Letter from Ghana — From the May 2017 issue

A Prayer’s Chance

The scandal of mental health in West Africa

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Samuel Donkoh had just turned ten when he began to slip away. His brother Martin, two years his senior, first realized something was wrong during a game of soccer with a group of kids from the neighborhood. One minute Samuel was fine, dribbling the ball, and the next he was doubled over in spasms of laughter, as if reacting to a joke nobody else had heard. His teammates, baffled by the bizarre display, chuckled along with him, a response Samuel took for mockery. He grew threatening and belligerent, and Martin was forced to drag him home.

Samuel and Martin Donkoh at the Ankaful Psychiatric Hospital, in Ankaful, Ghana. All photographs by Robin Hammond/NOOR

Samuel and Martin Donkoh at the Ankaful Psychiatric Hospital, in Ankaful, Ghana. All photographs by Robin Hammond/NOOR

The episode marked the onset of a frightening metamorphosis. Martin couldn’t understand what was happening to his brother, for although he had seen many abodamfo (“mad” men and women, in the Twi dialect) on the streets, the conventional wisdom was that such maladies afflicted only those who deserved it — excessive drinking or drug use was a popular explanation — or were otherwise spiritually or morally compromised. Samuel, the sensitive, well-behaved son of devout born-again Christians, did not fit that mold. Yet over a few short weeks, without any apparent cause, his condition devolved into ever more unsettling and erratic behavior, punctuated by drastic mood swings and hallucination-induced fits of anger. Martin looked on helplessly. Satan’s demons, he concluded, had seized his brother. He pleaded with God to bring Samuel back.

That was in July 1998. The boys, who lived with their family in Tema, an industrial port city in southeastern Ghana, were on holiday from school and were almost never apart. “Before Samuel fell sick, we were doing everything together,” Martin told me when I met him last summer. They read books together, did their homework together, went to church together, and stayed up late together to watch their favorite soccer team, Manchester United, on television. They looked strikingly alike: both skinny, on the shorter side, with earnest, serious eyes. On those rare occasions when one ventured out alone, into town or to the crowded market where their mother, Agnes, worked as a petty trader, he was often mistaken for the other. Later, after the illness struck, Martin sometimes found himself the recipient of taunts and epithets intended for his sibling.

The Nazareth Prayer Centre, in Akim Akroso

The Nazareth Prayer Centre, in Akim Akroso

Samuel suffered worst at night. He would wake up screaming, pointing to venomous snakes and rats that weren’t there, yelling at the voices he said were tormenting him. Soon they were goading the ten-year-old to hurt himself. Their father, Anthony, a supervisor at a nearby textile factory, believed that the outbursts could be disciplined out of his son. “He was very quick-tempered,” Martin said. “Whenever he became harsh with Samuel, my mom had to intervene to stop him.” When the symptoms were most acute, Agnes would cradle her son and recite Psalm 35:

Contend, Lord, with those who contend with me;
fight against those who fight against me.
Take up shield and armor;
arise and come to my aid.
Lord, you have seen this; do not be silent.
Do not be far from me, Lord.
Awake, and rise to my defense.

The martial language was not incidental: Samuel, as terrified and confused as the rest of the family, was plainly under some sort of attack.

When the holiday concluded, Martin returned to school by himself; Samuel’s education was effectively over. Agnes stopped working so she could care for her son at home. But it quickly became clear that this arrangement was not sustainable. The Donkohs lived in rented rooms in a large compound house, whose kitchen and bathroom facilities were shared by all the tenants. The close quarters seemed to exacerbate Samuel’s agitation; it wasn’t long before he was destroying their neighbors’ property, disappearing into town, even defecating in the house’s common areas. Word crept out about a dangerous boy at loose in the neighborhood.

His parents, fearing eviction and worried about his safety, tried keeping him inside. But he still managed to escape. One evening, a group of men approached the house, dragging Samuel, crying and badly beaten, behind them. The men demanded reimbursement for a windshield they said he had smashed to pieces. Samuel, for his part, couldn’t grasp why the men had hurt him.

What was to be done? The approach advocated by members of the Donkohs’ church — prolonged fasting and that brand of combative, focused prayer known as spiritual warfare — had brought little respite, but pursuing a medical route seemed fraught as well. Two of Agnes’s aunts had been diagnosed with schizophrenia, and repeated stays at Ghana’s largest mental hospital, in the capital, Accra, had not helped them. Infamous for its chaotic atmosphere and rampant abuse, the hospital, built in 1906 by the British colonial regime as an asylum for the criminally insane, had rather aggravated their situation. One aunt died alone, a vagrant outcast; the other subsisted on the margins of her hometown. Agnes resolved that a similar fate would not befall Samuel.

A family friend suggested a drastic course of action. He urged them to seek treatment at Nazareth Prayer Centre, a distant religious retreat, or “prayer camp,” renowned as a place where people struck with madness could be cleansed of the demonic forces holding them captive. Spurred by the Pentecostal revival that swept West Africa during the 1990s, these rural camps — some of which allowed families to stay for months or even years on end — had come to serve as alternative sites of care in a region where health services, particularly mental health services, were notoriously scarce and underfunded. The camp seemed to promise the two things Samuel needed most: a spiritually intensive form of treatment, on the one hand, and protection from his self-destructive impulses, on the other.

The Nazareth Prayer Centre, in Akim Akroso

The Nazareth Prayer Centre, in Akim Akroso

Agnes balked at the friend’s advice. Moving to Nazareth, located in Akim Akroso, in Ghana’s Eastern Region, would require uprooting not only Samuel but her other children too — potentially costing them their friendships, their stability, their educations. She kept trying to manage at home, until, in early 1999 — almost eight months to the day after Samuel’s first attack — her eldest daughter, Philomena, a shy, mild-mannered twenty-year-old, who had recently apprenticed to become a seamstress, plunged into a similar state. The malevolent voices, the hallucinations, the strange, often combative inclinations: there it was all over again, like a virus spreading from one member of the household to another.

“We wondered if God forgot about us — if he’d forsaken us,” Martin said. Some relatives, conscious of the social disgrace and financial burden of mental illness, recommended a quick solution: take Samuel and Philomena to the hospital, leave false contact information with the staff, and move on with their lives. For Agnes, abandoning her children was inconceivable. Yet continuing to look after them at home had become impossible. She traveled to a regional medical clinic, hoping for guidance, but the doctor she saw had little to offer. He referred her to the psychiatric institution in Accra and provided no further assistance or instruction.

On August 18, 1999, Agnes and her children left behind their lives in Ashaiman and departed for Nazareth.

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is a 2017 Luce/ACLS Fellow in Religion, Journalism and International Affairs at Emory University.

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