The Chains of Mental Illness in West Africa

Gosh. Many of these comments are so backwards. Antipsychotics are as bad as chains. They'll never contribute to society. Or the worst. They'll kill us if we don't restrain them. I have bipolar and take an antipsychotic among other meds and work as as a mental health professional. Our whole department is staffed by the mentally ill (we're peer advocates). With the correct treatment (meds as well as therapy usually) we are able to stay sane and help others. Deinstirutionalization has it's pros and cons but community treatment can be great. And meds aren't like chains. They set us free. We help our clients live fulfilling useful lives. Medicine when used right is a lifesaver. It saved mine.

Is the treatment in africa of being restricted in chains really worse than someone being locked in a psych ward here? Speaking from personal experience, I could relate to the descriptions of the feeling of the experience. I'm not criticizing the technique, just saying that it seems simply like a difference in budget for the same basic treatment. If the only difference is medications, keep in mind medications are more likely to cause psychosis long term - and the APA has known this since at least the 1970s ( http://psychrights.org/research/Digest/Chronicity/nids.pdf )

Just like us they are locking up their mentally ill!. Kudos West Africa.

why does everyone keep talking about america? everyone in this country is so vain. yes, we have an issue with treating mental health in this country- NO, this article has nothing to do with that. save it for an article that's specific to the US. this has to do with these poor human beings confined to a tree in these prayer camps. this is virtually a human puppy mill. this is the saddest things i think i've ever seen in my entire life having to do with the human race.. gregoire is a true saint.

I really looked at this story on the front page of the NYT this morning with utter disbelief...I immediately thought, this can't be happening...but obviously it is.. The mental health world really needs some serious,serious attention..It just immediately took me back to what happened less than two weeks ago in Roseburg...People,populations..whatever need to act..and not just with words..and more ego driven rationalizations.....

Good idea America! Lets tell other countries what to do with their mentally ill because of the fine job we do. We closed up all the institutions instead of properly staffing and funding them because it was the politically correct thing to do. Now most are on the streets. We don't have enough beds for them and they commit mass murders every few months. What a joke.

For those of us with a mental illness who are lucky enough to be in the US and have unlimited resources, we get to pay $300 per hour to a psychiatrist who nods his head and then prescribes random drugs he hopes will work. They don't. And then we get locked up in a hotel like hospital where they give us different random drugs and then some of us get our brains zapped. There is no good solution anywhere.

Thank you for an excellent article that calls attention to people who have been marginalized or forgotten. The pictures conveyed the tone of the article without exploiting those who suffer from mental illness. One can clearly see their humanity even in inhumane conditions. Well done.

The French psychiatrist, Henri Collomb, was decades ahead of his peers when he promoted "les villages psychiatriques" in Senegal in the 1960s. This was a non-western, non-asylum model that accommodated the mentally ill in a local social, village setting. Collomb was prophetic to the current dilemma of mental illness treatment, as stated in a 1965 article in Psychopathologie africaine (English translation) "If modern psychiatry retreats into its walls, it is condemned to life in prison and the impossibility of establishing contact between the caregiver, the patient, and his environment. Modern psychiatry will then live by only by its illusions.....and discover, in twenty or thirty years, it has not accomplished any progress, while other forms of medicine have advanced. In a word, it will not have fulfilled its mission." https://fr.wikipedia.org/wiki/Henri_Collomb_%28psychiatre%29

....people without resources and no way to go, do the most basic things...here in San Francisco, awash with resources...we just let them sleep in the street, in their own urine and feces...we step over and around them...on our way to important meetings...

It seems so sad that we, via greedy politicians like Ronald Reagan (who got kickbacks from friends who started private homes for the mentally ill), shut down so many facilities where people could be given intensive help with their mental health issues. We once had hospitals where we had trained staff to administer to their needs. We put them out on the streets, costing us all a whole lot more for each recidivistic cycle of emergency room care and brief "at will" stays in "get the medications adjusted" clinics. Why? Why do we incarcerate these people in prisons that torture them? Before we critique the shackles in Africa, we employ the same brutal techniques here.

Excellent article, but the video format is so huge I can't watch it (90 MB).

Our experience in West African villages (25 years ago) was that the mentally ill were hobbled, but able to move around. It was preferable to the handling they receive in the U.S., being locked away from society. Of course, cure or treatment is preferable to confinement; but in a poor country, illnesses of all kinds go untreated.

Thank you for this story. Mental illness is a scourge everywhere. We in America are really not doing well helping those in need either. In our cities and towns mentally ill people are left to the streets to make through their way through difficult, often lonely lives. If we can't deal effectively and compassionately with the issue here in wealthy America, I can't begin to fathom how difficult it must be for poorer African nations to contend with it. Hopefully the U.N initiative will help, but perhaps, given all the extreme wealth floating about, some with means will begin to use their excessive wealth for good, rather than add another mansion to their holdings....

I look at this article and see the good. For one thing, the families are given an opportunity to remain lovingly involved. For another, the person with psychosis is not given, long-term, potentially destabilizing (and often lethal) antipsychotic drugs. Robert Whitaker, in his excellent book "Anatomy of an Epidemic" showed quite conclusively that the Western approach of giving long-term medication to someone with a mental illness can destabilize and cause chronicity. In one very hopeful chapter, he highlights work being done in Western Finland where minimal medication is used, families are encouraged to remain involved, and outcomes are remarkably good. The number of those deemed mentally ill here in America, using current medication-heavy approaches and minimal psychotherapy, is growing.

These kind of stories break my heart. In the 21st Century there remains a sad 18th Century mentality of things like mental illness and the irrational fear of those who suffer from it. The fact is whether it is Africa or the U.S. or Canada; those suffering souls are virtually outcasts from society; shunned and hidden from view so society can feel comfortable. Out of sight/ Out of mind. Shame on the world for treating some of humanities brothers and sisters in such barbaric ways; no matter if it is in Africa; or someone in the U.S. being allowed access to act out violent fantasies because of of insane gun rights. We will all be living in a better world when mental illness is no longer a dark/ dirty little secret; and we treat it as the illness it is!

What an article; it is not easy to report, or describe, the unthinkable and in this country mental health is just that, unthinkable. Even now we wallow in the quiet between shootings, many of us hoping it won't happen again and knowing it will - not unlike a psychotic in remission. This is terribly sad - but what hit me in this piece were the reoccurring mentions of compassion that underlies the whole effort. They drug him because they care. They chain because they care. They pray because they care and without money or access to medicine or science they have created their own attempt at a system. Ours, feeble as it is, may be at least trying to be science based (the drug part anyway) but much of the elements are the same - isolate, exist, restrain. Above all respond only once all hell has broken loose - don't attempt to identify, or address, the myriad small signs that are the prelude to a breakdown. We seem to be, as a species, reactive rather than proactive across the globe, to the detriment of all concerned particularly the sufferers. The reality is that psychosis is part of an illness and these people have inner lives full of suffering...and yes, dreams of being well. Just like you.

I read all the comments here, and am amazed at all the criticism of our present system of caring for mental illness both in Africa and the Western World. If it was an easy thing to fix, it would have been done already. And if prayers could have fixed this, we would all be believers. The emergence of major tranquilizers in the middle of the last century emptied out the Unites States' barbaric asylums, but I still remember what it was like inside them, when I was in training as a health care provider. The reason that people are chained to trees, is because their families have no alternative, just as US families in the previous generations had no alternatives. Now we do. It isn't perfect, using a pharmaceutical model to fix such a complex social problem, but I celebrate our advances, however crude they seem. For all you folks who think psychotropic medications ought to be optional for the seriously mentally ill amongst us, I give you Sandy Hook.

And Western culture does what? Lets psychotics out on the street to rot and roam. We are not too much removed from this. The question will always be- how do you keep the patient and the public safe? Not easy. And some cures are worse than the illness.

By the way, the faith and Jesus is really for those who have to care for the sick. They need it to persevere.

As a victim myself ,I cannot but be amazed at the fast way I became healed when I was treated with love and care in Nigeria even though I had to be bound in chains due to the violent way the disease made me act I could not imagine myself being treated for any mental disease when it took it toll on me when my engagement was called off. But the government in Nigeria or Africa according to this article does not help with middle class or poor families hereby leaving the sick at the detriment of the disease , I remember I wasn't even told what I was being treated for, I had to Google and research about the symptoms and later asked my doctor when I was better and out of the hospital . I felt better knowing what was wrong with me and not discontinuing my medications but what about those who are not in a better position to do these researches and don't even have loved ones who are informed? . I was even told not to talk about it or tell anyone , like I had a kind of episode in my life to keep as secret,people should be aware that mental health is very crucial and anybody could suffer from it as well as knowing your family history on health grounds ,that is important

There is little surprise that folks in the West African cultures understand and treat mental illness in this way. For all its supposed sophistication and knowledge, even Western culture can be surprisingly ignorant about mental illness. Many in the West still view mental illness as a form of weakness; others believe that things like depression can be healed by prayer and faith.

With some mental illness, particularly in the paranoid range, even in the US, it can be hard to get folks to take meds regularly. Many psychiatric medications have troubling side effects making them unpleasant to take long term. Still, mental illness is an agony for which the developed world has many treatments. We certainly should do more to both educate folks and to alleviate such suffering.

Very good article. The journalist did well by researching this complex issue thoroughly and discussing specific details -- Even went as far as mentioning specific towns and villages (some of which i am familiar with, and can imagine American readers breaking their jaws over the pronunciations lol.)
However, to the readers and commenters, I'll say please calm down. Yes, mental health treatment is woefully underfunded in many parts of west Africa. Yes, the sick deserve much better than they may be afforded at the moment. And believe me, our governments and authorities are doing all they possibly and Practically can to address these issues. Mental illness is unfortunately one of those afflictions that is very hard to diagnose, treat and completely cure. Some never get cured even. But never make the mistake of thinking that these people's families do not care about them, or just abandon them to their fate. On the contrary, many of these poor families spend vast amounts of resources, time and effort trying to find viable treatments. Some are able to afford professional care. Many simply keep the ill at home and care for them for the rest of their lives, as you would a seriously disabled person. It is usually only those who exhausted all options, tried all sources of treatment, spent all resources, or simply cannot keep the ill at home due to increased aggression or erratic behavior. It is those who have no where else to turn to, who may resort to these "prayer camps".

I did some research on a 1950 election at the LA library. Totally unconnected from what I was looking for was a story in the old LA Daily News that six mental patients had died because of a fire, they were shackled and in cells in a basement.

Don't feel superior, we are only two generations removed from this. Ask Grandpa.

In the West, iron chains have been replaced with chemical ones...more palatable I guess, but same effect.

There must be millions of dollars worth of unused medications lying around in doctor's offices and patient's medicine cabinets that could be used to help these people. Plus ways of restraining them more suitable than chains.

“Don’t you pray for me,” Mr. Gbedjeha...sometimes shouted at camp workers who asked God to cast out the dark spirits they believed were making him sick. “I should be praying for you.”

i think that mr. gbedjeha is right. a man who appears lucid enough to make a sound argument and understand the society around him and the many hypocrisies of religion, christian and otherwise. filled with the holy spirit? i will pass.

p.s. many mental illnesses develop in prison or while imprisoned.

Thankfully, many modernized countries no longer use cruel methods to physically restrain mentally ill people, who display disruptive behavior.

However, most mainline Western psychiatric treatment for acute episodes of schizophrenia usually disparages symptoms of hearing voices as being a totally meaningless experience, which must be quickly suppressed with anti-psychotic drugs. The minimizing of empathetic psychotherapy often may result in a life-time of relapses of symptoms.

Many people who have little or no understanding regarding the often complex process of the unconscious mind, may often blame the devil, or other evil spirits, for causing many physical or mental illnesses.

I recommend the following resources regarding more enlightened treatment of schizophrenia.

- YouTube - "The Voices In My Head - Eleanor Longden" - TED Talk

- Wikipedia - "Hearing Voices Movement"
"People who cope well with their (inner) voice experiences use different strategies to manage their voices than those voice hear hearers who are overwhelmed with them."

- Websites -
- intervoiceonline.org - International Hearing Voices Network
Has support groups in 20 countries
- hearing-voices.org (England)
- hearingvoicesusa.org - USA

- Article - "A Conversation With Dr. John Weir Perry" - 1982- global-vision.org -
Non-drug treatment of schizophrenia

- Wikipedia - "Analytical Psychology"
Developed by psychiatrist Carl Jung

As a christian, I am quietly and fervently appalled at this article and the description of "New Jerusalem" "Jesus is the Solution" "aproaches"
Like something out of a Joseph Conrad novel, this is indeed a living "heart of darkness". I find this a disastrous reflection on much of the pentecostal and evangelical movements in these countries. It is enough to make me want to shed my beliefs altogether. I would like to know percentages. How many people are afflicted by mental challenges that are being shackled in this barbaric manner. I cannot imagine the larger body of faith based organizations of ANY belief system, condoning this. I am horrified and ashamed that so many of those who claim to believe, would practice these inhumane "treatments". Another heartbreak, which frankly irks me , that we are constantly exposed to the miasma of toxicity in this world, without at least some mention of those that are doing good. This is NOT representative of Christianity as a whole. There is a sensationalist aspect to this, that I do not entirely trust. I have written 2 books about India, and I do not overwhelm the reader with harrowing scenes purposely, so as not to devastate people . I try to show the the possibilities for good that exist, this article is nothing short of a Hieronymous Bosch painting come to life.

This sad situation does resemble that of the USA prior to the discovery of chlorpromazine and court decisions guaranteeing due process and civil rights for the mentally ill. Just today the NYT book review discussed the tragedy of Rose Kennedy. I still meet patients who decline medication in favor of prayer. The Scientologists and followers of Szaz and the anti-psychiatry mental illness denyers should read this eye opener.

So have we forgotten Willowbrook - now a university campus Staten Island? NY state is still full of asylums now termed developmental centers, mental health institutes, community living centers, and worse case; Riker's Island prison.
The face behind the chains rarely changes much, no matter what the culture. The U.S.may be considered to have more humane treatment of the mentally ill as spending for a prison inmate is about $35K/year. But if we look at the reality of the conditions, there is little difference - some stay inside and some outside and some in solitary confinement. This is an issue known as a Wicked Problem - one that has been with us forever and has shown little change.
I would hope that further information on the issue not indicate that this is a simple issue with no grey areas. Religion can play a part in healing, just as can herbs, shamans, shrinks, (aka psychoanalyists in NYC), and oh yes, the ever popular and bankrupting- the- country, big pharma. Grey area thinking and support of both families and individuals in a range of ways are needed. Shaming any single approach does not move us forward.

I wish we could see that we're better than this example. If we are, it's just barely--a substantial number of incarcerated people in the US are mentally ill, some of whom are kept in solitary confinement and usually without any form of therapy or medication.

"But religious feeling is strong in this part of the world, and the pastors who run the camps preach that, through them, God can heal almost any ailment — especially ones thought to be essentially spiritual, like psychosis."

The cause of mental illness certainly isn't of a spiritual nature; no doubt, the cause is physiological, such as blocked arterial flow in the brain, a bodily chemical imbalance of some sort or even a brain tumor. Religion is the wrong place to search for help with mental illness or for cures for other types of defects. In the Holy Bible, the Lord declares that people with any defects are not to approach His altar (e.g. to offer food) and that their presence would defile His sanctuary (Leviticus 21:16-23).

This is a frightening and all too common example of the bizarre belief religionists have that prayer can heal people (or have any impact on reality). There isn't one shred of incontrovertible evidence in the history of the world that prayer has ever done anything other than possibly assuage the unmitigated fear one might feel when he or she is forced to accept the powerlessness we all feel on occasion when struggling to overcome obstacles or adversity.

I am tired of hearing people say "Our prayers are with [fill in the blank]." Aside from being useless, it ends up providing a copout from having to actually take substantive action to address a given problem.

And, as we know from myriad examples throughout history, religionists frequently call on dogmatic superstition to assert control over the masses and take advantage of vulnerable people.

The more education one receives, the less likely they are to succumb to religious delusions and empty myths that allow manipulative ministers and other snake oil salesmen to feast on the poor and disadvantaged. The solution to all our problems is education and encouraging independent critical thinking in as many people as we can reach.

There is a reason why the most religious regions of the U.S. (primarily the South) are also the poorest, least educated, and most backward states in the nation. As Obama inadvertently admitted years ago when running for president, uneducated Christians in the South cling to god and guns out of fear.

"I proceed, Gentlemen, briefly to call your attention to the present state of Insane Persons confined within this Commonwealth, in cages, closets, cellars, stalls, pens! Chained, naked, beaten with rods, and lashed into obedience!"

These were the words of Dorothea Dix, addressing the Commonwealth of Massachusetts, in the 1840s. Dix worked tirelessly to establish (very Christian) asylums devoted to the humane treatment, if not the cure, of people with mental illness. Over time, asylums devolved into snake pits, and JFK moved to liberate the mentally ill from institutionalization, based on the twin hopes of community mental health care and antipsychotic drugs. Antipsychotics are truly wonderful medications, when well prescribed, but need expert supervision to prevent awful side-effects - and the community mental health clinics meant to safeguard people with mental illness within the community never materialized.

Today, the mentally ill are back in prison, brought there by the lash of the policeman's baton (when they're not shot dead in the streets, as happened in my home town of Monterey just five days ago).

It's easy to scorn poor nations for their standards of mental health care - but I ask you, when was the last time you extended a helping hand to a raving man on your own neighborhood's streets, or called your representatives to advocate not for more restrictive supervision, but for more humane care?

I just calculated: thats
Ninety-two million six hundred twenty-five thousand schizophrenics on earth and we are too scared to look at them.

Naively, writers here seem to expect first-world treatment in the third-world. How easy it is to judge and condemn the efforts of these well-meaning Africans from a lofty perch in one's comfortable dwelling within reasonable distance of a psychiatrist's office or a pharmacy. This is Africa, people. These people are doing the best they can.

Mr. Carey,

Thank you for covering this story. I also witnessed a prayer camp while researching my thesis in Lougué, Senegal. The traditional healer chained victims of mental illness to trees and inside a compound. Many families traveled from Senegal and Mauritania to have him treat their family member struggling with psychosis.

As someone who has a mental illness, this is truly terrifying to here. Being chained is a last resort to help mentally ill? Mental health care being almost impossible or unreachable is absolutely awful; I feel it is needed almost as much as physical care is. There are some truly damaging illnesses out there and it's scary that pretty much no one talks about this- I can say for certain I've never even thought about this problem before; but I'm very glad I did.

I was brought to tears by the situation of these horribly mistreated mentally ill people in West Africa. How can Paul Noumonvi, head pastor of the Jesus is the Solution prayer camp, justify the inhumanity of keeping them shackled up in abominable circumstances? Does he not feel their suffering? Is this his takeaway from Christian ideas of charity and compassion?

On the other hand, Grégoire Ahongbonon is to be commended for his efforts to bring standard psychiatric care and dignified treatment to as many people as possible. I wish him great success. Meanwhile, I grieve for the mentally ill people of West Africa.

I wonder when the New York Times will publish a front-page headline article about religion that doesn't play right into reflexive anti-religion bias. Unfortunately, it's starting to look like the answer is "never." Even though religion is one of the most important motivators of human behavior across cultures, and plays a demonstrably positive role in the emotional lives of billions, the Times seems pretty well committed to producing a drumbeat of negative stories that all combine to paint a picture of religion as as atavistic, ugly, and monstrous – a picture so cartoonish that even the most vociferous of French anti-clericalists might be expected to ask for a more balanced picture.

Please note: I am not arguing that the chain-and-prayer camps are good or even defensible. They're not. I am not arguing that religion isn't to blame for many ills, or that people are never led by religious beliefs to do serious harm to themselves or others. What I am arguing is that religion is complicated. The great majority of religious believers across the world report positive benefits, subjective or otherwise, from their faith commitments. This is a valid datum (as self-report), and as such you'd expect at least some lead articles about religion to highlight those positive reports. But if you only ever read the New York Times front page, you'd think that religion was nothing but monstrous. Which, to judge from comments, is what the average Times reader already thinks. How open-minded.

Why is not the whole world working for a cure for schizophrenia. 1 percent in the western world. 1.5% in the developing world!
Chained in the developing world, roaming the streets without medication in the western world.

What happened to the idea of asylum?