Humour us and think back to a time when you felt sick, had a runny nose perhaps, how did you deal with this? Now, think about a time when you felt anxious about something that you thought was minor, how did you cope in this scenario?
In the first scenario, you struggled with your physical health, and in the second, your mental health. Our approach on how we manage these two parts of our health differ greatly. We tend to dismiss our mental health challenges more readily than we would those that stem from our physical health. This is due to two main factors: a lack of education and resources on mental health as a whole and the prevalence and perpetuation of stigma against mental illnesses in our communities. The stigma surrounding mental health is evident in the way that we give both ourselves, and the people around us, a lot more grace for struggling with physical health than for struggling with mental health.
Mental health is an integral part of our overall well-being. As Tanzanians this is something that is not often talked about and thus it is essential for us to start learning the importance of taking care of our mental health. The World Health Organization defines mental health as “a state of well-being in which an individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.” Mental health does not simply constitute the absence of mental health disorders, it is also the way we view and interact with the world.
Mental Health Stigma & the Patriarchy
Stigma as defined by Merriam-Webster is “a mark of shame or discredit” and Cambridge Dictionary defines it as “a strong feeling of disapproval that most people in a society have about something, especially when this [feeling] is unfair”. There are two types of stigma, public stigma and self stigma. The former is how the general population views people with a mental illness and the latter is the reaction that people with mental illnesses have of themselves.
Stigma can be understood as a stereotype (belief), prejudice (emotional reaction) and discrimination (behavioural response). An example of how stigma against people with mental illnesses shows up is in the language we use. Swahili terms like “mwehu” and “tahira” are used to describe people with mental illnesses and they are always used in a derogatory manner. This, coupled with prevalent myths and superstitions about mental health—relating “kichaa” (insanity) with “kurogwa” (being bewitched)—ostracises people and deters much-needed conversations on mental health.
Patriarchy plays a huge role in perpetuating this pressure to ascribe to certain standards of being and interacting, and it affects everyone regardless of gender. People perceived as men and people perceived as women are socialised differently. At the intersection of toxic masculinity and mental health are social cues on how men and women are expected to cope with mental health struggles. Men are awarded with what is generally accepted as a derogatory remark that it is “umama” (motherly/womanly) when they express their emotion. This remark is given to them whether they are laughing too hard, crying or simply eating chipsi mayai with a toothpick. There is a lot to unpack here, including the fact that being referred to as “womanly” is aimed at inciting offense, but first let us explore the way men are expected to stifle their humanity in order to truly embody manhood.
Talking about mental health requires vulnerability which so happens to be the antithesis of toxic masculinity. Opening up about mental health is terrifying for men because mental health stigma makes doing so seem impossible or wrong. Women’s experiences with mental health are even more complex (and will be explored in further detail in an upcoming article) because not only are women not supposed to struggle with their mental health, but doing so also confirms all the sexist preconceived notions about women as weak and incapable. Women deal with verbal abuse, sexual harassment and sexual assault, in addition to structural barriers, and yet whenever these issues take a toll on their mental health their role in society as the lesser-capable gender is further emphasised.
“Women live to please. They do things that take a toll on their mental health because they worry about how they would be perceived if they did otherwise.”
— A Tanzanian woman in her twenties via Clubhouse.
The vilification of mental illness
Stigmatising and stereotyping mental illness leads to prejudice and discrimination against people living with a mental illness. This leads to a variety of negative outcomes for communities and individuals as proper care, attention and education is scarce. In Tanzania, having a mental illness or suffering from any sort of mental health challenge is individualised, vilified and seen as shameful.
In large cities like Dar es Salaam, there are people who roam the streets by themselves; some of whom appear to be going through psychosis–which is when one loses some contact with reality. The general Tanzanian society teaches us to either look away in embarrassment or taunt and mock people going through this publicly, and rarely do people offer support. This apathy and often dislike of people with mental illnesses in both public and private realms leads to abuse & harassment against them; this is detrimental to their mental health.
Mainstream media is among the biggest perpetrators in pushing harmful stereotypes of mentally ill people. They tend to reflect societal views on mental health by blowing up stories that fit into the narrative that people with mental illnesses are inherently violent. Although local newspapers have featured articles talking about different mental health challenges, there is still a long road ahead. Bongo movies, for example, often portray mental illness as a fall from grace. These movies are popular among Tanzanians and they often have an overarching message on how to be a “good” member of society. The two main tropes related to mental health are the main antagonist being cursed with a mental illness as punishment for their sins towards the end of the film, or the main protagonist being cursed with a mental illness and needs to seek help to “rise above it”. These harmful narratives cement public and self stigma and encourages maltreatment of the self and others.
The way mental health is perceived contributes highly to the gap in mental health services within the country. Those who take it upon themselves to fill this gap are often faced with structural challenges. A study conducted at Dar es Salaam’s Temeke Hospital by Joel Seme Ambikile and Masunga Iseselo found that an overwhelming majority of the staff providing mental health services at the hospital had no prior training in the field. Temeke Hospital is the largest hospital serving the Temeke district and among the largest operating hospitals in the country; and yet the mental health department has no full-time working psychiatrists, with the rest of the staff being massively overwhelmed. Ambikile and Iseselo also found that patients were taunted and mistreated by their care providers—further enforcing the vilification of mental illness.
Abolishing Mental Health Stigma
One way we can reverse the harms of mental health stigma is through community mental health education. A culturally specific mental health curriculum in schools, especially those in rural areas where most of the Tanzanian population resides, will enable young people to have the tools to talk about their mental health. This curriculum ought to be designed with the community it is geared for in mind and should be present at all educational levels. This curriculum should be modified to be workshops that are adaptable to religious settings, workplaces, vijiwe, etc. Making sure these workshops are widely accessible and ongoing will encourage a culture of supporting each other through mental health challenges without having to leave one’s community.
Training community healthcare providers on how to care for patients with mental illnesses is an essential part of decreasing the stigma surrounding mental illnesses. This is also a project that can and should be started sooner. A report communicated the outcomes of a training program for community healthcare providers that enabled them to provide care to young people with depression. This report showed that “training significantly improved knowledge, decreased stigma, and enhanced provider self-confidence in this clinically important area.” (Kutcher et al., 2017). Thus ongoing education on mental health and mental illnesses will lead to positive hospital experiences and better health outcomes as healthcare providers know what they are doing and are not retraumatising their patients.
A continuous acknowledgement of the role that systemic harms wreak on one’s psyche is also important. As we have explored mental health challenges and mental health stigma does not occur in a vacuum. This continuous acknowledgement will promote a culture of accountability. The end goal is eventual overhaul of systems such as white supremacy and the patriarchy that are detrimental to one’s mental health and one’s ability to seek care for mental health challenges.
A culture of silence persists in communities all over Tanzania. Not acknowledging mental illnesses and stigmatising people who are mentally ill removes the need to look at the problems within societal structure that make mental illness so prevalent among folks, especially poor, working-class women. Little will improve if we remain unwilling to lift the veil and look at our structures and within ourselves, to hold ourselves accountable and change what needs to be changed.
This is a research article written by Leticia Kulwa Maganga and Kerin Shilla
Please see here for the comprehensive bibliography used to source this work