Track Changes: Countering a Limited Perspective on Mental Illness

In our ongoing series, “Track Changes,” we link to online content that we have found to be problematic in its assumptions, framing, or language and provide a question or thought(s) provoked by each piece. We ask how portrayals and representations need to be not only rephrased, but also reframed and rethought.

This time, our response has two parts. This one deals with the blind spots that are present in treatment (or lack of treatment) of mental illness in the United States. Tomorrow’s piece will focus on what the article misses about how mental illness is treated in West Africa.

by Carrie Reiling

In October 2015, The New York Times published an article titled “The Chains of Mental Illness in West Africa.” The author, Benedict Carey, provides insight into prayer camps in Togo, which were established for families with few other resources to house and ostensibly treat those with mental illness (and possibly intellectual or developmental disabilities).

While Carey does write that “Every society struggles to care for people with mental illness” and acknowledges that people with mental illness are bound in the United States and other places as well, he solely focuses on what he sees as the barbarity of the practice in West Africa. The article sets up a dichotomy between “real” approaches to alleviating or ameliorating mental illness and non-proven practices like prayer and traditional healing.

What is missing from his article is that both restraint and non-medical approaches to mental illness are also prevalent in the United States and that the differences in approach between Togo and the United States is one of magnitude, not of kind, likely attributable to the money allocated to mental illness in each country.

In the United States, patients with mental illness or other behavioral issues are not technically chained but are instead restrained – at times forcibly so with straps or sedating chemicals – in psychiatric institutions or in prisons, the latter of which was never intended to help those with mental illness. The U.S. criminal justice system has become the de facto method of dealing with mental illness in face of the lack of social structures to help. About 15 percent of state prisoners and 24 percent of jail inmates report symptoms that meet the criteria for a psychiatric disorder, according to the U.S. Department of Justice, and more than 10 times the number of mentally ill patients are in prisons and jails than in state psychiatric hospitals, according to the Treatment Advocacy Center.

Carey’s article reports that “most countries in Africa, if they have a dedicated budget for mental health care at all, devote an average of less than 1 percent of their health spending to the problem, compared with 6 to 12 percent in the wealthy countries of the West.” In fact, the United States is on the low end, spending about 5.6 percent of its national health-care budget on mental health treatment, more than a quarter of which goes toward prescription drugs.

In any culture, mental illness is difficult for families, with the tension between the dignity and autonomy of the individual while families attend to their medical care and protecting them from themselves and others. An article from IRIN News points out that victims, former combatants, and their families in the Democratic Republic of Congo are allocated few provisions for mental health in North Kivu but that private clinics are working together with NGOs and communities to train mental health professionals, as well as pastors and traditional healers. They spread messages on the radio, in churches, and among state authorities to educate about mental illness and the available treatments, even if those treatments remain limited.

By only focusing on one aspect of mental health treatment in a foreign place while neglecting to mention how the United States similarly treats much of its population or that many of the treatments described are part of a larger treatment effort, The New York Times piece sadly overlooks the holistic approach that is vital to treating mental health issues – including mental, physical, and spiritual aspects.

Carrie Reiling is a PhD candidate in political science at the University of California, Irvine and is an editorial assistant for The CIHA Blog.