The man in the photo below has a chain around his ankle, and he’s chained to the tree he’s leaning against. That’s his wife, and he has a mental illness. This photo, taken by photographer Robin Hammond, is in Ghana, but this doesn’t just happen there. I’m feeling rather grateful about living in Canada right about now, where I can feel confident that my illness won’t be managed with chains.
Ghana
A 2020 article in The Guardian includes an interview with a woman in Ghana, who describes how her son became unwell and quite aggressive. Initially, he was able to get some medication, which helped, but then it ran out and it was impossible to get any more. He tried to attack her with a cutlass, at which point she and her husband felt like chaining him was their only option.
In Ghana, mental illness is often attributed to evil spirits, and chaining isn’t uncommon. There’s even a “chain maker” that’s typically found in every third or fourth village. A Ghanaian psychiatric nurse, Stephen Asante, told The Guardian in the same article, “So many do not know what to do and in most cases, they abandon the person, or they take them to prayer camps.” He added that the government hadn’t sent any psychiatric medications to the region where he works in all of 2019. With so much stigma around mental illness, it’s unlikely to be a government priority.
Togo
A 2017 article in Global Citizen tells the story of a young man in Togo who became ill. His family drugged him, kidnapped him, and hauled him off to a “prayer camp” in a rural area. At the prayer camp, he was chained to a tree, and prayer was used in an attempt to drive out the evil spirits that had taken over him.
Pakistan
According to a 2001 paper in Psychiatric Bulletin, in Pakistan, mental illnesses are seen as a result of possession by evil spirits or the effect of magic spells. Faith healers sometimes use extreme practices like scalp lacerations, blood-letting, burning people’s faces with hot irons, and beatings. Chaining people to trees outside holy shrines happens in certain areas of the country. The authors wrote:
“We saw patients of all ages, from children as young as 8 years to the elderly in their late 60s, helplessly tied to trees with metal chains. We later discovered that the chains were obtained on rent from the care-takers of the shrine, who also charged a certain fee for allocating a tree to be used for tying the unfortunate patient. While some patients had been tied for weeks and months, there were others who had been there for years.”
India
I came across several reports of chaining in India, although it’s against the law there. In 2001, 28 people were killed at a mental asylum in Erwardi Village in Tamil Nadu. Inmates at the faith-based institution were tied to trees by day and chained to their beds by night. Those who operated it believed that holy water and an oil lamp, combined with frequent canings, would cure the problem. When a fire started in the middle of the night, there wasn’t much hope for those who were shackled.
Somalia
A 2013 article published in Thompson Reuters Foundation News explains that in Somali culture, there is a belief that mental illness is due to bad spirits. One traditional practice is to lock the person up with a hyena, as it’s thought that the hyena will cause the evil spirit to leave the person’s body. The fact that the hyena sometimes kills the person doesn’t appear to be a deterrent. Desperate families will resort to chaining their mentally ill relatives to trees or beds. This often lasts for years, causing significant trauma.
The World Health Organization published a report in 2010 about the treatment of mentally ill people in Somalia. It stated that “degrading and dangerous cultural practices such as being restrained with chains are not only widespread but also socially and medically accepted.” The use of chains is routine in both rural and urban areas, and it occurs regardless of gender. Chains are used not only in acute flares of illness; they’re used for years at a time. The mentally ill may also be the target of violence, including throwing stones.
In Somali culture, there is no spectrum of mental health and illness; there’s simply crazy and not crazy. Mental illness is commonly believed to be caused by God or evil spirits. Religious leaders and traditional healers are considered the main source of treatment.
Chain-free initiative
The WHO developed a 3-phase chain-free initiative, consisting of:
- Phase 1: chain-free hospitals: transform hospitals into more humane environments with minimal use of restraints
- Phase 2: chain-free homes: provide education to families and provide support with home visits
- Phase 3: chain-free environments: reducing the invisible chains due to stigma and increasing access to opportunities
How are chains actually happening?
Besides the countries already mentioned, I came across reports from within the last 20 years of chaining in Afghanistan, South Africa, Cambodia, Indonesia, Nigeria, China, and Ethiopia.
I had no idea. When I stumbled across this while doing research for my next book, I wondered how I hadn’t come across it before. I find it strange that chaining people to trees specifically is a thing in diverse parts of the world.
Various articles among the ones already mentioned that had interviewed family members explained that it wasn’t a choice to inflict cruel punishment; rather, it was a matter of desperation and lack of other choices. Medical treatment often isn’t available, and even if there are practitioners, there aren’t meds.
The authors of the paper in Psychiatric Bulletin commented that what they witnessed in Pakistan was like a zoo, except the animals were the ones that were free. Maybe the animals get a barn of some sort to go into in inclement weather. The “crazy” people get left outside.
I can wrap my head around the idea that, especially if someone is living in a remote village, people would believe the cultural lore that being “crazy” results from possession by evil spirits, and religious leaders are the best ones to deal with it.
Humans deserve better
The chaining is a whole other matter. It’s so profoundly dehumanizing, especially since it’s not just to manage acute agitation. Imagine how destroyed someone’s soul (in any sense of the word) would be after 10 years chained to a tree. How must these poor people feel, knowing that if they don’t crouch as small as they can in the darkness of the shadows, chains may await them?
There are really no words. Our brothers and sisters deserve better from humanity.
Is this something you’d heard of before?
As a final comment, I haven’t used “proper” person-first language in this post; it seems like it would be rather absurd to do so when describing this sort of treatment.
My latest book, A Brief History of Stigma, looks at the nature of stigma, the contexts in which it occurs, and how to challenge it most effectively.
You can find it on Amazon and Google Play.
There’s more on stigma on Mental Health @ Home’s Stop the Stigma page.
A very interesting read on how other countries deal with mental illness and thankful that I am able to get the help I need, but it is a worrying thought that other are not lucky enough to get that x
Yeah, scary to think how easily that could have been us.
It does make you think and the realisation of it all, brought a tear to my eye with them been tied and abandoned for them to deal with their mental illness alone, or with very little interaction x
It’s really horrible.
Thank you for writing on this very important issue. We need a lot of education on mental illnesses and how to deal with them. Allow me to make this correction : the people of Ghana are called Ghanaians and not Ghanese. Yes, many mental illnesses are linked to witchcrafts due to lack of education.
Thanks for pointing that out – I’ll fix it right now.