Introduction

Individuals who suffer from mental illness are believed to be suffering from some form of punishment from the “gods”. All over the world, there is an increasing awareness of mental illness as a cause of morbidity (Kabir, et al., 2004).

Mental illness is common. It affects more than 25% of all people at some time during their lives (Kabir, et al., 2004). It is universal in reach, affecting people of all countries and societal level, regardless of age, income and gender (Kabir, et al., 2004).

There is widespread stigmatization of mental illness in the Nigerian community. These negative attitudes to mental illness are encouraged by beliefs that affected persons are responsible for such illness (Gureje, et al., 2005).

In our society, the expressed views of what causes mental illness are strongly stigmatizing. Some claim that mental illness is due to possession by evil spirits in form of witchcraft and evil manipulation, and others believe that mental illness is due to divine punishment for sinful lives or curse for breaking some privately entered covenants with forces of darkness. It is these beliefs that have led some people to conclude that mentally ill patient do rightfully deserve what they suffer.

The study intends to establish the beliefs among the traditional mental practitioners as o what causes mental illness.

Materials and Methods

Research communities

Communities in Abraka, Ethiope East Local Government Area, and Obiaruku in Ukuani Local Government Area, both in Delta State, Nigeria were chosen. A total of 25 actively practicing traditional mental health workers were selected. These traditional health workers have been in practice for over 5 years.

Information collection

Responses to research questions were obtained by semi-structured questionnaire, which was self administered to these traditional health workers.

Results

The information obtained from the survey is shown on Table 1. The results show that 20% of the respondents have been practicing traditional psychiatric medicine for 21 – 25 years while 40% have been practicing for 26 – 50 years. Thirty-two percent have been practicing for 5 – 20 years, and 8% for over 50 years.

Table 1:    Socio-demographic data and information on causative beliefs of mental illness in Abraka and Obiaruku, Delta State.

The misuse of illicit substances (24.44%) was identified as the greatest cause of mental illness, followed by the activities of witchcraft from forces of darkness (17.77%).

Surprisingly, the traditional health practitioners recognized that some of the cases of mental illnesses were due to hereditary factors (11.11%). Evil manipulation or more popularly known as “remote control” (8.89%) was identified as one of the causes of mental illness by traditional healers. Again, involvement in human ritualistic sacrifices (4.44%) usually for money, long life (protection) or supernatural powers was among the observed factors believed to cause mental illness.

Incidentally, anxiety arising from too much thinking (2.22%) was expressed as yet another cause of mental illness.

Discussion

In the traditional medical setting, mental illness is defined as a situation where the victim is seen to perpetually act over every issue haphazardly. Such a one is prone to misbehaviour, for instance, he could just abandon his family for no just reasons. Such a person does not readily care about what he does or says to whomever (Omonzejele, 2004).

The beliefs about the supernatural causation of mental illness have existed in most parts of the world. People tend to have strong beliefs about the mentally ill, and many of those concepts are based on prevailing local system of belief. Peoples beliefs regarding mental illness should not only be known, but the purpose of their beliefs should be understood (Kabir, et al., 2004). This is because many workers now assert that health delivery strategies that ignore regional beliefs about the illness may fail, because such beliefs reflect on the treatment procedures.

Our result shows that the misuse of drugs ranked highest among the perceived causes mental illness than the other traditional aetiologies. Drug misuse includes alcohol ingestion, cannabis smoking (Indian hemp), and other psychoactive street drugs.

The finding may not be unconnected with increasing use of illicit drugs among the youth in developing countries such as ours. Our findings here agree with the findings of Kabir, et al., (2004), who found that drug abuse was the commonest cause of mental illness in their survey in Karfi village in Northern Nigeria.

Belief in demons operating through witchcraft and forces of darkness was the next aetiologic factor in our findings. Supernatural causes such as sorcery, cause, witchcraft, offenses against the spirits of ancestors and gods were greatly acceptable aetological factors among both the mentally ill patients and their relatives in our region (Kabir, et al., 2004). The number of patients who believed in supernatural causes of their mentally illness were usually higher among those who have consulted traditional mental health practitioners than among those who have not consulted them (Razali, et al., 1996).

The belief that mental illness is caused by supernatural agents is reinforced by those traditionalists. Supernatural view of the origin of mental illness implies that orthodox medical care would not help, but that help can only be given by spiritualists and traditional health workers.

Most of these patients seek help from traditional healers. In Nigeria, there is a great access to these healers. The healers are accustomed to their patients, and the people believe that they have links with the spirits of ancestors. Because of their knowledge of the ways of the people, the traditional healer can provide peace of mind to the patients. This is so, because the healers often have good understanding of the local beliefs.

Incidentally, hereditary causes ranked third among the traditional aetiologies identified by the respondents. The belief among the people is that an offspring will probably be mentally retarded if one of the parents was actually “crazy” during the act of conception. Also, that “madness” can be transferred from the mother’s breast milk. The result is usually aimed at punishing a parent through such evil visitations on their offspring (Razali, et al., 1996). The fact is that there are only few cases of mental retardation that are hereditary in origin (WHO).

Eating poisonous foods or drinks, was also given as one cause of mental illness. This is even more dangerous and more difficult to treat if the acts of eating or drinking are done in the dream since it is then seen as an act of the evil sprits.

Such sinful activities such as adultery and incest especially, are seen as invitation for the anger of the gods, who will visit the offender with a certain slow death or make him insane.

Evil manipulation, known in the local parlance as “remote control” is seen as the controlling activities of the victim by special demons. They are said to control the entire activities of the victim which is usually evil and obscene and of no good.

Divine punishment is perceived as the cause of mental illness for those who are involved in human sacrifices. Their mental illnesses are seen as permanent and with no hope of cure since their illness is due to the wrath of God Almighty.

Also in this category are those who break sealed covenants with forces of darkness. Usually, the covenant is sealed with the victim’s blood (blood covenant) and the resultant punishment from the “gods” is usually insanity. Again, the mental illness is incurable, since the illness is from the “god”.

The respondents gave a 52% chance of good recovery from mental illness and 20% as those who will not recover after treatment. Those patients who will not recover are those whose illness are seen as hereditary in nature and those whose illness are divine in origin. The patients whose illnesses are due to “remote control” are also said to be incurable.

It is obvious that modern medicine is regarded very lowly by relatives of most mentally ill patients in this region, the people believe so much on traditional healers since they believe that these practitioners can by divination and by multiple sacrifices appease the offended gods, evil spirits and their ancestors. Generally, it is accepted that modern medicine can at best only take care of the manifestations of the problem but not the root causes. Therefore, the populace needs education on the causes and treatment of mental ill cases.

Reference

1. Gureje, O., Lasebikan, V.O., and Ephraim – Oluiwanuga, O. (2005). Community Study of Knowledge of and attitude to mental illness in Nigeria. The British Journal of Psychiatry 186: 436 – 441.
2. Kabir, M., Iliaysu, Z., Abubakar, I.S., and Aliyu, M.H. (2004). Perception and beliefs about mental illness among adults in Karfi village, Northern Nigeria. Bio Med Central International Health and Human Rights 4:3.
3. Omonzejele, F.P. (2004), Mental health care in African traditional medicine and society: A Philosophical Appraisal. Eubios Journal of Asian and International Bioethics 14 (5): 165 – 169.
4. Razali S.M., Khan, U.A., and Hasanah C.I. (1996). Belief in supernatural causes of mental illness among Malay patients: Impact on treatment. Acta Psychiatrica Scandinavica, 94 (4): 229 – 233.
5. WHO Regional office for South-East Asia. Mental retardation: Myths and misconceptions about mental retardation http://searo.who.int/en/section1174/section1199/section1567/_section1825-8073.htm.