DID you know that marital or relationship problems can lead to a mental disorder? Well, according to Dr Francis Simenda, Chainama Hills College Hospital head of clinical care, the number one cause of mental illness among women is mood disorders that are primarily triggered or maintained by life events like marriages and divorces. Dr Simenda, a specialist psychiatrist, says marital discourse; problems in marriage, general dissatisfaction in marriage, lack of children, unresolved problems with husbands, families and extended families can lead to a mental disorder.
"Actually the big one is the death of the spouse; when a husband dies, the women don't take it properly. Sometimes even when they lose a boyfriend, so life events contribute a lot in the genesis and maintenance of these disorders," he explains.
Mental illness
Dr Simenda says mental illness is a group of disorders or illnesses that affect the mind and the brain. He says there are many classes and types of mental illnesses. Dr Simenda says the first group under the World Health Organisation (WHO) classification is mental disorders that are related to loss or decline in brain functioning.
"These are called dementias; so the memory fades away and the general function to control the motor and the speech abilities of a person slowly decline. When we use the word dementia then we are describing a disorder where the loss of memory primarily is irreversible," he says.
He says under this class, the other disorders are just amnesic syndromes, retrograde or anterograde amnesia which is a technical term of loss of memory. "We also have what we call deliriums under the same group. It is an acute confusional state, acute loss of brain function. It arises after surgery, acute infections, septicaemia; so the brain function recovers quickly after treatment," he says.
Dr Simenda says the second group of mental illness arises from the use of poly-substances like alcohol, cannabis, nicotine, glue, cocaine and heroin. He says the third group or class of disorders is called schizophrenia and related psychosis.
"We have mood disorders - mental disorders that are primarily characterised by a disordered mood or emotions, so these include depression or mania which is the opposite of depression," he says. Dr Simenda says in the fourth group, are personality disorders.
"We have disorders or adult personalities. Like you say this man is stubborn or quiet. When these human straits become a problem or so pronounced that they interfere with occupational or social wellbeing, then we call it a disorder and it needs treatment. Then we have histrionic disorders. These are mainly women who very dramatic in the way they carry themselves. They are cheerful but at the same time can quickly change and become sad. So they exhibit swings in their character," he says.
He also says there are disorders related to sexual orientation. "Maybe we haven't described them very well in Zambia but all these cases where someone might just like to have sex in a bizarre way. We have heard of masochism (receiving pleasure - often sexual - from acts involving the infliction or reception of pain or humiliation), vouryerism (sexual interest in or practice of spying on people engaged in intimate behaviours, such as undressing, sexual activity, or other actions usually considered to be of a private nature); frotteurism (a paraphilia in which sexual arousal or orgasm is achieved by actual or fantasised rubbing up against another person, usually in a crowded place with an unsuspecting victim) and sexual preference with children (paedophilia) like you've heard nowadays. That's an illness," he says.
Dr Simenda says that for men with paedophilia, (it could include women) they have a tendency to have sex with minors or watching naked minors on the internet or circulating some materials to gratify their sexual pleasure. "They get satisfaction...some just watch videos, some just take pictures but in our Zambian case, they actually have sex with them. It could be that people are reporting more now and these cases have come to light. I suspect these offences used to happen but they were not reported but with the coming of the NGOs, the police's VSU Victim Support Unit and general awareness, these cases are no longer in the dark," he says.
He says it is yet to be seen whether these people reform when they are sent to prison because if it is a disorder then it needs to be treated.
"Actually the big one is the death of the spouse; when a husband dies, the women don't take it properly. Sometimes even when they lose a boyfriend, so life events contribute a lot in the genesis and maintenance of these disorders," he explains.
Mental illness
Dr Simenda says mental illness is a group of disorders or illnesses that affect the mind and the brain. He says there are many classes and types of mental illnesses. Dr Simenda says the first group under the World Health Organisation (WHO) classification is mental disorders that are related to loss or decline in brain functioning.
"These are called dementias; so the memory fades away and the general function to control the motor and the speech abilities of a person slowly decline. When we use the word dementia then we are describing a disorder where the loss of memory primarily is irreversible," he says.
He says under this class, the other disorders are just amnesic syndromes, retrograde or anterograde amnesia which is a technical term of loss of memory. "We also have what we call deliriums under the same group. It is an acute confusional state, acute loss of brain function. It arises after surgery, acute infections, septicaemia; so the brain function recovers quickly after treatment," he says.
Dr Simenda says the second group of mental illness arises from the use of poly-substances like alcohol, cannabis, nicotine, glue, cocaine and heroin. He says the third group or class of disorders is called schizophrenia and related psychosis.
"We have mood disorders - mental disorders that are primarily characterised by a disordered mood or emotions, so these include depression or mania which is the opposite of depression," he says. Dr Simenda says in the fourth group, are personality disorders.
"We have disorders or adult personalities. Like you say this man is stubborn or quiet. When these human straits become a problem or so pronounced that they interfere with occupational or social wellbeing, then we call it a disorder and it needs treatment. Then we have histrionic disorders. These are mainly women who very dramatic in the way they carry themselves. They are cheerful but at the same time can quickly change and become sad. So they exhibit swings in their character," he says.
He also says there are disorders related to sexual orientation. "Maybe we haven't described them very well in Zambia but all these cases where someone might just like to have sex in a bizarre way. We have heard of masochism (receiving pleasure - often sexual - from acts involving the infliction or reception of pain or humiliation), vouryerism (sexual interest in or practice of spying on people engaged in intimate behaviours, such as undressing, sexual activity, or other actions usually considered to be of a private nature); frotteurism (a paraphilia in which sexual arousal or orgasm is achieved by actual or fantasised rubbing up against another person, usually in a crowded place with an unsuspecting victim) and sexual preference with children (paedophilia) like you've heard nowadays. That's an illness," he says.
Dr Simenda says that for men with paedophilia, (it could include women) they have a tendency to have sex with minors or watching naked minors on the internet or circulating some materials to gratify their sexual pleasure. "They get satisfaction...some just watch videos, some just take pictures but in our Zambian case, they actually have sex with them. It could be that people are reporting more now and these cases have come to light. I suspect these offences used to happen but they were not reported but with the coming of the NGOs, the police's VSU Victim Support Unit and general awareness, these cases are no longer in the dark," he says.
He says it is yet to be seen whether these people reform when they are sent to prison because if it is a disorder then it needs to be treated.
However, Dr Simenda says if it is sheer criminality then the outcome is also different. Dr Simenda says it could be a man or a woman who prefers to have any form of sex which is outside the normal form.
"There are some who like to exhibit their private parts and they obtain gratification from that. Others whip themselves in the bedrooms; so there are many forms but you must note that nowadays homosexuality and gayism were removed from the list as a disorder of sexual orientation, that is WHO removed it. It was classified as a medical illness in the beginning but in the latest classification it was removed," he says.
He says masturbation was also removed as it used to be classified as a mental disorder.
Dr Simenda says there are also disorders that are normally related to early childhood. The perversion mental disorders. "You have heard of autistic disorder. It starts after two and half years. This is a child who does not develop communication skills especially on the outside world, they remain withdrawn, within themselves. Most of them are associated with very pervasive mannerisms like banging of the head and talking to themselves. They are in their own lost world," he says.
"There are times it is associated with epilepsy that is fits and when that happens, there is usually an element of mental retardation. We also have intellectual disabilities in children. When the child is failing to cope like others, we look for specific disorders. We have children with reading disorders, mathematic disorders and speech disorders."
He says there are also eating disorders though not common in Zambia but are common among models. "We have anxiety disorders, panic disorders common with near death experiences. We have phobia like if you have a person that is afraid of heights or animals. The disorder is named according to that specific animal or fear. Among the young, we have conduct disorders where they behave unacceptably," he says.
Dr Simenda says there are also disorders that are not classified in any specific group. Dr Simenda says the common causes of mental illnesses in Zambia vary with some inheritable.
"Almost all of the them can be inherited and there is research currently going on to continuously identify which chromosome, which genes and in what combination but these you will note that genetics alone does not mean that there will be an outcome of disease so there is an interaction between the genetics, the environmental factors that person is living in and of course the lifestyle, what we take in. So there is an interaction between the genes, the hormones and the neural transmitters. This is what we think leads to a manifestation of a mental disorder. So it's a collection of a number of factors," he says.
He says the hospital admits about 4,000 patients per year.
"Last year we received about 3,700 patients. On a daily basis, since we struggle with bed space, we admit a maximum of 150 patients. We keep people for a short time and discharge them due to the unavailability of bed space. So our capacity right now is about 150 and the majority are male. It is not to say that women do not have mental disorders. It's because women in most parts of the world are less violent," he says.
Dr Simenda says when men develop psychosis, they tend to be violent.
"Women suffer quietly in the homes or they are manageable as outpatients," he says. He says the cause of the disorders vary and are a combination of different things. Dr Simenda says for men, more than 60 per cent of those admitted have a combination of different things.
"They will be using either alcohol, cannabis, or some other substance or abuse and as we are becoming open at the border, we are beginning to see drugs that were less common in the past like cocaine, heroin and others," he says.
He says women do not use much of the substances but a few do.
Dr Simenda says when a person develops even a mild mental disorder, the stigma from the family and the community sometimes fuels or continues to fuel the disorder.
"Even from the employers if they know, you can imagine even in church, people with mental disorders are highly discriminated against and this actually makes the disease outcome worse," he says.
For treatment, Dr Simenda says there is promotive treatment - health promotion in mental health.
"We also educate that most of these diseases are actually treatable," he says.
He says the next stage is prevention.
"We want people to attain self-actualisation, that is living a life that is very productive and being at the pinnacle or going through the stages of life successfully until old age. We do physical treatment that is provision of medicines, that's actually treating most of these disorders and controlling the symptoms associated with these disorders. Mostly we call them anti-psychotics. We use mood stabilisers, anti-depressants, that is drugs that are able to lift the mood when it is depressed," he says.
"We use drugs called anxiolytics that abolish anxiety disorders so they help when you have anxiety disorders. With personality disorders most of the time the treatment is psychotherapy but in severe cases, we use medicines to control the behaviours and compulsions and obsessions"
For the pervasive development disorders, Dr Simenda says they combine a number of strategies like school education therapy with parents and caregivers.
He says mental retardation, has its own special treatment.
Dr Simenda says conduct disorders in the youth are mainly treated using psychotherapy and other educative programmes.
"In short all the mental disorders have a treatment of some kind. We also have other physical treatments called electric convulsive therapy. It is an old treatment where we introduce a surge of electrical energy in the brain to induce a fit and that helps in the symptom control of some mental disorders like severe depression and suicide," he says.
He says mental disorders destroy the core function of the brain.
"So we want to rehabilitate our patients. We do a number of rehabilitation services by bringing back the skills, occupational therapy and physiotherapy if the muscles were affected. And these therapies are nowadays recommended to be done in the communities where people stay. We follow up these patients," he says.
Dr Simenda says getting better is a measurement.
"We have what we call rating scales where we measure the symptoms and then we see from the time we started and where we are now in terms of improvement. I am sure for the community, they want 100 percent recovery but in some cases it's not possible but we control the symptoms especially the most common symptoms of self-grooming, violence, staying outside, not eating, being a danger to themselves as a mental patient and to the community," he says.
He says sometimes patients escape from the hospital because the very nature of all mental disorders is that they attack the personality.
"So they don't realise that they are actually unwell so the first thing when they are brought to Chainama is to plan to escape. They must go out and continue what they are doing, they don't have the ability to perceive that they are unwell. Some of them we get them back, some their relatives bring them back because they go and cause problems in the homes, fighting, breaking property," he says.
Dr Simenda says those found on the streets are chronic schizophrenic patients where the families would have abandoned them to roam the streets.
"Now there are challenges with collecting them against their will because of the legal system and as I speak to you, the law that governs mental illness was done in 1951, the Mental Disorders Act, but right now, we are repealing it and there is a new Bill coming out. We now have a Mental Health Services Bill that is currently in development. Maybe this law will make us develop the service even better but by order of a Magistrate you can get them off the streets," he says.
Dr Simenda says the public should appreciate that mental health and mental illnesses exist.
He says people should start appreciating that these groups of diseases are treatable. He says eliminating stigma and discrimination is key.
"We need to mount a campaign so that people know and become supportive of mental programmes in schools, universities, in the work place and communities. We must be talking about mental illnesses everywhere. In this country most of the time we act when it is too late or when there is violence; evident of broken windows but really all the mild mental illnesses, anxieties should be treated by a professional, the outcome is better that way," he says.
"There is also stigma, they don't want the neighbours to know because they think their daughter will not get married and so on. They actually deny mental patients, they go and hide them in the village and don't educate them but we want even someone with a mental disorder to undergo some education and find a meaningful occupation in future other than withdrawing patients because they have epilepsy and they couldn't go to school." http://www.postzambia.com/post-read_article.php?articleId=26142&highlight=mental disorder in marriage
"There are some who like to exhibit their private parts and they obtain gratification from that. Others whip themselves in the bedrooms; so there are many forms but you must note that nowadays homosexuality and gayism were removed from the list as a disorder of sexual orientation, that is WHO removed it. It was classified as a medical illness in the beginning but in the latest classification it was removed," he says.
He says masturbation was also removed as it used to be classified as a mental disorder.
Dr Simenda says there are also disorders that are normally related to early childhood. The perversion mental disorders. "You have heard of autistic disorder. It starts after two and half years. This is a child who does not develop communication skills especially on the outside world, they remain withdrawn, within themselves. Most of them are associated with very pervasive mannerisms like banging of the head and talking to themselves. They are in their own lost world," he says.
"There are times it is associated with epilepsy that is fits and when that happens, there is usually an element of mental retardation. We also have intellectual disabilities in children. When the child is failing to cope like others, we look for specific disorders. We have children with reading disorders, mathematic disorders and speech disorders."
He says there are also eating disorders though not common in Zambia but are common among models. "We have anxiety disorders, panic disorders common with near death experiences. We have phobia like if you have a person that is afraid of heights or animals. The disorder is named according to that specific animal or fear. Among the young, we have conduct disorders where they behave unacceptably," he says.
Dr Simenda says there are also disorders that are not classified in any specific group. Dr Simenda says the common causes of mental illnesses in Zambia vary with some inheritable.
"Almost all of the them can be inherited and there is research currently going on to continuously identify which chromosome, which genes and in what combination but these you will note that genetics alone does not mean that there will be an outcome of disease so there is an interaction between the genetics, the environmental factors that person is living in and of course the lifestyle, what we take in. So there is an interaction between the genes, the hormones and the neural transmitters. This is what we think leads to a manifestation of a mental disorder. So it's a collection of a number of factors," he says.
He says the hospital admits about 4,000 patients per year.
"Last year we received about 3,700 patients. On a daily basis, since we struggle with bed space, we admit a maximum of 150 patients. We keep people for a short time and discharge them due to the unavailability of bed space. So our capacity right now is about 150 and the majority are male. It is not to say that women do not have mental disorders. It's because women in most parts of the world are less violent," he says.
Dr Simenda says when men develop psychosis, they tend to be violent.
"Women suffer quietly in the homes or they are manageable as outpatients," he says. He says the cause of the disorders vary and are a combination of different things. Dr Simenda says for men, more than 60 per cent of those admitted have a combination of different things.
"They will be using either alcohol, cannabis, or some other substance or abuse and as we are becoming open at the border, we are beginning to see drugs that were less common in the past like cocaine, heroin and others," he says.
He says women do not use much of the substances but a few do.
Dr Simenda says when a person develops even a mild mental disorder, the stigma from the family and the community sometimes fuels or continues to fuel the disorder.
"Even from the employers if they know, you can imagine even in church, people with mental disorders are highly discriminated against and this actually makes the disease outcome worse," he says.
For treatment, Dr Simenda says there is promotive treatment - health promotion in mental health.
"We also educate that most of these diseases are actually treatable," he says.
He says the next stage is prevention.
"We want people to attain self-actualisation, that is living a life that is very productive and being at the pinnacle or going through the stages of life successfully until old age. We do physical treatment that is provision of medicines, that's actually treating most of these disorders and controlling the symptoms associated with these disorders. Mostly we call them anti-psychotics. We use mood stabilisers, anti-depressants, that is drugs that are able to lift the mood when it is depressed," he says.
"We use drugs called anxiolytics that abolish anxiety disorders so they help when you have anxiety disorders. With personality disorders most of the time the treatment is psychotherapy but in severe cases, we use medicines to control the behaviours and compulsions and obsessions"
For the pervasive development disorders, Dr Simenda says they combine a number of strategies like school education therapy with parents and caregivers.
He says mental retardation, has its own special treatment.
Dr Simenda says conduct disorders in the youth are mainly treated using psychotherapy and other educative programmes.
"In short all the mental disorders have a treatment of some kind. We also have other physical treatments called electric convulsive therapy. It is an old treatment where we introduce a surge of electrical energy in the brain to induce a fit and that helps in the symptom control of some mental disorders like severe depression and suicide," he says.
He says mental disorders destroy the core function of the brain.
"So we want to rehabilitate our patients. We do a number of rehabilitation services by bringing back the skills, occupational therapy and physiotherapy if the muscles were affected. And these therapies are nowadays recommended to be done in the communities where people stay. We follow up these patients," he says.
Dr Simenda says getting better is a measurement.
"We have what we call rating scales where we measure the symptoms and then we see from the time we started and where we are now in terms of improvement. I am sure for the community, they want 100 percent recovery but in some cases it's not possible but we control the symptoms especially the most common symptoms of self-grooming, violence, staying outside, not eating, being a danger to themselves as a mental patient and to the community," he says.
He says sometimes patients escape from the hospital because the very nature of all mental disorders is that they attack the personality.
"So they don't realise that they are actually unwell so the first thing when they are brought to Chainama is to plan to escape. They must go out and continue what they are doing, they don't have the ability to perceive that they are unwell. Some of them we get them back, some their relatives bring them back because they go and cause problems in the homes, fighting, breaking property," he says.
Dr Simenda says those found on the streets are chronic schizophrenic patients where the families would have abandoned them to roam the streets.
"Now there are challenges with collecting them against their will because of the legal system and as I speak to you, the law that governs mental illness was done in 1951, the Mental Disorders Act, but right now, we are repealing it and there is a new Bill coming out. We now have a Mental Health Services Bill that is currently in development. Maybe this law will make us develop the service even better but by order of a Magistrate you can get them off the streets," he says.
Dr Simenda says the public should appreciate that mental health and mental illnesses exist.
He says people should start appreciating that these groups of diseases are treatable. He says eliminating stigma and discrimination is key.
"We need to mount a campaign so that people know and become supportive of mental programmes in schools, universities, in the work place and communities. We must be talking about mental illnesses everywhere. In this country most of the time we act when it is too late or when there is violence; evident of broken windows but really all the mild mental illnesses, anxieties should be treated by a professional, the outcome is better that way," he says.
"There is also stigma, they don't want the neighbours to know because they think their daughter will not get married and so on. They actually deny mental patients, they go and hide them in the village and don't educate them but we want even someone with a mental disorder to undergo some education and find a meaningful occupation in future other than withdrawing patients because they have epilepsy and they couldn't go to school." http://www.postzambia.com/post-read_article.php?articleId=26142&highlight=mental disorder in marriage
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