Mental health in Africa: the stigma and the suffering
It’s time to face up to the real mental health issues on the African continent, argues Caleb Onah.
For about three months, various problems in Debbie’s life threw her into a deep depression. Everything started with the struggle to find a new job. After years of an easy life, she suddenly had to set and achieve new goals and things just got harder and harder.
After a while, she gave up, convinced she couldn’t manage it. She was lost and confused about her future, not knowing what she wanted anymore. She lost all motivation and faith in herself and the world around her. This dissatisfaction with herself soon began to affect other aspects of her life, especially her relationships with her family, relatives and close friends. She was very far from the things, and people, she had once loved. Her emotions got ever more out of control and her depression intensified.
Even though she kept up her smile and happy face, inside she was screaming for someone to realise how unhappy she was.
Her sadness turned to anger and she became angry at the world, at herself and everyone else. Even as her mental health counsellor, I had a share of this. She started taking out her anger on her family, constantly fighting with everyone even at the slightest provocation. She was just lost and vented her frustration on others.
As dramatic as this situation might seem, the amazing thing is that after only three counselling sessions, she quickly began to improve and was able to find an outlet for her emotions in writing, music, and drawing.
By putting everything down on paper, and by expressing herself in dancing and singing, Debbie (which of course is not her real name) started to think more clearly and understand how she feels.
Things started to improve when she finally decided to talk about her situation. Suddenly everything wasn’t so bad anymore. She opened up more to her friends, and after tears and reflection, she soon realised there are other people like her. It was as if a heavy burden had been lifted off her shoulders.
As she gradually overcame her depression, she began to learn more about life. It’s not easy, but it’s not that hard either. Difficult times and experiences make us better and stronger.
This is a practical, real-life experience of depression in our African society. And it goes without saying that I have Debbie’s permission to relate all this, so that others can be helped by what she had to go through, and hopefully avoid it themselves.
Living in Africa for over 20 years, I have learned that our countries have competing health and development priorities, but lack the means to address them all. The result is a severe lack of psychiatric and mental healthcare. Data recorded in health care systems do not include mental health, which contributes to an underestimation of the problem in continental African countries. And this lack of the necessary data then means that politicians and policymakers are unable to understand the depth of the mental health challenges African countries face.
Worldwide, 300 million people suffer from a depressive disorder, and about 80% of sufferers in low-income countries do not receive treatment. In my practice, I see depression levels as high as 30% in the people we have treated.
Despite the high prevalence of mental illness on the African continent, mental health remains a low priority.
Limited mental health education and awareness, shame and stigma are significant barriers, as well as name calling, teasing and punishment. This is what most people living with mental illness and problems in our communities have to face, which often stems from a lack of awareness and understanding of mental illness and its treatments. Yet my experience with depressed clients has made me a mental health optimist in Nigeria.
This might sound contradictory given the scenario I have just outlined, but what I really mean is that the experience of working with patients with poor mental health gives me hope that Nigerian society is becoming more open to dialogue and taking action for mental health.
I hope that by sharing my experience, I can play a small part in bringing about this change and help to solve some of the mental health challenges we Africans are facing.
Like other African countries, Nigeria still has a lot of stigmas around mental health. In my personal experience as a mental health counsellor, I often find people around me looking to their faith to overcome mental health issues.
Certainly faith can have a positive effect, giving people hope in God, and, although this is not the place to discuss his existence, if he does exist he might well help them. Though there can be forms of madness linked to religions, as there can be forms of madness linked to other aspects of life, one certainly comes across many people who are helped to remain optimistic and positive through their faith. And the decline of faith in the West certainly does not seem to be improving mental health.
However, in such a religious culture as Nigeria, there can be the tendency to seek a spiritual solution to everything, and even on occasions a superstitious one, and this does not help. Priests in the West often have more experience in distinguishing between what needs prayer and spiritual support and what requires professional psychological help. As one priest told me, “There are situations where I realise I simply don’t have the competence to deal with them.” I find there is not this same level of experience in my country.
I have also noticed there is a close relationship between body and soul. Often the body leads and the soul follows. When the body is severely injured, it drags down the soul like a metal ball tied to the ankle. Indeed, I’ve found that one of the most effective ways to build one’s faith begins with the body, and it certainly contributes to mental health.
Exercising, going for a walk, or basking in the sun will make you feel better. The blood and oxygen circulating through one’s body refreshes and nourishes it. When you feel better, you can think and see things more clearly. This was certainly the case with one client who had sessions with me after the Covid-19 pandemic in November, 2021.
But while a healthy lifestyle can bring comfort, strength, and healing, there is also the risk that some people with clinical mental illness do not always receive the professional support and treatment they need.
A suspicion of psychological care pervades our society and means we are sometimes reluctant to discuss mental health as freely as our physical health and often do not realise that professional support for mental health is available.
But I think this is starting to change and think raising more awareness can play a big role in further changing the narrative.
In December 2021, I met another patient suffering from depression due to unemployment and divorce from her husband. Her depression made her feel there was no bright future and no way forward in life. With the increased stress from the aftermath of the COVID-19 pandemic, her mental state deteriorated and at one point she felt suicidal.
Only when she reached rock bottom did she realise she needed help. But as her counsellor, I found her to be a generally optimistic positive person and I was able to sort out a treatment session for her.
In her own words after our first counselling session, which I quote with her permission, she said, “I realised during counselling that my depression was related to an unresolved trauma in my past, including high school bullying, anxiety issues, poverty and failed marriage”.
While she knows that all her problems haven’t gone away, counselling has given her a new perspective, helping her to become a more resilient and self-confident person. Above all she has found meaning in the struggles she went through. She is now better able to recognise the possible causes of other anxieties she is experiencing and she is much more open about her own feelings without worrying about the reactions of her friends, colleagues and her family.
My observations further suggest that she is also inspired by the music she listens to, the books she reads and the places she visits and has incorporated yoga, meditation and exercise into her regimen and changed her diet.
In her words, “I’ve found that being open about my mental health challenges and experiences, despite my background, experience and status, helps others open up about their struggles and love each other. Ask for help when you need it”, she concluded.
People with mental health issues fear that family and friends will avoid them, treat them differently, or disclose information about their mental health state, leading to adverse attitudes and perceptions at work, at home, and in their communities.
In Nigeria particularly, we are inefficient, inadequate and unfair in managing people’s mental health. Because of the high cost of treatment, most of us have no choice but to live with an untreated mental disorder or consult an alternative traditional leader, use traditional herbs, or go to spiritual deities for healing.
It’s time that faith and mental health practitioners worked together, each one respecting the remit and competence of the other. Then together we can help to remove the stigma around mental health in our continent and give suffering people the support and care they need, and deserve.
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Not all countries regard the same issues with full seriousness. It is sad that mental health is not a top priority in a country’s health care agenda.