Mentally Ill People In Chains: A Disturbing Reality

Mentally ill people in chains - image of leg shackles

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.

Man chained to a tree in Ghana – Photo by Robin Hammond, The Guardian, Feb 3/20 – small, low-resolution version included as fair use
Photo by Robin Hammond, The Guardian, Feb 3/20 – small, low-resolution version included here as fair use for critical analysis of subject matter of high public significance


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.


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.


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.”


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.


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.

Book cover: A Brief History of Stigma by Ashley L. Peterson

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.

59 thoughts on “Mentally Ill People In Chains: A Disturbing Reality”

  1. I hadn’t heard of this, no. It is not dissimilar to how mental illness was treated in the West before the late nineteenth century (albeit usually incarcerated indoors, not to trees). While I’m aware that many drugs are hard to get hold of in the developing world, it didn’t really occur to me that outdated “treatments” would still be used instead, although I am aware of the role of faith healers in many parts of the world.

    1. I would have thought at least some of the original antidepressants and antipsychotics would be cheap enough to distribute in poorer countries, but I guess even if they’re cheap, governments would still have to choose to spend the money.

        1. This is so true. Most of us in western developed countries have no idea of the poverty and misery most of the world experiences daily. Mental health would be far down this list of concerns for most people, who may not have eaten for several days.

  2. I clicked the “like” button, but I don’t like this. I am grateful to you for spreading awareness though. Will reblog in hopes it will go further and perhaps once there is more awareness there will be political will to change things. Quite honestly though, mental illness still holds a lot of stigma in our own country (Canada) though we’ve come a long way there is still much road to travel.

      1. I had not heard of this particular “treatment” of the mentally ill and it is very disturbing. I could not see a re-blog option on your post so I have written a short post and copied the link to your blog post. I hope it helps spread awareness. Thanks for sharing this important information.

  3. I had never heard of this. I thought that having a mental health in the US had its stigmas. I guess I should consider myself lucky. Thank you for sharing.

  4. I lived in various developing countries on the Asia continent and I can tell you they do not embrace western thinking of medication and psychiatry. Virtually unheard of in remote villages that lack the most basic medical care or clean water. So what you have reported is not at all surprising, I noted that many of the references are nearly 20 years old but I’m quite sure they are still going on today. Religious and cultural differences for men, women and children are a major factor in treatment, combined with distrust and suspicion of outsiders.

  5. Heartbreaking and unfortunate. The families seem to continue to try to support the healing of the ill but are without resource. There are alternate centers popping up in these countries but resources remain slim. Resources and education both needed to address mental health in these countries desperately. I’ll be keeping an eye on this topic.

  6. This is horrible: and another reason that we need world-wide universal health care and free education. Strengthening our international institutions to prevent such “treatment” and behavior comes from education about illnesses, and also from sharing the resources to treat them properly (maybe a few rich folks can give up some caviar to pay for this).

    1. This has nothing to do with people giving up caviar. There have been billions of dollars donated by many nations and the UN to help developing countries with health issues. As a former aid worker, I can tell you that most of it never reaches its intended recipient, it is siphoned off by corrupt politicians and bottom feeders along the way, who are only too happy to steal as much as they can from the poor.

      There’s also the problem that many local villages will not accept help from outsiders. They are suspicious of the west, do not speak the language, cannot read or write and have likely never been farther than they can walk in a day. They are fearful of consequences and retaliation. So to airlift drugs, as someone suggested, is not even a remotely successful strategy.

      Children die from very treatable conditions, someone mentioned cleft palate, that is a very common birth defect as are many deformities of the arms and legs. In many countries, FGM is still practiced daily, including by wealthy and educated women. People do not have clean water, lack food, shelter, basic medicine and clothing. In many countries, drug and human trafficking is a rampant way of life.

      I don’t have any solutions. I would urge anyone who is considering donating to any worldwide Humanitarian aid organization to carefully review their results, to be sure that the money and aid is actually reaching its intended recipient. You can research humanitarian relief organizations on sites like Some of the best I’ve seen are faith based and Doctors Without Borders.

      It is particularly cruel to those suffering from mental illness, who, as many have mentioned, maybe subject to faith healings, beatings, imprisonment or chained to a tree for years. It makes me sad, to think of the human suffering that exists, not only in remote locations but in our cities.

      There are no simple solutions, in any country or in your own backyard. Do what you can, every day, for the loved one in your life or for yourself, and if you see some one who is clearly suffering, do what you can right then to help them.

      1. Hence my long term suggestion for education and full universal health care, on a world-wide level. That was what I meant by the super-rich giving up their caviar. We can find ways to even out the distribution of resources and to root out corruption if the global political will is there. The structures in place need changing, not only individual action.

      2. I totally agree with you Victoria. Having worked with ‘psychiatric nurses’ from some of these countries, I’ve heard of the diabolical treatment of those with mental illness. The nurses had to learn a new way of working in the UK.

        These nurses told us how little of the money they received from donations and charitable organisations around the world. It’s disgusting and someone needs to address this situation, stopping all the corrupt leaders and politicians from siphoning away the money!

        I too believe that there are no simple solutions, and quite often all we can do is to look out for our friends, families and own communities to ensure that they get the best care and treatment available in whatever country we live in.

        1. This is my experience too. Corruption and theft are rampant at all levels. I continue to wonder how human beings can be so despicable.

          “Think globally, act locally”. Since retiring a few years ago, I’ve been an advocate for the mentally ill at the local level. I believe that is the best I can do, surely there are some mentally ill and/or homeless people near where you currently live, that you can help in some way and make some small difference in their quality of life?

          Throwing money at a problem does not the help the problem, it simply creates a new wave of people looking to siphon off more money. I get that westerners are extraordinarily generous with their money, unfortunately, it usually doesn’t end up helping anyone except bottom feeders.

          “Do what you can, where you can, start where you are.” Arthur Ashe

          1. Yes, unfortunately, we have many despicable people in this world. I’ve just written about being scammed online twice recently. These people make me so angry.

            I was medically retired a few years ago from the job I loved best in all the world. I was a mental health nurse first then a Ward Manager and I still miss it. However, I still advocate both online and in the community. The block of flats I live in houses some thirty (ish) people who have mental health disorders, mainly schizophrenia. I do a lot of advocating for them with their teams because I see these mainly youngsters day in and day out and see how sometimes the care and support is lacking.

            Like you’ve said, if we can all do out bit, every little helps. Nice talking to you Victoria. Caz

  7. It is truly amazing what some cultures believe about illness, mental and physical. I work with children and adults born with a cleft lip and/or palate. The treatment of these children in certain countries just beggars belief. Born of the devil, a punishment for the sins in a previous life, not worthy of social contact or connection. The list is endless. It does make me grateful to have been born here in the UK. I don’t always say that but stories like the one you tell give us a wake up call to how others are forced to live.

  8. This is very disturbing.. Nonetheless thanks for bringing attention to this. When communities are still getting medical help from religious leaders it just shows how far we are lagging (and failing) as a human race..

  9. Yes I am very aware of this approach; I was met with that in Bali. When help isn’t available it’s so hard for family to deal with an ill loved-one. People are chained or put in cages, just to protect the people around them. I think family suffers deeply too when met with such a faith. Proper medicine needs to be distributed and proper mental health education wouldn’t be a luxury at all.
    While working I met a few Moroccan families where other methods were being used to ‘heal’ the ill person, sometimes inflicting real trauma upon the illness. ‘Evil spirits’ who are being ‘chased’ in painful and scary ways to the ill person.
    Praying can’t hurt but when you’re told that an evil spirit lives inside of you, that is just not right. That would be our (more western) view of course. A dialogue is deeply needed to bring worlds together and to make treatment work for people who are suffering from mental illness.

    1. This is why the international institutions need funding to provide governance oversight, education and distribution of resources directly to the populations involved if necessary, but all governments around the world also need to be strongly encouraged and helped to implement universal health care and free education. Countries that “cannot afford,” or refuse, to educate and give health care to thier populations should have debt cancelled and direct UN oversight and help.
      Looking at stats from the European Union (which is not perfect, by any means, but does better at leveling some of the inequalities, economically and in healthcare terms)…

      1. I just mentioned it briefly in the post, but the WHO’s chain-free initiative in Somalia seemed like it had some successes, and that could be used as a model and expanded to support other areas.

        1. Yes, sorry I did see that, and it is a start. What I’d like to see is the WHO given actual authority and resources to act as a governmental institution in every nation. But first, every nation needs to have full universal health care, and the resources to have European-level health care systems. This is not a difficult thing to do if all of the citizens of all of the Republics in the Global North were to agree on it.

  10. “(Harmful practices which are not only widespread but also socially and medically accepted”

    Wish I could quote this to every white person who tells me “I can’t judge this clearly Harmful Thing because it’s common in your culture.”

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