In the first of a three-part series on mental health and activism in Kenya, Noosim Naimasiah writes about the pandemic of mental health breakdown in Kenya. She notes how activists respond increasingly to distress calls, extrajudicial executions, sexual abuse, fatal domestic violence, and suicides are interspersed by the chronic conditions of violence in the informal settlements of Nairobi. Naimasiah writes how communities once connected by values of respect, dignity and love have been left to the cold machinations of a brutal system registering only exchange value.
By Noosim Naimasiah
Women activists in Nairobi are struggling with mental health problems, further aggravated by the onset of the COVID 19 Pandemic. As part of the larger community of African activists, I comprehend in sharper relief the myriad ways that women activists suffer. Caring for others and ourselves is a balance most struggle to strike, so that in the end many activists have become overwhelmed, exhausted, frustrated, and resentful.
The manifestation of living in a patriarchal society, the culturally alienating effects of colonization compounded by the suffering inflicted by a highly unequal neoliberal society melt into each other to form a toxic political amalgam. Talk therapy or ‘self-care’ is extended at a prohibitive cost, holding the possibility of healing at bay and leaving most activists depressed and dystopic. It also reinforces individual healing which though important, cannot be isolated from context of the dis-ease. Short retreats or mental health workshops might provide temporary reprieve, but do not address the issues holistically or with long-term healing in mind. Dysfunctional and destructive coping mechanisms like alcoholism have become common coping strategies.
In this three-part series for roape.net, I will be exploring how alienation is manifested in the context of Kenya women activists. The first part will look at how national mental health documents and statistics remain ensnared in imperial hegemony and therefore do not reflect the reality on the ground. The second part will contend with activism as labour and look at how patriarchal structures in the home and the influence of NGOs have further alienated the labour of women activist historically. The third part looks back at African mental health structures before western hegemony and examines colonialism as a watershed period during which cultural structures and social networks were violently discontinued. The conclusion proposes that African methodologies and practitioners should form communities of healing practice to address mental health problems not just for activists, but for the larger African public.
Mental health – a Kenyan retrospective
The meteoric rise in mental breakdown cases in Kenya is symptomatic and catastrophic. Symptomatic because they signal an inner implosion provoked by the unbearable conditions of being today. Catastrophic because it seems, rather suddenly, that intimate relations of the self, of lovers and families, friends and communities are the prelude to a crime scene; for suicide and gruesome murders. As the advance guard in our communities, activists experience a double burden. They not only have to contend with the escalating violence in our local communities but also to deal with the manifestation of this social upheaval in their own lives.
Activists at Vita Books and Ukombozi Library who are also linked with the social justice movement across the city are permanently attending to distress calls, mostly of a violent nature. The severe cases of extrajudicial executions, sexual abuse – even of minors, fatal domestic violence and suicides are interspersed by the chronic conditions of horizontal violence in the informal settlements of Nairobi. Lack of toilet facilities for instance, are the precursor to recurrent urinary tract infections. Or rape. Medical services were privatized since the advent of SAPs in the 1980s and continue to be unaffordable to most working-class people. Gendered relations are buttressed by a capitalist system, making them increasingly transactional and culturally alienated from their history and context. Political systems that held communities together by values of respect, dignity and love have been left to the cold machinations of a brutal and punitive schema registering only exchange value.
It is easy to censure Covid 19 as the primary cause, but the pandemic is a strawman for the complex historical layers that have created a monstrosity whose soft white underbelly was exposed in the last few years. Jobs that were already precariously held were lost. Labouring bodies enervated by decades of consuming pesticides, new age diseases and the liberalization of public hospitals were easily asphyxiated by Covid. And tragically, the fragile conditions of African minds long deracinated by colonialism were crippled further by debt and failed aspirations.
A recent continent-wide study carried out by the African Women Development Fund in 2020, found that 73 million women in Africa were affected by mental health conditions with more than 25 million suffering from neurological conditions. In Kenya specifically, the crisis is escalating with a reported 483 suicide cases and 409 cases of grievous assaults in just three months April – June, 2021, compared to 196 cases in all of 2019. Domestic violence and homicides in Kenya are soaring, with a conservative estimate of at least three people killed by a family member every day, according to statistics compiled from the Nation and police news reports.
For women activists, this trend has been exacerbated with the onset of Covid 19, where personal burdens both at home and in the frontlines of providing support and security, especially for women have been compounded. The UN Women has labelled these incidents the ‘shadow pandemic’ where more than one in three women has experienced physical or sexual violence since the pandemic began. Though the Kenyan President, Uhuru Kenyatta noted the seriousness of this crisis and committed millions of funds to address it, little had changed on the ground.
In a recent study on the wellbeing of Kenyan women activists, 200 WHRDs (Women human rights defenders) in the informal settlements reported that they experienced serious mental health challenges.[1] On a list of possible disorders including depression, anxiety, paranoia and PTSD, the women acknowledged experiencing at least 80% of these conditions. They cited the lack of a regular income, the trauma generated by their work, the physical and sexual harassment sometimes from the community and co-activists, a general sense of dystopia because of the injustice perpetrated by the criminal justice system and the strenuous effect on families and intimate relationships as the precursors for their mental health problems.[2] This recent study is important and illuminating on the general situation of WHRD. However, a political typology of the activists was not articulated, the ‘list of mental illnesses’ was pre-emptive as it was presented during the research and might have undermined the possibility of engaging with the formulations of illnesses as experienced rather than as referenced. Categories are derivations of pathologies researched and articulated elsewhere, in a historically consistent display of colonial dominance over indigenous knowledge systems.
Part One: Imperial Games of Numbers and Manuals
The current national statistics on the prevalence and character of mental illness in Kenya are elusive. Old research data is recycled, presenting a false diagnosis on a vastly altering social and political terrain. Health policies are xeroxed from WHO with little cognizance of the prevailing history and context. Recommendations reveal no engagement with indigenous modes of healing and make the exact same appeals presented more than 40 years ago. We are generating imperial neuro-scapes, effacing the real portrait of a continent in distress.
Case in point: the Taskforce on Mental Health in Kenya. This committee was a presidential directive in 2019 that set out to assess the mental health challenges in Kenya and advice government on resource allocation. They visited health facilities in the major towns and held sector-specific meetings and in total, ‘held discussions with 1,569 Kenyans, received 206 memoranda (submitted 121 on emails, 73 hard copies and 12 on Taskforce website)’. They also stated, with certainty; ‘It was clear that at least 25% of outpatients and 40% of inpatients in different health facilities had a mental illness, and an estimated prevalence of psychosis stated as 1% of the general population’. Yet, there was no reference.
I had encountered this very statistic on another government funded institution – the (KNCHR) Kenya National Commission on Human Rights report on mental health – written in 2011. In turn, this KNCHR presents these very statistics as if they were current, but a cursory look at the reference reveals a paper written in 1979! Professor David M. Ndetei and Professor J. Muhangi conducted this research 40 years ago in a day clinic (the 40% inpatient statistic hence a strange addition) and articulated their findings in an article in which the neurological, cultural, social and political context were expressly demarcated. Firstly, class was a fundamental lens through which psychiatric illness was assessed. The setting was Athi River, a suburban area at the time consisting mainly of immigrant who worked as labourers in the factories, who were low-income earners and a minority peasant Kamba and pastoralist Maasai population existing mainly in a subsistence economy. Secondly, parameters were elaborate, expansive and historical – a psychiatric history which included family histories, personality development, sexual activities, sleep patterns, bowel functions and appetite rather than preemptive. Thirdly, the criterion of culture was a crucial basis for analysis, where an earlier article, was referenced showing how patients with psychiatric disorders had culturally specific symptoms – the more rural and non-literate patients exhibited symptoms related to the gut and the more urban population had more-head related symptoms.[3] Limitations like lack of laboratory investigations were cited. This signals a regression in the way of research capacity and critical analysis.
Why were the obvious ‘laboratories’ for research like the local hospitals, local healers and the police reports that generally serve as the first points of contact for the mentally unwell not consulted? Instead, the usual liberal rhetoric on ‘declaring national emergencies and national health months’ were pronounced. More aggravatingly, a commission on national happiness was recommended, in tandem with the World Happiness Report, with highly subjective criterion, none of which, of course, were generated in the continent. For instance, generosity, cited as one of the indicators for happiness in the survey, is premised on a question of whether one has donated money to a charity in the past month?! In a context where the social relations that bolster generosity have not been fully institutionalized, this is a strange and socially adulterated question.
The definition and determinants of mental health in Kenyan policy though in some ways comprehensive are quoted directly from the WHO manual. Public participation is a farce, the notion that policy interventions were developed through a consultative process are not reflected in the content of the policy. As always it seems, history is censored. Strategies that include reviewing legislation, developing guidelines and standards, investing in finance, technology, human resources, service delivery and developing Monitoring and Evaluation (M&E) frameworks are generic functions that are unlikely to facilitate genuine local engagement.
Like the WHO mental health manual, the very basis of mental health diagnosis in Kenya – the Diagnostic and Statistical Manual of Mental Disorders (DSM) is developed by the American Association of Psychiatry. These are western cultural documents, predicated on American notions on ‘what constitutes a real disorder, what counts as scientific evidence, and how research should be conducted’.[4] Psychiatric disorders make dramatic appearances, are declassified as illnesses, changing into pharmaceutically curable ailments reflecting shifts in western social and political contexts. Even when non-western populations are engaged and assessed, the primary criterion for psychopathy are those developed within western subjects. The criterion for health, the distinctions between disorder and normal responses to distress, and the ideas of personhood superimpose foreign categories producing a social dissonance and political disarticulation in local communities.
This very process of mental and medical imperialism is likely a primary basis for mental disorders. The understanding of western diagnostic criteria as ethnopsychiatry is crucial in dismantling western medical hegemony. Even in their own territory, questions abound on over-diagnosis in the pursuit of pharmaceutical profits. It is not a coincidence that the two institutions producing global data on mental health, the WHO and the Institute for Health Metrics and Evaluation, are both heavily funded by the Bill and Melinda Gates Foundation. Concerns have been advanced on the lack of transparency on the methods and data used by the institute, as well as the lack of a variety of independent views by scientists that could deflect from the political and economic objectives of the foundation.
Even in seemingly benign accounts of health like statistics, imperial machinations remain afoot, preventing us from developing local concepts for research, screening, and diagnosis of mental illness.
Noosim Naimasiah is a Pan-Africanist filmmaker, scholar, and social justice activist whose focus is on indigenous knowledge, political economy and liberatory politics. She is currently a lead researcher and editor at Vita Books and Ukombozi Library.
Featured Photograph: Kibera informal settlement, Nairobi, Kenya (7 May 2015).
Notes
[1] Kibra, Mathare, Kayole, Starehe, Githurai and Embakasi West in Nairobi County and others in Nakuru county.
[2] This recent study is important and illuminating on the general situation of WHRD. However, a political typology of the activists was not articulated, the ‘list of mental illnesses’ was pre-emptive as it was presented during the research and might have undermined the possibility of engaging with the formulations of illnesses as experienced rather than as referenced. In this case, symptoms of unwellness might have been a better criterion.
[3] It is interesting to note that his paper was presented at the third pan-African psychiatric conference. An analysis of these conferences would provide critical political history on psychiatry and mental illness in Africa.
[4] Derek Summerfield, ‘How scientifically valid is the knowledge base of global mental health?’, British Medical Journal, 2008, Vol 336: 992 – 994.
