Mental Illness: The Way We See It

As far back as I can remember, I wanted to become a psychiatrist. At the age of 10, the word “psychiatry” was a chore to pronounce, but I took this lingual predicament in good faith. In my teenage years, I could not differentiate a clinical psychologist from a psychiatrist. I did not even realise that a psychiatrist was a medical doctor.

Years of acquired knowledge have since washed out my ignorance. Today, I am a Senior Registrar of Psychiatry, earning a living at a place popularly called “Yaba Left” in Lagos street parlance; a place that is feared more than it is revered.

Ask the average Lagosian if he or she has seen the interior of this compound and watch their face contort in anger at the implication of your question. The mischievous person might tell you, straight-faced, of zombies in manacles or violent people in straitjackets, perpetuating a silly myth.

The average Lagosian who has used the hospital precinct as a thoroughfare from Montgomery Street to Tejuosho Market may not tell you about the imposing green building, manicured gardens or even the tarred roads, perhaps because this individual walks through the area anxiously, heart in mouth, mind laden with thoughts of encountering an aggressive, naked psychotic with a devilish grin.

If mental illness is shrouded in mystery, how can the place for its care be exempted? How can the people who work in it be exempted from this mystery? Even amongst doctors, psychiatrists are believed to be ‘of a different ilk’. Psychiatry is a specialised specialty. Nobody wants to touch our patients. When mentally disturbed people suffer from other health conditions, they suffer stigma from their first contact with the healthcare official (presumably record officers) all the way to the doctor who hurriedly scribbles a referral letter addressed to Federal Neuropsychiatric, Hospital Yaba.

Back in the late 1900s, when Yaba was an outskirt town of Lagos, an outpost that was far-flung enough to situate a hospital or a prison, or both, I don’t imagine things were any different. Before the then asylum was established, mentally ill Nigerians were taken as far away as the only asylum in Sierra Leone for treatment. As can be expected, this place was overcrowded. To make matters worse, there were no empirical treatments available, besides custody and restriction of movement.

A Brief History of Modern Psychiatry

Psychiatry moved away from the harmful practices of trephination and blood-letting to seemingly effective physical therapies like insulin coma therapy in the 1920s and 1930s. Asylums within colonial Nigeria also moved with the time, from bogus therapies used with a dint of hope to the first antipsychotic, Chlorpromazine, which was delivered in the 1950s, leading to a dramatic revolution that emptied asylums, the place of custodial care.

Suddenly and excitingly, mentally disturbed people had a drug that could “calm their nerves”. In the years that followed, psychotropic medications were discovered in quick succession to cater for a collection of mental disorders and this only helped the West to further divorce itself from religious beliefs about mental illness being a consequence of sin or demonic afflictions.

Mental healthcare, over the years, has been divided into the traditional, custodial and therapeutic phases. Clearly, the West is in the therapeutic phase of mental health care and the scientific revolution is still ongoing. Psychotherapy, pioneered by Freud, has also evolved beyond the couch to specialised techniques that help people stay afloat despite their mental troubles.

In Lagos, these treatments are available: antipsychotic medications as recent as Aripiprazole, and therapies as sophisticated as dialectical behavioural therapy. However, relevance is our problem. The asylum which began as a disused railway building began its transformation into a hospital in the 1950s and has continued to stay within the ambit of acceptable modern practices. With close to 600 bed spaces and Doctor Residency training dating back to 1994, this state-of-the-art hospital is easily one of the biggest health facilities in Nigeria.

Interestingly, these almost 600 bed spaces are always fully occupied, even if a significant number of these beds are perennially occupied by patients designated as “paupers”.

Paupers are patients who have been abandoned by relatives who can no longer be traced. Such patients become the hospital’s responsibility till death. Sadly, they have been institutionalised for life, becoming ‘fauna’ in the mental hospital’s ecosystem.

One in Every Four Humans?

Federal Neuropsychiatric Hospital Yaba is accessed by close to 25 new patients on a daily basis. Of course, this statistic dwarfs the epidemiological maxim that one out of every four people are said to have mental illness. There are reasons for this.

The first is that the mental health specialist and the community have yet to agree on what mental illness is.

While mental health workers opine that symptoms of mental illness are sometimes pragmatic emotional experiences seen in normal individuals, they also assert that these symptoms, if they persist long enough to be durable, distressing to sufferers and carriers alike, and are disabling enough to deter normal activities, qualify to be christened as illness.

For example, if 50 people are laid off from a firm without severance pay, on account of the ongoing economic recession in Nigeria, they are expected to be unhappy and withdrawn from daily activities. How then do we explain the individual whose sadness is so extreme that he has niggling thoughts to end his life by hanging himself from the branch of a strong tree behind his house? Or the individual who consistently hears the voices of his former colleagues discussing his actions when he is alone in his home and they are supposedly at the office? To our community, to their families, many times, this is not mental illness.

They may call it names like ‘severe stress’ or ‘profound frustration’. Some may say it is over-thinking and describe the temperamental defects of the individual. It is everything but mental illness, because, in our community, to be mentally ill is to be stark raving mad. You must lose full control of your faculties; you must be rendered homeless or clothes-less by your illness. You must brandish a weapon; be a danger to yourself or to your family. This is what our society sees as mental illness.

A mentally ill person in Nigeria. Photo Credit Steve Aborisade (Flickr), Ibadan, Nigeria

Mental Illness and African Writing

On the other hand, those who know better are constantly bemused by the fluidity of the phenomenon that is mental illness. Mental illness is on a continuum with mental health and, many times, the diagnosis of traversing normalcy is retrospective. Interestingly, this same close relationship mental disorders shares with normalcy, it also shares with genius and creativity.

The likes of Fela Kuti and Dambudzo Marechera, in retrospect, would not pass through a psychiatric interview without a confident diagnosis. James Joyce’s daughter was known to have suffered from schizophrenia; ditto for Kurt Vonnegut’s siblings. Within three generations of Hemingways, there have been five suicides, including that of Ernest Hemingway. In the 1960s, Sylvia Plath, who suffered from a depressive illness which she thinly disguised in her only novel The Bell Jar, committed suicide. David Foster Wallace, author of the acclaimed tome of a novel Infinite Jest, hung himself in 2008.

Yet in African writing, like in African societies, one can confidently say that art imitates life. Think Jadum, the village lunatic from the poetry of the late poet Christopher Okigbo, or Abulu, the prophetic madman in The Fishermen, the Booker Prize-shortlisted first novel of Chigozie Obioma — sufferers of mental disorders have been shrouded in mystery.

In retrospect, the Delta-awarding winning novel by Hansen Ayoola, She Died Yesterday, published in the 1980s, also comes to mind. The protagonist’s friend’s mother, an agile trader, was said to have gone the market place, affirming that she was a witch and confessing to all sort of heinous crimes. Prior to this, she had suffered a series of misfortunes. In fiction, as in reality, a small pool of people gathers around these individuals, who may be suffering from a depressive illness, with stones or other paraphernalia of the mob, to deliver jungle justice.

Psychiatry vs. Religion

Our civilization often defines mental illness as caused by evil affliction or as punishment for wrongdoing. These dated beliefs still hold sway today and are consequently followed with practices as alarming as manacling the mentally ill and whipping them to confess their sins so that they may be forgiven.

In a panel discussion at a symposium called Mental Illness and Religion held recently at Yaba Neuropsychiatric Hospital, an Ifa priest of the Ijo Orunmila, Pastor Agbato, affirmed that 80 percent of mental illness of today is caused by the conduct of religious leaders, often in a bid to get rich quick.

Enter the Pentecostal pastors in bespoke, colourful suits, Bible-wielding, tongues speaking—the types who conduct miracles in which part of their well-worn script is to ask the mentally disturbed to bring medical reports from certified mental hospitals as a prelude to their miracles. Or those who ask hapless patients to bring their medication to the scene of the miracle, where it is poured onto the ground for dramatic effect and they are sent away with the euphoria of having being purged of their affliction.

As can be expected, these patients often return to the hospital without an appointment card or any recollection of their erstwhile medications. Sometimes they visit other mental hospitals as far away from Yaba as possible. Sometimes, when symptoms begin to nudge their minds, they wear a coat of denial. They insist on the healing that has been meted upon them by their pastor. They find scriptural markings and make a mantra of it. They push farther and farther into their illness, beyond the boundaries of reality into that abyss that is called psychosis.

Usually, when their relatives eventually seek help, they set off from spiritual homes and walk their languorous journey; from charismatic churches of all kinds, where religious paraphernalia as mundane as anointed handkerchiefs are offered, till they eventually find their way back to the psychiatric hospital.