Thursday, November 26, 2009

Ghanaians and Mental health

Written by Marian Sakley anang

Does any Ghanaian language have a word for “depression?” It is impossible to turn on American television and not see a commercial for Cymbalta, Abilify, Zoloft. If you are new to these names, they are popular anti-depressant drugs a growing percentage of Americans just can’t seem to do without. These drugs are meant to elevate mood and boost confidence. Some call it a “happy pill.” They are known to restore chemical imbalances in the brain thus alleviate the sadness, loss of interest in daily living and sometimes suicidal thinking associated with depression. The number of people who depend on these drugs to remain “stable” is enough to shock any Ghanaian immigrant. It is not strange to go to work in the US and have a coworker who you thought was “normal,” you know clam, jovial with everybody, smart even, become unhinged and exhibit pseudo-psychotic or aggressive behavior because they forgot to take their meds that morning. Or because the one they took this morning is beginning to leave the system. You are probably thinking OMG what did I do to make them fly off the handle like that? But nooo….it has nothing to do with you. It’s that time for them to be excused, go to the car and get a fix. They come back an hour later smiling and you are like…”ok…”…until next time. Of course some people are on illicit drugs too, marijuana, and the like.

So I want to ask do Ghanaians living in Ghana get depressed too? Do we get suicidal? I mean growing up in Accra I heard of an occasional suicide here and there, but nothing compared to what I have seen in the US. Ok if we tend to be less suicidal and depressed than the average White person, why is that ? Is it because we Ghanaians have better coping skills in response to stressful situations? And please don’t tell me poverty, poor health, hunger and all the ku me preko lifestyle in Ghana doesn’t take its toll. Ghanaians have not been called magicians for nothing. We have always felt the pinch of living in a tough economy. Yet our mental health doesn’t suffer so much that we need occasional trips to the psychologist or psychiatrist. Genetics play a part in mental health too I must mention. But it is largely influenced by the environment.

Most people who end up with mental health problems have a history of sexual, physical or emotional abuse in childhood. Rape, sodomy, dysfunctional families and physical abuse at the hands of family member and strangers can create emotional and personality disorders that when left unchecked become more severe and manifest itself as psychotic behavior or “craziness” as we call it, over a period of time. Simply put, mental health degenerates if emotional problems are left unchecked. Ghanaian boys and girls are raped on daily basis. Sexual abuse and incest goes unfettered in the most conservative of Ghanaian families. We don’t like to talk about it, but we are hearing more about it every day. Where are the psychologists, the Dr, Phil’s and psychiatrists in Ghana to help this section of Ghanaians with the deal emotional issues that crop up as a result? Do they keep it under wraps well into adulthood? Do they share it with anyone? Their better halves?

At present it is reported that there are only 14 psychiatrists in Ghana in three psychiatric hospitals. Accra Psychiatric Hospital, Pantang and Ankaful in the Central Region. That is not to say people with mild emotional issues should consult a psych hospital, but how well can 14 doctors serve a population of 24 million people? Why are most Ghanaians embarrassed to talk about this? We will rather admit to having cancer and gonorrhea than admit that our mental health is challenged. Is it mentally healthy for us to keep everything bottled in the way we do? In the event that we do admit that we need help, who do we go to for the Cymbalas and Prozac’s? In Ghana if your mental health is so much as deemed unhealthy, you could be labeled “abodam” ‘seke yelo” ‘craze” and the like. Do those Ghanaians who are mentally challenged deserve that label? Or is it that you and I have better coping skills and so we haven’t found ourselves needing the help of a metal health worker--yet?


  1. Excellent post!!! An issues that seriously needs to be addressed. Apprantly In LA (yankee LA Not Labadi)... almost every yaa, abena and Kwame has a psychiatrist-madness huh but it would attest to the fact that there are a lot of people who need this and the pills to get through everyday living. anyway I dont want to go on and on but defo something we need to address - our mental institutions are more than full up and these are actually for the bordamfor ("mad people")- by Ghanaian definition anyway.xx

  2. Thanks for writing about this. I think most Ghanaians use church and God as a coping mechanism. We pray about whatever is bothering us and "let go and let God". i guess thats therapy in a way. Our pastors become our conselors and on the flip side, We tend to over spiritualize everything and label people dealing with serious issues as being possessed with some kind of spirit. some run to the bottle or other drugs to alleviate the pain. Since most pastors and "osofo maame's" have been relegated to lead and counsel their members , I recommend the government provide a way for them to get their counseling degree since there aren't enough psychiatrist to begin with. Plus it eliminates the stigma attached to seeing a psychiatrist. now regarding prescription drugs that help people with mental illness cope, that's a different beast in itself with addiction issues and side effects. This is unique in each situation and both benefits and risks have to be evaluated carefully.

  3. Well written post. As a nation, I think we would benefit from more exposure to and understanding of the complexities of mental health. The stigma definitely has to go.

    The sooner we start realising that the spectrum of mental health issues is broad and problems do not detract from one being a contributing member of society, we will be better for it.

    My pet peeve is the general classification of all troubled people as “bodam” “gyimi gyimi” or some other such derogatory term. I don’t profess to understand mental health issues to a great degree, but my time abroad has given me insight into the magnitude of the problem.

    Shame about the reported number of psychiatrists – I wonder how many of this small number try other methods of healing besides medication.

  4. Hi Esi - this is such a serious issue in Ghana - and important that we all expose it as much as possible.

    I posted about the same issue here:

    In the post, I noted that there are only 2 qualified and practising psychiatric doctors in Ghana. This is 1 to every 12 million people...

  5. It isn't just Ghanaians, mental health is a stigma in most black communities. It exists in Ghana, but Ghanaians are optimists. They have different coping mechanisms and are,in general, happier than those living in so called 1st world, affluent countries.Like someone said, they spritualize everything and they have the church, family, friends and socializing, which is a real tonic. You know how healing it is if you're forced to do without like many kweku bronis do here. The break down of family/extended families in the west is partly to blame, but I'm sure you've observed how hard it is to have a close knit group of friends in abrokyire.Plus people are totally unpredictable. One minute they're your friend, next they're wielding a knife threatening you. Years ago, I worked as a researcher with an african refugee group.I met 2 guys who were best friends, both pleasant, mild mannered, and very well educated. One day we turned up at work, only to find one had killed the other and although the body had been moved you could still see the blood and the knife marks on the door. Something about living in the west can make some people snap, so it's a real serious issue. I made the mistake once of speaking to my doc, whilst going through a stressful period.Before I could say jack I'd been put on anti -deppressants! 2 weeks later, I took myself off it against his advice. Truly, I could see no good reason for taking it.(All I needed was a bit of emmotional support, which is free in Ghana.You talk to your mum/ aunt/ friend/ Pastor /elder etc.) That was a few years ago,and I've since found out that some of my Ghanaian friends are on prozac, and have been for years.Now don't get me wrong, I know mental illness is real. On the hand, over here drs are quick to diagnose something and give you a cocktail of drugs b'cos the natural social network no longer exists.

    "Sexual abuse and incest goes unfettered in the most conservative of Ghanaian families."
    Esi is this really true?

  6. Probably a case of natural selection at work here.

    Life in Ghana is so stressful that only those with the ability to live with the stress survive long enough to procreate.

    Making abodam acceptable as it has in the west will mean more people with mental problems will get to have children and possibly pass it on to their offspring.

    There are many reason why Ghanaina tradional marriages include a "knocking" part. One of them is for the girl's family to check your family history to see whether you're "difficult". Quarrelsome is another and so is having mental problems in your family.

    Of course these days we young people are "enlightened" and dont want anyone else to "put their mouth in our matter" [which is incidentally another major reason for having less mental health problems. The sense of kinship and family that most Ghanaians enjoy]

    So yeah we have the social aspects and the theoretical science behind it but as someone I know once said... what time do you have to be sad when you're hungry [the economical aspect]

    PS: On Ghanaians committing suicide, the only stories I remember hearing about suicide in Ghana were men killing themselves over a love lost. That one be the same everywhere!

  7. @MerryMary: Do Yaa's, Abena's and co. really have psychiatrists? As somebody mentioned, it is hard to get people who support you fully in aborokyire. I'll bet they wanted somebody with whom to discuss their problems and were prescribed anti-depressants as a part of the deal. LA I hear, is a very isolating place to live.

    @anonymous yes Ghanaians would rather go to a spirtual advisor/pastor to vent. We dont buy into the notion that somebody with a PhD. in psycho(fill in the gap) has more insight into affairs than the average Kofi or Ama. Even in Yankee, the thought of some doctor documenting every single emotion or problem I tell him and filling it on a shelf where somebody can get access to it is unsettling.

    @LastBornChild. The spectrum of mental health is indeed broad. It could be just wanting to talk over a problem to get support to becoming psychotic. But anything that smells of mental health is deemed "abodam" in Ghana lol.

    @anthia-ofo: You are so right! You mentioned some very insightful stuff. We dont realize just how valuable our support system is back home until we are way from them! Something about living in the West can make someone snap. How true. I'll bet there are more Ghanaians on prozac where I live than I will ever know. Why do Ghanians abroad find it so hard to talk to one another, trust one another? You know really talk? Everybody is trying to outdo eachother.

    @Faf..natural selection....hmmm...interesting.

  8. Anthia said "Is this really true?"

    You'd be surprised to see the figures. sadly, they do not exist. In talking to Ghanaian friends about child molestation and such, the majority of friends who have confessed such to me were from well to do homes. They of course were told never to speak of it. Family will protect family in Ghana and you dare not draw attention to the household. Kids running away from abusive parents are left in orphanages because the extended family's are ashamed of them for bringing the abuse into the limelight. They feel such things should be dealt with internally.

    Who molests children in Ghanaian homes? Family members as seen in foreign homes. Cousins, siblings, parents... and then there's the lurkers from outside who lure the children away or kidnap them.

    @ Esi....Ghanaians use the GOD model of medical science. Be it for physical or mental illness, their answer lies in the church! There's more cases of suicide in the country than you think but sadly, figures are not consistent. Also, people holding psych degrees are not so concerned with the counseling aspect of the job but are rushing into industrial psychology. Those studying clinical are rushing outside as soon as they can to practice on people who CAN afford to pay for their services.

    We've always had mental cases here. It's not a new phenomena. The simple truth is that they've been able to hide schizophrenia with witchcraft and juju. Either the person is a witch or a prophet. Depressed people are told to cheer up. And those who go manic usually do crazy things that take them off the wheel of life anyway. Now however, we're turning Japanese. People are undertaking honour suicides, especially students. Inability to pass out of academic institutions successfully results in them jumping to their deaths and such. We need PEER educators!!! And more counsellors!!! I can only hope that I and the rest of this generation can do something to help.

    I apologise for the super long rant....I have lots more to say but will speak of it later.

  9. This issue is not a Ghanaian specific or Blacks as a whole.I think it wild spread in almost all developing or so called Ethnic groups of the world,what you Guys are talking about i have seen it in India most south and south eastern groups.Latin America you name it.It sounds like you we tryin adopt Western approach to mental health i have no problem with that ,one it just too expensive for most so called 3rd world people.Most poor people with mental problems even in America can not even get help.They are all on the streets of downtown los Angeles.

  10. I second what the last poster said, it's all well and good to be concerned but have we counted the cost?

  11. The truth of the matter is that we're quickly turning into the west. Our country for instance is learning that it's becoming each man for himself. Family bonds are not what they used to be and whether we like it or not, western medicine has a niche cut out for it here. What we need to do is to help build it up cuz no matter what we do, there WILL be people who can't ascribe to our traditional and God models of healing. People who can't simply go to church and scream away their troubles.

    It will be expensive but what is our university training psychologists for then? I am depressed but I know I don't need pills to calm me down. Talking about my issues helps and it just might help someone else. When it comes to issues like molestation and PTSD, it's impossible to talk to family about it. In these cases, our old methods fail. How do you tell a family member about your issues with what happened to you and how it affects your relationships, bonds and sex life now? IMPOSSIBLE unless you have no trouble with causing rifts within the clan.

    There's some times when you have to say costs be damned. Suicide rates are going up, more and more people are in jail for murder and other reasons and more and more broken homes and lives are left to fester. By all means those who believe in the old ways should seek treatment there but those seeking proper mental health SHOULD have it made available for them.

    When you go to the supermarket, there's a variety of goods on the shelf and each man or woman buys what is to their tastes and suits their pockets. My take is that it should be the same for mental health. We should be able to look at our pockets and our personal belief systems and use whichever suits us best.

    I don't think we should adopt the western model in totality has its flaws. A merger of the two may very well be necessary for our part of the world. Least that's MY belief

  12. You have all made some very interesting points. I've grown up in America most my life and it's such a lonely place that I have felted depressed on and off at times. And even though I have friends and family, I feel like they have their own issues they're going through and can't really do anything to help mine so why talk about it. But you know it's crazy how westerners look at our society and what we don't have and pity us, when in fact a lot of the western culture, in terms of loneliness and depression, should be pitied. Many many people here are not happy. Expectations are two high and often polarized and therefore un reachable and no one really feels like they can turn to or burden another. I've definitely noticed on my visits to Ghana that even those in the village are generally happy and it's hard to be lonely in a place where you are constantly surrounded by family. I have somewhat of an issue with turning to church and God so much. I feel like rather than dealing with problems we brush it under a rug but in the end it may be a much better coping mechanism than what we practice here in the states. Great article and discussion.

  13. Hi Esi,

    ( I have been checking in every so often. Your blog always has very interesting and relevant topics, so today i thought to get off my backside and figure out how to, well done on your great work!!)

    First of all I'm very surprised that anti-depressants are being advertised on TV in the states. Surely this could only lead to increased addictition and anyone just taking pills just because they are feeling a bit low and then self prescribe?

    Being interested in social issues I feel that
    One possible contributing factor to higher levels of mental health in developed countries, is the fact that there is a high level of isolation. People have less support systems, which could be due to more emphasis on nuclear rather than extended families, working life (24-7), and migration amongst others. Reserach has shown that no matter what difficulties people face, they are able to get through it without detrimetal effects if they have a reliable support system. i feel that that is one positive thing about Ghaniaian culture - there is more support in communities, families and faith systems. could the difference between developed and less developed countries could be evident on a smaller scale within Ghana in terms of bigger cities and smaller towns or villages?

    Another possible reason for higher levels (or perceived higher levels) of mental health in western societies could be the fact that it is actually addressed, and people are more aware of it. As the article highlights, mental health is not an issue tackled massively in Ghana, with there only being 14 psychiatrics in the country. Growing up in Ghana for most of my childhood (based in the UK at the moment) my knowldge of mental health extended to the thinking depression was occasionally feeling low, and 'mad' people who roamed the streets naked and dirty, talking and singing to themselves and with that the stigma attached. If there is no awareness, it becomes a taboo issues and even if someone is suffering from some forms of mental difficulties, they would not know how to deal with it. I definitely feel there should be more awareness and education on the issue.

    In relation to resilience to difficulties, I feel that people who are faced with difficulties over and over, over time build a coping mechanism and are able to face further problams that may by. Someone who has had everything they want in life and all of a sudden in adult life is faced with a difficult situation, which he has not idea how to deal with, the skills, mechanisms or support systems are not in place, which may lead to mental health problems. Although some people may have a genetic predosposition, i feel the environment plays a huge part.

    in terms of dealing with mental health problems although there is a wide spectrum, and it may not be the answer for everything, i feel we should look at appraoches that work in our culture such as family, friends and support system and relate it to talking therapies such as counselling as treatment, rather than running straight for pills. Sometimes people just need someone to listen, and give them the space and encouragement to make their own decisions.

    In terms of sexual, physical and emotional abuse, a lot of it is kept under wraps as they are taboo areas. The effects of this may manifest in other aspects of behaviour.

    My last point - there is also the issue of people suffering from mental health or other illness may be branded as a witch or possessed by evil

    - Neet

  14. This is the reason I'm struggling through years and years of grad school to become a clinical psychologist. There's stigma surrounding mental health in both the developed and developing world across all cultural groups. In the U.S. in particular, this stigma is greater in people of color, but it's important to recognize that this is really confounded with socioeconomic status. That is, the more economic and educational resources one has, the more likely they are to seek treatment. Just like with any treatment for health problems, mental health services are not free. But if you're financially disadvantaged, would you rather pay for psychotherapy or buy medication for a physical health problem so that you can go to work to support your family?

    Now in the developing world, you've got limited resources and cultural beliefs and values which combined, definitely don't facilitate the recognition and treatment of mental health issues. In Ghana, many people would say that mental health isn't really a problem- that it's a Western notion. I'm sure that the strong social support systems that we have in place buffer the potentially negative effects of disorders like depression and anxiety. And perhaps people are more resilient to difficulties and find ways to cope. But when people are experiencing severe symptoms, no amount of family can take that away, no coping mechanism is going to be enough. I am not a huge fan of medication, but for severe psychopathology, you need drugs and you need therapy to help you function effectively.

    It's true that many Ghanaians depend on the church for counseling and there’s nothing wrong with that. Since we know that religion is so important to people, then treatment needs to be tailored to address that need. The problem is that many religious leaders think they are qualified to deal with serious mental health issues and they are very wrong. My father's a minister but he's also a trained professional counselor with a PhD. He sees people from the church in his pastoral role and also sees people in his other role as a counselor. He helped establish a master’s level pastoral counseling program so that there some trained mental health professional who can effectively integrate psychology and spirituality. Interestingly, he recently told me that most of his current clients are severely depressed and many of them have suicidal ideations (and he strongly recommends medication to these people). So much for that being an abrokyire problem.

    I could go on and on and on about this because there are so many issues to discuss; but instead I will just end abruptly :-).

  15. @ Aya. I agree with you on several of your points. It's definitely not an abrokyire problem. And with the current decline of our social system, it's only a matter of time before the situation gets worse. With the current expose on the situation at the Pantang and Accra Psychiatric hospitals, it may very well be a struggle to get people to visit these institutions.

    I think that with the world becoming a global village and people being exposed to other cultures and beliefs, we are quickly losing that which made us special (our extended support system). I also still insist that most people with mental problems took themselves off the grid in the past (Reckless drivers, murders, etc) It's only that we're now actually recording these instances.

    Why, in the past, someone would start rattling nonsense or seeing and hearing things and we'd say they were being possessed or that they were receiving a vision, be it from God or from some spirits. YOu and I know it was clearly schizophrenia and that it's proof of there always being a problem in this part of the world.

    Glad you're doing clinical psych. I don't have the stomach for it and have little patience for counselling. But I am trying to get something set up. Have had the idea for months now and am writing up a proposal for sponsorship. I need more Ghanaians willing to support the cause.

    Please holla @ me on or even better, I am ever willing to have others on board, especially as it seems I will be studying for my masters in Counselling and won't be around as much as i would want to.