The chains of mental illness in West Africa

The church grounds here sprawled through a strange, dreamlike forest. More than 150 men and women were chained by the ankle to a tree or concrete block, a short walk from the central place of worship. Most were experiencing the fearsome delusions of schizophrenia. On a recent visit, some glared, while others slept or muttered […]

The church grounds here sprawled through a strange, dreamlike forest. More than 150 men and women were chained by the ankle to a tree or concrete block, a short walk from the central place of worship. Most were experiencing the fearsome delusions of schizophrenia. On a recent visit, some glared, while others slept or muttered to themselves. A few pushed to their feet and gestured wildly, their cries piercing the stillness.
Until this year, Koffi Gbedjeha, 45, a carpenter and father of four, was one of them — a resident of the Jesus Is the Solution prayer camp here, shackled like the others, his family and camp staff members said. For more than two years, his youngest sister, Akossiwa, 27, tended to him. Rising early each morning, she walked along a cool red-earth path to the human forest; each day, amid the stirring bodies and clinking chains, she emptied her brother’s chamber pot, swept the ground and cooked his meals over a charcoal fire.
“Don’t you pray for me,” Mr. Gbedjeha (pronounced guh-BED-zhe-ha) sometimes shouted at camp workers who asked God to cast out the dark spirits they believed were making him sick. “I should be praying for you.”
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In parts of West Africa, where psychiatry is virtually unknown, the chain is often a last resort for desperate families who cannot control a loved one in the grip of psychosis. Religious retreats, known as prayer camps, set up makeshift psychiatric wards, usually with prayer as the only intervention. Nine camps visited recently in Togo ranged from small family operations to this one, Jesus Is the Solution, by far the largest and most elaborate.
“We try to talk people out of going to the camps,” said Dr. Simliwa Kolou Valentin Dassa, Togo’s director of mental health services, “but we cannot tell them to stop if there’s no alternative.”
Historically, mental illness has lingered near the bottom of both African and global health priorities, well behind deadly threats like malaria, measles and H.I.V. But recently, the United Nations adopted global development goals that, for the first time, include a commitment to “promote mental health and well-being” and to reduce premature deaths from noncommunicable diseases, including mental disorders, by one-third by 2030. The World Health Organization has also intensified its focus on mental health, calling for an end to the chaining of people with mental illnesses.
The United Nations pledge, though little more than a promise of change, is the culmination of years of efforts by doctors, field workers and advocates across the developing world. According to the World Health Organization, most countries in Africa, if they have a dedicated budget for mental health care at all, devote an average of less than 1 percent of their health spending to the problem, compared with 6 to 12 percent in the wealthy countries of the West. At last count, Liberia had just one practicing psychiatrist. Niger had three, Togo four and Benin seven. Sierra Leone had none.
For now in Africa, it is the families of people with mental illnesses who bear the overwhelming costs of care — and the greatest burden falls on mothers, sisters and daughters.
“I wondered if he would ever get better,” said Ms. Gbedjeha, who put everything else on hold to care for her brother: sleeping on the ground along with other families, passing endless afternoons alone, reading the Bible and praying, feeling an encroaching despair with each passing month. “I wanted to return to my life.”
She did what she could to maintain an identity beyond caregiving, sewing when she had materials and volunteering to clean the pastor’s house now and again.
Then, one morning in January, she walked to the forest of shackled people and found only her brother’s broken chain. She looked for him, frantically, but there was no trace. The camp quickly assembled a search party.
 
The Prayer Camps: Good estimates of the number of West Africans with mental illnesses living in chains are not available, in part because people are shackled out of sight — by family members, traditional healers and at prayer camps.
The camps in Togo vary widely in character. They include Jesus Is the Solution, a large operation, as well as bare-bones family outfits like Sitsopé, which means “place of refuge,” and Rama, both on the outskirts of the capital, Lomé. The camps often reflect the personality of the head pastor, whether grandiose or humble, and tend to have a sleepy, sun-drained rhythm, with the day’s quiet occasionally punctuated by an outburst from someone in chains or the scurry of chickens.
In neighbouring Ghana, Human Rights Watch visited eight prayer camps with roots in Pentecostal or evangelical denominations that held close to 200 people. Nearly all the residents were chained by their ankles to trees in open compounds, where they slept, urinated and defecated, and bathed, the group reported in 2012. None of the camps employed a “qualified medical or psychiatric practitioner.”
In Western countries, hundreds of thousands of people with psychosis or other severe mental health problems land in prison, including more than 100,000 in the United States alone. In Indonesia and other parts of Asia, restraints — like shackles, wooden stocks, even cages — are also common.
Surveys, like one by psychiatrists at the University of Ibadan in Nigeria, put the prevalence of schizophrenia, characterized by hallucinations and delusions, at 0.5 to 2.5 percent, roughly the same as the global prevalence. That is at least a million people in countries where chaining is common, like Togo, Ghana and Nigeria.
Chaining people against their will violates the United Nations’ disability rights convention, which most West African countries, including Togo, Ghana and Nigeria, have ratified. But religious feeling is strong in this part of the world, and the pastors who run the camps preach that, through them, God can heal almost any ailment — especially ones thought to be essentially spiritual, like psychosis.
In the Rama camp one afternoon, three boys chased a soccer ball in a shaded, dusty yard between small cabins; past the cabins was a fenced field with a row of cinder-block bunkers. Kodjo Didier Akarabi, 47, who had been left at the camp a year earlier by two brothers, was folded into the corner of one of them. “I stay here now because I see things,” he said, his eyes watchful and his wiry frame naked beneath a small sheet. The camp secretary said that workers kept him chained because he had wandered off, and that they were tending to him until his family could be found.
In the rear of the Sitsopé camp, three young men were chained in a row of concrete, three-sided bunkers with walls broken and cracked over the years “by the people kept here lashing out,” a pastor said. And at midmorning, the New Jerusalem camp near Atakpamé, Togo, was all but deserted, the church’s members out working the surrounding fields.
“When the person is alert and thinking clearly, that’s when we know to take the chain off,” said Kwami Somenou, an assistant pastor at the New Jerusalem camp. Sometimes people do not improve, Mr. Somenou said, and in those cases, “we pray for some resolution, and usually the family takes the person back.”
People who had been shackled at camps recalled in interviews the terror of being led into chains, but said much of the experience was a blur, dominated by psychosis and confusion. “Like, I woke up, I remember, and said: ‘What’s going on here? Why am I chained? Get me out of here,’ ” said Yawa Ague, 31, a mother of seven who spent weeks at New Jerusalem several years ago.
At Jesus Is the Solution, Paul Noumonvi, a charismatic pastor, has built a retreat that includes an open-air church the size of an airplane hangar, a cafeteria, cabins, an outdoor “ward” for residents with mental illnesses, and, down the road, a walled-off compound that encloses his spacious house.
At a recent revival, thousands of worshipers thronged the camp, and pastors from around the Plateaux Region in southern Togo joined Mr. Noumonvi for a five-hour service amplified by microphones and enlivened by a band. People raised their arms in praise, and some threw themselves to the ground, overcome with feeling.
A police detail circulated, keeping an eye on the gate, the proceedings and the pastor’s house.
After the service, Mr. Noumonvi received visitors on his shaded back porch. In an interview, he said that the camp had been in operation for 12 years and that praying for people with mental problems was a service he offered. Each family is required to provide food, cleanup and a chain, but he does not ask for payment, he said, adding that the camp currently held 175 people.
“Many of these people already have tried other things, like traditional healers, herbs and drugs, but the problem didn’t go away,” he said. “As for healing, we believe a spell has been cast on them. It can be witchcraft — this is the cause of the illness. When a person is reasonable again, acting normally, rationally, we say, ‘O.K., this person is healed.’ ”
Anthropological studies in the region have found that people will often remove a relative from a prayer camp if they are not satisfied and try something else, whether a hospital, a healer, another camp or medication.
“West African families are as practical as anyone else, whatever their beliefs about mental illness,” said Dr. Julian Eaton, the global mental health adviser for CBM, an international Christian organization working on development and disability issues.
A Frightened Family: Kodjo Didier Akarabi, 47, had been left at a prayer camp in Togo for a year by his brothers. “I stay here now because I see things,” he said.
Mr. Gbedjeha, the eldest of five, was his family’s rock. When his younger brother Komlan quit trade school, Mr. Gbedjeha persuaded him to persist and to become a motorbike mechanic. When an aunt was using his sisters as housekeepers, he made sure they were sent back home to the family village.
“He was so important to us, because he fought for us all the time,” his sister Akossiwa said.
So his siblings were deeply shaken when he began having serious mental problems in his early 30s — problems that he denied. He would denounce strangers on the street as sorcerers or demons, they said, and then have conversations with figures invisible to everyone but him. “I was the only one who could really talk to him,” Komlan said. “I wanted him to go to the hospital, because something was very wrong.”
His siblings gathered in their home village — Djagblé, just outside the capital — with their mother, uncles and aunts. The elders favored traditional healers who used herbal concoctions, incantations and spells to drive away evil spirits or remove curses.
But Komlan and his sisters knew that their older brother, who had studied to be a pastor, would not agree to traditional methods. So they suggested a compromise: Why not use his Christian faith in the service of recovery? The family had heard about Jesus Is the Solution, about 100 miles north. The elders agreed — but not Mr. Gbedjeha. “We had to capture him,” Komlan said.
One night in December 2012, when Mr. Gbedjeha was at a sister’s home, acting bizarrely, she dissolved a strong sedative into his soup, and he fell into a deep sleep. Komlan and two friends stole into his room and tied him up.
“I cried and cried, seeing him like that,” Komlan said. “He, Koffi, who always was there for me.”
At Jesus Is the Solution, the camp secretary registered Mr. Gbedjeha as a patient and told Komlan the family would be responsible for his care and feeding. The siblings begged the youngest, Akossiwa, who was unmarried, to mind her brother; she reluctantly agreed.
And there was one more requirement.
“The chain,” Komlan said. “He told us we had to buy our own chain.”
At the camp, Mr. Gbedjeha was restless and intensely watchful. His mood sometimes settled enough that he was unshackled, but before long, he would be back in chains: unapproachable, distant, nothing like his old self.
Once, in a rage, he threw urine at his sister. She slugged him. “Being in chains,” she said, “he couldn’t do anything more than stare back in anger.”
That is, until the night in January when he broke free. The next morning, Ms. Gbedjeha found nothing but his steel chain, uselessly bolted to a concrete block.
The Demons Return
Mr. Gbedjeha had taken no chances, he told her later. He stayed off roads, drank from streams, and lived mostly on cassava root roasted over the embers of abandoned campfires, which he found by tracking smoke trails in the sky.
After weeks on the run, he arrived at his home village. An uncle spotted him, and he was welcomed back. But soon, Mr. Gbedjeha moved back to Lomé, and the aggression and the demons returned.
This time, Komlan was determined to get his brother to a medical facility, and the elders quickly agreed.
In March, Komlan contrived for a mutual friend to lure Mr. Gbedjeha into his car with the promise of a job. The friend then picked up Komlan, and the two overpowered and bound Mr. Gbedjeha and took him to St. John the Divine, a small Roman Catholic mental health clinic near the capital.
When they arrived, the clinic’s director, Brother Emmanuel Agbedzinou, a psychiatric nurse, rushed over and demanded that Mr. Gbedjeha be unbound.
“This is a human being, and you treat him like that?” Brother Agbedzinou recalled saying. But he relented when Komlan said that Mr. Gbedjeha was too aggressive to consent to treatment.
Brother Agbedzinou injected Mr. Gbedjeha with an antipsychotic drug combined with a sedative. After a week of daily drug treatment, Mr. Gbedjeha grew calmer, but by then, his family had run out of money. In April, he moved back to Lomé.
While sweeping his yard there this spring, he recalled in an interview the trauma of being kidnapped by his brother and taken to the clinic, and insisted he was sane. “I am not mad,” he said.
Then he pulled some herbs from his pocket. “This is to help me think clearly,” he explained, “and keep the demons away.”
But Mr. Gbedjeha had a difficult time in Lomé and is now back in his home village, working with his uncle selling water from a well. He has stabilized on antipsychotic medication and hopes one day to set up a carpentry workshop — as long as his family can afford the drugs, which it has struggled to do.
It is good to have him back, Komlan said, but “no one knows what is coming next.”
Culled from International New York Times.