Mental Health and Social Suffering in Africa
Summary of the public meeting with Prof. Kleinman and Dr. Igreja.

 

22nd of November 2007 | Faculty of Social Sciences, Leiden University | In cooperation with the African Studies Centre in Leiden

 

 

- Aangezien deze activiteit in het Engels was, is er ook enkel een Engels verslag -

 

kleinmanOn Thursday the 22nd of November, many students and interesting profesionals, working in the field of mental health, gathered for this public meeting. To begin with, Prof. Dr. Arthur Kleinman, psychiatrist and professor of Medical Anthropology at Harvard University, and Dr. Victor Igreja, fellow at the Netherlands Institute for Advanced Study in the Humanities and Social Sciences in Wassenaar, were the two keynote speakers of the afternoon. Prof. Allan V. Horwitz was the discussant and Dr. Ria Reis was chairlady. This summary will give a short overview of the issues addressed in the two keynote speeches of the afternoon.

 

Mr. Kleinman started with an introduction on research regarding mental health that has taken place all over the world. One of the most important conclusions is that there are many different ways to treat mental health. Many different views exist on mental illnesses like schizophrenia, depression, fear and thus there are many different ways to treat these.

 

Kleinman continued to speak about a few African countries and the present condition of their public health system and which position mental health has within this system. One of the most important findings was that, in most countries, there is a severe lack of epidemiological data. Thus, it becomes very difficult to get a good idea of the situation regarding the mental health of its populations and subsequently it raises difficulties for setting up mental health care programmes. In many poor countries, the development of mental health care programmes is far from a priority. Mental health care programmes, or community based care, do exist, but there is very little training available. Research has taught us that it is possible to train personnel to recognize mental illnesses, but these illnesses (even when diagnoses' are hardly ever treated).

 

The following problem areas were summed up by Kleinman: the present health care system, intervention that comes too late, the lack of financial resources for mental illnesses and the quality of care. Another problem, which lies on a more ethical level, is that there seems to be severe lack of moral dedication to the subject. This also has much to do with the financial means that are available, but that are just not allocated to the mental health sector.

 

The political world needs to start paying more attention to mental health and has to start taking responsibility when it comes to the proper functioning of the health system. The political and economical problems, as well as the difficulties that arise when actually giving care to people, all amount to the present situation in which people with serious mental illnesses are suffering needlessly and even die.

 

 

number_of_psychiatrists_per_100_000_population

Number of psychiatrists per 100,000 population (Project atlas, WHO 2001)

 

Kleinman's suggestions for future research are: what is the list of problems that we need to address, what are the side-effects of these problems on mental illnesses, and which political and social aspects are tied to this? Furthermore, Kleinman is of the opinion that the mental health care practitioners have failed in terms of supporting non-Western societies. When one looks at where they work, one sees that they concentrate themselves first and foremost in Europe and North America. This also counts for the pharmaceutical industries, because these do not feel the African market is profitable enough for their business.

 

Thus, there are many different problems we face when it comes to the way we cope with and treat mental illnesses, especially those that occur in poorer countries.

 

igrejaMr. Igreja's lecture provided us with an interesting view of the mental health situation in the Southern African country of Mozambique. In this country, as of 2005, there did not exist an official state policy on mental health care. Furthermore, no evaluations were being done on mental health care projects, so there is no way of knowing if these had a positive effect.

 

 

In his research, Igreja focused on state and community responses to social suffering in post-colonial Africa. This topic is not addressed very often as it is a very complex one. There are regional differences in Africa on the way people respond to social suffering, but overall there are three consistent realities:

 

  • There is a lack of human and financial resources being allocated to mental health care.
  • There is a wide prevalence of infectious diseases such as malaria and malnutrition and there are also no resources to address these issues.
  • Mental illness is a serious problem everywhere across Africa and is on the rise due to wars, natural disasters etcetera.

 

Thus, there is a great need for setting clear priorities: policymakers need to prioritize investments as mental health care hardly receives any. This is forms a certain paradox, because the World Health Organisation states that no form of development can take place when the mental health of the persons involved is not properly looked after. But, African policymakers fail to invest in this area. A popular post-colonial African slogan was: temos que contar com as nossas próprias forças. This Portuguese phrase means: we have to work with our own strengths, and implies that there is not much more that can be done if there are not any resources available. Igreja is of the opinion that this is only an excuse, and that the state should be the provider of mental health care, together with communities and families.

 

The support of family has always been important in the African culture, and because health care facilities are presently in very poor condition, this support system has remained very significant. Furthermore, there is a rise of religious groups because they provide material support. Also, self-help groups are growing in popularity. The issue of traditional healers in Mozambique is a complex one. The importance of these healers is very big, and interestingly enough, they are sometimes specialized in specific mental illnesses. The field of traditional medicine is very dynamic and often they are promoters of social change. Igreja tells us this was one of the most interesting outcomes of his research.

 

However, we have to remain critical about the effectiveness of these resources in relation to severe mental illnesses. This is where, according to Igreja, the real problem actually only begins. Severe mental illnesses often become more complicated when violence starts playing a role. People suffering from this might be victims of violence and therefore become violent themselves. This is usually not tolerated by their environment, and they end up in jail or even deceased. According to Igreja, situations like this happen very often.

 

Ultimately, the issue of mental health care in Africa is a political problem, because the government is not interested in investing in facilities. Igreja ends his lecture with two statements: we have to end the use of the slogan that Africa has to work with its own resources, because at the end of the day this is just not enough to fix the problem. Furthermore, we have to be more concrete about the problem and try to move forward in a practical manner.

 

kleinmanpresentatieView the ASC announcement with abstracts of this meeting.

And download Kleinmans powerpoint from the ASC site: