Stigma, Mental Health Literacy, and the Nigerian Youth

A few days into the new year, I got a message from a Whatsapp group about an essay competition an organization was holding. The organization was the Asido Foundation, an organization dedicated to promoting mental health literacy among Nigerians, and building communities where speaking about mental health was not looked down upon (which is a legitimate problem in Nigeria, and in many parts of the world), and the essay competition was organized in memory of their brave and kind-hearted Programs Manager, Jemila Abubakar, who passed away sometime last year. I had not ever written an essay for a competition before (and I hadn’t even done an extended piece of writing since schools shut down March 2020), and I felt the subject, which was “Stigma, Mental Health Literacy, and the Nigerian Youth”, was interesting enough for me to dip into the waters of essay writing for the first time.

Due to my lack of knowledge (overconfidence) about the intricacies of essay writing, I didn’t win (or expect to win). But I am deciding to post the full essay here on Medium because I thought that even with my poor writing skills, this subject isn’t being spoken about enough in Nigeria, and one unsatisfactory contribution is a contribution nonetheless.

In this essay, I argue that focusing on the older generation when trying to purify and expand the Overton Window of mental health discussions in Nigeria is a waste of time and potentially finite resources; and that young people are a better focus of these resources. I argue that the traditional forms of outreach are pretty much dead, and that valuable attention are resources should be turned to the Internet, as it is the primary form of communication among Nigerian youths. In making the case for the Internet, I point out that the Internet is a transformative tool that can, and must, be harnessed to productive ends. My faith in the power of the Internet is not pure idealism, though, as I focus on the harmful ways in which the Internet has changed our social dynamics and our perception of reality.

A few ideas that did not make it into the final, submitted version of the essay are included here. The maximum length provided by the organisers was 1500 words, and this version exceeds 3000 words. This version has been lightly edited for clarity and citations I did not have the opportunity to add have been added. I hope you find something worthwhile in this essay.

Deji.

STIGMA, MENTAL HEALTH LITERACY, AND THE NIGERIAN YOUTH

In September 2019, a news story broke in Nigeria. The story contained reports of the myriad abuse and violations of human rights that men and boys, some as young as 10 years old, faced in Islamic rehabilitation centres all around Northern Nigeria, but specifically in Kano State. The people were chained to bedposts, usually on the suspicion of mental illness, drug use, or “delinquency”. The existence of these “torture chambers”, as the president called them, shocked quite a few in the international human rights space, and the news went global.

But it didn’t shock the vast majority of Nigerians. Many Nigerians felt uncomfortable with the world’s focus on us and just wanted to get back to life as usual. It wasn’t the news that made us uncomfortable, it was the fact that people thought this was abnormal. In Nigeria, the ostracizing of people thought to be mentally ill has gone on for decades, and is considered common practice. This is because the discussion of mental health in Nigerian communities is nonexistent, and is defined by a stigma that considers the mentally ill/unstable as beyond the purview/scope of civil society, and as such, subhuman.

Stigma, according to the Merriam-Webster Dictionary, is defined as “a mark of shame or discredit”, and our relationship to mental health is defined very much by shame and discredit. To understand why we stigmatize mental health and mental illness, we need to look at our collective theory of how the mind works. It is no exaggeration to say that our understanding of mental health in Nigeria is influenced in no way whatsoever by the science or the statistics on mental health. Instead, our knowledge of mental health is defined very much by religion and traditional values.

Part of our knowledge of the causes of mental illness is based on the misperception that such problems are caused by demonic possession, evil forces (such as a relative with a vendetta), or supernatural powers. This perception exists in much of our popular culture especially in film and television, where the usual plot is one that involves a young, successful individual being targeted by a vindictive relative, be it a mother, father, or aunt, who resorts to soliciting help from evil spirits or an evil society (which he or she is usually a member of) to strike that individual with some ailment, usually insanity, but it is not uncommon to see movies where multiple personality disorder is the affliction of choice, or bipolar disorder, or hyperactivity (but this usually occurs with the child of the person who is being targeted), and the only solution is to go to some healer from any of the religions, who then “heals” the individual, and transfers it to the original instigator. This perception of mental health as something supernatural, not biological, has the effect of removing the subject from our circle of control and into the scope of religious healers. Physically and mentally dissociating ourselves from the plight of the mentally different, we find it remarkably easy to send them to detention centres, where they will be “taken care of”. In reality, numerous human rights abuses are perpetrated in the name of “healing”: rape, chaining, flogging, starving, and the like.

As a result, we find it pointless to talk about mental health because, in our frame of the world, all our speech has no effect whatsoever on our mental state and the mental states of our loved ones. But silence about the mind leads to a vicious cycle in which mental health problems arise and our glaring inadequacy at solving these problems leads us to stigmatize them, solidifying the belief that it is out of our control, which makes us even more inadequate at addressing these issues.

Another misperception that fuels the stigma around mental health issues is the reductionist perspective taken by many people when they happen to come into contact with someone with a mental health condition. For example, people with OCD are just very neat people, people with depression are just moody, and people with anxiety are simply stressed. This lack of nuance from otherwise intelligent people causes them to write off serious problems as little more than child’s play, letting serious problems fester like an open wound without a bandage.

There is also the dangerous path of thinking that mental health problems are the fault of those who suffer from them, what could be called the “personal responsibility paradigm” of mental health cause-and-effect chains. One of the forms this takes is concluding that the mentally ill person has arrived at that situation by abusing drugs, whereas the person might never have taken drugs at any point in their existence before.

Beyond both the reductionism and the spiritualizing of mental health and the discussion around mental health, the single largest misconception is the reflexive tarring of anything concerned with mental health as “negative”. making the affected individual “sick”, or a lesser person. The central assumption of this perception is that the brains, and by extension, minds, of these people are somehow malfunctioning, and that they are to be pitied. Of all the misconceptions, this is most likely to alienate people from the social system, sending them to other resorts like drugs and alcohol, that only make the problem worse. In the long run, this has the effect of turning bright minds away from professions like psychology and psychiatry, leading to a shortage of manpower and the requisite expertise to deal with the complexity of mental health. The negativity of discussions about mental health also has the even more ghastly effect of turning mentally ill people, who cannot fend for themselves into fodder for criminals and unsavoury elements in society. Alienating them from the horizon of society leads us to develop a hard skin when we are confronted with the plight of the mentally ill. So we see no problem in watching a mentally ill woman, who cannot give consent, get raped repeatedly by lecherous men, and some of us even made jokes about it, because it’s normal, and they are “mad”, so there’s no problem with it. We find it palatable when the body parts of defenceless people are cut off for money rituals because they’re “mad”, so there’s no problem with it. We actively and passively alienate people with “abnormal” mental states, not just because we simply do not know what to do with it, but also because even if we did, these “mental patients” are outside of our social structure, and interacting with them stains us somehow.

The twin problems confronting Nigerians as we try to move to a more hospitable mental health space, stigma and the illiteracy of Nigerians concerning these problems, have numerous effects beyond just feeding each other and perpetuating the vicious loop of clouding the collective consciousness with false ideas and perceptions.

Understanding the effect of this stigma on the individual, that is, the person(s) confronted by these mental health conditions that are out of the ordinary and who has to face a barrage of insults and misplaced priorities, is of prime importance if we truly seek to understand what stigma does to a society. He/She might not even know that they are confronted by a mental health problem which is treatable; it is altogether more likely that the ideas of the society-at-large (demonic possession, supernatural powers, divine justice, vindictive relatives etc) are the opinions that hold sway in their minds. Even if they possess extensive knowledge of their mental health situations, the discrimination and shaming they face make it hard for them to find treatment and makes it harder for them to recover. It is little wonder that suicide cases have been rising and that the World Bank estimates that around 22% of Nigerians suffer from chronic depression.

Beyond the level of the outright mentally ill, our reluctance to discuss simple problems in our mental state, like what happens to the mind at adolescence, coping with the loss of family and loved ones, feelings of academic or professional inadequacy (in a country where the majority of students who attempt to get into university do not and unemployment is at high levels, this is very important), bodily insecurities, bullying and the like, turns people like you and me away from traditional channels of communication and social cohesion that could repair some of the damage caused by factors outside of our control, and to channels that make the problem worse, like drugs and alcohol, that serve to alienate these people from the society even further and increases the incidence of already worrisome trends like depression and suicide.

Certain cultural assumptions, too, have the dangerous effect of making the mental states of people worse. Consider the assumption in the West of Nigeria, that seizures are caused by “ile tutu”, meaning “the coldness of the land” and that the remedy to this is to take the feet of the affected and place them over a fire or a hot surface. The result of this is usually burning. Take, as another example, the shaming and tarring of old women, who naturally live longer than men, as witches and the killers of their husbands. This certain assumption is so pervasive that it spreads beyond tribal and geographical distinctions. The isolated life that these old women live affects their mental state in such a perverse way that sometimes they just confess to whatever “crimes” alleged against them, and are often stoned or beaten to death as retribution.

It is at the level of the state, where quality healthcare is expected to be rendered to citizens irrespective of public opinion, that this stigma and gross misunderstanding is made most clear. Chronically understaffed, ravaged by corruption, and left to disrepair, the Nigerian psychiatric system is the biggest example of the effect of stigma in action. Fisayo Soyombo, an investigative journalist, went undercover as a mentally ill person and enrolled at the Yaba Neuropsychiatric Hospital, popularly known as “Yaba Left”, one of Nigeria’s most iconic health institutions, for three weeks, including 10 days on straight ward admission, to discover the state of this institution. The conditions he found made the hospital look like one of the detention centres that made the news for their gross abuses. Understaffed, yet with a bloated workforce (populated for the most part by ghost workers, nonexistent workers that are paid salaries), short of equipment, ravaged by rats and disease, poor food, corrupt staff (some collected bribes and extracted exorbitant charges from their patients) all reveal a space that professes to welcome the mentally ill or struggling, yet stigmatizes them relentlessly.

For years, mental health activists and professionals have been seeking to change the tone of the discourse around mental health conditions, but with little widespread or sustained success. A big part of why the conversation around mental health remains nearly nonexistent has been that most of the outreach into communities has been to adults. Unfortunately, most of the adults already have set opinions that are baked into their minds, and by extension, into the social structure. The primary incentive in social structures is to maintain the status quo, no matter how restrictive or outdated, and as such, the efforts have fallen on dry soil.

Surveying this picture, there is an argument to be made that the opinion of Nigerians towards mental health will never change, and as such, it is best to let things stay as they are. Fortunately, that argument is invalid, because it excludes Nigeria’s largest demographic: the youth. The median age of a Nigerian is 18.1 years. The youth is an important factor if we want to introduce mental health to the public space because they are a malleable cohort, not having fully found their place in society, and due to their large share of the populace, they can forge a new status quo where Nigerians are no longer reluctant to take action to protect those with different mental health conditions and extend support to the vulnerable, which, not coincidentally, also includes the youth. Mental health activists and professionals should target their resources and manpower to the youth in an effort not to change the existing social contract to keep mum about mental health but to create a new, humane society where help and support are extended to all irrespective of background, class, or social status.

To target the Nigerian youth effectively, efforts must be made to understand how the youth interact, their areas of interest, and where these two meets. Fundamentally, the way previous generations strengthened social ties is far different from the way the present generation converses and creates communities. The single most important change agent is the internet, particularly social networks and messaging applications like Facebook, Twitter, Instagram, and WhatsApp. Our more online generation is connected to the world more than any other generation prior, and we are exposed to different standards in treating people, and how much happier the weak and ailing are in societies that create a safety net for them. This globalist perspective makes the minds of young Nigerians fertile for change, as we get more information about how far we fall short of international standards for treating people kindly and are encouraged to talk more due to the less personal nature of the internet.

Sadly, there is also a negative side to the rise of the internet. The less personal nature of the internet and the potential breaches of privacy that exist with a more connected information ecosystem means that important and delicate information that might cause massive damage to the lives of people are easier to access. Nude photographs, account details, academic information, and even personal information shared in chats can be leaked to the wider internet, which can facilitate cyber-bullying, weakening the already fragile mental state of the young people on the internet. Even without private details making their way to the wider Internet, harassment, public shaming, and a culture of “savagery” (mostly found on Twitter, in which people compete to give the most caustic, sarcastic replies they can come up with to unsuspecting posters who might be making simple grammatical errors to “go viral” and gain “clout”) contribute to toxifying the open Internet causing real harm to people. An example is body-shaming, which is the practice of subjecting people, usually women and girls to unfair criticism and mockery for supposed bodily faults or imperfections. Others include victim-blaming, racial or sexual harassment, homophobia and Islamophobia (the Internet generally has a culture of religious sectarianism, but special hate is directed at Islam). People who are interested in bringing mental health to the fore must place special focus on these dynamics that the internet has introduced.

To change attitudes, Nigerian youths should be educated on the social networks that have come to define our generation. Since the internet culture is one where anonymity, privacy, and speed are prized assets, channels of communication where young people can speak without having their identity ratted out are key to building trust. It is important that professionals and activists alike study the ways Nigerian youths communicate, and trying to understand what catches their attention (“goes viral”), how it achieves that, what mediums are favoured (video tends to be the optimal form for efforts like these), and in what style these popular posts take (could be in the form of a comedic skit; a short, narrated video with engaging graphics and an interesting story, etc.) and adjust their modes of communication as the trends suggest. For example, youths on Twitter and Facebook could be polled to get a general feel for their perceptions about mental health, and that provides a foundation for what the target subject should be.

The spirit of the Internet is also, for good and for evil, one in which popularity is a major factor in influencing how people behave. “Influencers”, usually beautiful, savvy people with the ear of the public, and top-level bloggers like Instablog and Linda Ikeji provide the outstanding examples of how important popularity is in influencing public discourse. Even an abhorrent opinion made public by one influencer could dominate the discourse for days. Noting their importance, it could be very useful to either create an influencer dedicated to the subject of improving the talk about mental health or forming deals with major influencers to post regularly about mental health.

There should be special attention paid to urging youths to identify inequities on their own, not having the systemic injustice pointed out to them, to facilitate a reflective, thoughtful conversation in which young people can think about their conduct and how it has affected people in the past. Large amounts of time should also be devoted to urging youths to demand political accountability for the state institutions responsible for overseeing the care and rehabilitation of the mentally ill.

Of course, neglecting the older Nigerians who are very much the ones in power will only result in polarization, but as more Nigerians adopt the Internet as a major method of communication (Whatsapp and Facebook are particularly favoured by older Nigerians), the foundations and methods that exist already in the minds of the youth will, in some sense, “trickle-down”, to the older cohort, without any need to change what has already been created, and with the old methods of reaching out to Nigerians still in use, a more unified, more coherent arena for humanely discussing mental health can be formed.

For many years, the discussions about mental health have been characterised by toxicity, cover-ups, corruption, and inefficiencies in getting the right kinds of messages across. Now, with the rise of a generation whose views have the potential to map out a new era for the nation in all aspects, mental health activists and professionals have as a good an opportunity as they could ever get to change the conversation about mental health. The current conversation around mental health in Nigeria is missing, but with the rise of an open-minded cohort of young, politically engaged, idealistic Nigerians, that can all change. Because to envision the reverse, a world in which the efforts of activists to change the landscape result in failure, or even worse, backfire, is a dark and dangerous world, one where seeing lecherous men rape a mentally ill woman is just another opportunity to go viral; one where funding is diverted from mental health care centres to the pockets of politicians; that kind of world is not one worth living in.

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The Armchair Nigerian

20. Avid Reader. Nigerian. Interested in literature, psychology, economics, biology, finance, computer science, and football (soccer). Passive comics fan.