Culture Related Mental Illness

In medical practice generally and specifically for psychiatry; issues of culture are of central importance. It is difficult for a psychiatrist to have an impactful career without a particular interest in culture. This may explain why the bulk of our quantitative research evidence has not exhaustively communicated the burden of mental illness in Africa and profer effective intervention programmes. This method does not elicit the sociocultural dynamics of a culturally displaced people as a result of colonization with attendant mental health challenges. An anthropological approach to mental health research leveraging on the participant-observation methodology may be a very crucial compliment for a contextual understanding of our mental health challenges.

Culture is defined according to most treaties in comparative psychiatry as comprising the ideas, values, habits and other patterns of behaviour which a human group transmits from one generation to another, or as the whole complex of traditional experiences, concepts, the system of values and behavioural roles in society.

Sufficient evidence abound as early as 1909 that some culture specific-psychiatric disorders exists known under a great variety of folk names. This concept of culture-bound mental illness has been the focus of debates between universalists who interpret these conditions as cultural elaborations of psychopathological phenomena and relativists who view them as expressions of distinctive features of a particular culture. The current clinical paradigm attempts to view them as clusters of symptoms and abnormal behaviors that are plausibly related to specific stress situations consequent on cultural emphases typical of particular populations. These disorders have folk names with peculiar manifestations traceable to cultural factors.

In Nigeria, a couple of these disorders had been described. The Late Professor Adeoye Lambo; a foremost Nigerian psychiatrist and former Deputy Director General of the World Health Organization (WHO) described a particular disorder directly related to culture and culture change."Frenzied anxiety" as he called it was characterized by undue suspicion, hearing and seeing things others cannot perceive in clear consciousness, extreme anxiety, agitation often demonstrative and sometimes dangerous acting-out behaviour in apparent confusion. Usually as a result of fear over sorcery and witchcraft that heightens under rapid sociocultural changes like during the military era. Psychiatrists in neighboring French-speaking countries call it "bouffe delieriante" meaning a cocktail of delusions to capture the dramatic clinical picture. The underlying causes are usually due to potent sociocultural factors. Among these factors according to Lambo is the acculturative stress affecting many persons in many parts of contemporary Africa who have become marginalized in society through rapid cultural change. Under modern situations of urbanization and westernizing acculturative pressure's the traditional communalistic society is disintegrating and the supportive kin network is breaking down. The individual experiences an increasing economic rivalry and social isolation that intensifies the old fears of witchcraft and sorcery; never obliterated by Christianity; while the traditional protective and remedial resources are no longer readily available.

Another popular one is the ‘brain fag’  first reported in 1959 by an expatriate psychiatrist Raymond Prince among Nigerian students. This disorder has been described in students of other African countries who are exposed to the acculturative stress of a western-type education system emphasizing theoretical book knowledge quite different from the practical know-how and traditional apprenticeship acquired through oral traditions from older generations in Africa.

Nevertheless, the older generations expect their wards to achieve academic and socioeconomic success in the emerging modern society and these parental expectations constitute the emotional pressure on them.

Brain fag is usually characterized by bothering sensations on or in the head and body, especially aches, burning and crawling; visual disturbances especially blurred vision and tears when reading; impaired concentration, difficulty in comprehending and retaining learning material in written or oral presentation, feelings of general weakness, dizzy spells and daytime fatigue. This brain fag may actually explain the reason some Nigerians who traveled abroad in the early ’60s did not complete their education and had to withdraw from the university while we claim that they have been called home using traditional spiritual methods.

During the military era and the attendant harsh economic and insecurity situations; ‘genital shrinking’ usually associated with the transient state of acute anxiety, some physical symptoms, and penile retraction. The females may complain of the shrinking of the breasts which were usually associated with fears of impotence or sterility and death in some cases traceable to the predominant thought of magic robbing or bewitchment. Such cases should be referred to mental health experts as these symptoms will temporarily remit with appropriate medications. 

However for effective management; there is a need for synergy with the relevant culturally sensitive healing procedures. Paradoxically, our cultural beliefs are being eroded by foreign religious practices albeit retaining basic cultural vestiges such as the use of anointed holy water, oil, handkerchiefs and the touch of a spiritual leader. Other mental illnesses may benefit from this approach if properly articulated.

Dr Adeoye Oyewole

adeoyewole2000@yahoo.com

+234 8157236268 (WhatsApp Only)