A Different Life
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To clear things in my own mind, I find I have to look closely at
the symptoms of schizophrenia as ICD 10 describes them, but the
individual’s interpretation and understanding of what is wrong with
them is quite distinct. It’s expressed as a recognition there is
something wrong and out of their control, and it’s a problem in
their mind that they want to resolve. I’ve found that people can
work with psychiatry on this, and collaborate in their treatment.
Indeed it doesn’t always hinder their relationship with medical
treatment, although it does delay them in seeking it, having
invariably already sought help from a Maribu first.
The message to patients is that the two approaches can work
together to avoid losing their engagement in a medical approach
which after all, they have not grown up with.
A young woman was brought to Tanka Tanka by
the police last month having been charged with infanticide of her 4
day old baby. Rather tragically, she had defaulted treatment for
schizophrenia some 3 years ago. Her family have been supporting her
at home in the way they believed was best for her, intending to
help her care for her baby at home but with no intervention from
services. During her illness, she offended a neighbour by
interfering with their good luck charms by cutting them off her
body. The family may have believed a spell was cast upon her as
revenge for doing this, explaining her state of ill health and
their reason for not seeking medical treatment.
After arrest the police were convinced of her
unstable mental state at the station and brought her to hospital.
We negotiated an agreement with them that she should stay in
hospital rather than on remand. They advised me that her mental
illness would be taken into account if provided with a medical
report, as no one was in doubt of her condition.
She has somewhat improved with treatment from
a fluctuating catatonic state and is now able to communicate and
speak about all that has happened, which she finds unbearable but
seems to be coping. There is no relevant forensic mental health law
to help here, and plans for the patient's future
care will be a challenge considering a lack of outreach
community services. The staff will of course do their best but in
I went with the CMHT to visit a traditional
healer, specialising in mental health, who is about an hour and a
half’s drive outside Banjul, near the South Gambia-Senegal border.
He has a large compound in a rural village with rooms for
inpatients and consulting rooms for outpatients. The treatment is
by way of the Quran, using recitations of certain verses, and
He told me about the beliefs of the causes of
mental illness, which are based in the work of djinns and spells
invoked against people by other Maribus.He said he believed there
are psychoses which do not respond to his treatment and took me to
meet such patients.One young man had been there for 7 months, his
mother staying with him in the healer’s compound.
He was floridly psychotic and threatening, and
being kept there with no improvement in mental state despite the
healer’s best efforts.He had absconded from the hospital twice
before his mother took him there in desperation.The healer is
allowing us to work with him, including supply him with appropriate
medication, in fact he asked the CMHT to help.Of course the first
instinct is to wade in with medical interventions, but the services
here are well aware that without providing a safe alternative, that
would be a naive and potentially dangerous interference.
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Dr Imogen Kretzschmar is a CT2 in psychiatry at South West
London and St Georges Mental Health Trust, and is spending 6 months
in The Gambia in West Africa on Out of Programme Experience.