Psychiatric Illness in Ghana

Psychiatric Illness in Ghana

by E. Ofori Akyea

The Medical Director of the Accra Psychiatric Hospital and acting Chief Psychiatrist, Dr. Akwasi Osei has, in the course of the previous weeks been speaking to the media about the situation of psychiatry in Ghana. The more I listened to him there more I became alarmed and felt frustrated that a significant part of our population is not well enough to enjoy life to the full.

A lot more needs to be done to bring patients and their treatment to acceptable levels. The real impact of their plight hits me each time I drive around Accra and elsewhere in our country. OurI have also seen how the mentally sick are treated in Prayer Camps as well as in Traditional Healing Centres dotted around the country.

The impact of the gravity of the problem hits me when I recall the slogan that “the mind is a terrible thing to waste” or words to that effect. At the time that we need all hands on deck, so to speak, we sit by to see a significant group of our own citizenry wasting away.

Dr. Osei mentioned that about 10 per cent of the total population of any country suffered from schizophrenia. We need to take account of the other manifestations of mental illness such as depression. Our country needs to tackle with urgency and vigour a problem involving significant numbers of our compatriots and by extension almost all of us. The manifestation of the illness in a family inevitably takes in large numbers of the population.

Schizophrenia, according to Webster’s Dictionary, refers to a major mental disorder of unknown cause typically characterized by a separation between the thought processes and the emotions, a distortion of reality accompanied by delusions and hallucination frequently characterized by a fragmentation of the personality, motor disturbances, bizarre behaviour and so on often with no loss of basic intellectual functions.

The causes of some other mental illnesses like drug and alcohol abuse are known. Researchers are making a lot of progress in identifying the causes and treatment for depression, for example. We learn that large majority of the inmates of the Psychiatric hospital are women with marital problems

In this piece we shall concentrate on the popular or cultural attitudes that are hampering the effective treatment of mental patients

Culturally, a family feels stigmatized when a member is said to be a mental case. Every effort is made to keep the ill person out of sight. However, when the person is sent to the Psychiatric Hospital the family visits. It is when they are discharged that families do not take them in as Dr. Asare points out in his comments

One has the feeling that the community is unforgiving in their attitude towards those who fall outside the circle. This why the promotion of community based treatment, although an uphill task, is to be encouraged.

In a society where people do not marry necessarily for love but arranged as a liaison between families one of the key questions asked about the prospective bride or groom is to find out if someone has had mental problems in either family. The confirmation of the fact in either family could lead to the immediate termination of all negotiations.

In these days when love plays a large part in the marriage of partners it is not uncommon for a man or a woman to be called aside by the mother or an elder to ask if he or she has determined if there are no insane person in the partner’s family. The belief is that insanity, like criminal behaviour, run in families. One is, therefore, to make sure that no negative trait is introduced into the family.

The other reason that the community is unforgiving of mental patients is that the only reason that brings about mental illness is that the person who is ill or some one in the family must have committed a heinous crime. The family against whom the crime was committed would invoke the help of a powerful shrine to punish the perpetrator of the crime. Either there would be lots of people dying or becoming insane in the offending family. These punishments or the prospect of being so harshly dealt with become powerful instruments of social control.

In traditional societies mental illness is the result of spiritual forces. The traditional society is regulated by powerful unseen forces. If the society and its members follow diligently the precepts of the protective deity everything would be fine. No one understands why a perfectly sane person wakes up one day and starts behaving in a most irrational manner. Nothing, however, happens without a reason. There are mediums who can find answers to all manner of problems.

Let us consider the following fictional situation. Why is my headache still persisting in spite of all the medications that I have been taking? Could it be that after the argument about seniority that I had with that colleague he went to see that powerful spiritualist to put a curse on me? And just about that time that the headaches begun my girlfriend walked out on me. I also received a message that my mother was ill in our hometown. I wonder what’s going on. I need to look into this matter with some care. I shall go to see my uncle next weekend. He would certainly know who can handle this matter. And so the questions that have spiralled out of control take one on to some strange paths and leading to a psychosomatic situation.

And this is where the Prayer Camps come in. Being part of a group where the traditional belief is that mental illness is the result of a curse the prayer camp operators attribute mental illness to demons and to sin. In the Gospels, as indeed, in the Bible there are many references to the attribution of madness to the presence of demons. In one spectacular instance the demons beg Jesus not to destroy them when he cast them out of the two violent madmen. He then orders them to enter into a herd of swine. The herd is eventually drowned in the lake. It is interesting to note that the Jews regard pigs as unclean.

The prayer camp spiritualists see their task as working to cast out the devil from taking possession of the patient. In doing this they often resort to extreme methods bordering on torture. The poor ill persons are shackled and chained to tree stumps. The ways they are restrained make it almost impossible to stand, lie or sleep comfortably. They are left to the elements. Their feeding is most irregular and inadequate. A lot of the treatment consists of long spells of fasting and prayer interspersed with anointing sessions. This kind of treatment leaves the patient weak and disoriented. On occasion this state is interpreted as progress in the cure

The above treatment is not limited to Prayer Camps. There are Traditional Medicine men who specialize in the cure of mentally ill patients. In the traditional camps there is the use of herbs to carry the cure along. Since the problem of the mental illness lies in the head most of the herbs are administered through the nose. To prevent the patient from escaping they are most of the time restrained much like in the Prayer Camps.

In traditional treatment and I find that this happens also in the Prayer Camps, a major cause of mental sickness is attributed to witchcraft. We are surrounded by a host of witches. We do not know exactly who our enemies are. This is why some people hide their wealth so as not to attract the attention of witches and wizards. These creatures are up to no good. Small or large mishaps are of their doing. Once you are targeted by them you require the services of a powerful specialist to rescue you from their clutches.

In a short article like this one cannot explore in detail the many causes of mental illness in our society. Suffice it to say that the society has many norms that one has to understand and live by. Any infraction, however minor, exacts dire consequences. Short of dying one becomes deranged. The precept seems to be that to survive one has to do good to all manner of persons both seen and unseen in order to survive being sane.

In a changing society such as ours there is a phenomenon that must engage our attention. We should be disturbed by the daily stories of drugs and alcohol that fill columns of our press. Apart from corrupting our society these two items are actually destroying our youth. According to the World Health Organization and our specialist psychiatrists more and more of our young people are falling under the spell of alcohol and drugs. We seem not to care. We read about them, we see them in the streets and we seem to say out of sight out of mind. When last did you talk about these problems with a young person or persons that you know even slightly?

I am continually amazed when my nephews and their friends tell me of some of their friends who are in psychiatric hospitals with advanced mental health problems. The numbers are going up. We can no longer look the other way. If we do nothing now it will, like someone says, be like offering our heads with which to crack a coconut. We should not be surprised if we do not live to eat the fruit of the coconut.