Adel Nassar is 45, and knows more than most the strengths and pitfalls of the Lebanese mental health system. Since being diagnosed with schizophrenia in 1994, he’s seen almost as many therapists as he has years of his life. More often than not, being a veteran of the civil war in turn leads one to become a veteran of the Lebanese mental health system, as is the case with Adel.
He fought for the left during the civil war, a time he recounts “not with pride.” His condition is partly physiological, and partly a result of his years spent fighting.
“During the war there was a lot of stress and a lot of emotion, but I didn’t feel it as much as most because I was fighting,” he says.
It wasn’t until after the war that its effects began to take their toll on Adel’s mental health. The numbness he had felt during the fighting soon disappeared, and signs of his condition began to show.
“It got worse after the war ended, the defeat took its toll on me, and I was disappointed. During the war I was committed to a certain plan, when the war ended there was no hope. I was 30 years old and I had no hope. If you want to build a life you do it before you are 30.”
“Shortly after the war I left for Brazil to work as a merchant. Instead of coming back with money, I came back with an illness.”
With a cigarette in one hand and a coffee in the other, Adel smiles as he talks in a lucid and open manner about his condition. This has always been the case for him, he explains. Indeed, he has gone as far as to publish a book about his condition entitled “Confessions of a schizophrenic.” Much has been said about the taboo mental illness carries with it in Lebanon, Adel is aware of the taboo, but doesn’t allow it to affect his relationships with people.
“I tell people about it and I make them treat me the way I want. For example I often joke about it to make it easier. The illness has become part of my character. It depends on the person as to how they treat you,” he says, though he is acutely aware of the stigma attached to the illness.
“Some people know they are mentally ill, but they don’t see a doctor. A patient’s family might notice that he is mentally ill but they don’t take him to see a doctor. The reason is because some see it as a shame.”
While in Brazil, Adel and his wife had a child. As his condition worsened they got divorced and Adel was unable to see his child for a while. The severity of his condition put his family under enormous stress he says, and he didn’t tell his son about his condition until he was 15.
“It’s difficult for the patient’s family, they suffer a lot. You have to ask, how much can they handle?”
Upon being diagnosed in 1994, Adel was prescribed three courses of electric shock treatment. Since then he has been on medication for schizophrenia, until three years ago when he was diagnosed with bi-polar disorder.
Adel’s medication costs him $80 a mont;, a cost he struggles to afford. Like many suffering from mental disorders in Lebanon, he often has to borrow money to pay for his treatment.
“This year I am receiving help from a friend in the States, before that my brother helped me with the costs. I have trouble paying for the treatments but I always find a way. Many times I need to go to the doctor but can’t afford it, so sometimes I get loans, sometimes I lie to the pharmacy and sometimes I gather money from my friends.”
In addition to paying for his medication, Adel needs to find money for therapy sessions. In some cases Adel finds himself desperate to speak to someone but cannot afford it. “They are getting paid by the hour, so if I am short of money they will only see me for two minutes.”
Finding payment for his medication is but one of the problems Adel faces. His ability to work is also severely affected by his condition, though he works part time with local NGO UMAM, an organization which “aims to preserve and revive fading memories of civil violence and war.” He also works as a freelance journalist and has had a book of his poems published.
“With this type of condition you cannot function as a normal person, you cannot stick to a schedule of regular work hours. This is what is good about my work with UMAM. The pay is little because of the few hours, but I am very comfortable there.”
Adel has often become disheartened with the treatment he receives. He claims that he was uninformed about the side-effects of the drugs he was prescribed.
“Some doctors treat the patient as a robot. They give him the medication but they don’t care about the side-effects, they just want to control the illness. I always feel tired and I sleep for about 12 hours a day. The doctors aren’t interested in hearing about this.”
Being a writer, Adel is well adept at expressing his feelings. Despite the difficulties his condition causes with his family, his work, and his finances, he is able to be philosophical when talking about his condition. “A mental illness is an illness for life. You have to become friends with it, good friends.”
Adel is currently working on a new book about his illness, and his relationship with his therapists.