The Sunday News
Panashe Marufu
ACCORDING to the World Health Organisation, one person commits suicide every 40 seconds — that’s at least seven people die in the time it takes you to read through this article.
“We’ve been thrown into mourning because of an idiot”, allegedly remarked one relative — a medical doctor no less — upon learning of my uncle’s suicide last week. Although one would expect that the growing body of scientific evidence legitimating the more “commonplace” mental disorders such as depression and anxiety would, at a minimum, sway our medical practitioners into acknowledging their ubiquity in our society, mental health in Zimbabwe has largely remained secondary to physical health.
To many Zimbabweans, the term ‘‘mental illness’’ itself is often understood as a synonym for the more severe forms of ill-health — namely insanity or psychosis. In fact, more often than not, when most consider mental disorderliness, they envision their neighbourhood vagrant — unkempt, unreasonable, and uncivilised — mumbling to himself in a makeshift cardboard-box shelter. Misguided though this archetype may be, it is but a symptom of the wider cultural and political shortcomings which undermine mental health concerns.
Of those that do acknowledge mental illness, the devout among them are often quick to diagnose it as a consequence of sinfulness at best, and as demonic possession at worst. In superstitious circles, explanations range from karmic justice to witchcraft. And, in both cases — never mind the modern medicine that many rely on when they pop their daily blood pressure (BP) pill or vaccinate their children — the only appropriate treatment for mental illness is quite simply, prayer.
For the sceptics, two narratives prevail: the first being that mental illness is a “Western” concept, or a “white people’s disease”; and the second being that when compared to physical illness (which we all know to be the more dignified ailment), mental illness isn’t always easily identifiable — after-all, how could one who looks and acts like themselves and isn’t in any ascertainable pain possibly be suffering from any legitimate illness? On an unrelated note, a few decades ago cancer was largely considered to be a “white” illness, just as HIV/Aids was reserved for “gays” and Blacks — both of which may present without perceptible signs.
In fact, our collective doubt is so ingrained in our society that the Shona term for a wide range of mental disorders, “kufungisisa”, which translates to ‘‘overthinking’’, presupposes a certain level of culpability. Those seeking help with mental illness are often either mocked for their perceived psychological weakness, advised to “just get better”, or are subjected to long-winded speeches about how everyone has their own struggles in life. These textbook responses not only play down the importance of mental health, but also almost admonish the sufferer for daring to claim unwellness.
At a societal level, our reluctance to acknowledge or assist cases of mental illness shun the core principle of ubuntu by shifting the responsibility of recovery solely onto the ill themselves — diminishing the duty of care between one another in our communities.
Comparatively, those suffering from a physical illness are often treated to a cascade of sympathy; waited on hand and foot by family and friends; given time off work, school and social or familial obligations; and have access to a variety of medical services and over-the-counter medication. In contrast, those suffering from mental illness are often ignored, dismissed as attention-seeking, suspected of illicit drug use, and have little to no access to appropriate medical care — isolating the patient.
Counter-productively, this societal apathy may, in fact, exacerbate the illness and contribute towards self-destructive behaviours such as self-harm, substance abuse, and, in the extreme, suicide. Rather ironically, acts of suicide are often then labelled as ‘‘selfish’’ — an absurd judgment from the very same society which wilfully shirks any responsibility for the mentally ill. The truth is that in many cases suicide is entirely preventable — like any other illness, left unattended, and mental illness will likely only worsen. Our reluctance to address mental health — our passivity — are instrumental in driving suicide rates.
Similarly, suicide is often perceived as an act of cowardice with the deceased commonly seen to be “running away” from her/his problems. In the vast majority of cases, however, suicide is a last resort. Every living organism has a sense of self-preservation, an innate desire to stay alive or “survival instinct”, which manifests a set of behaviours designed to keep it alive — for example, running away from danger, a fear of heights, our pain tolerance, or the urge to procreate. Suicide bypasses that basic instinct — a testament to the extent to which mental illness can wreak havoc to the self.
The reality is that mental illness is often only taken seriously after a failed suicide attempt — a reactive approach that ensures more casualties where, instead, a preventative approach should triumph. Learning to identify the signs and symptoms of mental illness as effortlessly as one might recognise the signs and symptoms of a physical ailment should be the norm in any society.
Of course, mental health cannot be a purely social project — Government must be held accountable for failings in the healthcare industry.
But then again, if we the people continue to belittle mental health and shame sufferers into silence, then Government cannot be incentivised to invest in initiatives that address mental health, thus perpetuating the state of affairs — a vicious circle, if you will. In the past year, for example, those who have sought treatment at Ingutsheni Central Hospital, a mental health referral institution in Bulawayo, report an elusive psychiatrist (one, out of a mere handful in the country), long queues, and woefully short sessions with psychologists.
Consequently, many of those who are cognisant of the gravity of mental well-being in their communities have built informal structures, like online support groups. However, problematically, the inadequacy of our healthcare sector has seen unqualified and unregulated persons offering counselling services for-profit; a booming industry in alternative medicines and snake-oils; and pharmacists indiscriminately dispensing prescription medication to the public.
It should go without saying that there is a glaring need for more stringent enforcement mechanisms by Government. With that said, however, the current state of health services has created a gap which has allowed the black market to flourish, making the success of any enforcement measures partially predicated on Government’s ability to improve service provision in the health sector. At a foundational level, mental illness will only be truly de-stigmatised in our society through a national educational initiative that places as much stock in psychological wellness as it does in physical wellness. Until then, our society is doomed to sit idly by as thousands of Zimbabweans die preventable deaths as a result of often treatable, or at least manageable, conditions.
As an aside, although this article explores suicide in the context of mental illness, it’s important to recognise two things: the first being that not all suicides necessarily indicate an underlying mental illness — the right to die movement, which advocates for the legalisation of voluntary euthanasia and assisted suicide, particularly the context of terminally ill patients, is possibly one example; and the second being that not all mental illnesses result in suicide.
Finally, if you or someone close to you is in distress, please, get help immediately by approaching your local healthcare service provider.
