Inxeba Elinga Phakathi: The Danger of Mental Health Invisibility and the Role of Social Community Caregiving

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for sharing your thoughts and this writing. It is an important topic. 

The strength of this article is that you are pulling from a distinct positionality to make sense of mental health from the context of South Africa and Indigenous community. Thank you for sharing these concepts and proverbs with us. The history and events you shared, such as those after COVID-19, help the reader gain a deeper understanding of the community in South Africa and continued responses to trauma that is faced.  

Some areas of improvement you might consider is how you bring all these diverse and complex topics together. There were some areas where the structure could be improved, and where your analysis could be further developed. Some areas were difficult to make sense of your point, or how you were connecting Indigenous methodology to scripture. 

Another point you might consider is the diversity of mental health, including depression. You talked about concepts such as harmony and belonging. I am interested to know more about how amaXhosa make sense of these concepts and some of the ways that they are expressed in everyday life. This would greatly enrich the article. 

Thank you for sharing. 

Comments for author File: Comments.pdf

Author Response

The abstract has been revised to clearly articulate the scope of the article, with specific reference to Black South African women. This refinement provides a more precise and informative overview of the article’s focus and intent (Lines 9–15).

Lines 26–28: Relevant references have now been incorporated to strengthen the argument.

Lines 40–41: These concerns have been addressed by refining the abstract to improve both clarity and thematic focus.

Line 52: The sentence has been removed, as per your suggestion.

Line 59: The work of De Vincenzo et al. (2024) is now appropriately cited in this section.

Methodology:

This section has been significantly expanded to provide deeper insight into the research framework and to ensure alignment with the article’s epistemological and conceptual commitments.

Reviewer 2 Report

Comments and Suggestions for Authors I found this article refreshing.   The author theorises inxeba elingaphakathi  and applies this to two narratives of Black women's lives and their relationship with their own mental health and healing, in particular as a response to debilitating stigma. The "role of indigenous storytelling and social community caregiving is unpacked, along with the societal factors that contribute to mental health challenges and  their impact on the community, illustrated through narrative examples." [lines 47-48]   This is not a scientific article but one that positions mental health and healing within an Indigenous epistemology. The author cites two authoritative sources to support the link to mental health stigma, and stress and responding in the Ubuntu paradigm. The author positions herself through the concept of ukuzithutha and acknowledges her biases, citing authoritative precedents for this approach.   Within health literature where Western perspectives and epistemologies are dominant, it is original in topic, scope and authorship. From a Western perspective, It addresses a gap in the field because Western approaches to mental health can be reductionist in ignoring the psycho-social-emotional mechanisms underpinning mental health and healing and the structural and historical harms that continue to exert effects in the present. From this perspective it offers a valuable critical lens.   It offers the perspective of mental health and healing as it is conceptualised within the umXhosa culture.  It offers an example of how local, traditional and cultural knowledge can be considered to better understand the context within which bio-psycho-social wellbeing can be supported.   -The author might consider:

1. Positioning the need for this analysis by explicitly stating an accessible, relevant rationale, e.g. self-determination, inappropriate framing, ineffective social marketing... This justification is possibly alluded to in the citations used in the introduction, but it would be good to make this explicit.
2. Acknowledging the gap between Western psychiatry and Indigenous knowledge of metal health by referring to a discussion of the topic, for example the discussion in https://journals.sagepub.com/doi/full/10.1177/13634615211038167?casa_token=pfNxBezRRXkAAAAA%3A2HqaybfATtLfKajggDuf-VF71xxVC326rpLjysdTb-ySrkdYKXhZuGGGOtiCMAskIyzVrLDFnalw6g
3. Consider linking the aims of the article to notions of mental health as they are defined by the World Helth Organisation  https://www.who.int/health-topics/mental-health#tab=tab_1 and the importance of stigma reduction and improved health determinants, including self-determination and freedom from discrimination.

Please provide citation(s) to support the importance of belonging and stigma reduction in the following statement at lines 374-376: "For someone struggling with mental health, the need for belonging is paramount. 374 The stigma surrounding mental illness often fosters a profound sense of isolation and displacement. These lyrics offer a powerful counter-narrative, restoring a sense of belonging and hope."   The conclusions are supported by the analysis which presents evidence of culturally framed responses to mental health are conceptualised through inclusive social mechanisms, collaboration and empathy. Examples of how this manifests in a cultural context are necessary to communicate the concept; attempting to reduce this to analytical words and mechanisms will dilute the concept.    Please provide one or two concrete, practical examples for how the conclusions could be translated into practice.
References are appropriate.

Author Response

We thank you for highlighting the need to explicitly position the rationale and aims of the article.

Lines 40–59: The article now explicitly articulates the need for this analysis by foregrounding the significance of self-determination and challenging dominant narratives that often misrepresent or silence Black South African women. The revised section makes clear the article’s resistance to frameworks that portray them as passive recipients of care, drawing on both local and global literature to justify this stance.

Lines 40–73: The manuscript now acknowledges the epistemological gap between Western psychiatry and Indigenous understandings of mental health. We have incorporated a reference to the discussion found in the following article to support this point:

https://journals.sagepub.com/doi/full/10.1177/13634615211038167

Lines 40–73: We have also linked the aims of the article to global mental health frameworks, specifically those defined by the World Health Organization. The revised section emphasizes the importance of stigma reduction, self-determination, and freedom from discrimination as central to mental health and well-being.

(See: https://www.who.int/health-topics/mental-health#tab=tab_1)

Lines 374–378: The importance of belonging, particularly in relation to stigma and isolation, is now supported with relevant scholarly citations. These additions affirm the significance of belonging in mental health recovery and strengthen the paragraph’s argument.

Reviewer 3 Report

Comments and Suggestions for Authors

Dear Author/s,

 

I would like to extend my congratulation, and gratitude, for your research paper, which I found really well-written and interesting.

As you will see from the PDF I provide, there are just few minor issues I raised regarding a restructure of the Abstract, which I think would benefit the readers, as well as other minor readjustements in the logical presentations of the arguments, that sometimes are difficult to grasp.

A minor note is also presented in the Method section, where I invite you, if possibile, to share more about indigenous epistemologies and their position in contemporary social theory.

Well done!

Comments for author File: Comments.pdf

Author Response

Thank you for your detailed observations on clarity, language, and structural flow. All points have been addressed as follows:

Line 28: The punctuation issue has been corrected.

Line 44: The appearance of methodology in the introduction has been clarified.

Line 52: The sentence has been deleted.

Line 67: This line has been expanded to offer further explanation.

Line 70: Concrete examples of self-praise are now provided.

Lines 77–78: The Bible verse has been removed, as suggested, due to its lack of contextual relevance.

Lines 138–139: The content has been further clarified.

Line 154: The term “trauma” has been replaced with “inner wound” for conceptual accuracy and consistency with the article’s framing.

Line 166: The concept in question has been further explained.

Line 185: The section has been contextualized to enhance clarity.

Lines 238–240: This portion has been removed.

Line 252: The argument here has been strengthened with additional support.

 

We appreciate the time, expertise, and care that each reviewer brought to this process. Your feedback has greatly contributed to the depth and precision of the final version of this article.