“I am angry for no reason. I smash things. I decided it was better for me here. There’s nothing to smash,” says Mohamad. When the doctor asks him about the past, he demurs. “The past is not interesting,” he says.
Ismail reckons that as much as two-thirds of Somaliland’s population has been afflicted by post-traumatic stress disorder, a condition that can masquerade as depression or bipolar disorder. As the political situation has improved and people have returned home from the camps, the long-suppressed trauma of the war has bubbled up. Patient visits to the ward have spiked.
“Six or seven years ago, all of the patients suffered from acute mental illness,” Ismail says. “Now I see more people like Mohamad. They’re hard to diagnose, because their symptoms are diffuse: anger, depression, malaise, insomnia. And it’s the tip of the iceberg. Most will never seek help. If they do, they go to a healer. Or they chew khat to make the problem go away.”
Somali culture understands mental illness as a sickness of the spirit brought on by outside forces, as something to be cured once and for all rather than managed. Like many patients, Mohamad first sought the help of a traditional healer to exorcise any jinn and lift any curses afflicting him. “It helped,” says Nura, “but then he started to break things again. The medication didn’t work either.”
“Those pills made my arms and legs hurt,” her brother says. Mohamad joins Abdi in the appointment book. The doctor also schedules a follow-up meeting with Nura.
The chlorpromazine tablets, supplied by the World Health Organization, are a stopgap, Ismail explains later. “It’s an effective antipsychotic, but it doesn’t work for everyone, and the side effects are bad.” If a patient has relatives in the West, Ismail will fax them the proper prescription so that they can fill it and send back the medication. A surprising number of patients get their medication this way, because so many Somalilanders emigrated during the war. But the majority receive the ministrations of a healer, chlorpromazine, or nothing at all.
It’s late afternoon now, and the patients have abandoned the courtyard for the shelter of the dormitory. The riddles they’ve left behind express the ward’s story better, somehow, than a doctor ever could: a cup of water filled to the brim and set neatly in dust, the blackened remains of Abdi’s mattress, the contents of someone’s stomach. A pair of trousers crumpled in a fringe of grass. Again, a few men spot Ismail and, rising stiffly to their feet, emerge from the shade. By the time they’ve shuffled over, though, he will be gone, at least for today.
