Saturday, 18 October 2014

Vagrant psychotics is increasing due to stigma – Umeh

By: Chioma Umeha

Dr. Charles S. Umeh, is a lecturer and clinical psychologist at the Department of Psychiatry, University of Lagos Teaching Hospital (LUTH), in Lagos. In this interview with CHIOMA UMEHA (HEALTH EDITOR) Umeh says that stigma is a major factor in the rising incidence of emotional problems in the country.

Dr. Charles S. Umeh
 What are the major problems that those with emotional conditions come down with?
From the wider societal perspective, they use a common term to label a person who has cause to visit psychiatrist, a clinic psychologist that is the person is ‘mad.’ But, we say ‘no’ to such term. The term ‘mad’ has caused a lot of stigma to people who come down with emotional problems and from the look of things, virtually everybody has come down with certain level of emotional problems at what point in time or another; are we going to say, they are mad? Because of this they are cow, they are afraid of how people will see them for visiting a professional that can help them. They keep going on with a problem that can easily be nipped in the bud until it becomes a major issue. Now if you look at yourself, as an example, there are times you get weighed down by work or stress of work and you could see that you might not function very well, at that point in time, all you need is somebody, so that you can unburden. When you are talking about somebody you could talk to, it has to be somebody that understands the dynamics of human behaviour that is where the professional thing comes in. But our people don’t see it that way; that is when stigma is involved in emotional problems. Obviously when you have emotional problems, they will say you are going to visit ‘Yaba Left.’ That ‘Yaba Left’ is a big hitch.

‘Yaba Left’ is a name they call Yaba Psychiatric Hospital. Nobody will see you as the same again for visiting that place; they wouldn’t even why you visited that place, for the fact that you said, you were going to ‘Yaba Left’ then, it is assumed that; ‘oh, you’ve no other business to be there if you are not ‘mad.’ And if you come back to talk to the same person, you see his attitude changes automatically, because he is assuming now that you are now a ‘Yaba Left’ candidate. More so, based on the myth in this part of the world that ‘once a mad person, always a mad person.’ But, I can tell you those emotional ailments are like any other ailment that can be treated; and it is not as severe as some conditions like diabetes and hypertension that you have to live with all your life together with medication. But, because those are more like accepted, nobody is looking at it as an object of stigma, but once you have an emotional issue; yes, you’re mad. For instance, I just finished doing a job with HIV patient who enjoys a chunk of the stigma. The work shows some startling revelation about stigma; that those people are bordered more by stigma from healthcare professionals and family members. And in this kind of this of mental health issues, who are the first people that will label you as mad? Is it not family members; is it not the healthcare professional that you see? This is because if the person does not know you, he might know the condition you are coming with. This is because some emotional problems are masked that if you don’t know the person very well, you won’t know that something is wrong except insiders. And they are the ones that will tell outsider that initiate the stigma.

They are the ones that will tell outsiders; oh, don’t you know him, he has emotional problems; before you know it, the news spreads. And the impact it has on the client or the patient is not measurable, first, you have to explain yourself for every action you take so that people will not misunderstand it as a sign of illness. Even when you are very lucid, you are making very cogent point, nobody will believe you; they will say; ‘he used to have emotional problems, maybe, he is in his state again.’ So these people are trying to impress it on people that ‘for the fact that we have this does not mean that we are not reasonable anymore.’  They are reasonable. Even the so called vagrant psychotic patient you see roaming the street, still have lucid periods. But, to many; ‘nothing good can ever come from them.’ So they still suffer stigma. One of my Professors did a study comparing psychotic patients and normal people, and he discovered that they are the same in all ramifications except for some affective issues and the affective issues are the tune of their illness which could be managed and they go back to function normally again. So, you could see if you keep looking at it that way, the society because someone has been labeled ‘mentally ill’ has rejected the person. So, he can never be part of the society anymore. But, that is wrong. I look back; why is it that if someone comes down with hypertension, the society will not look at it as if he has committed a crime and he will be accepted back after treatment. That’s the way it should be with mental illness, they are sound and okay again. But, probably yes, if they don’t continue with their medication, there could be relapse which happens in all other kinds of accepted illnesses.

This is because if you are hypertensive and you don’t take your medication; what happens? You will relapse. So, why are we not stigmatizing people with hypertension? But, for the fact that somebody has a minor emotional problem like stress or depression, then it becomes a big thing, so the person can function again in the society. So that is one of the major problems people avoid assessing psychiatric services and it is a big issue that must be look into. And the way to look into it is to begin to educate the populace about the nature of emotional problems. They range from very mild to severe. The milder ones are; depression and anxiety.
For instance, there are some people who anxiety is an on-going problem, that it affects their general functioning. Now, if such a person goes to see a psychiatric; are we saying, he is going ‘Ga ga’ from the societal perspective? Are we saying that he anxious to certain level, that he should be stigmatized? Then, all of us are guilty; this is because everybody has had anxiety problem one time or the other, so, all of us are victims of emotional problems. So if you are talking about stigma, you begin from yourself; to stigmatise yourself. So we are working on the society understanding these leverages because some people don’t even know that  anxiety is an emotional problem that will need a clinical psychologist to see. Some of them don’t even know that depression is like everyday issue that needs to be treated and the person becomes normal. But, there is only one category of mental illness that has taken shine over every other person and that is how the society sees people with emotional problems; that is psychotic disorder in which the person is like losing touch with reality. But the good news is that this condition is an illness that is treatable. But, people don’t give those with such conditions the benefit of doubt that; ‘oh, for the fact that they have these things does not mean that their life has ended. Once they access treatment, they recover.’

What are other factors which contribute to rising incidences of emotional problem in the country?
Another important factor that could throw more insight into the rising incidences of emotional problem in Nigeria is circumstances of existence.  Now first, we look at what are the possible causes of emotional problems? We classify them into two broad levels. One is environmental issue, another one is the biological issue, the nature nurture.  And in most cases, we look at the interaction between both in order to explain any condition. Now the environmental issue comes from circumstances of our existence. For instance, if you’re living in an urban area where we have a lot of stresses.  Another factor is that some of these emotional issues are hereditary; temperament. Some people might have the latent threats to develop certain kind of emotional disorders and the threshold of accepting stressors could be very low.

So when they are subjected to certain kind of environmental stressors, they come down easily because they have the genetic predisposition. Another issue is that if the environment is all right, they might have the latent threat, they might not come down because the environmental issues are all right, so you wouldn’t push them into coming down with emotional problems. That is where we look at other socio-cultural factors that are responsible for emotional problems. That is the basis for comparison with maybe what we have outside. In this part of the world, we have a lot of social inter-connectivity; if you have emotional problems, it is either this uncle or aunty will come to your help as against what we have in an individualistic environment in US where people fend for themselves.

Because they don’t have such kind of social structure, the tendency is that they can easily come down with emotional problems over there than here. That is why it is the in-thing to have shrinks as they call it; it is normal thing for everybody to have one or two shrinks they see on daily basis to  enable them cope. But, here, our ability to cope with stress is a bit high. Due to environmental circumstances, people are beginning to breakdown. Because how long can you cope with all these avalanche of problems impinging on you on daily basis. And the next aspect, you don’t even know when going to end; it throws you into an emotional journey that has no end. And a lot of people cave in and come down with that. And these are some of the dimensions of emotional problems we do have. I have not discussed the psychotic ones; those are the severe aspect of it. They could be a product of trauma, genetics and environmental stressors as well. So, the high time we started managing stresses around us, the better we do such management and the more coping skills we adapt, the more some of these problems are put in check. But, the way we going, Nigeria is a developing country and in most developing country, like America witnessed in the 50s, there had a lot of emotional problems coming with the new introduction of technology and ability to cope with the changing environment.

What is the statistics of persons who have faced emotional problems in the last ten years?
It will be very difficult. Here are in Nigeria, people with emotional problems don’t come to hospital until it is severe – the severity comes when you have frank psychotic symptoms; that is the person is beginning to lose touch with reality. The reason why they don’t that is because of the stigma. That is what I’ve trying to emphasize. We’re beginning to do a bit of prevalent studies, but that prevalent study does not say much about what happens in the outer society based on experience.

Is there any statistics on deaths from emotional problems?
Death is not always easy with emotional problem; it is not an emergency that could kill immediately. That is why you can actually quantify the number of people who dies as a result of it. You could see the vagrant psychotics along the road. There are times they will increase in upsurge, there are times you don’t get to see them because some organizations are beginning to provide shelter for them and take them off the road. That is the point we are talking about; why do we have vagrant psychotics because the family the person is coming from disassociated themselves from the client and they push the person outside. Nobody wants to identify with such illness. This is because if they say; he is from our family, then, the future of younger generation there is in jeopardy there. Tomorrow if one of them wants to get married; ‘oh madness runs in that family, nobody wants to there.’ Can you see why it is a bit of a secret thing that nobody wants to be associated with it? Now if you come from a family where people keep making reference to; ‘oh that family, madness runs in that family and you know that ‘madness’ is a genetic thing; will want to go into that family? Even if you’ve the illness, will you want people to know about it? That is the problem we having with all these things. Now we need to debrief the society on the nature of these conditions, so that people will really come out and access treatment and function better in the society. The major problem like I mentioned earlier is stigma. How I wish we can take away stigma from this illness, then people will access treatment and function better in the society and until we start doing that, it is going to still be a deep secret. And sooner or later, we will start having a real study of how much Nigeria is loses.

Is there statistics on what Nigeria is losing following the incidence of emotional disorder among productive people?
You cannot say. Usually, they look at mental illness as the problem of the poor that is why emphasis has not been placed on it for a long time. But, today there are mental illnesses that are associated with psycho-active ills and it is stripping the country gradually and it is becoming a problem to the rich men that run the states because they are the one that can afford the psycho-active substances. And a lot of them are becoming problem to the state. With the way things are going, sooner or later they will start paying attention to it. How will you carry such research if you are not funded? How many of government votes go into mental health research? They will tell you they are concerned more about infant and maternal mortality that is the focus of the health sector now; not knowing that a bigger problem is brewing in mental health.

This story was published in Daily Newswatch on May 1, 2013.

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