There is a one Hajjat Sukali in Mpererwe, a suburb bordering Kampala and Wakiso districts. No one among the new residents in the area seems to know where she goes to sleep, but on a daily basis, during the day, you will find her tiny body wrapped in a number of clothes, seated by the roadside.
One theory by a boda boda rider is that she was set to inherit her parents’ wealth and a malicious person bewitched her to that state.
“Now she is just there barking at flies, witchcraft is bad,” the boda boda rider says. Other theories include her having a big shop that only sold sugar but she ran mad after being bewitched by competitors and another one suggests she used to be sexually generous and after stealing someone’s man she was bewitched.
Apparently the name ‘sukali’ came from the sexual favours she willingly dished out.
Much as no one seems to know Sukali that much, or why some men call her by the nickname in the first place, there is a general belief that a supernatural power is responsible for her mental state. For many, the first time they interface with mental problems, rarely is it presented as an illness.
From the literature they read, films they watch to other forms of art that shape culture, mental illness is successfully portrayed as a punishment from a higher being.
Not a coincidence
Rev Dismas Bwesigye, the chaplain of St Luke Church in Butabika Hospital says mental health, since time immemorial has been treated with a lot of disdain.
“I can tell you that long ago, before a boy and girl got married, families would send spies to check if the family has no history of mental illness,” he says adding that this would cause families to hide the mentally ill from the public and in some cruel cases, they would be poisoned.
Bwesigye says for many of these African societies, mental illness was more of a curse and since it is a common belief that things do not simply happen without a cause, mental illness too was thought to happen because someone or a mightier power is annoyed with you.
While talking to journalists earlier this year, Dr Caroline Birungi, a psychiatrist and lecturer in the department of psychiatry at Makerere University, noted that many families, when faced with a case of mental illness, the very first intervention they seek is usually spiritual. “Some take the afflicted to shrines or to pastors because they believe these people have been attacked by demons,” she noted.
According to a definition by the World Health Organisation (WHO), mental health is a state of emotional and psychological wellbeing in which an individual is able to use his or her cognitive and emotional capabilities, function in society, and meet the ordinary demands of everyday life.
Though, with Uganda being a religiously diverse population with almost 98 per cent at least attached to a certain belief or denomination, the notion that mania, hysteria or psychosis is a medical condition may not make a lot of sense, especially with the fact that on TV and crusades, they have been exposed to characters with the same symptoms that have been “healed”.
And this is the story of Sukali and many other mentally ill Ugandans that have been taken through shrines, churches to palm readers in search of answers.
Eric Kwebiha, an occupational therapist at Butabika Hospital, says they receive many clients that have been to shrines, churches and eventually the facility. “And most of the time, even when they come here, they still believe it is satan attacking their child,” he says.
Matters regarding psychiatry, according to Eddie Nkurunungi of Butabika Recovery College are still alien to our setting. “The origin of psychology is western-based, so when people get such problems, it becomes natural for them to seek spiritual help,” he says adding that Butabika facility is usually a last resort.
Yet for both Bwesigye and Birungi, mental illness has not received much attention thus allowing all wrong perceptions to thrive.
“Uganda has come a long way in its recognition and treatment of mental health problems, but stigma and a misunderstanding of conditions remain,” Birungi says.
Faith and mental illness
Some of the misunderstandings Birungi talks about are, of course, faith-related. Much as many research papers have noted that devoted people have fewer symptoms of anxiety, the same faith has been termed a double edged sword especially with beliefs that God is testing one’s faith with illness or punishing, which makes cases of depression even harder.
According to Kwebiha, people always believe in something, with or without evidence. “The orientation of people sends them to explain things based on their deeply rooted affiliations,” he says adding that because of this, as a facility, they listen to clients and all their explanations regardless. “...We put our focus on the care,” he says.
In Uganda where there has been a rapid growth of Pentecostal churches and many of their believers create an illusion that like Jesus, they can heal in a snap, some will go as far as seeing into a patient’s past and insinuate he/she is actually under a spell. And, of course, stress that they can make the situation go away.
“Very often, clients will tell you that science is frustrating. They argue that in churches, they are told they are healed yet in such facilities they are told it is simply recovery,” says Kwebiha.
Kwebiha says because people will always believe in what they are brought up to believe in, they know that pastors or witch doctors do not speak maliciously when they promise to heal people. “They are only dedicated to their faith,” he says.
He, however, notes that as long as there is no proof that witchcraft or religion has healed a person with a mental illness, as a facility, they stick to known scientific procedures. “Faith is complicated because if you are prayed for and you do not heal, it is easy to say that one’s faith was not enough,” he says.
Using belief for relief
However, even when many things around faith are questionable, the facility (Butabika) has a chaplain, which directly means that they have faith, God and religion in their care system. “We do not stop people from praying or having beliefs,” he says.
Kwebiha notes that their treatment taps into the clients’ belief system and if one believes they heal by standing under a tree, they let them do that on top of the treatment and it is only when their belief tampers with the medication that doctors will intervene.
For many people on treatment, medication is supplemented by yoga, dance, while for some it is prayer among other things. “If someone takes medication and adds prayers as a support, we let them be,” he says.
However, as Kwebiha notes, sometimes when the clients go back home, they praise and thank God for the recovery and at times get off their medication. It has been said that like other sicknesses, some faithful go to shrines and churches where they are advised to dump medication for prayers.
However, Pastor Joseph Serwadda of Victory Christian Church notes that this is not the way the church does things.
“I have not encountered people that were on medication and abandoned it for prayers,” he says adding that in any case; “we advise our people to listen to their doctors’ instructions and take their medication.”
Streamlining faith and mental health
Rev Dismas Bwesigye, the chaplain of St Luke Church in Butabika Hospital, says today people are gaining knowledge about mental health. “They are getting closer to God and know that much as a spiritual sickness exists, mental health is real.”
But he notes that to avoid cases of preachers misunderstanding mental health, spiritual leaders need basic training so as to tell the differences between the cases they receive.
“It would be helpful if church leaders are explained to that they know their limits,” he says adding that Jesus heals but sometimes church leaders do more harm especially with a fact that people with mental illness are so suggestible.
Today, Butabika has faith as one of the branches helping clients with recovery, in fact, even when Bwesigye is simply strolling through the facility, patients will often stop him and ask for a prayer or a simple head touch to mean a blessing.
Of course, much as some ask for spiritual intervention, their problems are indeed psychological. “Our work is to help patients discern the difference; if what they see comes from God or is formed by the brain,” he says.
At the moment, faith plays an important role especially with prayer and open sessions where clients talk to religious persons about things such as forgiveness, letting go and, of course, living exemplary. Bwesigye says for all prayer sessions, they have to work within the limits that they do not end up saying things that will deter patients from taking their medication.