Psychiatry and mental illness in Africa: the omerta continues – Jeune Afrique

For more than fifty years, I have been a psychiatrist entirely devoted to the cause of the mentally ill. At almost 80 years old and for ten years, I have devoted my retirement to humanitarian missions in several African countries. As my long career comes to an end and these missions will soon no longer be possible, I want to share my concern and my bitterness regarding the situation on this continent. How to ignore what looks like a real tragedy?

Among its 1.4 billion inhabitants, Africa has, like everywhere else, between 5 and 7% of mentally ill people, of whom we hardly ever speak, of serious pathologies such as schizophrenia or disorders such as autism. And that without counting the psychopathological sequelae of the wars. The often inhuman treatment that is reserved for these patients, the violence, the confinement, the chaining are largely passed over in silence, on the rather hypocritical pretext of the “cultural particularities of Africa”.

A deafening silence

For the past ten years, I have denounced this omerta. In 2018, after several missions with the mentally ill in West Africa – Benin and Côte d’Ivoire, and in Madagascar – I wanted to alert opinions in a book, Fools of Africa, omerta, in the hope of drawing attention to the suffering of these patients.

The fate reserved for these particular patients is scary

I recounted some of my experiences in the field, I offered a history of psychiatry in Africa, since the arrival in 1958 of Professor Henri Collomb (1913-1979) at the Fann hospital in Senegal. I made a complete tour of international publications on psychiatry on the continent, as well as on the health situation in this field, from wealthy South Africa to Egypt, via Kenya, Uganda, Nigeria, Ghana, Liberia, Sierra Leone or the Maghreb countries…

I am indignant that the observation is almost the same everywhere: the ratio of psychiatrists per number of inhabitants is terrible, and the fate reserved for these particular patients is frightening. Today, four years later, after several missions, again in Côte d’Ivoire and Madagascar, then in Mayotte, I am relaunching exactly the same alert, revised and augmented, with my latest findings. To my previous work on major pathologies, I add a particular work on autism, which I had already perceived as the poor relation of mental disorders.

In the twilight of my long career as a psychiatrist, I cannot bring myself to the deafening silence that stifles mental illness in Africa! I gave my book to dozens of decision-makers and African personalities, I tried to alert the media, French and African, the associations, which often replace the States… but the omerta is appalling!

Imprisonment and violence

In Africa, I lived experiences of intense work: up to 100 daily consultations, journeys in the bush, staff too little or not qualified, often without crossing a single European, housed in the heart of treatment centers for mentally ill or in families of autistic parents… Honestly, I didn’t think I would see again in the 21st century what I had experienced in French psychiatric asylums in the 1970s, when I was a young intern.

Because it’s Africa, we should accept that chained patients

This confinement and this violence against which I had fought with so many other psychiatrists of the time. And there, I discovered that, because it’s Africa, we should accept that patients are chained or bludgeoned with massive doses of drugs, the “delay neuroleptics” which conveniently knock patients out, often for their entire lives! I have even seen patients die suddenly from drug overdoses…

Like in the Middle Ages

Over the past ten years, I have visited a number of mentally ill support structures, often under the wing of the Catholic Church or Western benefactors, or run by parents of autistics. I confess to having known the wonder beginnings, landing in marvelous associations. And then it was the time of disillusions, disappointments, when I realized that such a charismatic leader, well publicized but absolutely not qualified, had ended up extending a dictatorial stranglehold on the care, its organization and even the astronomical financing paid by naive or uncaring humanitarian organizations.

We pray, we exorcise, we medicalize heavily, we hit a little…

I discovered the relationships of influence between these leaders – Catholics, Protestants or evangelists –, patients, benefactors and even Western volunteers, under the spell of tireless piety. When I asked embarrassing questions, I was told that God would provide, that it was the design of Providence… a story of a “gift” bestowed by God. And during that time, without taking into account the opinions of the volunteer doctors, the patients were beaten relentlessly… “See how calm and peaceful they are…”

Similarly, I visited other places of care, the “tobys” of Madagascar, where the sick are clearly chained, as in the Middle Ages. I’m not inventing anything, I have many photos and several photo or audiovisual reports that testify to these still too widespread practices. We pray, we exorcise, we medicalize heavily, we hit a little, we go on…

Move heaven and earth

Obviously, however, all is not gloomy. I also saw, elsewhere, interesting things, even fascinating. In Côte d’Ivoire, I lived and worked in a place run by the Sisters of Charity, courageous women who had gone through serious political events and internal struggles in order to defend themselves against the famous leader mentioned above who wanted them swallow it raw. I quietly attended, me the unbelieving doctor, the blessings before meal; but above all I worked well, in freedom, in a situation of total independence and transparency.

Finally, with autistic children, particularly in Madagascar, one of the poorest countries in the world, I have also experienced extraordinary adventures, received by volunteers, most often young women, who never talked about religion, but who moved heaven and earth so that I could diagnose children with autism, at the rate of five long exams a day. Because autism, one of the great subjects of my medical career, is as present in Africa as elsewhere. And unfortunately, it is still too often associated with a divine curse, witch children, or even the reincarnation of the Devil.

As for the West, it don’t care damn…