KPOVÉ, Togo — The church grounds here sprawled through a strange, dreamlike forest. More than 150 men and women were chained by the ankle to a tree or concrete block, a short walk from the central place of worship. Most were experiencing the fearsome delusions of schizophrenia. On a recent visit, some glared, while others slept or muttered to themselves. A few pushed to their feet and gestured wildly, their cries piercing the stillness.

Until this year, Koffi Gbedjeha, 45, a carpenter and father of four, was one of them — a resident of the Jesus Is the Solution prayer camp here, shackled like the others, his family and camp staff members said. For more than two years, his youngest sister, Akossiwa, 27, tended to him. Rising early each morning, she walked along a cool red-earth path to the human forest; each day, amid the stirring bodies and clinking chains, she emptied her brother’s chamber pot, swept the ground and cooked his meals over a charcoal fire.

So begins a series of articles on mental illness in West Africa.

This week’s Reading: “The Chains of Mental Illness in West Africa” by Benedict Carey, which was published earlier this month in The New York Times.

The selection may seem a bit unusual – Readings, after all, usually draw from journals, not from the Sunday paper. But Carey’s reporting is unusually lucid. If you haven’t read his article, I invite you to read it; if you saw this before, it’s worth re-reading.

You can find the article here:

Benedict Carey

Mr. Gbedjeha, the eldest of five, was once “his family’s rock.” The article notes a time when he persuaded a brother to return to trades’ school after dropping out. In his early 30s, however, he grew ill. Psychotic, he denounced neighbours as demons. Worried and devout, his family sedated him and took him to a prayer camp.

The article describes these camps where the mentally ill are prayed for and, often, chained. Mr. Gbedjeha ends up in chains himself.

Though his family eventually takes him to a clinic and he receives antipsychotics, money is limited and he is soon discharged. Back in his hometown, he seems better on medications – but it’s not clear how long his family will be able to afford them.

The New York Times

I highlight a few points:

· “Historically, mental illness has lingered near the bottom of both African and global health priorities, well behind deadly threats like malaria, measles and HIV.”

· Last month, the UN adopted global development goals that include a commitment to “promote mental health and well-being.” As well, the UN commits to reduce premature deaths from non-communicable diseases (including mental disorders) by one-third by 2030.

· The WHO has called for an end to the chaining of people with mental illnesses.

· According to the WHO, most countries in Africa, if they have a mental health budget, spend an average of less than 1% of their total health spending (compared with 6 to 12% in the West).

· “At last count, Liberia had just one practicing psychiatrist. Niger had three, Togo four and Benin seven. Sierra Leone had none.”

A few thoughts:

1. This article is beautifully written – and haunting.

2. We have deep problems with access to mental health services in this country, and across the west. But this article puts our issues in a larger perspective. At the end of the day, we have a good set of problems to work on.

3. This article isn’t particularly hopeful, but the series does touch on the work of Dr. Vikram Patel who is taking a creative and decidedly low tech approach. Dr. Patel, for example, trains lay woman to offer evidence-based therapies in Goa.

Further Reading

The second part in the series, “In West Africa, a Mission to Save Minds,” can be found here:

The series also runs with a short Q&A with the photographer.

Reading of the Week. Every week I pick a reading — often an article or a paper — from the world of Psychiatry.