Democracy has many criticisms and yet a good number of the points raised are valid but it is still the best form of government. It is all-inclusive and quite representative, which equips society to sufficiently calm the agitating nerves of the members of the society. The power of choice and self-determination differentiates human beings from animals which is the facility that democracy offers as a better alternative to military government, aristocracy or theocracy where a few may be leading others on behalf of God without a selection process engineered by the people. This process of selection occurs through the election, which is very competitive and challenging anywhere in the world.
The electorates essentially constitute the market that the intending leaders cajole, persuade and may even indulge to vote for them. The process may actually involve certain use of abrasive and damaging words to sell a candidate to the detriment of others. This is not peculiar only to Nigeria but the character and the content of such endeavours depend on the maturity of the democratic institutions especially the proven ideological leanings of the parties of participating political parties in such nations. Ours is a very young democracy that parades political parties that in my opinion do not differ from each other but vary in membership from time to time.
The variation in membership could be dictated by some complaints from the voiceless polity, which necessitated modification of the strategies used by the minority thieving political elites to hold on to power. The elite class in Nigeria views power as their necessary possession and privilege, which is not only peculiar to Nigeria but also quite dramatic here owing to our pre-colonial leadership cultural software that canonizes certain individuals and grants them immunity to questionings and challenges. This is how our institutions are governed which make it difficult for the principle of democracy to thrive.
Democracy is participatory and seeks to dethrone the oligarchy, the exclusive tendencies of the elite class to always determine the fate of men. The colonial masters saw this opportunity and chose to court the elite class through the indirect rule rather than canvassing the support of the masses. Our successive military governments also rode on the facility of this rulership cultural software to perpetuate themselves in power in quick succession. This has been responsible for our mental conditioning until the advent of democracy again 20 years ago.
Previous elections had been met with arson, killings and violence. Democracy furnishes a process of getting the people who have been repressed and conditioned by dictatorship the freedom to express themselves. This is usually attended by excessive use of extreme and damaging words, character assassination and at times violence against others and their properties. This creates grave mental health issues as long years of hard-earned friendships could be strained with psychological implications even siblings can use the election process to express siblings rivalry. There are situations in which husbands and wives may belong to opposing parties in a way that could threaten the marital relationship. The animosity of the electioneering process could apparently affect the incoming government becoming partial and assume a tool of witch- hunting. This could engender much of mental health implications where certain tribes, persons, families may be discriminated against to score political points. Those who have lost the elections may face grave economic consequences.
The overall message is that we should keep the peace as an indispensable mental health commodity that is crucial for nation building and development. The overall index of social welfare and national development is mental health. Democracy cannot work effectively when leaders do not recognize the doctrine of mental health as the rally point of their manifestoes and style of governance. True leadership is self-transcendent and puts the interest of the masses over and above primitive tendencies. Nigeria needs leaders that can break the primitive rulership software of selfishness and selfish preoccupations by empowering the masses through self-transcendence. The business of governance is not just about the selfish interests of a few but the good of all which is the beauty of democracy that seeks to establish the tenets of mental health.
Lastly, mental health should be in the front burner of our political agenda and programs. The burden of mental health challenges is so enormous occasioned by succeeding years of cumulative leadership failure. As we march forward in nation building, adequate priority and focus should be given to programs like housing, employment, cheap and affordable health care, power and safe roads, which invariably impinge on the mental health of the citizens. Mental health departments should be created in all arms of government to function in a way to help government focus resources on those programs that impact significantly on the mental wellbeing of the citizenry.
Saint Valentine’s Day also known as Valentine’s Day or the feast of Saint Valentine is a holiday observed on February 14 each year. It is celebrated in many countries around the world, although it is not a holiday in most of them. Valentine’s Day began as a liturgical celebration of one of the earliest Christian Saints named Valentinus. Several martyrdom stories were later invented for the various Valentines that belonged to February 14 and added to later martyrologies. A popular account of Saint Valentine of Rome states that he was imprisoned for performing a wedding for soldiers who were forbidden to marry and for ministering to Christians who were persecuted under the Roman Empire. According to legend, during his imprisonment, he helped the daughter of his jailer –Asterius, whom he wrote a letter signed “Your Valentine” as a farewell. The day was later associated with romantic love in the high middle ages when the tradition of courtly love flourished.
In the 18th Century England, it evolved into an occasion in which lovers expressed their love for each other by presenting flowers, confectioneries and sending greeting cards. In Europe, Saint Valentine’s keys are given to lovers ‘as a romantic symbol of a tool to unlock the giver’s heart’.
The modern-day symbols include the heart-shaped outline, doves and the figure of the winged Cupid. The day is observed all over the world and has the same overall message of love. The celebration of Valentine cuts across age, race and social class with embellishments peculiar to the particular group. Overall, it is a day folks make special commitment to give love, receive love and recommit themselves to the tenets of love. The most important aspect of life is relationship hence the measure of the quality of life is essentially the appraisal of the relationship in the person’s life. Beyond the material physical life; our life reflects satisfaction or frustration in the quality of relationships in our lives. Our relationships with one another and in different settings remain the template to invest love or hatred which invariably determines our mental well-being. It is interesting to know that the questions that constitute validated psychological instruments for measuring mental well-being or otherwise investigate the amount of love in our relationships. As we interact with one another; we offend, cross psychological boundaries capable of inflicting psychic pain on others no matter the level of our development.
A good number of mental illnesses arise from the mismanagement of our relationships. Deeds of omission or commission, blatant insensitive words are capable of inflicting psychological injury. Our modern marriages are challenged because of various competing selfish interests capable of causing injury to our mental well-being when love is deficient in our relationships. Even our places of work are riddled with all sorts of conflicts, community clashes and of late terrorism. Beyond the barrels of gun and courtroom fireworks; love is the crucial ingredient for healing our broken relationships. Love has a creative and reconstructive element to it such that it is indispensable in any life. Every human being irrespective of age, race and status desires to love and be loved. No wonder the enormous commercial and social investments that go into the celebration of Valentine worldwide.
Love is a deep affection, fondness, tenderness, warmth, intimacy, attachment and endearment. Beyond these emotional qualities of love; it also has a mystical connotation as a principle of life which makes it a central theme of all religions. Take love out of human existence; chaos emerges. Love at its best transcends fleeting emotions of self-gratification, sex or intimacy. In mystical parlance; love is the bedrock of sacrificial commitment to the utmost good of my neighbor. It is a psychological capacity emanating from some form of mystical experience that transcends selfishness, social class, tribe or religion. Genuine and mature love is more than selfish emotional gratification that refuses to take responsibility. Young people are easily deceived by the chemistry; the emotional firework they have for the opposite sex which is mere infatuation that lacks the quality of self-transcendence and responsibility. Love as a mental attitude remains the most important attribute that our world needs today to heal our broken relationships that serve as a substrate for mental illness. A lot of lives are broken because of the absence of love. I wish I could make tablets of love and give to my patients to heal them.
Let us make a commitment today to engage our relationships on the premise of self-transcendent love. It is the greatest investment for mental well-being as hurts, bitterness and unforgiveness will be eliminated. This Valentine should be an opportunity for us to heal our broken relationships and invest the self-transcendent love in all the dimensions of our lives. This will definitely add up to our overall mental well-being.
Over the years, understanding of the interrelationship of culture, medicine and psychiatry has changed enormously just as the understanding of illness experience as distinct from disease entity has also changed. Today, it is better understood that cultural understandings of health and illness, and beliefs about causes and cures; are directly related to actual as well as perceived effectiveness and ultimate recovery. Medicine has become far more ‘Social’ and cross-cultural which has given birth to a more encompassing, interdisciplinary and less culturally parochial perspective of mental health even in developing countries. These advances suggest that mental health in an indigenous context is better thought of as a qualitative index of the integrity and strength of an individual’s relationships with his or her natural, spiritual and social world.
The medical model of mental illness comes out clear even in cross-cultural and international psychiatry where a strong orientation exists among psychiatrists to discover cross-cultural similarities and universalities in mental disorder. The underlying principle is to demonstrate that mental illness as other disorders occur in all societies and can be detected universally if certain standardized guidelines and diagnostic criteria are followed. The World Health Organization conducted certain pilot studies to demonstrate that mental illness has symptoms occurring together in certain ways in western and non-western, industrialized and non-industrialized societies.
Over 100 years ago, Emil Kraepelin envisaged a new discipline of studying mental illness that will focus ethnic and cultural aspects of mental health and illness. This new discipline was eventually organized in 1950 as Transcultural Psychiatry by Eric Wittkover of McGill University, Montreal. His Collaborator, Henry Murphy defined the principal objectives of the discipline as to identify, verify and explain the links between mental disorder and the broad psychosocial characteristics that differentiate nations, peoples and cultures. Despite ample evidence demonstrating that major psychiatric disorders exist in all societies with similar presentations. There is also evidence that culture exerts modification in a way that determines form, course and outcome of major disorders. It has been amply demonstrated that these sociocultural factors shape the symptoms profile manifested by sufferers differently in developed and developing countries.
A special corporative study conducted in Agra, India and Ibadan, Nigeria showed important differences in manifestations of schizophrenia, which led investigators to conclude that the manifestation of mental illness tends to identify critical problems existing in a particular culture. These potent ethnic and cultural differences are reflective on the symptom profiles of mental illness even if the populations adhere to the same religion as revealed in the findings of comparative studies of patients in Pakistan and Saudi Arabia. Major and more global studies had amply demonstrated that the course and outcome of mental illness have been more favourable in developing countries than in highly developed countries. However, the specific cultural factors could not be defined and in what manner. Factors such as the nuclear pattern of the family, dwindling kinship support for the mentally ill, covert rejection and isolation and confusing roles for the young in our emerging societies.
Our African societies are no longer culturally virgin as we parade a hybrid of western and native cultural orientations with grave mental health consequences. Although we have seen how cultural factors modify mental illness, but certain situations of socio-cultural change in which the stress of acculturation or enculturation can exert profound psychological effect capable of causing mental illness either at individual or community level. The impact of rapid westernization transforms small, tradition - directed communalist societies, consolidated over many centuries into modern mass societies, which invariably lead to an anonymous impersonation of social relationships that generates the loss of guiding norms of behaviour. This breeds conflict between the modern western notions and traditional non-western values which in turn creates cultural confusion and a widening gap between the models of an affluent western lifestyle and the often bleak socioeconomic reality causing feelings of relative deprivation, attrition of traditional guiding norms, cultural identity confusion which may lead to the development of psychosocial syndrome loaded with mental illness.
The recent inhuman Xenophobia that took place in South Africa falls into this category and should be carefully studied in this context. Africa is bedevilled with these forms of occurrences consequent on the loss of traditional culture and of social marginalization due to imposed westernization. Africans should interrogate their cultural beliefs and practices to modify them in the context of emerging globalization of values rather than parochially holding on to them despite apparent signs of irrelevance and mediocrity. This paradigm can adequately explain the model and fundamentally handle the Boko Haram terror group and other emerging militant groups in Africa.
Overall, the crucial role of the mental health paradigm of engaging these issues cannot be over-emphasized.
In medical practice generally and specifically for psychiatry; issues of culture are of central importance. It is difficult for a psychiatrist to have an impactful career without a particular interest in culture. This may explain why the bulk of our quantitative research evidence has not exhaustively communicated the burden of mental illness in Africa and profer effective intervention programmes. This method does not elicit the sociocultural dynamics of a culturally displaced people as a result of colonization with attendant mental health challenges. An anthropological approach to mental health research leveraging on the participant-observation methodology may be a very crucial compliment for a contextual understanding of our mental health challenges.
Culture is defined according to most treaties in comparative psychiatry as comprising the ideas, values, habits and other patterns of behaviour which a human group transmits from one generation to another, or as the whole complex of traditional experiences, concepts, the system of values and behavioural roles in society.
Sufficient evidence abound as early as 1909 that some culture specific-psychiatric disorders exists known under a great variety of folk names. This concept of culture-bound mental illness has been the focus of debates between universalists who interpret these conditions as cultural elaborations of psychopathological phenomena and relativists who view them as expressions of distinctive features of a particular culture. The current clinical paradigm attempts to view them as clusters of symptoms and abnormal behaviors that are plausibly related to specific stress situations consequent on cultural emphases typical of particular populations. These disorders have folk names with peculiar manifestations traceable to cultural factors.
In Nigeria, a couple of these disorders had been described. The Late Professor Adeoye Lambo; a foremost Nigerian psychiatrist and former Deputy Director General of the World Health Organization (WHO) described a particular disorder directly related to culture and culture change."Frenzied anxiety" as he called it was characterized by undue suspicion, hearing and seeing things others cannot perceive in clear consciousness, extreme anxiety, agitation often demonstrative and sometimes dangerous acting-out behaviour in apparent confusion. Usually as a result of fear over sorcery and witchcraft that heightens under rapid sociocultural changes like during the military era. Psychiatrists in neighboring French-speaking countries call it "bouffe delieriante" meaning a cocktail of delusions to capture the dramatic clinical picture. The underlying causes are usually due to potent sociocultural factors. Among these factors according to Lambo is the acculturative stress affecting many persons in many parts of contemporary Africa who have become marginalized in society through rapid cultural change. Under modern situations of urbanization and westernizing acculturative pressure's the traditional communalistic society is disintegrating and the supportive kin network is breaking down. The individual experiences an increasing economic rivalry and social isolation that intensifies the old fears of witchcraft and sorcery; never obliterated by Christianity; while the traditional protective and remedial resources are no longer readily available.
Another popular one is the ‘brain fag’ first reported in 1959 by an expatriate psychiatrist Raymond Prince among Nigerian students. This disorder has been described in students of other African countries who are exposed to the acculturative stress of a western-type education system emphasizing theoretical book knowledge quite different from the practical know-how and traditional apprenticeship acquired through oral traditions from older generations in Africa.
Nevertheless, the older generations expect their wards to achieve academic and socioeconomic success in the emerging modern society and these parental expectations constitute the emotional pressure on them.
Brain fag is usually characterized by bothering sensations on or in the head and body, especially aches, burning and crawling; visual disturbances especially blurred vision and tears when reading; impaired concentration, difficulty in comprehending and retaining learning material in written or oral presentation, feelings of general weakness, dizzy spells and daytime fatigue. This brain fag may actually explain the reason some Nigerians who traveled abroad in the early ’60s did not complete their education and had to withdraw from the university while we claim that they have been called home using traditional spiritual methods.
During the military era and the attendant harsh economic and insecurity situations; ‘genital shrinking’ usually associated with the transient state of acute anxiety, some physical symptoms, and penile retraction. The females may complain of the shrinking of the breasts which were usually associated with fears of impotence or sterility and death in some cases traceable to the predominant thought of magic robbing or bewitchment. Such cases should be referred to mental health experts as these symptoms will temporarily remit with appropriate medications.
However for effective management; there is a need for synergy with the relevant culturally sensitive healing procedures. Paradoxically, our cultural beliefs are being eroded by foreign religious practices albeit retaining basic cultural vestiges such as the use of anointed holy water, oil, handkerchiefs and the touch of a spiritual leader. Other mental illnesses may benefit from this approach if properly articulated.
Almost everyone experiences fear in situations adjudged to be dangerous. In some cases fear is protective because it empowers the individual to come up with psychological and physiological mechanisms to avert a sinister outcome. Fear is an emotional experience with tremendous dramatic manifestations primarily physiological as combat hormones are released. These hormones have immediate reactions on the heart manifesting as increased heart rate that one becomes aware of with attendant feelings of anxiety and tension at times. All these responses are geared towards instituting a response that is defensive and most times proactively protective. The emotion of fear curtailed within the limits of functional equilibrium drives us in the direction of proficiency and excellence so that we will avoid the embarrassment of failure. The menace of diseases and the attendant incapacitation has driven medical science into developing protective strategies rather than cure even in non- communicable diseases. Fear of insecurity and invasion make a whole nation to plan proactively to ward off encroachments. The price we pay for living in the modern age is essentially the fear that our physiological and attendant psychological mechanisms situations generate especially in excess of what is expected and the basic systems of the body can handle. I have a feeling that the unprocessed hijacking of our cultural processes without a systematic evolution of our native mindset may be responsible for our undue fearfulness even as we indulge in the many advances that the western civilization has brought to us. This has made fear an epidemic that has become an integral part of our lifestyle with attendant immature defense mechanisms dominating our sociocultural milieu especially our religious practices, myths and superstitious beliefs. It is essentially a psychodynamic issue rather than the magnitude of the external environmental stimulus because the threshold for fear is usually internalized. When the reason for fear is known; an average person mounts formidable conscious coping mechanisms to handle this emotional state and as adaptation occurs the experience of fear abates. However when fear is experienced without a reasonable cause or when it is definitely in excess of what it is expected then such group of individuals fear could actually become distressing in a way that is difficult for the adaptive strategies to handle. There is a considerable evidence for a familiar or genetic transmission of undue fearfulness. Some psychological theories attempt to explain this undue fearfulness as an unresolved unconscious psychological conflict following some traumatic experiences of childhood. A handful of psychologists attempt to explain this phenomenon as being learnt through association of negative experiences with an object or situation. The repeated negative reinforcement of the attendant avoidance behavior maintains the fear and makes it resistant to extinction.
Definitely fear has torment and can be potently incapacitating in this group of individuals. Undue fear can arise in situations involving potential evaluation by others like at job interviews, public speaking engagements, first dates and any other social setting with a prospect of interacting with others. Many of them are self critical and perfectionist as they attempt to conduct themselves according to extreme and exacting standards to avoid the negative evaluation of others. There are possible associated symptoms like blushing, trembling, dry mouth or perspiring which they believe will be noticed by others and provide further evidence of their incompetence. They attempt to escape from such situations and objects or come up with avoidance behavior to prevent the immediate experience of the fearfulness. These individuals experience significant impairment in social, educational and vocational functioning. They may find it difficult to initiate or maintain social or romantic relationships, avoid classes that require public presentations, discontinue their education prematurely or take jobs below their ability to avoid social or performance demands. They are more likely to be single, less well educated, and they are also more likely to contemplate suicide.. Undue fearfulness can also occur when there is the prospect of directly encountering a specific object or situation or just the mere prospect of encountering the same. Some of these folks maintain a relatively normal routine by pursuing a lifestyle that minimizes exposure to the feared object or situation. This is usually significant enough to interfere with individuals’ career, academic pursuit, social and interpersonal activities. Some of the feared objects include animals, blood, injections, insects, some aspects of the natural environment and situations like the dental procedure or travelling in aircraft and others. Folks with this experience hardly ever get help because the religious and sociocultural milieu encourages denial rater than intervention.. It is s expected that they are referred to mental health specialists where some medications and professional psychotherapeutic interventions can be instituted. Reconstruction of thinking patterns and relaxation strategies to control the attendant physiological responses are crucial as well as problem solving and social skills training.
Sexual assault is an emotionally charged issue with medical, social, political and legal undertones. Many definitions abound depending on the circumstance and context of the assault. The terms "childhood sexual abuse" and "adulthood sexual violence" are based on definitions developed by the American Medical Association (1992); childhood sexual abuse consists of contact abuse ranging from fondling to rape and non-contact abuse; such as modeling inappropriate sexual behavior, forced involvement in child pornography or indiscriminate exposure of the genitals. Adulthood sexual violence includes contact and non-contact acts performed without the survivors’ consent. Sexual violence is defined as completed or attempted contact between the penis and the vulva or the penis and the anus involving contraction; contact between the mouth and the penis, vulva or anus; penetration of the anus or genital opening; and intentional touching of the genitalia, anus, groin, breast, inner thigh or buttocks. Non-contact acts include indecent exposure of the genitalia, verbal and behavioral sexual harassment. These acts are considered sexual violence if they are non-consensual or committed against someone that is unable to provide consent. There are many different terms for sexual violence but I prefer sexual trauma which refers to one or multiple sexual violations that invoke significant mental distress. This term is recommended and used by many clinician and advocates in response to the observation that some victims do not label their experiences as assault due to the familiarity with the perpetrator or the absence of force. The sexual trauma designation is apt because it considers the infringement of the victim’s psychological space and its consequences. This paradigm broadens the scope of the definition of sexual assault as it interrogates the impact on the psyche much beyond the physical observable dramas. It is in this context that rape is deemed possible within the context of marriage. The object of concern here is consent which definitely must have been involved at the inception of the marital relationship as a statutory requirement but equally crucial in the dynamic living out of the contracted relationship. Consent in the context of mental health and possibly in the eye of the law must be dynamic since it provides the psychological visa for a partner to explore the body of the giver within a consensual framework that insulates the partner from mental distress. This paradigm actually overrules a lot of our draconian, primitive, cultural and religious values as it guarantees mental wellbeing. Sexual assault is not only a physical experience but has concomitant psychological consequences. Survivals of childhood sexual trauma are at high risk of post-traumatic stress disorder characterized by intense fear, helplessness, horror, reoccurring recollections or dreams of the event, persistent avoidance of all things associated with the trauma, lack of responsiveness and increased alertness to perceived threats. They are also more likely to suffer from depression, suicide, drug abuse, and eating disorders. Adult survivors of childhood sexual abuse report problems with low sexual interest and few close relationships. In other cases, some survivors display high-risk sexual behaviors (e.g. promiscuity) that may be attributed in part to modeling some of the behaviors shaped earlier in life by the perpetrator. Such folks adopt maladaptive coping mechanisms to induce changes in consciousness and memory; producing perceptions that one is living in a dream or a movie. These experiences are capable of impairing abilities to work or socialize. Extreme experiences of victimization are also associated with symptoms of borderline personality disorder characterized by enduring patterns of instability in relationships, goals, values and mood; non-fatal suicidal behavior and suicidal threats and other harmful impulsive behaviors. Other forms of personality disorders may be distinguished by enduring patterns of suspiciousness, grandiosity and morbid craving for admiration, social inhibition and feelings of inadequacy or submissive and clingy behavior. Victims of adult sexual trauma are vulnerable to immediate distress, fear, anxiety and confusion. They also experience emotional detachment, flashbacks and sleeping problems. Some develop a depressive illness, physical symptoms without medical conditions, severe preoccupations with physical appearances, sexual dysfunction and extreme body piercing and tattooing. Some may have deliberate self-harm and abuse illicit drugs. Parents, mental health workers, nongovernmental organizations and other stakeholders should provide platforms for the referral and care of victims as we encourage disclosures to reduce stigma and raise awareness of available interventions for victims. Parents also must be vigilant to protect children from sexual victimization.
Dr. Adeoye Oyewole firstname.lastname@example.org +234 803 490 5808
Within the first one week of the year; folks will come up with their resolutions for the year. This could be written or remain as thoughts but certainly, this ritual is repeated yearly whether in a religious house, shrine, bar or in the bedroom. What is very certain is that these resolutions are not only peculiar to individuals but applicable to corporate organizations and governments as they allocate resources to actualize their resolutions.
Resolution in basic English language evokes about 5 meanings that are very instructive namely; decision, solution, promise, determination, and a clear picture. Paradoxically, as popular as the practice of New Year resolutions can be; there is equally the cynicism that goes with it. Most folks will readily assure you that their resolutions will fizzle by the third month of the year just as governments talk of 30 percent budget implementation in November of a year. Our failure to live by our resolutions emanate from mental laziness. At the national level, our economic experts rationalize our economic failures on the premise that brilliant economic resolutions fail because of poor implementation strategies. While I am not a management expert, I strongly presume that effective implementation strategies constitute the nucleus of any resolution whether at individual or national level. Our new year and other resolutions fail because they are at best some wishful thinking, some ‘brainwaves’, some esoteric ideology that are not contextually thought through or just frank paranoia at times. The central meaning of resolution around which the other ones hang is that of promising oneself to do something which prescribes that the self must be appraised. The rigorous process of arriving at a definitive diagnosis remains the responsibility of an intelligent clinician by juggling data obtained from history taking, clinical observation and laboratory. Once the diagnosis is missed; no clinical resolution implemented will be effective.
Resolutions are expected to be relevant and practical action plans intelligently designed to remedy deficits elicited through objective appraisal of data. In this context; a 360 degrees feedback from our relationships provide the data. The challenge of articulating an effective resolution rests on the courage to identify and confront our bad attitudes without injuring our self-esteem. Defense mechanisms which are mostly unconscious psychological strategies protect us from coming face to face with our real selves. The human resource industry in the past few years has been parading psychometric instruments for self-diagnosis without a robust contextual appraisal of feedbacks from vital relationships. We can only do an effective self-appraisal as we harvest and objectively engage the many feedbacks emanating from our relationships. Beyond psychometric assessment; our varied relationships with our spouse, siblings, children, colleagues, and community provide the substrate that can facilitate a fund of data that will be useful in self-diagnosis. However this may not come directly but could be excavated from previous arguments, quarrels, business failures, relationship failures even financial misfortunes. Most of us do not realize what life is all about until more than half of it is gone which explains the psychological distress of midlife because it is the critical period that life itself compels us to do a compulsory self-appraisal and the crisis occurs when a workable remedial resolution is not obtainable.
In human resource development seminars that I have facilitated; I discover that an average Nigerian finds it extremely difficult owning up to defective attitudes as they rationalize them as part of their personality characteristics. No personality is bad but there are bad attitudes that require modification through intelligent resolutions. Our bad attitudes emanate from the environment while our innocent personality only acts as the substrate. Personality once formed cannot change because the characteristics are enduring but attitude can be continuously modified. There are obvious impediments to self-diagnosis in our culture essentially because we do not have a contemplative habit; we are very noisy as a people and this stifles our capacity for reflective introspection. Feedbacks from our relationship networks may not always be sincere because our culture forbids spontaneous and sincere feedback. Superstitions, taboos, and myths exist that stifle those pathways that could provide useful data for self-diagnosis. Corruption thrives in our country despite articulate and strong resolutions to combat it because we have a fundamental cultural software that feeds it. Our civil service and academic institutions are bereft of objective appraisal because of nepotism.
A critical and objective engagement of our significant others are almost impossible which has been carried over into our contemporary religion. Our ‘prosperous’ jet flying general overseers find it difficult to define ill-gotten wealth hence they have lost their voice against corruption . Everyone has become self-defensive and self-conceited and as such our resolutions are merely empty chatters explaining the reason for epidemic mediocrity in all the facets of our lives.
Hope is defined as the belief or expectation that something wished for will happen. This attitude of mind connects us to the future and keeps the activities of life focused on future goals in a way that invigorates life. However, the accruable state of mind can experience setbacks and at times total breakdown when the future seems bleak and hopeless especially when certain permutations, forecasts and projections coming from the news media spell doom.
This has serious implications for the mental health according to Aaron Beck in his explanation for cognitive distortions. He is of the opinion that human minds operate according to certain cognitive templates such that when they malfunction can lead to depressive illness which is a very common disorder. My basic deduction here is that our moods are a product of our thoughts. What our thoughts dwell on will invariably dictate the tone of our mood. Hope is in the future and a little distance apart from it being very vulnerable to disillusionment since it is usually not within the conscious rational control of the individual. However, faith is personal, active, functional, energetic, creative and dynamic. It converts the wishful thinking of the future and impregnates it with energy and life. Faith is in the present, active and engaging as it transforms hope from a wish into a real psychic experience described as a conviction.
When I consult with a depressed patient; I perceive incapacitation of a mind to expunge negative thoughts holding it captive and helpless. This incapacitation could manifest as guilt feelings as they take responsibility for every bad thing that has happened in their neighborhoods which provides an explanation for the widowed, old women usually abandoned in the dilapidated family house and most times barren hence bereft of psychosocial support taking responsibility for deaths and mishaps in the neighborhood. The community responds by prescribing death as punishment for witchcraft instead of medical attention and social rehabilitation. For modern city folks; guilt feelings about the past may come as an exaggerated sense of mistake in major life decisions especially at midlife. Death may become the desired means of escape from this tormenting thought pattern. I want to believe that these thought patterns according to Aaron Beck, grow unconsciously in a cumulative manner when uninterrupted. This becomes plausible since mild depressive illness may respond to cognitive behavioral therapy where distortions of the thought patterns are engaged and empirically straightened before they fester deeply and become insurmountable.
Thought distortions can affect the present where the individual perceives self as worthless and injures the hope of a future. When hope is injured; only faith can come to the rescue. Faith has the capacity to take the wreckage of hope and build life into it as individuals get empowered from the inner recesses of their minds to locate the power of omnipotence. Faith then becomes therapeutic as it becomes the assurance, the very psychic energy and the conviction of a new future. The experience of faith builds conviction as a present tangible experience which is superior to fantasy and wishful thinking of the future.
As we enter the New Year we must learn to courageously confront our challenges. The denial of the reality of life- challenges based on an unfounded non-personal conviction in a supreme being is the breeding ground for delusions. This state of mind impairs reality and injures mental health. Faith, as opposed to delusion, confronts the reality of life- experiences, engage it and strips it of its torment by connecting to the power of omnipotence.
It is the Nigerian brand of our religious faith that breeds materialism rather than heal people of it so that they can engage in productive, problem-solving activities. Faith disconnects us from our destructive psychic impulses of survivalism, ego, materialism, nepotism and connects us to the energy of egalitarianism and productivity. Faith releases us from the hurt and bitterness of the past and launches us into love and service to mankind. The principle of faith cannot work when we dwell on negative thoughts of hatred, anger, bickering and selfishness. Faith provides the facility for forgiveness and true reconciliation whether at the family and community levels. Faith in the power of omnipotence secures peace within and peace without.
The message for us especially in Nigeria as we enter the New Year is to confront our challenges in the power of faith as we realistically deploy our problem-solving skills. Faith changes our perception of the situation from the negative to the positive reinforced by the neuro-linguistic practice of positive affirmation. We should endeavor to speak positive words of faith to affirm our belief in the power of omnipotence concerning ourselves, our family, our community and our nation. Wishing everyone a glorious New Year in sound mental health.
A season is a subdivision of the year, marked by changes in weather, ecology and hours of daylight. Seasons are products of the yearly revolution of the earth around the sun. In temperate and subpolar regions, generally, four calendar-based seasons are recognized namely; spring, summer, autumn, and winter. However, ecologists mostly use a six-season model for temperate climate regions that include prespring and late summer as distinct seasons along with the traditional four.
The seasonal changes in weather, ecology and hours of daylight are known to have a direct effect on mental health, possibly through the biological clock and of course indirectly through disasters in the physical environment. Lifetime studies that investigated the relationship between world climate and cultural activities back to the dawn of recorded civilization have shown that there exists a most important 100-year cycle of climatic changes that influences human affair through solar minimums and maximums as the geomagnetic fields intensify interaction with humans electrochemically within the brain. This affects man’s psychological wellbeing by creating anomalous hormonal swings and significantly mutating brain activities. While this fact should not be overstretched, there is significant evidence in medical literature that establishes linkages of seasons to some mental illness.
Man is endowed with a hormonal system that is regulated by an inbuilt biological clock which may be sensitive to hours of daylight as a cue for regulation. The pineal gland in the brain and the uterus in women are major organs in humans with a hormonal activity that may be linked to mental health.
Seasons can impact the physical environment through changes in vegetation, varying rainfall patterns which determine food crops availability and seasonal presence of disease vectors just as flood disasters, hurricanes and tsunamis can exert a grave impact on the mental wellbeing of the people. Folks lose their loved ones and properties and may experience an economic downturn.
The importance of the solar system especially the sun in determining the seasons may explain the reason for its designation as a god to be worshipped. A solar deity also known as the sun goddess represents the sun in its perceived power and strength. Solar deities can be found throughout most of recorded history in various forms. Hence many beliefs have formed around this worship, such as the ‘missing sun’ found in many cultures.
In Nigeria, the Tiv people for instance consider the sun to be the son of the Supreme Being- Amindo. These deities are celebrated in festivals and indirectly through an important food product peculiar to the season like the new yam festival. The essence of this discourse is for us to appreciate the interplay between seasons and the dynamics of human behavior. A good number of our culture-related disorders are associated with seasonal changes. Prominent among them are the ‘Arctic hysteria’ which is a vague general term used by outside observers for often dramatic behavioral reactions shown by indigenous inhabitants of arctic and sub arctic areas in stress situation in which the person affected experiences a temporary state of dissociated consciousness induced by anxiety. Physical deprivation, mineral and vitamin deficiencies and the psychological stress of surviving in an extreme climate have been adduced to explain this phenomenon.
There is substantial evidence that more schizophrenic persons are born in late winter and spring than expected; since respiratory viral infections tend to occur in autumn and water, maternal infection especially during the second trimester of pregnancy may be the risk factor.
Seasonal affective disorder was formally described and named in 1984 by Norman E Rosenthal and colleagues at the National Institute of Mental Health and known variously as winter depression, winter blues and summer depression. Considered as a mood disorder which occurs in folks who are normal most part of the year but experience depressive symptoms specifically in winter or summer. Although experts were initially skeptical; this condition is now recognized as a common disorder with its prevalence increasing especially in the US. While it may no longer have the status of a unique mood disorder, it serves as a strong qualifier for destructing mood disorders. There is also some evidence that suicide is about 10 times commoner in spring than in winter or summer which is consistent with peak times for hospital admission for depressive illness. Africans tend to disguise mental illness as a consequence of seasonal changes and menstrual cycles. Oftentimes this premise is not sustainable but only a form of denial.
Seasonal festivals are oftentimes not directly related to the solar system but could be consequential. Death anniversary of a loved one may be seasonal especially their birthdates The most important lesson is to be proactive and curb certain harmful practices to mental well-being very common during festivals and seek mental health experts opinion when an abnormal behavior is seasonal .
Our society is very primitive both in terms of infrastructure and leadership development. Evolutionists assist us in rationalizing our mediocrity in this part of the world by staging the reason of an endowed, conducive geographical environment as the basis for our complacency. Despite our oil wealth; leadership over the years in Nigeria has not been able to transcend itself. Locked up and imprisoned by primitive appetites, the political elites of this country from independence till date have not been able to develop a robust and functional social welfare system, especially for the vulnerable.
Having experienced both the military and democratic systems of government, it is very clear that our problem as a nation is not the system of government but the thieving elite class that got fixated at the survival plane of the hierarchy of needs resulting in poorly developed social welfare facilities. Massive looting and corruption by the leadership class diverted funds that could have been used for sound social welfare programmes into private pockets to build houses they may never live in while thousands are homeless and mentally ill.
Apart from the paucity of social welfare programs which could have taken care of the mentally ill upon discharge, potent factors that could reenact illness, precipitate and perpetuate it are epidemic.
Unemployment, poor socioeconomic condition, poor housing, insecurity are a few of those factors that our stable mentally ill patients that have recovered insight are discharged into which invariably guarantees a relapse. This may answer the question folks ask about whether psychiatric patients actually get well since the recovery from mental illness is not just a clinical event alone in a sheltered environment but a continuous process of reclaiming lost grounds from the mind with respect to the emotional, social, economic and physical dimensions of their lives. Even for those without the history of mental illness, our present socioeconomic circumstance is capable of collapsing the most adaptive coping mechanisms and tilt folks into mental illness.
Borrowing strongly from the clinical paradigm, relatives are tempted to think that once the patient recovers from an episode of mental illness, behaves normally and takes the prescribed drugs then we can relent. Paradoxically, this is the beginning of another therapeutic process in the journey of recovery. In the developed countries, community based psychiatric practice is robustly developed where competent social workers and duly trained community mental health practitioners follow up discharged psychiatric patients into the community. Through this service, drugs are promptly served and early signs of relapse are noted for immediate intervention. Beyond the clinical services; the social workers who are also part of the team usually help to sort out varied socioeconomic difficulties that are capable of inducing relapse in the patients. Issues of housing, employment and economic sustenance are effectively taken care of in this programme.
In Nigeria, even folks who are fully engaged in a relevant job in the civil service may not be paid for 8 months without any social welfare package talkless of the mentally ill who are still being persecuted at work and being daily threatened to be laid off since they are viewed as unproductive and economic liabilities apart from other forms of discrimination in the society at large. The relatives of the newly discharged patient must take responsibility for providing the social welfare facilities for the ultimate recovery of the patient. Unlike patients discharged from other medical units where drug compliance and clinic attendance are the major issues, families of discharged psychiatric patients in a country like Nigeria must hold meetings to formulate a strategy to empower the patient. Socioeconomic factors, marital stability for those that are married, marital prospects for those not yet married, returning to a place of employment after being discharged, decent housing are part of the factors that promote ultimate recovery.
It is obvious that our governments cannot immediately provide all of these as it is done in the developed countries through a robust community mental health programme, families therefore in our present circumstance should fill in this gap and institute a robust and effective rehabilitative programme. The acquisition of insight by the patient at discharge equips the patient to engage his / her world afresh assisted by adherence to other clinical prescriptions and advice. Insight into the illness provides a rational interactive template between the patient and the therapeutic community with the ultimate goal of recovery. This should be the responsibility of the family making creative use of the cultural value of our sense of kinship in the extended family system while we encourage, persuade and assist our governments at all levels to institute a robust community mental health program.