Dr.Adebayo Sunday Adebisi is Fellow and Faculty Board Member of the National Postgraduate Medical College of Nigeria. He is also a Consultant psychiatrist and Head of Residency Training at the Federal Neuropsychiatric Hospital Kware, Sokoto Nigeria where he works.He is a minister of the gospel and coordinator of the Singles fellowship at Love Family Assembly,Sokoto where he worships. He spoke with Church’ Times Nigeria on mental health issues to mark the world mental health day on October 10.
You’re a psychiatrist. What attracted you to the field of Psychiatry
Well, I think it’s basically just because of the interest I had developed while in medical school. Then, I had this inclination towards exploring new areas of medicine. I love solving complex issues. I also felt I would thrive more in difficult areas.
My colleagues then were surprised that I preferred that area of medicine. But then, I found out that over the years, coming into the field of psychiatry has shown that there are still a lot yet to be explored. And each time there is a breakthrough in the treatment of any mental disorder, it goes a long way to help humanity. But it takes a lot of hard work to achieve that breakthrough.
Would you regard it as one of the most complex areas of medicine?
Yes. Because in Psychiatry, you are dealing with issues that are beyond the physical. You are dealing also with the mind, the way people think or feel and also the way they behave. These are complex aspects that vary from one individual to the other. It’s unlike other fields of medicine. Somebody has a hernia, for instance, you know where the problem is and you go to deal with it. But for psychiatry, it takes a lot of patience and skill to be able to identify that something is going wrong with the mind and what could be the causative factor.
From your experience, what is likely the root of a psychiatric case?
For every psychiatric patient, there is usually no one “cause” because most of what we term causes are risk factors, not direct causes. The real cause for most mental disorders has not been identified but there is a constellation of risk factors that come to play in the occurrence of a mental disorder and it can vary from person to person. However, there are a group of cases that are actually due to direct damage to the brain. But most cases of mental illnesses are due to a constellation of these risk factors as stated earlier.
Can we then say psychiatry is more of hypothetical medicine?
It’s not hypothetical. Those risk factors that have been identified are a product of research. They are not things that were arrived at just like that. Before arriving at any of the conclusions, factors like age, gender,, environment, social support, , lifestyle factors, family history and a host of other factors are considered. The use of substances like the illicit drugs we talked about is also a key factor in determining causes. You look at these factors and prove empirically how they contribute to the occurrence of the mental disorder. So, it’s not that we just arrived at those elements without empirical evidence. The findings have been tested over and over for years. and they produce the same result. So they are reliable.
What were your expectations before you qualified as a psychiatric doctor and the reality you met on the ground?
I had a lot of expectations before going to the field. I was hoping that I would be able to do a lot of research and help a lot of people have access to mental health care. But coming into the industry itself, I discovered that there are stigmas attached to the industry not only for the patients even for the practitioners in the field.
When you tell people you are a psychiatrist, the first thing is that they will think you are likely to be someone who has some form of a mental illness. People tend to believe that having contact with mentally sick people will eventually lead to you contracting the mental illness itself.
Are you saying people have stigmatized you?
Yes. There was even a medical colleague one time. Immediately I introduced myself as a psychiatrstr, he stepped backwards, he looked at me and was hesitant in exchanging pleasantries. Even among family members, they call you names. People don’t want to be seen to be close to you. They feel you have a mental problem. They don’t want to be seen in public with you so that other people don’t start thinking they have a mental problem.. They prefer to relate with you from a distance.
That implies perhaps that a lot of doctors don’t want to do psychiatry. Is there a dearth of Practitioners?
Yes, there is a dearth. Presently, we have roughly one psychiatrist to about 800,000 Nigerians. So you’re talking of about 250 psychiatrists to a population of 200 million people. The colleges have produced more than that, but many have left the country for greener pastures.
What are the causative factors of psychiatric cases?
We talked about risk factors earlier. There are mental disorders which come as a result of some physical damage to the brain due to road accidents or some other forms of brain infections or diseases..If these affect the areas of the brain that have to do with behaviour, memory or expression of moods such a person could end up having a mental illness.
We easily know that when we do brain imaging or what is called a brain scan. There are some mental illnesses that come as a result of chemical imbalances in the brain. These imbalances, can affect the way nerves in the brain work and ultimately the functions of certain areas of the brain concerned with mental activity. There are genetic factors too. In such a case, the mental disorder was passed from generation to generation. But then, that somebody carries the gene does not mean the person will manifest it.
The major risk factors in psychological causes of mental illness could be due to stress. This could arise due to the loss of loved ones, it could be relationship problems , financial problems and work issues. If one has work overload or a marital problem such could lead to a risk factior for mental disorders. For some people, stress will precipitate mental illness if they already carry the gene for a mental disorder.
Other psychological causes are people with low self-esteem,those who have been sexually abused when they were young and those who lose their parents when they were very young. There are cases caused by the use of substances like illicit drugs. There are environmental and social factors too like unemployment and poor family support
The parenting style also matters. If one has been brought up in a permissive way in that parents allow their children to live the way they want, when they grow up, such children will become anti-social and kick against societal norms.
Children like that later go into drugs and end up killing their parents at times when their parents now want to be assertive. The point is that some of those children have developed anti-social personality while growing up because their parents failed to strike the balance between discipline and allowing their children to express themselves. So it leads to some forms of mental illness we call personality disorders when they grow older.
There are different manifestations of mental cases. Some are violent when they manifest. Is there a particular reason why some are violent and some are not?
The violent behaviour could be as a result of the part of the brain that was affected which led to the mental illness. Those who have injuries in a part of the frontal end of their brain are prone to being impulsive, restless and aggressive. They also exhibit mood changes like excessive cheerfulness and all other kinds of behavioural changes associated with that part of the brain.. But a lot of other mental disorders manifest differently without being violent at all depending on the part of the brain affected.
Some could be due to some neurochemical imbalances in the brain. And that is one of the theories that have been used to develop drugs that make up for these chemical deficiencies.Quite a number also are due to use of psychoactive substances what lay people call ‘hard drugs’ . These drugs alter people’s mood and behaviour.
Do you believe some mental illnesses could be caused by spiritual attacks?
When it comes to medicine, such assumptions are not entertained except you can prove scientifically how someone could be attacked spiritually and the scientific evidence of this on the brain or the body in general. But as a Christian, we know that life is spiritual. I usually tell people there is a spirit behind every infirmity even malaria. Jesus rebuked infirmities in the lives of people. It’s just that they are in levels.
When you say there is a spirit behind every sickness, are you saying for instance that if I overwork myself and I fall sick a spirit is responsible?
The point I am trying to make is that the spirit responsible for sicknesses will need an attitude and a behavioural system for it to manifest itself. There is a way we conduct our lives that makes us prone to illness. If you don’t have good hygiene, you will be prone to illness. That is why the Bible tells us not to give a place to the devil. We have to maintain good personal health especially mental health so that we do not give a place for the devil. Even at that, if we have done all that, we also believe that being clean and hygienic is not a guarantee that one would be completely free. We need to have faith in God that after we have done that which is needful, He will keep us.
Does mental illness just happen? We have had cases of couples killing themselves due to some perceived mental agitation. Could it just happen?
To the layman, it appears sudden, but for professionals, there are subtle symptoms that will show that someone is prone to mental illness. You see changes in the mood of the person. You also see changes in the thinking and the behaviour of the person. The symptoms could sometimes begin with a sleep problem, speech problem etc. but the layman may not know some of these symptoms
So are there things that could be done to avert mental illness?
One of the things to do is to adopt a lifestyle that wards it off. Reduce stress as much as possible. Manage stress. A balanced diet generally is a good. Fruits are good for the brain. Also, we need to manage all other health conditions well or take steps in preventing them. For example, If one has hypertension or one is diabetic and it is not well managed, it could lead to a situation which is a risk factor for mental illnesses like depression that is now a leading cause of disability worldwide. That is, depression makes the medical condition worse and makes people function below normally accepted standards in social relationships and occupation.
When one has diabetes, hypertension or some terminal diseases, such person is prone to mental disorder because the mere realization that they have a terminal disease could be stressful and lead to depression.
Other preventive measures include developing good relationships, having positive perspectives about issues of life and avoiding the use addictive drugs or self-medication.
People who live in isolation and have few friends are prone to mental disorder than those who have a good number of friends with supportive relationships. When you interact with people, you get a support system not just material support but also emotional support. We should also learn to develop good perspectives about life. For those us of us who are Christians, we have God’s word to create the right perspectives when we face life issues. Studies have shown that it is the perception of the problem that people go through that really contribute immensely to the stress experienced not necessarily the magnitude of the problem.
To be continued
