Wednesday, April 22, 2015

Seeing things, don't call the Sangomas just yet

Seeing things or hallucinating can be a very worrying symptom for Africans because it plays well into our superstitious notions of witchcraft and ghosts. No matter how well educated you are there is an element of you that holds some of your basic African cultural beliefs dearly. Hard to fathom phenomenon like hallucinations make most of us Africans turn to these basic beliefs for possible answers and it is very understandable for us to do this. Seeing things is also worrying because it is associated with possible mental illness which is laden with stigma in many African communities or any community for that matter.

Before you call the Sangoma you need to know that many things other than witchcraft and mental illness can cause hallucinations.

It is true that mental illness can cause hallucinations however the hallucinations due to mental illness are rarely ever visual. Psychotic conditions like schizophrenia usually involve auditory hallucinations. Auditory hallucinations means that you hear voices that are not there. 

Seeing things or visual hallucinations where you see and hear well formed people, objects or animals is not a common symptom of schizophrenia. Visual hallucinations are usually a side effect of medications. They can also be due to intoxication and/or withdrawal from illicit drugs.

When you are not a user of illicit drugs and you start seeing things it's very important to think hard about any new medications or recent changes to your medications. Also think about any herbal remedies you may be using. If a doctor does not take a good history of your current medications you might end up being refered to psychiatrists and risk being put on anti-psychotics when you do not need them. Take a list of all your medications to the doctor and ask the doctor to check if any of the medications can cause hallucinations as a side effect. If you are asthmatic and recently had an asthma attack ask your doctor if they gave you medications called steroids to help open up your airways. Steroids are known to cause hallucinations in some people. Stress and lack of adequate sleep might also cause hallucinations therefore think about these issues to discuss with the doctor. Also think about new foods you have eaten recently or beverages you may have taken with possible hallucinogens.

In the unlikely case that you may be developing a mental health problem do not feel defeated. Psychiatrists can work with you to control whatever condition you are developing. Remember the brain is an organ like any other part of the body and if it is unwell we need to treat it just like we treat a cough or a broken bone. Mental health problems can be well controlled by psychiatrists so do not be ashamed to ask for help.

If you do go to the Sangoma try not to accept any remedies you have to eat or drink because these might be toxic or may cause you to see things more. 


Saturday, April 11, 2015

Africans and Anxiety

Africans are lively people who love to sing and dance or perform with no worries. This is what we are commonly led to believe. However intelligent Africans can suffer from all kinds of anxieties from perfomance anxiety to social anxiety and generalized anxiety disorder. Unfortunately the sufferers may not always get help and may go through life avoiding situations that bring out the anxieties at the cost of not performing to their full potential at home and at work.

I first realized that I suffered from severe stage fright in late primary school. I never had trouble raising my hand in class because I never thought of the classroom as a stage. I joined the debate club and was one of the enthusiastic organizers of a school wide debate tournament. On the day of the tournament I had my great points prepared and when I stood up to speak in front of the whole school my voice started shaking and I could not look up. My hand also started shaking uncontrollably and I barely made any sense. My debate team mates could not understand how someone who had great points could turn out to be such a disappointment on stage. I had similar scarring moments in secondary school. As time went on it became harder and harder to control my stage fright and I ended up touring with my school's debate team to help them with points but was asked not to debate. It was devastating. It became obvious that I could never be a lawyer, a judge, a professor or any job where my stage fright would be an issue. 

The awareness of anxiety disorders among my teachers was non-existent. In an ideal world a teacher would have refered me to an educational psychologist who would have realised I had severe performance anxiety and then refered me to a child and adolescent psychiatrist. The psychiatrist would have tried cognitive behavioral therapy to help me realise that the stage was not a threatening place. If this failed I would get pharmacological help like beta blockers to take before any performance situation.

I never got any help with my anxiety. I just avoid situations where it comes up as best I can. I have developed coping mechanisms for presentations, I practice countless times until I have no fear. In situations where I am put in a performance situation off guard I still fumble and people who do not know that I went to Stanford always dismiss me as a very unintelligent person. I know my potential so I never feel down for long about such situations. In medical school I have no anxiety when interacting with patients but practical exams can be challenging if my mind decides it is a stage set up. The amazing thing about medical school is that it helped me put a name to my struggle with public speaking and I now know where to turn for help if my fear threatens my future. I know that having an anxiety problem does not mean you are not smart, in fact many people in the U.S and the U.K get help with their anxieties and live productive lives as teachers, doctors, lawyers, judges and so on.

Teachers in African schools must be more aware of anxieties that could prevent otherwise intelligent children from flourishing. As soon as a teacher notes a child has a problem they should refer them on to educational psychologists and then a psychiatrist may get into the picture if necessary.