For many years mental disorders have been looked at as a mind-blowing concept in African cultures. People did not understand why their neighbors, family members or the neighborhood scraper acted the way that they did and would immediately just call them crazy and walk away, not knowing that it is deeper than that and very much diagnosable and treatable. This lack of knowledge has made it a lot harder for Africans living with mental disorders to attempt to feel ‘normal’. This paper holds a short discussion on the stigmatization, negative attitudes, marginalizing and discrimination that people suffering from mental disorders are faced with; how the governments of Africa have ruled mental disorders as a low priority; the comorbidity between mental and physical health and a comparison between the Western culture and the African culture.
According to the American Psychiatric Association (2013), a “mental illness is a general term describing a range of disorders that affect thinking, behavior and mood. Mental disorder is a more specific term that describes a condition characterized by clinically significant disruption in various aspects of mental functioning”. Over many years in the African culture, mental disorders have been looked at as a curse cast upon them by local witchdoctors, a demonic possession or even evil spirits. They never had the slightest idea that these disorders where actually diagnosable and manageable because they simply lacked this knowledge. But as time has progressed, many African countries have embraced psychology and finally taken the time to understand and find adequate treatment for their people with these various mental illnesses. Unfortunately, the rural areas, and surprisingly some urban areas too, still have the traditional way of thinking. Although a single view point on mental health isn’t possible in Africa, seeing as the continent has 54 countries that all have different cultures and beliefs, there still have been similarities in ways that it had and has been approached.
Stigmatization, negative attitudes, marginalizing and discrimination as a result of mental illnesses have been prevalent throughout the years making it a lot harder for people to seek help in fear of being shunned from society. These cultural influences have impacted the continent in a negative way in regard to psychiatric treatment. In the West, disorders are deemed a private matter between the patient and therapist, in contrast with Africa where disorders are intervened by society and religion seeing as Africa is predominantly a collectivist culture, so to be shunned away due to ways beyond you can be difficult. Disorders like Schizophrenia, where people lose touch with reality and start to have hallucinations and delusions and Bipolar, where people fluctuate between manic and depressive episodes have culturally been looked at as demonic possessions. Many families in villages and even urban areas fell prey to shame if one of their members were visibly mentally ill and as a result discrimate against their own. If my own family can have negative attitudes towards me, how can the society accept me? Is a question that many of these people ask themselves, leading them to living a very lonely life at times and not getting the help that they need. And ironically, when they do indeed attempt to get the help that they need, they may find themselves in mental health facilities that give inhumane and degrading living conditions.
Ampofo (1978) proposed that “for the African, the original concept of nature includes simultaneously the physical world and the social environment of both the living and the dead, together with the metaphysical forces of the universe. This concept is fundamental to grasp traditional African medicine in all its dimensions” (as cited in Johnson, 1994). Many times, treatments for such illnesses was by a ‘traditional healer’, giving mixtures of herbs or performing rituals but unfortunately these ‘treatments’ were only temporary and would end up being a financial burden on the patients. Forster (1971) confirmed that,
In precolonial times, the traditional healer was alone in helping people solve their health problems. Nowadays, there is no doubt that 75%, or more, of the rural population has no alternative to traditional healers. In both rural and urban areas, the majority of African people initially consult a traditional healer with their health problems, then a modern Western-trained physician, and finally, return to the traditional healer for a total healing or reconciliation with the community. (as cited in Johnson, 1994)
After a while though, this treatment, as stated before, becomes expensive so they stop seeking treatment all together. According to Lund (2018), absence of treatment is the norm rather than the exception across the continent. The “treatment gap” – the proportion of people with mental illness who don’t get treatment – ranges from 75% in South Africa to more than 90% in Ethiopia and Nigeria.
Some mental illnesses can be termed very Western, anorexia nervosa for example. Njenga (2007) illustrated, “trying to explain to the hungry African mother and child that there are girls who die in Western countries because they refuse to eat food goes beyond reason and logic and would not make sense as a mental disorder, and yet in the West, there is no room for such a discussion”. Their lack of food is only due to poverty, so if they did have food but actively refused it with the intent to look a certain way would be absolutely ridiculous. Also, some ‘illnesses’ are shunned in African context yet embraced in the Western culture, homosexuality for example. Homosexuality was classified in the DSM for many years as a mental disorder but as time progressed, people in the West began to be more liberal but this didn’t mean that the African culture would follow suit. Many times, homosexuality is described as demonic and call religion for intervention.
Comorbidity between mental and physical health was found in Africa. Many times, when a person is suffering from a mental disorder, they end up falling sick to diagnosable diseases as well. Lund (2018) highlighted that “a study in Ethiopia showed that people living with severe mental illness – conditions like schizophrenia, bipolar mood disorder and severe depression – died 30 years earlier than the general population, mainly from infectious causes”. It shows that when a mind is weak, the body is more vulnerable to physical illness seeing as the immune system equally weakens. Mental health is held to low priority when it comes to the health infrastructure and plans seeing as infections like HIV, tuberculosis and malaria have caused epidemics making us forget that mental health is also a silent epidemic. The lack of knowledge by the society, lack of mental health policies and specialists funded by the government makes it a lot harder to tackle this issue. According to the World Health Organization (2005) data, 53 per cent of countries have no mental health policy. And according to Daar et al. (2014), on average, most countries in Africa spend less than 1% of their limited health budgets on mental health care (as cited in Monteiro, 2015). Fortunately, psychiatric treatments and education on the topic were gradually introduced during the late 19th century and early 20th century from European countries, so a lot more can be achieved on helping patients if implemented.
So, in conclusion, mental health in Africa is still held to an alarmingly low priority which is leaving many people in this continent untreated and discriminated against. With time, knowledge about these illnesses and treatments should spread, as many people are now more interested in going to learning institutions to gain further knowledge on psychology and psychiatric treatment. With the help of the governments in Africa, proper equipment and facilities should be brought up to help with diagnosis and containing the prognosis of multiple mental disorders. The positive note about all of this is that there has been visible progress on how mental illnesses are approached.