In our ongoing series, “Track Changes,” we link to online content that we have found to be problematic in its assumptions, framing, or language and provide a question or thought(s) provoked by each piece. We ask how portrayals and representations need to be not only rephrased, but also reframed and rethought.
This time, our response has two parts. Today’s piece focuses on what the article misses about how mental illness is treated in West Africa. Yesterday’s dealt with the blind spots that are present in treatment (or lack of treatment) of mental illness in the United States.
by Matthew Claeys
In Ghana, psychiatric hospitals are notorious for being overcrowded, under funded and accessible to mostly urbanites residing in the southern half of the country. This reality makes access to bio-medical treatments of mental illness for the vast majority of Ghanaians limited at best. Thus, Ghanaians with mental illness engage in a process of “patient shopping” for healthcare, weighing a multitude of realities and preferences. A majority of Ghanaians hold spiritual worldviews, which, in turn, reinforce the popularity of traditional and faith healers who also consider the impacts of evil spirits, sorcery and witchcraft on mental health. Rights abuse of those with mental illness, namely chaining and beating, are used as a means to protect the larger society from the ill individual, as well as keep individuals safe from themselves. Nevertheless, these measures are also embedded within spiritual and moral understandings of the person and society. This is particularly true of individuals deemed spiritually possessed; abuse is suffered by the spirit, not the human being.
Many assertions in the NY Times articles by Benedict Carey substantiate observations in my own academic and field research concerning mental health healing and human rights abuse in Ghana. However, Carey’s work, along with reports from organizations such as Amnesty International and Human Rights Watch, maintain narrow views of the role of the traditional healer in West African societies, as well as the importance of understanding mental illness healing not just from a Western perspective, but as a unique product of particular African worldviews produced by particular African societies. The bias in such reports assumes that bio-medical understandings of mental illness, including over-diagnoses of schizophrenia among African peoples and the high success rate of bio-medical drugs in treating such individuals, is preferable to traditional modes of treatment. Without going so far as to denigrate traditional views held by African people, little effort is made in such reports to understand spiritual possession and the importance and successful craft of traditional healers. Along this vein, human rights abuses are understood solely from the legally based doctrines of western society, not the African social realities from which they stem. As a scholar of anthropology, history, politics and Africa, I find it incredibly important to consider the assumptions we hold against cultures, religion and the change of time. The research must view mental illness as a function of the unique experience of being a member of a particular society, which is itself influenced by economic constraints, social relations and worldviews.
It is important to note here that African Traditional Religions continue to be neglected by both scholars and the general public as substantial world religions. This is partially explained by the fact that many African societies did not develop writing systems early on with which to document and codify their beliefs, as many other societies around the world have done for centuries. Yet tradition in Africa is no less robust because of a preference for oral rather than written language. The Akan have a proverb: “nipa wu a, ne tekyerema nporo”, which translates to: “to wit, even though human beings die, their tongues (words) do not rot.”
Historically African worldviews have stressed a distinction between two worlds: the material, visible world and a spiritual and invisible world. This core belief concerning the separation of worlds has major influences over the role of the individual in society, systems of governance, religious cosmology, and even health, healing and social wellbeing. In fact, one understands the Akan belief that God has balanced nature through the saying: “onyame ma wo yare a, oma wo adur”, translated as, “when God gives you sickness, he also gives you medicine.”
In my ethnography of mental health practitioners in Ghana, I found that traditional healers employ structured and case-specific treatments for individuals with mental and spiritual illness. The first step in most treatments is a sit-down interview, a screening process of sorts, in which the healer ascertains symptoms, treatments used or healers consulted, whether common afflictions such as malaria can be ruled out, and to gain a general understanding of who the individual is. In cases in which the healer cannot ascertain spiritual affliction, the mentally ill individual is often referred to a local clinic or hospital. In the opposite direction, doctors and clinicians actually refer patients that they deem spiritually possessed to local healers.
There appears to be a general consensus among healers that physical restraint and mistreatment of the mentally ill and spiritually possessed is unacceptable. However, many healers admit that binding is necessary in situations in which individuals present themselves in a violent manner and herbal relaxers or bio-medical sedatives are unavailable. There appears to be frustration among healers with the poor infrastructure of the medical sector in being able to provide alternatives to physical restraint.
In discussing spiritual possession, some healers imply a loss of identity and rights among the possessed, thus negating the need for consent in treatment. This is particularly true in the Islamic belief in jinn, where a spirit literally has the power to completely assume a human body and thus control both the behavior and actions of the host. In light of this, forced confessions, binding, beatings, and denial of food and water are not believed to be suffered by the person, but rather the spirit dwelling within.
While it is easy to assume that bio-medical practitioners and proponents of human rights would be at odds with traditional and faith healers, observations from the field prove otherwise. Driven by the efforts of local NGOs and an increasingly concerned and educated civil society, mental illness is rising the ranks of national priorities in Ghana. Traditional and faith healers, emboldened by their commitment to community wellbeing and progress, are responding to these concerns with increased willingness to integrate, cooperate, and participate with the medical sector and human rights proponents. This is perhaps best exemplified by traditional healers in the northern regions of Ghana, areas which have historically lacked resources and access to state mental health care. Traditional healers are now convening in democratic forums to discuss concerns, share advice, and commit to cooperation between all forms of mental healing to ensure healing and rights of their patients. Importantly, the agendas for these forums are being conducted by healers themselves. The result is a robust community of traditional and faith healers working in conjunction with local NGOs, clinics, hospitals, doctors, and nurses to provide the best and most relevant mental health care possible.
Considering the long history of political and social indifference to mental health issues across world societies, including the West, it is remarkable to see demonstrable and compelling evidence of rapid attitudinal change in Ghanaian society. Far from being antiquated modes of treatment, traditional and spiritual healers remain relevant practitioners and are respected by the bio-medical sector both as propagators of effective modes of treatment and community figures integral to social welfare. Traditional and spiritual healing among various groups and regions of Ghana are increasingly being incorporated into a mental health system that stresses community-based care. Rather than fostering an “illusion of traditional society” contemporary traditional and spiritual healers demonstrate that African worldviews, especially the belief in a separate spiritual world, not only survive the forces of modernity, but are emboldened by cooperation with new systems and respecting the legally based rights determined by the state.
Although I am reluctant to perpetuate the most common of conclusions by calling for more research, in this instance the call is necessary. There is an absolute need for further field data that informs us how non-western practitioners and society in general perceive and respond to severe mental illness and in what ways this informs universal perceptions regarding human rights. In thinking outside the box of traditional human rights theory and mental health studies researchers should aim to gain deeper insight into the complexity of the subjects. I believe that it is only through the broadening of the scope of questions asked and biases held that fresh perspectives and cause for interventions can be made.
Matthew Claeys will graduate in May 2016 with a Masters in African Studies from the Institute of African Studies at the University of Ghana. His thesis research surveyed perceptions and treatment of mental health in Ghana as a means to understand human rights theory in Africa. He has been involved in additional research with Participatory Development Associates, Ghana, on modern “slavery” across Ghana (PI: Professor A Adomako Ampofo). In 2015 he was awarded a student travel award from the African Studies Association of America with which he expanded his experience on the African continent into Morocco and the Western Sahara.