Dr Aina Oyekanmi is Chief Consultant Psychiatrist at Federal Neuropsychiatric Hospital, Abeokuta (a World Health Organisation, WHO Collaborating Centre for Research and Training in Mental Health in Nigeria).
She has over two decades of practice and experience in mental health care, and has conducted extensive works in women’s mental health, as well as workplace and performance impacting mental assets. She has attended and participated in several workshops and training in the field of psychiatry and community health care delivery.
The veteran psychiatrist has contributed to national mental health through several public education and enlightenment programmes, as well as publications, covering general mental health, women, children and adolescent mental health, and psycho-social issues.
She is the founder and coordinator of MentalForte, an organisation aimed at promoting mental health literacy and quality care delivery through various multidisciplinary intervention programmes, and mentalforte.com – Nigeria’s first multilingual platform for mental health.
In this exclusive interview with NewsClick Nigeria’s Toyibat Ajose, she unambiguously takes on the important subject of mental health and illnesses using simple language for the understanding of the everyday Nigerian. Amongst other things, she touched on stereotypes, symptoms types and treatment of mental illnesses in adults and children.
How will you describe mental health to a layman?
Mental health is a topic that a lot of people don’t understand. There are a lot of misconceptions about mental health. Now, when you say Mental Health, let me take it one by one. Mental means the mind. In medicine, we have technical term for all the organs of the body. For the liver, we’ll say hepatic, for the heart will say cardiac, for the bone to say Osteo, for the eyes rule says ophthalmology, for the kidneys we say renal, so when we say mental we mean the mind, we’re referring to the mind. A lot of people think that mental means madness. No it doesn’t. It simply refers to the mind.
When you say mental health, we are talking about the health of the mind, which is mind health. Just as we used to say cardiac health, we are talking about the health of your heart. If you say renal health we are talking about the health of the kidney.
Mental health is the health of the mind. Where is the mind? A lot of times people think that the mind is located outside of our body, that’s not correct. The mind is in our brain. So the brain is the organ of the mind. And the brain is inside our heads. So it is your brain that controls your thoughts, emotions and your behavior. So Mental Health simply refers to the action of your mind, in terms of your thoughts, your feelings, and your behavior that helps you to be able to enjoy life, to cope with challenges, to deal with different challenges that come your way, to be productive, to contribute meaningfully to the society to live a meaningful life, that is what mental health is all about.
Mental health is the capacity of one’s thought, feelings, and behaviour to help one to be productive, to have seaming relationships, to be able to handle challenges that come with life. That’s what mental health is all about.
Can you list the types of mental illnesses we have?
Okay, now, there are many types of mental illness. When people think about mental illness they think it is only about those people that walk naked on the street that hoard or pick rubbish from the ground or talk things that people do not understand. That’s not the only type of mental illness we have. In fact, that’s one is just an extreme. Very extreme type of mental illness. We have different categories of mental illness. Mental illness can affect the thought, can affect emotions, and it can affect our behavior, right? So I’ll just mention some common ones, the two type of commonest mental illness that exists is depression and anxiety disorder. They are very, very, very common. And a lot of time, a lot of people suffer from these disorders and they don’t even know what it is. Other types of mental illnesses would include things like substance abuse, which many people can call addiction; we also have schizophrenia, bipolar disorder.
Bipolar disorder is a disorder of the mood wherein somebody would have two extremes moods so at one point, the person might be too happy. At another point, the person might be too sad. So it’s like the person choosing between one end of the pole or another.
Schizophrenia is when there is a breakdown in our thought and affection. Other mental health conditions include things like, Obsessive Compulsive Disorder (OCD), Personality disorders. You know, just to mention, but the commonest ones are depression and anxiety disorder. We still have a lot, but these are the commonness ones that we have.
What are the symptoms of mental illness?
Okay, now, most mental illnesses don’t start in a severe form like most illnesses, for example, malaria. Most times when we have malaria, malaria can start with maybe slight headache, and then can progress to maybe severe malaria whereby one may be hospitalized. The same thing happens in mental illness. A lot of times, it’s start little. It starts with small symptom, and people ignore or they don’t even know what it is. Each type of mental illness has its own unique symptoms. However, there are some common symptoms in most mental illnesses; things like changes in appetite and sleep patterns. It could be that the person starts sleeping more or loses appetite. It could be that the person is now sleeping too much or not sleeping well. Sometimes, you can wake up in the morning and don’t feel refreshed.
Another symptom is inability to concentrate, like finding it so hard to keep your mind on a particular task. Sometimes, it can manifest as negative emotions like sadness, instability, you know, little things would upset you and people will have to be walking on eggshells around you. It can manifest with despondent mood, it can manifest with anxiety. It can manifest with too much happiness, when somebody is too happy. You know, for example, when somebody has mania. Mania is one end of a bipolar disorder. The person can believe that he owns the world, has a lot of money in the bank, and the person may just be giving out a lot of possession, that’s one type of manifestation. Sometimes it can manifest as social withdrawal. Like someone who likes to mingle before with people just withdraws. It is called social withdrawal and can as well be a symptom of mental illness.
Sometimes forgetfulness too can be a symptom. So by and large, any change in one’s behavior, any change in one’s thinking patterns, or any change in one’s emotion can actually be symptoms of mental illness. And I have mentioned the commonest symptoms. These symptoms usually appear in the onset but they can progress into what we call delusions and hallucinations. Hallucination is perception without any stimuli. So, for example, somebody might say that he’s hearing voices. He might say that he is hearing voices of people talking to/about him when actually no one is talking about him. He might say that the birds are calling his name, the trees are talking to him, he might say that the neighbours are always talking about him when they are discussing and that him he can hear them and none of this might be true.
Sometimes it can also manifest as delusions. These are abnormal beliefs that are held even when there is evidence to the contrary. So for example, a person may say that he is God, and he has the power to do anything.
Sometimes it can manifest as delusions that some people are out to kill him. The person might even accuse his loved ones of trying to kill him, this is called paranoid delusions.
In this part of the world we are so religious. We ascribe a lot of things to spirituality. So imagine somebody who is mentally ill and his hearing voices, or having paranoid delusions, that can be misinterpreted. The pastor, Imam or herbalist might interpret it as people from the village wanting to kill the person when in reality it is not so.
A lot of time because people don’t understand that these are symptoms of mental health, there will now be going from one church, mosque or herbal home to another doing different types of deliverance believing that people want to kill them. In fact, a lot of times people believe that mental illnesses are afflictions from devil, or that they are caused by demonic possession, or that they are results of some evil the person has done. This is also propagated by Nigerians home videos. If you watch an average Nigeria movie, all these Nollywood movies whether its Igbo or Yoruba or English, they portray mental illness as an affliction for wrong doing. So, for example, they might say that, oh, this person is mentally ill, because she’s snatch somebody’s husband. Or they might say that this one became mentally ill because they tried to collect somebody’s money. A lot of times they send wrong messages to the public. When people watch these things, they think that mental illness is a retributive illness that people that experience mental illness must have done something bad, and that is not correct.
Mental illness can happen to anybody, as long as you have a brain, except you are not a human being. If you if you have a brain, then you can develop any form of mental illness. Just like anybody can have hypertension, diabetes, everybody can have cancer, and so on everybody can have it. Although we don’t pay for these things but anybody can have it. So mental illnesses are biological illnesses, they are legitimate illnesses. People should not look down on people with mental illnesses it could happen to anybody.
Children also can experience mental illnesses. A lot of people also think because children are young they can’t experience it. They also have brain (although not fully developed) so they can experience mental illness. Some common mental illnesses in children include things like Neuro developmental disorder. We also have things like conduct disorder. Conduct disorder is just like personality disorder in children. For example, if a child has conduct disorder, the child can be very rebellious. The child can be lying, stealing, and not wanting to obey authority. The child might even be running away from school. So if you see a child that appears stubborn, the child might actually have what we call conduct disorder.
Children can also have depression, they can also have bipolar disorder, they can also have schizophrenia. So children too are not spared. They can also have intellectual disability. Intellectual disability is when somebody has problems with learning. For example, you see a child that is not performing well in school, it might be that that child has intellectual disability or another type of learning disability. When we see children like that, we should take them to the doctor for assessment rather than shaming them. It might be that that child has some learning disability.
What are the diagnosis and treatment for mental illness?
Good. Mental illnesses are very very treatable. But unfortunately, a lot of people don’t come to the hospital on time. Now I’ll go back to the example of malaria, there are different degrees of malaria, you can have mild malaria, you can have very severe malaria that you might even die if nothing is done on time. A lot of people have malaria and once they take treatment its gone. You won’t even know that they are on treatment for malaria as long as the person start treatment early. So what I’m trying to say is that every illness start small. Its only few illnesses that starts in an aggressive way. Most illnesses start small but people don’t pay attention until they now get so so bad, before they now start doing what they should have done since. Just like if somebody has high blood pressure, high blood pressure ordinarily is a very common type of disorder of the cardiovascular system. As long as you take your drugs regularly you don’t have any problem but if you don’t take your drugs you can come down with stroke where maybe one side of your body will be paralyzed. So what I’m trying to say is that mental illnesses are like every other illness and there are treatments.
We have two types of treatments we have Pharmacotherapy and we have psychotherapy. Pharmacotherapy is giving drugs, drug treatment. Psychotherapy involve things like talk. Its called talk therapy. We talk to that person. Sometimes some of these mental illnesses are caused by abnormal way of thinking. For instance there are some people that have a tendency to focus on the negative things that happened in their life. Instead of them to look at the picture holistically they have a tendency to only focus on the negative. So, such people have a higher risk of coming down with mental illness. So, when we identify such, we counsel the person, we talk to the person to change how he views life and if the person is able to change it, he will be well. Its not all forms of mental illnesses that we give medication. If somebody has mild depression, he might not need medication, the person might only need psychotherapy. So its either psychotherapy or pharmacotherapy and sometimes we combine the two. The bottom line is, people should prevent on time. They shouldn’t wait until things gets out of hand before coming to the doctor.
What are the stages of Mental illness?
There are mild stages, and then if nothing is done it can progress to severe stages. Now, let me give you an example, the people that walk naked on the road, on the street that people call mad people, they have severe case of mental illness. But it did not happen in the day. If somebody for example start sleeping poorly now and nothing is done, it can progress to other symptoms. And then it can progress and then the person might start wandering aimlessly around. So what I’m saying is that there are different stages of mental illness. Most mental illnesses start small, start with minor symptoms like poor sleep, poor appetite, in ability to concentrate, and so on. When people don’t do anything about it cannot progress to severe form.
Is mental illness hereditary?
Yes and no. Some forms of mental illness can be hereditary. Meaning if you are from a family that has some type of mental illness, you also have a higher risk of having it, especially when you encounter stress in life. But it doesn’t mean that because somebody has mental illness in your family, you must have it, No. Sometimes too the fact that nobody in your family ever had any mental illness doesn’t mean that you can’t have it. What I am trying to say is that yes, there is some degree of benefit involved but that is not the only factor. Mental illnesses are caused by many, many factors combined together. Genetics is only just one part of it.
Is there a surge of mental illness cases in Nigeria?
Now you know because we are living in very, very stressful times now. And then digital explosion, social media news travel faster, it may appear that, oh, maybe there is a small increase in the incidences of mental illness.
You know now everything has changed, the type of change we are experiencing now is exponential. It is so fast. You can wake up tomorrow morning, and everything has changed. When change like occurs in man’s life, and doesn’t give us room to adapt to one change before another one comes, it can actually be very, very stressful.
Now we live in a very complex time, we live in a very, very uncertain time, so all these stresses can combine to actually increase the likelihood of coming down with mental illnesses. Also, family dynamics have changed. Now we have a lot of divorce, a lot of single parenthood, a lot of single mothers and fathers raising children and researches have shown that when children are raised by single parents, it might actually predispose them to having mental illness is when they grow up, because God did not create it that way. God created a man and a woman, to have children and to take care of them. So divorce have a negative impact on children, a lot of people don’t know this. A lot of people don’t know that divorce can negatively impact the mental health of children. So think about it before divorce. So family dynamics have changed and now you know, we have lost our togetherness because of social media, internet and all. We are not wired that way.
As human being we need to mingle, we need to socialise, we need each other. We are not designed to function alone. Virtual friendship is not the same as physical friendship. The fact that somebody has 1000 followers on Facebook doesn’t translate to friendship because social support helps our mental health. If you have very good social network, it butters you against problems with your mental health. It is very, very, very helpful. Having a wonderful social support. So many of these things have changed. Many people are now more individualistic in our living and thinking. All these things negatively impact our mental health.
And now a lot of times when young people watch television shows, drugs are glamorized with people smoking and drinking, you know, having good times and they think that it is okay. It is not okay to do drugs or drink. When somebody drink or smoke, whether it is cigarettes or cannabis or any other illicit substances can actually negatively impact on your mental health. All these factors are combined.
So with all these factors, there is likelihood of having a surge of mental health issues a major area, and other parts of the world. When we combine all these factors, for instance in Nigeria, a lot of people are facing economic hardship, insecurity, people are suffering, inflation in food prices, this put a lot of pressure or pressure on us. Anything that put pressure on us can actually make us to come down with any type of mental illness.
What factors will warrant someone to want to commit suicide?
Beautiful question! Now, researches have shown that over 90% of people that actually died by suicide actually have mental illnesses that are not attended to. Let me repeat again, over 90% of people that actually kill themselves have mental illness that nobody paid attention to. Meaning that majority of the people that die by suicide could have been prevented from dying. This means that lets pay attention to our mental health, it can happen to anybody. So for example, if somebody has depression, depression that starts small, it might start with sadness, not sleeping well and then it progresses. The person starts feeling worthless, hopeless, the person doesn’t do anything, suicidal thoughts may come in and before you know it, the person can die by suicide. Suicide doesn’t just happen; it is usually combination of symptoms that were not taken care of. So most time, when we do a psychological autopsy of people that die by suicide, we find that they actually have symptoms of mental illness that nobody did anything about it. So people just don’t wake up and jump off the bridge or jump into a lagoon or take sniper. It is not spiritual attacks, it is not demonic possession, and most times it is mental illness.