Mental health and Nigerian society today
BEING text of a public lecture delivered by Prof. Layi Erinosho, formerly professor of Sociology, Olabisi Onabanjo University, Ago-Iwoye, Ogun State, at Ogun State College of Health Technology, Ilese-Ijebu, Ogun State, in October 2009.
ACCORDING the World Health Organisation, health is a complete state of physical, social and mental well-being and not necessarily the absence of infirmity1. Mental health is therefore one of the key components of health. Mental illness which is the opposite of mental health is about incapacitating conditions that necessitate short and/or lifelong care and support. It is very much unlike a social condition like poverty or quite a number of physical disorders which can be successfully managed and which are also devoid of social stigma. Mental disorders are still socially stigmatized in many societies including ours. We tend to avoid our next of kin or friends or co-workers who suffer from mental illness. The result is that many of the treated mentally ill patients often lack the necessary support of their next of kin and significant others after they are discharged from hospital.
Although I specialised in the area of sociology of mental health in my doctorate degree in Toronto, nevertheless I have moved into other areas like health planning and systems including implementation research. This notwithstanding, I still retain primordial interest in the study of mental health and ill-health. Indeed, I wrote two papers on the field recently, one was presented six years ago when Aro Neuropsychiatric Hospital, Abeokuta organized a national conference and another was barely two years ago when I was privileged to deliver a lecture on anniversary of the death of the doyen of modern psychiatry in Africa, the late Prof. Thomas Adeoye Lambo2. The late professor was my mentor because he spotted me during my formative years and saw me through graduate studies and also to the top of my career. Consequently, the invitation from your institution is pushing me back into the sociology of mental health and illness.
I believe that you have invited me to address you on a key question which is uppermost in the minds of Nigerians today, namely, what has mental health got to do with Nigerian society? Nigeria celebrated its 49th birthday a few days ago not with joy and but in sorrow judging by the commentaries in our newspapers. Nearly all the writers bemoaned the state of affairs in our country, asking over and over again in their contributions, why is our country in such a sorrowful state?
Nigeria is depicted as a country in serious crisis. It is a country in which everything has gone wrong and where men sit and hear each other groan in the words of John Keats, the famous English poet. Nigeria is indeed likened to a failed state, one that is physically, economically, socially and mentally disabled. Paradoxically, the situation is not brought upon our country by outsiders but insiders. Most commentators concluded that our sorry state is attributable to bad leadership by successive Nigerian military and civilian leaders since the end of the civil war.
Our revered world renowned psychiatrist, the late Professor Adeoye Lambo once observed that many of our leaders eminently qualify for psychiatric examination and care in view of their bizarre behaviour patterns over their neurotic need for power and money to the detriment of public good. This view was recently echoed by the Head of EFCC, Mrs. Farida Waziri.
This assertion over the mental health status of our leaders inevitably leads to a number of questions: Is it true that many of our leaders are indeed crazy and therefore need urgent psychiatric care? If the answer is yes to the question, have we the followers been insulated from their behaviour pattern or has their bizarre behaviour impacted on the rest of us in one way or another? More importantly, have their followers like you and I been able to protect ourselves from their seemingly infectious craziness? How can our leaders be cured of their craziness? Who should assist us to cure their craziness? Should they be psychiatrists or religious leaders?
These are undoubtedly worthwhile questions which deserve interrogation. However, the aim of my lecture today is not to interrogate the hunch of the late Professor Adeoye Lambo and lately that of Mrs. Farida Waziri of EFCC or to explore the foregoing questions but to do something else. This is because these questions require much more indepth investigation and verifiable evidence which I am not in a position to adduce at this point in time. But I am inclined to believe that there is some truth in the assertion of our late eminent psychiatrist and the lay Mrs. Farida Waziri of EFCC on the mental health status of our leaders.
These remarks notwithstanding, the central thesis of my paper is that there is interplay between mental health/ill-health and stage of development of a society or country. This general hypothesis is further broken down into a much more specific one, namely, certain forms of mental disorders/conditions are more likely to be prevalent in low than in the high income countries.
These propositions or assertions could be explored against the backdrop of Charles Darwin's evolutionary theory3 which the founders of western sociology appropriated and used to categorize and explain the evolution of societies. The founders of western sociology, chief among who were Auguste Comte4 and Herbert Spencer5, argued that societies evolve through three stages, - the theological, metaphysical, and positive (i.e., scientific stage). While western societies had reached the scientific in the eighteenth century when sociology was established as a discipline, others in the third world or what was then described as the new world were still trapped in the theological and/or metaphysical stages.
Societies that are in the theological stage are often obsessed with religion and are inclined to believe in the awesome power and role of the Almighty who is revered as the creator of heaven and earth. The unseen creator of the universe shapes destiny. It was, and is still customary for such societies to invent all sorts of totems as the intermediary between them and their creator. As examples, the societies that located by huge rivers are inclined to worship them while those that are around the fringes of huge mountains do likewise. We know of societies that show deference to monkeys because of their abundance in their midst or the significant role that they (i.e., the monkeys) play in their daily life. One of such is Indonesia where any visitor is struck by how the people edify monkeys, using its image and also its carving to adorn public buildings etc.
The founders of western sociology argued that societies gradually evolve into the next stage, namely, the metaphysical, as their members begin to search for explanations and also seek to have firmer control over the environment. This is the stage when more and more individuals in societies device ways of tackling the problems of everyday living, using their innate skill and intelligence. They begin to experiment or try to conjure or manipulate events. They invent magic or seek to exercise control over events, environment, and life through mystical means. Magic and mysticism therefore become the tools for understanding life or manipulating destiny and/or controlling the affairs of human beings or the immediate environment.
What follows the metaphysical is the scientific stage. Human beings sooner or later realize that magic and mysticism cannot provide answers to all the problems of life. The failure of magic and mysticism to provide adequate explanation compels human beings to embark on experimentation, based on systematic methods. The aim of science is to adduce evidence, using tested methods of investigation. Evidence is subjected to scrutiny and the results of today could be refuted tomorrow if new evidence that indicates otherwise is found. This is of course unlike magic and mysticism where the aim is to beseech or manipulate in order to produce certain results. Thus, the failure of magic and mysticism prompted human beings to have an open rather than a closed mind. Scientific attitudes are about confirming or refuting outcomes through experimentation. The results of today may be thrown away tomorrow if there is new evidence. Thus, every scientific result has a character of hypothesis.
This logic or attitude is a complete departure from magic and mystical explanation of events. The magicians or metaphysicians never really question their experiments or the tools of experiments. For example, the rain maker/stopper who is unable to make/stop rain after his "experiment" does not necessarily search for explanation for the failure of his/her experiment. Rather, a magician is likely to resort to what social anthropologists refer to as secondary elaboration. One of such explanations or secondary elaborations could be that : ''the rain could not be stopped from failing because a woman (i.e., women are believed to unleash negative aura) passed by while the magician was invoking incantation to stop rain from falling!!! The assumption is that the experiment of the magician would have succeeded but for the woman who passed by.
By and large, the critics of the evolutionary theory of societies argue that these stages are not necessarily mutually exclusive. Rather, they overlap because there is hardly any society that is strictly at any of the stages. Societies that are largely anchored on the theological could have strands of metaphysics while those that are ostensibly in the scientific stage could also harbour beliefs in the supernatural forces. For example, western societies today are not necessarily and completely devoid of belief in supernatural forces while those which are supposed to be trapped in the theological stage like those in Africa now embrace science and technology.
While the critics of the evolutionary theory of societies might be valid, nonetheless the theory cannot be dismissed completely because those in societies that are presumably in the scientific stage could still be under the influence of religion. Religion still plays an important role in the United States and Eastern Europe which are supposedly in the scientific stage while Nigerian scholars in the field of science and technology are inclined to proudly and loudly proclaim the awesome power of the Almighty.
You might ask at this point - what has this preamble on evolutionary theory of societies got to do with mental health or illness? Yes, it has a lot to do with mental health in our society. For example, past studies including current behaviour patterns in our society suggest that there was, and is still a high level of acute anxiety state and paranoia among Nigerians which cannot but be linked to our stage of development. Several of the reports by the late Professor Adeoye Lambo drew our attention to the prevalence of acute anxiety state and paranoia in our society7. Nigerians believed and still believe that they can be harmed by their next of kin and significant others. Misfortunes in life, premature deaths and even some deaths in old age may be attributed to the evil machination of wicked enemies. These evildoers are usually spouses, children, next of kin, co-workers, and significant others. The Devil or Satan is real and or social fact in the language of sociologists. The Devil or Satan is always likened to a roaring lion who is out to devour its victim or target.
What can be deduced from the above is that the commonest mental or emotional disorders in our society today are stress, acute anxiety state and paranoia which are linked to profound belief in the role of the Devil or Satan. Everyone seems to be anxious about one thing or the other. There is anxiety over career, family, and health. There is a high degree of paranoia over matters concerning success in life or the possibility that someone somewhere is after one or one's children or one's wife or one's husband etc. No misfortune in life is explained by chance or carelessness on the part of the individual or by what is normally referred to as que sera sera (i.e., what will be will be) among Nigerians. Even Nigerian Muslims who proclaim the WILL of Allah are also inclined to also accept that events in life could be manipulated by unseen forces. Consequently, we generally link events to the role of Satan or Devil or his/her agents.
The result is that our behaviour has not undergone any fundamental change ever since Professor Adeoye Lambo wrote his Doctor of Medicine thesis on the prevalence of paranoid psychoses and malignant anxiety among Nigerians some forty-four years ago. We are still profoundly concerned about magic, witchcraft, and sorcery despite rapid development and exposure to formal education which should have impacted on our understanding of events. The themes of our films which are popular around the world are anchored on role of magic, witchcraft, and sorcery in family and social life. By and large, avid watchers of these films concede that the films mirror the realities in our various communities.
The response to excessive concern with Satan or the Devil in the affairs of humankind among Nigerians has undoubtedly prompted the remarkable drift towards Christian religion for solution to physical and emotional problems. This is unlike in the past when millions sought care from assorted native doctors. The therapeutic care of native doctors became increasingly expensive because their clients were often required to produce goats or chickens or clothing or eggs or palm oil etc for symbolic rituals as well as pay for their services before they could obtain relief from their ailments and/or other problems. The average Nigerian who nowadays cannot afford three square meals is no longer prepared to seek care from native doctors who demand eggs, goats etc which himself/herself cannot even afford to buy and eat!!
It is therefore not surprising that Christianity, most especially of the Pentecostal brand rather than native doctors or formally trained psychiatrists is offering the way out for Nigerians on how to cope with the vicissitudes of life today. The proliferation of Pentecostal Christian ministries and the following which they command in Nigeria could be explained by the solution they seem to be able to offer to those who are in need of succour. Nigeria is in crisis. Poverty is widespread as close to two-thirds live below poverty line (i.e., one to two US dollars a day). Urban slums are mushrooming. Crime wave is high and vast numbers cannot access quality health care and education. Our country is noted for child sexual abuse and harmful practices that are targeted at women and children. Besides, there other serious vices like corruption and outright thievery of funds in all sectors including religious institutions. Basic amenities like electric power supply, piped water, and motorable roads are not available.
These problems of everyday life in Nigeria presumably trigger high level of anxiety and paranoia which are being tackled through spiritual means. The church has become the veritable medium for letting out the steam or releasing tension. In other words, the difficulties facing Nigerians are not necessarily linked to the harsh realities of life in the country but to the handiwork of Satan or the Devil. Armed robberies are not linked to the failure of the state to provide security but to the work of Satan. Ill-health is never attributed to poor nutrition and lack of access to portable water but to the evil machination of the enemy. This widely accepted spiritual solution is in consonance with the dominant belief system which is anchored on the capacity of fellow human beings to cause harm to one another through the practice of magic, witchcraft or sorcery.
The liturgy, lyrics, and manner of worship of the Pentecostal brand of Christianity are attuned to the belief-system and worldview of Nigerians. Besides, the Pentecostal brand of Christianity is dynamic, affordable, accessible, and has been found to be effective in dealing with the machination of Satan or the Devil. These assertions are not farfetched but can be supported if the doctrines, lyrics, and the testimonies of the followership of this brand of Christianity are closely studied.
Worship is predicated on lyrics that instil confidence in members. Singing the lyrics assures them of eternal protection from harm. Sermons are delivered in passionate manner to assure members that no matter what they are will be protected by the Good Lord from harm and they will overcome all the vicissitudes of life that are traceable to the handiwork of Satan and the Devil. Prayer points are fiercely aimed at destroying Satan or the Devil and all its agents. Exorcism is performed while members are encouraged to speak in tongues. The Holy Spirit is beseeched to take perfect control during which the gifted see visions which are interpreted to the congregation. Here are some of the powerful prayers lines that followers are encouraged to use to tackle, disarm, and destroy Satan and the Devil. One Pastor Wole Oladiyun who espouses the prototypic Pentecostal strategy for tackling Satan or the Devil enjoins readers to wage the war fiercely using the power of words. Below are a few of his innumerable exhortations in the widely read weekly magazine named City People,
Every witchcraft battle attacking my glory through dreams, receive the judgement of fire in Jesus name And/or Battles that have bowed down my head as a result of my position in the family (1st born male or female, last born male or female; children born in old age; children born twins, Idowu, Alaba etc) gather all your wares and instruments of oppression come out and die in Jesus name8.
Followers are also enjoined to read certain Psalms that are effective in dealing with their enemies or Satan. One of such Psalms is 109. I quote parts for emphasis:
O God, whom I praise, do not remain silent,
For wicked and deceitful men have opened their mouths against
Me; They have spoken against me with lying tongues.
With words of hatred they surround Me;
They attack me without cause,
In return for my friendship they accuse Me,
But I am a man of prayer
They repay me evil for good,
And hatred for my friendship.
Appoint an evil man to oppose him;
Let an accuser stand at his right Hand
When he is tried; let him be found Guilty,
And may his prayers condemn him,
May his days be few;
May another take his place of Leadership.
May his children be fatherless
And may his wife a widow.
May his children be wandering Beggars; May they be driven from their ruined homes9.....
There are countless testimonies by followers who proclaim loudly how they have surmounted personal difficulties and trauma using the power of spoken words. Barren women are reprieved when they receive the fruit of the womb. Those with long-term physical disabilities which may be psychosomatic are healed after fervent prayers and anointing and at times through hypnosis. The blind claim that they have regained their sight while the deaf and dumb proclaim that they can now hear and talk.
The past decade has witnessed decline in the followership of orthodox missions like the Roman Catholics, Anglicans, Baptists and Methodists. Indeed, they have been forced to do something in order to stem the trend. The orthodox have really had no choice but to embrace aspects of Pentecostalism otherwise they would have risked losing many hundreds or thousands of their followers. As an example, the orthodox have incorporated night vigils and special mid-week prayer sessions including anointing services into their worship. Drumming and what is usually referred to as praise worship are now accepted part of orthodox mode of worship.
All of the foregoing was unthinkable about forty years ago in orthodox churches when Sunday service was staid, solemn, and completely devoid of seemingly sensuous dance steps, cacophonic singing, as well as unusually loud prayer sessions.
Times have also changed to the extent that even the normally conservative Roman Catholics are also bending over to accommodate a special group like the charismatic Catholics within their establishment. The principal goal of such groups is to bring action, spiritual development and more importantly, healing into worship.
Overall, the American brand of Pentecostalism has no doubt influenced the orthodox missions most especially in Nigeria. The Americans introduced the concept of social marketing into the propagation of Christianity and this seems to have paid off in our country where all manner of Pentecostal ministries have mushroomed in the past two decades. As shall be discussed in the subsequent section, the Pentecostals are playing more than spiritual role in the lives of their members and certainly for good cause, so it seems.
One of the critical points which is being canvassed in this paper is that Nigeria is still by and large trapped in the theological/metaphysical stages. Secondly, all manner frustrations, acute anxieties, and paranoia are channelled through religion and mysticism. Both provide the succour to those in physical and emotional distress. The Pentecostals are in the forefront of the battle while the native doctors are trailing far behind today. This is simply because the therapeutic regimen of the traditional healers is no longer affordable to the consumers. It is therefore not surprising that the traditional healers and magicians have resorted to ample advertisements in the media to attract clients. One of such advertisements is reproduced below for emphasis:
Our organization (name withheld) has assisted people from all works of life to achieve something good for their lives for centuries. We are reputed for handling cases such as: removal of curses, bad luck, hardship, delayed destiny, fast sales, unemployment, bewitchment, control of power and influence. We stock the best spiritual items composed with the four elements for love, marriage to win contract, win pools and visa lottery. Control of money, gain favour, wealth and estate protection of life and property. Aversion of sudden death, pass that exam, promotion and recovery of debt. The best argument is to try us. We conduct initiation into the highest mysteries, for visionary power. Healing power, success in your undertakings both material and spiritual richness. Be the Lady Master, overcome enemies and for long life and prosperity. All preparations are with no side effect. All cases are treated in utmost confidence with special guarantee no matter your religion, caste, creed or position in life, there is no barrier. Don't miss it.....10
One could surmise from this discussion so far that there is interplay between mental health and illness and the stage of the development of a society. The solution to the problems of everyday life like stress, acute anxiety, and paranoia is likely to be sought in religion in societies that are still trapped in the theological/metaphysical stages. This is the case in Nigeria. Our society is still trapped in these stages despite years of modernization. Formal education including science and technology has presumably made little or no impact on how our people respond to pathological conditions like stress, acute anxiety and paranoia. The use of religion (based on the belief in the awesome power of the Almighty) or mystical powers to achieve set goals is still very much regarded as the strategy for tackling these conditions successfully.
A corollary to this hypothesis is that pathological conditions like stress, anxiety, and paranoia are more likely to be channelled through secular than non-secular social institutions in scientific societies. This is generally the case in western societies where hospitals, formally trained psychologists, doctors and psychiatrists are principally the channels for solving emotional problems rather than religious institutions.
Nigerian psychiatrists do have a long way to go in persuading our people to bring such problems in the first instance to their attention because we are still at the theological/metaphysical stages. Belief in the evil machination of known and unknown enemies through sorcery or the practice of witchcraft is still deep-rooted. Even though Nigerian psychiatrists are also part of the culture and may well nigh also think there is something is this belief-system, they are unlikely to admit this openly, or before their patients. Patients are therefore attracted to religious bodies and native doctors that are always at home with this worldview. But the native doctors have lost out to religious bodies most especially to the Pentecostals as previously argued because their services are no longer affordable.
I wish to conclude this lecture by addressing the promotion of mental health in a theological/metaphysical society like Nigeria. It is obvious that one of the reasons for the prevalent pathological conditions of acute anxiety and paranoia in our country today is poverty. Poverty drives people in different directions. Vast numbers are poor because they lack skills while those who with skills cannot find gainful employment. The fear of the unknown looms in the mind of every Nigerian and this explains why we seek solace in religion/mysticism. We therefore need to show appreciation for the contribution of religion and religious bodies to the mental well-being of Nigerians I have no doubt in my mind that religion in particular and mysticism must have played an important role in the outcome of a worldwide survey some years ago which found that Nigerians were the happiest people in the world. However, the Norwegians have now superseded Nigerians.
By and large, it is doubtful if religion/mysticism can handle all our mental health problems. Consequently, there is a window of opportunity for formally trained experts to work hand-in-hand with religious bodies to provide succour to our people. I believe that psychiatrists, psychologists and counsellors should reach out and collaborate with religious bodies to provide care. Such collaboration will demystify mental illness and reduce the stigma that is often associated with anyone who is seen in the premises of a mental hospital. By available epidemiological data, we all need emotional support/care at one time or another in our life time and it is vital for us to take advantage of those who are formally trained in the field.
Let us quickly illustrate this point with an example. The solution that is usually prescribed by Christian religion which disapproves divorce to a woman who is in distress or acute anxiety state or depressed as a result battering by her husband is to manage. But should the women who are being battered by their vicious and brutal husbands continue to manage and manage and manage until they are maimed or killed? Is there no way of educating members of a congregation on the impact of wife battering on the woman and the entire family? Is it not possible for religious bodies to work hand-in-hand with psychologists and psychiatrists in order to get battered married women (or men at times) out of stressful situations? These are some of the issues which can be dealt with if formally trained experts collaborate with religious bodies which appear to be trusted and to be playing vital role in the management of stress, acute anxiety, and paranoia in our country. What the writer is suggesting is that there is ample room for collaborative work among lay managers like religious bodies/spiritual leaders of mental health problems and experts like psychologists and psychiatrists in Nigeria.
I would therefore very much like to see our formally trained experts becoming more proactive by selling their skill, i.e., using their skill to educate the public on the aetiology of mental disorders. I would like our psychiatrists to have weekly radio and television programmes that educate people about mental illness and how they can be prevented. I would like to read their weekly contributions in national newspapers or see them to popularize mental health through lectures in schools, colleges, and churches. I would like these experts to become visible in society by using the media to reduce misconceptions and the stigma that is often associated with those who come to their clinics for treatment. It is a pity that psychiatrists have allowed the religious bodies to seize the initiative. There is no doubt that the visibility of these experts will protect the public from harm by religious bodies that might be using their acceptance to extort money from the gullible public in a society that is still trapped in the theological/metaphysical stages. The time is right for these experts to act.
Finally, an old adage says - prevention is better than cure. One of the keys to good mental health is social and economic well-being. I repeat, the socio-economic is just one of them. Others are access to good roads and portable water, steady power supply, access to qualitative health care and education etc. Financial hardship is however one of the indisputable causes of stress and acute anxiety and is indeed one of the major reasons for the drift to religion/mysticism in the country. Religious bodies have a role to play by making contributions towards the social and economic well-being of their members. They can establish cooperatives or community banks to assist their members in the absence of good governance. This of course does not mean that all the tiers of Government should abdicate their responsibility on improving the economic climate in the country. Rather, the religious bodies should expand their role beyond merely ministering to the spiritual needs of their members. They should be rendering financial services to them in order to empower them and lift them out of poverty. I believe that they have the human and financial resources to do so and they should be seen to be empowering their needy members. This is my command.
See A. Lewis, Health as a Social Concept, "British Medical Journal, British Journal of Sociology, 4, 1953, 109-124 which provides classic elaboration of the dimension of health, showing its complexity.
2 See Layi Erinosho, The Intellectual Legacy of Professor Thomas Adeoye Lambo, Lecture delivered at the Dinner Organized by Association of Nigerian Psychiatrists, Sheraton and Towers Hotels Ltd., November 15, 2007.
3 Charles Darwin, Origin of Species, 1859
4 Auguste Comte, The Positive Philosophy, Trans and condensed by Harriet Martineau, 3 vols. Calvin Blanchard, New York, 1855.
5 Herbert Spencer, Principles of Sociology, Appleton Century Crofts, New York, 1897.
6 Robin Horton explored these issues concerning the differences between magic and science and why African traditional healers/magicians are some sort of scientists but fail the litmus test because of their inclination to have a closed rather than an open mind in the experiments. The tendency is not for them to question their methods but to invoke secondary elaboration to justify them and therefore blame something else for failure to achieve desired results.
7 See among others the following essays by Professor Adeoye Lambo: The Role of Cultural Factors in Paranoid Psychoses among the Yoruba tribe, Journal of Mental Science, 101, 1955, 239-266 and Malignant Anxiety: A Syndrome Associated with Criminal Conduct in Africans, Journal of Mental Science, 108, 1962, 256-264; and African Traditional Beliefs, Concepts of Health and Medical Practice, Ibadan University Press, 1963.
8 See Pastor Wole Oladiyun, Repossess All your Stolen Possessions, in City People, August 26, 2009, page 8.
9 See Psalm 109 in the Holy Bible, New International Version, Zondervan Grand rapids, Michigan USA, 1984
