11Depression, according to the Brain & Spine Institute, affects at least 400 million people worldwide, around 10 million in France alone. About one in five people in France suffer or will suffer from the mental illness in the course of their lives. It’s characterized by nine symptoms, at least five of which must be present on a daily basis to be diagnosed. Although depression is becoming well known (and well treated) in developed countries, it requires specialists and established infrastructures that aren’t always accessible in poorer countries. In Zimbabwe, psychiatrist Dixon Chibanda has nonetheless managed to find a way to fight against it: a friendship and “grandmother’s” bench.
Depression, a Zimbabwean taboo
A small country in southern Africa, Zimbabwe had just two psychiatrists for its population of 12 million people (circa 2000). By comparison, France had 13,436 in 2001, or in relative terms, 22 psychiatrists per 100,000 people. Zimbabwe, then and now, has a definite dearth of qualified personnel to handle the many people suffering from the mental illness. According to statistics from Zimbabwe’s Minister of Health, at least 1.3 million people in the country have some kind of mental illness.
One of Zimbabwe’s 16 official languages, Shona has a special word for symptoms that are similar to depression: kufungisisa, or “thinking too much.” Kufungisisa is particularly prevalent now thanks to the country’s lack of economic resources, but also because of colonialism’s heavy legacy. Western psychiatrists long believed that colonized people didn’t have the same mental health needs and, therefore, didn’t have the same deficiencies. In an article in Jeune Afrique, Jean Baptiste, a Tunisian professor of psychology, explained that the French sociologist Lucien Lévy-Bruhl (among others) “counterpose[d] logical European thought with mythic, magic, and unreasonable non-European thought.”
In addition to poor treatment resulting from a lack of qualified care professionals, depression and other mental illnesses have long been flat-out denied in Zimbabwe. This aforementioned colonial inheritance might help explain why depression and related illnesses are such a taboo subject in modern Zimbabwe.
In an article in the Zimbabwean newspaper The Herald, Lyn Chidavaenzi recounts the ordeal she suffered when her mother developed a mental illness: “I remember that the stigma associated with the mental illness was (and still is) untenable. I remember the icy looks people gave in the kombis or when we were on our way to the Ingutsheni Mental Hospital.” The country’s economic, social and health problems (nearly 25% of adults were positive for AIDS at the beginning of the 1990s) have created a conducive environment for developing mental illnesses.
A community-based solution
Zimbabwe’s example is instructive in many regards, not least in that it bears hope. Despite a heavy legacy, omnipresent social taboos and a near-total absence of qualified medical personnel, a clever solution has been surprisingly effective at helping many people suffering from depression in the country.
Dixon Chibanda, one of the few active psychiatrists in the country, has created a project with the goal of using a double approach, one both therapeutic and social, to fight the disorder. The project, titled “the friendship bench,” is being watched and cited around the world. All you need to set it up is a bench and a “grandmother” trained to listen and offer solutions to the patient.
In 2005, Dixon Chibanda brought together 14 elderly women. Already involved in their respective communities as caregivers, social workers and informal educators, they now took on a new role. As he explained in a Ted Talk, the idea was to fight depression by offering basic psychological therapy to the people they used to visit. Their ability to do just that, despite their collective lack of formal medical training, rested on two pillars: their previous integration in their communities as well as their capacity to listen and translate in simple, vernacular terms the advice of doctors. To avoid over-medicalizing the process, the women decided to meet patients suffering from depression on wooden benches, or “friendship benches.”
Simple tools, promising results
In addition to this integration in the community, the success of the friendship bench comes from the “grandmothers’” simple therapeutic techniques. The primary tool is problem-solving therapy, which “rests on the hypothesis that an important part of what we consider to be psychopathology results from the ineffectiveness or inadaptability of the behaviors we develop to cope with stress and difficulties.” Basically, it’s a matter of guiding patients toward their own solutions by getting to the roots of their problems. A long-unemployed person, for example, will be encouraged to think about the idea of starting a small business.
To this curative tool we can add one more: evaluation. Developed by the Indian researcher Vikram Patel, it consists of a questionnaire in Shona. Simple and easy to understand, it gives the “grandmothers” 14 questions to evaluate whether the person she’s with needs further psychological assessment. If eight or more questions are answered “yes,” then the answer is “yes.” Finally, to assure that the person gets care, their information is stored and a follow-up telephone call is placed to encourage them, Dixon Chibanda explained in an interview with the World Health Organization (WHO).
These tools, which more or less effectively substitute for advanced or medical treatments, also serve to establish a human connection for sufferers. This, along with improving the personal well-being of hundreds of people, benefits the entire community. Domestic violence and poverty tend to diminish among those who go through the program. With this level of success, the “friendship bench” project has now been extended to 70 different communities in cities across Zimbabwe. It will soon be developed in Zanzibar, Malawi and Tanzania. Even New York City has embraced it.
Today, Zimbabwe has 16 psychiatrists for its population of nearly 17 million people. The ratio is still skewed. But Zimbabweans have learned to compensate for their lack of resources, infrastructure and personnel with creativity. Dixon Chibanda has done just that. His friendship bench project is a medical, social and economic success.