Hello again everyone!
As I begin writing my report on mental illness within the African population, I cannot help but notice a common theme. It is the fact that stigma toward those with mental illnesses seems to be relentless throughout the literature. Whether it is a focus of the research or not, it continues to be a common thread in most literature findings; and a contributing cause in the continuance of mental illness in the African population.
Although my previous intention of this blog was to discuss viable strategies to combat mental illness within this population, I feel that none will be viable until we begin to acknowledge this deep-rooted, and perpetuating issue—which is stigma against those with mental illness. For instance, as observed throughout the literature, the two most common themes regarding stigma toward those who are mentally ill in Africa are either (1) seen as an act of punishment for a person’s personal faults, or (2) the result of supernatural powers/being possessed and the person needing some kind of spiritual intervention (Workneh, 2016). Other factors such as level of education also seemed to be an underlying factor in whether people exhibited stigma toward mentally ill individuals. These reasons for stigma toward the mentally ill are difficult to resolve since they have long been ingrained in Africa’s cultural, social and religious institutions.
For example, Eritrea is a war-torn country in East Africa, and as a result, many citizens suffer from mental illnesses such as depression, anxiety and post-traumatic stress disorder (Medecins Sans Frontieres [MSF], 2018). Citizens involved in war activities are often thrown in jail when captured, and the conditions are horrendous. For instance, the conditions citizens are made to live in involve little to no food, minimal water, and are placed in a hole in the ground with around 80 other people in one room; a room with no windows, no lights and not even enough space to lie down comfortably (MSF, 2018). Thus based on these conditions, it seems inevitable that citizens of Eritrea, or anyone for that matter, would suffer some kind of mental distress and illnesses related to such experiences (MSF, 2018). Despite these expected outcomes, many citizens are still afraid to come forward and seek treatment due to the stigma related to mental illnesses and being labelled “crazy” (Voices from the field, 2018). Albeit, in 2015, a mental health project launched by Medecins Sans Frontieres (MSF) was developed to address mental illnesses related to the effects of war. To counteract challenges such as citizens—also called refugees—not wanting to discuss their mental health openly, community health workers (CMHWs) were hired to provide door-to-door culturally appropriate awareness raising, education, and de-stigmatization of mental illness (MSF, 2018). Every-day the CMHWs would go from shelter to shelter and explain how mental illnesses/issues manifest themselves, treatment that is available and why it is necessary to seek help (MSF, 2018). As a result, the program began to see that citizens felt reassured that others were experiencing the same issues they were, and this made them feel less isolated (MSF, 2018). Now, the program has 26 CMHWs and provides counselling sessions to around 2,800 citizens, and 3,600 psychiatric consultations per year (MSF, 2018).
Moreover, it also offers primary and secondary health care services along with 24/7 inpatient care and ambulance referral services to citizens needing urgent care (MSF, 2018). Therefore, it can be observed from this example that once people are made to feel like they belong and their symptoms are validated/legitimized, then they will feel more comfortable coming forward and seeking treatment. Similar findings were also evident throughout my research. Whether it be via advocacy strategies directed toward political crowds such as policy makers or community education sessions directed to toward improving social acceptance within communities, individuals affected by mental health issues always felt more comfortable coming forward and seeking treatment when their illness was legitimized as an issue worth discussing and investing in.
However, it is also important to remember that the issue of stigma toward those who are mentally ill is also farther reaching than just being relevant to the African population. As it is, unfortunately, an issue that propagates in all populations, and hence, is a global problem. This is why I think it is a critical discussion at this point since we can develop and implement as many mental health strategies as we want, but if a correct understanding of the illness is not acknowledged, these strategies will be merely actions; resulting in no meaning or understanding as to why they are required. The problem with this line of thinking is that it devalues the health issue. Moreover, if people do not think the health issue is an issue, then it will be placed at the bottom of the priority list. This can be witnessed in many African countries, for far too long non-communicable diseases such as mental illnesses/disorders have been viewed as a bottom level priority, with a higher focus on communicable diseases such as HIV. Thus, it is time for mental illness to be finally viewed as a priority, and for these individuals to receive the care they rightfully deserve. To do this, stigma must be addressed, and at all levels—community, political, and socially.
To provide a more precise visualization of how stigma affects mentally ill individuals daily and the compounding effect it can have on the health issue over-time, I cannot help but refer to a social experiment by filmmakers of the United Nations Children’s Fund. The experiment involves filming a six-year-old girl named Anna walking into a busy food court in two very different outfits and witnessing very different reactions among patrons. The outfits ranged from (1) a smart and tidy looking attire to (2) a grubby and dirty looking attire. The researchers sent this little girl into the same busy food court, each time with the different attire (i.e., clean vs. dirty), and each time she had a different experience based on what her outward appearance/narrative was telling citizens. For instance, the first experience involved her entering the food court alone and dressed in her smart and tidy looking attire—this was an enjoyable experience for her, as patrons expressed genuine concern for her well-being and asked why she was alone if she needed help finding her parents/guardians, etc. The little girl was feeling great about herself and had a good perception of society after the first experiment. However, the second experiment ended much differently. The researchers sent the same little girl into the same busy food court but this time she was dressed in her grubby and dirty looking attire, patrons were not so friendly and willing to help this time. Instead, the food court patrons stared at the little girl, whispered about her, exhibited fear as a result of her presence, and not one person asked her where her parents were or even tried to talk to her. The researchers conducted the same experience in several different venues like outside on the street and in a busy restaurant, but the outcomes were the same—clean Anna equated to a positive experience with society and dirty Anna equated to a negative experience with society. The overall experience became so emotionally overwhelming for the little girl that she eventually could not take the unwarranted ridicule, disgust, and rejection that she fled the experiment in tears. Although this was a social experiment involving a little “homeless” girl, it is, unfortunately, an actual scenario that happens if not every day, then at least several times a day, to individuals who have a mental illness. Except these individuals cannot run or hide, and often, they do not have loving arms to embrace them as Anna did. Further, and as noted in my research, these individuals are not only ridiculed by peers, social support networks and other citizens but governments, health care workers, and policymakers—the individuals who make decisions about the care they receive and services they are offered. Thus, you can see from this example that stigma based on ones outward appearance certainly exists, and since a symptom of mental illness tends to cause these individuals to exhibit the same dirty and un-kept appearance as Anna, they too are unfairly judged and treated poorly by society much like Anna was.
For a visual representation of stigma associated with the above experiment, see below:
This is the busy food court, and Anna dressed in outfit (1) smart and tidy.
This is the busy food court, and Anna dressed in outfit (2) grubby and dirty.
This picture depicts Anna seeking a much needed and deserved warm embrace from her mother after the ordeal.
Here’s a link to the full video:
To conclude, when dealing with any health issues, particularly those that tend to evoke fear, discomfort such as mental illnesses, please must heed the adage “Do not judge a book by its cover.” As people are more than their illnesses/diseases, and hence, outward narratives. Thus, those involved in the treatment/care of mentally ill individuals can accomplish this by using Sir William Osler’s brilliant quote, “remember to treat the person who has the disease/symptoms”, rather than just the disease/symptoms, as the former understands not only the illness but the context of the individual's illness.
Medecins Sans Frontieres (MSF). (2018). Fighting stigma and providing mental health to Eritrean refugees. Voices from the Field. Retrieved from https://www.msf.org/fighting-stigma-and-providing-mental-health-eritrean-refugees
Workneh, L. (2016). New film by Ethiopian nurse combats mental health stigmas in Africa. Huffington Post: BLACK VOICES. Retrieved from https://www.huffingtonpost.ca/entry/new-film-by-ethiopian-nurse-combats-mental-health-stigmas-in-africa_us_57acdd7ee4b071840410663b