Mental Health work in Chad brings you into contact with all walks of life; everybody can and will show the signs of strain under difficult protracted and circumstances. Some people who have heard about our services have walked up to 20km from neighbouring towns for treatment. In the past weeks, I’ve seen an 80 year-old man with obsessive-compulsive disorder, severe autism in 9 and 10 year-old siblings, three cases of sexual violence, post-partum depression, two persons with schizophrenia, and anxiety and depression of manifold stripes. The incidence of trauma is expectedly high, and although the stories of trauma are concordantly common, they remain shocking all the while. Each person has a story to tell, and given that family members sit down with our patients at the assessment, we often hear their stories, too. It is meaningful work, and while endlessly stimulating it is taxing at times, too, for myself and for the team.
(Please note that while I describe “trauma” as common, I am not making a comment about the prevalence of posttraumatic stress, or the disorders that accompany it, most notably PTSD, but also depression and anxiety disorders. While it is commonplace to equate the two, that being trauma and subsequent illness, as has become almost seamless vernacular, this is a mistake. Describing trauma is more of a comment on the observer than the observed. It is a secular albeit impassioned description of an event, a simple, humble, humanist acknowledgement of the bodily trials faced by those I meet. This is not a clinical description by a psychiatrist. That one has endured trauma is no more a tacit nod to to inevitable development of PTSD than would be the expectation of inevitable joy when winning of a lottery or some such desired victory. Humans are rather bad at predicting what an emotional experience will entail (see massive social psychology literature on affective forecasting). More to the point, however, and more germane to this side-bar, is that I am finding that PTSD is quite uncommonly found in our MHS, and I don’t know why this is the case. More to come on this theme in future posts.)
After a heavy day with the mobile clinic last week, Jochen, Christian and I decided to take a walk towards the foothills. Exercise is hard to do here with our schedule and curfews, but it’s important in maintaining a modicum of sanity, so we jetted off from the Arkoum camp toward the nearby hills.
(second side-bar comment: exercise is a silver-bullet remedy for anxiety. Just like eating whole foods and mostly vegetables is for cardiovascular disease. No meds prescribed, so minimal medical press. But the data is robust an one ignores it at their peril and professionalism.)
Nothing tells you more about a place than having its earth between your toes. The language of people is translated in so many ways through this neo-cortical helmet, but the messages of the land whisper to you from your blood. “The land teaches us how to live,” I was once told by an Inuit man in Cambridge Bay, Nunavut. The soil here is dry and chalky, and although you find the occasional patch of red and yellow ochres, it is a crusty light brown that pervades.
Walking over the scrub brush and gullies has a meditative and primal quality. This is where we’re from, really. All of us. Somewhere in the savannahs and steppes of sub-Saharan Africa humans evolved that which makes us who we are: our brains got bigger, we developed language, started walking upright on two legs, and organized social and institutional structures that can loosely be called “civilization.” We fashioned tools, told stories about hunts and herbs, made fires (probably here, but it could have been later in China), and started to sweat. This last development is the unsung hero of human evolution, as far as I’m concerned. It was the sweat gland that allowed us to hunt and forage during the day while the other large predators were sitting under a tree panting like mad in the heat. Our primate fore-bears ruled the noon-time, and probably hung out in trees at night for safety. Below is a picture of a copse of mango trees lining a dried-up riverbed.
Some have theorized that language developed while we were hanging out in trees. You could transmit information about danger to your clan along the row of trees lining the riverbed. Statements like “big danger, left river-bed, twenty-ish unhappy-looking jackals” could have been the rather bland start of it all. We had to wait a long time before we were sophisticated enough to ask “does this jacket come in seersucker?” or “would you like to come up and see my frescoes?” And some people say that there’s no such thing as progress…
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