Accepting our imperfections
Judith Ancer on SA’s mental health
Aquestion all too infrequently asked of mental health professionals is: “Who will help the helpers?” One might expect a person whose job is to heal the pain of others to be weighed down by all she has to absorb, her own happiness infected by the constant barrage of anxiety and sadness she confronts every day.
And yet Judith Ancer, speaking on Zoom from her home office in Greenside, Johannesburg, exudes positivity and joy.
Ancer insists she is no sentimentalist, but she does believe in finding the good that hides in dark places.
“I’m not Pollyanna,” she says in relation to lockdown and Covid-19. “I’m not saying we should look on the bright side of pandemics. But there have been some unanticipated pleasures and benefits.”
For Ancer, the pleasure has been more time with her husband, an English teacher, and their 19-yearold son.
“The privilege of spending time with a young adult child who otherwise would have been out in the world has been lovely,” she says. “But the world is a very hard place. Lockdown might have had unexpected benefits for those in good circumstances, with income, who are still working, but for those in intolerable relationships, for people who have young children or financial stress, it is incredibly hard.”
A clinical psychologist in private practice, Ancer devotes much of her time to supervising and training other mental health professionals. During the first few weeks of lockdown, she and a handful of colleagues established the Healthcare Workers Care Network.
“Lockdown was happening and there we were, largely people in private practice, and a few of us connected to ask how we could offer support to health-care workers. We’d seen what was coming out of China, Italy and the UK, the stress that frontline health-care workers were under. Not just doctors and nurses — laundry staff, janitors, paramedics, cleaners, orderlies and community health-care workers are all on the frontline
“We developed this two-tiered approach. The first prong is to train and sensitise managers to have a compassionate leadership model, to understand how to manage teams, because the research shows that the better a manager handles a team, with more compassion and thoughtfulness, the better the team does.
“The second prong is a 24/7 toll-free helpline that anybody working in health care can phone to get counselling support. Within weeks a whole national network sprang up. We have over 600 psychologists, psychiatrists, GPs and registered counsellors available, and it’s all voluntary.
“When I do online talks for health-care workers now, I talk about the thing that will get us through the pandemic: hope. And this is the most hopeful thing I’ve done in a long time.”
She is less sanguine about how mental health professionals are viewed in SA. “One of the struggles around mental health is that government and industry and the third-party payers, the health insurers and medical aids, pay absolute lip service to mental health as a priority.
“We see so much about the mental health pandemic that’s on us, that’s coming, that will be the second pandemic, not just for health-care workers but for all people because of what we are facing. But in fact, in SA, the vast majority of psychologists are in private practice, not because we want to be but because there are hardly any jobs in the public sector. People want those public posts, they are sought after, but they just aren’t there.”
To those who argue that state money should be spent on people’s physical needs before it can go to the “luxury” of mental health services, Ancer says: “Mental health services are expensive to fund, but the value is huge. If people are well, both physically and mentally, they can be more resourceful.”
What does it mean to be mentally well? Apart from the obvious — not suffering from a mental illness and not being subject to any form of external abuse or deprivation — Ancer thinks it has to do with accepting imperfection, both our own shortcomings and the failings of others.
A running theme in her therapy sessions recently has been failure, she says. People feel let down by themselves, the government, those around them or their parents.
“A lot of people feel their parents failed them. Those parents might have been abusive or neglectful, but more often were just very imperfect and thoughtless. There’s a sense of: ‘How do I become an adult in the world if I’ve never been properly parented?’ At a global level, I think people keep looking for the idealised parent who will make the world better, but I don’t think there’s ever been an adult in the room. The world has always been run by people who have their own interests. So one of the current crises as I see it is the sense that there aren’t grown-ups running the world who we can rely on to make us feel safe. We’re left with financial insecurity, doubts, flip-flopping and irrationality in policy.”
In the absence of certainty, people look for false news and scapegoats, which Ancer thinks “adds to the sense of distress that ordinary people feel in what was already a polarised world”.
She is grateful for being so busy during lockdown. “People who have not been able to work, who have not been busy, I think that’s dreadful: the solitude, the loneliness, the anxiety. I’ve been thinking about what makes life meaningful when it is difficult and what I think makes the pandemic bearable is connectedness and hope. But it’s hard, if you’re not working or not earning. That’s terrifying.”
Ancer’s strong drive for social justice and easing the burdens of others arose partly from the history she was taught as “a middle-class Jewish girl”, she says.
“I think part of why I became a psychologist was because I grew up knowing about the Holocaust, and feeling quite anxious. I remember as a child wondering who would hide us if the Nazis came. This might be why I have such a strong identification for the plight of people who are treated unjustly, marginalised people.”
Women, in many senses, are still marginalised. Ancer agrees that “women are disproportionately going to bear the brunt and the savage consequences of the lockdown”.
She refers to the “double-shift” concept, whereby women go out to workplaces and then come home to deal with all the household chores. “Some fathers are stepping up, but by and large women still carry the pressures of schooling and child care. Child care is still predominantly women’s work, even if some small parts of the world are changing.”
Ancer’s long-running parenting column in the Sunday Times made her, she jokes, “the bête noire of daughters-in-law”.
“I’m sure I was hated by all the daughters-in-law who had my advice pushed on them,” she laughs. “Women were always telling me: ‘I cut out your article and gave it to my daughter-in-law.’ ”
She is disarmingly frank about her own imperfections, particularly when it comes to parenting.
“When I had my child, who is now 19 and an irritating Gen Z-er (he knows everything of course) — a colleague said to me: ‘I hope you’re not going to become one of those psychologists who just wants to talk about parenting,’ and I said: ‘Oh no, I’m much deeper than that,’ but of course when I became a parent it was apparent to me that it was the hardest thing I’d ever done.”
She began doing more parenting work as a psychologist, because it mirrored her interest in tolerating imperfection.
“There’s a lot of psychological theory around the difficult feelings that being a parent causes: how do you do the best for your child when you’re struggling yourself, how children make you feel powerful — in the sense that you could really damage them — but also powerless, because you can’t make them do what you want. You’re supposed to be in control but not controlling; you’re supposed to be responsible but not joyless. All those terrible messages that women in particular have to absorb and manage.”
This has led to a busy schedule of supportive talks, lately given online, to parents, teachers and pupils. In therapy her work involves mostly listening, but she jokes that she “comes from a family of talkers”. Her father, an advocate, taught her the value of a good argument. One of her formative memories is of him travelling constantly to Pretoria Central to visit the accused in the “Soweto 11” trial.
“He was on the defence team for those teenagers — who were young adults when the trial finally happened — accused of starting the Soweto uprising in 1976. They were up for high treason and sedition and could have got the death penalty, but they got fairly light sentences, which was remarkable.
“My role, and this is my whole role in the struggle, when I was about 12, is that I would make a cake for each of the accused when it was their birthday and my father would take it to them. Towards the end of the trial, they sent me a thank-you card made out of a cardboard biscuit box. Each of them had written a note and signed it, and I was so overwhelmed — we still didn’t know what would happen to them and I just cried. The saddest thing for me is that now I don’t know where that card is and I feel like, damn, my role in the struggle and I can’t even prove it!”
This takes us back to talk of facing one’s imperfections. Ancer says when she went to Wits University to study psychology in the late 1980s she “wanted to be a struggle person but was also a ninny. I would go to the marches but I’d want to be near the back so that if everyone had to turn around and run
I’d be near the front, because I was a very slow runner. It’s a terrible tension when your sense of justice collides with your sense of neurotic anxiety. I wish I could say I did more than bake cakes and run at the back of a march.”
She finds it offensive when people say the struggle is over, or apartheid is over, because so much inherited trauma and disadvantage is still with us. Another subject that gets Ancer’s dander up is the underfunding of early childhood development (ECD).
“Part of this lip service paid to parenting and ‘women’s work’ is that the government doesn’t fund early childhood development properly. It’s horrifying. To think that we can wait till grade R is too late. The fundamentals of literacy, of how to learn in the world, how to be in the world, and of feeling safe in the world, start with early child care.
“There are NGOs that offer parenting support and mental health support — Family Life Centre, JPCCC [Johannesburg Parent & Child Counselling Centre], Rape Crisis and many others that are not funded by government. The lottery has failed them. These places offer services that should be provided by the state.”
This week, a nationwide campaign has been protesting vociferously about the lack of financial support for the ECD sector. According to a statement released by the C19 People’s Coalition: “Without support, some 30,000 ECD centres across the country are set to close their doors permanently. Almost 1-million children will be affected by the closure of these centres and 1-million other jobs that depend on access to child care will be affected.”
Ancer applauds those who make a noise about such travesties. “My trigger is unfairness and injustice. I can’t bear inconsiderate people,” she says.
Despite her self-deprecating jokes, in addition to multiple jobs Ancer is chair of her suburb’s residents’ association, which makes her the target of many and varied quibbles. As we speak she receives a text from a local restaurant owner asking: “Is smoking legal?”
Despite the frustrations of this position, Ancer says: “I felt like if I wanted to make a difference to my community I had to step up. I hate committees. I hate meetings. I’m lazy. I like watching Netflix and drinking tea, and I’m busy, but I kept thinking: ‘I can’t complain if I don’t try to help.’ You always get the people who say: ‘We’re paying rates and taxes, why should we do anything else?’ But if we don’t do it, who will?”
In the gaps between dealing with residents’ queries, giving therapy and public talks, working with the voluntary helpline, supervising other professionals, listening to podcasts, playing Candy Crush and completing a book on mental health in the workplace (co-authored with industrial psychology professor Karen Milner), Ancer goes for walks and reflects, among other things, on imperfection.
“Child psychoanalyst Donald Winnicott said that the mistakes are not just inevitable — whether you’re a parent or a psychotherapist or a leader — they’re actually necessary because the mistake allows for the repair. In a relationship, when someone makes a mistake and there is the capacity for repair, that builds strength. The problem is if the mistakes are too big … when our governments betray us, that’s not just a rupture we can learn from. Maybe that’s why it’s so hard at the moment. But the best we can do, in the small world we occupy, is to try and understand that all relationships, all endeavours, are compromises. Nothing is perfect. I suppose that’s what I hope for my clients to learn, to tolerate their imperfections.
“I have to learn to tolerate mine. When I joke about being a coward I wish I wasn’t that but I am and I’ve had to work on it. If you have no fear then it takes no courage to do something. Courage only comes from fear.”
‘One of the crises is the sense that there aren’t grown-ups running the world who we can rely on to make us feel safe’
‘I’m lazy. I like watching Netflix and drinking tea, but I kept thinking: “I can’t complain if I don’t try to help” ’