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It’s a Disease not a Deity: Mental Health in Africa.

Four years ago, when I was working as an intern in Psychiatry, a story about a witch who had been caught in a surbub in Harare trended on social media. Apparently she was on her way to her next victim when she got trapped by some witch doctor’s magic. Pictures of this middle aged woman totally naked and obviously disinhibited, circulated widely on social media. Her story was further given credibility by the fact that she actually confessed to being a witch who had magical powers and who fed on humans and rode on hyenas. 

To any African who has spent some time on the motherland, there is nothing unusual about this story, as much as it sounds like a scene from a horror movie it actually is a true story. A few days later this lady ended up in our psychiatric unit, having passed through a witch doctor’s shrine, a prophet’s shrine and the police. After a very comprehensive assessment she was diagnosed with schizophrenia, put on the appropriate treatment and alas, she was not a witch after all but a wife and a mother who suffered from mental illness. She had a hazy recollection of what had happened but the social worker managed to track her family who confirmed that there was a history of mental illness in the family and and she had always exhibited “strange” behaviour.

In Africa mental illness is is not well understood, and being a group of disorders on a wide spectrum, the patients are also viewed on an even wider spectrum that ranges from being discriminated against to being revered as possessing divine powers. Our societies are reluctant to seek help for those afflicted with mental illness, instead they are either shunned or indulged. It is not unusual for a person who suffers from mental illness to claim that they have special abilities that other people do not possess, or that they see and hear things that other people are unaware of.

  • Delusions – fixed beliefs that are not amenable to change in light of conflicting evidence. Their content may include a variety of themes (e.g. persecutory, religious, grandiose) usually a result of mental illness.

  • Hallucinations – an experience involving the apparent perception of something not present. ( visual, auditory, olfactory etc )

In the village that I grew up in there was a woman who was believed to have supernatural powers. She occasionally heard voices and saw people that other people could not see. Her whole family and the whole village believed that her dead ancestors spoke to the family through her, she was a spirit medium. She was known to wander away from home and disappear for days, the villagers believed this to be part of her process. While I wouldn’t want to antagonize some beliefs, I am convinced that this woman had a mental illness which resulted in visual and auditory hallucinations, possibly delusions. The fact that her illness was indulged and even celebrated may have reinforced her hallucinations.

Our culture has never accepted mental illness, this denial has been passed down generations. Many unseen forces have been blamed for these disorders. Even though modern medicine has tried to explain the causes of mental illness, somehow it does not seem to be enough. The decades of fear, ignorance and even worship of mental illness has resulted in a deep seated stigma that has become a barrier to seeking help. 

In today’s societies we still have some individuals who claim to hear some deity’s voice (God, Ancestors, Angels etc) sometimes they even claim to see them. Because we are so desperate for miracles we fail to separate those who need help from those who are just conmen. There are those on the other end of the spectrum of mental illness who wander the streets unkempt. Even children ( the next generation) have learnt to call them derogatory names and at times even throw stones at them. As long as this is the culture we have towards mental illness, any advances in modern medicine will not ease the burden. A new approach is required.

Recent surveys in Zimbabwe have shown that cases of mental illness are on the rise.

For any national problem to be solved, the government needs to show commitment. Our governments in Africa have not demonstrated this commitment beyonds words. In Zimbabwe we do not have rehabilitation facilities worth talking about. Most of the facilities we have are treatment centers and even these are not more than 5 for the whole country. Similarly the number of psychiatrists in the country can be counted on one’s fingers.

While the fight against “politically correct” diseases like HIV/AIDS, TB and malaria are largely funded by NGOs and donors, mental health seems to be a neglected area. This imbalance needs to be addressed in order to make productive citizens out of our brothers and sisters who have the potential to contribute towards building our economies.

The end…..

drtendai writes in his own capacity, the views expressed are his own. Follow him on twitter @conmut

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