Before a work trip I was instructed to take an anti-malarial drug. We were going to Nigeria for work and the previous team that had gone there to do research had all come back malarial. Not a big deal for people who’ve developed a resistance to it but as folks from the US/EU, they were all incapacitated by it. As another person from the US/EU, I was a focal point of the “get an anti-malarial” talk, as if mosquitos like white people more. At the time I was living in Nairobi and in Nairobi if you need medication you just go to the pharmacist, explain what you want, and they give something to you. No need to go to a doctor for a prescription, you just show up with some cash and you get some pills. The pharmacist I went to in the Lavington Mall asked how long I would be in malarial country and duly handed over 10 pills after I said 5 weeks. “This one isn’t the once a day, it’s the once a week. It’s better.” Once a week sounds easier to manage, less likely that I’d forget, less to pack, and Atovaquone, the once-daily anti-malarial, had given me weird dreams before. I popped one once I got back to the office and two days later, off we went to Nigeria.
The insomnia came on slowly. I had been sleeping well in Nairobi in general. With guard dogs barking, the landlords’ staff coming and going and slamming wrought iron fences, the caws of Kenyan crows so unlike the caws of Seattle crows. I didn’t notice much at first, just a few nights of not sleeping well. But soon it became more pronounced: six hours slipped to four slipped to sometimes three. The world began to feel far away and I began to feel remarkably fragile, wan, weak, and strained by every interaction. I’ve always been a fan of melatonin but it seemed to lose any effect on me. I would sleep for a half hour, wake, lay staring at the ceiling wired awake by something un-nameable and elusive. My mind was an irritable blank chalkboard. We went to Nigeria, it passed in somnambulant haze. I came back to Kenya with another trip still to come. I took another dose of anti-malarial.
It’s not uncommon to be flagged down by a police officer in Nairobi and have a friendly-ish conversation that leaves you driving away free and them in possession a few hundred or thousand shillings. Usually the equivalent of 5–20USD. But when I was flagged down on my way into the office one Tuesday I found myself shaking uncontrollably. The cop looked at me and probably surmised that I had done something wrong enough that I would be a generous donor to the cause. He informed me that my drivers license was invalid, which it was not, and then asked if I had 100USD. I started to cry. The cop stared at me for a moment and then took my driver license and walked away to harass a motorcycle driver. I hyper-ventilated. I’ve never had a panic attack before so I wasn’t quite sure how to respond. The cop had probably never seen a mzungu freak out like this before so he wasn’t sure how to respond either. Eventually after nearly an hour of phone calls and me shaking with terror, with the help of a co-worker I managed to get my drivers license back and go on my way. I took another dose of anti-malarial. Low grade panic attacks became the norm. In short order I got used to going out to my car to cry and then fall asleep for a short nap and then wake up crying again.
One morning I was out for a run after a sleeplessness night when I heard a voice in my head which was sort of my own but possessing an authority that my own voice does not. It said very clearly to me: “you should kill yourself.” That isn’t the sort of thing I usually say to myself, or to versions of my self. But instead of just shrugging it off I thought: sure, why not. One would think this would be sort of a warning sign but somehow in my sleep deprived and anxiety ridden state it seemed pretty normal. I was 41 with hazy career prospects ahead of me, limited utility to my employers at the time, a nagging sense of alienation from everything around me, no relationship or progeny. I was, frankly, a pretty good candidate for suicide. But suicide is a surprisingly cultural thing. In the US you get a gun, you hang yourself in Eastern Europe, you OD in the Nordic countries, you jump off tall buildings in Hong Kong. In Kenya though, hardly anyone kills themselves. They’re 114 out of 175 in the country rankings, the US for instance has a suicide rate almost 5 times that of Kenya. Kenyans may simply have other things to worry about. So it felt a little weird to be so caught up in this spontaneous suicidal ideation. I had no idea how to do it and I didn’t really see much around except knives and that didn’t seem like the right way to go. I decided to just, in corporate parlance, table it and get on with things for a little bit. I may have simply been too sleep deprived and haggard to get creative. And there was certainly a part of me that was suspicious of that voice I kept hearing which was mine but also not mine. I took more anti-malarial, I didn’t sleep, I hyperventilated a lot, I got extremely paranoid, and I now had to listen to this voice which was confusingly my own try to talk me out of this existence. It became clear to me that I couldn’t entirely trust myself.
A very strange April slipped into a very strange May. I thought I needed to change careers, or find God, or check into psychiatric care, or all of the above. I read through Peace Corp postings, I read strange religious tracts, I pondered becoming an EMT. Finally one day I was out rock climbing with some friends and I finally confessed that I was having, as I said, “a nervous breakdown”. I mean I just said “yeah no big deal I’m just having a nervous breakdown” as I stood in knee high grass surrounded by the bright orange cliffs and lazily grazing giraffes. She asked what I meant and I described the sleeplessness, the anxiety, the panic attacks, the paranoia. She asked when it started and I said that it was right before I went to Nigeria. “Are you taking Lariam?” she asked. “Yep, it’s great” I said, connecting absolutely none of the dots. “You might want to google that” she replied, “there’s a reason they don’t prescribe it any more.”
Sure enough, I googled Lariam and read scads of research on sleeplessness, anxiety, the markedly increased suicidality of British soldiers who had been prescribed it, psychotic breaks, a treasure trove of red flags. And suddenly all of these things which were me were suddenly Lariam. I was absolved from all responsibility. I didn’t need to change careers or find God or get psychiatric help. I wasn’t a lost middle-aged white guy in Africa wracked with his failures, fears, and incompetence. I wasn’t suddenly experiencing the onset of schizophrenia. It was just Lariam. Silly little pills from the mall. I had the privilege of suffering some not insubstantial mental illness and of also having it revoked almost immediately. I could walk right up to the brink and then, like in the laziest story mechanic, have it all fall away deus ex machina. It was the closest thing to magic that I have ever experienced. I’m not suspicious nor religious nor particularly spiritual but in that moment I felt what the deeply observant must feel when they feel the hand of the divine guiding them: there is very much something else at work here.
In thinking back on this episode, I’m reminded of what Claude Lévi-Strauss called “magical thinking”. Confusingly lots of disciplines use the term “magical thinking” to mean slightly different things but I always like the way that Lévi-Strauss used it: magical thinking is that which allows for mutually exclusive ‘truths’ to be simultaneously true. You can balance thinking that is pretty normal with thinking that is completely pathological to keep the mind focused on that which it can deal with and not on that which it can’t.
Kenya is in so many ways a fiercely modern place, contemporaneous with the rest of the world. And yet amidst all that technology and development is a culture that says: “yes but, you know, witches”. My coworkers cracked jokes about who was a witch or a shaman and not in an accusatory way but in a way that said “well that explains that.” If you don’t get it, if it doesn’t make any sense, maybe it’s witchcraft. Because why not? And I always said that I understood that in the dry sort of academic way that we can understand things which empathy and observation gives us access to. After the Lariam though, I completely understand witches in a way that is real and visceral and true. When you cannot explain something and someone comes to you and says “it’s this person or thing or curse or force” the relief is immediate, immense, and profound. It’s better than being forgiven, it’s being absolved of all responsibility. The drug-induced reckoning that I was having with myself was far beyond my powers to manage or resolve and it was going to end badly. And yet as soon as I knew that it was elsewhere, other, outside, I could laugh it all off. I stopped taking the medication and I stopped caring what my brain was doing and within a week I was sleeping again. No lasting harm, no permanent damage, but a healthy respect for the power of the witch who is over there and who is at once the source of all your woes and their solution.
The most attractive thing about magical thinking is how it lets you externalize blame. Now of course externalizing isn’t all that great. You scapegoat people, genders, ethnicities, minority religions, there are all sorts of nasty vicious ways that blaming the other is bad. That’s true at the macro societal scale and at the individual scale. The DSM has a whole category of “externalizing disorders” in with the Disruptive, Impulse-Control, and Conduct Disorders for a good reason: it’s almost never all just the big bad world outside or that one thing or that one person. In my case plenty of people take Lariam and have no side effects whatsoever, my psychopharmacology played a big part in my un-fun spring. But you’ve got to externalize a little bit, you can’t say “everything is all my fault” because that’s equally dangerous and damaging. The irrational melange of the psyche usually doesn’t know how assign blame with cool perfect rationality; you develop coping strategies, biases, superstitions, and explanations all of which can rooted in sense or nonsense and still have equal effect. When you don’t know what to do, when things don’t make sense, magical thinking is there to tell you that it’s ok, that things don’t have to entirely make sense, that the blame can in part or in whole be laid somewhere else. Fate, God, the witch, that misdiagnosis, that one roll of the dice. And that feeling is easily the most calming reassuring and deeply human feeling one can have.