Mental health from a patient’s perspective
Moses Mpanga
In Uganda, it is estimated that 35 percent of the population suffers from some form of mental illness.
Between statistics and reality, lie the mental ill-health patients who, for the bigger part, rely on their relatives, friends and people from their communities of origin or residence. These are meant to be their safety nets, but more than often write them off for failure to look at them from their (patients’) lenses!
Here is an excerpt from one of my family sessions. A client interjected, and I let him:
“I am bipolar and here’s how it feels: “I experience hallucinations and misapprehensions which I have only come to learn of during my stay here! As I speak now, I can hear my late mama’s voice, I hear her cry out for help. I feel her presence; I do smell her favourite perfume all over here! There have been times she has held conversations with me; all these feel convincingly real to me, while I undoubtedly appear hare-brained to all those around me!
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There are times I am consumed by uncontrollable sadness, anger, and bitterness; these feelings are like a plague, they own me up like a pregnant woman’s urge to eat raw mangoes or taste soil to quench a craving! Like a toddler’s make-belief impulse to feed in the wee hours of the night! Every time you see me out of control, I am in a world that is believable to me! When my rough tide episodes pass and I realise the mess I have caused around me, I am as shocked as you are! I see the disgust, disappointment, frustration on your faces and I can only imagine just how bad it must have been while I was at it, but it’s all involuntary! I am out of control, and that is when I want you to save me from myself, but more than often, you forsake me!”
There are times when people with bipolar disorder slide into manic episodes like in the case above. The word ‘manic’ describes the times when someone with bipolar disorder feels overly excited and confident. These feelings can also involve irritability and impulsive or reckless decision-making. About half of people during mania can have delusions or hallucinations.
However, it is worthwhile noting that different illnesses present different challenges/perspectives. Take dementia for instance as illustrated in an encounter during one of my other sessions. An elderly lady who was dementing was whisked into my therapy room by her son whom she was convinced had died at birth! She was grieving the death of a son genuinely believing he was dead. Her son reported that she had been in that state for over two weeks, wandering off to go for his burial! She had refused to eat, kept in isolation, refused to brush or shower in protest! The mother was increasingly getting depressed and delusional for refusal to go bury her son.
The son’s frustration stemmed from the mother’s failure to recognise that he was not dead. Oftentimes, when we (the caregivers), fail to recognise the patient’s realities from their perspective, clashes ensue!
Take this for example, the elderly lady above, was diagnosed with dementia comorbid with depression. Her changes in moods manifested with irritability and emotionality. It did not matter to her how she made her son feel, but it mattered how her son made her feel because she was the patient!
On a sunnier note, the son and I entered his mother’s mental world before I referred her to a psychiatrist, we grieved with her. I also recommended that they visit his late twin brother’s burial site, which they did, and this calmed her down.
Understanding a mentally-ill patient from their perspective will undoubtedly make a happy caregiver.
Mr Moses Mpanga is a clinical psychologist, founder and director of MIND Nest Uganda
