The chains of mental illness in west africa

KPOVÉ, Togo — The church grounds here sprawled through a strange, dreamlike forest. More than 150 men and women were chained by the ankle to a tree or concrete block, a short walk from the central place of worship. Most were experiencing the fearsome delusions of schizophrenia. On a recent visit, some glared, while others slept or muttered to themselves. A few pushed to their feet and gestured wildly, their cries piercing the stillness.

Until this year, Koffi Gbedjeha, 45, a carpenter and father of four, was one of them — a resident of the Jesus Is the Solution prayer camp here, shackled like the others, his family and camp staff members said. For more than two years, his youngest sister, Akossiwa, 27, tended to him. Rising early each morning, she walked along a cool red-earth path to the human forest; each day, amid the stirring bodies and clinking chains, she emptied her brother’s chamber pot, swept the ground and cooked his meals over a charcoal fire.

“Don’t you pray for me,” Mr. Gbedjeha (pronounced guh-BED-zhe-ha) 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.”

Every society struggles to care for people with mental illness. In parts of West Africa, where psychiatry is virtually unknown, the chain is often a last resort for desperate families who cannot control a loved one in the grip of psychosis. Religious retreats, known as prayer camps, set up makeshift psychiatric wards, usually with prayer as the only intervention. Nine camps visited recently in Togo ranged from small family operations to this one, Jesus Is the Solution, by far the largest and most elaborate.

“We try to talk people out of going to the camps,” said Dr. Simliwa Kolou Valentin Dassa, Togo’s director of mental health services, “but we cannot tell them to stop if there’s no alternative.”

Historically, mental illness has lingered near the bottom of both African and global health priorities, well behind deadly threats like malariameasles and H.I.V. But last month, the United Nations adopted global development goals that, for the first time, include a commitment to “promote mental health and well-being” and to reduce premature deaths from noncommunicable diseases, including mental disorders, by one-third by 2030. The World Health Organization has also intensified its focus on mental health, calling for an end to the chaining of people with mental illnesses.

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