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Reflections

Am I Going Mad: A Reflection on Mental Health in Kenya

While the public debate on mental health is welcome, as a person recovering from a mental disorder, there is need to push a wholesome discussion on the reality of the state of mental health in Kenya beyond depression.

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Am I Going Mad: A Reflection on Mental Health in Kenya
Photo: Olu Famule on Unsplash
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Monday, 17th December 2018 was a normal day that stubbornly refused to conform to my expectations. An impulsive decision made at 3:30 PM in a 46 Matatu heading to the Nairobi city centre dramatically altered the direction of my life.

I was on my way from Inuka Kenya offices, when a gut feeling nudged me towards the Doctor’s plaza at Nairobi Hospital. I wanted to see a psychiatrist who could recommend some sleeping pills.

When I arrived at the Nairobi Hospital, the two psychiatric consultants had both closed their offices for the Christmas holidays. Feeling unsettled, I decide to seek help at the adjacent Upper Hill Medical Centre where I quickly scanned the directory board on the first floor desperately trying to locate a psychiatrist before closing time.

Too impatient to wait for the lift, I bolted up the staircase, arrived at the reception on the third floor, and to my relief, I found other patients waiting in turn.

I walked up to the receptionist who would not accept my Jubilee Medical Insurance card: “Your insurer hasn’t installed glade which should be used to raise a claim for your card. Sorry we can’t serve you,” she said bluntly while handing it over.

I was adamant and decided to press on. “Is there any other way? Can you call the insurance company so that I can be treated and you deal with the claims later?” My persistence paid off. A few minutes later, as if fate was moving mountains, I was on the phone with my insurer who found a way to resolve the challenge.

I had seen celebrated psychiatrist Dr Frank Njenga on TV. His analysis fascinated me. Only this day, I was not arriving in my capacity as a journalist to get expert opinion on a story. I was a patient.

My sleep patterns had gradually deteriorated to their worst state as far as I could recall. It had been weeks of violent nightmares. Bad people with crude weapons wanting to kill me and rogue Ikolomani Bulls chasing me through the night.

I could not outrun death and when I tried to scream for help, I found my voice frozen. I felt helpless and trapped in the nightmares. I would wake up in panic, breathless and sweaty. I wanted to see a psychiatrist who could recommend some sleeping pills just like one had done in 2014 when I had a similar experience.

Frank Njenga was wearing a clean white shirt with a blue-stripped tie. His smile and calm demeanor disarmed me on the spot. “Tell me more about yourself,” he asked after exchanging a few pleasantries.

I went on and on about my family’s history, and myself while his head was glued on my file taking notes. Sometimes he would lift his head when I said something that sounded like a trigger. “Tell me more about incident, what happened?” he would ask when I explained some of the darkest seasons I had gone through recently.

He gave me a piece of paper, which had about 30 questions and told me to tick statements that closely represented how I had lived my life. While he had hoped that I would only tick about 10 when he looked at the paper, I had ticked 25 out of 30 and that’s how he partly discovered what had been eating me. To ascertain his preliminary findings, he sent me for a cognitive test to corroborate what he was suspecting.

What I thought was just a simple sleep issue turned out to a symptom of something deeper.

“I’m glad you came here, we are going to help you,” he reassured me as we chatted for about an hour, the longest I have been in a doctor’s office.

“Odongo, we may need to take you to a place so that we can monitor your sleep and find out if there are other underlying issues,” he advised as there was sufficient evidence that I needed to be monitored.

I knew the weight of inadequate sleep and was desperate for a solution. I accepted his suggestion.

“Mental health is like an onion, we peel it from the outer layer as we dig in. That’s the only way we can find out the core of the problem,” he added.

When we arrived at the gate of Chiromo Lane Medical Centre in Lavington, I saw a disturbing sign: Visiting hours is between 9-11 am and 3-6 PM. My panic buttons went off. I was not suicidal and I did not have the urge to harm other people. I just had migraines, nightmares and an anxious mind. Why was I being admitted into a restrictive hospital?

Begrudgingly, I agreed to check in for a night. The bungalow house that sat on a lush green serene environment complimented by the friendly staff all disarmed me.

In hindsight, this was one of the best decisions, I made in my life. For the next six days, I would go through an overwhelming journey of self discovery that I was hardly prepared for.

At the end of the first day, I was diagnosed with clinical depression, mild Attention Deficiency Hyperactivity Disorder (ADHD) and trauma. Though I was predisposed to some of the disorders, a toxic work environment for five years, an emotionally abusive relationship and front row coverage of the 2017 traumatic elections as a reporter played a key role in triggering the sleeping demons that landed me in a hospital.

After I was done with a two-hour therapy session, I slowly dragged my exhausted body back to my admission room. As I sat on my bed while listening to music, a wave of emotions descended and I broke down and wept. I slowly moved from the bed and sat on the floor with my back against the wall and legs straightened. For the next three hours, I wept until I felt weak.

Kenya Mental Health Policy (2015-2030) indicates that mental disorder cases have risen exponentially in Kenya. Estimates point that 20-25 percent of outpatients seeking primary healthcare present symptoms of mental illness at any one time. There are no sufficient qualified medical personnel and facilities to take care of this lot of patients.

A 2015 performance audit report from the Office of the Auditor General (OAG) on the state of mental health paints a grim picture. As at 2015, there were only 92 psychiatrists in the country instead of the 1,533 required. 327 psychiatrist nurses instead of 7,666. The report stated that “While it’s expected that a psychiatrist should serve 30,000 citizens, currently a psychiatrist is serving about half a million citizens”.

I still count myself privileged to have gotten medical attention. The ability to afford private insurance cover, know where to go when symptoms arise and get treated by Dr. Njenga is privilege.

Millions of Kenyans who struggle to meet basic needs are exposed to mental disorder triggers stemming from their environment and cannot afford this privilege. For the poor masses in Kenya, quality primary health care is a mirage. Add the lack of specialized mental healthcare and you condemn a whole section of the population to destitution.

Mathari Hospital, which is an affordable public facility and the only hospital in the country offering specialized psychiatric services and training is in a sorry state according to the OAG. For the three financial years, 2013/14, 2014/15 and 2015/16 Mathari hospital was provided only about 30% of the funds allocated under the recurrent expenditure and nothing under the development expenditure.

As government policy, all mentally ill law offenders who require in-patient services can only be admitted in Mathari Hospital under the Maximum Security Unit regardless of severity of their condition. They make up 35 percent of the inpatients in the hospital yet there is no cost sharing to take care of them thereby straining the already limited resources.

Low funding means that apart from inadequate equipments, the wards are also insufficient with the hospital being reported to have an average bed occupancy rate of 115 percent. The low stock of critical drugs, inadequate skilled and qualified personnel to handle the patients are some of the issues plaguing Mathari as raised by the OAG report.

On the receiving end are the patients who are dependent on the hospital receive poor services including delayed diagnosis that can make the condition worse. While National referral hospitals should provide specialized healthcare services and should operate with a defined level of autonomy including a Board and a Chief Executive Officer, Mathari hospital is the only psychiatric hospital of its caliber in Kenya that operates under a department in the Ministry of Health.

The national statistics do not offer any reprieve either. County managed hospitals where the bulk of the nation relies on for mental health care is stuff of horror.

In the 47 counties, only 25 have psychiatric units. Even in the 25 counties where the services are available, they are pledged with the challenge of outdated equipment, inadequate stocks for essential drugs and insufficient personnel to treat mentally ill patients.

According to the OAG, besides Mathari national referral hospital, mental healthcare services are only available at 29 of the 284 hospitals in Level 4 and above of the referral chain. “This represents just 10% of the total facilities in Level 4 and above and 0.7% of the 3,956 government-owned health facilities,” notes the report.

A month before I walked into the hospital, I hardly thought that my relationship challenges could compound my psychological well-being. The revelations from a text message that came from my ex took me to the brink. That night, the thought of going to bed haunted me. I stayed on my couch writing until 4 am. I tried to pray but I could not. My heart was heavy.

My head was never the same after that night. It started to sound like the world’s busiest construction site. Constant hammering, grinders cutting through metal, welding machines and all sorts of construction chaos formed an unholy symphony in my head.

During the day, migraines became the norm and at night, insomnia took over. When I closed my eyes, I was battling anxiety unable to focus my attention on anything. I experienced anger, bitterness and a heavy dark cloud hovered above. I had never felt like this before.

While the public debate on mental health is welcome, as a person recovering from a mental disorder, there is need to push a wholesome discussion on the reality of the state of mental health in Kenya beyond depression.

We need to broaden the discussion to talk about different conditions and their symptoms, different medication and management of disorders. According to the World Health Organisation (WHO), there are over 10 mental health disorders affecting human beings including borderline personality disorder, anxiety and panic attacks, bipolar disorder attention-deficit/hyperactivity disorder (ADHD) among others. Depression is just one of them.

We also need to talk about inadequate mental health facilities and the few stretched mental health professionals. By solely pushing the message of depression, we downplay the reality of mental health challenges in Kenya and the manifest consequences.

Stigma and lack of accurate information continues to cost the global economy about $1 trillion every year in productivity due to depression and anxiety. WHO data, reveals that mental illness accounts for 30 percent of non-fatal disease burden worldwide and 10 percent of overall disease burden, including death and disability.

In 2016, the grim reality necessitated the World Bank Group (WBG), the World Health Organization (WHO) and other partners to kick start a call to action to governments, international partners, health professionals among others to find solutions to what is fast becoming a global mental health problem.

Leaving the hospital on 24th December, I was informed that Jubilee Insurance Company had rejected my claim for two reasons: The condition I was diagnosed with is not covered in my policy I was holding (Never mind that ADHD predisposes one to other mental illnesses like depression which they claim to cover).

For trauma and depression, which is covered under the policy, they said I needed a one-year waiting period (I took the cover in September 2018 after leaving formal employment) despite the fact that I was a previous policyholder with the same company for three years and my claim history was generally low and it didn’t have any mental illness.

I was furious because while signing the form, nobody informed me that I was entitled to a waiver. While I took time (2 weeks) to read the policy document, I didn’t notice that ADHD (I knew this condition when I was diagnosed in December) was not covered. The agent who signed me on was either too concerned with the commission or the corporate culture of the organization encourages ambiguity for profit gain.

My review of the mental health policy and the relevant laws including the Mental Health Act of 1978 and the Mental Health (Amendment) Act 2018, showed that the same clause they used to decline my claim is potentially discriminatory. The policy states in part “Ensuring that the health insurance system does not discriminate against persons with Mental, Neurological and Substance use (MNS) disorders in accessing insurance policies,”

Though not yet enacted, clause 3D(3) of the Mental health amendment bill of 2018 amplifies the 1978 Act more expressly: “A person with mental illness shall have the right of access to medical Insurance for the treatment from public or private health insurance providers. An insurance company or person providing health insurance services shall not discriminate against a person with mental illness or subject a person with mental illness to unfair treatment in obtaining the necessary insurance cover.”

As a good citizen, I appealed their decision using internal mechanism but I still hit a dead wall. I am now preparing to take the dispute before the Insurance Regulatory Authority (IRA) with a view to not only settle my bills but also to amend the discriminatory clause for personal policy holders.

Kenya grapples with a low insurance penetration rate at 2.68 percent. The 2017’s Insurance Industry Annual Report 2017 by IRA flags mistrust among the reasons listed for the cause of low rate of insurance penetration in Kenya.

As I began to investigate the nature of insurance claims for mental health cases, I have encountered numerous patients who have suffered mental health challenges and the stories are similar: A clever refusal to pay claims using technicality.

In developing countries like Kenya, the mental health landscape is often plagued with insufficient data to show the economic impact of mental illnesses. However, the effects are wide-ranging and long-lasting including the impact on the families’ and care-givers’ resources; the expenses related to crimes caused by the mental disorders; the productivity losses due to debility, morbidity and premature death; and the psychological pain borne by the patients and their family members.

There is also a correlation between the state of mental health and rise of the Sexual and Gender Based Violence (SGBV). Evidence shows that mental health has a crucial role in the primary prevention of sexual and gender-based violence (SGBV) even though most standard practice has focused on the role of mental health post-violence, and primary prevention relying on public health models that do not explicitly include mental health.

For example, research shows that empathy, self-esteem, compassion, emotional regulation and resilience, stress management, relationship building, and challenging problematic social norms are crucial for primary prevention of SGBV.

A 2016 report by the National Gender and Equality Commission estimated that the cost of GBV stood at KES 46 billion, which translated to about 1.1 percent of Kenya’s GDP due to medical related expenses, litigation costs, productivity losses among others.

More needs to be done to create awareness about mental health and its economic cost. Also, there is need for an immediate taskforce to collect data about mental health in Kenya to advise policy decisions.

In the words of Owen Arthur, former Prime Minister of Barbados: “For he who has health has hope; and he who has hope, has everything.”

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Dannish Odongo is a writer, journalist & researcher based in Nairobi. He's interested in the Nexus between mental health & governance. Follow him on Twitter @dannishodongo

Reflections

Depression Is an Illness of the Soul, and My Faith Failed Me

When we grow up in a religious nation, a huge part of our identity rests on religion/faith/God, whatever you wish to call it. When this is shaken, the centre cannot hold, and we crumble.

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Depression Is an Illness of the Soul, and My Faith Failed Me
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In 2014, a friend confessed that he had been battling depression and had been on anti-depressants for a number of years. This friend is one of the most brilliant minds I have ever met, he seems to have it all together, and is admired by many. This confession took me by surprise because I never could have imagined that someone like him would be struggling with depression. I voiced my doubts to him; I told him he seemed okay, he didn’t look like it, was he sure? My naivety on the subject was clear. But that confession did for me was life changing, and took me on my own journey to face my own demons.

What I knew about depression was that people who suffered from it were sad all the time. That’s it. However, since that conversation, my understanding has changed dramatically, especially suicidal depression. Looking back at my life in the months prior to that conversation, and as I read and educated myself on mental health, I concluded that if there is a spectrum on depression, then I am somewhere on it – despite my quick reassurances to my friend that day. I have days when I am overwhelmed with life, I question my existence and can’t find a good enough reason for it. It leaves me with a profound emptiness, which I do not know what to do with but sit with it, cover myself with and stew in it.

They say depression is a mental illness, but I think it is more than that. It is an illness of the soul. The soul as defined by Wikipedia is the “incorporeal essence of a living being. It is the mental ability of a living being: reason, character, feeling, consciousness, memory, perception, thinking, etc.” ‘Incorporeal’ means without a physical body, presence or form. Therefore, it makes sense to me that it is a sort of malfunction of the soul.

I have heard numerous psychologists rightfully say that some symptoms of depression include not enjoying the activities one used to, social isolation, and difficulty getting out of bed. On that last point, it is not the usual oh-my-god-its-Monday-I-can’t-get-up, rather it is that you literally and inexplicably cannot get out of bed. The thing about sleep in this case, like many of life’s vices including alcohol and drugs, is that for a moment you forget everything and do not exist. Getting out of bed means facing yourself in this mess, and it is too much.

On some days, the mess falls to the background, and there you are – smiling, getting work done, having a social life, being productive. However, the mess still clings to you, it never leaves, hence the yo-yo effect of: today I’m fine, next week I’m back in the thick of it. Sometimes this cycle is weeks or months long. And no, talking to someone does not seem to help. You don’t even want to talk to anyone, even a good friend. I lost a great friendship during one of these periods because I couldn’t bring myself to pick up phone calls as I felt I couldn’t do it.

As a nation that is religious, or spiritual if you will, depression can be closely linked with God. Let me explain. Like most Kenyans, I have grown up going to church. I grew up Catholic and even served at the altar. Every Sunday, my mother would wake us up, scolding us when we were not moving fast enough to make it for the 9am service. The struggle to get up and get ready to go to church, with all the rushing and scolding, always felt like a punishment.

If you are Catholic, then you know how ceremonial the mass is. Because everything is structured so tightly and unfolds in the same way every time, after attending for years you can be present in the body but be totally checked out mentally during mass. So because I knew the flow, I had gotten used to zoning out after the second reading when it was time for the priest to deliver the sermon. Around me were people dozing off, so I thought zoning out was better than blatantly sleeping in church. Besides, what if my mom’s friends from Jumuia saw me and told her?!

In any case, we sang, “Jesus Loves Me” long before we could comprehend what that love looks like. We were taught to pray and love God more as an obligation than because we meant it. We were taught to profess our love to God – more than actually understand it. Why should we love Him? Because he made us, His son died on the cross for our sins, because we hope to go to Heaven when life on earth ends. Doesn’t the Bible teach us to instruct our children in the way of the Lord and they will never depart from it? So, we grew up believing all of this before we had time to question any of it. We are told that as children of God, we are special and are here for a purpose.

It reached a point when I could no longer carry on with all of this simply out of obligation. In 2015, I started questioning this whole notion of a God-given purpose after going through a year of overwhelming hopelessness. I wanted to know for myself who God was, if He exists, if he loved me, what He wants from me and so on. I was really going out of my mind at this point because I was having an identity crisis. Relying on the idea of God loving me because the Bible says so wasn’t enough. I needed to know for myself, and I didn’t. The reason this is important is because when we grow up in a religious nation, a huge part of our identity rests on religion/faith/God, whatever you wish to call it. When this is shaken, the centre cannot hold, and we crumble.

I didn’t know just how huge a part of my identity God was until I was shaken and felt I had lost myself. The death in my life came from a loss of faith. It was time to get out of the childish way of obligatory faith, and really believe as a choice. But the truth is, I couldn’t find my footing. Feeling worthless, I began seeking out answers to my existence. I’m sure to those around me, I looked fine and had accomplished a lot, but inside I was stuck. My whole life felt like a lie the moment I wondered what my purpose in life was. Answers on the mystery of God, on how we should not question His ways were no longer good enough. It is like when someone dies, and people quickly say that His will is being done. Such answers didn’t cut it for me any more. I wondered, was I an agnostic, a nihilist? Are all depression sufferers just pessimists? It was the beginning of an identity breakdown that has brought me to my knees and left me there. I don’t know who I am, and the personality and character attributes ascribed to me by others feel foreign.

What I know is that on some days, it is like I am trapped in limbo, neither alive nor dead. I wonder why I am wrapped in this mess, never moving forward or backwards. It is like you are sitting on the edge of a cliff and you can’t jump off nor retreat to safety. This is what depression looks like to and for me. The anti-depressants you might be prescribed ensure you keep retreating to safety while suicidal ideation ensures you take that leap.

When I think about people I know or I know about who have died by suicide, including Millie Kithinji, Stephen Mumbo, Robin Williams, Anthony Bourdain, Kate Spade, Avicii, several students in Kenyan universities… I am certain of one thing. Prior to their deaths, they were on this cliff, like so many of us are. Questioning their existence, even those who seemed to have it all – money, fame, love, power. Even with all this, they must have asked: who am I? They must have felt guilty and ashamed at the same time.

I know it sounds selfish especially to those of us struggling financially. You wonder, this person “had it all” and still ended their life. And so, people call them sinners and criminals for ending their lives, and we reach for the refrain we have always been told since childhood – that life is precious and a gift from God, even when we don’t feel it and when our cruel society shows us our lives don’t matter, especially if you are not rich and not politically connected.

Take Millie Kithinji, who died by suicide this March. This wasn’t a spur of the moment decision for her – for a long time, since around 2017, she had been begging God for strength and grace to carry on through the trials she was facing, going by her Facebook posts. She was unemployed with a young daughter, the father of her child had abandoned her, and she was struggling to make ends meet.

The spiral was slow but steady. We don’t know what else was shaking her identity, to the point where she wondered what she was doing alive instead of dead. Who knows how many times she came close to ending her life, but perhaps the thought of her daughter kept her going, until this last time. Ultimately, ending the pain took the upper hand to holding on for the sake of love.

Another recent case was Stephen Mumbo, who was a star employee at audit firm Price Waterhouse Coopers (PwC). He was intelligent, a family man and a committed employee, he was put together and had everything going for him. The death of his mother shook him, and perhaps other things we don’t know. Piecing his last moments alive reveals a trail of work-related stress and a man who was broken long before he fell to his death.

Those like Millie and Stephen were on the cliff, hurting, feeling the burden of their mess and how all the love from their families did not count in that moment before they jumped off the cliff. “They will be better off without me,” they must have thought.

When you are on the cliff, you sit there until jumping is the only viable option to end the pain. It is the only option because you have retreated to safety many times (perhaps from friends who checked up on you, or the thought of loved ones) yet here you are back at the cliff, and the pain is too much. Yes, suicide is a choice. It is the only choice in that moment, and if you have ever come close to jumping, then you understand. Granted, I still don’t have answers, I can only describe what my depression looks like in hopes that someone out there might see themselves through this. You don’t have to know my name, gender, age, or educational status to resonate with me. Because the truth is that a lot of things will bring you and your mess to the edge of the cliff. Mine is my identity crisis. What you can bear might be too much for another person. What has brought me here is a mess perhaps easily cleaned up by somebody else. What will bring you here is a mess that I could easily discard. What is your mess? Are you sitting on the edge of the cliff too?

If you or someone you know is experiencing depression or suicidal thoughts, or if you want to know more, reach out to Befrienders Kenya on +254 722 178 177, or the Meshack Samson Foundation, at +254 715 713 212. You can also find these organisations on Facebook.

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Reflections

Land, Dance and Finding a Way Through This Painful Life Together

Trusting one’s body, and one’s experience of the world is not celebrated or even tolerated in the formal education forced on Africa through missionary and colonial education. School and religion alienated me and us from ourselves, and from the Earth.

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Land, Dance and Finding a Way Through This Painful Life Together
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For British colonisers, the lands that now form Kenya were a space that needed to be traversed on the way to the ‘Pearl of Africa’, Uganda.

The Pearl of Africa was a place where kingdoms, a form of governance recognisable to colonisers from a kingdom country, existed. It was the place where the long-sought source of the Nile was found, and with it the assurance of outwitting challengers to the control of Sudan and Egypt. In Uganda, on top of the cotton varieties they found, the British saw potential for commercial cotton production. A place rolling with greenery, lots of rain, lakes and rivers, teeming with flora and fauna. Winston Churchill visiting in 1807 recommended that Britain should “concentrate on Uganda” whose people, climate, scenery and vegetation were “different to anything else in Africa”, and his statement reaffirmed the title of Pearl that had been given to Uganda earlier by other colonial scouts, Speke and Stanley.

However, to get to the Pearl there was the problem of a strip of coastal lands controlled by the Sultan of Zanzibar (and having had numerous other controllers in centuries prior), and the vast lands and peoples in between the coast and the prized kingdoms. No such fancy names as Pearl were reserved for what was to become Kenya and Kenyans. We were in the way. When the Uganda Railway (note the name), proved expensive, the lands and people that now form Kenya were dispossessed of their inherent value and of themselves, made objects, and turned to profit-making to enable this venture.

This was unseeing violence. Disembedding violence. Dispossessing violence. Appropriative violence. Thingifying violence. It must do something to you to know that you are only a throughway to a thing, body or place more desired. Your value only tied to enabling arrival elsewhere.

The first violence remade land into an inert source of potential capital to be realised through exploitation by a colonial State, and now by a post-independent and still colonial State. Life was rethought dead, chopped up and offered at a cheap price to profit settlers, who were producing value, to enable the journey to the Pearl. It was violence peoples’ bodies, being-ways, knowledge-ways, economies, cultures, and psychologies, on their embodied and unembodied earth relations, and on the interrelationships amongst them.

The dispossession and appropriation that birthed the Kenyan State in the late 1800s, did not end with flag independence in 1963, but was reinforced, frozen, made ‘State-ic’.

Peter Ekeh helps me understand how. In a theory of two publics which I think of as the two Africas, the psychological disruption of Africans who participated in the colonial system caused an unsettlement. To regain equilibrium, these unsettled Africans attempted settlement by being better at being the coloniser than the colonisers were. They regained a kind of psychological balance by being better at performing violence than those who first performed violence on our spirits, human, Earth and ancestral.

This goes on even today. Newspaper headlines regularly detail the numerous ways in which lands and bodies turned into things are appropriated and made disposable for the benefit of the few in State. It happens so frequently and so efficiently that we are numb, frozen, as we watch and hear play-by-play accounts of who can violate us more, like commentary in a football match.

***

Slowing down enough to feel the pain

Violence hurts. Violence injures. One common response to violence is to brace oneself and keep moving. After all no use in crying over spilt milk, right? And there is so much more that needs doing, who has the time to feel? Not feeling is a powerful protection against potential future vulnerability and violence, and there are times we need this survival. But this does not, cannot, go on forever.

In my psychology study and practice I have come to learn that trauma which doesn’t get processed gets stuck and continues to replay until we acknowledge it and move it through our bodies and psyches. Slowing down enough to feel and witness the pain of the historic and present day violences on our spirits is far from indulgence. Rather it is what enables me, and us, to be resilient and to retain my humanity, pushing back against the actions and forces that would have me be an object with no inherent value. Here is an example:

It is August 2018. I am at a protest and memorial for the 34 humans slain during the Marikana Strike in 2012. This protest is happening outside the South African High Commission in London. Speeches are made, we sing and hold signs. A tall thin man, briefcase in hand, walks past us briskly. After he goes some distance, he turns and shouts, “You already got your independence, fuck off!” I laughed at his receding back.

What I didn’t say was “ouch.” Later that evening I am in a group workshop on racism and colonialism. We are doing some role play, and one man is taking the role of a coloniser. He says this, acknowledging a truth he didn’t even realise, “We took what we wanted, and we left what we didn’t want.”

A dam breaks and I weep. Slowed down, I can breathe my pain – the same one I couldn’t when the brisk walker shouted. In that moment I have the space to create a relationship to my own hurt and pain at the violence we and I have been through and continue to go through. Through the tears a song comes – the same one I had led at the protest: Senzeni na. What have we done? A comrade sings with me.

Even while it is not always easy or comfortable, I have learnt that I need to go through my pain to pick up my power, lest I harden, and also become a perpetrator of appropriative violence, seeking to outdo the one who was first violent towards me.

Seeing with new eyes

When a people are mired in the unseeing dynamics of dispossessing violence, we begin to believe that there is nothing to see in ourselves, our places, our histories after all. So I have to remind myself of all that was unseen, in order to reclaim our value.

British colonisers unsaw us and all who we are. I mean us in the full sense of community: human spirits, embodied and unembodied earth spirits (plants, animals, ancestors, and more). They unsaw the remarkable irrigation systems of the Cheranganis, the wonder of setting life to the rhythm of bee migrations, the beauty of decentralised cohesiveness in various governance systems, the science of making rains, the studied play of producing life from an equally dancing set of ecologies as pastoralists do, the connective rituals with which we ensured cycles of life, incorporating the past, present and future, and so much more.

It doesn’t help that for the majority, our upbringing doesn’t tell us of these lives and lifeways either. I recall my high school geography class for instance, which focused on how we can do more unseeing in the style of those that first unsaw us. “Tropical indigenous forests are uneconomical because they grow in mixed stand [i.e. haphazardly, going by that worldview]. Planted coniferous forest is more efficient as it enables mechanised harvest.” This is true, if your goal is to take without reciprocity. And there is no need for reciprocity where the other is a thing without value. The goal of the coloniser was to take, and to enable arrival and capture of the Pearl without putting back.

I set different goals – reciprocity, rebuilding and reconnecting relationships.

We are not the dregs of humanity. We are not what is not wanted. I am not what is not wanted. I see my self, our selves. I want to always sink deep into the knowledge that I have value. We have value.

Re-membering land as living entity

Trusting one’s body, and one’s experience of the world is not celebrated or even tolerated in the formal education forced on Africa through missionary and colonial education. School and religion alienated me and us from ourselves, and from the Earth. I, and we, learnt to trust only in our teachers and in the state-approved textbooks for knowledge.

In trying to reconnect broken relationships I am constantly re-evaluating my relationship with land and with those with whom I share this Earth – plants, animals, soil, etc. I recollect and learn new practices that reaffirm the intrinsic value and self-possession of embodied and unembodied entities that collectively share the Earth.

I do this by talking to plants and trees, approaching them as the living selves they are, and listening to what they say. Thanking my food for making its way to me. Sitting in silence by water and acknowledging how often we treat water badly. Lying on the Earth and taking the time to really feel how the Earth holds me from my heels to the back of my head, inch by inch.

Appropriative violence empties all of spirithood or personhood, making all living things parts of a machine, a means to an end. Acknowledging that I am held and nurtured by the Earth puts a pause on that lie, and helps me to be present to what kind of interaction I want to have with all my Earth relations. This replenishes my stores of care and value that I then come to the rest of life with.

Building collective power

What does one do when they are stuck? Move. The violence that continues to (re)play out today in ever tenacious forms is a collective violence. As I seek ways to name what happened/happens, and to see, feel and move through it, there is work that must be collectively done to repair the harms inflicted on us. Movement and movements do that for me.

Moving my body and doing so with others through dance is a form of collective healing to unstick the stuck places in order to be well, and to be well with others. Dancing with presence has become a practice to shift and move things that I cannot do only with words.

I also work to build movements that can acknowledge and heal this collective violence so that we can start again from a different place. I combine working for justice with healing in my movement building, and understanding healing to also be justice work. I think this is necessary if we are to avoid the race to outdo each other in who is better at performing appropriative violence. It is a way of rewriting our origin story to begin elsewhere. An elsewhere that acknowledges our value – all of us, human, Earth and ancestral spirits.

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Reflections

An ADHD Diagnosis: ‘My Nights Were Characterized by Racing Ideas, and Days Filled with Failed Projects’

My mind had failed me so many times I could no longer trust the ideas it put forth, no matter how brilliant or mundane they were. The tipping point came after a violent altercation with my cousin, which landed her in hospital and me in the refurbished blue container recounting my life story, and eventually, finding a turning point.

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An ADHD Diagnosis: ‘My Nights Were Characterized by Racing Ideas, and Days Filled with Failed Projects’
Photo: Melanie Wasser on Unsplash
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The diagnosis came about seven months ago. I was sitting in the counselling room of the hospital, a refurbished 40-ft shipping container painted light blue. I remember being annoyed by the breaks in the painting caused by the vertical ridges on the walls, and sucked on piece after piece of hard candy to calm down.

After a series of routine questions to get my history, an analysis by the psychiatrist, and several written tests, the verdict was delivered to me. Attention Deficit Hyperactivity Disorder. At first I was skeptical about the diagnosis. It was a strange case of déjà vu, one on which I’d sat in the same position across a psychiatrist two years ago and was given a host of diagnoses: I was told I had major depressive disorder, then affective disorder and then bipolar 1 disorder.

So I prodded the doctor, testing to find out if my symptoms covered a wide scope of diseases, or comorbidities, as the medical fraternity called them. To put my heart at ease, he showed me a TED Talk of a lady talking about her struggle with the condition, and the end of the video, I broke down and cried.

I’ll call the beginning of my visible symptoms as the crash. I’d excelled academically in primary and high school. I was a relentless high achiever, adapting the routine of school life which accommodated my bursts of energy and productivity. I graduated from high school with a good grade and joined university. But campus life came with the absence of a strict routine, and the unravelling at the seams of the thread of my life began.

I dropped out of my course after one semester and was kicked out of the halls of residence after failing to pay accommodation fees, due to procrastination. I resorted to clever methods to hide the absences in school from my parents. To cope, I drank and smoked a lot of weed. My nights were characterized by racing ideas, and days filled with failed projects because I couldn’t map them out; the brainstorm process ended up being crowded by other ideas and my mind couldn’t shut down. Then came the shame and low self-esteem. My mind had failed me so many times I could no longer trust the ideas it put forth, no matter how brilliant or mundane they were.

The first psychiatrist I visited was a referral from a general doctor. I’d arrived at the triage suicidal, struggling to breathe, and paranoid that I was being followed and watched. He prescribed some sleeping pills and handed me a sealed envelope addressed to a private psychiatrist clinic at the Doctor’s Plaza at Nairobi Hospital.

I didn’t feel bipolar – I was told bipolar disorder entailed massive mood swings, and this didn’t quite apply to me – but I accepted the diagnosis as it gave me a semblance of peace. At least I had a reason for my behaviour.

For two years, it cost nearly Ksh800 a day to pay for consultation and medication. Physically, the drugs left me feeling comatose on most days, and demoralised because I was still messy and erratic, but with a Ksh288,000 annual price tag to keep me stable. I sunk further into depression, culminating in a failed suicide attempt.

At the peak of my treatment, I was on a cocktail of seven different pills in the class of antipsychotics, antidepressants, and anti-anxiety medication. They gave me sleep jerks at night and vivid nightmares — eventually, I developed a dependency on the lulling effects of the anti-anxiety pills to help me sleep. The tipping point came after a violent altercation with my cousin, which landed her in hospital and me in the refurbished blue container recounting my life story, and eventually, finding a turning point.

The psycho-stimulants prescribed by the doctor were a relief. I could finally consistently complete my tasks and rein in errant thoughts, but the new ADHD diagnosis was exhausting. I imagined having to explain myself again to my friends about my condition over and over like I’d done for the past two years, and I was hardly prepared for the emotional or mental labour.

ADHD is a condition of limited self-regulation rather than a deficit of attention. A person with ADHD is able to concentrate for long periods of time in a state known as hyperfocus, that is when they are interested. ADHD exists on a spectrum and some people have it worse than others. We all have moments of ‘zoning out’ and procrastination, but for the ADHD individual, their symptoms fall on the extreme end of the scale and can be crippling.

Dopamine is a neurotransmitter that is responsible for a range of functions in the human body including emotional regulation, and motivation to guide your brain to accomplish specific tasks in order to get the desired reward. To use an analogy a psychologist gave – our brains are engines. Different parts initiate and receive tasks, others execute them and help manage one’s routine. Dopamine is the fuel between these areas, but ADHD brains have a deficit of dopamine. The result is that coordination is missing.

ADHD is a highly comorbid condition, meaning it exists with other mental conditions such as anxiety and depression. The emotional dysregulation and hyperfocus often leads to misdiagnosis as bipolar disorder, borderline personality disorder or other affective disorders – like it happened in my case.

The DSM V – a diagnostic criteria by the American Psychiatric Association used to identify mental illnesses, leaves out a key factor of ADHD diagnosis – emotional dysregulation – from its list of symptoms, further increasing the likelihood of misdiagnosis.

While ADHD in children is extensively studied and treated, very little academic literature covers adult ADHD, and in particular ADHD in women, which is complicated by changing estrogen levels that affect the availability of dopamine in the brain at different points in the menstrual cycle. The link between estrogen and ADHD means that at different times of the month, the symptoms get worse and might require a recalibration of medication and more money to cover the cost of drugs.

By the time an adult is given an ADHD diagnosis, their lives are littered with failure because of trying to conform in a neurotypical world, with shame, guilt, broken relationships, and a calcified negative view of themselves as lazy, inconsistent, rude, violent, stupid…the list goes on and on.

As I discovered, conventional therapy is often expensive and limited to brief sessions with the psychiatrist and counselor once a month. Adults with ADHD need extensive help, an almost round the clock treatment in the form of non-judgemental accountability partners to help them form a routine, map out their life and follow through on decisions. In the case of an adult diagnosis, and given the individual demands of everyone else’s lives, such accommodations seem like ridiculous requests and one continues to live with their dysphoria.

ADHD and its treatment is very misunderstood. There are stereotypes such as “We are all a little ADD”, and there’s scepticism over whether or not it’s a real illness. Misleading media coverage about the alleged performance-enhancing abilities of the drugs used in treatment also hinder objective discourse about the reality of living with ADHD. The victims are the adults who continue to suffer, very often without knowing what their condition really is, at the workplace, in school or in their homes.

My life hasn’t completely changed, but it’s a lot better than it was. I have interacted with other adults who also live with ADHD and formed a small support group of sorts. I got back on track with my studies and graduated. Living with ADHD forced me to be extremely honest with myself about what I can and cannot do, who I can be and who I am not. There can be no illusions about my strengths, weaknesses and ability to commit to tasks, in order to avoid that vicious cycle of depression and anxiety.

As for the medication, it is not a panacea. I needed to be honest with myself about this too. It was easy to use the drugs as a crutch and avoid putting in place mechanisms to regulate my behaviour – and then blame mishaps on ‘being off the meds’.

What do I look forward to? More research. Particularly on ADHD and women and how environmental factors, socialisation and biology exaggerates or diminishes how the symptoms manifest. I keep a journal and note down observations on days where something strikes me as odd, and use that to inform my treatment. It’s the beginning of my own personal research, and I hope it can help someone else someday.

To conclude, ADHD is neither a gift nor a disability. We can have no illusions about that. It can make you prone to certain harmful behaviours and may give you some advantages over neurotypical brains, but the labels of gift or disability may prevent us from being objective about its management. But with a little more knowledge, and a lot more empathy, we can create a society where lives are not littered with failures that could have been avoided.

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