I
When I was seven years old, only two years into primary school, I was shipped off to a boarding school far away from home. I remember my mother leaving me with the class teacher and saying, suddenly, that she’d to pick something from the car. She said she’d be right back. I waited and waited. She never returned, and it was years later, now fully grown up, that I considered why she’d told a lie that day. She probably couldn’t bear to say goodbye, or maybe she was worried I’d cling to her and beg to be taken back home, or maybe it was something else together.
I didn’t know it at the time, but that day would be the last I felt close to my mother.
Later, after it became apparent that my mother was not coming back, the class teacher said I needed to prepare for night prep. It was getting dark outside. The school campus had been set up in such a way that the classrooms were downhill while the dormitories were atop the hill. As I walked, my attention was drawn to some girls in the assembly ground, all of them alarmingly tall, giants compared to the tiny being I was. I got lost trying to find my way to the dormitory, and I will never forget the stares I got while I tried to situate myself in a strange new place. I climbed the first set of stairs I saw, thankfully ending up in the matron’s quarters. The woman was kind enough to lead me to the bedwetters’ dormitory. There were triple-bunk beds, with a pair of them separated by a narrow corridor to form some kind of cubicle. I got a bottom bed. Two of my immediate mates were biological sisters.
Not long after I settled in, one of the sisters, the one who slept in the bed above mine, said she had lost her pajamas and blamed me. She said she had left them on my bed and that their disappearance only meant I’d stolen them. The accusation was terrifying, and the girl threatened to report me to the matron as a thief whenever we got back from night prep. I remember being so scared I’d crawl under the bed in search of the missing pajamas I knew wouldn’t be anywhere I looked. Because we never kept anything on the floor, it was possible to have a clean view of the entire dorm floor if one crept on all fours and looked everywhere. Yet I’d continue my search for the missing pajamas till at last I fell asleep on the cold floor beneath my own bed. Later, waking up in the middle of the night to confirm if my tormentor was asleep, I’d slip into my bed.
At the end of my second term in boarding school, the change in me was so visible when I went back home: my bed was always neatly laid, the blanket folded into a perfect rectangle, my suitcase squeaky clean with my uniforms, my underwear neatly packed. Perhaps the only thing that could be said to not have improved was my handwriting. In spite of all the beatings that turned my palms red and itchy, they said my handwriting was still poor. I dreaded the journey back to school, first of all because it was so long it took a whole day to get there. I often would doze off, only waking up as the car turned into the school gate.
Unlike the other girls I knew, I never looked forward to visitation days. Mostly I wanted the food those who came to see me would bring: the salted chicken, fancy crackers and apples I would receive. My mother usually sent an aunt or the maid to represent her on the days she was swamped with work. Sometimes she’d show up after they’d rung the last warning bell for parents to leave. I’d glimpse her from a distance, walking uphill after hours of waiting and searching for her face in the multitudes looking for – and finding – their own children. Somehow I’d still find the strength run up to her with such excitement. Even when she delegated others to see me, I still waited for my mother in the vain hope she would come.
It was at this school, this military-grade primary school, that I grew up. It played a significant part in creating the person I am today. I got used to being regularly caned for misdemeanors. A certain teacher said to us that if we ever found ourselves in need of being caned, we shouldn’t hesitate to go to the staffroom and request him to do the needful. I considered going there a few times, never mustering the courage to actually ask to be assaulted.
Back home, I lived with two brothers, a sister, and our working parents. My father was always away at work. He’d come home every two weeks, sometimes only at the end of the month. We would be on high alert during those weekends when we suspected he’d be back. We’d be watching TV and a familiar hoot at the gate would send everyone running to a different corner of the house, pulling out books or holiday homework, or entering the bed, or pretending to be doing some domestic chore. The last one in the TV room, before making her getaway, would be tasked with switching the machine off and covering it with a cloth in the manner it usually was, just as our father had left it. Of course our father only had to touch the screen and feel its heat to know we were deceiving him, but he never said a word. He was a man of very few words, managing the occasional lecture during which he warned us that we were spending too much time in front of the TV instead of studying.
He largely left the disciplining to my mother, who was doing most of the parenting on her own. She grew protective of us, with a growing need to control everything. We weren’t allowed to step out of the gate or play with the neighbors’ kids, especially the boys. Once, when I went out to play with a neighbor’s teenage son, a boy I felt I got along with and who had a cool-looking digital watch he let me put on my wrist, my mother lost her head that evening. She saw the watch and her temper went through the roof, speaking loudly and with anger in the presence of my father. She went on and on with warnings to steer clear of obulenzi bw’okukyalo, the little boys of the neighborhood, and saying, too many times, that if she ever found me outside the gate or found me pregnant she’d beat the hell out of me. I had my first sex talk that day, and it would seem that the moment, the event in which all of my mother’s irritability was enshrined, has stuck with me to date.
She’d get back home tired from work and somehow find a way to complain about something we did or didn’t do. Why had we been watching TV when the compound was not clean? Why had we not yet showered? Why were we just sitting there and doing nothing? My siblings and I got a book in which we documented all the possible wrongdoings she had ever identified, the bad behavior she did not expect of us. We called it the “Miwunyo Book,” the book of foul things.
I was mostly quiet and reserved growing up, and I’d cry when someone raised their voice at me. I still prefer serenity, and I never like it when someone speaks loudly in my presence. They tell me babies always fell asleep in my hands. On those nights when the power failed and everyone else sat around a charcoal stove, seeking its warmth and light, laughing and joking about something from the past, I went and sat meters away in some dark place, quietly observing. Whenever the unspoken home rules would allow it, I found myself going to sleep in my room. I’d sleep for hours during the day and still manage to sleep through the night. My siblings nicknamed me “Gift of Kado,” Kado being high-school slang for sleep. I still go to sleep whenever I have the opportunity, and, from years of practice, I maintain a very calm outlook even amid a storm.
One day, when my little sister heard a harsh conversation between our parents, she became visibly upset because she worried they were going to separate. I held her hand and walked her to the furthest room in the house, sat her on my lap and told her Father and Mother weren’t going to separate. Afterwards, we sat at the dining table in dark silence till the voice in her head died down. Even at my tender age I became my sister’s shrink in a sense, as I would be for others in my family. The preference, most of the time, was to listen rather than talk.
II
As a practicing psychiatrist these days, I get asked quite often, Why psychiatry and not pediatrics? Or, as others say, Why go into madness? I dread this question for the simple reason that it shouldn’t be asked. It’s like a stranger finding you at the bar drinking a Fanta and proceeding to ask, “You don’t drink?” If the answer is no, the interrogator might then ask, “How come?” It can seem as if there’s supposed to be some tragic story behind one’s temperance.
The insensitive ones will go so far as asking, “Aren’t you going to end up like your patients?” At the core of such questioning, I have determined, is a failure by many of our people to appreciate psychiatry as a major branch of medicine, as important if not more important than internal medicine. Mental health is one of the defining issues of our digital age. The world needs more psychiatrists, not less.
In the psychological thriller novel The Silent Patient, Alex Michaelides writes about a psychologist faced with the same question who finds himself forced to give a socially desirable (noble and admirable even) answer: “I wanted to help people I suppose, that’s it really.” But he admits to himself that this imperative was secondary. His true motivation was purely selfish; he was drawn to the field because of his “damaged nature,” the need and motivation for many mental health professionals to heal their own psychological wounds through understanding and treating others. I’d like to think my answer is quite similar to his, although, one must believe, there are plenty of good reasons to want to be a psychiatrist. On some subconscious level, the mind seeks out the help it needs so that it can better equip itself for survival. I also believe that a good way to help oneself is to help others.
I remember my very first patient, a middle-aged lady who had been escorted to the hospital by a physician. Her complaint was that she was always angry and just couldn’t stop crying. This had worsened progressively after she’d had a baby. She said, “Doc, I love my child, but I just can’t stand the sight of him. I can barely look at him.” She’d left all the nurturing to the bottle of formula. She admitted she found her partner and most of the people around her annoying. Small inconveniences left her feeling upset. She kept in her bed most of the day, crying for no apparent reason, sometimes crying uncontrollably and, ultimately, feeling so exhausted she was unable to sleep. Then came the headaches, probably from a combination of the cumulative sleep debt, dehydration and poor feeding. She said she wished to die in her sleep, or for God to end her life, which meant she was suicidal. Here was someone whose family depended on her without necessarily knowing she was suffering great mental anguish, often bed-bound and unable to take care of herself, much less anyone else. For me, this was a reminder that the patients we see in the psychiatry unit actually come from our homes, the homes in which we grew up, the homes in which we live. Mental illness might not necessarily kill, but it does hinder many from fulfilling their responsibilities and reaching their full potential.
One morning, as I sat in my small clinical room, I noticed that the white walls had accumulated dust over the years and that the half-open door was anchored in position by a heavy stone. This heightened my sense of the place’s neglect but also somehow made me feel more eager than I was to see my next patient. Two humble-looking men walked in, like little boys reporting to the principal’s office. Their faces showed they were aging faster than they should; one had blood-shot eyes, the kind one gets from excessive consumption of weed, and a stench of fermented alcohol trailed him. The stench hit right at the back of my tongue, leaving me with an urgent need to go and throw up. I tried to keep my facial muscles relaxed, aiming to maintain my professional look and not wanting to show the slightest hint of judgment or disdain. I wanted to hear what these men had to say, what problem they had. They turned out to be brothers – and both of them actually needed my help. The brother who had brought his sick brother held a bottle of mineral water in his hand, sipping from time to time what I knew to be alcohol and not water.
The sick brother had been drinking heavily for years but recently had quit alcohol, only to start hearing the voices of people he could not see. Like many in our cultural setting, he deduced that these were the voices of his ancestors – empewo z’ekika, as some say – and the man thought, he told me, that what he needed to do was to go back to his village and clear the bush around his ancestors’ graveyard. In psychiatry school they teach us to look at the client as a whole, to pay attention to the socio-cultural aspects of their lives. So while there was a clear biological explanation for why the man was hearing voices, something that in all certainty had nothing to with his angry ancestors, I couldn’t ignore his explanation for the voices in his head and what they meant to him. I explained to him the biological basis of the voices and encouraged him to continue abstaining from alcohol and other dangerous substances. Then I wrote him a prescription and asked him to see me in a fortnight. As to whether he went back to his village to perform the ritual he felt would appease his ancestors, I never found out what happened next. But I was pleased to learn, when he returned six weeks later, that he felt relieved after the voices in his head went silent.
I once had the opportunity to be apprenticed to a senior psychiatrist at a prominent private facility in Kampala. At the end of my first day it became apparent that mental illness does not discriminate according to economic status. It affects people from all walks of life. The facility received many patients in the course of a day. When I was there, two patients we received stood out for me. Both had been sent abroad by their parents for their college education, transplanted so young into a totally unfamiliar setting, there to fend for themselves while still adolescents. Eventually they succumbed to drug use and the depression that followed. Both kids returned home without graduating, and later it was discovered that money meant for tuition and upkeep had been wasted on drugs. Their parents had to come up with emergency stories in order to dupe the boys into getting on a plane back home.
In a country that’s one of the world’s top consumers of alcohol per capita, we are not doing enough to help our young people who find themselves handicapped by addiction. But we can’t afford to leave these people behind. Many Africans struggle with mental illness behind closed doors because of the stigma surrounding it, because they don’t want to be seen as weak or labeled mad. Seeking therapy or professional care in a hospital setting is seen as the last option after other measures have been taken. They visit the shrines of traditional healers, or go to church to have their demons exorcised, without seeing any improvement and before they realize they should probably see a psychiatrist.
I hope we can begin to see mental illness not just as something that affects the dirty, unkempt balalu we see in the streets but as a reality that exists within our own homes – often suffered in silence and behind closed doors. Many of the patients we encounter come from households just like ours, surrounded by people who love them deeply and sometimes even by those with whom relationships are strained. If we find ourselves unable to cope with stress through healthy strategies such as eating well and getting enough sleep, let us remember that support is available from those of us who are not only willing but happy to be so helpful. ▪