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Mental health: Misconceptions, assumptions and a dash of truth

  • Mental health

    When was the very first time you heard that term? Take a moment to ponder.

    I don’t remember. Most of those I interviewed for this article couldn’t either but one thing is certain - there is a lot to understand about it.

    In Nigeria, there are many interpretations of this term but chief among them is that it is the degree of lunacy a person exhibits. Note that this is not even a question of whether one is a lunatic or not but simply how crazy an individual is. Thus, if you are talking about mental health, you are believed to be definitely talking about lunatics.

    Aisha Hussein, mental health advocate and lead of the Mental Health Team of Jela’s Development Initiatives (JDI) notes of her prior misconception, “I thought mentally unstable people were crazy. The first image that comes to mind when I heard mental health was a mad person with tattered clothes roaming the streets.”

    Chisom Onwuekwe, member of the same team has a similar memory to share, “I first heard about mental health in 2010. I was more familiar with mental illness whose meaning I drew from the interpretations adults around me had. The traits I thought of were of a mad person who would roam the streets half or stark naked, dirty or dressed in rags. So, before 2010, at the mention of ‘mental health’, my mind had the image of a mad person, nothing more.”

    These bring me to a rather interesting conversation- 5 common misconceptions about mental health in Nigeria.

    1. Mental illness is equal to lunacy

    This is quite an obvious misconception. Anyone that has worked in the mental health advocacy space as I have would have seen this a million and one times. In fact, it is at the heart of the responses from interviewees.

    Too often, it is assumed that mental illness is tantamount to needing shackles because one has gone irate.

    This is even seen in the kind of law operating in Nigeria, where it concerns mental health. First off, it is called ‘Lunacy Act’. How ludicrous is that?

    Nonso Attoh, a lecturer at the Faculty of Law, University of Nigeria had this to say, “Our current legislation on mental health is the Lunacy Act, 1958.  Starting with its title, which is now considered derogatory, it is a law belonging to another time, a time when mental illness was more poorly understood, and when the human rights of the mentally ill were taken much less seriously.  There is currently no clear regulation of mental health care, no direct legal protections, and no financial or welfare provisions for mentally ill persons”

    The Act focuses on restraining the patient rather than treating him/her because it was fashioned at a time when there was no known treatment for mental illness. It even goes as far as criminalizing attempted suicide. This is why a guy that is about to throw himself off Third Mainland Bridge or a lady who swallows a poisonous substance but survives will be hauled into jail.

    Suicide is seen as a punishable act rather than a cry for help. The fundamental human rights of the mentally ill are not recognized and those suffering from mental illness are seen as threats to society.

    This mindset largely explains why there is still stigma around mental illness in 2020. We simply haven’t moved past seeing it as demon possession or for lack of a better word, madness!

    Related article: Theories and framework that explain human behavior and productivity

    2. Mental health and mental illness are the same

    Feeding off point 1, too often the two terms, ‘mental health’ and ‘mental illness’ are used interchangeably.

    According to Onwuekwe, “Mental health is a complete state of wellness of the mind.”

    On the other hand, American Psychiatric Association describes mental illness as, “Mental illnesses are health conditions involving changes in emotion, thinking or behavior (or a combination of these)”

    Medical News Today explains, “mental health refers to our cognitive, behavioral, and emotional wellbeing – it is all about how we think, feel, and behave. The term ‘mental health’ is sometimes used to mean an absence of a mental disorder.”

    Yet, a lot of people confuse the two terms. We must learn that mental health is a state of being while mental illness is absence of good health when it comes to seat of emotions or the mind. Capisce?

    3. Mental illness starts and ends with depression

    Take a random sample of people around you and ask them the mental illnesses they know and you get answers like this, “Depression… depression and depression” but hello guys, depression is not the only mental illness that exists.

    The unfortunate, recent spate of suicide running through Nigeria like wildfire has many people assuming that depression is the beginning and end of mental illnesses.

    In fact, let me digress a little here. Mental illness is a risk factor that makes an individual more likely to commit/attempt suicide. Is it the only prerequisite for someone wanting to end his or her own life? No!

    Also, an individual who treads that painful path of suicide may have other illnesses other than depression. Healthline shares, “Depression is the top mental health risk factor, but others include bipolar disorderschizophreniaanxiety disorders, and personality disorders.

    Aside from mental health conditions, other factors that increase the risk of suicide include:

    • incarceration
    • poor job security or low levels of job satisfaction
    • history of being abused or witnessing continuous abuse
    • being diagnosed with a serious medical condition, such as cancer or HIV
    • being socially isolated or a victim of bullying or harassment
    • substance use disorder
    • childhood abuse or trauma
    • family history of suicide
    • previous suicide attempts
    • having a chronic disease
    • social loss, such as the loss of a significant relationship
    • loss of a job
    • access to lethal means, including firearms and drugs
    • being exposed to suicide
    • difficulty seeking help or support
    • lack of access to mental health or substance use treatment
    • following belief systems that accept suicide as a solution to personal problems.”

    You should also note this point by Mayo Clinic,There also may be a genetic link to suicide. People who complete suicide or who have suicidal thoughts or behavior are more likely to have a family history of suicide.”

    Now back to the issue. There are other mental health issues like anxiety disorder, schizophrenia, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), borderline personality disorder, eating disorders, drug abuse and alcoholism (didn’t expect to see these here, did you?) and many more.

    Mental health does not start and end with depression.

    Also, check out this article that investigates suicide according to diathesis-stress models. 

    4. Mental illnesses do not affect teens and children

    World Health Organization notes that, “Worldwide 10-20% of children and adolescents experience mental disorders. Half of all mental illnesses begin by the age of 14 and three-quarters by mid-20s.”

    This clearly shows that mental illnesses can affect those who are less than 18 but the focus is usually on those in their 20s and 30s.

    Perhaps, one can say the negligence of children when it comes to mental health is part of a wider problem in Nigerian society.

    Too often, children are ignored and treated as half-humans because they have not ‘come of age’. Their needs are blindly reduced to food, clothing, shelter and in some cases, education. So, it becomes difficult to grasp the possibility of a very young person having stress-related issues, a difficult time processing certain experiences or battling emotional anxiety.

    6. The only way to treat mental illness is psychotherapy, which Nigerians avoid

    The widespread assumption is that the only way to treatment a mental ailment is by seeing a therapist.

    Many do not realize that treatment could be in the form of medication, group therapy, psychotherapy and residential treatment programs. Usually, these are used in a mix and so it is not a one-way route of psychotherapy alone.

    This erroneous belief that talking to a therapist is the only way of treating mental health issues makes many people stay away from getting help.

    Meet a typical Nigerian and you would have found a person who strongly denounces psychotherapy (talk therapy).

    Even Nigerians who admit battling a mental illness would rather twiddle their thumbs in the hope that ‘it will pass away’ than visit a therapist. God forbid that it be known that they are ‘having issues upstairs’.

    Actually, I am a classic example of this, so maybe I am a kettle calling pot black but this all goes back to the stigma and misunderstanding around mental health. I went through a really low period of my life and I needed to talk to someone. Did I? Nope. I braved through it with scars that I still nurse today.

    Beyond the stigma associated with mental illness is the silly belief that talking to a stranger about one’s issues is ‘something that only oyinbo people do’. We believe that Nigerians are too strong and self-sufficient for that.

    I got to see this side of Nigerians when I was trying to invite some people for the Unburden session that the mental health team of Jela’s Development Initiatives organizes every month. As a member of the team, I was trying to explain how the group therapy session works and the person I was speaking to said, “Then what? I talk to the person and that’s it? My issues are miraculously resolved?”

    This is a sentiment that many other Nigerians share and it is no fault of ours that we think this way. It is simply not our culture but it is something that can be learnt but first, let’s understand that psychotherapy is one tool in a nexus of treatments for mental illness. 

    What do I want you take away from all this?

    1. I would like you to see mental health is a different light, in the way that World Health Organization describes it, “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.”

    More beautifully, I want you to see it as my friend, writer and fellow mental health advocate,  Hauwa Saleh Abubakar puts it, “[It is] everything. Your mental health affects all aspects of your life, from your relationships to physical health.”

    2. I would like you to stop seeing mental illness as such a terrible thing that happens to only the weak-willed. If we have come to a point where telling someone that you are treating malaria is not a big deal then why can’t it be same when it concerns mental illness? After all, mental health is one of the indicators of good overall health. 

    3. I would like you to pay as much attention as possible to the children around you, understanding that they are as human as adults. This means that the same set of emotions, stress and pain you feel is what children and teens can go through. 

    4. I would like you to seek help if you need it. Be honest with yourself and don’t shame those who are brave enough to seek the help they need. 

    Now, you may not remember when you first heard the term, ‘mental health’ but you are sure to remember today when a misconception about it may have been debunked.

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