This column will today complete a trilogy of pieces on mental health. The exercise has been deliberately targeted at sharing understanding of how traditional African societies, from Yorubaland to Matabeleland, view and try to deal with ‘serious mental illness.’ So-called ‘Minor’ Mental Disorders, such as Anxiety and Depression, are vastly more common and occupy a great deal of public attention and sympathy.
But when people talk about mental illness, especially in a pejorative sense, they are referring to the ‘serious mental illness’ known as Schizophrenia. It is the ‘madness’ or ‘insanity’ of old-time writing, and ‘were’ in Yoruba traditional parlance.
Sadly, most of the people with this easy-to-diagnose problem in Nigeria do not receive treatment. This is due to a multiplicity of factors. Treatment is scarce, it is not free, and is even excluded from routine National and Social Health Insurance coverage
More than 50 percent of people on admission at any time in any psychiatric hospital are likely to be on treatment for Schizophrenia. It is the public face of Mental Illness and the reason why there are so many false beliefs and wrong assumptions about mental illness generally. In Lagos, and in Nigeria at large, there are lot of otherwise able-bodied young men and women wandering about the streets, naked or in tattered clothing, talking to themselves and appearing unmindful of their environment.
They illustrate some features that make schizophrenia an unpleasant social condition all over the world, such as the fact that those who are ill with it do not believe there is anything wrong with them. Because of this absence of insight, the troubled person would generally not seek treatment, and might resist if an attempt is made to force it on him.
Schizophrenia is one of the main reasons why countries have Mental Health Laws, which give doctors and law officers the right, under certain conditions, to arrange to forcibly convey a person suspected of such illness to a ‘place of safety’ for observation and treatment.
Schizophrenia affects approximately 24 million people worldwide, or 1 in every 300 people (0.32%). This rate is 1 in 222 people (0.45%) among adults. This relatively low rate may be compared with the often-stated fact that between 10-20 percent of people in society are likely to experience Anxiety, Depression, or some other related condition in the course of a lifetime.
The internal experience of schizophrenia for the affected individual is among the most disturbing feelings known to man. Among them is the experience of delusion, where a person develops a firm unshakeable belief that is, unfortunately, not true. One of the breaking-in experiences for this writer, while working as an NYSC doctor in a psychiatric facility, was seeing a well-dressed young man bundled into the consulting room by some fierce-looking soldiers.
The story was that one morning, he went to Dodan Barracks, where the then Military President held court, and announced to the soldiers at the gate that he was the President of Nigeria and he had come to claim his seat. Needless to say, he was beaten black and blue, and barely escaped being shot as a coup plotter. When you talked with him one-on-one, he was calm and polite. He did not see why the soldiers were acting so strangely. He did not get it.
Another experience may be the hearing of voices which sound very real to the person, even though nobody else can hear them. The voices may be threatening or abusive, and they may be running commentary on the person’s actions. The person may feel his thoughts and actions are being controlled or manipulated by an outside force, or that they can be heard or known by them. His thinking and emotions may be disorganised, and his speech may become incoherent. He may lose the ability to perform simple cognitive tasks, such as doing sums or writing a memo in the office.
Sadly, most of the people with this easy-to-diagnose problem in Nigeria do not receive treatment. This is due to a multiplicity of factors. Treatment is scarce, it is not free, and is even excluded from routine National and Social Health Insurance coverage.
There are few psychiatrists in the country and few specialist facilities. The universal movement towards community care and taking mental health to the primary care level is yet to take off properly in Nigeria. Relatives often get tired of caring, because of the cost and also because of the sometimes-disruptive behaviour of the individual. People with long-established untreated illness may wander away from home.
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The man sitting in tattered clothing on the culvert in Victoria Island, talking to himself and feeding on scrap may have walked all the way from Badagry. His relatives most likely have no idea where he is.
The state of knowledge regarding what causes the illness is that it is an interplay between a person’s genes and certain environmental factors, including upbringing, drug abuse and social trauma.
There is a wide variety of effective treatments. Most people improve on treatment. There is a tendency to relapse, especially if long-term follow-up is not carried out.
How a society deals with schizophrenia is a test of its own humanity. Persons living with schizophrenia are the most stigmatised people on earth. Their rights are violated by family members and outsiders. Even after treatment and recovery, they are discriminated against in the workplace, and in inheritance and other legal matters.
A useful addition to the sparse caring resources for Mental Health in Nigeria is the ‘Half-way House’ – where someone who has been ill for a long time and has received treatment but is not yet fully ready to resume the responsibilities of outside living is rehabilitated and gradually reintegrated into society under supervision. The outlier and replicable model for this crucial linkage is a privately owned facility named Nature’s Crest which is in Oto Awori town on the outskirts of Lagos.
The world-wide Schizophrenia Day celebration on the 24th of May and the focus on the subject all week long, present a fresh opportunity for society to understand the illness better, and to creatively plug the existing gaps in the fabric of the nation’s mental healthcare. Afterall, nobody is immune to mental illness, one way or another.
