₦airaland Forum

@poster

Yes.

Here are some simple do- it-yourself steps that you can try.

1. Learn to pause before you want to say anything.
2. Speak more slowly-don't feel presured by anybody or by circumstances
3. Don't always expect that you will stammer or stutter-it will become a self-fulfilling prophesy. Instead, try to 'mentalise' what you want to say first.i.e. say it to yourself first subvocally.
4. Don't bottle things in, only to blurt them out all together. So when you're feeling pressured or stressed out do a simple relaxation exercise (breath in while slowly counting up to 3 in your mind, hold your breath again while counting up to 3 and then breath out the same way). That should calm you down a bit!

5. But always be patient with yourself and say what you want to say in your own words!

Good luck

ps: if it's debilitating, you may require the help of a speach therapist. I'm hoping that there'd be some in Naija

That's helpful information.

What your wife presents with looks more like a bipolar affective disorder with psychotic symptoms. Not that it makes a lot of difference what the diagnoses is., seeing that it could also be unresolved postnatal psychosis, which would present that way as well. It's no longer a postnatal depression. 

What does your wife make of her experiences (the voices, her fluctating mood etc)? Does she recognise that she may be unwell?
The first step will be getting her to recognise that her presentation may be due to illness. The good thing is that it is treatable.

From your concern i suspect that you are already very supportive of her. That's commendable.

It's important to continue to reassure her about the fact that you have no intentions of giving up on her, even if she has a 'mental' illness. For the sake of the stigma, it's best to describe it in terms of 'stress-related experiences'.

What you guys can do together is to actually read up more about the illness. That would demonstrate to her that you are committed, inspite of her blaming you for her problems.

Here's a link to the Royal College of Psychiatrists most recent evidence-based information on postnatal mental illness for the public.
http://www.rcpsych.ac.uk/mentalhealthinformation/mentalhealthproblems/postnatalmentalhealth.aspx

Next thing you should do is to arrange to have her seen by a Doctor, who would probably start her on a neuroleptic medication with or without a mood stabiliser. In an ideal world, she'd have been screened for possible metabolic disturbances (thyroid function, especially), and also had her electolytes and sugar level checked out by now, since you say she's already had loads of investigations.

The most wise thing to do though, would be to get her seen by a Psychiatrist, not a Psychologist.

I wish you the best and stay strong.

Sorry to read about your experience. I am a Mental Health Practitioner and may be of help.

This is a very delicate issue, but to be able to help you, i would like to know a bit more about her presentation. Of course you should ensure that the info. you give remains 'confidential' as this is a very public forum.

1. When you say 'mood swings' can you be a little bit more specific. Does the mood 'swing' from being very low (when she would not have the energy to do anything, be feeling sorry for herself, not enjoy the company of family members etc) to a 'high' when she'd come across as full of energy, irrational in her thinking, irritable etc? When she turned 'violent' can you remember the precipitant? What was her explaination for the behaviour?

2. The 'hallucinations' you mentioned are they real to her? i.e. is she convinced that they are real? Does she also hear 'voices' etc.

3. What does she think of the children or how does she relate with them?

4. Can you say more about what she was like before she started to have children. For instance did she have periods of being withdrawn, irrational, too preoccupied with others plotting against her or  about people trying to harm her?

5. Is there any family history of 'unusual' behaviour on her side?

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!

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…

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.

@Kabikala
Don't kid yourself. A lot of people go into 'professions' whether medical, legal or whatever for financial security (spelt MONEY). So, let's cut the balderash (no insult intended).

About the brain drain thing. Highly skilled professionals will always move around until they get to the place that they want to be. That's what drives them to rise above the average. So there's nothing that can be done about that.

However, if the people involved with our health policies focused on giving us a health system then half of the problem will be solved. I have said this in different posts: there needs to be clarity about the pathways of accessing health care. There needs to be clarity about what constitutes primary, secondary and tertiary care. There needs to be clarity about the health insurance thing, it's scope and coverage. With that the private sector will begin to be more clear about it's role.  Things should not be done haphazardly.

With a bit more clarity, people and organisations will come in to fill in the gaps and Doctors with skills will be able to carve out clear niches for themselves. That's the way things work.

@Epiphany
You are right. Once a Doctor is able to specialise, then only he can put a cap on how much he earns. The secret is in being creative with your skills. One of my senior colleagues that i look up to here, has an agent for crying out loud! When he's not working in the NHS, he spends his time on his yacht of the coast of the Caribbeans creating health-related products (books, scripts etc) to sell.

The thing is to become an authority in whatever subspecialty we choose and not limit ourselves to seeking employment from the government! With the MBBS, the choices and scope is a lot more limited.

@FSB
To be honest with you, i had asked myself the same questions you've posed about why one should bother to spend all those years in further training, when you could earn a lot more in the corporate world. But what to do? Once you're in, you're in and have to make the best of what you have. And that's where a forum like this, where we can share information comes in.

The reality is that in Nigeria the Medical Doctor is in dire straits.
There is no organised health system, no clear pathways of accessing healthcare, no proper quality regulatory body, no agenda for development ad nauseatum! And as long as the situation remains the way it is, there's no way that Doctors employed by the government can expect to earn anything remotely comparable to what people earn in better organised societies.

In the UK an NHS Consultant earns between £70-90,000 per annum before tax. In the employed private sector you can earn up to £150.000. If you know what you're doing and decide to go independent you can earn up to £240,000. So it's really those who know what they're doing who achieve a bit of financial security. I am aware that some of my friends in the US earn up to $300,000 as Attendants (Consultants) there. What you earn depends on what you can do.

The gist of what i am saying is that once somebody is ensnared in the becoming a Nigerian Doctor thing, then the person should aim to specialise with a view to creating their own wealth. Where you get specialised depends on the resources available to you. But strive to do so. Once you've done so, then put your creative talent to use and strategise to make wealth for yourself. That's my advice.

Being dependent on government employment or employment by somebody else is in effect resigning oneself to mediocrity and penury. period.

The only doctors working in the 'supermarkets', if any are those who have not passed their PLAB exams.
There is a shortage of Doctors in the UK currently, but only for those who are willing to work in non-training roles i.e. jobs that don't lead anywhere.

In the last 2-3 years there's been a complete overhaul of the postgraduate training for Doctors here and this has affected mostly the overseas Doctors. So anybody thinking of further training in the UK should forget it for now. You can still do courses and even get postgraduate qualifications like the MpH or MSc in whatever tickles your fancy and target  jobs with the United Nations http://unjobs.org/organizations/who.

For anybody who is interested in further training, US is one of the few places remaining overseas. You do have to muster the resources for the USMLE, but it's not impossible. Nigerians are passing the exam in their hoardes!

There are still occasional opportunities in the Caribbeans. I know that Queen Elizabeth Hospital in Barbados has quite a few Nigerians doing there residency there. You will need to contact which ever Caribbean countries embassy you're interested in and ask about the contact details for whoever you need to correspond with for jobs in their country.

Down South in South Africa, Namibia and Botswana there may be opportunities for work, but not for residency.

The condition you present with is known as somatization.i.e. translation of emotion/psychological conflicts into 'physical' symptoms.
It becomes a disorder once it affects your day to day functioning, in which case it would be called a Somatization disorder.

It's quite common, especially in the developing world where having emotional problems is stigmatized and considered a weakness, however it's not life threatening. There are no laboratory investigations that would 'reveal' the diagnosis, but it's still advisable to get your Doctor to first check you out.

The healing, however, starts once you understand that it won't kill you!

I hope that helps.

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.

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.

Where have all the trees gone?

The big trees are fast disappearing from Igboland.  In the Ngwa area from which I hail, that was the frightening discovery I made during my visit in August, 2004.  There no apu trees in Amapu, nor orji trees in Amorji, no egbu trees in a market called Nkwo Egbu, no ugba trees in Ugba Junction, no ahaba to be seen along a road that used to be known as Okporo Ahaba.
-http://www.amadipress.com/Tales%20of%20Igbo%20Childhood.htm

I stumbled on the above piece, while looking for information relating to the different peoples that make up Nd’Igbo.

I find this piece laden with a certain nostalgia and symbolism that resonates with me.

This is not about ethno-centric nationalism but the nostalgia of one who left home an African child, but who has become gradually lost in the maze of trying to be a man of the world…

To my shame, I know very little about our people and our culture.

And while there are many out there who will be quick to jump up and point the ‘more-Igbo-than-thou-fingers’ at me, I think that the problem is a lot deeper than my lack of knowledge about our history and our identity. It has become a problem that afflicts most Africans-nay most young people of all cultures-in this age of the global village,

The last time I went home and visited Aba and then my village in Ngwa land, and later saw the level of infrastructural and moral decadence that had taken us hostage, I left with a certain pain gripping my chest. A pain that lingered long after I had bid my kinsmen goodbye and boarded the plane, yet again, on my journey back to ala bekee, the land of the 'white man' where I have made my home in my quest for a place of refuge for my soul.

Where have all the trees that were to have symbolised our resurgent sence of pride and liberty gone?

In his poem titled 'Africa', David Diop made reference to the significance of the trees thus:

That tree over there
Splendidly alone amidst white and faded flowers
That is your Africa springing up anew
Springing up patiently, obstinately
Whose fruit bit by bit acquires
The bitter taste of liberty.
                -David Diop (1927-1960)

This list is embarrassing!

Becomerich please go and see a Psychiatrist. This is no longer a laughing matter.

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.

We should return to the Holy book.

Let the Holy book-and the conscience of the man in question-be the judge.

Is buying a private jet the deed of one who really knows the Christ? Perhaps it is. I can not answer for the man.

At the end of the day, who are we to judge him, if his conscience does not judge him?

If the man-note that i call him a man, for that is what he is-is convinced that were Yeshua or any of the founding fathers of the Christian faith on earth today, that they would have done as he has done, then let him be.

If on the other hand, after searching the scriptures-the only thing that should really guide him-he sees nothing to justify what he has done, then he and he alone will have to answer to God. Not the other leaders of the church, not the rest of the congregation, but he the 'holy' man, alone.

The book says, 'let God be found true, but every man a liar; as it is written, That you might be justified in your sayings, and might overcome when you are judged, '(Romans 3:4)

The only problem that i have though, is that from where i stand, all this doesn't look Christ-like to me.

I disagree with people who say that you're not Igbo if you don't speak Igbo.

Different posts on this forum have tried to argue about what it means to be Igbo, telling some that they are Igbo, when they say that they are not, and then denying others who want to identify themselves as such, the priviledge.

There have been a few people on this forum from the diaspora who have wanted to identify with their Igbo Heritage and African ancestry, but some people argue with them that by virtue of their having been dislocated by many generations from the motherland, that they are no longer African!

I find that, in all honesty, rather ridiculous. But then that's my humble opinion.

The question i want answered is; what does it mean to be Igbo? What is ones Igbo-ness?

If it is about the language, then is an Hausa man named Adamu in ama hausa in Owerri, who speaks Igbo, more Igbo than say an Obinna in New Jersey who doesn't?

Is it about the name?

Then is Daniel Jackson an African-American who discovers that his genes are predominantly Igbo less Igbo than Emeka Amadi in Portharcourt who says that he isn't?

Is being Igbo then a way of life? Is it an innate identity, a knowing?

I don't claim to know the answers but i do know for sure that those who arrogate to themselves the right to determine who is and who is not Igbo, may be getting it wrong.

@ 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.

Are there any reliable books anybody can recommend on the history of the Osu caste? I am not satisfied with stuff you find on Wikipedia!

I am also interested in the Aro people, their history and migration and have been looking for books that can enlighten me more on them. One of my questions is 'does the history of the Osu caste predate the Aro Kingdom or not?'

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!

As stated by Outstrip, the figures may actually be a lot more than that!

Current research suggests that up to 20% of people who go to see their Doctors actually have a mental health problem, but present with what is interpreted as physical symptoms. The majority remain undiagnosed, undertreated and therefore continue to suffer. Pregnant woman and Children are particularly very vulnerable.

The world Health Organisation recognises the need for governments to start investing more in mental health services, including public enlightenment programmes and basic training of health workers to recognise it. http://www.who.int/mental_health/en/

Phobia is a lot more complex than some people think.

The good news is that it is not too complex a problem, that it can't be solved. The approach to solving the problem is the use of a Cognitive Behavioural approach know as de-sensitization.

Fortunately, Psychiatry has advanced to the stage where we can offer e-CBT (electronic cognitive behavioural therapy). So you can be helped electronically.

@ poster

Send me a PM. There are certain details about your circumstnaces that should not be disclosed in a public forum, so i won't be able to give you the personalised infomation that you need here. However, rest assured that, in the spirit of nairaland, i won't be charging you for the consultation!

I will try to cover the topic of phobias and the approach to managing it (and related Anxiety Disorders), at some point in my post 'Your Resident Shrink'.https://www.nairaland.com/nigeria/topic-244818.0.html

@ Topic: Challenging for whom, if I may ask? Is it for the undergraduate student or for the practitioner?

What are the criteriae for comparison? Did we take into consideration such confounding variables as personality type of the individuals choosing the courses, their socio-economic background etc

I chose ‘Medicine’ because I always wanted to be a Doctor, even before I got into secondary school. I doubt that I’d have been able to become an Engineer, simply because it doesn’t appeal to me as a profession and not because I wouldn’t have been able to handle the mathematics and so on involved. I’m sure any ‘Engineers’ here would probably say the same. Did I find training to become a Doctor challenging? I certainly did, but I can’t say how challenging Engineering is, because I don’t know. Likewise an Engineer can’t come and say how ‘challenging’ medicine is because s/he is not in a position to say. Only somebody who has actually studied both would be able to pass an informed (but still not very accurate) judgement,

Those who think that Medicine is not creative and does not challenge the status quo, with all due respect, don’t know what they are talking about!

I am a Specialist in Psychiatry. In my field we are currently identifying the genes responsible for aggression and love. We have localised the part of the brain that makes us to 'desire' things, to 'hate' things, to 'believe' in things and we are on the verge of bringing forth pharmacological and instrumental interventions that can obliterate memory or awaken lost memories. We have been able to change human personality for decades using surgery and pharmacology, but we have acquired skills to use 'talking' therapy to quieten restless human 'spirits'.

We are mapping the human ‘soul’ and the very nature of man, and we have learnt how to control emotion, will and human intelligence.

Yet Psychiatry is just one of the many subspecialties of Medicine that are pushing the boundaries of human knowledge and understanding. And you dare to say that we are not creative?

@ 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.

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.

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.

If this is true, it is immoral, unchrist-like and, quite honestly, a big shame.

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

@Sauron
I am from Ngwa Ukwu in Isiala Ngwa. 
I too have heard about this Cannibalism business that people, like you, claim we partake in.
But i can tell you, if it will bring you peace, that we don't eat human meat!

Are you satisfied?

It's actually a very laughable thing to think that informed Nigerians on this side of the 21st century, who have interacted with people from outside their villages, can continue to believe that rubbish!

And yes, i do go home often, so i know wetin dey.

Na wa for people!

Shaking his head and wondering why seemingly intelligent Nigerians can continue to be so prejudiced and ignorant when discussing people from outside their ethnic groups, 

What this man presents with are 'Neologisms' (a disorder of thought form) and 'pseudo-philosophical ramblings' (a disorder of thought content). These symptoms are seen in Schizophrenia, amongst other mental disorders.

Nigeria, behold your leaders!

Pardon my use of long words and pedantic[i]ity[/i]