoke of ill-treatment and being asked to do heavy chores inappropriate for their age. Two examples are germane here. Nombeko who lived with adoptive maternal grandparents said;

…I started working when I was 8 years to pick up firewood, and bring it home on my head. I stopped going to the veldt when I was accidently cut by an axe on the foot but when it healed, I resumed… (22, female)

Exploitative and differential treatment was perceived when non-biological siblings in the household were not expected to carry out similar chores. Though informal fostering within families is often presented by families as an act of sisterly duty, some participants received little and were turned into child servants. This evoked a longing for one’s own parents. Being chased out of the guardian’s homes and invited back at the guardian’s convenience was common. Khanyisa (18, female) helped look after her aunt’s small children and do household chores and in return her aunt supported her with school and other needs. Khanyisa felt bitter towards her aunt, perceiving that helping with housework appeared to be the main reason that she was taken. Her own family was her source of distress which was independent of the treatment she received from her aunt. Her mother had been arrested for murder in Durban, while her older brother served a separate murder sentence in Mthatha. Like others, Khanyisa was consistently vilified for her biological parent’s misbehaviour and inability to care for her. She said it hurt her when “…my aunt would say I will be like them because I do insane things When her aunt told her teacher about her background she felt ashamed, ran away from home and stopped school. Similar to her case was Phathiswa’s (17, female). Whenever she erred, her grandaunt publicly reminded her about how poor her family was and her friends, neighbours and schoolmates came to know about it. This was embarrassing and painful as Phathiswa explained that friends “…tease me about these things [grandaunt’s insults]…it hurts me…” Others reported that guardians enforced discipline with severe corporal punishment and spoke of efforts to marginalise them in families in order to deny them access to resources. These were participants’ guardians who resented their dependency on them and responded with abuse resulting in participants feeling responsible and guilty for their parent’s indigence or death.

Access to resources was difficult and highly contested within homes and some were forced to go and look for food. For example, Sipho’s mother was unemployed and lived in Johannesburg and he lived in Butterworth with his uncle who worked in East London and came home one weekend per month. Sipho said his uncle’s support was not forthcoming and “…like even with clothes I have to fend for myself because when I ask my mom for money she will say she will trywith food here at homeI will be thinking ok let me fend for something…” (20, male). Sipho did not know his father though he once heard that he was a teacher in a neighbouring town. Other participants too, described life spent moving between different relatives; between village and township, school interruptions and having to worry about basic needs.

Gender-Based Violence

A dominant feature of the narratives of young women with dating experience was gender-based violence. They related this to their low socio-economic status. For example, Busisiwe (22, female) came from a family of four, reliant on her mother’s meagre wages. Busisiwe had a child who was not supported by the putative father, and who had delayed acknowledging responsibility for her pregnancy until the child was over a year old. She felt obliged to live off her current abusive boyfriend and her explanation was my background, he knows I depend on himI think he is treating me this way[beating] because he does things for me and he does things needed for my child…(22, female). One participant spoke about an attempted rape at gun-point by a family friend, another about a date rape on University campus and third, of her experience of incest. What was common among these women was that they lived with guardians at the time of the assault and attributed their ‘misfortunes’ to lost status stemming from their family’s poverty that rendered them easy targets for cruel people. They were worried about their families who were unable to provide them with protection.

Undisclosed Paternity

Some participants did not know their fathers and others had recently discovered them. In Black South African families children born out of wedlock are not seen as exceptional in any way, however, participants seemed to carry an internalised stigma related to this and there was some evidence of it being deployed as a stigma by others. The desire to know one’s father seemed substantially motivated by financial difficulties, notably a lack of money to pay school fees, scarcity of and conflict over food. In some instances it was connected to unpleasant experiences in maternal homes, for example guardians not defending them during conflict with cousins where their uncertain paternity was used against them. Those who had not asked their mothers or carers about their fathers indicated that they feared victimisation, such as being thrown out of the house; or wanted to keep relationships with the mother positive, avoiding conflict or being labelled as disrespectful and ungrateful for their single mother’s support. Among those who asked, some reported receiving a negative, dismissive response that suggested that the question of their father’s identity was an ‘adult matter’ of no concern to children. At worst, punishment was administered for asking.

Distress Related to Sexuality

If a woman participant had not mentioned distress in sexual relationships, this was routinely asked towards the end of the interview. Cheating, desertion, abuse, blackmail, control and bullying from partners featured dominantly in their narratives. Being rejected by a boyfriend in itself caused one participant to attempt suicide. She had discovered him with another woman and he had chosen the other woman. In a remarkable display of tolerance and acquiescence to their subordinate position (R. Jewkes and Morrell 2011), participants rarely constructed abusive relationships as distressing. Some women spoke of the pain of sexual bargaining through supply of sex in order to please an abusive boyfriend or of being locked in an abusive relationship in order to secure material support. Two spoke of worry about coming out as lesbians. They were acutely aware of homophobic attitudes displayed towards them by some family, friends and teachers.

Denied and Disputed Pregnancy

In narratives of young women who had been pregnant, rejection and denial of pregnancy responsibility by the putative father were described as the most hurtful of their sources of distress. Vuyokazi (22) said that her (ex)boyfriend, who subsequently switched his cell phone number and left town after being told of the pregnancy, claimed that he did not know that she was telling him the truth that she was pregnant. Another participant, Zoliswa (22, female) said her boyfriend denied acknowledgement of his child as punishment for her for not taking contraception. Accusations of promiscuity from peers, her family and the man worsened the shame, stigma and distress. The men were reported to have later accepted paternity on the basis of the child’s resemblance. However, acceptance of paternity did not always result in the expected payment of ‘damages’ to parents or maintenance of the child, a distressing situation to those concerned. ‘Damages’ refers to monetary compensation to the value of a cow(s) paid to the woman’s family to acknowledge paternity. Another participant, Nokwazi said

…at the age of 16 I fell pregnant…he accepted the child as his but he never supported him…he was unemployed then but he ultimately got a job and even then didn’t support…he dated other people around me, I mean neighbors, and he dated one girl then dropped her and dated my cousin… (22)

Traditional and legal recourse were ineffective in aiding participants to make claims against the men. Though it was lack of knowledge that prevented Nokwazi from approaching the maintenance court because she “…never thought of thatI have heard about that (lowering her voice) but she thought it was for married people. Busisiwe (22), whose pregnancy was denied, agreed with her boyfriend that they would go for a paternity test. She was then thwarted by the bureaucracy finding they needed identity documents (which they didn’t have). After this he relented and accepted responsibility. She was unable to pursue a maintenance case without proof of his income, which she could not access.


This research has highlighted a multiplicity of sources of distress rooted in a context of orphanhood, poverty and gender inequity. These often intersected with each other, as well as with subsequent disempowerment (mainly in the home), through disinheritance, marginalisation and exploitation to magnify distress. These experiences often emerged from the micro-dynamics of survival in poverty stricken, destitute and patriarchal communities. This is a province where the rate of orphanhood is above the national average (25 vs. 19%), corruption is rife, and there are bureaucratic obstacles in receiving death benefits from insurance schemes and pension fund payouts (de Villiers and Giese 2008). Whilst some of the problems described here may have been outside the control of families, when the difficulties were not communicated clearly to young people it contributed to distrust and perceptions of being dispossessed.

Findings on sense of insecurity, worries about the future, decline in social position, negative self worth and threats to opportunity to finish school, support the assertion that children of impoverished adults become socially excluded and are presented with intergenerational transmission of vulnerability through similar risks to those that made their parents poor and face the “poverty of opportunity” (Jonsson 2010; May and Norton 1997). Early school exit further places vulnerable youth at risk of pregnancy, HIV infection, delinquency and future distress (Operario et al. 2008; Sengendo and Nambi 1997).

Some participants’ perceptions of poor treatment provided the foundation for feelings of emotional neglect. This underlies distress in young people (Kaggwa and Hindin 2010). When participants perceived that they did not come from ‘right families’ they were apt to thinking that the community and peers were looking at them. A typical adolescent ego-centric feature called ‘imaginary audience’(Plotnik 1999; Santrock 1992). These family evaluations and feelings that they occupied a lower status among peers, or that their family occupied a lower status in the community, formed a cornerstone of a psychological response to adversity, a perception that amplified ‘misfortune’.

Alternative care arrangements, or fostering, within families has been common in African families. This is the practice whereby children may be passed for all or part of their lives to the care of relatives which are not biological parents. It became particularly common during the apartheid years because families were forcibly split and working women often found it impossible to live with and look after their children. It provides a social security arrangement for some teenage mothers, orphans or families where mothers cannot afford to look after their children, but is also a chosen practice by others (Freeman and Nkomo 2006; Mekoa 2003). It is well recognised as being a circumstance of vulnerability for children and the relational families described here did not act in the best interests of the adoptees. The adoptees’ low social status demanded that they consistently behaved in deferential, discreet ways with a great deal of circumspection to seemingly resentful guardians, so that they might continue to benefit from any small advantages offered to them. However, those adoptive families would often have been financially stretched, as there is no State support for informal adoptions (South African Social Secuity Agency 2009). Adopted girls are commonly expected to contribute in kind through a great deal of house-work, which participants perceived as abuse and exploitation by their guardians. They did not frequently use the term child abuse, but their descriptions of life trajectories constituted habitual abuse and neglect as discussed in literature (Cassiem 2000; Silverman et al. 1996). This study confirms that the guardian’s levels of investment in the adoptees were mediated by perceptions of ‘responsibility’ and status of their biological parents. Similar findings have been described before (Euler et al. 2001; Trickett et al. 2009). Some accounts of entrepreneurship were clearly forced by circumstances, and are perhaps best interpreted as a sign of harsh conditions which transformed those young men and women into premature adults.

Literature describes suboptimal parenting and the negative impact of economic hardships on parenting (McLoyd 1990; Trickett et al. 2009). These findings are evidence that optimal parenting can be further compromised in contexts of poverty. Similar to a situation reported in Swaziland (Phakathi 2009), harsh physical punishment meted on participants were noticeably commonly administered by relatives other than the participants’ biological parents; another example of how poverty rendered biological parents (mostly mothers) unable to protect and defend their children as they appeared too disempowered to intervene. Participants’ evaluations of their families’ imagined protective role was central in the study. Diminished parental protection, unpredictable home environments and negative childhood experiences were personalised and constructed in pessimistic and distressing ways. When family functioning conflicted with expectations of access to resources, information or decision making, the discrepancy left participants feeling absolutely isolated, misunderstood, confused, unprotected and unfairly treated. Such was the case when there was secrecy around death; which is not necessarily a cultural phenomenon here, but perhaps made so by the stigma of AIDS.

Paternal Identity

When fathers were not spoken of in the interviews, this was not probed further as this was interpreted to either mean their absence was not considered distressing or it was experienced privately and we respected that. Father absence in South African homes concerns researchers as a potential source of psychological distress (Kane-Berman 2009; Nduna and Jewkes 2011). A dominant narrative was of undisclosed father identity rather than father absence. Participants felt powerless when they could not uncover information about their fathers and where parents withheld information some felt that this meant they held ambivalent orientation towards them as children/adults. Most participants did not ask (see Nduna and Jewkes Accepted). This self-restraint was a prominent theme in these findings and reflects how in this society children are expected to show respect by not talking on or questioning adult authority (Nduna and Jewkes 2011; see also Nduna and Jewkes Accepted).

Sexuality and Sexual Relationships

In the face of penury, the devised solutions by some, such as involvement in sexual relationships for financial gain furthered distress through shame, embarrassment and powerlessness. Transactional sex due to poverty is common in this region and it leads to further problems such as HIV risk and abuse (Chatterji et al. 2005; Dunkle et al. 2004). Work by Jewkes et al. (2006a, b) from the Eastern Cape region reports high levels of both intimate partner and interpersonal violence against women here. Notably, different forms of abuse described by young women in the interviews—although well recognised as causing depression and suicide (Meel 2004)—were not construed and reported as a source of distress without the interviewer probing. It appears that if we were to create a hierarchy of importance by contribution to distress, relationship distress was discussed to a lesser extent than family issues. However, this may be because it was seen as ‘unavoidable’ or something to be tolerated, whereas family problems were not. More research is needed to further explore this. Pregnancy denial brought embarrassment, stigma, humiliation, accusations of promiscuity and rejection by families, the man’s friends or relatives and added a financial burden to homes of those affected and was considered a very distressing experience by women involved. Interestingly, sexual relationships were only found in women’s narratives of distress, speaking to the need to address the broader patriarchal society for prevention of psychological distress in young women.

Though study participants did not relate their concerns to the spate of violence against lesbians that has been prominently reported in the national news (Kinama 2011; Timms 2011), their fear of negative responses and prejudice to disclosure cannot be detached from this context. Invariably, these attacks happen in Black townships similar to where participants in this study came from. This creates a sense of insecurity and disempowerment to those who publicly identify as being lesbian. Though the South African Constitution protects the rights of sexual minorities (South African Government Information 1996), young lesbian women may feel disempowered by structural violence that is rife in townships.

This paper is important as there is very little published literature that explores young people’s experiences of distress in South Africa from their perspective. It is based on a relatively large sample of interviews, with both young men and women and has enabled new ground to be broken in terms of understanding young people’s mental health. These interviews provided a good opportunity for participants to talk about their experiences however they should be interpreted within the context from which they were generated. This was qualitative research and participants were not randomly selected so these findings cannot be generalised to include the wider population of young people. It is important to recognise that participants’ emphasis on problems, interpretation and attributions of their experiences are highly subjective and may change over time, and that their lives have multiple realities. Therefore accounts of experiences and perceptions described here do not represent the full life histories, but dominant narratives in a spectrum of problems that participants chose to speak about at the time. These are none the less of interest and provide important insights into the lives and preoccupations of the young people interviewed. In addition, participants are expected to have positive experiences in their lives though these were not the focus of the study. The scope of inquiry did not extend to discussion of coping strategies or positive aspects of the lives of participants.


Psychological distress is highly prevalent among the youth and has serious consequences for their well-being and physical and mental health. This small, exploratory study has provided important insights into sources of psychological distress for a group of young rural South Africans. Whilst we cannot generalise from their accounts, they highlight many issues which are widely shared by youth in the country. These include the vulnerability of young people to family distress, tensions and conflict, especially after bereavement, when families are dysfunctional and when fathers are not present or playing an active role in their children’s lives. We have shown that in the lives of these young people, their power within families was critically influenced by their material resources, but also by the status and respect accorded to their (usually) mother within the family, as well as their gender. Where children lacked power, they were vulnerable to a range of misfortunes and forms of exploitation as relatively impoverished families fought over meager resources. These findings highlight the importance of interventions to protect both children (under 18s) and young adults after bereavement and when living in contexts of alternative care. Efforts to strengthen livelihoods in the broadest sense are important, including economic and social capital. Given the constraints placed on youth by rules of respect, and limited access to and knowledge about legal processes, youth and child counselling and advocacy services could make a significant contribution to reducing young people’s distress.


We thank all the participants for sharing their life stories in this study. We extend a special appreciation to Nosiphe Mxoli and Mrs Vuyelwa Mphithi who were very helpful in assisting with field work logistics. Collection of data for this paper was made possible by funding from the Africa Regional Sexuality Resources Centre and the Faculty of Humanities at the University of Witwatersrand. The writing of this publication was supported by the Carnegie Foundation through the University of the Witwatersrand’s Transformation Office.

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© Springer Science+Business Media, LLC 2012