Understanding mental illness in the African context

A mentally ill man at his "residence" in Manzini, Swaziland

On the 10^th of this month, the world commemorated Mental Health Day. I have decided to also add my little voice to raise awareness as I really don’t think enough noise is made in Africa regarding issues of mental health. They are among the least understood conditions on the continent. In the countries that I’ve resided in – Zimbabwe, South Africa and Swaziland, the trend is almost similar. People believe that mental illness is not a medical, but spiritual condition. Where there is mental illness, there has to be an enemy involved, a dark-hearted aunt who doesn’t want to see his brother’s children progress, a jealous neighbour or an ugly witching grandmother. Alternatively, the illness is attributed to avenging spirits. Sometimes there are tales of an ancestor that murdered someone whose spirit is not at peace and is now manifesting in the form of mental illness in the affected individual.

In my mother language, Shona, there is no distinction among different forms of mental health conditions. There are various ways of describing it, which are largely derogatory without being distinctive. While in English there are names for mental conditions such as depression, bipolar disorder, schizophrenia, and eating, anxiety, obsessive-compulsive and post-traumatic stress disorders as well as neurodevelopmental conditions such as autism and Down Syndrome, in Shona, anyone with a mental condition is simply called benzi (mad person) or “sascam”, (derived from Salisbury Association for the Care of the African Mentally Handicapped, an organisation in pre-independent Zimbabwe) if they have a mild disorder or learning difficulties. Those who throw such terms around might not realise how terrible they are, until someone in their circle is affected. Poking fun at mental conditions or any condition that afflicts other people for that matter, while targeted at demeaning those affected actually makes the offending person stand out for their ignorance. I’m really convinced that people are not educated enough on mental health, which results in people who might be mentally ill or depressed avoiding seeing psychiatrist because thereof the vile stigma attached to mental illnesses, with very adverse consequences sometimes.

The belief that mental illnesses are only spiritual attacks is what has resulted in many mentally ill people sometimes getting neglected and roaming around the streets because some people believe they cannot be helped in hospitals. In some cases, mentally ill people pose a danger to themselves and the community, which is why it is essential for them to get help. Dr Violet Mwanjali, a Psychiatrist and Mental Health Specialist, said the majority of mental illnesses, among them depression and suicide, could be totally treated if those affected consulted mental health professionals. Those illnesses that cannot be treated can be managed, the same way ailments like diabetes and hypertension can. People with mental illness can lead normal, fulfilling lives if they get the correct help and take their medication as prescribed. There is, however, a disturbing trend of people neglecting to take their medication whenever they feel better. They would hate to take the medication because once people know that you take medication for a mental illness, song and dance will be made out of it. Asthmatics and diabetics fall short of sticking their inhalers and insulin injections on their foreheads because they are not ashamed of their ailments. Mental illness, however, has to be hidden at all costs because it’s regarded as shameful and evil. My friend, Sihle, was telling me a nurse told her most people ended up not taking medication because pastors or spiritual healers encouraged them to do so believing they were healed by the holy spirit. I’ve seen that happen a lot.  Some people say if you believe in Jesus don’t take medication. But I believe it is God that leads me to the right places so that I can get the help I need. It would be folly to reject that help because doctors were created by Him so that they could help us.

I really pray that more is done to enlighten people on mental conditions so that they can be supportive to affected individuals, who with the right support, can also be contributing members of society. 

Appalling treatment of mentally ill people in Swaziland

A story published in last week’s Observer on Saturday about the appalling state of the National Psychiatric Centre was quite heartbreaking.  It appears people have just written off the patients at the hospital.

The story painted a bleak picture of patient-neglect as mentally ill people are living in very humiliating conditions where the hospital is flooding owing to poor drainage. It does not only rain but pours for these fellow members of our society, literally and figuratively. Not only do they have to live in less than ideal circumstances, they also have to contend with insensitive journalists who use derogatory terms to refer to mental illness. It now appears everybody is out to get them.

On January 22 2015, there was a headline in The Observer that referred to an alleged robber suspected to be mentally ill as a “nutcase”. More recently, on May 18, there was another story headlined “Stark raving lunaticson the loose in Siteki”. Now, that is a very insensitive way of referring to fellow citizens of the kingdom. The story published in May highlighted how there was an influx of mentally handicapped people in Siteki, with some of them accused of committing serious crimes. That is a huge concern that calls for prompt intervention and screaming headlines, but not those that are insulting to the mentally ill.

Following the offending headline, I spoke to Psychiatrist and Mental Health Specialist, Dr Violet Mwanjali, to get an understanding of the facts around mental illness. She defined mental illness as any illness that affects the mind, and there are many of them affecting thousands of people in the country. Schizophrenia, depression, bipolar,  autism, and eating, anxiety, obsessive-compulsive and post-traumatic stress disorders are examples.  

Dr Mwanjali called on the people of Swaziland to come together in managing mental illness so that it does not end up having adverse effects on society, such as crime, violence, broken families and suicides. It should never be forgotten that some mentally ill people are also caregivers, and failure to get treatment might result in them losing their jobs and failing to cater for their families, like paying school fees and buying food, for example.  Mental illness, very unfortunately, is one of the illnesses that suffer a lot of discrimination from the less informed. This discrimination, said Dr Mwanjali, is among the major impediments to treating mental illness.

It is worse when the discrimination is perpetuated by the media, because society usually takes what newspapers say as the gospel truth, and when headlines call mentally ill people “nutcases” and “stark raving lunatics”, some members of society will believe that it is acceptable to throw around such ugly names. 

 “Mentally ill people delay going to the hospital, even when they see the symptoms. Sometimes they are afraid to collect their medication because they are afraid that people will see them and laugh. They then end up with complications because they are afraid of the labels,” Dr Mwanjali said.

The state of affairs at the National Psychiatric Centre at the moment does not encourage anyone to go and seek treatment. Nobody wants to live in such a wretched fashion. Apart from drainage system malfunction, there is also overcrowding, which has seen some of the patients having to sleep on the wet floor as water seeps into their dormitories. Apart from the existing ailments they have, they might end up picking new ones as a result of the deplorable living conditions. If patients have to walk on human waste in an effort to take a bath, doesn’t it negate the whole idea of taking a bath in the first place?

Vision 2022 must certainly look like a castle in the air for patients at the Psychiatric Centre. In progressive countries a building like that would be condemned as it is not safe for human habitation, and those who ran discriminatory headlines would be censured.

We should never be seen to be taking advantage of those that cannot speak for themselves. We would never be that nasty to people with HIV, because they have the mental capacity to stand up and fight for themselves and a big stink, excuse the pun, would be raised by organisations that represent them. People with HIV and other ailments are also being hauled before the courts for committing crimes, but they are not profiled as is done with the mentally ill.

 Dr Mwanjali said the majority of mental illnesses, among them depression and suicide, could be totally treated if those affected consulted mental health professionals. Those illnesses that could not be treated could be managed, the same way ailments like diabetes and hypertension are. People with mental illness can lead normal, fulfilling lives if they get the correct help and take their medication as prescribed. They need moral support so that they do not feel that they have to deal with their condition all by themselves. Supporting them also involves accompanying them to the hospital as soon as signs of mental illness are noticed. Other family members also need to understand how the medication should be administered, just in case the patient is incapacitated to remember by himself.

What’s worrying now is that the conditions under which mentally ill people live might exacerbate feelings of desolation. I would feel despondent too if I had to be woken up at night to wipe away sewage water from the floor.

There is a saying that goes, “The greatest measure of society is in how it treats its vulnerable members.” What is happening at the Psychiatric Centre is shocking and deplorable. The patients there are real people, not shadows. They have aspirations to get better and get on with life like everybody else.  They are somebody’s mother, father, child, or aunt. They deserve to be treated with dignity. There are associations for the deaf, those with HIV, epilepsy and other conditions, but who stands for the mentally ill in Swaziland? Surely people can come together and forego a few luxuries to ensure that the ablution facilities at the Psychiatric Centre are fixed? The world is too rich to allow vulnerable citizens of the country to live like that. Hefty sums of money are being offered for the protection of the rhino, and we must believe there’s nothing for mentally ill human beings? It doesn’t make sense.  Let us be our brother’s keeper.

 Published in Sunday Observer

Related:
Discussion on high suicide rate in Swaziland

No hope for the human race

The Metro Music Awards were held on March 1, and what happened during, and after, the band Big Nuz's performance broke my heart to smithereens. 

One of the band members Sibusiso Khomo, popularly known as R. Mashesha has been in the media spotlight for a while now because of his ill health. On Saturday there was evidence of weight loss on his part, and twitterverse descended on him like a tonne of bricks. Speculation is rife that he is HIV positive and twitter was abuzz! Mean comments were irresponsibly thrown around, comments that will surely break his heart when he gets to read or hear about them. Jokes about his health were cracked left, right and centre, with some people asking: "Are we sure they're splitting the money equally?", insinuating that Khomo's weight loss was caused by starvation owing to getting a raw deal from his fellow band members. Some wrote "010 - that's Big Nuz with R Mashesha in the middle", others called him the toothpick from Big Nuz. When did someone's poor health evolve to entertainment? I can't wrap my head around that. 

No-one has Khomo's medical records to prove he indeed has HIV, and even if he does, does it make it OK to find that hilarious? Where does the indecency to laugh like a pack of hyenas at someone's suffering come from? If he had cancer or some other illness, people would have been compassionate. I would have thought at this point in time we would be educated enough not to stigmatise those with HIV. Billboards about stopping the stigma are peppered everywhere, there are countless drama series covering that too, lots of money has been spent towards that cause. But evidently no-one is listening. 

Some of the people who said mean things are probably people who respected R Mashesha before he got ill , now they've reduced to the butt of every sick HIV joke. Does one lose respect for being ill or having HIV? Such attitude counteracts all the efforts that have been made to ensure people get to know their HIV status. Who wants to get tested and risk having salt rubbed into their wounds should they be found to be HIV positive? 

I'm not even a Big Nuz fan but I'm thinking of anybody else who is in Khomo's shoes and has too endure dirty looks and being kicked while they are down. 

In this day and age of technological advancement, it is unwise to act so thoughtlessly on public platforms. It will come back to haunt you one day because once it's out there, it's out there like an unstoppable inferno. Prospective employers might dig all that up and not want to offer a job to an imbecile that just throws insults around. Once you make such comments, you've made your cyber footprint.

One day the grandchildren of the grandchildren of those insensitive people will be able to read the cruel things their ancestors tweeted about. Instead of remembering them with respect , all they will do is shake their heads in disbelief and disgust and say, "What a moron grandpa/ grandma was!" 

And all I can say now is what a shame, what a crying shame!