Mental Health Treatment & Gender Equality in Uganda

Conflict, poverty and instances of social injustice can provide the context within which a person develops mental health issues. And yet, while studying to become a creative/psychomotor therapist, I learned very little about this.

I didn’t question it at the time, because mental health is a personal issue, right? My time in a counselling centre in Uganda last summer showed me that the answer to this question is, in fact, a clear no.

I volunteered as a psychomotor therapist in the Bishop Asili Counselling, Rehabilitation and Community Centre in Ngetta, northern Uganda. The local population living here suffered badly during the Lord’s Resistance Army insurgency.

More than a decade after the end of the war, I came to Uganda with a stack of books on trauma and post-traumatic stress, ready to do creative therapeutic interventions that might help women cope with their war-time experiences.

Very quickly, it became clear to me that the conditions these women lived in asked for something different. Something more.

Sister Florence, an Ugandan psychologist who founded and runs the counselling centre, reminded me that next to their history of war, “there are so many [other] sources of trauma, so many, so many, so many”.

Women in Ngetta face many challenges. The patriarchal context leaves women with few, to zero, rights.

They have no right to land or any kind of ownership, and the moment a woman marries, her new husband acquires rights over her sexuality and reproductive ability.

Ellen, one of the women I worked with in the counselling centre, described the patriarchal culture: “I was now in the hands of my husband and I was now under authority of my husband. I need to respect him and do everything he tells me.”

Her words reflect the complex power dynamics and hegemonic masculinity that undermine women’s social status and power. On top of this, many women struggle to feed their families every day, while often their husbands drink away the little money there is. Other women have lived through (often multiple) more recent traumatic events, such as emotional and physical abuse by a husband or brother.

It made me wonder how much help my therapeutic interventions focused on (individual) war-trauma could be.

Recognizing the unequal social position of women, I needed to have a clear feminist ideology underlying my therapy. This meant focusing on women’s social position and equality.

Our sessions were related to resilience, visibility and communication, grounding techniques, personal boundaries, and more. Work related to the strive for equality for women was essential. However, paying attention to – and ultimately challenging – violent and unjust structures is not often included in mental health interventions in the Global South.

The importance of women’s mental health for general health is widely recognized. Mental health in international contexts is slowly becoming more of an acknowledged topic within the field of international development. This is really good news, especially considering the fact that only a small minority of the 450 million people suffering from mental or behavioural disorders worldwide receive treatment.

In 2013, the World Health Organization published their Mental Health Action Plan: 2013-2020. It is an ambitious action plan that understands ‘the essential role of mental health in achieving health for all people’. Global Mental Health (GMH) is thus an emergent topic in which more and more people are currently working. However, with this renewed focus on mental health, many critiques have emerged, some of them accusing GMH of being a colonial practice.

GMH is accused of globally enforcing biomedical systems, which are characteristic of the Global North’s approach to health. The biomedical framework locates illness, including mental illness, within a person. Though psychological and social principles are sometimes taken into account, biological variables are the most central.

Issues of social injustice and structural violence (such as poverty, conflict, sexism, racism) are not taken into account, despite their significant impact on women’s mental health.

Very important work is being done in the field of GMH. Organizations like SOS Children’s Villages or Action for Child Trauma International are great examples of a rights-based approach to trauma.

We must be careful to avoid new forms of imperialism in which the Global North enforces its biomedical approach to health on all cultures. We should work towards locally-informed care which approaches mental health not as an individual issue, but as something to be addressed on personal, community, national and global levels.

Mental health should be seen as a social issue.

This would allow us to challenge discriminating structures, both globally and nationally, while also focusing on community and personal struggles.

In order to achieve mental health for all, there is an essential role for work towards an equal world, and this work is should be integrated in the field of Global Mental Health.

My Not-So-Easy Mental Health Recovery Journey

I’ve noticed that many of the stories I encounter about mental health tend to focus either on the darkest moments or on the triumphant ones – including the stories I’ve shared myself. In between those two opposites, however, there is a long road of treatment, recovery, and daily battles, as well as a lot of gray days that are neither too dark nor too triumphant.

Here is something I wished people knew about my mental health recovery journey so far…

If I say that I see a psychiatrist, take medication and have weekly therapy sessions, it does not mean that I’m always ‘well’ (much less ‘cured’).

I’ve had many people congratulating me for getting help and saying that they’re glad I am working with professionals to address my mental health conditions. But the truth is, doing these things doesn’t mean I’m always well. I still have bad (and even horrible) days, but treatment and recovery have helped me gain skills and tools to better deal with those days.

It may seem ‘easy’ to take medication and go to therapy. But what people who’ve never been on this journey may not know is that treatment for mental health conditions is very difficult, and it’s work — a lot of hard work.

It’s very ‘easy’ to take my three daily pills – one gulp of water and it’s done. But it’s not easy to deal with side effects, and medication changes, and how expensive they can get sometimes even with health insurance. And then there’s dealing with health insurance issues, and not being able to go out with colleagues after work because I have to stop by the pharmacy which is far away.

I have to keep tabs on my medications to make sure I never run out and organize them weekly into my medication container. I have to make sure I don’t forget to take them with me when needed and reach out to my psychiatrist when I need refills — all of which takes time and energy to do; and energy is not something I have much of when struggling with anxiety and depression.

I’ve changed medications several times and have experienced difficult side effects both starting and stopping medications: severe nausea, headaches, and increased anxiety that left me bed-bound for days.

I even had a pretty serious reaction to one of my medications that scared me – my provider couldn’t explain it. Because of how that experience destabilized me, there was even a moment when going into a psychiatric unit was a real possibility (which would have meant taking leave from my internship and master’s program).

Therapy has not been any easier. It’s expensive for me and a weekly commitment means having to say ‘no’ to more enjoyable activities. Therapy has been challenging and uncomfortable. It pushes me out of my comfort zone, which is hard to do even when my comfort zone has been harmful to me. It challenges my thoughts and behaviors. And in all therapy settings I’ve been in, I’ve always had some homework to do during the week (on top of all the work I have to do as a Ph.D. student).

I don’t regret getting help for my mental health, but I do wish someone had told me how long and difficult the journey of treatment and recovery could be.

Sometimes, I feel like quitting. I feel like never going to therapy again or canceling my next appointment with my psychiatrist, because the truth is, I’m tired and recovery is exhausting. I can’t make any plans or decisions without considering my treatment: how is it going to affect my therapy schedule? Will I have enough medication for this trip?

I will always encourage people to reach out for help if they are struggling with their mental health — it is important, and can be life-saving.

But I also believe it’s important that we start a conversation about what ‘getting help’ is actually like — and the truth is that it’s hardly ever easy.

It’s a sacrifice and for some, like me, it’s a life-long commitment. It’s challenging and uncomfortable. And through it all, we’re still experiencing our mental health conditions. It’s having a panic attack and going to therapy anyway. It’s going through a depressive episode and still getting out of bed for a psychiatric appointment.

Recovery for me has been still struggling but knowing I’m not struggling alone.

And though the journey is long and hard, treatment and recovery have given me hope and strength to carry on.

Opinions and experiences published on girlsglobe.org are not medical advice. If you are struggling with your mental health, please seek help from a doctor or mental health professional.

If you or someone you know is struggling with suicidal thoughts, please reach out for help immediately. In the United States, call 1-800-273-TALK (8255) or text TWT to 741741. For a list of international suicide hotlines, visit www.buddy-project.org/hotlines.

Myths about Mental Health

As a psychologist, I routinely hear many damaging myths about mental health. Some people hold myths to be truths, which leads them to suffer alone. Although this saddens me, I also have the advantage of hearing these myths and debunking them. Uncovering these false ideas can lead to more honest conversations and much-needed treatment.

Here are some of the most common myths patients share with me:

“I’m weak.”

Mental illness is not a weakness in character. We all experience a spectrum of emotions, everything from feeling highly emotional to feeling numb. It might be because of an accumulation of circumstances we’ve experienced in the past, our biological make up, or both. It is in fact a show of strength to express your emotions and seek help you need.

“I’m crazy.”

1 in 4 people will be affected by mental or neurological disorders at some point in their lives, and the rate is likely higher due to people’s fears of sharing their mental health concerns. Life is hard and we’re human, therefore we react.

“Other people don’t feel like this.”

How would you know this? We really have no idea of how other people react. Even the people we’re closest with don’t know how we’re really feeling unless we tell them. Why do we assume that everyone reacts the same way? We’re far too different to behave or feel the same in every situation.

“I have to hide my mental illness.”

Of course, this is your decision. Although if you decide to share with someone you trust, you may find that more people can relate with you than you think. They or someone they know may suffer from mental illness. The reality is, there are people who don’t understand and people who do. It’s important to figure out who your trusted loved ones are.

“Medication will turn me into a zombie.”

All medications have side effects. Everyone reacts differently to each medicine based on body chemistry. Some medications cause uncomfortable side effects when you first start taking them. The biggest question to ask yourself, your therapist and your doctor is whether the benefits outweigh the side effects.

“I don’t have enough faith in God. I just need to pray more.”

I know spiritual leaders who suffer from anxiety, depression and other mental health difficulties. Does it mean they don’t have enough faith? Prayer can be powerful. However, have you been able to pray away all of the problems in your life? Do you pray rather than seek medical attention for a physical condition?

“Counseling is for white people.”

People of color tend to have a unique dynamic of stress specifically related to being people of color. Discrimination is real, people hold strange stereotypes about those they perceive as different and people of color are often targets of hate. Have you ever wondered if you didn’t get a job or a promotion because of your ethnicity? Chronic worries such as these accumulate and the build up can be tremendously stressful.

“My family will be upset if they know I’m sharing our private business.”

Every family has its family business. What you’re sharing is your business. You’re talking about how life affects you.

“It’s selfish to take care of myself.”

This is a cultural lie in much of the world, especially amongst girls and women. You deserve to care for yourself and express your desire to be well cared for. Also, you can’t help anyone if we’re sick ourselves.

“I don’t want to express myself in front of others.”

Everything we do is an opportunity to model behavior to others, especially those we care about the most. Wouldn’t it be wonderful to teach our children or partner that emotional expression is healthy?

“My boss will find out I’m talking to a therapist.”

Therapy is highly confidential and there are very few reasons this information would need to be revealed. The first couple of sessions of treatment are spent reviewing confidentiality so that you’re very clear on how it all works.

“Asking people if they are thinking about suicide will cause them to feel suicidal.”

Simply asking this question does not cause someone to become suicidal. In fact, asking about it may open up conversation and potentially save someone’s life. Most countries have a hotline to call if you need support. If you or someone you know is in immediate danger, call emergency services.

Fight these myths so that they don’t stand in the way of your wellness. Please share with someone who needs to hear the truth about psychological treatment.