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The mental health crisis in Lesotho

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It is common, if not traditional to start a mental health column with the definition of health. How about we adopt a non-traditional approach and explore what fails to happen that ultimately results in mental illness and/or disorders.

In true Basotho culture, there are provisions and response strategies regarding suffering.

Elders have shared that people consulted with ‘Ngaka tsa Sesotho’ in attempt to ease their suffering. People would seek guidance from family members, the chiefs and their counsel, appease the ancestors, pray to Tlhatlha-macholo, etc.

Nonetheless, life would continue with or without these problems that individuals were faced with.

It is significant to highlight that suffering for people that reside in the same context or environment can be similar or different (we will circle back to this).

Not paying any attention to years and dates, colonialism happened and with it came a new way of doing things. As part of the colonial regime, Lesotho was introduced to the missionaries.

There was introduction of new systems e.g., nursing schools through the Catholic Church.

This presented a new way of doing things through the introduction of medical/clinical care.

This would later be regarded as the ‘formal type of care’ in the Mountain Kingdom.

There was also Christian religiosity that promised salvation, blessings, as well as abundance if one turned to God, and they denounced their pagan belief systems. Basotho would get introduced to a new way of life, one that summoned angels and God’s mercy to ease suffering.

Bear in mind that this is not about religion, spirituality, or colonialism.

By now, the reader is aware that in all these eras, one thing that has been constant is that human beings experience suffering at one point in their lives.

With that said, we see phenomena like religion, spirituality and clinical care existing within one context, Lesotho.

Based on how the clinical and religious forms of care were introduced, the traditional care offered by traditional healers was at an all-time disadvantage.

Unbecoming labels would belittle what was once a way of life for Basotho. Obviously, this led to an unintended consequence of purposive action.

A bit of indulgence, there was once a sociologist by the name of Robert King Merton who gifted the world the “Unintended Consequences Theory.”

Merton went on to share his learnings that purposeful action is taken by humans every day, in small and large ways, which influence the trajectory of our individual lives and our civilisation.

He asserted that our actions have unintended effects which are as impactful and probable in our history as the ones that are desired.

Merton identified five causes of unintended consequences namely: Ignorance, Error, Short-termism, Dogmatism, and Self-defeating prophecies.

The above causes are merely starting points. Unintended consequences are the end. We see the introduction of a new system during the colonial era, the approach was somewhat ignorant and had error.
The new way lacked knowledge in what constituted social suffering and what response techniques looked like for Basotho. Consequently, there was a dissonance.

The colonial systems, much like the Basotho traditional systems lacked the repertoire to describe mental suffering.

For church goers it was the work of evil spirits, for traditional healing seekers it was the result of witchcraft. For both, anything pertaining to mental suffering was bad and undesirable.

Asylums became the norm during those years. They were what made sense during that era. Thankfully, human beings and ways of existing evolved, culture shifted, and modern approaches came about.

The psychiatric model and diagnostic approaches would reign. Many schools of thoughts would rise from studying human behaviour, the human mind, social life, social change, and the social causes and consequences of human behaviour. This is the intertwine alluded to earlier.

Ever heard of that saying that change is inevitable, it would ring true here. Contemporary approaches in the form of clinical mental health, psychology, psychometric testing, wellness were born.

Now, the crux of it all is that for us to fully understand mental health, it requires us to be mindful of the people, the context, the culture, forms of care in that given context, and tailor make mental health with these factors in mind.

You wonder where the mental health stigma comes from, refer back to how introduction of new systems during colonialism disfavoured the traditional ways of understanding it.

You wonder why anyone would let outsiders come uninvited and dismantle their systems?

There was close to no option to resist, as that resulted in punitive action from the said colonisers.

You wonder about the language and terminology used to refer to those living with mental illnesses, yes refer back to history books for these were lesser important people in society.

Ones who had to be hidden from mainstream society, ones that were bound by chains because their wrongdoing was being “a little off” as compared to everybody.

Now, with this unsolicited lesson of sociology and psychology, ask yourself, what is mental illness? What is mental disorder? What is mental care? An informed answer is one that is cognisant of Basotho’s acculturation process.

This brings us to concepts of sameness vs individualism within one group. Basotho are similar- Basotho are different.

Acculturation implies that some Basotho subscribe to the church, while others adhere to traditional methods.

Basotho’s view and understanding of mental illness is consequential of the aforementioned systems.

To produce solutions to mental illness, we first have to start by fully comprehending the people that mental health programmes are being designed for.

You design a 12-step AA programme for Basotho to sit in a circle and admit to their powerlessness over alcohol…good luck!

Why the best wishes? Because, in true, the Basotho belief is monna ke nku ha alle (Old ways).

It does not start with getting people to talk, it begins with raising people’s awareness about the importance of talking (New ways). How can traditional practices like khotla ea banna le pitiki ea basali inform therapeutic approaches for improved mental health outcomes?

Do not let naysayers and their use of the word evidence-based dissuade you. All approaches were ideas until tried and tested. Let us backtrack a little, we are not shunning any model.

We are growing our understanding for improved outcomes in that the 12-step AA model is culture specific. How can it be modified to suit the needs of a culture for which it was not primarily designed?

This will answer why most interventions fail in the African context. In psychological assessments, there is what is called validity and reliability.

This is too technical and requires its own column, but the two concepts are measured using a sample population (n).

We are basically saying Test A produced constant results when administered to males and females aged (16-19), racial background was this and that, the sample population has a 6th Grade reading level, for example.

What this means is that if that test was administered to someone without a 6th grade reading level, special consideration has to be applied when interpreting their results. Right!

The same logic applies to modification of approaches to respond to the needs of a given group/population in a specific context.

Questions we should be asking are, “what is going on in your life that is disturbing your peace,” “what is this that is weighing you down and taking your joy away?”

Ask someone if they are okay and the response is almost guaranteed to be a definite: Yes.

It would seem in the context of Lesotho, we are asking the right people wrong questions pertaining to mental health.

So, I ask you what is mental health in Lesotho? Are we ready to put our individual beliefs about mental illness aside (bias) and engage with those that are facing mental illness in a meaningful way?

Are we skilful in navigating topics surrounding suicide and depression when our go-to is, “Life is showing all of us flames my love.”

Are we ready to swim in these unknown waters where mental suffering looks so different for people?

Do we possess the literacy to tackle mental health issues?

When we have answers to these questions, we can have intentional conversations about: “What is mental health and what does it look like for Basotho?’’

I challenge you to think about what mental health is for you. Not self-care, mental health.

● The author of this article works as a Psychotherapist. She holds a Master’s degree in Counselling Psychology.

She has certifications in Global Health Delivery, Policy Development & Advocacy in Global Health, Leadership & Management in Health, as well as Fundamentals in Implementation Science.

Her views are independent and not representative of her professional roles. She is ambitious about equitable health delivery, health policy and decolonised mental health approaches.

‘Makamohelo Malimabe

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We need a coordinated approach on youth challenges

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For a number of good reasons, all of us are concerned about problems that face Lesotho’s young people, particularly youth unemployment, and the increasing tendency towards anti-social behaviour among sections of Lesotho youth including their increasing admiration for criminality.

Not only do members of such groups admire criminality and actually commit crimes but they commit crimes without much care as to the harm and other costs that their actions inflict on immediate victims and on society-at-large.

Evidence of public concern about these problems includes the fact that within society individuals, groups and public and private institutions have all expressed concerns over problems facing the youth, with some of these parties making attempts to come up with ideas and measures to assist.

However, a number of problems seem to be emerging on, at least, three fronts. Firstly, a seeming lack of coordination in addressing problems that face young people. Secondly, lack of clarity on questions of whether (a) parties that seek to assist are basing their interventions on credibly identified sources of problems that face young people; and (b) whether any credible assessments are made to ensure that interventions such parties are proposing and implementing have potential to solve problems that face Lesotho’s young people.

There are many examples of what may seem to us, members of the general public, to be lack of coordination in approaches to solve problems facing young people. One such example may be sufficient. On January 8, 2024, Lesotho TV broadcast a statement in which the Lesotho Defence Force (LDF) authorities announced establishment of some army facility where Basotho young people would be taught some values, including patriotism.

The very next day, on January 9, 2024, Lesotho TV broadcast another statement, this time by the Lesotho Mounted Police Service (LMPS) authorities, announcing the LMPS’s plan to establish a police facility at which young people would be taught anti-crime and other values. In their essence, the LMPS’s plan sounded not totally dissimilar to LDF’s.
Apart from the LDF and LMPS’s plans for Lesotho’s youth, there are also public and private sector initiatives to nurture and support entrepreneurial talents of Lesotho’s youth with a view, among others, to fight youth unemployment and develop the country’s private sector.

Politicians have also been seen to sponsor football games for young people in their constituencies with a view, they say, to keep young people from crime and narcotics. These events cannot be criticised too much but given that they are one, or two-day events that take place during specific times, they look more like publicity stunts.

National sports federations are now complaining that politicians who sponsor these events put too much stress on sports as a means to fight crime. What federations want is that, if politicians want to help, they should stress the importance of sports as careers, and sponsor young people to develop their sporting talents accordingly.

Amidst expressions of concerns and various parties’ attempts to address problems facing Lesotho youth, public authorities that we have not heard from, or from who we do not hear enough, are those charged with responsibilities over precisely problems facing young people; that is, authorities at the Ministry of Youth.

Admittedly, we do not know if the initiatives of the LDF, LMPS, and others are carried out in consultation with or with the blessing of the Ministry of Youth.

The worry ought to be not only whether interventions of the LDF, LMPS, and others have the blessings of the Ministry of Youth. Instead, the worry should extend to the question of whether the Ministry has any national plan to address problems facing young people. And, if such a plan exists, we would expect that it identifies the LDF and LMPS as places where young place can be coached; and initiatives of these and other institutions would align with such a plan.

Without an identification of the army and the police as implementing agencies of the Ministry’s plan, and without the army and police’s initiatives alignment with the Ministry’s plan, at least two things are likely to result: duplication of effort — as seems to be the case with the LDF and LPMS plans; or, at worst, LDF and LMPS plans might contradict and undermine national plans entrusted to the Ministry of Youth.

In the worst case scenario that a national plan does not exist, we face the danger that anybody wishing to address problems facing Lesotho’s young people can do so, basing herself, or himself on a personal or group perception, and implementing plans and solutions based on such perception.

As in the case of too many people stirring the same cooking pot without coordination, undesirable consequences can be expected from a situation where just about anybody can apply a solution to a public problem.

As hinted above, a good national plan aimed at addressing problems that face Lesotho’s young people would have two characteristics, at least. First, it would be based on our assertion of the kind of society we want to be; an investigation of problems that stand in the way of achieving such a society; how such problems can be overcome, say, through school curricula; and how, in general, from Early Childhood Care & Development (ECCD), young people can be brought up and socialised in ways that ensure they will be useful members of a society we wish to be.

Any action that is not based on an investigation of the problems that stand in the way of achieving a society we want to be has little chances of success. Such action would be based on some understanding that the young who are anti-social, unpatriotic and criminals are naturally bad people.

It is, of course, not as simple as that. For example, one possible explanation for the absence of patriotism among young people may have something to do with socio-economic inequality in Lesotho: those who are closed out of, and excluded from, benefiting from Lesotho’s wealth and power cannot be expected to be patriots.

A second characteristic of a plan aimed at addressing problems that face Lesotho’s young people is that, such a plan should identify and/or establish institutions designed — and with appropriate skills — to implement ideas and proposals that come out of credible investigations.

It is unclear whether the LDF and LMPS plans have resulted from something like considerations suggested above. While it is admitted that these institutions’ initiatives are limited to addressing problems of lack of patriotism and criminality among the young people, one clear problem with their plans and solutions is that, it might be the case that they are catching young people a little late, when schooling and general socialisation have already entrenched anti-social values that we see among sections of young people; namely, individualism and the inability to think of others.

In one word, these institutions catch these young people when tendencies towards criminality, anti-social behaviour, and lack of patriotism might have already hardened.
Perhaps the biggest hope we should have is that the army and the police will have full complement of resources necessary for providing full and wholesome mentoring to young people who undergo army and police mentoring.

Short of adequate resources necessary for achieving what the army and the police have in mind, we might end up with cohorts of young people with a faulty army and police culture that may come back to haunt us. Inserting a faulty army culture among a section of young people brought us bitter results in the 1970s and 1980s that should not be repeated.

To conclude, no one can argue against all of us being concerned with problems of youth unemployment; increasing tendencies of young people’s admiration of criminality and their participation in crime. And no one can argue against all of us coming up with ideas and proposals of how to address these problems.

However, our concerns and proposals ought to be based on:
a nationally-agreed assertion of society we want to be;
a credible investigation of difficulties that stand in the way of us becoming society we want to be;

and coordination of proposals and ideas aimed at becoming society we want to be.

As with other specific instances of socio-economic development in Lesotho, problems facing the country’s young people cry out for the long-neglected establishment of the National Planning Board, as prescribed in Section 105 of the Constitution of Lesotho.

Prof Motlatsi Thabane

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Insight

Call that a muffin?

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In Oscar Wilde’s short story “The Canterville Ghost” (1887) one of the characters says about the British, “We have everything in common with America nowadays except, of course, language.” Between American English and British English there are many, many differences. Which is not to say that either American or British English are standardised; there are multiple varieties within each. As a south-western Brit I can find it difficult to fully understand what someone from Liverpool or Newcastle is saying.

I remember one year during the NUL’s International Theatre for Development project we had a student from the islands of Scotland. She was brilliant and hard-working and full of good ideas — if only one could understand the ideas when she introduced them. The NUL students grouped together and asked me: “Chris, can you translate what Kirsty is saying for us?” and I replied: “I’m as lost as you are.”

Between American and British English it’s not just a matter of pronunciation but also of vocabulary (I’ll be coming to muffins — see the title of this piece — in a while) and spelling.
In the biographical film Prick Up Your Ears British, dramatist Joe Orton shares a room with Ken Halliwell and they decide to write a novel together. Ken asks Joe “can you spell?” and Joe replies “yes, but not accurately.”

This is hardly a surprise, given that he’s a Brit. The American spelling system is far more regular and rational than the British. (Readers with laptops will have noticed that your spell-check gives the option of British or American spelling, but that doesn’t help you as in Lesotho the British system is used, so for the time being you’re stuck with it).

I mean, what can you say about a spelling system where “plough” rhymes with “now”, but “tough” rhymes with “stuff”– and “now” doesn’t rhyme with “low.” Yipes (as the Americans say). When I was lecturing in Lesotho and in Nigeria and marking assignments I was always very lenient over spelling, because I know what a mountain it is to climb (the latter word rhyming with “time”, of course).

Then there is the matter of vocabulary or denotation (a term I hope readers remember from a few weeks back). There are many examples of things that are denoted by different words in British and American English: lift / elevator; pavement / sidewalk; windscreen / windshield; petrol / gas; cinema / movie theater (and look at the American spelling of (Brit) “theatre”– a lot easier). And some of these reflect our different histories.

For example, there’s a vegetable, a kind of small marrow, the British call it a courgette (one of my favourite vegetables, in case any of you are planning to invite me for dinner). That’s a word that British English has borrowed directly from French — that is, a loan word (I’m not sure we plan to give it back).

The Americans on the other hand call it a zucchini, a loan word from Italian, which I guess reflects the size and influence of the Italian community in the USA. (Speaking of vegetables, I can’t give you an explanation for why the Brits call an aubergine an aubergine — another loan word from French — but the Americans call it an egg-plant).

Next week I’ll get around to muffins — a sore point — and I’ll move on to differences between English and French and between Sesotho and Setswana. Bet you can’t wait.

Chris Dunton is a former Professor of English and Dean of Humanities at the National University of Lesotho.

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Insight

Lessons from Israel: Part 3

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I shall round off my account of my 1995 trip to Israel by putting on my tour guide cap. Staying in Tel Aviv, most days were fully taken up by the conference, which was my reason for being there. Tel Aviv in July is scorchingly hot, so there were walks along the beach only before breakfast and after sunset. I did take a little time off to go with South African author Stephen Gray to an art gallery that had a painting he wanted to see (a portrait by Modigliani of Beatrice Hastings, whose biography Stephen was then writing).

I wasn’t especially keen on the hotel restaurant, where dinner comprised meat served by the ton (surprisingly little fish, given that we were on the coast. By contrast, I had always been surprised and happy that Maseru restaurants are so good on fish, despite the fact that Lesotho isn’t exactly maritime). But I discovered a little Russian Jewish restaurant that offered Beluga caviar at an amazingly cheap price. I suspect it had fallen off the back of a lorry, as we say in the UK — i.e. that it was contraband, acquired illegally. I just blinked innocently and enjoyed myself. I can’t think of a more delicious way of starting a meal than with caviar, freshly-made blinis and a large glass of deeply chilled Wyberowa vodka — no ice, please. (I only say all this to show you what a very cosmopolitan chap I am).

The conference ran to a packed schedule and we worked hard (no, really). Half-way through we were given a day off and taken to Jerusalem. On arrival I teamed up with an old Nigerian friend and a friend of his from Senegal and we took ourselves first to the Dome of the Rock, the main mosque, which is splendid and radiant (wow, the mosaics!) Then we saw the Wailing Wall.

Then we trudged up the Via Dolorosa to the Church of the Holy Sepulchre. The Via marks the route along which Christ was forced to carry his cross on the way to his crucifixion (dolorosa means something like “of miseries”). I had expected it to be lined with sculptures showing the Stations of the Cross (rather like the lovely ones at Fatima, near Ramabanta).

Instead it was one tourist gift shop after another. Here I came across one of the most repugnant things I’ve seen in my life. Proudly displayed for sale, a wall clock with the face adorned with the image of the head of Christ, the two clock hands protruding from his nose.

At the top of the Via Dolorosa, the fourth century Church of the Holy Sepulchre, the holiest site in the world for Christians, which is breathtakingly beautiful. The interior is (not visibly) divided into sections, the upkeep of each of which is the responsibility of one of the major denominations: Roman Catholic, Anglican, Methodist, Greek Orthodox, Egyptian Coptic, and so on. I had had the impression this was an arrangement worked out under the colonial regime of British Palestine, but Google tells me it dates back to the Status Quo of 1757.

My companions had done their homework and suggested we head first for the roof, which had been allocated to the Ethiopian Orthodox Church (dare one possibly suggest a tinge of racism in this marginalisation?). There we found a cluster of monkish cells, each inhabited by an elderly Ethiopian monk, at least two of whom spoke English or French. They were delighted to see us, and utterly sweet, hospitable, and in their accounts of their pastoral work spellbinding.

To be concluded

Chris Dunton

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