Health is not just the absence of illness

By Professor Taiwo Sheikh

Welcome to this week’s mental health conversation, this is a chat room where we discuss the basics of our mental health in order for us to understand and have a full grasp of the rudiments of mental health and well-being.

This is part of our mental health advocacy activities aimed at promoting our wholesome wellness, prevention of mental illness, improving our awareness of mental illness, understanding that effective, qualitative and modern (technology based) mental health services are available to ensure quality living, harmonious interpersonal relationships, peaceful coexistence within our communities and enhancement of our commonwealth.

That we can discuss mental health in major public forum like this and social media is a significant stride for global mental health and specifically, our local mental health advocacy! Especially considering the enormity of social, cultural and traditional barriers to mental health/mental illness discussions.

A recap of our last conversation: we discussed “depression and suicide”! That depression is a mental health disorder characterised by persistently sad/depressed mood or loss of interest in pleasurable activities (including work) or loss of energy or a combination of any of these symptoms, causing significant impairment in daily life.That depression is a common mental disorder affecting more than 264 million people worldwide and about 8million (4 percent) Nigerians (Female 5 percent : Male 3.6 percent) and suicide is a dreaded complication of depression. Today, we are discussing stigmatisation of mental disorders.

I will like to illustrate today’s conversation with the story of Abdullahi, Monday and Engineer James (all hypothetical).Abdullahi and Monday are friends; they are both in the same class (primary four) in a village primary school. Abdullahi is a friendly, honest and fun loving boy, admired by most of his classmates. He finds Monday to be a honest and hardworking friend who never wants to get into trouble with the teachers or senior pupils.

They have many things in common but most significantly, they are both from a humble family background. Monday had few friends in the class and in the school as well, he has a sister (Rose) in primary three who seems to have no friend at all in the school!

Monday cherishes his friendship with Abdullahi and they spend most of their time together. Some days after school, Abdullahi will follow Monday to his house before proceeding home. Monday once told Abdullahi that he (Abdullahi) is the only pupil in their school who goes to their house and this further strengthened their friendship.

Monday’s mother likes Abdullahi and she treats him well, though she doesn’t speak much and only occasionally. Sometimes she will insist Abdullahi eats with her son (Monday) and he (Abdullahi) will oblige. Abdullahi often notices that Monday’s mother appears withdrawn and lonely.

He has never seen visitors in Monday’s home, he also observes that most times she utters inaudible words to herself, while at other times she converses aloud with unseen people and often laughs alone (fatuously). But these observations did not affect their friendship, he never mentioned them to Monday and it didn’t discourage from following his friend home.

One day, Abdullahi returned home from school and his mother sat him down for a serious talk!

He suspected something must be wrong. She told him that she heard that he is befriending the son of the “mad woman” in the village, and that she also heard that he had been going to the house of the “mad woman”.

She expressed disappointment that Abdullahi even eats the food cooked by the “mad woman”! She then went on to warn him to sever his friendship with Monday and stop visiting the house.

She told him that Monday’s mother is afflicted with “spirit” and that she could transmit the “spirit” to him either by touching him or through the food that she cooks!! She threatened to severely punish him or even withdraw him from the school if she ever hears that he maintains his friendship with Monday.

She then assigned Abdullahi’s cousin who was in primary five to watch over him in school and always escort him home.

She finally told Abdullahi that his friendship with Monday is bringing shame to their family in the village.James is a young university graduate; he read mechanical engineering and was the best in his class. He secured a job as plant engineer at a large plastic manufacturing company.

He is a friendly and pleasant young man, hardworking and always meets his set goals. His attitude to work, energy and social receptiveness endeared him to many of his colleagues in the factory. The factory runs three shifts because of the volume of their production, they have orders that must be met and with workers like Engr. James, they never failed their clients.

One of the three engineers had to resign because he had opportunity to migrate to Canada; the factory was left with only two engineers. James had to do double shift to cover the vacuum created, and being the most junior engineer, he had to take on more hours and additional responsibilities.

This translated to longer working hours and sleepless nights! After four weeks, James started experiencing difficulty with initiating sleep and later felt he had little need for sleep. He became happier than usual, quite talkative, socially disinhibited and was more ambitious than he used to be.

His happiness gradually turned into irritability, he became more argumentative, overconfident and unreasonable sense of  self-esteem. This change in behaviour brought him head-on with co-workers and resulted in a fight with one of the technicians. The senior engineer attributed his behavioral problems to stress and advised he should take a week off work to rest.

The General Manager of the Factory had a different opinion; he attributed the change in behaviour to arrogance and “suspected use of (psychoactive) drugs”, although no one has ever seen James with drugs.

A week after the onset of the problem, James’ condition was worse, the inappropriate lack of social inhibition was uncontrollable and irritability has grown into aggressiveness.

His family stopped him from going to work and sought spiritual intervention believing that it was handiwork of enemies.

Some advised traditional intervention (medicine). The family spent another three weeks shuffling between spiritual homes and traditional healers, at some point, James had to be restrained through shackling, he was quite pitiable and his condition continued to deteriorate.

After four weeks and pressure from family friends, he was taken to a psychiatric hospital where he received treatment for three weeks and he made good recovery. He was pronounced well and was ready to return to his work.

Many of his colleagues at the factory appeared to be happy when James appeared at work. The General Manager invited him to his office and after exchange of pleasantries, he advised James to return home to convalescence for another week. James was surprised at his proposal but obeyed. Four days later, James received a letter from the factory informing him that his service was no longer needed, he had been laid off!

Prejudices against people with mental illness are widespread in our society leading to so much detrimental consequences (physical, social and economical).

Stigma can be defined the action of describing or regarding someone or something as worthy of disgrace or great disapproval, it is a sign of disgrace or discredit, which sets a person apart from others.

If you stigmatise someone, you have given that person a label, and it’s usually a label that is limiting (degrading) in some way.

Stigma arises from sets of certain stereotypes due to some myths and misconceptions about particular conditions; it leads to development of prejudice that leads to discrimination and social exclusion (as Monday’s family was treated in the village).

Public mental illness stigma involves the negative or discriminatory attitudes that others have about mental illness. Self-stigma refers to the negative attitudes, including internalised shame that people with mental illness have about their own condition.

The stigmatisation of mental illness is a serious problem affecting patients and their relatives as well as mental health care personnel working with persons with mental illness and mental health institutions.

The more a mentally ill person feels stigmatised, the lower is their self-esteem, social adjustment and quality of life.

Stigma can adversely affect family relationships as we have seen in the friendship of Abdullahi and Monday, it can lead to employment discrimination as we have seen with Engr. James and can also lead to general social rejection.

Finally, stigma can lead to poor mental health seeking behaviour and therefore constitute a barrier to uptake of mental health services.

It is also a major reason why sufferers of mental illness fail to acknowledge their illness (denial of mental illness due to self stigma) and it has been described as the underlying factor mitigating against the social re-integration of those recovering from mental illness as seen in both stories we read today.

Negative and stigmatising public attitudes towards mentally ill persons therefore have direct implications for the prevention, treatment, rehabilitation and quality of life of those affected. Poor community knowledge of causes and the presentation of mental disorders have sometimes been advanced as reasons for stigmatising attitudes. At the workplaces, mental illness is among the most difficult problems to handle.

There are several enduring myths about employees with mental illness, the beliefs that they cannot handle stress or do quality work, that they are unpredictable and potentially violent and that their conditions are incurable abound. None of these is true! The public often trivialises mental health issues and treat as if they are something people can overcome if they just “try harder”.

At other times the public use phrases like “mad”, “crazy”, “kolo” or “nuts” to describe other people or their behaviour, especially the media. These are stigmatising words and descriptions. Knowledge about mental illness and familiarity or contact with the mentally ill is important in reducing stigma. The Nigerian mental health service delivery policy and the mental health bill that is awaiting passage into law contain include anti-stigma educational programmes and encourage diagnosis, treatment and care of people with mental illness in the community.

I hope today’s conversation will add value to your understanding of mental illness stigma and its deleterious effects. Stigma could be public or self, it has been reported to be a major determinant of mental health care service uptake. It has also been shown that stigma involves discriminatory attitudes that others have about mental illness that can be directed towards mentally ill patients and their relatives as well as mental health care personnel working with persons with mental illness and mental health institutions.

Situations, where stigma is deeply seated among policy makers, can lead to lack of equity in the distribution resources for the care of the mentally ill and mental health institutions. Specific advocacy targeting reduction of stigma and discrimination of the mentally ill, improving awareness of the public on mental health and mental illnesses, improved mental health care services by integrating mental health into all levels of health care delivery will stem down mental health stigma. Importantly, addressing mental health stigma in Nigeria entails that the government should implement the national mental health service delivery policy and pass the mental health bill into law.

Readers’ comments

Are these symptoms of mental health problem?

Dear Prof, 

Thank you for your contribution on the above subject matter. Could the following be  symptoms of mental health problem:1?

A lady of 30 years does not show interest in marriage and having children, and does not have known relationship with the opposite sex.

2. She hardly goes out, is a freelance writer for media houses overseas. She does not disclose the names of the media houses nor make her articles available to family members.

3. Mostly on her own, occasionally comes out of her room.4. Goes out occasionally to meet with friends unknown to members of her family in locations she does not disclose.

5. Had suffered from depression.6. Suspected to have taken drugs some years ago.   How could she be assisted?

Kindly consider this as a private affair.

Thank you.

Anonymous

‘Stigma’ benefits no one

Dear Prof,

I am not persuaded that employing the term “stigma” instead of prejudice and discrimination in any way benefits anyone

Anonymous

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