Am I mad or mentally ill?

On New Year’s Day, I watched actors Funny Face and Akrobeto engage in friendly banter on UTV as they presented ‘Real News’ review of the year 2020 with Jackie Appiah. I watched with unease as Funny Face desperately tried to explain to Akrobeto that depression is not madness. He also tried to explain (albeit not so rightly) that, all creative people have some level of mental illness, and that receiving psychological treatment, implies you are not mad. This gave me the impetus to begin something I have long desired to do. That is; to demystify mental illness, reduce stigma and encourage people to seek professional help.

Our misunderstanding of mental illness as a society has contributed immensely to stigma. It is also the reason why people with mental illness do not seek the right help, and why families and friends send their loved ones who need help to some camps and other ‘spiritual’ places for a help, they hardly get. Do not get me wrong. I am not against prayer camps and spiritual treatment. I am Christian, so, I am a firm believer in seeking the face of God or whomever you believe can help cure you. Indeed, some prayer camps even team up with mental health professionals to provide a holistic treatment to the patient. Besides, there is scientific evidence that spirituality and religiosity improve mental health and facilitate general well-being. What I am against is the abuse, extortion and inhumane treatment that go on in some of these ‘spiritual’ places.

Before we talk about mental illness, let us see what mental health is. A simple search in Google shows various, yet similar definitions. However, let us stick to that of World Health Organization (WHO). “Mental health is a state of well-being in which an individual realises his own abilities, can cope with normal stresses of life, can work productively and is able to make a contribution to his or her community”. It is not just merely the absence of mental illness. Mental health is fundamental to our collective and individual ability to think, feel, interact with each other, earn a living and enjoy life. It is a state of balance within yourself and with your environment. Physical, social, psychological, cultural, spiritual and other factors contribute to this balance.

What does this mean? It means that one may not have diagnosable mental illness; However, to be considered mentally healthy is to be able to have balanced thoughts, feelings and actions; such that, you can solve problems, enjoy a healthy relationship with loved ones, work productively within your capabilities, contribute to your community and be spiritually at ease. So, imagine 24-year-old Kofi, who is a born again Christian.

Kofi occasionally watches pornography and masturbates. As a Christian, he feels guilty and ashamed of this. He hates himself and, thinks he is weak, has taken God’s love for granted and has let God down. This is because whenever he tries to stop, he finds himself back in the same situation after some time. As a result, he no longer reads the bible or prays. When he goes to church, he feels guilty and does not enjoy the service anymore. He is now so worried and is unhappy with himself that he has begun avoiding his Christian friends and is contemplating stopping church entirely.

Even though Kofi may not meet the criteria for a full mental disorder, we can clearly see that he is also not socially, spiritually or emotionally at ease; and hence not in a state of good mental health.

So, what comes to mind when you first hear of mental illness? Is it a naked mad man roaming on the streets; someone talking to himself; or an aggressive man attacking people? Mental illness (I will use interchangeably with mental or psychological disorder) is a health condition that affects how we think, feel and act; it is distressing (to the sufferer or others), and/or causes impairment or problem in social, work or family activities or functioning. This means that mental illness significantly affects or disrupt one’s social life, relationships, work or academic life. Mental illnesses are quite common, yes, even in Ghana. They affect children, adults, men and women of all ages. Usually, in our part of the world, mental illness (or even the word psychiatrist or psychologist) conjures images of a raving mad man. Some people assume that all mental illnesses are madness. Madness is what we call schizophrenia (and I will add, bipolar- especially, manic episodes).

It is this misunderstanding that maintains the stigma associated with mental illness and prevents people from seeking professional help. Schizophrenia and bipolar constitute just a little fraction of psychological disorders. In fact, there are hundreds and hundreds of psychological disorders. Some even affect our sexuality (oh yes, you read right, sexuality) and personality. For example, delayed or inability to achieve ejaculation could be a psychological disorder or mental illness. I am not saying that if someone has difficulty ejaculating then, he is mentally ill. I am saying IT COULD BE A POSSIBILITY.

Your psychologist or other mental health professionals can determine this, after taking you through some form of evaluation. In the same way, an excessive need to be taken care of by others, leading to clingy and submissive behaviours could be a symptom of a personality disorder. In addition, a common condition called social phobia/anxiety could be diagnosed if someone has an extreme fear of social situations, such as speaking or eating in public, meeting with and having conversation with unfamiliar people. The fear can so be paralysing that the individual experiences symptoms such as trembling, choking, butterflies in the stomach among others. This is one of the commonest problems among my students who come for therapy. Imagine you have a presentation to make, and yet have or experience this paralysing stage fright. Does having a severe stage fright mean one is mad? No, but it is psychological disorder.

One cannot always tell by looking at someone’s face that he or she has a mental illness. It will also surprise you that, most people with mental illness are not aggressive; if anything, they are mostly withdrawn and docile. Most people will not admit to having mental illness or psychological disorder because of the stigma associated with it.

Others genuinely also do not know because they are able to go on with their life (albeit with much pain and suffering within). Besides, some psychological disorders show themselves as physical or medical problems; for example paralysis, loss of hearing or sight without any underlying medical cause. Since it appears as a medical problem, the patient keeps visiting the hospitals for medical treatment, until doctors realise that it may be more psychological than medical, and refer for psychological or psychiatric treatment.

As mentioned earlier, there are numerous mental illnesses or psychological disorders. To make it simple to understand, they could be grouped into two: common mental disorders and severe mental disorders. Common mental disorders are characterised by symptoms that we all experience from time to time such as worry, sadness, fear, guilt, and sleep and appetite problems. These include disorders like anxieties, depression, and substance (drug) use. Since the symptoms of such disorders may be common, it may be difficult for loved ones to recognise them as illnesses. A lot of people with common mental disorders therefore, do not receive treatment and suffer in silence. Severe mental disorders are much more debilitating and characterised by symptoms that are often difficult for the general community to understand. These are easily recognised because the patients behave differently and strangely.

Hearing voices or expressing strange or unusual beliefs, for instance, are some of these symptoms. Severe mental illnesses include schizophrenia, bipolar, and other psychotic disorders. Since these are easily recognised, some people wrongly assume that all mental disorders are these severe ones. It also because of the strangeness of the symptoms that make people stigmatise people with these illnesses.

Specific mental disorders have specific symptoms. Generally, however, mental illness symptoms can be put into five main groups:

1. Physical Symptoms: These include tiredness, aches, pains, weight loss, sleep and appetite problems, lack of energy, shortness of breath, heart pounding, stomach upset.

2. Feeling Symptoms: Such as sadness, fear, anxiety, guilt, helplessness, loss of emotion, hopelessness, loss of motivation, mood swings, low self-esteem, extreme excitement or elation

3. Thinking Symptoms: includes excessive worry, self-blame and criticism, indecision, thoughts of death and suicide, poor judgement.

4. Behavioural Symptoms: includes crying, withdrawing from people, talking to self, aggression, poor personal hygiene, avoiding people and situations, speaking rapidly, slowly, loudly or lowly, irritability, attempting suicide, not making sense.

5. Breaking with reality: It includes, false beliefs (delusions) and seeing things, hearing voices, smelling, tasting and feeling things that are not there(hallucinations)

Let me put on record that, having these symptoms does not necessarily mean one is mentally ill. You need to see your mental health professional who will assess you to determine if the symptoms meet the criteria of a diagnosable mental illness.

Mental illness is caused by a combination of factors such as biological, social and psychological. It runs through families, and that suggests perhaps a genetic contribution. They have also been found to be caused by abnormalities in brain activities. In addition, psychosocial factors like financial, relationship/marital, academic, health, legal, and employment problems are also implicated.

One thing Comedian Funny Face sought to explain to Akrobeto is that he received only (psycho)therapy and not medication, and so he did not really suffer madness. Psychological conditions can be treated with both medication and psychotherapy. A combination of both therapeutic approaches has been found to be more efficacious, especially in severe cases. However, when the symptoms are mild, psychotherapy alone may be ok, due to the side effects associated with medications. One question clients often ask is that, “is the illness spiritual?” As always, my answer is, “I do not have a spiritual eye to see if any spirit brought the illness. However, what I do know is that in Christ, we have power over any illness”.

It is usually the belief that mental illness is caused by some spiritual forces that make people not seek professional help but go from one pastor or prayer camp to another, where they may be taken advantage of. As I said, I am a person of faith and know that faith helps a lot in healing, so, I am not against faith healing at all. However, God has given us knowledge and wisdom to treat illnesses. As Akrobeto said on the show, “If you are sick, you are sick”. When we have high blood pressure, cancer, malaria or any illness, we seek professional help; why not mental illness? Professional help is available, and I have realised that it is cheaper compared to the amount of money some of my clients say they pay when they go to some of these places.

Another question clients usually ask me is: “will the illness ever go away?” The answer I usually give them is, “well, I cannot exactly tell”. When patients and families hear this, they get quite disappointed. However, the truth is that I have worked with patients who experienced the illness only just once in their lives, (and have never come back to me again), and I have also worked with others who still come for therapy, even after several years. We do know that, some disorders like schizophrenia tend to be chronic or recur. However, it is difficult to definitely tell if someone who has recovered will suffer the illness again. Once the activating, contributing and maintaining factors of the disorder exist, it is more likely it will return.

We also know that, when one is first afflicted earlier in life, particularly during adolescence and early adulthood, the illness is more likely to be chronic (especially for schizophrenia). My experience with patients is that, with the exception of few cases, once someone suffers or is diagnosed on a psychological disorder, their self-esteem or sense of self-worth is lowered (low self-esteem in itself could be a symptom of a psychological disorder). They become sensitive and may misinterpret comments and may be more susceptible to relapse. Therefore, we need to be supportive, especially in speech and action, and not be critical or judgemental, as this could also lead relapse or the illness recurring.

One thing we have to know is that mental illness can affect anybody. I have worked with doctors, lecturers, pastors, farmers, lawyers, carpenters, traders and people from all walks of lives. There are so many people who are suffering in silence, not enjoying their relationships, not functioning at their optimum level, who have lost opportunities and relationships, whose professions and academic works are suffering, because they suffer some form of mental illness, for which they are not receiving treatment. If we begin to look beyond schizophrenia, bipolar (madness) and other severe forms, we may find that mental illness is quite common. Thus, instead of stigmatising people with mental illness, we should encourage them to seek professional help. Hearing mental illness, psychiatrists or psychologist should not necessarily conjure an image of a mad person. Even if the person is mad, he or she can be professionally helped to function.

In summary:

• One may not have or meet the criteria for a diagnosable mental illness, but one may not be mentally healthy.

• Mental illness is common. Schizophrenia or madness is just one type mental illness.

• Mental illness is treatable, and professional help is readily available.

• It is important to gain enough knowledge to understand mental illness, so as not stigmatise, but support people with mental illness.

TOMORROW IT COULD BE YOU OR A LOVED ONE.