When the madness goes to the market place
A bright wintry sun poured through the windows as we met for the final session of the workshop. In prayer time, Peter Green chose the story of the healing of Legion and my thoughts went back not only to my patients who have exhibited similar excessive and destructive strength but also to our first session three nights before. Participants from a number of African countries, India and Nepal highlighted the breadth of the problems of mental illness in their countries, the few facilities and the valiant efforts of family to cope with the ill relative. But when 'the madness goes to the market place' their coping mechanisms fail. With violence and aggression or a 'David' dancing naked in public places, and in the absence of freely available anti-psychotic drugs, many patients end up as vagrants.
Church based projects
Examples of 'up and running' church based projects in Nepal, Malawi and Nigeria captured the imagination. I found particularly interesting the very innovative Nigerian project helping vagrant, chronic psychotic patients arriving at a village settlement. There they are able to come and go as they please, living and working side by side with mentally healthy compatriots. Because they are enabled to have treatment, many are eventually rehabilitated back into their families. As a result other families ask for their mentally ill relatives, still within the family fold, to be admitted for treatment. This has led to a community based service funded by national and local government sources but organised by the same Christian group.
Changes required
The workshop was a good blend of academic learning and participants' contributions of their own experiences. Professor Andrew Sims reviewed the changes in practice and advances in treatment which make it even more incumbent on Christians to provide for the care and treatment of people with mental illness. This will need efforts to change attitudes inside and outside the Church and programmes to train local staff in the variety of disciplines which need to cooperate in the care of the mentally ill. With the shortage of national professionals this still needs expatriate help.
Professional assessment: community choice
From her experience in Nepal Dr Christine Wright spoke of the necessity for a professional approach to assessing the needs of a population, and letting the local community give priority to those needs. One community considered an alcohol service essential and that led to a whole series of rehabilitation measures and social changes. The professionals would have chosen a different priority! Dr Ewan Wilkinson - ex Malawi and with a public health background - gave valuable practical advice on the collection of data to optimise the usefulness of such assessments.
A biblical framework
From Singapore, Robert Solomon doctor, theologian and pastor - brought a wealth of practical experience and academic learning as he discussed 'A biblical framework for mental health care'. He started with the Christian belief that we are:
Traditional healers
Then came the necessity of acknowledging the role of the many types of traditional healers, who in Africa and Asia are the first line of treatment for the vast majority of the population. How do we co-operate with them and where do we draw the line? The issue is different for Westerners whose cultures largely ignore the spirit world - even though we acknowledge its existence Sunday by Sunday in our worship - but for colleagues in Africa and elsewhere the spirit world is an ever present reality for the vast majority of their compatriots. The tensions of this dilemma for African Christians were obvious as delegates discussed the subject.
Of great help in assessing where to draw the line was the paper 'Challenge and opportunity' - traditional medicine and a Christian response' by Brother Raphael Ngong Teh. Traditional medicine has so many components from straightforward herbalism to witchcraft. The debate is similar to the Western one about alternative medicine and its New Age connections.
Physical, mental, social and spiritual factors
Other speakers outlined ways of weeding out from general medical clinics patients with mental illness presenting with physical symptoms. Professor Ager quoted research findings from Israel showing that the support from a self-help group reduced the mental symptoms in women undergoing continuing severe stresses. He also raised the subject of the effect of such stressful experience on expatriates working in the developing world. We were warned of the danger of seeing mental illness solely in the context of the science of psychiatry and neglecting the role of global developments, local cultural understandings, and the input of Christian faith.
The global burden of mental disorder
John Lowther has mission experience, was a consultant psychiatrist and is now medical adviser to the Salvation Army International Headquarters
Church based projects
Examples of 'up and running' church based projects in Nepal, Malawi and Nigeria captured the imagination. I found particularly interesting the very innovative Nigerian project helping vagrant, chronic psychotic patients arriving at a village settlement. There they are able to come and go as they please, living and working side by side with mentally healthy compatriots. Because they are enabled to have treatment, many are eventually rehabilitated back into their families. As a result other families ask for their mentally ill relatives, still within the family fold, to be admitted for treatment. This has led to a community based service funded by national and local government sources but organised by the same Christian group.
Changes required
The workshop was a good blend of academic learning and participants' contributions of their own experiences. Professor Andrew Sims reviewed the changes in practice and advances in treatment which make it even more incumbent on Christians to provide for the care and treatment of people with mental illness. This will need efforts to change attitudes inside and outside the Church and programmes to train local staff in the variety of disciplines which need to cooperate in the care of the mentally ill. With the shortage of national professionals this still needs expatriate help.
Professional assessment: community choice
From her experience in Nepal Dr Christine Wright spoke of the necessity for a professional approach to assessing the needs of a population, and letting the local community give priority to those needs. One community considered an alcohol service essential and that led to a whole series of rehabilitation measures and social changes. The professionals would have chosen a different priority! Dr Ewan Wilkinson - ex Malawi and with a public health background - gave valuable practical advice on the collection of data to optimise the usefulness of such assessments.
A biblical framework
From Singapore, Robert Solomon doctor, theologian and pastor - brought a wealth of practical experience and academic learning as he discussed 'A biblical framework for mental health care'. He started with the Christian belief that we are:
- created in god's image which requires us to give to all the dignity we owe to God
- social beings made to live in community
- embodied beings - made of clay into whom God has breathed; bodies to be temples of God, not prisons
Traditional healers
Then came the necessity of acknowledging the role of the many types of traditional healers, who in Africa and Asia are the first line of treatment for the vast majority of the population. How do we co-operate with them and where do we draw the line? The issue is different for Westerners whose cultures largely ignore the spirit world - even though we acknowledge its existence Sunday by Sunday in our worship - but for colleagues in Africa and elsewhere the spirit world is an ever present reality for the vast majority of their compatriots. The tensions of this dilemma for African Christians were obvious as delegates discussed the subject.
Of great help in assessing where to draw the line was the paper 'Challenge and opportunity' - traditional medicine and a Christian response' by Brother Raphael Ngong Teh. Traditional medicine has so many components from straightforward herbalism to witchcraft. The debate is similar to the Western one about alternative medicine and its New Age connections.
Physical, mental, social and spiritual factors
Other speakers outlined ways of weeding out from general medical clinics patients with mental illness presenting with physical symptoms. Professor Ager quoted research findings from Israel showing that the support from a self-help group reduced the mental symptoms in women undergoing continuing severe stresses. He also raised the subject of the effect of such stressful experience on expatriates working in the developing world. We were warned of the danger of seeing mental illness solely in the context of the science of psychiatry and neglecting the role of global developments, local cultural understandings, and the input of Christian faith.
The global burden of mental disorder
- 12% of the global burden of disease in 14-44 year olds is caused by mental health problems
- 40 million worldwide suffer from severe mental disorder
- By the year 2000 there will be 23 million people with schizophrenia in the developing countries
John Lowther has mission experience, was a consultant psychiatrist and is now medical adviser to the Salvation Army International Headquarters
