Misperceptions and stigma on mental illness

You fall into one of two categories: normal or abnormal. Because mental health is non-existent in developing countries, there is no in-between of rather mental disorders. That is, if there is nothing physically wrong with you, you must be fine; otherwise, you are insane, or perhaps your behavior is insane. If your behavior is far beyond what most people can comprehend, you are unquestionably abnormal.

“Look at a crazy man”– that is the most common phrase used for people with schizophrenia in developing African countries. It’s heartbreaking, but no one realizes it’s a brain disorder; instead, someone thinks they’re crazy. In some countries, it is believed that a mentally ill person has been bewitched (black magic) or cursed, is possessed by evil spirits, or suffers from other metaphysical ailments. Not only are you cursed, but your entire family is thought to be cursed as well. If one member of a family is determined to be insane, the entire family may be excluded. Women and girls, for example, are unable to marry into other households for fear that their children will be affected as well. If a mental ailment is thought to have a metaphysical origin, it’s only natural to look for a metaphysical cure. The most common practice is to take people suffering from disorders to traditional healers. Ancestor rituals are performed in voodoo temples in Togo, Benin, and Nigeria[1]. The ceremonies are thought to enlist the assistance of the gods or ancestors. Others take persons suffering from mental disorders to church and leave them there until they recover. People who are disturbed, as exorcists refer to them, are possessed by evil spirits, according to them. They attempt to liberate afflicted people from such entities through ceremonies and prayers— I’m curious, do people suffering from schizophrenia or perhaps any brain disorder get better from church or perhaps an exorcism?

Most people with brain disorders live on the streets, helpless. They have families and friends, but because they believe they are cursed or bewitched, there is no room for them any longer. Others accept them as they are, but if or when the journey becomes frustrating, as it often does in West Africa, if psychological problems are linked to violent outbursts, the person is frequently beaten, confined for weeks or months without food, or chased into the jungle or forest to fend for oneself. [1]

People suffering from mental illnesses are perceived as dangerous and violent, widening Asia’s social gap. The application of supernatural, religious, and magical therapies to mental illness is gaining popularity. The road to treatment is frequently shaped by the skepticism of mental health services and therapies. The stigma imposed by family members is widespread. Furthermore, the societal rejection and devaluation of families containing mentally ill members is concerning. This is particularly true in the cases of marriage, divorce, and marital separation. Psychic symptoms, unlike physical ailments, are regarded as socially inconvenient. [2]

In Malaysia, 15 patients with mental illnesses participated in studies. 12 of the 15 respondents reported severe stigmatization and discrimination from their family. According to a state psychiatrist, there are instances when a patient is discharged from the hospital and no family members are available to pick them up. As a result, an ambulance is dispatched to bring them back. When the patient’s family notices him approaching, they lock the doors and windows. They’re pretending they’re not at home. Eight of the fifteen patients reported having difficulty maintaining friendships. Some people are friendly at first, but once they realize you’re mentally ill, they stop answering your calls or refuse to hang out with you, according to one patient. It’s a tragedy, the patient continued. Seventeen out of fifteen employees reported active stigma from their employers. In one case, a patient told potential employers about his condition at the end of the interview, and they later rescinded his offer. Another person mentioned taking sick leave because he was depressed. When he returned, he was fired[3].

“Patients are thrown out of their own homes and they don’t know where to go. So they sleep by the road. Or at back alleys. They are left tattered and dirty. So how to get a job? Without a job, how to get money to live? So they are stuck, having to rely on people for it, sometimes having to beg. They have no power at all”. – [P003, private clinical psychologist].

Mental illness is still viewed through the lens of socio-cultural and religious beliefs, which contributes to stigma. The prevalence of mental disease stigma has been repeatedly demonstrated to be a significant disabling factor for those suffering from mental illnesses. It raises the possibility of a vicious circle of prejudice and deterioration. As a result, individuals with mental health issues face increased stigma and have fewer opportunities in many areas of their lives, including social connections, employment, and health rehabilitation. [3] Mental health stigma is an issue that must be addressed as soon as possible because it has a negative impact on the lives of those who suffer from mental disorders, potentially resulting in social and economic losses. Furthermore, mental health stigma discourages people from seeking mental health treatment. As a result, the significance of reducing mental health stigma cannot be overstated. [4]

The most significant sources of mental illness stigma and misperceptions appear to be a lack of knowledge and awareness, as well as unfavorable media representations. There is an urgent need to eliminate stigma associated with mental illness in society and the health system through education and awareness initiatives.

References

[1] New 21/09/2021 – by Mahwish Gul, et al. “In West Africa, Traditional or Religious Practices Are Often the Preferred Method of Treating Mental Disorders.” D+C, https://www.dandc.eu/en/article/west-africa-traditional-or-religious-practices-are-often-preferred-method-treating-mental.

[2] W;, Lauber C;Rössler. “Stigma towards People with Mental Illness in Developing Countries in Asia.” International Review of Psychiatry (Abingdon, England), U.S. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/17464793/.

[3] Hanafiah, Ainul Nadhirah, and Tine Van Bortel. “A Qualitative Exploration of the Perspectives of Mental Health Professionals on Stigma and Discrimination of Mental Illness in Malaysia.” International Journal of Mental Health Systems, BioMed Central, 10 Mar. 2015, https://ijmhs.biomedcentral.com/articles/10.1186/s13033-015-0002-1#Sec34.

[4] Park, Jong-Ik, and Mina Jeon. “The Stigma of Mental Illness in Korea.” Journal of Korean Neuropsychiatric Association, Korean Neuropsychiatric Association, 30 Nov. 2016, https://synapse.koreamed.org/articles/1017812.

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Language barrier and mental health awareness.

Communication is essential in everyday life. Language is a powerful tool for conveying information. As a result, the language barrier impedes communication. Language barriers can exist not only when people or groups speak different languages and thus cannot communicate with one another, but also when dialects are spoken. Misunderstandings and communication gaps occur when people speak the same language but have dialectical differences. “India uses over 22 major languages written in 13 different scripts, with over 720 dialects,” for example. [1] As a result, it impedes communication when it comes to mental health awareness.

Most developing countries appear to have a large number of languages in comparison to developed countries, which have a limited number of languages. Papua New Guinea has the world’s highest level of linguistic diversity. They speak 840 different languages. Indonesia comes in second with 711 languages; “only 20% of the population speaks the national language of Bahasa Indonesian at home.” [2]

With more than 2,000 distinct languages, Africa has a third of the world’s languages with less than a seventh of the world’s population. By comparison, Europe, which has about an eighth of the world’s population, has only about 300 languages.

“Why Does Africa Have so Many Languages?” The Christian Science Monitor, The Christian Science Monitor, 21 Apr. 2015, http://www.csmonitor.com/Science/Science-Notebook/2015/0421/Why-does-Africa-have-so-many-languages.

The issue is not so much a proliferation of languages as a barrier to communication as it is a lack of a unified language. There are approximately 328 languages spoken in the United States, with English serving as the common language. Linguistic diversity is fascinating, and I hope that all languages survive. According to a study of 100 people in a city in western Uganda, the average speaker knows 4.34 different languages. [3] Isn’t that incredible? A unified language in a society, in addition to other languages, improves communication, which promotes the development of many sectors, including the health sector. People who are not fluent in an official language are thought to have difficulty obtaining psychiatric care when it is needed, owing to the obvious limitations they face. Making an appointment on time, determining affordability, and obtaining information on mental health care and the location of hospitals or clinics are all examples of these challenges. [4]

The majority of developing countries do not have a unified language. This is a significant impediment. As a result, it is difficult to conceptualize mental health awareness. Because mental health diagnoses are not objective examinations and must be communicated in order to be achieved, it is nearly impossible if the client and medical personnel speak different languages and cannot understand each other to any extent. When explaining the details of a diagnostic or treatment, it is critical to communicate the possibility of the associated risk factors appropriately. Failure to adequately explain the magnitude of the risk could have serious consequences, such as patients failing to follow instructions or declining potentially life-saving treatment. To complicate matters further, people from different ethnic groups describe pain and discomfort in a variety of ways: Even if you have excellent language skills, culturally specific terminology, idioms, or metaphors may be difficult to navigate. [5] It is not possible to establish a close relationship between the client and the medical personnel. It’s difficult to establish rapport when neither party understands the other. The use of a translator or interpretation services is an option, but this compromises privacy. Consider going to a therapeutic session and having a third person in the room ready to translate for both parties. In reality, it is difficult for the client to express their concerns when a third party is present. When you want to be understood but your brain is unable to decode the message of the spoken language, you experience a wave of frustration. High intuitive people, on the other hand, can easily connect with people of any language by absorbing their feelings.

We live in a time when technology is constantly evolving and on the rise. Despite the availability of human translators, technological advancements such as phone translating apps have been made. Despite the existence of phone translator apps, not every language is supported, rendering them ineffective to some extent. I’m thinking about how we might see a world in the future that isn’t hampered by a language barrier. Not because languages will become extinct, but because there will be, or perhaps already is, a breakthrough that transcends language. Is this to say that we should sit back, take a deep breath, and wait patiently? No way are we going to do that. To change the mental health landscape, we must make the most of the resources at our disposal. If that means teaching the next generation how to communicate in a common language, so be it. Allow the curriculum to expand if it means including a mental health subject in schools. Mental illnesses exist alongside physical illnesses, and the younger generation, as well as those yet to be born, must be aware of this.

There is no health without mental health; mental health is too important to be left to the professionals alone, and mental health is everyone’s business.

Vikram Patel

References

[1] Davis, Ben. “Home.” Mvorganizing.org, 22 May 2021, http://www.mvorganizing.org/what-is-linguistic-barriers-in-communication/.

[2] Ang, Carmen. “Ranked: The Countries with the Most Linguistic Diversity.” Visual Capitalist, 27 Jan. 2021, http://www.visualcapitalist.com/the-countries-with-the-most-linguistic-diversity/.

[3] “Why Does Africa Have so Many Languages?” The Christian Science Monitor, The Christian Science Monitor, 21 Apr. 2015, http://www.csmonitor.com/Science/Science-Notebook/2015/0421/Why-does-Africa-have-so-many-languages.

[4] Ohtani, Ai, et al. “Language Barriers and Access to Psychiatric Care: A Systematic Review.” Psychiatric Services, 1 May 2015, ps.psychiatryonline.org/doi/10.1176/appi.ps.201400351.

[5] Meuter, Renata F. I., et al. “Overcoming Language Barriers in Healthcare: A Protocol for Investigating Safe and Effective Communication When Patients or Clinicians Use a Second Language.” BMC Health Services Research, BioMed Central, 10 Sept. 2015, bmchealthservres.biomedcentral.com/articles/10.1186/s12913-015-1024-8.

Mental Health resources in developing countries

I noticed something while browsing and learning about the World Health Organization’s (WHO) website. There are homepage tabs such as health topics, countries, newsrooms, and so on. When I clicked on the countries tab, regions essentially dropped down, and I tapped into each one; all regions, with the exception of Africa and Southeast Asia, had a slot for mental health. WHY? You might as well have already come up with an answer (Leave a comment below). Clearly, there are few or no studies on mental health in these areas. Because there is a scarcity of existing data and facts about mental health in these areas, they are predisposed to mental disorders. The lack of awareness makes it impossible to move forward with sensitization and resource allocation.

Mental illnesses account for 7.4 percent of the global disease burden. Despite this, only 2% of the country’s health budget is spent on prevention. Low-income countries spend less than 25 cents per person per year on mental health, whereas high-income countries spend $44.8 per capita. [1] In terms of physical resources, there are 0.61 mental health outpatient facilities per 100,000 people globally, but there are huge disparities. In low-income countries, there are 0.04 outpatient facilities per 100,000 people, while in high-income countries, there are 2.32 outpatient facilities per 100,000 people. [3] Similar disparities exist in the availability of mental hospitals. The global median rate of mental hospitals is 0.03 per 100,000 people, ranging from 0.002 in the World Health Organization’s (WHO) Western Pacific region to 0.16 in the WHO European region. There are also significant differences in the number of psychiatric hospital beds available. The rate per 100 000 people in the WHO African zone is 1.7, compared to 39.4 in the WHO European zone. In some parts of the world, mostly developing countries, there is less than one psychiatrist for every 100,000 people, compared to 8.6 psychiatrists for every 100,000 people in developed countries. [1]

According to research, many developing countries lack adequately trained medical and nursing professionals to treat brain disorders. “For example, in India, there are approximately 3,000 psychiatrists and 565 neurologists to serve a billion people, whereas, in Zimbabwe, there are 10 psychiatrists and 29 neurologists to serve 11 million people. [4] In Indonesia, the ratio is one for every ten million people. In Uganda, the total number of human resources working in mental health facilities or private practice per 100,000 population was 1.13, with 0.08 psychiatrists, 0.04 other medical doctors, 0.78 nurses, 0.01 psychologists, 0.01 social workers, 0.01 occupational therapists, and 0.2 psychiatric clinical officers, not including auxiliary staff, non-doctor PHC workers, and health assistants. [5] The World Health Organization reported in 2005 that a number of countries, including Afghanistan, Rwanda, Chad, Eritrea, and Liberia, had only one or two psychiatrists.

The Uganda Ministry of Health (MoH) requires at least one encoded psychiatric nurse with a two-year certificate to work in outpatient communities, and clinical and medical officials to work in health centers, despite the fact that both levels have many vacancies. Regional referral hospitals have psychiatric units supervised by psychiatric Clinical Officers (Diploma-prepared professionals), and two National referral mental health facilities with psychiatrists and psychologists provide mental health treatment. Private international non-governmental organizations (INGOs) and health facilities that provide mental health care are expensive, concentrated in urban areas, and tend to focus on HIV/AIDS, limiting access for the vast majority of people who require assistance. [6]

I attended a boarding school where HIV/AIDS was noted on every sign on campus. When you arrived at the school’s gate, there was a large blue sign with the words “abstain from sex” written in white on it. As one walked from the staff building to each class, the dining hall, and the kitchen facility, one could see every HIV/AIDS signpost. All the way to the dormitory’s gates. Every day, there was either a play or a declaration about HIV/AIDS at assembly, or the matrons would make a point of telling a scary story about a boy or girl who died as a result of the disease. It was engraved on our unconscious minds because that is what our thoughts were focused on when we closed our eyes at night. Each year, the majority of the music, dance, and drama performed focused on HIV/AIDS. I remember reciting a poem about the disease, and our team did indeed win. According to the argument, HIV/AIDS is a topic of discussion and activism from the time a child is born until they reach adulthood. The government made every effort in this regard, and I believe we were all aware on a daily basis, which was greatly appreciated. How about we devote the same amount of effort to raising mental health awareness as we do to HIV/AIDS?

“It is time for governments to make mental health a priority and to allocate the resources, develop the policies and implement the reforms needed to address this urgent problem. One in four people will suffer from mental illness at some time in life,” added United Nations Secretary General Kofi Annan.

“Mental Health Care in the Developing World.” Psychiatric Times, http://www.psychiatrictimes.com/view/mental-health-care-developing-world.

References

[1]World Health Organization. Mental Health Atlas 2011. Geneva:
WHO, 2011

[2] World Health Organization. Global burden of mental disorders and
the need for a comprehensive, coordinated response from health and social sectors at the country level [monography in internet]. Geneva: WHO,
2012 [cited 2017 Dec 6]. Available from: http://apps.who.int/gb/ebwha/
pdf_files/EB130/B130_R8-en.pdf

[3] Octavio Gómez-Dantés, and Julio Frenk. “Neither Myth nor Stigma: Mainstreaming Mental Health in Developing Countries.” Salud Pública de México, vol. 60, no. 2,mar-abr, Mar. 2018, pp. 212–217. EBSCOhost, doi:10.21149/9244.

[4]“Mental Health Care in the Developing World.” Psychiatric Times, http://www.psychiatrictimes.com/view/mental-health-care-developing-world.

[5] Kigozi, Fred, et al. “An Overview Of Uganda’s Mental Health Care SYSTEM: Results from an Assessment Using the World Health ORGANIZATION’S Assessment Instrument for Mental Health Systems (Who-Aims).” International Journal of Mental Health Systems, BioMed Central, 20 Jan. 2010, ijmhs.biomedcentral.com/articles/10.1186/1752-4458-4-1.

[6]Kopinak, Janice Katherine. “Mental Health in Developing Countries: Challenges and Opportunities in INTRODUCING Western Mental Health System in Uganda.” International Journal of MCH and AIDS, Global Health and Education Projects, Inc, 2015, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4948168/.

Mental health in developing countries

Let us discuss the facts about mental health in developing countries. In developing countries, there is little information or research on mental health. If it does, I’m predicting it’s only a handful! In developing countries, there is little or no mental health awareness and advocacy. The World Health Organization launched Project Atlas to catalog mental health resources around the world. The Project conducted a survey and discovered the following findings:; 41% have no mental health policy, 25% have no legislation on mental health, 28% have no separate budget for mental health, 41% do not have treatment facilities for severe mental disorders in primary health care, 37% have no community health care facilities…[2]

There are numerous types of mental disorders, each with its own set of symptoms. They are generally distinguished by a combination of abnormal thoughts, perceptions, emotions, behavior, and interpersonal relationships[1]. They include but are not limited to, anxiety, depression, bipolar disorder, schizophrenia, and other psychoses, dementia, and developmental disorders such as autism.

According to a statement by Gro Harlem Brundland, M.D., Director General of the WHO, he mentions that “mental health — neglected for far too long — is crucial to the overall well-being of individuals, societies, and countries and must be universally regarded in a new light”…[2]

The ignorance about mental health

One of the most common mental disorders is depression. It is the main cause of disability worldwide–Globally, an estimated 264 million people are affected by depression…[1] It is characterized by sadness, loss of interest or happiness, feelings of guilt or low self-esteem, loss of sleep or appetite, fatigue, and inability to concentrate.

There is a blanket of ignorance about mental health in developing countries. Growing up, I had never heard the term “depression”; instead, we referred to that kind of state of mind as “sad.” People would tell you to snap out of it or grow up no matter how long you were sad. The term “SAD” is simple; everyone experiences sadness; therefore, it was never taken seriously that being sad for a longer period has its own term: depression. Yes, depression is unheard of in most developing countries; you had to be a robot and resilient — you had to be strong or drink your misery. Emotions are undervalued; it’s as if everyone is a walking machine that follows whatever society dictates. There were no questions asked! Oh, wait…regardless of how inquisitive one’s mind may be, who are you going to ask the questions to? There are no answers because mental illness is uncommon in these societies and cultures.

People in developing countries are left with wandering minds, more akin to a state of limbo when you know there’s something seriously wrong with you because you can feel it in every inch of your body, and it’s screaming at you excruciatingly—becoming louder and louder with time. You, on the other hand, have no idea what is or could be. People in the same environment have no notion what’s going on, so they resort to making fun of it. Is it possible to blame them? No, they have no idea what they’re doing. They find it amusing, but also strange because it is unusual. How long will this be amusing? Is it only a matter of time before more people die as a result of mental illness? Because there is no concept of mental illness in developing countries, more lives that could have been saved will be lost. My heart bleeds as I write this; I feel the agony of both ignorance and insight. Knowing right now is intensely painful.

When you live in ignorance, there is no suffering– the pain comes when you understand what is.

I recall my cousin sister from when I was younger before I emigrated to the United States of America from Uganda. She was one of the brightest persons I’d ever met, and she was a strong young woman. She motivated me to succeed in whatever I set my mind to since that’s exactly what she did: she succeeded at everything. She was a straight-A student who was constantly at the top of her class and set records at every school she attended. She began to detach randomly just before starting college. She couldn’t hold a conversation and went from one subject to the next, with no beginning or conclusion to what she said. The sweet girl was slowly dissipating. It got to the point where whatever was going on with her became so threatening that those around her picked up on something strange. They could hear her shouts, see her wilt, and sense her agony at not knowing. Regardless, they were at a loss for what to do. They took her to doctors, but nothing appeared to be wrong with her physically. They offered her some medications, but nothing seemed to improve her condition. They took her church in the hopes of enlisting the help of an exorcist, but nothing seemed to alter. Trying to make it to the next sunrise day after day. People who cared about her were left roaming in the wilderness, trying to figure out what was wrong but only finding dead ends. Uncertainty paralyzed her every day, and whatever ailment she had progressed on a daily basis. Later, the family opted to take her to the country’s only known psychiatric facility. Unfortunately, it was too late when the hospital called in a flash to inform her that she had passed away.

What occurred in the psychiatric facility? Did they assess her and run tests to figure out what’s wrong with her? Or did they simply give her some medicines to mask her signs and symptoms? Were there any certified psychiatric doctors on hand, or were the nurses doing the best they could in the absence of any doctors? What happened is that in underdeveloped nations, there is such little/no knowledge of mental health disorders that by the time persons with these conditions are transported to the hospital, there is no longer room for survival.

Several factors may influence the prevalence of mental health in developing countries. Some examples include language barriers, a lack of mental health resources, misconceptions and stigma surrounding mental disorders, and so on.

“We need to recognize that there is no health without mental health.”

Prince M, Patel V, Saxena S, Maj M, Maselko H, Phillips M, et al. No
health without mental health. Lancet. 2007;370(9590):859-877. https://doi.
org/10.1016/S0140-6736(07)61238-0

References

[1]“Mental Disorders.” World Health Organization, World Health Organization, http://www.who.int/news-room/fact-sheets/detail/mental-disorders.

[2]“What’s in a Word? Taking the Measure of Thoughts in Schizophrenia.” Psychiatric Times, http://www.psychiatrictimes.com/view/whats-in-a-word-taking-the-measure-of-thoughts-in-schizophrenia.