Q “My 54-year-old aunt was successfully treated for a mental breakdown two years ago though the doctor warned that we keep watch just in case of a relapse of the condition. What may cause such a condition to recur?”
As most readers of this column already know, there are almost 300 recognised mental disorders in the main classification systems. It is, therefore, important for us to know which of those conditions your aunt might have been treated for. This is crucial because, some mental disorders are very common while others not. Some get better with minimal effort and others are chronic and tend to be more difficult to treat. Most require careful follow up just like other medical conditions such as diabetes or high blood pressure.
Some years ago, the World Health Organisation came up with the maxim that ‘there is no health without mental health’. In some ways, that was the beginning of increased focus on mental health in the world, and Kenya is no exception.
There is a self-evident urgency for the people of Kenya to understand their mental health better and to do something about it. The recently launched Mental Health Task Force Report makes this point. Last year, we saw a 23-year-old university student who came to see us against the wish of his parents.
The young man had failed his third year exams at the university, a fact that confused and perplexed him and his family. This was the first time he had failed any exam in his life. His father blamed peer pressure and the new girl who had recently left him while his mother blamed evil spirits that were there for all to see in this day and age.
The young man had gone to Google and searched the symptoms that he had experienced. He felt sad, had no energy, did not sleep well, felt hopeless and useless and no longer enjoyed anything. He was losing weight rapidly and sometimes felt life was not worth living.
Google was clear. This constellation of symptoms meant that he had a major depressive disorder and he had to see a mental health specialist to get better.
After prayers, the priest who he had seen at their local church brought him to us for further assessment. The young priest had attended a training programme that enabled him to recognise the complementary nature of the relationship between mental health specialists and spiritual providers.
Following treatment, the young man was able to pass the supplementary exams offered a few months later and graduated soon after. The priest spoke to his parents about depression as an illness and it was then that his mother brought her 54-year-old sister, (the patient’s aunt) who was also diagnosed with depression.
An uncle who had wasted away in alcohol was also found to have a long standing depressive illness. The family is now converted to ambassadors for mental health advocacy.
This rather long story is told to capture the simple point that there is hope. Young Kenyans, through technology are at the forefront in the war against stigma and discrimination that was once so common in this country.
Without knowing which condition ails your aunt, all we can say is that it is possible that she was treated for a depressive illness and that the doctor was right in warning that without due care, the condition could relapse. That is also true for many conditions treated by doctors today.
She might have been told to take the medication for a certain length of time. Many people don’t follow this simple advice. They argue (wrongly) that because they now feel well, it is time to stop the medication. The opposite is the case. Because they feel well this is the reason to continue accepting the doctors’ advice. He has proved that he knows what he is doing.
Others are told to avoid certain things such as alcohol and again argue that since nothing has happened for six months of abstinence, then the alcohol at the marriage of their girl must not be missed.
That becomes the first step in a slippery slope. Others are taught how to resolve marital conflict and then they forget! Others will have been told how to deal with the stress of looking after a loved one and others how to deal with grief issues.
As you can see, there are lots of reasons for a relapse and that must be the warning given to your aunt by the doctor who clearly got her better in the first instance. He would also have told her to avoid a relapse because each subsequent episode of illness leaves the patient worse off and, therefore, it is best to avoid multiple episodes of mental illness.