‘Why are you depressed?’: The plight of Kenyans living with mental illness

A few days ago this month, Wambui (not her real name) walked into a Nairobi restaurant for lunch. She ordered medium-rare beef and sat patiently to wait for her food.

When it was finally brought, she says it was terribly done and practically raw.

However, she did not raise the issue with the waiter but instead requested that they pack it for her to take home, paid, and walked away with her order.

Wambui has many stories of her journeys home from the city centre. The 26-year-old businesswoman, who lives with her family at their home along Kiambu Road, has social anxiety disorder.

She says she cannot remember the number of times she has gone past her bus stop, to Kiambu Town, because she is terrified of getting up at a matatu to tell the conductor that she needs to alight.

She has been running a grocery vending business with her sister since 2020, which is a year before she was diagnosed with the mental condition.

I ask her what life is like operating such a business that involves interacting with people, and in general navigating life as a person living with anxiety.

“Eye contact is a very big deal to me, ordering something at a restaurant, telling the matatu tout that I need to alight. I have gone past my stage many times to take another matatu back because of being overwhelmed,” she says.

It also involves being overwhelmed ahead of things that she cannot avoid, such as job interviews.

“In the university, I missed out on all the presentation marks. I would go to the front of the class and almost cry,” says the Communications and Psychology graduate.

It has gotten better since she started going for therapy last year, though, she admits.

Wambui’s mental illness goes back to her high school days.

“Every year, I was voted funniest kid, I did my assignments well, I was very athletic and looked okay, but I was unhappy,” she recounts her teenage years.

She says she knew a few things about mental illnesses like depression at the time, but she told herself that she could not possibly be ill.

“All I knew was that depressed people don’t leave their bed, shower or eat, so I was telling myself that I am probably pretending,” she recalls.

It remained that way until she joined the university and decided to take up a Psychology minor because of her fascination with the subject.

Wambui says by the end of the first semester she could sense that whatever she had been experiencing was depression and anxiety.

So last year, two years after she had graduated, she decided to visit a psychiatrist and get tested after watching TikTok videos on mental health.

There, she was diagnosed with depression, anxiety disorder and attention-deficit/hyperactivity disorder (ADHD).

Mayo Clinic defines clinical depression as a mental health disorder characterised by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life.

Anxiety disorder is a mental health disorder characterised by feelings of worry, anxiety or fear that are strong enough to interfere with one’s daily activities.

ADHD on the other hand is a chronic condition comprising attention difficulty, hyperactivity and impulsiveness.

Two years before Wambui discovered she had all these mental issues, in 2020, Ogola walked into a psychiatrist feeling suicidal. The digital strategist, then 43, had gone for days without sleep.

It was at the height of the Covid-19 pandemic and the father of two, whose work involves telling positive stories and helping emergency response teams and humanitarian organisations communicate better on social media, was at the forefront of the fight against the virus that had brought the world to a standstill.

He was working with the Ministry of Health’s Covid response team and had previously handled crisis communication activities during the September 2013 Westgate Shopping Mall and the 2019 DusitD2 complex terror attacks, as well as other projects for the United Nations and Red Cross.

This time, though, he says it became too much. He was getting what he later came to know as trauma attacks.

Ogola also came to find out that the strange condition he had grown up and lived with for more than four decades was dyslexia.

Dyslexia is a neuro-developmental disorder that involves difficulty reading due to problems identifying speech sounds and learning how to decode them into letters and words.

“It gives you above normal intelligence and you tend to see things differently from people,” he describes it now, although his relationship with the condition has not always been this way.

Growing up, Ogola says he had a hard time in school as a result.

“I flunked in school and was labelled stupid, teachers told me I cannot be anyone and my parents were asking me why I cannot read and write properly. But when I look at letters I see images and so I am more of a visual learner,” he says of his childhood.

Despite his illustrious career, he says he has no formal education and that everything he knows now has been a result of self-education.

The 46-year-old has since been also diagnosed with post-traumatic stress disorder (PTSD) which is a mental health condition triggered by experiencing or witnessing a terrifying event.

For instance, Ogola says he is triggered by several things one would consider ordinary, such as his wife preparing liver in their kitchen.

“It might be from something like my son calling me ‘Daddy’, which takes me to the Westgate kids who were calling me Daddy, or the sight of liver and I am reminded of blood,” he says.

It also involves hallucinations, vivid dreams and sometimes insomnia; “you can go for three days without sleeping but you still have the energy to go on and on.”

Wambui and Ogola point out a shared experience with mental illness; being always misunderstood.

Wambui has high-functioning depression, which means being ill is not intense enough to noticeably affect her ability to perform daily responsibilities like job tasks and household chores.

“I do everything I need to do, but the moment I am alone, I am very low. Even when my business is doing very well and in school when my grades were perfect and had good friends, it can all seem pointless,” she says.

“I can hang out with my friends and after they are all gone, this life seems pointless and I get unmotivated to sustain relationships, become very bored, easily angered, sad and start seeking things to trigger me.”

So what reaction does she get when she discloses her condition to people?

“It is so common that it sounds scripted; ‘Really, you? There is no way you have depression. Maybe you are just sad today,” she says.

“At home, I am the one who makes everyone laugh, I am the funny one. I am the loudest, very lively and when we go out I am the life of the party.”

For Ogola, he says he has been labelled crazy and a psycho.

“I like to be away from people and people say that I am crazy and do not talk. I hate crowds and just want to be alone. I am very talkative, especially with topics I am interested in but I am very quiet when it is something I am not interested in. So most of the time, I just read the room and keep quiet,” he says.

During the moments he prefers to keep to himself, he notes that those around him “think this guy is either drunk or is a psycho.”

The same reactions cut across when I ask them the first reactions those around them gave when they told them of their respective diagnoses.

“People were saying ‘You have now gone mad, you have been bewitched, it is the alcohol,” says Ogola, despite the fact that he quit alcohol almost eight years ago after a near-kidney failure.

“My mum thinks I am bewitched and has sent me a pastor twice, and my brothers think I am a mad person, partly because of the work I do,” he adds.

Wambui recounts telling her mother that she had sought therapy: “She asked, ‘What is this and what can I do?’ and I could tell it was not to help but to make it go away because it is some form of disgrace to her.”

Wambui says for a person whose life seems to be going well, she is constantly tasked with explaining how on earth she could be having mental challenges.

“I am asked, ‘Why are you depressed? You are living at your parent’s home with no rent or bills to pay. You are not struggling; you have a thriving business and don’t have a bad boss, what is the reason?’” says the 26-year-old, who recently won a full Master’s scholarship to the United States.

Because of the fact that, unlike physical illnesses, mental illnesses cannot be seen, Wambui says people end up not acknowledging and therefore downplaying patients’ concerns.

“People say, ‘Just get over it!’ or ‘Adulting is hard for everyone, just be happy’ and I wonder, I do things to make me happy but still end up sad. I don’t have a reason. I too wish I knew what the issue is,” says Wambui.

The Ministry of Health estimates that one in every 10 people suffer from a common mental disorder in Kenya.

In the Kenya Mental Health Policy 2015-2030, the government estimates that the burden of mental illness is 25% among outpatients and 40% among inpatients in different health facilities, with an estimated prevalence of psychosis stated as 1% of the general population.

Given the Kenya's population of 47,564,296 according to the 2019 census, this means that 475,633 Kenyans are suffering from severe mental illnesses.

At the same time, a November 2022 report by the Kenya National Bureau of Statistics shows that more Kenyan men (about 56 per cent) than women (44 per cent) have mental illnesses.

The most common mental conditions in Kenya are depression, substance use disorder, bipolar disorder, schizophrenia and anxiety. Depression alone affects more than 1.9 million people in the country.

At its worst, depression can lead to suicide. In the 2015-2030 health policy, depressive disorders and schizophrenia are attributed as responsible for 60% of all suicides.

Leah Ndegwa, a clinical psychologist at Chiromo Hospital, notes that one of the biggest challenges in the fight for mental well-being has been how mental illness has been portrayed in the Kenyan society.

“For so long, we have portrayed people with mental illnesses in a certain light so that when people hear about mental illness they think about that dirty person in the street talking to himself,” she says.

“We don’t also see that functioning person who wakes up and goes to work and yet they are living with a particular mental disorder. There are doctors, actors, and people from all professions who are living with these disorders but we do not know because they are functioning.”

She agrees that because mental health is not physical like other illnesses, it is as a result brushed off as exaggeration and those suffering are told to ‘get over it’.

“If someone has broken a leg, you can see that it is broken, but with mental illness, people can’t see what this family is suffering from, so when people say they are anxious or depressed, it is thought of as an exaggeration because we all experience low moods and anxious situations, yet for this person, it has gone to the extreme side,” she says.

“Until it is stuff like schizophrenia and psychosis when the signs become apparent in the form of a strange behaviour,” adds the psychologist.

Wambui says this misunderstanding is the very reason why many victims are reluctant to seek help from their close networks, because even if their friends and family might have the best interest for them, they are not well equipped to offer support to those suffering.

“When suicide is reported and people wonder why the person never reached out, it is because they would not get substantial support help anyway. They would probably hear ‘Let’s go for a night out and you will feel better’ while it does not work like that,” she says.

“Sometimes I cannot reach out because people cannot relate and it is because they do not have the information,” adds Wambui.

It is also why she thinks there is need for the larger society’s enlightenment about mental health, beyond just patients and medical practitioners.

“My family, friends and boyfriend are all learning about mental health from me. If I did not have this struggle, they would not be as informed as they are so educating the public on what mental health looks or does not look like is key for support,” she says.

“It makes it easier for everyone because others can spot when someone in their circle is not okay.”

Ndegwa concurs, saying education also helps people familiarise themselves with the disorder and accept it as something that one can live with.

“With time, people come to see that yes, this person is going to school and work... so they not only understand the problem but to understand that this is an illness like any other,” says the psychologist, who also serves as a counsellor and therapist.

“The biggest participant here is the public, yet the public does not discuss mental health at the basic family level. The biggest stumbling block in this conversation is the family. It can discuss mental health in the workplace and social media but the conversation is not brought back home,” he says.

“Family needs to embrace the fact that these disorders are genetic. Dyslexic kids are seen as stupid but families should embrace these things and take children to be screened at an early age,” he adds, further emphasising the need for policy change to bring mental health screening centres at the county level.

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Many studies have found that media and the entertainment industry are crucial in shaping public opinions about mental health and illness.

Traditionally, people with mental health conditions are often depicted as dangerous, violent and unpredictable.

Researchers have also pointed out the tendency to run give prominence stories that sensationalise violent acts by a person alleged to have a mental health condition, yet there are fewer articles that feature stories of recovery or positive news on the same individuals.

In popular culture and entertainment, researchers have raised concerns about the negative images and stereotypes pushed about mental health conditions, which in turn have been associated with creating fear and misunderstanding.

It has also been linked to lack of empathy in the larger society, where patients with substance use disorders, for instance, are perceived to be suffering from their own choices and therefore fail to get the empathy accorded to patients.

The patients are also viewed as dangerous, inadequate, unlawful, unpredictable and unable to live fulfilling lives.

According to Ndegwa, this can be redeemed by telling more personal stories of mental health patients to broaden society’s understanding.

She particularly encourages patients themselves to come out and share their personal experiences to fight stigma and reclaim the narrative around mental illnesses.

“We usually encourage more people to come out and say, ‘I have been dealing with this particular type of mental illness, but I am doing well.’ A lot of people shy away from telling their story and the more they hide, we do not have good examples of people who are doing well despite what they are living with,” she says.

“We are left with those living in the streets abandoned by their families, forgetting that that person is there because they were not taken care of. If that person was taken care of, they would be better,” the therapist adds.

Even so, Ogola says there is an equally important need to make society a safe space for patients to share stories of mental illness in the first place, without fear of being treated harshly.

This, he says, begins with teaching boys and girls about mental health and encouraging them to be expressive from a young age.

“For me to come out, we must create a safe space for me. It must start from schools and families where men are allowed to cry, to vent out and rant and not have seen as weakness,” he says.

“We need to embrace healthy coping mechanisms such as dance, music and travelling because with what we are doing now, we are only losing men to alcoholism and sex.”

Both Wambui and Ogola note a significant improvement in the way the younger generation is approaching mental health in comparison to their parents.

Wambui shares about her boyfriend’s reaction to her diagnosis; “The next time we hung out he had done research on how to be supportive of someone with mental illness.”

“I think it shows how people in our age group are more accepting and willing to learn because the older generation mostly tells you ‘I went to school without shoes and you have ten pairs so you shouldn’t be complaining,’” she adds in a mocking adult tone.

For Ogola, the internet, despite all connections researchers have linked to the increased cases of mental disorders, has been a helpful tool for young people in accessing information, compared to his time growing up in the 1980s and 1990s.

“The younger generation is more aware of stuff. They are more equipped with the knowledge and with the internet now, they are also looking up things and hear testimonials of people with mental illnesses,” he notes.

Ndegwa says of Generation Z: “With the internet now, they are learning, asking questions and as a result, they can identify whenever they have a problem and bring themselves to the hospital.”

“Seeing is believing at the end of the day,” she adds.