Managing ignorance and neurotic disorders

Across the world 10th of October was observed as Mental Health Day. It is a day that has been set apart for creating awareness on mental health issues. First celebrated in 1992 at the instance and initiative of a global mental health body – World Federation for Mental Health- about one hundred and fifty countries celebrate this annual awareness programme. It is in recognition of the fact that mental illness is real, ought to be taken seriously and legislated on. In Nigeria, some advocacy groups took out time to celebrate the day through talk shows and other forms of awareness programmes.

However, mental health remains a ‘closet’ issue in Nigeria and indeed Africa. Although many persons suffering from different forms of mental health illness live in our country, it is still a taboo subject. Not much attention is paid to the illness nor to solutions and policy framework. Sadly, ignorance and superstition dominate most discussions on neurotic disorders.

In the last one year or so the number of persons who have committed suicide has increased. The most celebrated cases are the ones who took a plunge into the Lagos Lagoon from Third Mainland Bridge. Students and other young people now routinely drink poisonous substances or hang to end their trauma. This is worrying to say the least. Suicide or suicidal thoughts, as we may know, is one of the end stages of prolonged depression.

The Lunacy Act of 1958 was the first official policy document on mental health in Nigeria. In 1991, 2009, and 2013 there were efforts to revisit the rather antiquated and derogatory ‘Lunacy Act’. A new mental health policy was introduced in 1991, which made provisions for strategies, details and provisions of funds to deliver the key objectives of mental health. In reality, however, we are thousands of miles away from taking any vigorous action on issues of mental health. Central to this poor approach and social neglect is the level of profound ignorance about mental health illness.

Mental health refers to a level of psychological wellbeing. That is, the absence of illnesses associated with the mind or mental faculties. It ‘entails the optimal development and use of mental abilities (thinking, reasoning, understanding, feeling and behavior) required for normal level of functioning.” Mental ill health ranges from the mild to the severe. While some victims live through life and function properly some others are usually knocked down and debilitated by the diseases. Persons manifest strange behaviour, sometimes arising from severe trauma. As human, our threshold of strength or resistance varies. While some people are able to cope with adversity – financial loss, loss of a loved one, a failed relationship, marital difficulties, severe illness in close relatives, onset or terminal stage of a debilitating physiological ailment, disappointment- some others simply break down.

What most do not realise is that anybody can become a victim of mental ill-health. One’s age, religion, social or financial status is not always enough insulation or protection against depression, schizophrenia, bipolar disorder, psychotic behavior, dementia, hypomania/mania and other forms of neurotic disorders said to number up to two hundred. Across the world, there have been cases of highly successful people who suddenly (in the eyes of the world) took their lives. The truth is that such ‘happy and successful’ persons may have been battling mental ill-health privately.

One of the many myths associated with mental diseases is that it is the result of a ‘spiritual attack’ or the effect of punishment from ancestors because the victim committed a ‘tabooed act’. Yet some others erroneously believe that it is through spiritual ‘casting and binding’ that mental ill-health can be contained. As a result, victims are often taken to the notorious ‘spiritual churches’, spiritual healers, and/or ‘babalawos’ or ‘dibia’. At such homes, patients are subjected to harsh and violent treatment to ostensibly ‘drive out the evil spirits’ in them. They are often chained and kept in sub-human conditions. Some die in misery. One of the most embarrassing features of social life in Nigerian villages, towns and cities is the ubiquitous presence of ‘mad men and women’, referred to in local parlance as ‘crase men/women.’

Culturally, we seem to accept mentally unstable people roaming the streets as a normal. This we can find in some of our cultural practices and allusions. For example, the saying that, ‘a mad person is okay for the town; but it is not good for a family’, reflects this ambivalence and contradiction. The so-called ‘mad people’ come from families; and they can be cured through medication and social support and care.

No doubt, we need a cultural and social re-orientation. A new and vibrant mental health policy through government participation and direction is also required. The other day, the United Kingdom appointed a Minister of Suicide Prevention. The low-hanging fruit in this new thinking must be education and enlightenment through advocacy and curriculum review. It is curious why authorities in Abuja and most state capitals have been indifferent to this.

Mental health ought to be taught from primary school level in order to create sufficient awareness. The state of New York recently became the first State in the US to launch mandatory mental health classes in all New York schools from the age of three.

As a result of ignorance, people attribute symptoms and manifestations of abnormal behavior to juju or witchcraft attack. The use of words and expressions as ‘Yaba left’, Aro’, ‘Aro-mental’, and ‘lunatic’ in reference to people who have mental health disorders should be avoided. There should also be a campaign against stigmatization of persons who go down with mental health diseases. Often families live in denial when a nervous breakdown occurs.

Indeed, families often hide their relations who break down mentally. The mentally-ill needs support and understanding. Some of our aged parents also manifest symptoms of mental imbalance in their twilight years. Culturally, in some cases, before marriage is conducted between families, emissaries are quietly sent to find out whether ‘madness runs in their family!

Also, there should be adequate training of health personnel- psychiatrists, medical officers of health, psychiatric nurses, clinical psychologists, and community health workers. Although an accurate figure has not been provided by the appropriate authorities, it has been reported that we have less than one hundred psychiatric doctors practicing in Nigeria. Medical students are not encouraged by our social culture to venture into that branch of medicine because it is not ‘lucrative’.

The number of psychiatric hospitals in the country is also not enough, considering the number of cases that has been reported in recent times. Caregivers are not encouraged; indeed we lack sufficient personnel in the world of psychiatric medicine. The governments at different levels should encourage advocacy groups by making grants and funds available to them. This is because one of the by-products of the increased social pressure, which men and women are exposed to in the contemporary age is mental health challenges. The government should provide the lead in recognition of the terms of the social contract between the people and the leaders.