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At the end of 2014, Linda Givetash, then a young Canadian journalism graduate student with the Global Reporting Program, traveled to the West African nation of Togo to do a story about how the mentally ill are treated. She visited several religious camps where people suffering from psychological ailments undergo intensive prayer sessions that are supposed to cure them.
Eight years later, Givetash, now a free-lance journalist based in South Africa, recounted her visit to one of them, located in a remote rural area two hours from the capital of Lome.
What she described sounded like a scene from hell.
"There was a concrete shed which had different rooms, almost like a prison cell," she told me recently. "There was one person in each, people chained inside. When we went around that, beyond, there was almost a little forest of trees and there were dozens and dozens of people and each person was chained to a tree. Some of them had blankets. There was one guy and he had nothing. He was screaming. He was naked and he had been digging a hole and was sitting in the slope of the hole. Some people were very calm, almost catatonic in a way. Others were obviously in crisis, screaming and yelling. With some people, one ankle would be chained to a tree. There was one guy who had both wrists chained together behind his back and he just stood there. It was just horrific.``
A short distance away, at an open-air church, a pastor screeched a sermon, his voice blasted at high volume through a loudspeaker that was heavy with static. Before him was a large crowd of congregants.
On the periphery of the camp, a group of people were cooking food. These were family members of the "patients." They lived there adjacent to the camp in crude shelters, preparing food for and bringing water to their mentally impaired kin.
The "therapy" that the mentally ill patients receive at these camps consisted of intensive prayer, forced fasting and, sometimes, counseling sessions with the head pastor, who is the founder and leader of the prayer camp. Many were living in squalor so awful one observer told me it was "worse than animals."
"I said at the time and I still believe, if you didn't have a mental illness going into that place, you are going to leave with one because it was just so traumatic for those people," Givetash said when we spoke via Zoom.
There are estimated to be hundreds of these prayer camps in West Africa. In nations such as Togo, Ghana, Benin, Burkina Faso and others where there is little in the way of psychiatric treatment. Many people believe they are effective and, in any case, for most, they're the only practical option. As such, these prayer camps remain hugely popular despite the awful conditions and their questionable efficacy.
I first heard about the prayer camps a couple of months ago when I read about a Yale Divinity School graduate who was in Ghana doing research for her doctoral thesis about the camps. I have been to Ghana twice, once for work when I was a correspondent for ABC News and once just to visit after a DNA test traced my maternal lineage to the Asante people of Ghana. Because of the latter, I feel a connection to the country and its famously hospitable people. What I read about the prayer camps was deeply disturbing. I wanted to know more. I wanted to understand.
"Prayer camps are turning into the unofficial health care system of Ghana," said McKenzie Flowers Fergus, the divinity school alumna, now pursuing her PhD at the University of Edinburgh. She has spent the last eight months doing research in Ghana, including visiting the prayer camp sanitariums, as they are also called. She has spoken to the pastors -- who call themselves prophets -- and to many of the patients.
When asked a question, Fergus has the rare and impressive habit of pausing to consider what she will say and how to say it.
"Prayer camps are popular for a reason," she said. "There's limited health care options in Ghana, in general. There are only, like, 154 psychiatrists for 6 million people and only three public hospitals.."
Typically, a family member will bring the mentally disturbed relative to the camp. More rare are those who check themselves in. When Fergus asked family members why they had brought the stricken person to a prayer camp rather than a psychiatric facility, she said, "that question was usually answered with an attitude of 'why would you ask that question? Of course, I would go to prayer camp sanitarium.'"
Many Ghanians are deeply religious Christians and, at the same time, adherents of traditional cultural beliefs that view mental illness as a spiritual malady and the mentally ill with suspicion and even hostility. The psychological problem is often blamed on demonic possession, evil spirits or a diabolical curse. It's not unheard of for neighbors and even friends to harass the families with a member who is observed "acting crazy." Sometimes, the sufferer or entire family is ostracized; sometimes even forced from their homes.
Fergus said, "People that suffer a severe issue, whether it be schizophrenia or bipolar, will often be almost shunned by their society because there's a lot of discrimination and stigma that's attached to religious belief systems."
In a short documentary called Praying For A Cure, which Givetash helped report, Gregoire Ahongbonon, founder of the St. Camille-de-Lellis Association, a non-profit that has set up seven psychiatric clinics in three West African nations, said about the mentally ill in West Africa: "They're treated like garbage, like human waste in our society. People with mental illnesses are the forgotten of the forgotten."
For those who believe a person's psychological problems are the consequence of spiritual failing, spiritual therapy -- divine healing -- is the preferred remedy.
Paul Keweku Nii Okai, head of the Mt. Horeb prayer camp in Ghana told the BBC in 2018, "When it is spiritual, doctors can do all that they have learned from books. It will never work until the spiritual is applied."
Some prayer camps house only a handful of patients. A few have more than a hundred. Those who act out -- the most severely mentally impaired, but also sometimes epileptics -- are shackled or placed in often cramped cages or both. One researcher told me some chained patients complained of being caned. Housing conditions are at best spartan; at worst horrible.
The pastors or, if you will, prophets have defended manacling people by saying it's for their protection or to protect others from them. If they let them go, some say, they'd only end up wandering the streets in destitution and confusion.
How long do they stay? Sometimes just a few days. Sometimes weeks. Often months, and even years. They are free to go when the pastor decides they can be released.
"After interviewing the entirety of the prayer camp (at one Ghanaian sanitarium), I realized that the average person is there usually for two years," Fergus said. "That is new data. One person I interviewed had been there for thirty years waiting for a cure. But they were in chains at that point."
The families of patients pay a small fee for the prayer camp. Some patients are even allowed to stay without any payment (some family members drop off a mentally ill relative and never come back). That said, the pastors are often beneficiaries of sometimes substantial donations from members of their congregations, and even from grateful former patients and their families. As a consequence, some prophets live in relatively luxury with expensive possessions that may include nice cars (donated to them).
Fergus explained this to me as part of "prosperity gospel" that is widely believed in these countries. It's the concept that if you are a good Christian, you will be compensated for your piety. As an exemplary Christian, it seems, the prophet may be seen, and, of course, may see himself, as entitled to these comforts as a just reward.
I asked Fergus, "Are some of these prophets hustlers?"
For a long moment, she said nothing. Then, she asked, "Hustlers in what sense?"
I said, "You know, frauds."
"From a Western standpoint, it's easy to say they're all frauds," she said, carefully. "But from a cultural context in Ghana, where people believe in healing from a greater power, that belief has a lot of power. The prophet often believes that (he has) spiritual gifts."
In 2012, after a series of international press coverage and reports from groups such Human Rights Watch that embarrassed the Ghanian government, a law was passed prohibiting the abuse of patients in the camps. I was told it has essentially gone unenforced.
What has had some success was persuading pastors to allow psychiatric teams into their camps to treat the patients with medication. The New York Times reported in 2018 that a team led by Dr. Angela Ofori-Atta, a Ghanian professor of psychiatry was allowed to diagnose and provide antipsychotic drugs to chained patients.
"After six week, those on drugs showed clear improvements on a standard rating scale that racls feelings of hostility, emotional withdrawal and hallucinations," the article said. Dr. Atta told the Times one man who had been chained for 10 years became lucid for the first time in years.
But even the patients who showed improvement remained chained.
Writing about this subject is delicate and difficult. I believe we/I need to be respectful of cultural differences and unfamiliar customs and not rushing to judge others from the perspective of our own culture as superior or the proper standard of what's right or wrong, normal or abnormal. Chaining mentally disturbed people -- or for that matter, anyone who is not a violent threat -- just strikes me as wrong, regardless of your cultural background. But you also have to wonder how we are seen by others. What might a visiting African or other foreigner think if they came to, say, Los Angeles -- the second largest city in the wealthiest country in the world -- and saw the vast homeless encampments where many of our fellow citizens are mentally ill and untreated? I can easily imagine someone asking: "How can they allow such a thing?"
Cover photo credit: Linda Givetash, Global Reporting Program