On the Magical Thinking Related to Mental Health in Chad

The Republic of Chad, situated in northern central Africa, has an estimated population of 13.7 million inhabitants (1). Because of the desert climate prevailing in much of Chad, the country is sometimes referred to as “the Dead Heart of Africa.” Chad is one of the poorest countries in the world, according to the United Nations Human Development Index, with an estimated 86% of the country’s population living below the poverty line (2). The country represents a mixture of about 200 ethnic groups, mainly Muslims and Christians, who speak more than 100 languages and dialects. Five years after Chad gained independence from France in 1960, the country fell into a series of civil wars, which ended only provisionally in 2008, leaving the country’s economy exhausted and its development at a standstill. Concurrently, a humanitarian crisis threatens the country’s relative stability because of the displacement of hundreds of thousands of refugees from the Sudan’s Darfur region, from northern Nigeria, from Libya, and from the Central African Republic, adding to the burden of hundreds of thousands of internally displaced persons (3).

In the harsh and dark circumstances of life in Chad, awareness of how modern societies define and manage mental disorders seems to be among the least important subjects for the Chadian people. However, some glimmers of light have appeared. In 1990, the Jesuits founded an integrated health program in Goundi, a small city in the south of the country, that contains a hospital and eight primary health care centers situated within a 30-km radius, with the aim of providing treatment for the largest number of persons in need of it, at the lowest cost. In 1996, the World Health Organization awarded the Sasakawa Prize to the program. In 2004, the Good Samaritan University hospital complex was inaugurated by the Jesuits in Walia. As of 2007, a psychiatry module has been taught to the fifth-year medical students at the university. Dr. Egip Bolsane, the only psychiatrist practicing in Chad (Figure 1), has also been teaching psychiatry at the University of N'Djamena. In an interview, Dr. Bolsane stated that he has been struggling throughout his 28 years of practice in Chad to overcome the society’s misconceptions and magical thinking in the domain of mental health, as well as the lack of support from local institutions. According to Dr. Bolsane, the government hospital in N’Djamena has only two beds for patients with mental disorders. These patients are most frequently treated for schizophrenia. Dr. Bolsane expressed worry about the future of psychiatry in Chad after he retires, since no medical student has shown any interest in this particular specialty. Chadians believe that psychiatrists interact directly with sorcerer’s actions. As a result, they—or worse, one of their children—will eventually be afflicted with a mental disorder.