“We are in a masked society. Almost everyone, if not everyone, hides behind a veil that presents well-being and success. It’s how society has conditioned us—to trick others into believing that we are flourishing and that everything is alright.
It’s said, nobody knows what tomorrow may bring. Shantal Kisimba can confirm the veracity of this statement. She had been well—health-wise—going about her usual business, until she wasn’t. On a seemingly ordinary day in 2019, her normalcy was wrecked. She started experiencing unusual physical symptoms in her house, after coming back from her routine errands that revolved around running 'Socks World', her sock business based in Homa Bay, Kenya. First, it was restlessness and a quickening of her heartbeat—as though there was an urgent situation in her chest and her heart was desperate to escape. And then sharp muscle pains. Within a short time, she was experiencing shortness of breath.
What was happening to this visionary business lady, who, since graduating in 2015 from Egerton University with a degree in Environmental Studies, had chosen the self-employment path?
Amidst the pain and laboured breathing, Shantal Kisimba was able to get hold of her mobile phone and place a call to some of her friends.
“I am not okay” was all she managed. The friends treated Shantal’s distress call with the urgency it commanded. They rushed from different areas in Homa Bay and found her in bad shape. One of them had a doctor on her speed dial. The doctor agreed to come see the patient at home.
“Do you have a history of asthma attacks?” The doctor wanted to know.
“No.”
“What about in your family, anyone with a history of asthma attacks?”
“No.”
“And is there a history of any heart-related issues in the family?”
Once again, Shantal answered no.
The doctor gave her an injection to calm her down, and it worked. Her normalcy was restored. It wasn’t going to last, though. The next day, the same bizarre symptoms attacked her, sending the doctor rushing to her place, again. This time, Shantal suggested that the doctor should speak to her mother since her mother was a nurse (and still is) at the nearby Rachuonyo District Hospital in Oyugis. Over a phone call, Shantal’s mother listened as the doctor explained to her the symptoms that her daughter showed. The doctor then advised that Shantal should have an X-Ray examination to determine the state of her lungs and her heart—because all signs pointed toward a disease related to these crucial parts of the body system.
Or was there another issue masterfully hiding behind the veneer of lungs or heart complications? Shantal was about to find out, soon enough. The discovery would shift her entire life.
It was at Rachuonyo District Hospital that she had an X-Ray examination of her lungs and her heart. She had moved from her house to stay at her mother’s in Oyugis, because staying alone, in her condition, wasn’t an option. At home, she would be under the loving care of her mother—a trained nurse—and her younger brother.
While waiting for the results of her medical examination, she was restless. A complication in my lungs, or maybe it’s my heart? God, please, no.
Shantal Kisimba recalls the smile on the doctor’s face when he finally called her into the doctor’s room.
“Look at your face, knotted in fear,” he started. “Don’t worry, your lungs and heart are in perfect condition.”
Those two words perfect condition reverberated on the walls of her mind. She says her greatest fear had been that she was too young to have such serious complications and that she hadn’t lived to see her dream of marrying and raising a child come true. Her life was just starting, and if her recent successes in business were anything to go by, her future was promising.
Perfect condition. Two simple words which on this day symbolised a new lease of life, a lifeline saving her from the storm of fear that had rocked her world. The relief of having her lungs and heart in perfect shape, however, soon got replaced with the plaguing question: If my lungs and heart are okay, then what is wrong with me? The symptoms had been real. As real as blinding sunlight. The problem behind them, too, had to be real.
It was then that Shantal Kisimba was diagnosed with anxiety disorder, specifically panic attacks. Panic attacks apparently exhibit the same symptoms that she had shown.
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According to Mayo Clinic—a nonprofit academic medical centre that is a credible authority on matters of integrated health care, education, and research—a panic attack is “a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause. Panic attacks can be very frightening. When they occur, you might think you're losing control, having a heart attack, or even dying.”
While researchers have not quite established the exact causes, panic attacks are said to result from certain factors. These factors include genetics, intense stress, negative emotions, and changes in the way the brain functions. And once triggered, the attacks come without warning and with no respect to who you are, or where you are.
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In Shantal’s case, there wasn’t a history of panic attacks in the genealogy tree from which she branched. And neither was there a specific recent trigger of intense stress that she could point to. But was there an earlier trauma in her life that torpedoed her peace and set her on a path of sadness?
Shantal concedes it’s very hard to pinpoint the genesis of her sadness, although she can hazard a guess.
“I started being sad at a young age when my parents separated,” she says.
“I was just about to join campus, and I took a hit from the sudden shift in our family. In one moment, I had both parents. In the next, my dad was gone. I never talked to anyone about how I felt, but in retrospect, I struggled with processing the sudden shift and I was sad.”
After joining campus, Shantal started drinking to “suppress her sorrows”. She recalls being “experimental”, trying out different liquors, and at some point, getting addicted to cigarettes. She would, however, at the advice of a close friend and some spiritual help she got while in her fourth year of campus, not only quit excessive drinking but also smoking.
Initially, she blamed her parents. Their divorce had knocked out a couple of lights in her own life. “After a while, I stopped blaming them. They are human beings, and differences are common in human relationships. Unfortunately, their differences led to separation. I believe it was the best decision for both of them. And the way I see it now, if I’m in a relationship that isn’t working, I’ll also walk out. So no, I don’t blame them anymore.”
Shantal Kisimba began treatment for her panic attacks. She was put on anxiolytics. Still, the attacks kept coming at her, each episode more intense than the former—something she had never experienced before 2019. While the daily medication never fully treated her, it helped ward them off.
But the worst was yet to come.
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Throughout 2020, Shantal was on her meds. Things seemed to be getting better until 2021. She began experiencing long bouts of sadness, hopelessness, and zero interest in activities that would normally excite her.
“I lost touch with life. I no longer wanted to go out or be involved in various volunteer works I was doing in my society, including community engagement and youth mentorship. I would cry myself hoarse, and spend days in bed sleeping; feeling hopeless,” Shantal says.
She saw a psychiatrist and told her current story, and history. After a professional examination, she was diagnosed with serious depression and immediately put on antidepressants. Her life had, within a couple years, turned to one of popping pills, given she was still on her daily medication for panic attacks.
Shantal explains that with mental health drugs, it’s always “trials”. You keep trying different meds until you find the right ones for you. As such, she would have reviews with her psychiatrist after every 30 days of being on a particular treatment, to ascertain whether there were improvements or whether she needed a change of meds.
In Shantal’s words—what it feels like to be depressed
What does it feel like to be depressed? In one of her social media posts on Sunshine, a platform Shantal Kisimba runs to advocate for mental health awareness, she posted the cover image of the 2020 Netflix film No Escape (also known as Follow Me) and wrote that she relates to the situation of the woman depicted on the poster.
On this film’s poster is a picture of a woman trapped in a glass enclosure filled with water. She is drowning and desperately trying to break free.
How exactly does Shantal feel whenever depression claws at her?
“I relate with the woman on that movie poster. During my low episodes, I feel like I am…trapped. Drowning. Suffocating. Tired. It’s a bad space to be in.”
***
Despite the intense episodes of depression and numerous suggestions to start therapy sessions, Shantal chose otherwise. She preferred adhering to her medicine only. She wasn’t ready, yet, to open up to someone about her emotions.
A near-death experience: I’d been playing my burial in my head
In 2022 (Shantal can’t remember the exact month), she had a near-death experience—out of self-harm thoughts.
She was feeling lost, and tired. In the days that led to her attempted suicide, she had felt at peace whenever she thought about death.
“I’d been playing my burial in my head on repeat like a favourite song. The thought of being dead and gone gave me peace—I believed that I’d finally find rest. Sometimes when readying to cross the road, voices in my head gave me the idea of jumping in front of a speeding vehicle. But then luckily, I always overcame the thoughts.”
During this particular near-death experience, Shantal had decided that she would finally go through with suicide. She felt she’d be better off dead.
“I’d been crying for a long time, alone in my room. When I finally managed to get some strength, I twisted open my medicine bottle and spilled every last one of them onto my palm. I would have swallowed them had my mum not walked in on me. I quickly hid the pills from her. My precious mother saved my life. I will never forget it.”
Shantal’s mum asked how her daughter was doing, and that was when she broke down and opened up about her struggles with self-harm and suicide. Since matters had escalated and now Shantal’s depression had her teetering on the suicidal edge, they decided to take her to the hospital. She saw a different psychiatrist this time around, just to get a different opinion. She explained how her panic attacks had also heightened, to the point she had once fainted in the kitchen. The new psychiatrist changed her medication. But things were about to get worse for her.
Delusions and hallucinations
She started slitting her arms and thighs. Her life literally came to a standstill—no more fulfilment in running her business, no more volunteer work in the community, and for some time, she couldn’t remember what it felt like to be happy. It was then that she started experiencing delusions.
“I began believing that people could read or hear my thoughts. That scared the hell out of me. Sometimes I’d be in public and my mind would convince me that I had spoken out aloud. And then other times, my mind told me that I had phoned or texted someone or posted something on social media, yet the truth was, I hadn’t. I struggled to draw the line between the real and the unreal, floating between two conflicting parallel worlds. To date, I am tormented by delusions and I have to keep texting friends to confirm whether I messaged them or said something weird during an earlier conversation we shared.” (After the writer of this story interviewed Shantal, she reached out to him a day later, worried that she might have said something weird during the interview. All she needed to be calm was an assurance. An affirmation)
And then came the hallucinations. Whenever she slept at night, in the dark, she would see things. Mostly animals coming after her.
To date, she can’t sleep with the lights off.
This serious turnaround of events got her hospitalised for some time. She recalls the pain in her dad’s eyes when he came to see her.
“We had kept my dad in the dark but when things got serious, we had to come clean. I told him everything. He came running, and I could feel his pain, palpable and visible in his eyes. He was broken to see his girl broken.”
Shantal was diagnosed with schizophrenia, specifically schizoaffective disorder, which can be a combination of schizophrenia and depression or bipolar disorder. Hers was a combination of schizophrenia and depression.
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Schizophrenia is a serious mental illness that warps reality as perceived by the patient. It messes up one’s interpretation of reality. Mayo Clinic lists the symptoms as delusions, hallucinations, extremely disorganised motor behaviour, and disorganised speech and thinking.
Shantal was put on antipsychotics; on top of the anxiolytics and antidepressants.
About the schizophrenia diagnosis, she says, “It was and it still is a burden, but it came as a relief. A huge sigh of relief that, finally, I knew what caused my delusions and hallucinations.”
Up until the time of writing this story, Shantal is still on medication. In 2022, she finally decided to start online therapy and has been under the care of a professional therapist with whom she holds sessions, once a week.
“Therapy has helped me to unpack issues,” she says, “and to develop mechanisms to cope with and manage depression, anxiety and my expectations. It has also helped me to cope with delusions and to know and understand myself better.”
One major challenge she faces today is affording the expensive medication she’s on. Let’s leave the anxiolytics and antidepressants and focus only on the antipsychotics, which are the most expensive. One tablet costs her KSh 70. Every morning, she takes half a tablet and, in the evening, a full tablet. It means that in a day she takes one and a half tablets which will cost her KSh 105 (35 + 70). In a year (working with 365 days), that adds up to KSh 38, 325.
To bring you closer home, it would take you, with the current high cost of living, saving enough money for roughly five bags of cement per month, for you to have KSh 38, 325 at the end of the year.
And while it’s not certain, antipsychotic treatment for patients with schizophrenia could be lifelong.
It begs the question, can the government, through the Ministry of Health, provide these drugs for free or at a subsidised price? The writer sought a comment from the Ministry via email correspondence, but none was forthcoming.
For now, that possibility remains in Shantal’s imagination—of the country she hopes to live in someday. In the meantime, she has to grapple with the high costs. She’s been managing with the help of her mother’s financial aid.
Adverse Childhood Experiences (ACEs), through the eyes of an expert
The writer of this story, through email correspondence, managed to get a statement from Dr Steve Muthusi on mental illnesses and how trauma could be their trigger. Dr Muthusi is a cognitive psychologist and personal development coach with years of extensive research on the brain. In his statement, he shed more light on Adverse Childhood Experiences (ACEs).
“The causes of mental health illnesses are multifaceted and complex. From a cognitive development perspective, factors that affect the neurodevelopment of the brain are candidates for the aetiology of mental illnesses. One such factor is Adverse Childhood Experiences, that is, traumatic events involving some form of abuse, neglect, and/or family dysfunction in the years prior to 18.”
But what exactly happens to the brain when such traumatic events happen? Dr Muthusi explained how neurodevelopment is affected.
“When such events occur, neurodevelopment is delayed and/or disrupted, especially neurobiological systems and executive functions.”
The executive functions referred to here include cognitive and affective regulation processes that aid in adaptive responses to life events—the good, the bad, and the ugly.
“A notable dysfunction that seems to permeate mental well-being is evidenced by neurobiology and epidemiology studies,” Dr Muthusi says. The studies indicate that “exposure to traumatic events in the course of the early stages of development may cause deficits in stress-response systems. Stressful life events lead to the production of cortisol, the ‘stress hormone,’ as an adaptive biochemical response. Whereas this is a good thing, ACEs lead to sustained production of such hormones at a time when the brain is still developing. This may alter the functioning of the hypothalamic-pituitary-adrenal (HPA) axis, a stress response mechanism involving the central nervous system and the endocrine system responsible for adjusting and balancing hormones. This implies that when stress occurs later in life, the response systems responsible may not function optimally to respond adaptively to stress.”
What, then, is Dr Muthusi’s advice to mental health practitioners and mentally ill patients?
“I’d call for a shift from ‘What is wrong with me/the patient?’ to ‘What happened to me?/the patient?’ Moreover, early therapy, even before there is a symptomatic need for it, is necessary for one to unpack their issues. To see the issues for what they are, separating one’s self from them. The opposite is: when not resolved, these issues become so entwined with who we become as adults. And by the time we want to remove the masks, heal our inner world and face our authentic raw selves, we realise that the masks grew into our faces and have to come off with some skin when pulled off.”
Dr Muthusi ended his statement with a much-needed shot of hope: “There is hope in recent research on neuroplasticity of the brain. More than just correcting the manifested issues, it is possible to restore function. That is what therapy and other prevention and intervention programs should aim at.”
A paper that he (Dr Muthusi) co-authored with two other academics expounds on childhood trauma and the relation to cognitive-emotional deficits.
In 2021, Dr Muthusi also shed more light on ACEs, in Aron’s childhood trauma story that was published by Qazini.
I am not my mental illness! Shantal’s work as a mental health advocate
We are not defined by what we go through, but by how we react to what we go through. Shantal Kisimba realised that her life was getting better and better, because of the help she got and is still getting. In a truly selfless act, she decided to help create awareness on mental health and to help others who are going through what she has been through.
“I want to help others like me understand what they are going through, accept it, and seek help. And while at it, I am telling the world that just like your leg or heart or any other part of the body, the brain can get sick too.”
Her selflessness calls to mind these lines at the beginning of Eminem’s 2010 hit song Not Afraid: It’s been a ride…I guess I had to go to that place…to get to this one…Now some of you might still be in that place…if you’re tryna get out, just follow me…I’ll get you there.
Shantal Kisimba is now a mental health advocate working with various organisations to create awareness on mental illnesses. She is fighting for a world where the mentally ill will not be discriminated against or stigmatised. One of the major stigmas she’s had to fight came because of her sudden weight gain, which is a side effect of the antipsychotics she uses. But through her commendable disarming patience she has constantly explained to friends that her brain is sick and that the side effects of her meds include weight gain.
“After explaining to people, they always feel guilty for commenting on my weight. They end up apologising. For me, it’s always an opportunity to enlighten one more person, to teach them that mental illness can affect anyone and at any time because we don’t always have a choice as to what happens to us. Sometimes it’s just life doing its thing. Society should therefore support the mentally ill, not discriminate against or stigmatise them.”
Shantal has offered many public lectures on mental health and boldly shared her personal experience both online and at physical gatherings. She runs an online space called Sunshine, an apt name because her mission is to “radiate the sad days of others”. A passionate writer, she also runs a blog, Power Galore, where she tells stories of people’s pursuits—passions, talents, and career achievements. She was recently involved in a Twitter Spaces panel discussion where she bravely spoke about the importance of medicine adherence for those diagnosed with mental illness.
Some of the organisations she has worked with include Society Empowerment Project and Activate Champion. She has also partnered with individual mental health advocates, churches and schools to further the education and awareness of mental health. She is passionate about film production and is part of Zawadi Filamu Productions. During her free time, she enjoys dancing; travelling; socialising; trying out different foods; and having a good sleep. Indeed, nothing beats the peace of a good sleep.
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Writer’s note:
It’s never easy to open up like this, especially on personal struggles like mental health issues. That’s why I’d love to commend and appreciate Shantal Kisimba for selflessly sharing her story with me—and through that—with the world at large.
The best that we can all do for Shantal is give her an ear. To listen, and act. In a separate conversation with her, she lamented, “We are in a masked society. Almost everyone, if not everyone, hides behind a veil that presents well-being and success. It’s how society has conditioned us—to trick others into believing that we are flourishing and that everything is alright. We need to change this; we need to create a safe environment that enables people to speak out, honestly, about the various issues they face, and to bravely seek help. And when someone opens up to you, be a true safe space.”
It’s sad and regrettable that some people pester others to open up, yet they are not true spaces, all they’re after is a story to tell when indulging in banter.
My hope, dear reader, is that by telling Shantal’s story I’ve inspired you to build a better world for yourself and for others. I hope we can encourage those going through mental issues to shoot up a flare, and that when flares are shot, we can be true responders; true safe spaces.
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Kenya Red Cross runs a toll-free line; 1199 that provides 24-hour free tele-counselling to the public.
For more information on the efforts of the Kenya Red Cross in offering mental health and psychosocial support, visit their website.
