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The Ghosts of Africa: PTSD on the African Continent

A sound, A movement, a color, or a feeling, and suddenly you find yourself in a different time and place reliving a moment. You become anxious, your palms become sweaty, start to tremble, and no matter what you do you can't get out. Many people experience some, if not all, of the above and more. Most times they don't even know what is going on, they don't know that their reactions are a result of some traumatic event that their brain hasn't worked out or recovered from. Many suffer in silence without knowing better. In this article, we look at the phenomenon of PTSD breaking down what it is and its effect, especially on the African continent.

What is PTSD?

Post-traumatic stress disorder (PTSD) is a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event or who have been threatened with death, sexual violence, or serious injury. The disorder has been known by many names in the past, such as “shell shock” during World War I and “combat fatigue” after World War II. It is important to note that the disorder does not only happen to combat veterans and can occur in people, of any age, ethnicity, or nationality.  The symptoms can vary from person to person and are generally grouped into four types:   Intrusive memories may include: Recurrent, unwanted distressing memories, flashbacks nightmares or Severe emotional distress, or physical reactions to something that reminds you of the traumatic event Avoidance may include: Avoiding thinking or talking about the traumatic event, Avoiding places, activities or people that remind you of the traumatic event Negative changes in thinking and mood may include: Negative thoughts about yourself, other people or the world, Hopelessness, Memory problems relating to the traumatic event, Difficulty maintaining close relationships. Changes in physical and emotional reactions may include: Being easily startled or frightened, Always being on guard for danger, Self-destructive behavior, Trouble sleeping, Trouble concentrating, Irritability, angry outbursts or aggressive behavior, Overwhelming guilt or shame.  

PTSD in Africa

At least 100 million Africans are estimated to have PTSD caused by wars, terror attacks, natural disasters, sexual abuse, and chronic violence. In countries like the Democratic Republic of Congo, Rwanda, and South Sudan, as much as half of the population may suffer from PTSD. “PTSD blocks the education process, it blocks the creativity, it blocks family relationships… When you spend 100-150 dollars... you will have people able to study better, run their own businesses, and live a happy life,” These are the words of David Shapiro, President of African PTSD Relief. Little has been done to identify and treat PTSD in low-resourced sub-Saharan African (SSA) settings where multiple civil and tribal wars, social strife, and natural disasters have led to mass exposure of the population to traumatic events.  Several reasons could explain the poor identification and treatment of PTSD in SSA. First, some patients have spiritual and cultural beliefs that are different from conventional psychiatry and find meaning in the process of consulting traditional healers. Some individuals don’t volunteer information to health care workers due to stigma and a general lack of knowledge that PTSD is a medical condition.  Moreover, comorbidities such as substance use disorders which may have progressed from substance use as a coping strategy by individuals suffering from PTSD may negatively impact the clinician’s ability to diagnose PTSD. The considerations of efficiency are especially critical in a context of Africa where millions of people need immediate help, yet governments are severely constricted by resources. Furthermore, access to mental health care and severe shortages of trained mental health care staff hampers the identification and treatment of PTSD. An average of 1.4 mental health workers are available per 100 000 persons in Africa compared to the global average of 9 per 100 000. Progress has been made over the last few years as a result of global trends that recognize the importance of good mental health. Psychiatrists and other medical professionals have had success in treating PTSD using a variety of treatment methods to help people who suffer from the disorder. Some of these methods include: Medication. This is the most famous form of therapy. This is because of the bad reputation it gets as a result of reports of prolonged substance abuse to additive medications. However, when administered correctly This form of therapy can help to control the symptoms of PTSD. Antidepressant medications are particularly helpful in treating the core symptoms of PTSD. An added advantage is that these medications are non-addictive and help treat PTSD even when depression is not present. Cognitive-behavioral therapy (CBT). This treatment focuses on coping with the PTSD sufferer's painful and intrusive patterns of behavior by teaching them relaxation techniques and examining their mental processes. Discussion/Support Groups. This method encourages survivors of similar traumatic events to share their experiences. In doing so, group members offer support to help each person realize that they are not alone in their reactions or emotions. Counseling and Debriefing. Trauma counseling is another effective way of coping with the experience. The person may go for individual sessions where he or she can talk through the experience and work through the painful feelings such as anger, sadness, and guilt. Ways of coping with the symptoms can be explored. Debriefing is a form of crisis intervention that is used when a group of people have been through a traumatic event together. It is a structured group meeting that allows for each group member to vent their feelings and reactions to the event(s). Family therapy. The behavior of the spouse and children has been shown to affect the individual suffering from PTSD. Family members often report their loved ones don't communicate, show affection, or share in the family life. By working with the family, the members can learn to recognize and cope with the range of emotions felt by the sufferer and the spouse and children.  

The Lost Art of Being Happy

_doesn't make me happy anymore. Insert your pronoun.  These are words echoed by millions around the world every day, from couples contemplating divorces to people in dead-end jobs and careers. And it's okay. As humans, we are a complex species and as we grow, we change. Things that once made us happy can lose their shine and suddenly become a burden to us. That's fine too. Disclaimer this isn't an article guaranteed to make you happy but hopeful by reading this, you can realize you are not alone and that happiness is within your grasp.   First things first: No one can make you happy but you! (Louder for the people in the back). This is a fundamental truth echoed by psychologists, self-help books, and all the influencers on Instagram. And it's true. While we can find happiness in other people and things, this is often fleeting and personally, I don't consider it true happiness. For that, you have to start from you. Happiness is a state of mind. Like all emotions, happiness is just a combination of chemicals playing tricks on our brain (weird I know.) This leads us to a buzzword - Mental health, have you heard about it? The two are very much interlinked. If your mental state isn't right then happiness stays out of sight. (oh that rhymed). Talk to someone you trust about your problems, be it family or a professional (I highly recommend a professional). Cut out toxic relationships, handle problems as they come, and don't bottle up emotions. Anything to make sure your mental health is as healthy as it can be and those chemicals are mixing right. It's a journey, not a destination. Most people believe that happiness is this magical destination of beauty, light, and everything right (the rhymes just keep coming) and that once you get there you can set up shop, kick back and relax. If it were, I'd hate to see the price listings for the houses. But if this were the case, how come your second cousin Sophia who was on top of the world last week is currently sobbing into your shoulder about how unhappy she is. That's easy. Happiness isn’t a destination or a task to be ticked off a list. It's a journey and like any journey, there are good stretches and then there are Nairobi road sections. If you treat it as a destination or a one-time goal then every time you feel unhappy you will undoubtedly feel like you have failed and that leads to more unhappiness. This brings me to my next point. Sadness is a part of the process. Just because your goal is happiness doesn't mean sadness can't play a role. There is a stereotype that negative emotions are bad and should be avoided at all costs. This is simply not true. Case in point: when people tell you they feel better after a good cry or more scientifically, research that has shown that cursing in anger after feeling pain e.g stubbing your toe, helps lessen that pain (only a little, so don't go cursing up a storm). I choose to believe that this is because letting out these negative emotions in a good way is healthy and cleansing. This allows for the mental space that good emotions can fill up. So yes a good cry or occasionally feeling sad and down is allowed and even encouraged (let's be honest we are all secretly freaked out by perpetually happy people). After all, how can you appreciate joy if you never know sadness? You are enough. To really be happy you need to put yourself first. I once read something, once upon a time, where the author detested the line in the wedding vows about two becoming one. According to her, it made it seem that most people weren't whole or couldn't be whole until they found their partner. While I get the symbolism in a wedding, the implications, in reality, can be a little scary. You are whole by yourself. You are enough. Rather than think of this other person as completing you, think of them more as making a great thing even better. Like a real-life upgrade pack, helping you to achieve even greater heights that you never thought of because all those heights you wanted to achieve? you got there on your own.

Below are some things that help me and, I hope, can help you on your journey of happiness. 

Find something you love and make time to do it - this can be writing, painting, dancing, or solving complex math problems. Find what it is and make time to do it. Even if it's just for thirty minutes every day. Take a walk outside - everyone is different and if you’re like me, sunshine is not for you. I’m a rainy day baby and going outside when there's a slight drizzle makes me super happy (Petrichor - the smell of rain on dry earth. You’re welcome). Find your perfect weather and go outside, be it sunshine or rain or fog. But even if you’re a rainy baby, still make time to go out in the sun (Insert all the health benefits here). Listen to music - music has a way of reaching into our chest and pulling out emotions we didn't know we had or we can’t express. This is a good thing because it can help you cope with and identify unresolved feelings or just change your mood entirely (I dare you to be sad while singing along to Uptown Funk by Bruno Mars). Be creative -  this is not really for everyone. Doing something creative lets our imagination run wild and I've personally found this to be therapeutic in its own right. It allows me to see problems in a new and different way and find creative solutions (see what I did there) for them. Treat your body right - your body is a temple so treat it that way. Taking care of your body will always lead to positive results. Change up your diet by eating filling but healthy meals that incorporate more fruits and vegetables. Pamper yourself and not only after a long, tiring day. Be it by going to a spar or having your very own spa day in your house (this applies equally to men). Exercise. You don’t need to go for the intense gym session. Fast walking or jogging around your neighborhood several times a week does wonders for the body and soul. Also, visit a doctor to get checked out. This is also a part of the process. Treat yourself - Once in a while, you are allowed to buy yourself something just because you like the way it looks or smells, or tastes or because it's cute. And it doesn't have to be super expensive. A  pen, earrings, colorful notebooks, a belt, or a meal. You are allowed to buy something just because it makes you smile and every time you see it after a little shot of happiness will go through you. Don't be afraid to be by yourself - take a day off to just get to know yourself again and re-center. Listen to your thoughts and feelings, and what they are telling you. Keep a journal if you need to, it might help in identifying foreign feelings later in the week. But mainly take this time to know yourself.
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