Sunday, April 2, 2023

The forgotten people

There is widespread ignorance and stigma about mental illness which leads to marginalization of people who are mentally unwell, writes MESH MOETI
He never imaged it could happen to him.

The man has asked that his names be withheld. This is his story. He grew up a happy and bubbly child, perhaps a bit on the hyper side. From very early, he showed an inclination towards the performing arts ÔÇô particularly music. A recording career was one of the constant fantasies.

In 1996, he enrolled at Molepolole College of Education, to train to teach RE and Music. Being at college was like standing on a raised ground to view a horizon of endless possibilities. With a formal qualification in music, perhaps even a recording deal was possible afterall.

Then it happened.

He can’t put a finger to the cause, but speculates that it probably had to do with the excitement of being on campus, and the thought that he was inching close to his ambitions. The school sent an urgent dispatch to his family that he had been acting very strange, and most probably needed professional assistance.

At the time he didn’t know it, but medical science would diagnose his condition as bipolar mood disorder.

“I would get exceedingly excited,” he recalls. “Everything just goes on the extreme; you’re highly elated, you overspend, your appetite goes up, your sex drive increases.”
Bipolar mood disorder falls into the family of mood disorders, which include depression and mania.

The mood disorders are among the main psychiatric disorders that affect adults such as schizophrenia and related psychotic disorders; disorders related to anxiety, stress and adjustment; substance use disorders; as well as dementia and other cognitive disorders.

Available statistics from the Central Statistics Office website show that there were 40 223 outpatient attendances in Botswana for people with mental illness in 2006. Three years earlier, in 2003, the number was 29 520. Records at Sbrana Psychiatric Hospital, the country’s only specialist referral facility, indicate that in 2009 there were 1 244 admissions (67% males; 33% females), and 5 914 outpatient attendances (49% males; 51% females), while last year the numbers stood at 1 371 admissions (65% males; 35% females), and 5 073 outpatient attendances (51% males; 49% females).

Out of last year’s 1 371 admissions, 600 were new patients while 771 were repeat admissions. Of the 5 073 outpatients in the same year, 650 were new attendances while 4423 were repeat attendances.

Dr. Mpho Thula, the Acting Hospital Superintendent at Sbrana Psychiatric Hospital, explains that mental illness is caused by a combination of different things. These include the genetic make-up or genetic predisposition of an individual combined with environmental factors such as drug and alcohol abuse, family problems, stress, and a difficult up-bringing (for instance, social deprivation, physical or sexual abuse). Other factors which increase the likelihood of mental illness include brain damage and illnesses which affect the brain such as epilepsy, HIV/AIDS, stroke and other brain lesions. People with chronic illnesses are also prone to mental illness, particularly mood disorders such as depression.

There is also a hereditary component to most mental illnesses. Schizophrenia, for example, has a relatively high heritability. While the lifetime risk of the general population is 1%, if somebody has one parent with schizophrenia then their risk of having the illness rises to 13%. If both parents have schizophrenia, then their child has a 46% risk of suffering from the same illness. The risk is 9% for the sibling of a patient and 5% for the grandchild of a patient.

In the case of the man, as in many other cases, there was no family history of mental illness.

While statistics of people attending local psychiatric services over the years show an increase, Dr. Thula points out that no research has been carried out to find out if this conclusively means that there is a growth in psychiatric morbidity in Botswana. He puts the increase in the numbers recorded to various explanations, which include more people seeking assistance than before because they are more enlightened about mental illness; medical facilities being more widespread and more accessible; a decrease in stigma associated with mental illness resulting in people being more comfortable to seek help; as well as the country’s growing urbanization which results in traditional ways of dealing with mental illness (such as consulting traditional healers) being inaccessible or obsolete.

Close scrutiny of the numbers from Sbrana Psychiatric Hospital indicates that for admissions, the most affected age groups are 21-30 years, followed by 31-40 years, and then 41-50 years. For outpatient attendances, the largest age groups are 25-44 years, followed by 45-64 years, then 15 -24 years.

Dr. Thula explains that the reason the 20-40 age bracket is over-represented in the statistics is because it is the age range when most mental illnesses peak. For instance, schizophrenia is mostly diagnosed between 15-25years in males and 25-35 years in females. Depression peaks at the age range 30-40years while bipolar affective disorders peak at the age bracket 25-30, which is the age bracket the man whose story opens this article was in when his illness set in.

There is widespread stigma attached to mental illness. Our source talks of many friends lost, and a family divided by how to deal with his condition. He observes that any ailment is a lonely experience ÔÇô and mental illness is even lonelier.

“People can become inhuman when you have been through a dehumanizing experience,” he states.

Over the years, he has learnt to live with snide remarks such as, “mothaka yo o kile a ya Mental”, or “kana wena monna o ja ditlhare”. His major dilemma is that he’s never sure if a statement of that nature is made in jest, or as a slur meant to put him down.

“Fortunately, I don’t allow [negative] things to get in the way I relate with other people. You can’t stop people making such remarks. I managed to pull through because even as I was going through my illness I never considered myself a mad person,” he says.

He does admit that in the beginning it was difficult to handle ÔÇô so difficult that he once attempted suicide by overdosing on his medication. Fortunately, it wasn’t toxic.

“Part of the frustration was that I found myself not knowing how to define who I had become. Wherever I looked I saw gloom. So I thought, ‘let me go to another place, if there’s such a place’. I had lost hope,” he says.

Dr. Thula explains that the presence of social stigma results in people hiding away when they have mental illness and not seeking treatment early, leading to longer periods before recovery and sometimes incomplete recovery. The fear of stigma is blamed for driving people to improper and sometimes dangerous treatment from unregulated practitioners like traditional doctors because treatment there is more secretive.

At another level, stigma leads to marginalization of the mentally unwell resulting in difficulties to resettle them into society following treatment in hospital. Dr. Thula talks of various stereotypes that are formed about people with mental illness. In the process, they are shunned, disadvantaged at work, and have to live with derogatory remarks. This marginalization is sometimes held responsible for patients stopping treatment to prove that they are not “mad” so as to fit into society, which ultimately leads to multiple relapses.

Just where do you start to remove stigma from mental illness?

Dr. Thula raises a number of points. First, society needs to be educated about mental illness to understand it properly and get rid of distorted stereotypes held about people with mental illness. The assumption is that this will promote better social inclusion of those with mental illness and ensure that they develop more social networks, which could help in their recovery.
Employers also need to come into the picture and be encouraged to avoid discriminating against workers with mental illness. Dr. Thula asserts that people with mental illness are regularly denied entry into professions and progression even when they have the required competencies.

He makes an argument for government policies and schemes meant to uplift and promote equality for people with disabilities to incorporate and address the social disadvantages and equality issues of those with mental health problems and learning disabilities.

Then he holds the mirror to the news media, which he describes as a source of negative stereotypes about people with mental illness, and says media organisations should use their influence to combat ÔÇô rather than ÔÇô exacerbate stigma.

“Media reporting on mental health issues is sometimes not only offensive in the terminology they use against those with mental illness, leaving them open to ridicule, but is sensationalistic and creates inaccurate perceptions about those with mental illness being violent and out of control,” he observes.

As with many other medical conditions, the support of family and friends is crucial for recovery from mental illness. As well as respecting someone’s confidentiality, Dr. Thula advises that family and friends have to offer encouragement, and monitor that the individuals takes medication and conforms to the doctor’s treatment plan. Being there for someone requires being supportive and not afraid or avoid the person. He says colleagues should champion the individual’s rights against discrimination at work and from the public.

“They have to know what to do or when to seek help if the condition is not improving, is deteriorating or there is an emergency. They have to be able to recognize, watch out for and seek help when the individual develops side-effects from medication,” he says.

He states that some illnesses are curable, while others are not. Depression can be permanently cured in some individuals. However, it can become recurrent in other people. The same applies to illnesses such as anxiety, post-traumatic stress disorder and phobias. Illnesses such as schizophrenia and bipolar affective disorder tend to be chronic (relapsing and remitting) and may require long-term treatment.

And now for a wow ending.

The student teacher managed to make up for a lost academic year, and graduated. He teaches at a junior secondary school in Gaborone. Now aged 36, he’s a married father of two. With acceptance of his condition, came the ability to observe and manage it.

“These days I take things easy,” he says. “I count myself fortunate to have been able to recover and achieve what I have achieved. I know that a lot of people in similar circumstances have not made it.”

He still believes he can do something with his music talent ÔÇô someday perhaps.


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