The mental health crisis in Lesotho

It is common, if not traditional to start a mental health column with the definition of health. How about we adopt a non-traditional approach and explore what fails to happen that ultimately results in mental illness and/or disorders.

In true Basotho culture, there are provisions and response strategies regarding suffering.

Elders have shared that people consulted with ‘Ngaka tsa Sesotho’ in attempt to ease their suffering. People would seek guidance from family members, the chiefs and their counsel, appease the ancestors, pray to Tlhatlha-macholo, etc.

Nonetheless, life would continue with or without these problems that individuals were faced with.

It is significant to highlight that suffering for people that reside in the same context or environment can be similar or different (we will circle back to this).

Not paying any attention to years and dates, colonialism happened and with it came a new way of doing things. As part of the colonial regime, Lesotho was introduced to the missionaries.

There was introduction of new systems e.g., nursing schools through the Catholic Church.

This presented a new way of doing things through the introduction of medical/clinical care.

This would later be regarded as the ‘formal type of care’ in the Mountain Kingdom.

There was also Christian religiosity that promised salvation, blessings, as well as abundance if one turned to God, and they denounced their pagan belief systems. Basotho would get introduced to a new way of life, one that summoned angels and God’s mercy to ease suffering.

Bear in mind that this is not about religion, spirituality, or colonialism.

By now, the reader is aware that in all these eras, one thing that has been constant is that human beings experience suffering at one point in their lives.

With that said, we see phenomena like religion, spirituality and clinical care existing within one context, Lesotho.

Based on how the clinical and religious forms of care were introduced, the traditional care offered by traditional healers was at an all-time disadvantage.

Unbecoming labels would belittle what was once a way of life for Basotho. Obviously, this led to an unintended consequence of purposive action.

A bit of indulgence, there was once a sociologist by the name of Robert King Merton who gifted the world the “Unintended Consequences Theory.”

Merton went on to share his learnings that purposeful action is taken by humans every day, in small and large ways, which influence the trajectory of our individual lives and our civilisation.

He asserted that our actions have unintended effects which are as impactful and probable in our history as the ones that are desired.

Merton identified five causes of unintended consequences namely: Ignorance, Error, Short-termism, Dogmatism, and Self-defeating prophecies.

The above causes are merely starting points. Unintended consequences are the end. We see the introduction of a new system during the colonial era, the approach was somewhat ignorant and had error.
The new way lacked knowledge in what constituted social suffering and what response techniques looked like for Basotho. Consequently, there was a dissonance.

The colonial systems, much like the Basotho traditional systems lacked the repertoire to describe mental suffering.

For church goers it was the work of evil spirits, for traditional healing seekers it was the result of witchcraft. For both, anything pertaining to mental suffering was bad and undesirable.

Asylums became the norm during those years. They were what made sense during that era. Thankfully, human beings and ways of existing evolved, culture shifted, and modern approaches came about.

The psychiatric model and diagnostic approaches would reign. Many schools of thoughts would rise from studying human behaviour, the human mind, social life, social change, and the social causes and consequences of human behaviour. This is the intertwine alluded to earlier.

Ever heard of that saying that change is inevitable, it would ring true here. Contemporary approaches in the form of clinical mental health, psychology, psychometric testing, wellness were born.

Now, the crux of it all is that for us to fully understand mental health, it requires us to be mindful of the people, the context, the culture, forms of care in that given context, and tailor make mental health with these factors in mind.

You wonder where the mental health stigma comes from, refer back to how introduction of new systems during colonialism disfavoured the traditional ways of understanding it.

You wonder why anyone would let outsiders come uninvited and dismantle their systems?

There was close to no option to resist, as that resulted in punitive action from the said colonisers.

You wonder about the language and terminology used to refer to those living with mental illnesses, yes refer back to history books for these were lesser important people in society.

Ones who had to be hidden from mainstream society, ones that were bound by chains because their wrongdoing was being “a little off” as compared to everybody.

Now, with this unsolicited lesson of sociology and psychology, ask yourself, what is mental illness? What is mental disorder? What is mental care? An informed answer is one that is cognisant of Basotho’s acculturation process.

This brings us to concepts of sameness vs individualism within one group. Basotho are similar- Basotho are different.

Acculturation implies that some Basotho subscribe to the church, while others adhere to traditional methods.

Basotho’s view and understanding of mental illness is consequential of the aforementioned systems.

To produce solutions to mental illness, we first have to start by fully comprehending the people that mental health programmes are being designed for.

You design a 12-step AA programme for Basotho to sit in a circle and admit to their powerlessness over alcohol…good luck!

Why the best wishes? Because, in true, the Basotho belief is monna ke nku ha alle (Old ways).

It does not start with getting people to talk, it begins with raising people’s awareness about the importance of talking (New ways). How can traditional practices like khotla ea banna le pitiki ea basali inform therapeutic approaches for improved mental health outcomes?

Do not let naysayers and their use of the word evidence-based dissuade you. All approaches were ideas until tried and tested. Let us backtrack a little, we are not shunning any model.

We are growing our understanding for improved outcomes in that the 12-step AA model is culture specific. How can it be modified to suit the needs of a culture for which it was not primarily designed?

This will answer why most interventions fail in the African context. In psychological assessments, there is what is called validity and reliability.

This is too technical and requires its own column, but the two concepts are measured using a sample population (n).

We are basically saying Test A produced constant results when administered to males and females aged (16-19), racial background was this and that, the sample population has a 6th Grade reading level, for example.

What this means is that if that test was administered to someone without a 6th grade reading level, special consideration has to be applied when interpreting their results. Right!

The same logic applies to modification of approaches to respond to the needs of a given group/population in a specific context.

Questions we should be asking are, “what is going on in your life that is disturbing your peace,” “what is this that is weighing you down and taking your joy away?”

Ask someone if they are okay and the response is almost guaranteed to be a definite: Yes.

It would seem in the context of Lesotho, we are asking the right people wrong questions pertaining to mental health.

So, I ask you what is mental health in Lesotho? Are we ready to put our individual beliefs about mental illness aside (bias) and engage with those that are facing mental illness in a meaningful way?

Are we skilful in navigating topics surrounding suicide and depression when our go-to is, “Life is showing all of us flames my love.”

Are we ready to swim in these unknown waters where mental suffering looks so different for people?

Do we possess the literacy to tackle mental health issues?

When we have answers to these questions, we can have intentional conversations about: “What is mental health and what does it look like for Basotho?’’

I challenge you to think about what mental health is for you. Not self-care, mental health.

● The author of this article works as a Psychotherapist. She holds a Master’s degree in Counselling Psychology.

She has certifications in Global Health Delivery, Policy Development & Advocacy in Global Health, Leadership & Management in Health, as well as Fundamentals in Implementation Science.

Her views are independent and not representative of her professional roles. She is ambitious about equitable health delivery, health policy and decolonised mental health approaches.

‘Makamohelo Malimabe