I am starting this thread for the following reasons:

1. a lot of people are unaware that mental illness is much more common than they think

2. mental illness is not just about the naked 'mad' man, running about on the street, who actually only constitutes just a minority of the mentally ill!

3. a lot of people are silent sufferers of mental illness or have close relatives or friends who suffer from one form of it or the other

4. mental illness, even one as 'benign' as an anxiety spectrum disorder can affect your ability to function within a relationship, at work or in your day to day living, without you actually knowing what's wrong with you, tempting you into spending all your money visiting quacks who will tell you that you have a staph infection or something, similarly ridiculous, or lead you to blaming your inlaws, neighbours or relatives in the village for afflicting you

5. mental illness interfaces closely with culture and spirituality, so much so that the boundaries some times can be blurred in very 'traditional' societies such as ours in Nigeria, leading to a lot of misinterpretation and misrepresentation of people and neighbours (the evil neighbour syndome)

I will be responding to questions and providing advice where relevant.
I will also be providing basic generic psycho-education on the common mental illnesses, their interface with culture/spirituality and any other related topics that people may be interested in.

In my second post (which should be comig up sometime tomorrow, hopefully), i'll be discussing the difference between a 'Psychiatrist' and a 'Psychologist', and what each of the professionals do. This is to set the stage for the rest of the posts. 

By training I am a Psychiatrist(a Doctor who has specialised in Mental Illness).

So folks, come and journey with me into the recesses of that elusive phenomenon called the 'mind'; let's transverse it together and discover the darkness of the human 'soul'-that fragile world within us where genius and madnes are born.

E. Beneli

So who is a psychologist and what do they actually do?

A psychologist is an allied health professional who studies human behaviour.

The word 'psychologist' is made up of two greek words:
1 'psyche' meaning 'spirit', 'soul', or if you like, the mind
2. 'logia', which means 'the study of'.

So a direct translation for a Psychologist would be 'one who studies the mind (or soul)'.

The problem here, though, is that Scientists are still searching for the mind (soul), so the Psychologist works with that observable product of the mind; which is human behaviour.

There are different types of Psychologists, but for the purpose of this thread, we'll focus on the Clinical Psychologists. They're the ones who work directly with patients.

They use different clinical tools, including questionaires, direct observation and specialised assessment tools to try to understand why people behave the way they do. And based on their area of expertise they can work as Child Psychologists (who deal with developmenta issues a lot), Family psychologists (they study the behaviour of the family as a unit and then facilitate the process of making that unit function better), the Forensic psychologist (works mostly with individuals who are involved in the criminal justice system and are involved with personality profiling and 'actuarial' risk assessments) etc. The Clinical psychologist usually works as part of a team, which would ideally include the Psychiatrist.

That brings us to the next question: who is a psychiatrist then?

The Psychiatrist is one who treats mental disorders.

So, while the psychologist works mostly with 'mentally healthy'-whatever that means-individuals, the Psychiatrist is one who is saddled with the burdern of treating sick 'souls'! Okay, the mentally unwell, if you prefer something less dramatic!

The Psychiatrist finds himself in a big dilemma. Historically, he's had a bad press and people like Sigmund Freud-who in a lot of informed circles is considered a quack-did not do the Profession a lot of service, as he was too preoccupied with abstract things and sex. As a result of this the field of Psychiatry stagnated, while other medical specialties progressed, especially with the discovery of antibiotics and so on. It was only since the 1950's when mental illness was discovered to actaully respond to medication, that Psychitrists gradually became accepted as full fledged members of the medical profession, shedding their cloaks of charlatanry (quackary, if you prefer), and becoming, i dare say, even respected!

These days, we're sought after in most affluent societies. In places like Hollywood, practically everybody who matters (except the Tom Cruises of this world and the rest of the antipsychiatry movement who think that we're demonic) has his own shrink!

You see, technology has equipped Psychiatrists with new tools to investigate the mind and, indeed, human behaviour.
These days, Psychiatrists have a better understanding of the biology of behaviour and beliefs. They have tools, including medication and surgery to modify human behaviour, to the point where some (c/f the antipsychiatry movement) believe that Psychiatrists have become agents of mind control. But that's another topic.

In the past, it was thought that only misfits or failures who could not enter more 'competetive subspecialties, ended up becoming Psychiatrists! Some, including our colleagues in other subspecialties, wondered why any 'sane'and intelligent person would want to spend his life 'curing''insane' people (excuse the pun!)

Perhaps, once upon a time, they would have had a point! Go watch 'one flew over the cuckoos nest' but that's no longer the case, these days.

People get drawn to psychiatry for many reasons; for some, it's because of something traumatic that they witnessed, for others it's to answer some existential questions about the meaning of the soul and life in general. I probably fall into the latter group as I was drawn to Psychiatry as a second year medical student in the heart of Russia, while sitting at a conference where the discussion was about the nature of human gender. The case was of a young lady who believed that she was a man but that an accident of nature made her to end up locked up in a female body. She was eventually accepted as a true 'transexual' and given the Gender Re-assignment Surgey she craved. She now walks the world as a man!

This paradox of what constitutes the human identity, excited my curiosity and one of the questions that popped up in my mind during that conference was:'When i say i am, what do i mean by that?',

In my quest to answer that question i have ended up as a Psychiatrist-a person who treats the human soul when it is found to be 'sick'.

Some have said that Psychiatrists have a lot in common with Priests. They say that we both deal with the dark sides of the human soul. I agree to a point, but also believe that we are fundamentally different.

The priest sees the soul as something intangible; something that can only be pacified intangibly, using the power of prayers and other such religious approaches. The Psychiatrists, agrees that there is a lot more to the human being than can be explained away by science and its tools, but also understands that the 'spirit' (and indeed the divine), expresses itself mostly through biology (c/f 'the word became flesh' in Christian doctrine), so seeks to understand the biology of the human soul, looking for ways and the tools with which to intervene when it is humanly possible.

I dont see this as a contradiction or as incompatible with Religious doctrine. In fact a lot of Psychiatrists actually believe in God. I do.

From the next post, we'll begin to look at human behaviour and mental illness.

Anybody that claims to understand human behaviour is lying. Man is too complex a creature to be fully understood.

The diversity of human cultures and subcultures makes it even more complex for anybody to claim to be able to understand what is normal and abnormal behvaiour without taking into consideration the context of that behaviour. Even the Psychiatrist is not that arrogant to assume that he can box human behaviour into 'normal' and 'abnormal'.

To add to this complexity, each culture-and indeed each subculture-have evolved its own pattern of behaviours which are acceptable to them, but to others it would appear as 'abnormal'.

Let's take the following examples;
1. disciplining a child with the cane in most Nigerian communities is without doubt a demonstration of the parents love for the child. In some societies it would be considered as sign of inadequate parental skills.
2. men having sex with men is perfectly normal in some societies, while in others its a perversion.
3. some subcultures have no qualms about being exuberant and loud when communicating with each other and with starngers, while others would consider those same behaviour as rude
4. 'mental' illness elicits sympathy in some societies, while in others it is ridiculed and seen as an affliction of the gods

So that brings us to the question; what is mental illness?

The answer is not straightforward.

It is made even more difficult by the fact that unlike illnesses in other parts of the body, a lot of illnesses of the mind cannot be detected using the routine laboratory and instrumental investigations available today. And the simple reason for this is that in most cases 'Mental' illness is part of the narrative of an individuals life story. In other words, it doesn't just happen. It's an accumulation of the side-effects of a person's life, such that when it does happen, the person had it coming! And i am not just talking about the naked man running about on the street.

For more clarity, let's move back a few paragraphs to the part about human behaviour.

Human behaviour can either be 'adaptive' or 'maladaptive'.

Adaptive behaviour is behaviour that we have evolved that allows us to function within our subcultures and to become accepted (i.e. to be able to maintain relationships, work etc). Maladaptive behaviour is one that prevents the individual from being able to function within his subculture.

The interesting thing about maladaptive behaviour is that it usually serves a function for that individual either consciously or subconsciously.

Let's look at a curious example.

Joe is an intelligent young man whose family has invested a lot of money to see that he gets a degree and then gets a good job. A few years after graduation from University he is still unemployed having exhausted all possible avenues of securing a job.  He is not street wise, or business savvy so he can't create his own employment. His family have gotten tired of his not being employed and don't know what else to do.

Now Joe developes a peculiar illness.
He presents with generalised body pains and weakness, difficulty sleeping at night and a general lack of motivation to continue looking for jobs. Joe has gone to different hospitals where the lab results, depending on the mood of the lab technician, has read from Typhoid fever, malaria, staph infection etc. And his parents have exhausted their money treating him in one private hospital after the other, but nothing has helped. Instead Joes condition is getting worse. His mother, a prayer warrior at the local church, has recently got a 'revelation' that he is suffering from a 'spiritual attack' and that's why he's not been able to get a job,

The above scenario is obviously made up. But it is also fact[i]ion[/i].

Much as Joe may be suffering a 'spiritual attack', he is also most likely suffering from Depression.

Some variants of the above scenario are what we Psychiatrists like to call the 'Somatoform Disorders', where the body translates emotional and psychological stress into physical symptoms (such as unrelenting headches,  diarrhoea, erectile dysfunction/impotence, fainting spells etc). People have been known to present with blindness, seizures, paralysis,  ideas of being posessed and so on; all of which are driven by psychological conflicts, which the individual finds no other outlet for other than in expressing it in those terms which are understood (and sympathised) by his subculture.

In my next post, we will be looking a little closer at what 'function' the illness may serve for Joe, and why some people respond to stress in this way and others don't. We will also be looking into your everyday 'madness' and less understood experiences, which are also equally debilitating for the individual and for those around him/her.

PS: At this point i would want some sort of feedback from anybody reading the thread, if it is useful/informative to them or not; if i should change the style of presentation or if it's just too damned worded! Thanks.

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@ iice
Thanks for that!

@ tpia
Thanks for your questions.

1. 'Mental illness' is a vague term. If you are referring to the almighty 'Schizophrenic illness' i.e. where the individual hears voices, behaves weirdly and believes he's possessed of demons that command him to do stuff like take off his clothes, then the future risk to the patients niece or nephew would be about 1-3%. That's almost like in the general population, which is taken to be about 1%.
I'll talk about Schizophrenia in later posts.

2. The issue of a 'permanent' cure is a very interesting one.

A lot of illnesses don't have a permanent cure. Take Diabetes or Hypertension, which are very closer to home. A lot of mental disorders will, like diabetes, respond to medication, but just like in all chronic (by which i mean, lifelong ) illnesses the individual will need to be on medication for a very long time.

In Schizophrenia, depending on which conference you attend, it is generally accepted that about 10-20% may actually recover after a first episode of illnesses without needing subsequent medication. Another 30-50% will respond to medication, but will need to remain on them for a long time. About 20-30% don't respond to the first and second line medication and will need a more complicated management approach.

Other mental illnesses like the developmental disorders (Learning Disabilities and others) and those resulting from organic brain damage, unfortunately are only managed symptomatically (in other words we provide relief whenever the patient is in distress).

A large proportion of mental disorders are actually as result of dysfunctional personalities. We like to call these ones 'Personality Disorders'. There is ongoing debate about whether these constitute real mental illness or not but they end up as our 'patients' and they don't get cured! How can you cure somebody whose personality is-excuse my latin-bleeped up? You can't. You can provide symptomatic relief or temporary respite from the rat race but certainly not a cure.

Our friend Joe, in the scenario above may probably not respond to medication even though depression can be 'treated'. In Joe's case the illness' serves a function, which would be lost if he were to get well, so he may not actually want to get well.

We'll look at him again in another post.

3. Current evidence suggests that kids suffering from Depression can benefit from anti-depressants but that should not be first line. There is a better response however when the approach is 'bio-psycho-social'. In other words a combination of pharmacology (antidepressants), Psychology (talking therapy e.g. Cognitive behavioural therapy) and social intervention (addressing the social context within which the child became depressed).  Most of the depressed kids who come to see Child Psychiatrists don't need antidepressants though.

.

Thanks guys for the feedback and comments. They let me know that I am not ‘talking’ to myself!

In case you didn't know, talking to oneself is not a sign of madness! But' let's not digress.

Now back to the vignette on our sick friend Joe.

First, though, let us answer this rather interesting question: can somebody be sick and not want to get better?
Surprisingly, the answer is yes!

Sometimes playing (or rather being in) the sick role allows the patient some respite from the predisposing stressors that he otherwise wouldn't know how to escape from.

What do I mean by this?

Okay, let’s look at Joe. He is under stress from society, friends and family to step up to his role of a man. He’s been to University after his parents sacrificed their hard earned savings to pass on the baton to him, hoping that once he’s gainfully employed he’d look after them in their old age. Society expects him to become independent, get married and do the things successful men do. But it’s not working out for him.

So as long as Joe remains ‘healthy’ he really has no excuse, other than of course blaming the government and so on.

On a conscious level this excuse is obviously time-limited.

After a while Joe will certainly begin to question his own abilities, then lose hope in his future and, of course, learn to become very uncomfortable in the presence of his more successful (and in some cases, most insensitive) peers. This triad of experiences is what Aaron Beck, an esteemed Professor of Psychiatry who did a lot of work in the field of Depression, would call the Cognitive triad of Depression (i.e. having negative thoughts about the self, the future and the environment). These thoughts begin to feed into each other, such that every subsequent bad experience that he has; every uncomplimentary words that he hears from family members, friends or strangers; and in deed every succesful peer that he sees, would only re-inforce further his negative cognitions about himself. Hence the need for escape from the cycle!

On another-not intentional-level the illness offers Joe sympathy from his family and friends. So why would Joe want to get well and start hustling unsuccessfully again, if everybody can blame someone or something else for his failures and still sympathise with him? 

You may say that there's elements of selfishness in this and so on, but for Joe it's really about self-preservation, in a manner which is culturally acceptable. His mothers 'revelation' is his saving grace.

That's the function of Joe's illness. It protects him from ridicule and wins him sympathy.

But why do some people become the Joe's of this world and not others? Why can some people speak in public and others-the ones who suffer from social phobia-become petrified at the very thought? Why do some people suffer episodes of psychosis while others-in spite of their consumption of large volumes of adulterated marijuana and other such illicit psychedelic drugs-don't become ill?

In the next post, i will take you to the very beginning; to those stages in our individual process of becoming when our biologies and our personalities are formed; the period when the foundation stones for our becoming vulnerable to different types of mental illnesses are actually laid.

If you have any comments, questions or need for clarification in some of the things i have already written, please don't hesitate to interrupt!

Hi Beneli,

Just wanted to say that I think that this is a great post! Keep up the good work :-)

@ Mrs Oyibo. Thanks!

The question about what contributes most to the development of human behaviour-and by extension mental illness-has irked the mind of behavioural scientists, politicians, policy makers and everybody else who has had an opinion on things like crime, human intelligence, race etc for centuries.

This discourse has continued in the age-long nature versus nurture debate, which is ongoing even today.

Some have argued passionately that nature (i.e. an individuals innate qualities or to be more precise the genetic make-up) is to blame for aberrant human behaviour, and have used it to pursue an agenda, which at different times in human history have been overtly racist.

One example is the attribution of the above average incidence of Schizophrenia in the black population (especially in the first and second generation migrants) in both the UK and the US to a slightly inferior genetic make-up of this population.
Most recent evidence refutes the suggestion that black peoples genes are, excuse my Latin, bleeped up! It has been discovered that prolonged experience of frustration and social defeat (as seen in migrants) influences the biochemistry of the brain, leading to the higher incidence of Schizophrenia. Communities that have cohesive social support systems in place are able to cushion the effects of these negative experiences, while in those less cohesive communities the symptoms become more apparent.

To support the evidence is the fact that there are also raised rates of Schizophrenia in Finnish immigrants to Sweden, Australian immigrants to Denmark, German immigrants to Australia etc.

This brings us to the issue of the impact of ‘nurture’ in all this.

The ‘nurturists’ argue that environment and personal experience causes human behavioural differences and by extension mental illness. As a ‘black’ Psychiatrist and behavioural scientist, I must confess that I find the ‘nurture’ argument most seductive, but alas the truth most be told!

Nurture is significant, but nature also plays a big role. The truth is that human behaviour is a product of our genetic make-up and the environment (prenatal, parental, and social) within which our genes are expressed.

A little bit about the genes. A gene is the basic unit of inheritance, which passes on different traits from one generation to the next. For this discourse, the most important trait passed on from one generation to the other is the biochemical processes. We now know that our brain biochemistry determines how we feel or behave. Serotonin and Dopamine levels (i.e. increased or decreased) in different parts of the brain can lead to depression, anxiety, addiction, hypersexuality, aggression, religious experiences…

Dopamine is also the culprit in the development of Schizophrenia.

The environment plays an even bigger role. Our environmental experience starts in the womb. It is here that our nervous system is formed. During this period the brain begins to get wired up, using the template laid down in our genes, however it is also at this point in our individual stories that we are first made vulnerable to environmental stressors.

We become victims of the medication consumed by our mothers; victims of the nutrients our developing brains are nourished with; the illnesses that our mothers come down with; her emotional well-being and other such experiences that sets off biochemical reactions, which equally bathe our brains such that by the time we are born the whole argument about nature versus nurture is made nonsense of!

It is at this point that the stage is set for the development of different types of mental illness, such as Schizophrenia (which is multifactoral), learning disabilities, and developmental disorders in children, hyperactivity disorders and Conduct disorders. The latter is associated with criminogenic behaviour in adulthood.

Some of these illnesses are apparent from birth, while others unfold gradually as the brain developes.

In the next post we will be looking at how our personalities are shaped by the next stage of our encounter with the environment, more specifically we will be looking at the impact of the family environment and our early childhood experiences in the development of personality and types of mental illnesses.

Thanks iice. The whole nature vs nurture thing remains very controversial, yet interesting.

Today’s piece was really supposed to be about what happens once we’ve prevailed in the battles of the womb, but I think it’s important to highlight that something significant happens during the birthing process itself!

Before I get to that, let me just remind us that the conflicts between the genes and the intra-uterine environment (i.e. the environment within the womb) can, in some cases, chain some individuals to a certain destiny. People can become casualties who are subject to a life-long burden of learning disability, a condition that limits what they can achieve in life.

It is important to note that not all learning disabilities are the profound ones that you see, presenting with peculiar physical and facial features like the ones seen in Downs syndrome. Some present like you and me, but still have a borderline intelligence that limits their capacity to grasp abstract concepts or even navigate emotional conflicts, but which is of such subtlety that it goes undetected and the individual leads a ‘normal’ life on the fringes of his/her society. Such individuals may present with difficulties managing their angers, difficulties understanding other peoples point of view and in some cases come across as just 'another nasty piece of work'.

Now comes the time of birth.

Once we’ve survived the womb we are left at the mercy of our midwives, obstetricians and whoever else is involved in delivering us into the world. If this period is handled incorrectly, the individual is left with yet another scar for life!

Some of us maybe familiar with the Apgar score. This is a score that has been routinely used by midwives and obstetricians for a long time to determine how healthy the newborn individual is, after one minute of life and then at five minutes. Ten is considered the perfect Apgar score, which a lot of children do try to approach either at one minute or by the five minute mark.

The significance of the Apgar score to this write-up is the fact that according to the European researchers report ‘low Apgar scores at birth are associated with an increased likelihood of low IQ scores at age 18 years’! Draw your own conclusions about the effect this would have on the overall performance levels of individuals from socio-economically disadvantaged communities…

I think that we can now open the curtains for the next stage in our development and the battles we must overcome.

In the next post I’ll be focusing on attachment issues, early childhood development and also on the problems with Sigmund Freuds world view about childhood incestuous conflicts and the development of mental illness.

I will find time to continue with this tomorrow or at the weekend.

Sigismund Schlomo Freud, popularly known as Sigmund Freud, didn’t quite hit the mark when he attributed our conflicts to the struggle between what he described as the id, ego and superego. Something I will not get into here because it’s irrelevant to the objectives of this piece. 

But for the sake of knowledge it is worth knowing that Dr Freud, the one time cocaine abuser, is still unarguably a genius.  As a child he nursed sexual fantasies about his mother, which possibly laid the foundation for his ‘Oedipal complex’ (which suggests that everybody desires incest but has to repress it), and the understanding that our unconscious conflicts can be understood through interpretation of dreams. He also gave us an opinion on human psychosexual development, where he argued that we all go through periods of being fixated on specific things, including amongst others the anal stage (when we derive pleasures from bowel movements) and the phallic stage, when naturally the genitals become a primary source of pleasure. He also talked about 'penis envy' in women, but that's another story.

Though currently his ideas are held with some reservations in some circles, he is still considered the father of modern Psycho-analysis

Currently behavioural scientists understand that a lot of our life conflicts are based on the life script that we live by.

This script, which starts to be crafted when the child first meets his/her family, informs the personal meanings we give to things around us and how we respond to parental, familial, social and other environmental pressures, and it is usually written by the age of seven, the age by which we begin to understand the meaning of guilt.

Let’s look at some life scripts.

A child who is abandoned will internalise the belief that ‘people always abandon me’. This child will grow up believing that no matter what they do that they will always be ‘abandoned’, so they live life always trying to compensate for this, by either always being on the defensive and not letting people get too emotionally close in relationships, or becoming jealous easily because of the suspicion that they are going to be left for some one better…

A child who is told that they are useless, or not good enough will compensate by either becoming a workaholic to prove to the world that they are not, while remaining very sensitive to any slight criticism or their lives become a self-fulfilling prophesy as they find themselves always creating excuses for life and self-sabotaging endeavours that could have made a difference to their lives…

It is these life scripts that give us the personality attributes that make us either resilient or vulnerable to pressures in our day to day interaction with people and the environment.

It is accepted that the parent (care-giver)-infant relationship is most significant in the crafting of this life script. Indeed what our parent bring into this relationship and our own constitutional make-up, forged from genetics and our earlier experiences in the womb become the foundation stones (the metaphor doesn’t quite connect) for the life script, by which we will subsequently live our lives.

The starting point for this relationship is the attachment the infant forms with his/her primary care giver as s/he emerges from the womb and onto the laps of his/her mother…

Lets look at this attachment thing in a little bit more detail.

It’s an accepted fact that human beings are social creatures. It is also a fact that our emotional flexibility is fundamental to our ability to socialise.

Infact our capacity to interact with others and to manage our social environment-otherwise known as ‘emotional intelligence’-is one of the major vulnerability or resilience factors in the field of mental health.

As you may have discerned from your own life experiences, how we relate with others makes the greatest difference in how much success we can make out of our lives in general.

Central to a person’s capacity to relate functionally with people around him/her, is the concept of ‘Attachment’.

This concept was introduced into mainstream developmental and behavioural psychology by the Englishman, John Bolby. He used theis concept to try to explain the how’s and why’s of functional and dysfunctional interpersonal relationships. Other developmental psychologists like Mary Ainsworth and so on, later developed the concept a little further into its present understanding today.

So what is this whole attachment thing again?

To understand it let’s visualise the tango dance. There’s something fluid about the movements in the dance; something very seductive and indeed, very emotionally enriching to the dancers.  In case you’re not familiar with the tango, ‘it takes two to tango’, as the hackneyed phrase goes!

The imagery of the tango sticks with me, when I am thinking of the mother-child relationship,  not only for the fact that in my teens I loved to tango-and even blush at the memory of some of the associated escapades-but also because there’s something about a healthy mother-child relationship that is reminiscent of the tango. Okay, let’s forget the bit about the ‘seductiveness’, as, you may have guessed’ I am not an ardent fan of Dr Freud’s incestous line of thinking.

Now think about the tango again.

Attachment is really what the child derives from that fluid relationship. The mother’s lot in the 'dance' is the ‘bonding’ .

Though bonding and attachment response depend on each other, and subsequently enrich each other, ‘common sense’ suggests that the bonding behaviour of the mother, determines the type of attachment response of the child, setting the stage for them to be subsequently locked into a life-long emotional-and almost spiritual-realtionship that continues long after the child has left home….

It is understood that in the beginning of the child’s life it does not see itself as separate from the mother. Its sense of separateness is not yet formed until much later, such that it’s earliest sense of self is gleaned from what is mirrored in the face of it’s mother. A loving face reflects in the child an internalising of self appreciation; resentment and anger breeds self-loathing and a sense of inadequacy.

It is in these early months, long before the child can understand the spoken word, that it begins to see itself reflected in the one that makes it 'whole' in that mother-child tango. This relationship-or unit-is what others prefer to call the mother-child dyad, a functioning unit that is much greater than the sum of the component parts. I will try to elaborate on this a little later.

It is generally understood that when the mother brings with her emotional baggages from her own, possibly miserable childhood and issues of unresolved life conflicts the child soaks all this up, using the debris it sees splattered all over it’s mother’s face to start crafting its own life script….

In the next post we will look at the types of attachment and how it affects us as we grow up.

When attachment goes wrong, the child learns that the world is an unsafe, even scary place, where it cannot trust anybody.

It’s sad really.

It’s sad because this mistrust is carried into adulthood in the way s/he relate with friends, partners, family members and the rest of the world. They find themselves  always on the defensive, always reading meanings into other peoples actions, wanting-nay craving-to be understood and loved just a little bit more, but not knowing how to go about negotiating that appreciation from others.

It’s sad because though such people are the ones who really need love the most they are unable to recieve it even when given, because they cannot recognise it. They are unable to give it as well because they were not taught how to during those early pre-verbal days of attachment, when the cultivation of emotional stability is made and they become vulnerable to a lot of emotional problems as they grow older.

They can become ‘perfectionists’, the rigid and cold individuals who, borrowing a phrase from Freud, act ‘anally’ and are prone to Depression,  Anxiety Disorders when things don’t go their way.

Some become self-destructive in there unconscious yet palpable self-loathing. And end up either sexually promiscuous or addicted to substances, as the empty space within is filled temporarily by the tangible and physical pleasures, which leaves them feeling even emptier and more violated after each short-lived fix. 

In the developed world, some resort to inflicting physical pain on themselves. For them this is a way to try to control the pain that they feel within. Others engage in what is described as suicidal behaviour to gain 'attention in their quest for someone to hear and understand that they are hurting inside…

Behavioural scientists like to breakdown Attachment into three distinct types:

1. The Secure attachment-where the child is well cared for by the mother, so grows up into an adult who has a ‘secure’ base, becoming independent and responsive to others and the environment.
2. The resistant/avoidant type-this person would have a history of being neglected by the mother and also abused. As an infant they are friendlier to strangers than to their parents, paying more attention to objects than to people. As they grow up, they become increasingly hostile and socially isolated. They become angry individuals who are unable to show empathy.
3. The Anxious/disorganised type-these ones were brought up by mothers who themselves had a lot of unresolved issues that make them inconsistent in their care-giving. These grow up becoming very clingy and dependent individuals, who feel easily rejected. They some times come across as immature in their relationships, resorting to manipulative behaviour to get their own ways in life.

Of course you cant put anybody into a particular box as I have stated before.

Human beings are a lot more complex than that.

It is also important to remember that the child brings with it it’s own personality attributes to the relationship. And it is these attributes that would make her/him turn out differently even if they were exposed to any of those factors that i have hinted at as the things predisposing them to any of the attachment behaviours I’ve enumerated.

In my next post, I will begin to look at the groups of mental health problems and also respond to whatever questions people may have at the moment.

I hope this won't be too technical, but the earlier one get's it out of the way, the better!

So here goes.

The 5th Chapter of the World Health Organisations International Classification of Diseases (otherwise known as the ICD-10) recognises eleven ‘groups’ of mental and behavioural disorders.

For the purpose of simplicity and to reduce the 'technicality', we’ll break them down even further into 5 main groups.

The ‘organic’ Disorders
These are mental illnesses for which you can clearly identify an ‘organic’ cause. 

These can be found following a brain injury caused by an RTA, stroke etc. You can also have so called ‘organic’ mental disorders after the use of certain drugs for treatment. For instance the use of steroids, like Prednisolone, can precipitate an episode of mania. Such a person’s personality would dramatically change and you may notice odd behaviour like increasing disinhibition (including sexual, social etc) in somebody who was previously very reserved. 

Some vaccines, like the Hepatitis C vaccine and others may also precipitate a change in an individual’s mood and can lead to suicidal behaviour.

Most readers are familiar with the effects of psychoactive substances such as Cannabis (marijuana), which can make an individual to become increasingly paranoid and behave ‘weirdly’. The use of Cannabis is closely associated with Schizophrenia.

Functional’ illnesses
Historically the term 'functional' has been used for the illnesses in this group, even though modern instruments are identyfing their 'organic' natures. But for the purpose of this piece, we'll stick with the term. Here you will find those illnesses that most people are more familiar with when they think of mental illness, such as Schizophrenia and the mood disorders (depression and bipolar affective disorders, which was formally known as manic-depressive psychosis).

These illnesses are the ‘bread and butter’ of hospital psychiatrists, even though they don’t form the bulk of psychiatric illnesses, as other professionals are quite reluctant to attempt managing them.

Neurotic, habit and personality disorders
Though I have grouped the illnesses in this group together, each of them can actually head up their own groups of illnesses!

Neurotic disorders would include things like the phobias (social phobia-shyness, fear of public speaking); specific phobias (fear of snakes or other animals, fear of flying etc), Obsessive compulsive Disorders (where an individual has intrusive/obsessive thoughts and has to perform certain rituals in order to feel relief from those obsessions), and other anxiety spectrum disorders.

Habit disorders would include addiction problems. People can be addicted to drugs, sex, food etc. In this group one may also want to include the Eating Disorders (anorexia-where a person’s body refuses to recognise that they are starving themselves to death; bulimia-where the person binges on food then feels guilty about it and makes themselves throw up because of the guilt).

Personality disorders are those when the person’s 'personality attributes' don’t allow them to function well in relationships and in the larger society. They can be considered as exaggerations of the persoanlities of the everyday person. These include the Paranoid Personality that thinks that everybody is against him/her, so is always on the attack or fighting percieved slights by people, the antisocial personality who is more prone to criminal activities and feels little remorce about hurting others, the narcissistic personality who is in love with themselves and only themselves etc

Over 60% of prisoners in the UK suffer from one form of personality disorder or the other. They are also more likely to suffer from mood disorders, use drugs and kill themselves. They are also more likely to kill other people than somebody suffering from the Schizophrenia-type illness! In other words you are more likely to be killed by one of these guys than by the ‘raving’ lunatic on the street corner, who is struggling with his ‘demons’ and hardly has any time for you!

Mental retardation and Learning difficulties
These could be inherited like Down’s or due to some problems that occurred while the person was in the womb or at the time of birth.

In this group you can find illnesses like Dyslexia, where the individual has difficulties reading and mixes up letters. This diagnosis is becoming increasingly fashionable in the UK and in the USA among middle-class families, especially when the child is not doing so well at school and has behaviour problems.

Emotional and Behavioural disorders in children and Adolescents
Here you will find things like Hyperkinetic Disorders (also called ADHD), where the child has problems staying still, paying attention and with controlling their impulses (i.e. can’t wait their turn for things etc)!

This group includes conditions such as Conduct disorders, where the child persistently aggressive and defiant, beyond what is considered socially acceptable within the child’s culture.

Here you would also find problems like bed-wetting (non-organic enuresis); inappropriate passage of faeces (encopresis) etc.

In the next post I’ll continue with the story of our friend Joe and also bring in other vignettes to help us understand a little bit better the way the mind works sometimes…

There's one major group that i did not add. The Medically unexplained disoders and the Somatoform Disorders!

I can't believe that i did not include them, seeing that a lot of questions that people have been posting on the health section actually come under that grouping! It's also the group that is most difficult to recognise by other Doctors!

Somatoform Disorders are disoders, which present 'physically', even though their origins are due to Psychological conflicts or stress. Some readers are familiar with the term 'psychosomatic' disorders, which is another name for these disorders.

In this group you can find illnesses such as 'somatization disorders' where the body translates emotional conflicts into body pains, such as headaches, pain in different parst of the body etc. Some 'medical' problems such as Irritable bowel syndrome with diarrhoea or constipation and  non-organic erectile dysfunctions (i.e. weak erections, impotence) are included in this group.

The dissociative disorders are when the mind is unable to deal with avalable reality, so copes by disconnecting itself from reality! The person may present with non-epileptic seizures, sudden loss of sensory functions (such as blindness, deafness, sensation in the hands or legs etc). Possession states, where the individual believes that they have been taken over by something else (possibly spirits or aliens) have been included in this group, though they can also be due to a Schizophrenic illness.

Other conditions such as Munchaussens syndrome where an individual feigns illness just for the sake of being ill, also known as hospital addiction syndrome is included here. In Munchaussen's the individuals may actually inflict injuries on themselves or others just to adopt the sick role. The latter scenario is known as Munchaussen's by proxy. Some people have actually poisoned their spouses or children without malicious intent just to be close to the hospital all because of Munchaussen's!

I still can't believe that i forgot this interesting group!

Adam was found dead.

He was hanging from his bedroom window on the third floor of the council flat, where he lived in a run down part of South London, just four days after he had been discharged from hospital. What baffled his neighbours the most was that following his discharge from hospital, he’d actually come across as back to his ‘normal’ self, and nobody ever guessed that he would kill himself.

He was just 26 years old and had been so full of promise and hope. But he died instead a wasted man. A wasted life.

It is not clear when Adam first became ill.

His parent’s, who are from Nigeria, and who had resisted attempts to treat him when he first started to behave ‘weirdly’, attribute his problems to a spiritual attack and had been very reluctant to engage with services because they felt that what he suffered from was not a mental illness.

In summary, it is believed that Adam suffered a ‘brain gay’ during his final year exams in a Nigerian secondary school about 10 years ago. His parents became concerned about this and were convinced that Adam was the victim of some manipulations by evil people in his village, who were trying to ruin his life.

Adam's father decided that the  whole family needed to relocate to the UK, which they succesfully did over a period of 4 years. They first sent Adam to stay with his paternal Aunt, who resided somewhere in London, following which the rest of the family gradually made it to the UK, where they now reside.

Adam was 17 years when he first came to the UK.

After he arrived, his Aunt tried to get him into a college in South London to sort out his education from there, but Adam had other plans. He believed that he had a special assignment from God to save the ‘lost children’ whom he could identify by the colour of their socks. Any young man or woman wearing grey stockings needed to be ‘saved’. Adam knew this because a voice told him so.

One day, as he was passing a Turkish kebab shop, he saw his reflection in the window and suddenly realised that he needed to reveal himself to the world. So he started to take off his clothes in public, shouting ‘I am he!’, ‘I am he!’ He was subsequently arrested for public indecency, and by the time the police took him to the station he was described as ‘rambling’….

This story is made up but there are so many Adam’s out there, wandering the streets, misunderstood and vulnerable.

I’ll use the story of Adam to introduce the concept of defence mechanisms. Ordinarily, the vignette about Joe, which I gave at the beginning of this thread would have been sufficient but I think the thought that mental illness is a form of protection from reality, a defence from the onslaught of experiences we cannot deal with, is a very interesting one.

As Shakespeare once wrote;
‘Thou seest, we are not all alone unhappy. This wide and universal theatre presents more woeful pageants than the scene where-in we play…’

In my next post, we'll look a little bit more about how we try to navigate the tragedies of our individual experiences, using the defence mechanisms, one of Dr Freuds contributions to modern Psychology and psychoanalysis….

@ Mohawkchic
That's very encouraging. Thanks!

@beneli
I stay in nigeria i have been trying to see if i can see a shrink but anytime i come up with it my people ask me if am crazy or do i have any mental disorder my feelings and emotions are all going crazy at times i feel sucidal but at such moments i start thinking about my kids and my husband so it reduces or should i say supresses the thot.
I use to work in a financial institution and along the line i lost my job under a very nasty circumstance,the case is in court right now.I always think negative thot concerning the case at times i think that i might be sent to jail or somebody might just come and kill me.
I suspect my husband a lot even when i do not have any reason to,i am always scared everytime i want to go to the court,nobody is aware of this,i look for a secluded place where i talk to my self i mean i hear myself,i console myself ,i pity my self and do all sorts of funny talk.
I dont know if am okay or going crazy or maybe is the stress pls can u help or i dont need help

@bece: there's a Psychiatrist at LUTH. I met him.
And if all else fails, the best Psychiatrists are at the famous Aro hospital.
You don't have to tell anyone you're going there;
just gather some cash and get into a Taxi.

Psychological mumbo-jumbo aside, the drugs they prescribe really work.

@bece,

You are not going crazy. Okay?

It seems to me that you are experiencing a depressive illness that is becoming moderate in it's intensity.

The symptoms you describe, which in psychtalk would be described as emotional lability, fleeting suicidal thoughts, increasing guilt (hence worry about going to jail), suspicions about your husband and so on are all symptoms of Depression. Don't worry about talking to yourself. If it helps you, go right ahead and talk as much as you want. In the process you may actually begin to see that all is NOT gloom and doom. Psychiatrists recognise that talking is actually therapeutic, as it allows you to vent out your pent up emotions. In psychtalk we'd say that talking can be cathartic.

If your husband is accessible psychologically, it would be even better to talk to him about your anxieties and worries. But at the end of the day, what you have described suggests that you'll also need some Professional input.

Oga Seun has kindly advised about LUTH. I suggest you try to get seen by a Psychiatrist. The symptoms you've described suggest that you may need a course of antidepressants in addition to the 'talking' therapy.

If it will be any reassurance, Depression is VERY common. Much more common than people would like to admit. So you are not alone.

It's a pity though that something so common, is so maligned.

All the best

thanks seun and thanks to beneli too.
i dont stay in lagos.can one get from general hospital,private hospital or the national hospital

You're not very likely to get a Psychiatrist in most General Hospital but somebody there may be able to give you relevant information. Some big private hospitals may retain a Psychiatrist or a Physician with experience in Psychiatry.

If by 'National Hospital' you mean the National Hospial in Abuja, their official website (http://www.nationalhospitalabuja.net/) has not included it as one of the services they offer, but you could still go there and get seen by one of their clinicians who may point you in the right direction.

All the best.

Let’s look at this defence mechanism thing a little bit closer.

It can help us to understand ourselves a bit better…

Dr Freud postulated that in the struggle of the mind to cope with the memories of its growing up traumas and the difficulties of everyday interaction with reality, it tries to come up with a story that allows it to maintain its self-image. In some instances, this ‘self-image’ may be seen by an informed observer as self-deception. I’ll come back to that later…

Anna Freud, Sigismund’s daughter, who continued with the work of her father, came up with the concept of ego defence mechanisms, as an unconscious process that allows the mind to enter into a place of inner refuge from the realities it cannot otherwise cope with.

This process is used by both healthy and unhealthy individuals throughout there lives, to balance out the life scripts that they had crafted earlier on in their formative years, which gave them their self-image. (See my post about life scripts a few posts above).

For the purpose of this piece we will divide defence mechanisms into the following 4 groups:

The ‘mature’ defence mechanisms
These are used by emotionally healthy individuals to cope with difficult reality. These defence mechanisms helps the individual to continue to function and come across to others as individuals having a lot of virtues. Examples of these are:
• Sublimation-the unconscious diversion of unacceptable impulses into more socially appropriate behaviour or endeavours. I find this to be quite interesting, because the interpretation here is that some people (not all of course) who do ‘good works’ are actually motivated by an unconscious need to dominate others!
• Humor-the expression of ideas and feelings that give pleasure to others. A lot of famous comedians, use humor to divert from their own solitude and sadness.
• Identification-the modelling of ones behaviour upon that of somebody else, to reduce the pain of loss or separation. A male child who tries to be like the father, who did not want him…

The slightly neurotic defence mechanisms
Here the individual uses mechanisms that allow them to cope in the short-term, but which causes longer term difficulties in their relationships and interactions with the environment. Examples are:
• Displacement-the transfer of emotions from its true object or situation to another source. For example, a man who puts his work before the needs of his family in the last months of his wife’s death blames the doctor for failure to give adequate care, thus avoiding to blame himself…
• Rationalization-the use of a false but acceptable explanation for behaviour that has a less acceptable origin. An example is the use of biblical scriptures (the Hamitic theory, for instance) to justify slavery…
• Reaction Formation-when we adopt the opposite attitude to what we really think or believe. An example is the homophobic crusader who actually, has homosexual urges, or the overzealous fanatic who is excessively prudish about sex, to hide from their own raging horniness!

In my next post we will look at the last 2 groups of defence mechanisms and then explore a bit deeper, what may have been going on in the mind of Adam in our vignette above, before he killed himself…

The immature defence mechanisms:
here the individual resorts to ‘childish’ or immature mechanisms to deal with difficult reality and is most common in people suffering from mood disorders (depression, anxiety, panic etc) and personality disorders.
Examples of these are:
• Acting out-a person uses visible action to express emotional distress. For instance, a person who has been sexually abused may resort to self-destructive behaviour (e.g. self-mutilation, promiscuity) to offer them temporary emotional release from the pain of their thoughts.
• Passive aggression-the expression of aggression indirectly. For instance, somebody who is being bullied by their husband or boss, resorts to sabotaging things within the home or the office, in order to get back at their perceived bully.
• Hypochondriasis-the transformation of emotional difficulties and conflicts into physical pain or ‘illness’.  This is very common in societies, where individuals find it difficult to resolve emotional conflicts in more helpful ways, like talking.
• Projection-this is a very interesting one.  Here the individual shifts their own unacceptable weaknesses to another person in such a way they see those things that they don’t want about themselves in others. A common one is prejudice, where you assume the worst things about someone else, when in actual fact these are things about yourself, which you don’t want to acknowledge.

The pathological defence mechanisms;
here the individual ‘rearranges’ external reality in order to cope with it. In this state of mind the individual will be seen by others as ‘crazy’ or having ‘lost the plot’. Examples of this defence mechanism includes
• Denial-an individual refuses to accept their unpleasant reality even though it’s very clear to everybody else around them),
• Distortion-a person reshapes external reality to suit their way of thinking. A depressed person for instance will only see the negative things about themselves and the world around them, while dismissing positive things in their lives.
• Delusional projection-this is a more intense form of projection (see above), where the individual believes that others are out to harm them, or destroy them. This is described also as paranoia.

The pathological defence mechanisms are associated with biochemical changes in the brain and are very common in severe mood disorders, psychosis (like schizophrenia, mania etc).

To help us understand this a bit better, let’s go back to the vignette about Adam who killed himself, when he was supposed to be getting better. It is known that people who have suffered from a psychosis are at a high risk of killing themselves when they have just come out of hospital or their symptoms are resolving. This is actually a paradox, seeing that one would have thought that a psychotic person would want to get better!

The truth is that psychotic people don’t always want to get better. In my practice I have come across a lot of people, who I can almost empathise with their psychosis.

Let's look at Adam's story again. When Adam arrived the UK to live with his aunt, he came to live in a dysfunctional home, where the aunt started to call him all sorts of derogatory names, which all had something to do with evil spirits, demons, witchcraft etc. The stress of this drove Adam into a place of mental refuge.

The problem for Adam was that before he was sent off to the UK, there were already a lot of cracks in his family.

His mother was never really the woman that his fathers clan wanted him to marry. After she took in with Adam, there were rumours, started by his paternal Aunt (living in the UK, and whom Adam had been sent to live with), that Adam did not belong to his father.So Adam grew up with that dark cloud of doubt hanging over his head. He grew up believing that he was not wanted, and as a result his 'life script' had a lot to do with the need to prove himself to his father and to everybody else. For Adam there was also always an unconscious theme about ‘loss’ and ‘being lost’ in his life’s narrative, which gradually became part of the content of his illness (hence ‘the lost children’ and the need to be saved).

And as long as Adam was ‘ill’ he had a life mission and a sense of importance. Once he became well, the tragic wounds of his childhood and rejection became re-opened and he could not deal with them. So he killed himself.

I see a lot of patients like Adam, who feel comfortable in their ‘madness’. Recently one of my patients who had started to get better on his medication told me how he felt increasingly isolated. When he was very ill, he heard voices of ‘god and of angels’ tell him that he was special. The voices told him what to do and kept him ‘company’. Once the voices went silent, he found himself alone. In his recovery, he could now see himself the way others must see him; a mental patient and a 'nobody'. And this realisation makes him to feel shame and a lot of sadness. This particular patient preferred to have his voices back and to live in oblivion, than to be well in a world where he was an outcast.

I’ll pause here for a while and respond to questions that people may have.

I have found this post very very interesting. It is a pity I couldnt read something like this earlier when I really needed it, Instaed I was feelind depressed but thinking I was going mad which even made it worse cause it brought on more anxiety and made me stay at home 'hidind' instead of looking for help or talking to people that could help until it was almost too late,

My advice for nybody that feels or thinks they need help or cannot cope PLS reach out to someone such as a mentor, doctor or family member. nigeria needs more help regarding info on mental health, maybe more websites leading to sources that can give help. If there is nyone willing maybe we can hook up to do something.
Dr Beneli pls keep up the good work.

@ atilla,
Good to hear that you're finding this thread useful.

It's unfortunate that though mental health problems affects hundreds of millions of people worldwide, causing 'staggering economic and social costs'  (http://www.who.int/mental_health/en/index.html) very little effort is made by government and concerned professionals (inluding myself) to reduce the level of stigma it is associated with.

The majority of people who need to understand that their experiences are common and can be helped with, will not have access to a medium like this, unfortunately. So a lot more needs to be done, in a manner and medium that is easily accesible to the majority. In my world, waiting for the government and 'policy makers' is not good enough, so i am currently exploring the most effective ways to 'get my hands dirty' and do something about it!

But thanks for your kind words.

Please I need help. I am suffering from Avoidant Personality Disorder. this problem has really affected me in life in terms of relationship. Please advise me on best way to go about it. Thanks

@Beneli, you are doing a great job,wish there is increase awareness on mental illness. I suffered from depression too. Thank God I took a bold step and sort help from a 'shrink'. My friends actually did not encourage me, they were more concerned about the stigma,but I was bend on getting well.

At a point in my life I knew I was no longer the person I used to be any more. I became aggressive,suspcious,had to depend on caffine to boast my energy level as I felt exhausted quickly among others sysptoms. I read a lot then because I felt all was not okay with me and I needed answers. It was during this search I realised I have to see a doctor. Thank God I did, am a lot better now,thoug still on medication. Will 3 years in dec. I started medication, I have gained a lot of weight over this period though,am happier and set and meet my targets now.

Which more people will know about this health issue. Through my experience a number now see things differently.

I really. Need help
I think I have severe anxiety disorder , depression
As well

Everyone's telling me its OK

Buh I know its not
I need help
Itz ruining my whole life