The Medical Director, Federal Neuropsychiatric Centre, Kaduna, Dr T.L. Sheikh, in this interview with IDOWU SAMUEL, maintains that many Nigerians are due for routine psychiatric test, given the shocks and traumas they withstand daily.

Neuropsychiatry is certainly not an attractive aspect of Medicine to students. Why is this so?
One of the major reasons is that we don’t have the personnel. All along, psychiatry never used to be glamorous. Surgery, obstetrics and gynaecology have been the most glamorous aspects because people who studied the courses are well paid. Most of the people in the hospitals with neuropsychiatric ailments were usually presented with conditions attributable to insanity. A lot of people do not know that a lot of other illnesses belong to this field. So, majority of the patients that come to the hospitals usually present cases of insanity and because of that, most of them cannot afford treatment. If you charge them a huge amount of money, they usually don’t want to pay. That is what is making psychiatric business not to be lucrative. So, if it is not lucrative, people would not be interested. Another constraint is the issue of stigma in mental health. It is highly stigmatised. If you have a centre that deals in mental issues, people who are not insane and yet have the need to see a neuropsychiatrist in that centre would love to look around very well to ensure that no one sees them going into a psychiatric centre, so that people would not think that they are going insane. The measure being adopted in modern world now is to make the services available in all medical centres so that you can blend easily when going to see a psychiatry expert. That is why the emphasis is now on integrating psychiatry into primary, secondary and tertiary health care systems.

From your experience and research, how would you assess the mental state of an average Nigerian?
Nigerians are very smart people. Across the world, people know Nigerians to be smart. If you go outside the country, people in specialised areas are Nigerians. However, when you talk about mental health, it is not just about alertness. Mental health is when you have a state of well-being, not just physical absence of infirmity or disease. It is about well-being socially, economical, emotionally, stability in health as in sleeping regularly, eating well with good appetite, relating well with people around you and you don’t exhibit unnecessary anger and temper. But today, go to the streets, enter a bus, you will find out that being short-changed by the bus conductor would degenerate into street fighting. Go to the markets and see how chaotic scenes are created from avoidable arguments. Go to the homes, the head of the family comes in and starts harassing the people he met at home. These are means of showing that things are not going on well and that we are not able to cope with the day-to-day demands of life and the attendant stress. So, we are cracking health wise. That is why many people have high blood pressure, peptic ulcer, headache, back pain, joint pains and many other complaints that we make daily. You keep on patronising clinics, taking antibiotics, anti-malaria, pain killers and many more at will. We only struggle to cope with the challenges we face everyday in life. People struggle to go to work; they struggle to put food on the table for the family, attend classes as students, and struggle to concentrate on wheels as drivers. Mental instability creates miscreants in people.

Would it be correct to identify the general situation of things in the country as a major cause of mental imbalance for many Nigerians?
You cannot divorce the two. All the same, you cannot conclude that one is responsible for the other. But they are interrelated. Your constitution as a being in terms of heredity, magnitude of stress and your personal ability to withstand challenges, all determine what your mental health would be. But you and I know that the magnitude of stress that we have in the country today is 10 times more than what we used to have 10 years ago. Security, terror, shock, lack of job, marital crises, armed robbery, poverty and general frustration are the causes of stress in Nigeria today. You must be very resilient to be able to withstand the shocks.

Are Nigerians getting increasingly insane because of the recurrent crises they face?
Nigerians are not insane, but many are suffering from emotional disorder. You don’t have to be insane. Insanity means that your reality testing has failed. You cannot differentiate what is real from what is not real. You begin to suspect your friends as your enemies. Your belief system has changed. Then, you begin to exhibit some behavioural patterns that do not conform to your culture and attitude. You may start hearing strange voices, seeing strange things. These are signs of insanity. But most Nigerians are suffering from emotional disorder. This originated from anxiety, depression, problems of anger, irritability, appetite problem, sexual disorder, including chronic illnesses like diabetics, high blood pressure and tuberculosis, because they all inflict emotional problems that can be addressed. Many people are suffering in silence, and that is why they end up in spiritual homes, herbalists’ homes and with local medicine vendors who always proclaim power to cure all ailments. And then, they fall prey to these people.

People often go to hospitals to report normal ailments, but a few bother to go to psychiatric centres for proper examination. Would you recommend that to those who don’t feel well with their being?
Yes, you don’t have to ask whether or not you are mentally sound. You just go there and lay your complaints and tell the doctor how you feel. Every doctor has a scheme to diagnose every element of emotional distress in a patient that is presented to him at his clinic, maternity home, hospital or medical centre where he works. He will then refer you to experts for further treatment. You may never know that your case is about mental illness, but any trained doctor or nurse would always know and you would not know that. For instance, if you keep going to hospital for same ailment many times over, it is better you have a better opinion. The good thing is that some people have developed the confidence to bye-pass the regular doctors to insist on seeing the psychiatrist. I used to have a radio programme in Kaduna and each time I featured on the programme and talked about signs of emotional disorder and how to solve the problem, the hospital would be full the next day.

What are the signs of mental problem the next person would notice if anyone exhibits them?
The type and severity differ. It is a spectrum which ranges from mild ailment to chronic one. What most people construe as mental illness is the severest form that will come up with insanity, that is, when someone begins to walk the streets without clothes; when he is packing rubbish and mumbling, and so on. But we have the very mild form. This is characterised by sleep disorder, changes in appetite, sexual habit, relationship with people; complaints of persistent, crawling sensations and movements in the body, internal heat and so on. There are some signs in-between the milder form and the severe form. These include moderate or severe depression, anxiety, phobia and many others. We have at least 1,000 diagnostic categories of mental disorder. The moment that you go to bed and you realise that sleep is not coming quickly, you should be alarmed that something is going wrong. Or you go to sleep and the sleep is not smooth, you have terrifying dreams, or you wake up in the early hours of the day and sleep just disappears and then, you become restless. These are signs. Or when you lay on bed and you feel awake, but the people around you say you were snoring, yet you never felt you slept, then, something is wrong. If suddenly, you lost interest in the kind of food you like such that when you have the food, you cannot take even a spoonful or you took a bite but it was tasteless, or you don’t feel hungry anymore. Sometimes, you overeat by wanting to have something to eat every time. Those are signs of mental disorder. Lack of interest in sexual activity is another form of illness. I am talking of inability to perform when a woman is naked before you.