Tuesday, March 23, 2010

Schizophrenia and the Social-cultural fallacy

Schizophrenia and the Social-cultural fallacy
By Jennifer Ehidiamen

Many people have misleading concept about Schizophrenia, most of which are rooted in the Nigerian social-cultural system. Thus, most Schizophrenics experience dehumanizing conditions before they are eventually taken to a Psychiatric Hospital. In this interview, Dr. Richard Ademola Adebayo, a consultant Psychiatrist and a Clinical Psychologist at Federal Neuro-Psychiatric Hospital, elucidates further on some of the cultural factors that delays or limits the treatment of mental disorder.

Sir, do you believe some Psychotic conditions are spiritual?
Well, I will not say so directly as a Psychiatrist though I have my own Personal opinion. We try to be holistic in our approach because we cannot isolate our believe from how we see things. Thus, we do what is called evidence base medicine. That is, medicine is not just what you practice; there must be an evidence for it. From the cultural or religious point of view, I’m a Christian and I believe that everything that is not good is not of God. Because the Bible says that God’s thought towards us are thoughts of good and not of evil, to give us an expected end. So it means that anything that is not in line with that is not of God. Also, knowledge comes from God. Science is not an anti-god device, science is knowledge from God but it is the wrong application that is not desirable. So if you believe science comes from God and through science we have been able to proffer solutions to problem then it will be very wrong to say in a myopic way that mental disorder is from a particular cause. From the science point of view, the current thinking is that mental disorder can be seen from a biological and social perspective. This means that mental disorder can be genetic i.e hereditary or socially incurred. From the cultural point of view, they see it as a curse running in that family but in reality it is the genes. Just as Down syndrome can be genetic, so also can Psychiatric disorder be inherited from the genes of parents. Other biological conditions that can manifest into mental disorder later in life include childhood infections, road traffic accident that affects the brain, the medication a pregnant woman uses that may affects the child, drug or substance use, hypertension etc. while Psychological factors that may cause mental disorder include unemployment, broken relationship, abandonment etc. The Sociological factors include, overcrowding, traffic jam, even the current economic meltdown is enough to cause mental disorder.

Can a mental disorder caused by domestic accident be heritable?

No. such can not be inherited. That someone in a family has a mental disorder doesn’t mean his or her children will inherit it.

From your experience as a Psychiatrist, what are some of the social –cultural beliefs limiting the treatment of mental disorder in our society?
People tend to read meanings to the condition of someone suffering a mental disorder and such person is often stigmatized and ostracized. Even after the person is treated or the situation is managed, the person might still be avoided by others. Unlike developed countries, in this part of the world we are still holding on tenaciously to our cultural belief. Sometimes Schizophrenic people are called witches who want to confess their evil deeds. For example, a young patient once went to a grave and said she was responsible for the death of the person. Meanwhile, the dead had long been buried before the patient was born. If not for that the people would have thought she was a witch. As part of the cultural believes, people with mental disorder are taken to various places- herbalist homes, Churches etc. Some of them are dehumanized, chained, beaten and stigmatized etc in the process of finding solutions to what they deem is spiritual.

Please elucidate further on this pathway to care
This is one of the largest Psychiatric Hospital in West African. Because of the stigma associated with mental disorder, people don’t usually think of this place. Pathway to care refers to the passage or process of seeking help before the person is brought to the Hospital. Because of our cultural belief, people connote causes of mental disorder as religious and call it demonic attack or spiritual curses. So the first place they go to is religious or traditional places. They shop around for solution in these places thus causing delay in medical treatment. The patient passes through all sorts of things. Some of them are deprived of food, made to undergo vigil and even sexually abused before they are eventually brought to Hospital for treatment. But with enlightenment now, a lot of people come to the hospital directly, to avoid unnecessary delay in treatment which might lead to prolong recovery.

Sir, how can we eradicate such misconceptions?
That is why we are telling our people that the only thing that is permanent in life is change. We need to change from our perspective of being myopic. We shouldn’t just think that anyone that is having a particular problem must be addressed from the religious point of view. We thank God that a lot of patients have come to this place and they have recovered. The medication and mode of treatment we use is universal. Without anyone stigmatizing them, these people return home to live normally and fulfill their destiny.

What advice do you have for religious leaders?
They should not see Psychiatric conditions as being caused by demons because there are others causes. Even if they are caused by demons, they can still benefit from our treatment. Let them do the praying aspect but they must send the patients to us on time. While the patient is in Hospital, they can come here and pray with them. God is not limited by any barrier or distance. We don’t discourage our patients from going to churches. Unfortunately, we have some Pastors who will tell patients not to take treatment. They tell them to exercise their faith. But the same Bible tells us that faith without work is dead. The work aspect is for patient to take treatment, listen to doctors etc. We are not working against Pastors or religious leaders; we should have a meeting point. Ultimately, God is the healer and not man.

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