“Mental health is a state of well-being in which every individual is able to realize his/her own potential, can cope with the normal stresses of life, work productively and make a contribution to his/her family and community.” – World Health Organisation
In June 2018, the World Health Organisation (WHO) formally added Gaming Disorder to its International Classification of Diseases. This list is perhaps the most comprehensive index of diseases (including mental illnesses) in the world. The listed mental disorders range from the extremely severe and “popular” such as schizophrenia and Bipolar Disorder down to the somewhat less severe and “uncommon” such as Bibliomania and well, Gaming Disorder. With this latest addition though, the number of mental health conditions recognized by WHO rounded off to over a whopping three hundred.
When I read about this addition, I realised the huge difference between the way the rest of the world perceives mental health illnesses and the Nigerian perception.
When I was younger, my family had a neighbour whom the whole community dubbed mentally ill even he wasn’t always like that. As far as I could tell, he was a wonderful neighbour and a boisterous young man. The thing though was that he had a “drug” problem.
There were so many such signs and they were all roundly ignored, not just for lack of recognition as signs of a mental health illness but mostly because he still had lucid intervals and the alternative was just unthinkable. During that time, my father visited his family and urged them to get him medical help. His family said it was difficult to get a good psychiatric hospital; the options were discussed and my dad’s plea was promptly ignored. The years went by and as he got worse, the topic was increasingly avoided and his family contented themselves with locking him up in chains to curb his wanderings. Earlier this year I ran into him again. He was bone-thin, had blisters on the soles of his feet, wore rags and roamed the streets.
This personal experience more or less represents mental health in Nigeria. The reluctance to identify mental illness for what it is, the stigma of seeking treatment, the difficulty in obtaining treatment and finally, the underlying factor that what a lot of the world may consider mental illness may be acceptable as both strange and normal here.
The American Psychiatric Association defines mental illness as health conditions involving changes in emotion, thinking or behaviour (or a combination of these). Mental illnesses are associated with distress and/or problems functioning in social, work or family activities. Going by this definition, it is easy to see how conditions such as game addiction may be classed as a mental illness. In Nigeria though, as far as the average person is concerned, there is only one state of mental illness; the state of madness.
This term may be loosely defined as a state of utter and absolute inability to function and be a part of society and is often measured solely by asking the question: has the suspect began to wear rags and roam the streets? Where the answer to this query comes back as a no, then the final recommendation would be for the affected person to ‘man up’ and handle his/her issues because we all have problems and you don’t hear us all crying about them. Where the answer comes back as a Yes, then the conclusion would be a shrug and a mournful shake of the head because at that stage, what else can we do?
Going by this yardstick then, the number of Nigerians who actually ‘suffer’ from mental illnesses or afflictions remains low, minute and negligible. Every now and then, a bye-law comes in place and sweeps the ‘crazy’ from the streets into mental homes almost always lacking in qualified personnel or infrastructure. The population of ‘mad’ men and women roaming the streets, as far as the average Nigerian can tell therefore, is very small and unimportant. But the truth is that we know better.
Here, there is an absurdly high degree of reluctance to look closely into one’s emotions and actions with a view to identifying signs of mental health illness such as depression, general anxiety disorder or any other forms as listed by WHO. We very easily joke about our discomforts, compare notes on our physical illnesses but resort to whispering about our mental struggles, as if the mind is not a part of the body. The fact is that the Nigerian society expects every one of its citizens to be strong, weather all storms and keep forging their ways ahead.
It is expected that for us all, there are days when living could prove unbearable but we ought to keep going because maybe today was crappy but tomorrow might just be the best day we ever had. You were raped? Bullied? Robbed? Abused as a child? Lost your dream job or a loved one? Well accept our condolences but keep moving. To let your circumstances or an incident therefore weigh you down is considered a form of weakness and failing in my society. Such “disgrace” would forever reside with your family and friends and because this is not a label anyone of us would want, we ‘gird our loins’ and keep at it.
With this mindset, it is perhaps easier to understand the absence of the society (led by the government of course) to pay attention to the global discussion on mental health. Until recently, there existed little or no framework for the management of mental illness. No social welfare programs were set up for such ailments (at least none that the average Nigerian knew or cared about) so that when a person suffers from a mental ailment, he/she is considered the exclusive responsibility of family, friends and immediate community. There was no state health insurance or welfare scheme to help ease the burden on the relatives and the government only got involved when the patient had become a nuisance on the street. And when that happened, it was to bundle the patient off to a state-run psychiatric hospital.
Where the affected person or his family manages to get past the challenges of actually acknowledging the issues, then comes the frustrations of finding adequate treatment and management facilities. The health sector in Nigeria is not very close to the best there is and when it comes to mental health treatment and hospital wards, the case is worsened. There
A close friend of mine was mugged in a commercial vehicle sometime at the beginning of the year. Since then she has been having a hard time commuting across Lagos on public buses and taxis. I know this is a form of Post-Traumatic Stress Disorder, and more importantly, I know she knows this too. I also know she knows she should get help and maybe counselling, but even without actually talking about it, we both know she wouldn’t. She would find alternative and private but more costly ways of getting about her business and when she begins to use the public buses again, she would grit her teeth and repeat the exercise until the day it wouldn’t be as hard anymore.
Now I know that my society in this light might seem harsh and maybe even undeveloped to people in the West and I can understand that. The truth is that this approach to life has kept us on our feet regardless of countless disappointments by our elected officials, the horrors of insurgencies and more
Living, striving and thriving in countries such as mine requires an unimaginable level of fortitude and resilience. Despite my occasional reluctance to accept a few harsh realities, this fortitude is the sort that does not get built if we crumble in the face of the challenges that come our way (physical or mental) crippling though they may be.
We were not raised to bottle up emotions, to ignore them or to posture as though they don’t matter. We were raised to recognize them but to view them differently. We have been raised to continually acknowledge that there is a lot more to be happy about than to be sad or depressed about. Suicides are very rare because somehow, in the midst of all the craziness and struggles, we still view life as not just a property of one man but as belonging to both one’s family and his God. The effect is that we have less crimes of passion than is typically obtainable in the West. You cannot give into your emotions; there is just too much to lose.
With my generation though, things have begun to change. At least, on the surface. While the challenges I talked about has in no way been surmounted, the conversation around them has improved in that now there is actually an animated conversation about mental health in our schools, churches, homes and workplaces than ever before. Concepts such as depression and panic attacks have gone mainstream and now feature prominently in discussions, even with our parents of an older generation. Social media is awash with various handles and organisations, urging young people to seek help when they are depressed.
In spite of all these though, a lot of us still internalize our emotional struggles because it’s the way we know to handle them. We still jest about our inner challenges and we keep moving ahead as fast as we can and for a nation grappling with as many challenges as we face, I think we are doing great.
Here, it’s alright to jest about our woes as we face them. As long as you don’t go naked, roaming the streets.
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