[Applause]
okay I would like to start a little bit
different today actually while I just
walked up there are people providing me
with some plastic cups either blue cup
or yellow cup and there is just one cup
for every second person of you I’m just
gonna give them a little bit of time to
spread the cups to you if you’re
currently sitting on your own it’d
probably be best to partner up with
someone else is sitting on their own
it’s a good opportunity to get to know
each other maybe meet a beautiful girl
after all
okay once you have a plastic cup just
hold on there for a second because what
I would like you to do is have a read
through the instruction sheets that are
in the cup but please don’t show these
instructions to the person sitting next
to you on the left please also don’t
tell them what it says on the
instructions I’ll just give you a few
moments to do so and for everyone else
who doesn’t have a plastic cup yet let
me tell you what is about to happen for
those people without the plastic cup
your partner on the left or your
neighbor on the know your neighbor on
the right actually will in a minute once
I tell him or her to do so place that
plastic cup over your right ear and
start talking to you yes that’s on
purpose and I’ll be talking to you at
the same time okay does everyone have
plastic cup I think everyone has a
plastic cup so then we talk to you at
the same time now you don’t have to
participate in this if you’re completely
uncomfortable with the idea of a
possible stranger getting this close to
you or talking to you buy a plastic cup
that’s okay you don’t have to
participate however I hope that if you
could bear with me in this experiment
you’ll see that what’s initially
little bit of an uncomfortable ask will
turn out to be quite a valuable
experience okay so now if everyone has
read the instructions could I please ask
you to move the plastic cups over your
neighbor on the left ear and start
talking to them as outlined on the
instructions okay
right I will be using this time just to
tell you a tiny little bit more about
myself as you’ve already heard I’m a
clinical psychologist and I’ve worked in
this country for the last year and a
half prior to this I worked in the
United Kingdom which is also where
received all my training and degrees
actually what we’re doing right now is
also something that I did during my
training I’m very passionate about
mental health care and although it’s
actually not the most obvious career
choice here in Nigeria so I feel over
the last year and a half I’ve heard it
all from you’re wasting your potential
to you must be just as mad as the people
that you treat – you will have nothing
to do here well it turns out that
there’s actually quite a lot to do here
because in this chaos of Nigeria and in
this chaos of the current mental health
service system in Nigeria or the lack
thereof lies enters opportunity to
create and develop something very
meaningful and unique to us okay I’m
gonna ask you to stop here I don’t know
whether that work but I’m gonna ask you
to stop if you ever haven’t already done
so please remove the plastic cup from
your neighbours here now thank you
obviously I would like to hear about
everyone’s experience of this and I
would also like to reverse this
experiment so that everyone gets to feel
like what it’s like to hear a voice
through a plastic cup while I’m talking
to them but I guess I have to ask you to
do this in your own time maybe at home
maybe as a family activity later on
tonight or tomorrow but let me just talk
you through what should have happened
while I was talking to you and telling
you just a very short bio about myself
there was another wise talking to you
when initially this voice was saying
nice things like you’re shining you’re
looking really good but that boy started
saying less nice things like you mad are
you hearing me you’re mad or don’t
listen to her she’s stupid she wants to
harm you or you’re stupid
why don’t you just go home you can’t do
this he may have been initially quite
shocked by this and you may have tried
to move away from that noise or from the
car you may have also realized that the
law Boise was increasingly getting
louder and at the end it would have been
difficult to concentrate at what I was
saying what together probably a rather
uncomfortable and unusual experience I
would like to ask you this if this was
your everyday experience initially just
for one day but then for days and weeks
and months what would you do and what
would you do first
would you pray would you tell anyone
about it
would you try and get help and where
would you go to get helpful this is what
it feels like for many people who hear
voices because they suffer with mental
health care professionals call psychosis
a mental state that is factor
characterized by the loss of contact
with reality and which is the key
feature in many severe mental illnesses
such as schizophrenia or bipolar
disorder with psychotic features or
psychotic depression although this was
obviously a very very brief and
simplified insight because people who
suffer from psychosis often hear more
than just one voice and the voices start
becoming increasingly hostile towards
them asking them to harm themselves and
they may also experience several other
severe subjects
now mental illnesses have always existed
but there are three main theories to
explain the origin there is the
supernatural theory which basically says
or attributes mental illness to sins or
curses or the possession materi spirits
or the displeasure by gods there is also
the somatogenic theory or the biological
theory which attributes mental illness
to physical dysfunctioning so basically
sets that mental illness results because
of illness so because of brain damage or
because of genetic inheritance and then
this as I could psychogenic or
psychological theory which attributes
mental illness to stressful or traumatic
experiences or because of difficulties
with learning of perception or thinking
now these theories have always existed
and they have largely remained the same
over the last nine thousand years as
times they have coexisted in X times
they have recycled but much more
importantly it’s depending on which of
these theories the specific culture
believed in that has determined the
treatment of individuals with mental
illness in the Western world the more
humanitarian view of mental illness was
only derived in the early 18th and 19th
century and today believes are mostly
based on a mix between the biological
and the psychological theory or what we
call the biopsychosocial model so while
an individual may have a genetic
predisposition for certain mental
illness they also needs to be a bit of
psychological stress and other social
factors present to be present before
that illness develops and then treatment
is also usually based on both biological
or something like medication drugs and
psychological fear which is much more
what I think what people here know are
psychoanalysis or psychological therapy
or talking therapy now in Nigeria the
dominant narrative of mental illness is
based on supernatural theory with the
wide acceptance and practice of
traditional or faith based approaches to
mental illness
and this could include praying or
confession of sins or driving out of
evil demons or spirits sometimes by
force but these practices actually
account for 70% of all mental health
care delivery in this country and Sunday
Lee pointed out in his talk earlier this
year stigma and shame are so
far-reaching in Nigeria stigma and shame
about mental health and they are partly
maintained by some very unhelpful
generational and socio-cultural beliefs
such as the African masculinity concept
or the belief that these illnesses are
all or evil white people’s diseases that
somehow are not applicable to Africans
well at least not Nigerians and stigma
although it’s Universal it’s often to be
his often believed to be the result of a
lack of education with the solution to
be found in taking over what we know
works in the West now I’m very aware
that despite my very traditional Arriba
first name of Aruba being a village
lobbyists aid in Nigeria and my evil
surname to many of you I to look like in
a way per woman
or at most yellow but today I’m actually
not here to educate you water suggest
that the answer to mental healthcare
Nigeria lies and taking over what we
know works in the Western world in fact
I actually think that this what I call
the copy and paste approach is not a
solution at all and that it might even
be harmful to many Nigerians entering
for mental illness both here and abroad
I believe this partly because people
really tried it but with very limited
success Western models of psychiatric
health care or service delivery were
introduced in Nigeria in the early
twenty centuries by the British colonial
government and not undermining all the
good that these services have done their
sustainability has been a real problem
so today there’s actually a severe lack
of such services institutions and
professionals professionals further to
that research in Nigeria has not only
repeatedly shown that Nigerians prefer
traditional approach to mental health
care but also that the attribution of
mental illness to supernatural beliefs
is not only held by uneducated Nigerians
but that many educated Nigerians also
firmly hold this belief and this really
signifies the influence of cultural
notions in spite of increased access to
Western or modern learning and education
and we know that culture matters we know
that culture matters when it comes to
health and mental health from cultural
psychological research we know that
there are significant differences across
all psychological domains including
thinking and learning and perception and
that they’re also significant cultural
differences in the perception of self
the problem is that Western models of
mental health care are based on research
conducted in Western populations and if
endless research looks or includes other
populations these are highly
representative of the average Nigerian
living in Nigeria also in western models
the assessment the diagnosis and the
treatment are based on the beliefs of
Western people and these can be
radically at odds with the beliefs and
values of non-western populations and
that might actually create a crisis
situation for individuals not holding or
not represented by these claims let me
give you an example of that from my own
practice not too long ago I was
discussing a clinical case with some of
my colleagues in England we were
discussing a young woman who was
experiencing severe anxiety and
depression in the context of several
addictions including alcohol drugs but
also pornography now for the parents of
this young woman the answer to all of
her difficulties including her mental
health difficulties so the anxiety in
the depression
and her addictions but especially to do
pornography was female genital
mutilation FGM now the young lady come
from a came from a community and family
where this practice was actually still
very very much practiced on an everyday
basis and actually she was the only
female in her family who didn’t have
that procedure done her childhood so one
could say FGM is wrong it’s a human
rights violation case closed
but it’s not actually about FGM here
they could have been equally about
arranged marriage were beating as a form
of parental punishment
really so disregarding our own views on
FGM for a minute for this young female
who as I said came from a community and
the family where this practice was still
widely well we done and from this
practice was actually part interlinked
with her cultural identity and her
identity as a woman the case wasn’t just
closed what I’m really trying to
illustrate here is that the unique
narratives that cultures and
communities hold including the unique
narratives around health and mental
health important either because those
represent their unique values and
beliefs and constructed identities so
one cannot simply dismiss them
ultimately Western models of mental
health care were in itself constructed
in a social moment the elder Justin as
inherently vulnerable and unstable as
other constructs but don’t get me wrong
I’m not saying the West is bad or
Western models of mental health care
don’t work or they don’t work here but
what I’m saying is they need to be
adequately adapted to work here I’m also
not saying that all traditional
approaches work or a great again these
two shouldn’t cause any great greater
physical or emotional harm than they do
good yet I’m wondering this and my
slides went a little bit ahead of me
I’m wondering whether knowledge is
essentially the product of the Western
world and how can we tell that knowledge
is legitimate and as knowledge equal
truth and what is truth well I don’t
have the answer to any of these
questions I don’t believe the truth is
ultimately the preservation of just one
culture so for the future of mental
health care Nigeria I believe in a
both/and approach in which both Western
or more global models of mental health
care and traditional or more local
models of mental health care not only
coexist but work together and learn from
each other and that’s not the current
status quo and which everyone seems to
be doing whatever they want no I think
for the future of mental health care we
must realized first of all that mental
health is important it’s important for
the well-being and functioning of every
single Nigerian and it’s not just about
we how we feel but it also affects the
way we relate with each other and how we
see the world so the consequences of
poor mental health will ultimately also
affect our families our communities and
our economy and our society and country
as a whole so you must also realize that
we need adequate policy and regulation
about mental health and mental health
care and we need to realize that we need
investment investment into what works
finding out what works here both in
terms of global approaches and more
local or traditional approaches more
global approaches are currently looking
into the advancement and aid of
technology into the delivery of mental
health care I don’t think we can really
ignore that because it could also
provide solution for the accessibility
or the lack of the current lack of
accessibility of mental health services
in more rural areas in Nigeria on the
other hand the world views of the Ebers
the euro bars and many others for
nigerian tribes called yet untapped
wisdom and knowledge
human experience including health and
mental health and the storytelling
rituals of the ebo alone represent a
vast opportunity for non-invasive
holistic psychological interventions one
that might ultimately save us all when
technology fails or takes over the world
completely so my hope is that in that
both alternate verse of mental
healthcare in Nigeria any individual
that may have an unusual experience like
those that I made you feel at the
beginning of this talk will have access
to a service that is both evidence-based
and effective as well as true to his or
her beliefs and origins thank you
[Applause]
okay I would like to start a little bit
different today actually while I just
walked up there are people providing me
with some plastic cups either blue cup
or yellow cup and there is just one cup
for every second person of you I’m just
gonna give them a little bit of time to
spread the cups to you if you’re
currently sitting on your own it’d
probably be best to partner up with
someone else is sitting on their own
it’s a good opportunity to get to know
each other maybe meet a beautiful girl
after all
okay once you have a plastic cup just
hold on there for a second because what
I would like you to do is have a read
through the instruction sheets that are
in the cup but please don’t show these
instructions to the person sitting next
to you on the left please also don’t
tell them what it says on the
instructions I’ll just give you a few
moments to do so and for everyone else
who doesn’t have a plastic cup yet let
me tell you what is about to happen for
those people without the plastic cup
your partner on the left or your
neighbor on the know your neighbor on
the right actually will in a minute once
I tell him or her to do so place that
plastic cup over your right ear and
start talking to you yes that’s on
purpose and I’ll be talking to you at
the same time okay does everyone have
plastic cup I think everyone has a
plastic cup so then we talk to you at
the same time now you don’t have to
participate in this if you’re completely
uncomfortable with the idea of a
possible stranger getting this close to
you or talking to you buy a plastic cup
that’s okay you don’t have to
participate however I hope that if you
could bear with me in this experiment
you’ll see that what’s initially
little bit of an uncomfortable ask will
turn out to be quite a valuable
experience okay so now if everyone has
read the instructions could I please ask
you to move the plastic cups over your
neighbor on the left ear and start
talking to them as outlined on the
instructions okay
right I will be using this time just to
tell you a tiny little bit more about
myself as you’ve already heard I’m a
clinical psychologist and I’ve worked in
this country for the last year and a
half prior to this I worked in the
United Kingdom which is also where
received all my training and degrees
actually what we’re doing right now is
also something that I did during my
training I’m very passionate about
mental health care and although it’s
actually not the most obvious career
choice here in Nigeria so I feel over
the last year and a half I’ve heard it
all from you’re wasting your potential
to you must be just as mad as the people
that you treat – you will have nothing
to do here well it turns out that
there’s actually quite a lot to do here
because in this chaos of Nigeria and in
this chaos of the current mental health
service system in Nigeria or the lack
thereof lies enters opportunity to
create and develop something very
meaningful and unique to us okay I’m
gonna ask you to stop here I don’t know
whether that work but I’m gonna ask you
to stop if you ever haven’t already done
so please remove the plastic cup from
your neighbours here now thank you
obviously I would like to hear about
everyone’s experience of this and I
would also like to reverse this
experiment so that everyone gets to feel
like what it’s like to hear a voice
through a plastic cup while I’m talking
to them but I guess I have to ask you to
do this in your own time maybe at home
maybe as a family activity later on
tonight or tomorrow but let me just talk
you through what should have happened
while I was talking to you and telling
you just a very short bio about myself
there was another wise talking to you
when initially this voice was saying
nice things like you’re shining you’re
looking really good but that boy started
saying less nice things like you mad are
you hearing me you’re mad or don’t
listen to her she’s stupid she wants to
harm you or you’re stupid
why don’t you just go home you can’t do
this he may have been initially quite
shocked by this and you may have tried
to move away from that noise or from the
car you may have also realized that the
law Boise was increasingly getting
louder and at the end it would have been
difficult to concentrate at what I was
saying what together probably a rather
uncomfortable and unusual experience I
would like to ask you this if this was
your everyday experience initially just
for one day but then for days and weeks
and months what would you do and what
would you do first
would you pray would you tell anyone
about it
would you try and get help and where
would you go to get helpful this is what
it feels like for many people who hear
voices because they suffer with mental
health care professionals call psychosis
a mental state that is factor
characterized by the loss of contact
with reality and which is the key
feature in many severe mental illnesses
such as schizophrenia or bipolar
disorder with psychotic features or
psychotic depression although this was
obviously a very very brief and
simplified insight because people who
suffer from psychosis often hear more
than just one voice and the voices start
becoming increasingly hostile towards
them asking them to harm themselves and
they may also experience several other
severe subjects
now mental illnesses have always existed
but there are three main theories to
explain the origin there is the
supernatural theory which basically says
or attributes mental illness to sins or
curses or the possession materi spirits
or the displeasure by gods there is also
the somatogenic theory or the biological
theory which attributes mental illness
to physical dysfunctioning so basically
sets that mental illness results because
of illness so because of brain damage or
because of genetic inheritance and then
this as I could psychogenic or
psychological theory which attributes
mental illness to stressful or traumatic
experiences or because of difficulties
with learning of perception or thinking
now these theories have always existed
and they have largely remained the same
over the last nine thousand years as
times they have coexisted in X times
they have recycled but much more
importantly it’s depending on which of
these theories the specific culture
believed in that has determined the
treatment of individuals with mental
illness in the Western world the more
humanitarian view of mental illness was
only derived in the early 18th and 19th
century and today believes are mostly
based on a mix between the biological
and the psychological theory or what we
call the biopsychosocial model so while
an individual may have a genetic
predisposition for certain mental
illness they also needs to be a bit of
psychological stress and other social
factors present to be present before
that illness develops and then treatment
is also usually based on both biological
or something like medication drugs and
psychological fear which is much more
what I think what people here know are
psychoanalysis or psychological therapy
or talking therapy now in Nigeria the
dominant narrative of mental illness is
based on supernatural theory with the
wide acceptance and practice of
traditional or faith based approaches to
mental illness
and this could include praying or
confession of sins or driving out of
evil demons or spirits sometimes by
force but these practices actually
account for 70% of all mental health
care delivery in this country and Sunday
Lee pointed out in his talk earlier this
year stigma and shame are so
far-reaching in Nigeria stigma and shame
about mental health and they are partly
maintained by some very unhelpful
generational and socio-cultural beliefs
such as the African masculinity concept
or the belief that these illnesses are
all or evil white people’s diseases that
somehow are not applicable to Africans
well at least not Nigerians and stigma
although it’s Universal it’s often to be
his often believed to be the result of a
lack of education with the solution to
be found in taking over what we know
works in the West now I’m very aware
that despite my very traditional Arriba
first name of Aruba being a village
lobbyists aid in Nigeria and my evil
surname to many of you I to look like in
a way per woman
or at most yellow but today I’m actually
not here to educate you water suggest
that the answer to mental healthcare
Nigeria lies and taking over what we
know works in the Western world in fact
I actually think that this what I call
the copy and paste approach is not a
solution at all and that it might even
be harmful to many Nigerians entering
for mental illness both here and abroad
I believe this partly because people
really tried it but with very limited
success Western models of psychiatric
health care or service delivery were
introduced in Nigeria in the early
twenty centuries by the British colonial
government and not undermining all the
good that these services have done their
sustainability has been a real problem
so today there’s actually a severe lack
of such services institutions and
professionals professionals further to
that research in Nigeria has not only
repeatedly shown that Nigerians prefer
traditional approach to mental health
care but also that the attribution of
mental illness to supernatural beliefs
is not only held by uneducated Nigerians
but that many educated Nigerians also
firmly hold this belief and this really
signifies the influence of cultural
notions in spite of increased access to
Western or modern learning and education
and we know that culture matters we know
that culture matters when it comes to
health and mental health from cultural
psychological research we know that
there are significant differences across
all psychological domains including
thinking and learning and perception and
that they’re also significant cultural
differences in the perception of self
the problem is that Western models of
mental health care are based on research
conducted in Western populations and if
endless research looks or includes other
populations these are highly
representative of the average Nigerian
living in Nigeria also in western models
the assessment the diagnosis and the
treatment are based on the beliefs of
Western people and these can be
radically at odds with the beliefs and
values of non-western populations and
that might actually create a crisis
situation for individuals not holding or
not represented by these claims let me
give you an example of that from my own
practice not too long ago I was
discussing a clinical case with some of
my colleagues in England we were
discussing a young woman who was
experiencing severe anxiety and
depression in the context of several
addictions including alcohol drugs but
also pornography now for the parents of
this young woman the answer to all of
her difficulties including her mental
health difficulties so the anxiety in
the depression
and her addictions but especially to do
pornography was female genital
mutilation FGM now the young lady come
from a came from a community and family
where this practice was actually still
very very much practiced on an everyday
basis and actually she was the only
female in her family who didn’t have
that procedure done her childhood so one
could say FGM is wrong it’s a human
rights violation case closed
but it’s not actually about FGM here
they could have been equally about
arranged marriage were beating as a form
of parental punishment
really so disregarding our own views on
FGM for a minute for this young female
who as I said came from a community and
the family where this practice was still
widely well we done and from this
practice was actually part interlinked
with her cultural identity and her
identity as a woman the case wasn’t just
closed what I’m really trying to
illustrate here is that the unique
narratives that cultures and
communities hold including the unique
narratives around health and mental
health important either because those
represent their unique values and
beliefs and constructed identities so
one cannot simply dismiss them
ultimately Western models of mental
health care were in itself constructed
in a social moment the elder Justin as
inherently vulnerable and unstable as
other constructs but don’t get me wrong
I’m not saying the West is bad or
Western models of mental health care
don’t work or they don’t work here but
what I’m saying is they need to be
adequately adapted to work here I’m also
not saying that all traditional
approaches work or a great again these
two shouldn’t cause any great greater
physical or emotional harm than they do
good yet I’m wondering this and my
slides went a little bit ahead of me
I’m wondering whether knowledge is
essentially the product of the Western
world and how can we tell that knowledge
is legitimate and as knowledge equal
truth and what is truth well I don’t
have the answer to any of these
questions I don’t believe the truth is
ultimately the preservation of just one
culture so for the future of mental
health care Nigeria I believe in a
both/and approach in which both Western
or more global models of mental health
care and traditional or more local
models of mental health care not only
coexist but work together and learn from
each other and that’s not the current
status quo and which everyone seems to
be doing whatever they want no I think
for the future of mental health care we
must realized first of all that mental
health is important it’s important for
the well-being and functioning of every
single Nigerian and it’s not just about
we how we feel but it also affects the
way we relate with each other and how we
see the world so the consequences of
poor mental health will ultimately also
affect our families our communities and
our economy and our society and country
as a whole so you must also realize that
we need adequate policy and regulation
about mental health and mental health
care and we need to realize that we need
investment investment into what works
finding out what works here both in
terms of global approaches and more
local or traditional approaches more
global approaches are currently looking
into the advancement and aid of
technology into the delivery of mental
health care I don’t think we can really
ignore that because it could also
provide solution for the accessibility
or the lack of the current lack of
accessibility of mental health services
in more rural areas in Nigeria on the
other hand the world views of the Ebers
the euro bars and many others for
nigerian tribes called yet untapped
wisdom and knowledge
human experience including health and
mental health and the storytelling
rituals of the ebo alone represent a
vast opportunity for non-invasive
holistic psychological interventions one
that might ultimately save us all when
technology fails or takes over the world
completely so my hope is that in that
both alternate verse of mental
healthcare in Nigeria any individual
that may have an unusual experience like
those that I made you feel at the
beginning of this talk will have access
to a service that is both evidence-based
and effective as well as true to his or
her beliefs and origins thank you
[Applause]
Please follow and like us: