This year November, ‘A Physician’s diary’ will be five years old. And while it is certainly something to celebrate, there are many lessons I have learnt from being a doctor that writes for the public; chief among which is the mountains of emails I receive from people unburdening themselves to me. I suppose it’s the anonymity of writing behind a screen that gives people the guts to say things that they would normally would not be able to divulge under the watchful eyes of a doctor and harsh lights of a consulting room. Some of these complaints are mild and common, what I am used to seeing in everyday clinic. However, some are downright distressing and make me question the writer’s sanity.
You see this mental health? Its high time we made it a priority.
A few months ago, a woman in her mid-thirties reached out me. Recognising her symptoms as exceeding online consultation, I asked her to come to the clinic. Let us call her ‘Maryam’. Maryam came from one of the northern states and was a mother to five children. She was married in a polygamous setting as the first wife and sold wrappers for a living. Her main complaint was ‘excessive thinking’ and ‘depression’ for which she was being managed at a private hospital in her state of residence. Yet, as I observed and noticed the way she repeatedly smoothed her wrapper while speaking and picked at non-existing particles on the table, I knew there was more to the story.
She was a cleaner, but not literally speaking. She was one of those people who kept an obsessively clean house. Those people who swept their rooms six times a day and had their bath three times a day. Those people who washed their hands after every handshake and kept a dangerously organised wardrobe and dressing table. Those people for whom white is white and black is black. No room for ‘beige’ or ‘off white’ or God forbid- ‘grey’. Everything was black or white. No room for bending the rules. Maryam was one of those people.
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Growing up in a large household, she was teased as a teenager for her obsessively tidy habits. Her uniform had to be washed and ironed every day and her bed was always made. Nobody asked why she spent long hours in the bathroom as it was assumed she ‘just liked to bathe’. The reality was that she had a bath whenever she went to perform ablution and could spend up to an hour making sure that all her limbs were scrubbed clean.
In her twenties, she started praying multiple times as a tiny voice often whispered to her that her prayers were not performed correctly and so had not been accepted. She would pray Zuhr two or three times and pray Asr, four times. It was so bad that she once prayed Isha six times!
What she described as ‘excessive thinking’ was actually Obsessive-Compulsive Disorder (OCD). Her ‘too much thinking’ was causing her to be defiant and aggressive with family members and leading her to have palpitations, headaches and poor sleep. The poor woman was crying behind closed doors, unable to concentrate and contemplating death.
When people think about OCD, they visualise Monica Geller from ‘Friends’, Dr Hannibal Lecter from ‘Hannibal’ or Sheldon Cooper from ‘Big Bang Theory’. And while compulsive behaviour such as handwashing and checking is widely perceived as representative of OCD, the tormenting experience of having obsessional thoughts is still rarely acknowledged and discussed.
That’s the thing. That’s the big deal about mental health issues. Like Maryam, many mental disorders are hidden illnesses, hidden even from ourselves. It all seems obvious in hindsight, but at the early stage, we waive it away as part of a person’s personality. That is, until the symptoms push a person to a much graver complication like frank psychosis or suicide, then we begin to bite our nails in guilt.
According to World Health Organization (WHO), one in every four Nigerians has mental illness. Nigeria, the seventh-largest country in the world, has Africa’s highest caseload of depression, and ranks 15th in the world for the frequency of suicide. Do not kid yourselves and assume that because our religiosity, these suicide figures are not true. I am sorry to burst your bubble, but they are. In my 15years of medical practice predominantly in northern Nigeria, a few deaths I know, did not happen naturally.
‘A bar kaza cikin gashin ta’.
It goes without saying that a significant number of people with mental illness are not treated in many communities in Nigeria, due to the myths and stigma associated with it. In Africa, there are various beliefs surrounding schizophrenia and depression. It is a taboo in some quarters to even discuss them. Some view people with schizophrenia as witches or demons possessed. The condition is considered a spiritual attack and a punishment for evil-doing from God for illicit psychoactive substance use, among other things. Some families even go so far as not allowing their relatives to marry into families with a history of mental illness. Others believe that there is no need for treatment, as the mentally ill can “snap out of it” if they try hard enough. Till date, my mother believes people can ‘snap out of depression’ if they pray hard enough.
Sigh.
On one hand, we complain about mental health being underdiagnosed and underrepresented and on another hand, we have the younger generation (Millennials and Gen Z) who grew up in a time of rapid technological change and increasing mental health awareness. The latter group tend to be more open and accepting of discussing mental health issues. Social media and the internet have given them access to information and resources about mental health. As a result, they are more likely to seek help and support when needed. Mental health advocacy and self-care are central themes for many in this generation.
Yet, there is still work to be done.
Please, this year, let us make it one of our New Year Resolutions to make our mental health a priority. With less than 150 psychiatrists in the country of 200 million people, one would be foolhardy not to prioritise mental health. At the risk of sounding cliché, this year should be the year that we take control of our health. Are you having symptoms that you do not understand? Is there anything unsettling in your mind? Are you having problems relating with people? Are there symptoms you are ashamed of? Nightmares? Fearfulness? Hallucinations? Bad repetitive thoughts? Sleep issues? Sexual issues you are unnerved by? Some perpetrators of sexually violence or promiscuity have been diagnosed with mental health disorders. Do you have any friend or relative that behaves oddly? Someone that does not fit in with the norm? Encourage that person to visit the hospital.
Not every time demons and devils, abeg. Sometimes, it is what it is- a disease. Let us learn to shed all stigma and treat mental health disorders as we would malaria or appendicitis.
This is 2024! Welcome to a new dispensation.
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