Understanding mental illness

It started with a flip of the switch...

Rosemary Otieno noticed her daughter Josephine Adhiambo was showering in the dark, and decided to turn on the light.

What followed was a yell, and a command to turn off the lights immediately.

"Do you want all these people to see me?" said Josephine who was a teenager at that time.

There were no people.

The more Josephine explained why she preferred showering under the cover of darkness, the more her mother became convinced that there was something strange happening inside her daughter's head.

It was as if she was in her own world, surrounded by enemies and people who were out to get her.

That night, after her mother had assured her over and over that she was safe, a sense of calm descended on her, and she went to bed.
Rosemary on the other hand, tossed and turned, wondering what was happening to her child.

Josephine's childhood had been smooth. Her parents describe her as a disciplined girl who scooped a lot of academic awards in primary school.
When she sat for Kenya Certificate of Primary Education exams, she scored over 400 marks and was admitted to a national school.
By the time she got to high school, she was well known for topping her class in almost all subjects.

"I would go for her visiting day, and had to help her carry the trophies she won," says her father Carolus Otieno.

Then things crumbled.

As she edged towards teenage, she started having intense mood swings and her personality began to change. Her mother who had watched her three older children sail through adolescence, thought Josephine's transition to adulthood was more difficult than it had been for her other siblings.

By the time she was in Form Three, the mood swings, coupled with irritability, and the need for seclusion defined Josephine's character.

Her parents knew there was something behind the altering of their daughter's behaviour. Chores like cleaning the house, or waking up to face a new day became difficult for her.

"Oh, I caned her so much. It was frustrating, because I couldn't understand why someone who had been so active just changed suddenly," her mother says.

Her teachers recommended counselling, friends suggested prayers and Josephine's parents dangled the promise of a reward if only she would change.

She never did.

When she sat for her Kenya Certificate of Secondary Education exams, Josephine scored a D plus.
She had changed from the A student who challenged her classmates, to scoring so low that when her results came her parents didn't know how to react.

They tried more counselling, and took her back to school to retake the exam, with the hope that she would do better.
She scored another D plus, and sunk into a deeper fog of depression.

She suggested that she wanted to give it yet another try because she wanted to prove that she was intelligent.

"I was ashamed. I couldn't understand because I was trying so hard," Josephine says.

Her third try at KCSE gave her another D plus. It brought with it so much hopelessness, tears and further loss of self-esteem.
One Friday evening, they noticed something unfamiliar.

The whole family was preparing for their cousin's wedding and Josephine recalls feeling very excited; something she hadn't felt in a long time.

Her mum says she was extremely hyped up.

As the preparations hit a peak, she got even more restless, to a point where it seemed like she was slowly sliding into her own world.

By Saturday morning, on the wedding day, she could not contain herself. The music, the dancing, the joy around her was so much that she got overwhelmed and collapsed from it all.

Her parents, in desperate need to find answers on what really ailed their child visited many doctors. Finally, a psychiatrist game them a diagnosis: schizophrenia.

She was suffering from a mental disorder that affects how a person feels, thinks, or behaves. The disease, which often manifests during adolescence or the post-teenage years, changes how a person perceives what is real and what is not, and may come with intense mood changes, hallucinations, depression and delusions.

Dr. Catherine Syengo Mutisia, a consultant psychiatrist in Nairobi says the brain develops fast during adolescence, and that is when genetically predisposed conditions, or those caused by abnormalities in the brain's chemistry often start showing.

For Josephine, the diagnosis provided a slightly reassuring gloss to a gloomy reality. She was able to understand her constant distraction in school and the restlessness; everything started making sense even to her parents.
Josephine is now 25 years old and on medication.

She is also a college student, who says she will not let her mental condition define her.

She gets brief flashes of impulse that make her lose control of reality, but says she has fully understood that she can function well as long as she is medicated.

Unfortunately for her, and other Kenyans who live with mental disorders, the medication does not come cheap. Josephine's parents have to pay for the  medicine, weekly appointments with a therapist, and physiotherapy. Rosemary told SUNDAY that sometimes, her monthly dose costs more than Sh30,000.

"It is a struggle," says Rosemary.

She is however, proud of the milestones her daughter has covered, saying Josephine is resilient in her battle with schizophrenia.

She is performing well in college, and has made friends who help her navigate the difficult times.
She has also joined several support groups where they discuss the challenges of schizophrenia, chief among them being the stereotype that people with mental illnesses are wild, unreasonable and useless in society.

"We matter! Under the right medication, we can excel in anything we do," says Josephine.

Rose Gakii Kirimi is certainly excelling. She graduated college and now works at Kenyatta University despite having bipolar disorder.

For her, it has been a rough journey, characterised by mood swings, lethargy and uncontrollable anger.
Rose describes her childhood and teenage as very lonely.

She recalls many days locked up in the silence of her room, clinging to the delusions of grandeur that her mind had built for her.
"My mind was always creating something, or travelling to a far off place," she says.
Her high school days are mashed up in some kind of distant memory where she remembers only a few things. Everything else is a blur.

Her mother, not quite understanding what was weighing her down often gave her a tongue lashing, saying she was practicing 'witchcraft' since girls her age were not supposed to be as erratic as she was.

"Nobody knew what was going on with me, not even myself. I just thought I was strange and a misfit," she says.
When she joined campus, her mood swings took away her desire to live.

She was always getting into physical fights with her school mates.

But a visit to her sister in Kitengela, almost ten years ago, marked the start to finding a diagnosis. Rose remembers getting into an argument with her younger sister. She remembers a wave of anger passing through her till her whole body trembled in fury.

Then she remembers lunging towards her sister and beating her up. One blow after another. The more she hit her, the more powerful she felt.

She kept hitting until her sister fell on the floor in an unconscious heap.

As her sister was being wheeled to hospital, Rose says she kept thinking to herself:"What did I do? What in the world did I do?"

Still, nobody could explain why she experienced feelings that ranged from melancholy to paranoia and rage.
A few months after she had gotten into a fight with her sister, she got into another episode that saw her yelling and destroying everything in sight.

She locked herself in the toilet and banged the walls so hard that the mirror came crashing down.
She took a broken piece and made a deep cut on her wrist.

"There was so much blood. Red everywhere-but I still held onto that glass and sliced more...." She says.
When an ambulance finally got to her, she was lying on the floor, weeping.

She was taken to Mathari Hospital where she was diagnosed with bipolar disorder, a mental condition characterised by extreme mood swings, changes of energy levels and in serious cases, violent episodes.

People with bipolar disorder often find themselves swinging between extreme highs (mania) and lows (depression). During manic episodes,  they become overly active, energised and sometimes delusional, often thinking they are very important people in society.

"During my highs, I sometimes imagine myself as president of the country," says Rose.

When the swings hit a low they lose interest in life, and some might even contemplate suicide.
She says being diagnosed changed her life. She was finally able to piece together the things she did it the past, merge them with her present, and look forward to a future.

"Everything started making sense," she says.

She was diagnosed in 2007. She still looks for answers about her condition but with the help of medication, she functions well.

Her friend, Candida Milure, who has been with her through most of her journey since diagnosis says even though it takes a toll on her sometimes, she has learnt that the best support you can give someone with a mental disorder is to show them that you are willing to walk with them through it all.

"Without care, love and support, they sink even deeper," says Candida.