A casual walk through any of Nairobi’s wealthier middle class neighborhoods and it will not be long before you encounter spaces dedicated solely to happiness and well- being. Whether it is bookshop sections carrying titles on the same, office spaces with brightly colored furniture, office plants and large windows to create more positive working environments as they claim, yoga studios and a call to individuals to de-stress by interacting more with nature and find meaning in their life, the industry of happiness and positive thinking is booming.
Globally, the wellness industry was worth $4.2 trillion in 2018, and the behavioral health industry, acellarated by higher incidences of mental health disorders and mental ill health is predicted to reach $240 billion by 2026. The UN Happiness Report of 2019 ranked Kenya at 121 out of 156 countries in the world with a score of 4.509/10 on the happiness scale. The report used the following key parameters: well-being, income, health, life expectanacy, social support, freedom, trust and generosity to gauge the happiness levels of the world between 2016-2018.
One does not only need the UN Report to observe the mental distress of Kenyans, in the recent past, news stories of suicide and murder suicides have flooded our screens and newspaper pages. In April 2019, a BBC series of short films on modern masculinity in Africa highlighted the rate of suicide on Shamata Village in Nyandarua County where 70 people had committed suicide in the past year. Kenyan men were in crisis, the opening title sequence of the video said, a statement echoed across Kenyan dailies and reflections on mental health.
WHO places the rate of suicide in Kenya at 1408 deaths annually, which is higher than the official figures reported by the Kenya National Bureau of statistics which is 421. True estimates on the rate of suicides are unavailable largely due to poor reporting of such deaths and the criminalization of suicide under the Penal Code. Despite the inaccuracy of data on this, and WHO’s admittance that only 80 of its 194 member states – Kenya not being one of them, have good quality data on suicide rates, it is these estimates that frame their Mental Health Action Plan of 2015-2020, and form the framework for Kenya’s Mental Health Policy of 2015-2030.
These disparities in data and the Global Mental Health Movement – which has the scaling up of access to psychiatric services in developing countries as one of its aims form the basis of my article. The hegemony of western psychiatry is reproduced in our national mental health policy and in the forms of treatment and diagnostic criteria widely used in Kenya today to identify mental ill health and mental disorders. Who does a global mental health policy serve?
The diagnostic criteria used in Kenya is the DSM developed by the American Association of Psychiatry. This criteria of framing of mental ill health often disregards the complexities of cultures of the societies in which the incidences of ill health occur. Furthermore, developing a uniform picture of mental health and ill health that is quick to classify difference and mental distress as illness in order push to scale up access to mental health services in the global south threatens to create – if it has not already started creating – forms of chemical slavery through dependence on psychotropic drugs. It is even more worrying when some of the partners in the global mental health movement are pharmaceutical companies.
Western psychiatry was introduced to Africa during colonolism. It was weaponized against Africans and used by the colonizing governments to expand their rule. In Kenya, JC Carothers, who was head of the Mathari Mental Hospital, wrote a report on titled 'The Psychology of the Mau Mau' during the state of emergency on 1952, which was used by the British colonial settler government to justify barbaric treatment of the Mau Mau fighters. Carothers described members of the Kikuyu nationality as being of disturbed mind and of the general Kenyan African population as being of lesser intelligence than the Europeans.
During colonialism in Africa, the department of mental health was often under the command of the inspector of prisons. The colonial legacy of psychiatry exists today in the way that first, treatment more often than not, involves institutionalization. Second, different social classes have different experiences of mental health services. The urban poor are subjected to high doses of medication and involuntary detention without prior consultation from a doctor, spend listless days basking in the sun while wearing prison uniforms in Mathari Mental Hospital. In comparison, the rich in private mental hospitals access a wide range of entertainment, the serenity, cool air and birdsong in the leafy suburbs where they spend their stay.
Third, when one receives their diagnosis (and this is a privilege of those who can afford a doctor to examine them). The feelings are often of confusion and fear. The technical terms used to frame the experience of your life are alien and alienating. One hears terms like Bi-polar or ADHD for the first time and it becomes a frenzy of activity first to understand the diagnosis and then to explain it to your loved ones.
Fourth, alternative forms of treatment such as indigenous medication and forms of healing are shunned upon in favour of pharmaceuticals.
Lastly, in spite of seeing a psychiatrist once or twice a month for half an hour or less, they are the 'experts' on your life. Interpreting your lived experience for a few thousand shillings more into their pockets and for you to leave with a head full of alien terminology to unpack. There are no conclusive medical tests that determine a mental disorder. It is all based on accounts from the subject to the specialist and impositions of western categories of mental ill health on other cultures. What is to stop a doctor from misdiagnosing or over-diagnosing their subject?
A materialist analysis of the causes of mental ill health takes a back seat in favour of explanations of chemical imbalances and heredity. The ugly underbelly of class society remains mystefied yet the evidence shows that it is not enough to stop at chemical imbalances. In the BBC short film, the two stories highlighted cited business failure and poverty as the trigger that pushed the two men to commit suicide. In the Star Newspaper article, 'The Economics of Suicide' the period between 2008-2017 reported a 58% increase in suicide rates, the highest at 421 for every 100,000 Kenyans, the same year when inflation was the highest in the past five years at 8%. In 2010, when the rate of suicide was the lowest at 75 for 100,000 people, the GDP growth was at 8.4%, the highest in 41 years. The rate of inflation was at 4.3%. This data was drawn from the Kenya National Bureau of Statistics Economic Survey of 2018. As the burden of taxation and high cost of living continues to weigh down on the worker, then cases of suicides, femicides and murders will continue to go up. The article gives key insights on the social determinants of mental ill health however, while the family counselor, Dr. Kinyanjui Ng’ang’a who was consulted for the article, acknowledges that tough economic times are a source of depression, his proposed solution – for those affected to derive value and identity from pursuing purpose, meaning and significance - does not even begin to engage with the complexity of the economic aspect of mental health or provoke one to think critically about the causes of mental ill health and suicide. He goes on to add that one should not place value on things they can lose such as cars and houses, a contradiction given that class society places masculinity and purchasing power in one box, and judges men by these impossible standards of buying power. The specialists proposing these solutions probably drive high-end German vehicles, have not ridden public transport in years and live in gated communities. The article then ends on a vague and simplistic note on the importance of acknowledging social determinants of suicide.
The conversation on mental health is certainly getting more airtime on talk shows and blogs. When the economic causes are highlighted, it is merely acknowledged. It generates an attitude of passive acceptance of our mental and economic state rather than active participants and the source of the solutions to the disaster of mental ill health. Suggestions to reduce stress by talking walks in nature, yoga or meditation, that only drive up consumption with short term effects are still beyond the reach of the casual labourer, small scale farmer and small businesses owner who is most affected by mental ill health. It also ultimately still feeds the insatiable capitalist machine on the other side of the industry of happiness.
Commonly prescribed psychotropic drugs have adverse side effects. Benzodiazepines such as alprazolam or clonazepam used to treat anxiety disorders are highly addictive and some of the most misused prescription pills. Fluoxetine, a commonly prescribed anti-depressant, increases the risk of suicidal ideation in patients. Fluoxetine and Benzodiazepines are among the drugs on Kenya's Essential Drugs list provided by the Ministry of Health based World Health Organization Essential drugs list for 2016.
A global mental health policy de-politicizes mental distress. It moves us from collectively examining neo-liberal capitalism and it’s values and how these values run contradictory to those posited in cognitive behavioral therapy to change the individual to be better suited to the economic pressures of capitalism. This leads us to see how completely absurd such forms of treatment are. We will continue building houses on cracked foundations and stare in bewilderment when the structures collapse despite out best efforts. Mental ill health treatment is not a problem that can be solved on a individual effort or by personal lifestyle changes. It needs a collective effort to return the fruits of labor back into the hands of the laborer and out of the bellies and store-rooms of the few.