Most mental illnesses begin mildly, and in the case of Stella Nassali, it began as hysteria.
“A month to her Senior Six examinations, Nassali got anxiety attacks,” says Justine Birungi, her mother.
She worried about passing the examinations and the anxiety later developed into hysteria, with the girl claiming she could not see her own handwriting.
“An eye specialist proved that my daughter’s sight was perfect,” says Birungi, adding, “Sometimes, she woke up screaming, claiming that men had appeared in her dreams saying she would fail. I was not really worried because on other days, she was normal and even managed to sit for some of the papers.”
Mental disorders impact a person’s thinking and affect their ability to relate with others.
Affective disorders usually come in the form of depression, anxiety, and bipolar disorders. People swing from a calm and happy zone, to a sad and bitter one.
According to the Population and Housing Census report released by the Uganda Bureau of Statistics (Ubos) in 2002, three per cent of households in Uganda reported having someone with a mental disorder.
Dr Sheila Ndyanabangi, principal medical officer, in the Mental Health and Control of Substance Abuse department of Ministry of Health, says with affective disorders, there is usually no middle point.
“Some people, after testing positive for HIV, go into panic. Their only thought is that they are going to die, regardless of the knowledge that there are ARVs that can prolong life,” explains Dr Ndyanabangi.
When depression sets in, the individual loses interest in life, feels worthless and excessively sad for no good reason. Without treatment, these feelings may progress to suicidal thoughts.
What goes on in the brain?
Chemicals called neurotransmitters facilitate communication between different brain cells, helping in the functioning of the body and the thought processes.
“Neurotransmitters act as messengers between different parts of the brain. When a person has them in excess or in deficit, there will definitely be a problem,” says Dr Ndyanabangi.
Neurotransmitters such as serotonin and norepinephrine have to exist in balance, and function properly.
Serotonin maintains mood balance while Norepinephrine is secreted in response to stress.
An imbalance in any of these chemicals will lead to messages failing to make it from one part of the brain to another.
When the neurotransmitters are too low, the person may develop depression, among other things. Imbalances may also cause insomnia, memory loss, and Parkinson’s disease.
The role of neurotransmitters
When dealing with chronic stress, the brain uses up large amounts of neurotransmitters. With time, the supply is depleted.
“To balance the levels of the neurotransmitters, anti-depressant pills are administered to relieve the depression,” says Ndyanabangi.
Progression of the disease
Claire Kavuma, a retired secretary, began taking medication for schizophrenia as a young woman.
“My family told me that I began to change when my husband died. I shut myself away from everyone. I think I became depressed,” she says.
A few months later, whenever the full moon came out, Kavuma would hear voices speaking to her.
“It was my husband and other people talking. And I would hold conversations with them, sometimes lasting the whole day,” Kavuma recalls.
“When a person has a high amount of neurotransmitters the affective disorders will progress to psychotic disorders. At this point, a person will begin hearing voices or seeing things. Some people experience delusions of grandeur that to them appear like real life. Common psychotic disorders are mania and schizophrenia, and if untreated, the prognosis follows a downward course,” explains Dr Ndyanabangi.
The role of genetics
For Claire Kavuma, who suffered schizophrenia, the condition was not a surprise because in every generation of her family, someone develops a mental illness.
“Everything is determined by genes. Some people are born with neurotransmitter imbalances but not every person who is vulnerable to mental illness gets it,” says Dr Ndyanabangi.
A grandparent might have been mentally ill but their children will live normally if they have good social support systems. If their child, with an inherited chemical imbalance, suffers sexual or emotional abuse, and there is no psychiatric help, it may catalyse mental illness.
Five major mental illnesses — depression, bipolar disorder, ADHD, schizophrenia and autism — are traceable to the same inherited genetic variations, according to the largest genome-wide study of its kind. These variations account for 17-28 per cent of mental illness risk.
The overlap in heritability that could be attributed to common genetic variation was about 15 percent between schizophrenia and bipolar disorder, about 10 percent between bipolar disorder and depression, about nine per cent between schizophrenia and depression, and about three per cent between schizophrenia and autism.
The researchers looked for similarities in genetic variations among thousands of people with each illness and compared them to controls, figuring out how much each pair of disorders is linked to the same genetic variants.
The findings still leave much of the likely inherited genetic contribution to the disorders unexplained – and especially the non-inherited genetic factors.
What may catalyse the condition
In our day -to -day lives, we deal with environmental factors such as dysfunctional relationships, abuse, loss, or substance abuse that may bring on stress, People are unique in their reactions. Some may break down; others will move on.
“Mental disorders that come from stressors occur over time, and depend on the temperament and coping patterns of the individual,” says Ndyanabangi. “An environmental factor can trigger a mental disorder in a person who is already at risk of developing mental illness.”
“Before, people used to attribute mental illness to witchcraft; now they pray over it. Prayers can help in anxiety disorders and depression because social support is part of the treatment the mentally ill need. Coupled with prescribed medication, prayers offer hope to a depressed person or one who has a panic attack about life’s problems,” says Dr Sheila Ndyanabangi.
However, psychosis does not go away with prayer. Medical treatment is needed to work biologically on the brain to stabilise neurotransmitters.
Kavuma’s family took her to Nairobi for treatment, and she was able to continue with her life normally. Thirty years later, even with medication, Kavuma still hears voices once in a while. “I can shut them out now. I am able to distinguish between a voice in my thoughts and when it is other people talking.”
The key to recovery is to start treatment early. With depression, one can recover and be weaned off the anti-depressants. They also learn how to uplift their moods without medication.
“By recovering, we mean the person is able to function and live normally. With schizophrenia, medication reduces the amount of neurotransmitters generated in the brain, and the majority improves. They may hear voices but they are able to resist them.”