By Kagure Mugo
‘White people have therapists and Black people have Jesus.’
This is how the conversation seems to go when the issue of mental health comes up. When one begins to broach the subject of having depression you are told to start smiling ‘or we will get the Pastor to come and pray for you.’
For many it was something that is seen as being far away, something that happens to teenagers on American TV or wealthy white girls who ride ponies in the United Kingdom. I must admit that I was one of these people.
Experiences in secondary school increasingly convinced me that issues of mental health were ones of privilege and wealth, somewhat akin to trying to figure out if your Porsche needs custom seat warmers or the standard ones are sufficient. It was something that was aligned to certain global regions, certain ways of life, and to a larger extent a certain race. I ascribed to the school of thought that doctors were for ‘real illnesses’. Proper things like cancer or chronic kidney failure. If you wanted to you could go the Bill Gates route and throw polio on that list.
Mental health was mainly about getting it together and getting happy. I preferred if you kept those Western tendencies in check as black people sucked it up and kept it moving. However, with time and experience being the best teachers I begun to increasingly learn this was not the case.
Years later I find myself sitting and waiting for a friend at a local government hospital psychiatric unit during visiting hours. I look around and I see a family waiting for their mother, a woman crying whilst her daughter holds her and a man trying to engage with his son. All brown like me, and none of them confining themselves to the barely furnished beige ward because they want to, but because they need to. Their presence here is no more self-inflicted than the people in the maternity trauma ward a little way down the hall.
Recently Chimamanda Adichie’s documenting of her struggle with depression was released by the Guardian Network. The article was subsequently removed but not before quite a few people had gotten wind of it. Many had attempted to reblog it and some had posted the original link stating that they ‘understood how this felt’ or how this was a brave conversation to have. With such a prominent person speaking on the issue seemingly the seeds for it were sown. The candidness of such a prominent figure within the continent speaking on an issue seemed set to do for mental illness what Binyavanga Wainaina seemingly did for sexuality. However, once the article was pulled the focus shifted and it became about the drama of publishing something that she did not want published.
And with that the conversation seemed to end before it could even properly begin.
Much as one must respect Chimamanda’s privacy the withdrawal of the article reflects a common occurrence in terms of engaging with mental health on the continent, namely a continual silence. Due to the stigma and misunderstanding surrounding mental health issues often those who experience it do not seek help. Many stay quiet due to the fact that seeking help could possibly be met with disbelief, exasperation or general misunderstanding.
Of the many pathologies the human body can suffer ones involving the brain are the most difficult to understand for a number of reasons. The first is the extremely complex nature of it which makes it difficult to understand. From the medication to the nature of the treatment in the form of therapists it is difficult to conceptualise the path to recovery, or if there is even one.
Another problem with understanding it is simply, seeing is believing.
One can show signs of cancer, one can express symptoms of chronic kidney failure, one can see a cold, but it is very difficult to see that someone’s mind is at this moment in time working against them. It is a difficult thing to understand because humankind’s need for social interaction means one simply relates things to oneself in order to understand.
So if someone tells you they are suffering from depression you think ‘They are sad. I have been sad. But now I am not. So they can stop being sad as well.‘
Problem is that is not how it works.
To think of it medically, comparing sadness to depression is the equivalent of comparing being shot with a toy gun to a gunshot wound. It is simply not the same thing. Through the act of shaming people who would speak out on mental issues we have done the equivalent of shaming someone with a chronic disease into silence. By telling them that they must put a smile on and keep going we are giving advice that is as helpful as ‘put some Dettol and cotton wool on that gunshot wound, will clean it right up.’ We have left them extremely vulnerable in a way that would not be allowed for other severe illnesses. You tell someone with skin cancer to just ‘put on a little bit more lotion and sunscreen?’
Studies show that within South Africa 1 in 3 people suffer from a mental illness with more than 17 million people dealing with depression, bipolar disorder, anxiety and schizophrenia amongst other conditions. As many as 75 percent will not disclose this and, in turn, not seek help. That is 12.75 million people in South Africa alone.
Data also shows that 90 percent of people who remain untreated for schizophrenia live within developing countries.
Understandably not everyone can be a therapist in the same way not everyone can be a cardiovascular surgeon thus the call is not to try and counsel but simply to provide support; encouraging people to be able to speak and, in turn, seek help rather than be dismissive.
In terms of help within the continent in South Africa there are some institutions such as TARA which cater for in-patient care and allow for persons to engage with activities such as group work within a controlled environment. However private institutions can cost up to R2700 a night.
Within government hospitals there are also facilities but there are not nearly enough. It is simply not seen as a priority. The Department of Health in South Africa spends approximately 4% of its budget dealing with the crisis. There is an extreme shortage of psychiatric nurses, psychiatrists and psychologists as well as facilities. This is despite the fact that there is a clear problem when no year can go by without one hearing of a suicide on some university campus, or a policeman shooting both himself and partner.
Within Nigeria it is commonly known that the mentally ill are to rely on spiritual relief rather than medical. In some cases the cure is worse than the disease. There are many within the country who turn to spiritual healers who enact various ‘therapies’ including being shackled in small windowless rooms. Some have herbs placed into incisions within their head. Many are deemed to have spirits.
Within the country there are fewer than 200 psychiatrists working within a population of upwards of 168 million.
The options for mental health care in Africa range from meagre to very scary. All of this happens in a context in which many countries have experienced and continue to experience heightened levels of violence and destruction. We cannot simply state that those who escape these situations must just ‘keep it trucking’ because the effects (such as PTSD) manifest themselves much later in extremely distressing ways.
With the surge of global movement in the form of immigrants, refugees and all other manners of travellers this stops being one country’s problem and becomes a regional issue. We shall pay the cost of not setting up the requisite structure even when everything settles down because we will have a lot of people who physically escaped something but mentally did not. This goes a lot further than ‘people are sad’.
Mental health needs to begin to form a part of the general health care framework, both on a policy level and within rhetoric. It is not just about Aids anymore.
The World Health organisation has released data showing that depression will be the leading cause of disability overtaking Aids as a leading cause with about 350 million people experiencing it.
We unfortunately can no longer simply state that ‘Africans have Jesus’ because this is our reality. As much as prayer can be a good thing, pragmatism also goes a long way.
This was first published on This Is Africa.
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