LIVING IN DENIAL PREDISPOSES TO MENTAL ILLNESS

 

Denial in ordinary English Language is asserting that a statement or allegation is not true. The same word, and also abnegation is used for a psychological defense mechanism postulated by Sigmund Freud, in which a person is filled with a fact that is too uncomfortable to accept and rejects it instead, insisting that it is not true despite overwhelming evidence. The subject may use; Simple denial which involves denying the reality of the unpleasant fact altogether or minimization by admitting the fact but deny its  seriousness  which is a combination of denial and rationalization or projection by admitting both and fact but  deny responsibility by blaming somebody or something else. 

Although denial is an immature defense mechanism; it may however be the initial stage of an adaptive coping cycle. When an unwelcome change occurs, a trauma of some sort, the first impulse to disbelieve begins the process of coping at times allowing the mind to slowly rise to greater consciousness until a rational engagement of the problem is instituted. This occurs in association to death, dying and sometimes rape. In this context; denial grants the person the time to accumulate sufficient emotional resources to fully face the trauma. Once fixed, the person deals with the trauma in a stage alternately called acceptance or enlightenment.    

After this stage, the trauma sinks away from total conscious awareness again, left metaphorically upon a back burner or put away in a cupboard through sublimation that involves a balance of neither quite forgetting nor quite remembering.

However, it is definitely established that when immature defense mechanisms especially denial are overused, they can lead to psychological disorders since it does not help to resolve the anxiety producing situation.  It is important that we realize that pathological denial can be exhibited in a large scale – among groups, cultures or even nations. Lucy Bregman, gives an example of national denial of imminent mortality in the 1950s: the large scale denial by some that the World War II holocaust never occurred. This shows that societies are marked by peculiar beliefs, customs, practices and values energized by culture as the enabling software.  In Nigeria, the bulk of our cultural values codified as superstitions, myths and taboos have denial as the central theme. It may be that our fore fathers had the creative use of denial in mind   to give time to rationally engage problems but this defense mechanism has been largely abused in our cultural elaboration. This has been largely reinforced by authority figures in the clan and religious domains, specific instructions concerning certain issues in the society and several prohibitions without a basic rational engagement of issues. This has affected our style of governance where we parade ourselves as a wealthy nation based on a chance discovery of oil rather than creative productivity. The civil service, the professional group and even the academia are not engaging the real issues confronting our nation because the culture of denial is pervasive which frustrates real engagement of our problems. This denial mental paradigm provides the breeding ground for delusions that invariably culminate in mental illness. At a personal level, when denial becomes overused in the context of an ongoing problem; reality testing becomes impaired and mental illness ensues. The major difference between   spirituality and religiosity is that denial is very prominent with religiosity   while faith which involves the application of the power of omnipotence to deal with problems that are clearly defined and accepted is the hall mark of spirituality. Most Nigerians are only religious but not spiritual as our religion has failed to interrogate our cultural values to expunge the destructive aspects because we prefer to wallow in denial which is a breeding ground for mental illness.. Unfortunately our religious leadership because of pecuniary gains has borrowed heavily from our cultural software of denial through fear, brainwashing, manipulation and self-attribution.  I have always predicted that new patterns of mental illnesses will emerge from our religiosity where reality testing is largely impaired with a large scale reliance   on   another man’s faith rather than God which invariably makes such minds vulnerable to profound intrapsychic conflicts that survive on immature defense mechanism of denial leading to mental illness. Mental capital development prescribes that we encourage mature defense mechanisms and stimulate rational engagement of life problems as we trust God.  

Cultural standards and expectations can encourage denial of subjective experience. Men who belong to cultures with extreme notions of masculinity may view fear as a sign of weakness and deny internal feelings of fear. Some patients with personality disorder and substance abuse problems are thought to psychologically deny the reality of the harm they do to others and to self hence the traditional treatment program for substance abuse and other addictions take denial   as a central theme where patients are made recognize the extent of their denial   and work towards acceptance. Stress as a precursor of mental illness can only be managed as precipitating issues are confronted just as prayer cannot be beneficial in the atmosphere of denial.                

CULTURE AS TEMPLATE FOR MENTAL CAPITAL DEVELOPMENT.

This topic came up in my mind after I read an article ‘Are Nigeria politicians crazy’? What is quite obvious concerning Nigeria is that she is blessed with Natural resources and some folks add that we are blessed with human resources a point I disagree with? The fact that we have numerous professionals, technologists and even academicians  who possible may be literate but not educated as this does not confer on Nigeria the status  of being blessed  with human resources.   The value of human resource in   any society is the caliber of mental capital it can deliver. We have a critical mass of human resources with some literacy but not essentially   educated. We have acquired some   knowledge in a manner that did not interrogate our culture hence the disconnect   between our elites’ claim to education and their leadership failures in all ramifications. Our politicians do not have mental illness; they have only taken advantage of our mediocre cultural software to express their greed. We parade a culture that immunizes the leader from scrutiny and has no provision for   feedbacks from the polity.   It is amazing how modern technology through computer software programming controls huge, sophisticated and massive equipment. Those heavy machines   with their complex parts move together in synchrony towards a particular function as programmed by computer software. All nations have cultural software that programs their sociopolitical behavior. Education, contact with other civilizations and other means   of inculcation of new ideas are only external to the native cultural software of the people. This is in consonance to the principles of socialization. No race is superior to the other; but the difference lies in the degree that the native culture of such nations has been interrogated such that destructive components are expunged in the face of universal best practices. This is the mandate of mental capital development as it is being canvassed by the developed counties. Rather than single out the politicians as being sick; I locate our cultural software as being pathological which does not excuse the polity. Our poverty derives not from the scarcity of natural resources but from lack of mental capital. We have aggregates of literate persons   constituting the elite class in various sectors of our society who had cumulatively mismanaged our resources over the years because of mediocre mental capital.   Our pre-colonial   cultural software concerning leadership   is defective. As a matter of fact, it is more of rulership   than leadership where the elite class assumes the status of an unquestionable deity.  If the ruler deems fit to collect your wife   or farmland so be it. This rulership   style laid the foundation   for contemporary leadership failures and poverty. There is definitely no opportunity   for the development of mental capital which is a resource that grows as questions are asked and decisions are taken for the ultimate good   of all and not a select few. In our pre-colonial societies; there is no clear cut facility feedbacks   emanating from the masses to challenge leadership and make them do the right. The colonial masters only banished the traditional   institutions and imposed their own native colonial masters in all sectors of the society either through a military junta and a democratic arrangement.  This impunity and recklessness of our leaders supported by our cultural software   is reasonable for poor infrastructural development and most painfully poor mental capital development. The caliber and the quality of the mental capital of a nation eventually determine the prosperity of that nation. Mental capital is the resource that confers on us the resilience to effectively cope with the challenges of life. It is the resource that empowers individuals to contribute effectively to society and also to experience a high quality of life. This mandate transcends the clinical paradigms as it challenges all social institution to contribute to the mental capital development agenda. Leaders of those institutions should expunge stifling rulership tendencies and open up the space towards mental capital development by releasing the potentials embedded in the human capital towards the ultimate goal of wholesome development. The   family as the most basic unit of the society should be led in a way that   the children are empowered to give their best to the society. A good number of children taking to behavior injurious to health can be traced to families that are mismanaged. Our religious leaders should help to banish destructive   myths, taboos and superstitions that frustrate   mental capital development. Every sector of the society should have this agenda in my mind as we move into the new year  just as  our political leaders should endeavor to ensure that  they take decisions that will create the enabling environment for mental capital development.

CULTURAL TRANSITION AND MENTAL HEALTH

I believe that no culture is virgin; however there are regions  of the world that have much more consistent and enduring cultural values and traditions over time than others. Africa where I belong happens to be part of those regions of the world undergoing  cultural changes and transition without a certain destination in mind. I do not know  what the anthropologists  will call it; but certainly our culture is  evolving and has not reached a stable phase. In recent years, the concept of culture- bound syndromes has been the focus of a debate between the  universalists, who interprete these conditions as cultural  elaborations of universal neuropsychological  phenomena; and the  cultural relativists who see them as generated by, and expressive  of distinctive  features of a particular culture. Contemporary psychiatry however  avoids adopting  either of those ideologically influenced paradigms. It describes representative examples of culturally- related syndromes  as aggregates of symptoms  and behavioural disturbances  that can be plausibly related to cultural emphasis  and associated   stressful situations that are typical  of particular populations. This actually furnishes the intellectual template for this discourse. The precolonial  african culture was raped and infiltrated by colonialism. The colonial masters in their  bid to take over our land,understudied our culture  and introduced the indirect rule that initially made some  traditional rulers their agents  to gain  access into  our lives and cultural values. Their ultimate strategy was to nurture  a rival elite class that would replace  the traditional elite ruling class since they could read, write, speak english language and invariably live by a hybrid  western -african cultural values.These native Nigerian colonial masters lived  in GRAs manned  with dogs and  gate men thereby  preventing easy access to them as opposed to  the pre-colonial architectural designs that facilitated  unhindered social intercourse. The culture- change definitely has very grave impact on the mental health of the people. Brain fag syndrome has been recognised in many  african students at home and abroad and also  who are exposed to the aculturative stress of a western type education system emphasising theoretical book knowledge quite different from the practical know how acquired through  oral traditions by older generations in africa.Nevertheless, these  african parents expect their childern to achieve  socio- economic success in modern society associated with intense  emotional pressure thereby presenting with  crawling senstions  in the head and the body,  aches,eye trouble  especially blurred  vision and tears when reading, impaired concentration and difficulty in comprehending. Another example is the bouffee deliriante which is usually sudden ,self limiiting  and  usually as a form of reactions embedded in anxieties over sorcery and witchcraft that  increase under rapid sociocultural changes.Usually characterized by varied and uncharacteristic delusions;seeing and hearing things that others cannot perceive in clear consciousness;often demonstrative and sometimes dangerous acting out behaviour.The prominent sociocultural factors underlyingthe incidence of this disorder is the acculturative stress affecting many persons in many parts of contemporary Africa who have become marginalized in society through rapid culture change as  traditional communalistic society is disintegrating and the supportive kin network is breaking down.The individual experiences an increasing economic rivalry and social isolation that intensifies the old fears of witchcraft and sorcery,never obliterated by the western religous approaches  while the traditional protective and remedial resources are no longer readily available.These 2 examples clearly ilustrate the posible effect of  cultural transition on the mental health of an average Nigerian akin to  neo-colonialism and neo-imperialism as a consequence of globalization of values.We are no longer truly africans in our cultural orientation and essentially not  western.This obviously has very grave psychological  implications for our marriage,family-life,community-life,financial ,political,religious  and professional endeavors.The western media through music and video augmented by our own  Nollywood have produced a new generation  with profound  cognitive dissonance. Their values about marriage for instance may be  generally unrealistic  which may explain increasing rates of divorce,separation or  associated mental health issues. Social habits of the emerging generation in this cultural transition  invariably are  factors of predisposition for substance abuse and addiction,sexual disorders and other bahavioral disorders.Religious practices in this setting  may actually be a major precursor of mental disorders  when religious leaders place unrealistic demands for material prosperity on their adherents without a corressponding productive basis. Our fully westernized educational philosophy  may be responsible for increase in the level of unemployment amidst abundance of natural resources.The African  leadership crisis may be a product of the coexistence  of  2 strong opposing  ideologies in the mind of our ruling elite class namely;the rulership, exclusive african cultural software  and the egalitarian, democractic  western values  which  has produced a leadership without an identity  invariably floundering   in self preservation  by looting public funds and producing a sococultural mileu suitable for developing mental illness. Leadership in all facets of our lives must engage our values in this transition and entrench those that will encourage sound mental health.

CORPORATE SOCIAL RESPONSIBILITY AND MENTAL WELL-BEING

The Royal Niger Company was a British chartered company, active from 1886 through 1899 in the territory bordering the Niger and Benue Rivers in contemporary Nigeria that parlayed its administrative powers into a successful commercial monopoly. Such foreign-owned chartered companies played a significant role in the history of economic imperialism in sub-Saharan Africa during the colonial era. Scholars   feel that chartered companies were exploitative and profitable only for foreign investors and viewed as economic failures especially by the native Africans. This provides the background for understanding corporate social responsibility in Africa and Nigeria especially.

 The genesis of the debate on the concept of corporate social responsibility has been traced to the wave of crisis in social values that engulfed America in the post-World War II period and most especially in the sixties when it was observed that society has lost confidence in its institutions – in the government, in the press, in the church, in the military, as well as in business. 

As a response to this challenge, businesses in America were engineered to generate enormous positive impact on social life in America since the civil war II although the gains were threatened by a wave of protests from various publics it used to serve.  The crisis of confidence in the social role of business is made explicit in debates on corporate social responsibility that seeks to control and at least re-orientate its directions from the taunted profit maximization dogma and pay attention to the human lives and the environment. 

 The concept of corporate social responsibility is a crude blend of long-run profit-making and altruism; a doctrine which fuses social values with profit maximization goals. In the early years of the American Republic and especially in the post-civil war reconstruction era, business in America played an almost indispensable role as a powerful social tool for harnessing resources and ensuring material progress.  But as the years rolled on and business began to concentrate and centralize capital, its role in the economy became expansive and pervasive.  At the height of prosperity, the captains of industry were heralded as heroes of the society as they took responsibility for the company's effects on environment and social wellbeing.

 CSR may also be referred to as "corporate citizenship" and can involve incurring short-term costs that do not provide an immediate financial benefit to the company, but instead promote positive social and environmental change. Corporations can have enormously detrimental effects on the environment. Oil spills are some of the most conspicuous examples, but industries as varied as chemical manufacturing, mining, agriculture and fishing can do permanent damage to local ecosystems. Climate change can also be attributed in large part to corporations. While their responsibility is hard to untangle from that of the consumers who demand social responsibility.It is difficult to deny that many corporations have profited from the deterioration of the global environment.   Companies can therefore invest in local communities in order to offset the negative impact their operations might have. A natural resources firm that begins to operate in a poor community might build a school, offer medical services or improve irrigation and sanitation equipment. Similarly, a company might invest in research even though the project might not immediately lead to increased profitability. Companies might make extraordinary efforts to hire, foster and empower a diverse workforce. They might offer generous paid maternity and paternity leave. They might sponsor after-school programs in crime-affected neighborhoods, fund the clean-up of local river systems and put pressure on elected officials to consider the needs of all citizens rather than simply seeking political expediency. 

The Nigerian situation is precarious because there is no effective regulation for the corporate business where labor is cheap, abused and the workforce vulnerable to mental health issues. None of our major corporate organizations has invested in any mental health intervention despite enormous burden that exist. Most of our corporate settings have no vigorous program for proactively engaging the mental health needs of their employees. We have serious social issues that our corporate organizations may do well for by intervening in diverse social issues that may invariably have mental health consequences.  The immediate challenges we face as a nation are enormous especially as touching the unemployed youths, the drug addicts and the homeless mentally ill may benefit from so much of corporate responsibility and philanthropic efforts.  The public-private partnership model has many benefits but has served only the interest of the privileged political class rather than the vulnerable masses. The corporate social responsibility is a better model that can midwife a versatile futuristic public –private partnership after these institutions have helped to jumpstart programs of intervention for the vulnerable. The contemporary Nigerian corporate organizations need to convince us that they are different from the Royal Niger Company which was purely a colonial instrument of economic   exploitation of the natives as they make giant and deliberate strides in mental health intervention programmes.

CONNECTION BETWEEN GIVING AND MENTAL WELL- BEING

Christmas essentially is a religiously designated season for giving but research shows becoming more giving round the year can significantly boost physical health and mental wellbeing. However, the frenzy of Christmas shopping and the planning for parties can paradoxically feel a bit of a stretch and distraction when this idea of giving to others in a deliberate and constructive manner is entertained. It is now clear that doing good for others without any expectation of reward can confer better physical and mental health and even help live longer.

A US-based altruism and health researcher Stephen G. Post puts it this way; "A remarkable fact is that giving, even in later years, can delay death. The impact of giving is just as significant as not smoking and avoiding obesity." Indeed one study of 2025 older residents of California found those who volunteered for two or more organizations had a 44 per cent reduction in mortality over five years even after accounting for factors like differences in prior health status just as giving in a more material sense can boost mental wellbeing while “hands on" and face-to-face helping have enormous boost for wellbeing. This may take the form of volunteering or practicing acts of kindness as well as spending for others. Studies have established that those who spent money on others or on a charity are happier than those who perpetually spent on themselves.  The problem with giving at Christmas and any other religious festival that prescribes giving is that   we get sucked into the commercial and the religious rituals that have become completely divorced from any sort of intrinsic meaning. However, if the focus on why you're giving is to make another person happy it can really make you feel better with profound   physical changes that underpin that. Although how giving boosts health is not fully understood, but reduction in the exposure to stress hormones may be one factor. It takes so much stress to get competitive and accumulate material things at the expense of others. Knowing we've done something to improve the life of others not only boosts our self esteem and gives us a sense of purpose; it also shifts our attention away from our own stresses and worries.

Giving also integrates you more solidly and cohesively into your supportive social networks making it more likely you'll have helping behavior returned to you when you need it especially when you suffer a loss in your own life. A good number of mental illnesses are caused by major life events that challenge and overstretch the psychological resources of  individuals to a point that requires some form of external support that can augment the coping mechanisms. 

Twenty year follow-up studies at Harvard university  have mapped thousands of people and shown those who pay attention to others tend to move towards the centre of their social network, whereas those who don't get pushed further and further to the edges as the network changes over time. This is very crucial since shared social support is one of the things that would probably play a major role in longevity with some great impact on mental wellbeing. Some of the other changes that happen when we give have even been observed in brain scans. Studies involving functional magnetic resonance imaging scans have shown donating money to charity with well thought out meaning triggers the same pleasure and reward systems in the brain as food and sex. If you don't have time to commit to regular volunteer works, one can experience the benefits of giving  by practicing  simple acts of kindness which could be providing shelter for the homeless ones, phoning or visiting  a housebound person, Collecting goods for a charity and supervising a thoughtful and considerate distribution, letting someone in front of you in the traffic or in a queue especially giving consideration for the elderly, granting scholarship for an indigent student ,Surprising a colleague at work with a useful assistance concerning a problem, helping to provide care for wandering mentally ill or setting aside funds for the widows. However it is important that the primary motive is to enhance someone else's wellbeing not just about personal aggrandizement which will invariably lead to resentment if such acts are not properly appreciated. 

 The prevalent harsh socioeconomic situation in itself is responsible for the increase in mental illness which can be relieved through social support intervention from the privileged which invariably accrues as sound mental wellbeing for the giver. However, greed serves as the template for developing different kinds of mental illness which is prevalent in leadership positions in Nigeria whether in religion, politics, academics or business. Unfortunately, this has set a template that guarantees perpetual   increase in the incidence of mental illness for both the poor and the rich.

WHEN DEPRESSION IS HIDDEN

I find this article very interesting and quite relevant to our situation at this very challenging period of our national life when a sizeable number of our people may actually be depressed without knowing or making efforts to conceal it. This article was originally written by Dr. John Grohol who is an author, researcher and expert in mental health online and has been writing about mental health and psychology issues since 1992.

 However, the following signs might point to the depression such individuals may have been trying to conceal.

1. They have unusual sleep, eating or drinking habits that differ from their normal ones.

When a person seems to have changed the way they sleep or eat in significant ways, that’s often a sign that something is wrong.  When a person can’t sleep (or sleeps for far too long) every day, that may be a sign of hidden depression. Others turn to food or alcohol to try and quash their feelings. Overeating can help someone who is depressed feel full, which in turn helps them feel less emotionally empty inside. Drinking may be used to help cover up the feelings of sadness and loneliness that often accompany depression. Sometimes a person will go in the other direction too — losing all interest in food or drinking.

2. They wear a forced “happy face” and are always making excuses.

We’ve all seen someone who seems like they are trying to force happiness. It’s a mask we all wear from time to time. But in most cases, the mask wears thin the longer you spend time with the person who’s wearing it. That’s why lots of people with hidden depression try not to spend any more time with others than they absolutely have to. They seem to always have a quick and ready excuse for not being able to hang out, go to dinner, or see you.It’s hard to see behind the mask of happiness that people with hidden depression wear. Sometimes you can catch a glimpse of it in a moment of honesty, or when there’s a conversation lull.

3. They may talk more philosophically than normal.

When you do finally catch up with a person with masked depression, you may find the conversation turning to philosophical topics they don’t normally talk much about. These might include the meaning of life, or what their life has amounted to so far. They may even open up enough to acknowledge occasional thoughts of wanting to hurt themselves or even thoughts of death. They may talk about finding happiness or a better path in the journey of life.These kinds of topics may be a sign that a person is struggling internally with darker thoughts that they dare not share.

4. They may put out a cry for help, only to take it back.

People with hidden depression struggle fiercely with keeping it hidden. Sometimes, they give up the struggle to conceal their true feelings and so they tell someone about it. They may even take the first step and make an appointment with a doctor or therapist, and a handful will even will make it to the first session. But then they wake up the next day and realize they’ve gone too far. Seeking out help for their depression would be admitting they truly are depressed. That is an acknowledgment that many people with concealed depression struggle with and cannot make. Nobody else is allowed to see their weakness.

5. They feel things more intensely than normal.

A person with masked depression often feels emotions more intensely than others. This might come across as someone who doesn’t normally cry while watching a TV show or movie suddenly breaks out in tears during a poignant scene. Or someone who doesn’t normally get angry about anything suddenly gets very mad at a driver who cut them off in traffic. Or someone who doesn’t usually express terms of endearment suddenly is telling you that they love you. It’s like by keeping their depressive feelings all boxed up, other feelings leak out around the edges more easily.

6. They may look at things with a less optimistic point of view than usual.

This is depressive realism when such individuals appear to have a more realistic picture of the world around them. For instance, while normal people are usually more optimistic about life circumstances, those attempting to conceal depression may say things like “Well, I’m up for that promotion again, but I doubt I’ll get it.”In our own environment they may be more involved in overt religiously prescribed problem-solving approaches to the detriment of their overall quality of life. 

If anyone fits into any of these complaints, it is advisable to visit a psychiatrist or any mental health expert for effective intervention to prevent suicide.

CHALLENGES OF FAMILIES WITH SPECIAL CHILDREN.

Irrespective of culture, race or geographical location; children are not just bye products of the marital relationship but a crucial basis for societal modulation of the family unit. This explains the basis for   different cultures having varied but potent reactions to infertility where children cannot be produced and having children with peculiar challenges. Beyond the medical explanations for infertility or special children; there are very potent sociocultural and religious issues that are capable of militating against beneficial approach to the effective management options of these problems. Special children in this context are those with peculiar needs that require much more support than other children for them to function optimally. This condition  may have been precipitated  by the mishandling  of the pregnancy where certain drugs are  taken that  damage  the growing  brain  of fetus,   failure to take precautions against possibility of jaundice in  certain circumstances  or  mismanagement of the delivery process  such as  prolonged labor, premature draining of the waters  that can result in fetal distress and mechanical trauma  to the fragile brain of the new born baby through unprofessional  handling of the delivery process. We have   many untrained traditional birth attendants and religious maternity centers that are not professionally supervised which may lead to an increased incidence in the population of children with special needs.  There may be other causes traceable to some genetic factors, some inherited metabolic disorders or advanced maternal age. These children may be born with cognitive defects associated with seizures   that could manifest in many ways. As the child grows there may be deficits in the achievement of developmental milestones with associated poor performance in the school short of that expected for their chronological age.  The overall presentation could be mild, moderate or severe depending on the severity on the overall global functioning of the child. These children may also have problems with posture and sensations   that will require orthopedic and physiotherapeutic interventions. These children often require a multidisciplinarian   approach in their management with the ultimate goal of assisting them   maximize the available intellectual resources for their ultimate good.  There are some of them that can perform brilliantly well in certain aspects of life when appropriate educational techniques identify such dimensions and assist in developing them.  Drugs are often indicated in a number of them which should be professionally administered so that the side effects of some of these drugs do not outweigh the beneficial effects especially for children with behavioral challenges that require medications. 

However, our society through the sick role has explanations and prescribed interventions for these special children which make it difficult for the parents of these children to get the best out of them. Within this context, children with special needs are viewed as products of   spiritual attacks and that their parents may be serving some form of punishment from God for a wrongdoing which can explain the hostile attitude of some  neighbors to these children and the society at large. In some instances these children are viewed as spiritual agents of misfortune and some individuals in the society use them as agents of social crime.   As a result of the stigma, some of them are locked up away from the glare of the public without any intelligently coordinated intervention since they are seen as financial and emotional devourers.  Africans through our primitive culture have very wrong attitudes to these children that make them vulnerable to all forms of abuse. The parents by extension are also maligned especially the mothers who may be seen   as the custodian of evil forces that manifest through   abnormal children in their own reckoning. Several unwholesome religious and cultural interventions include   beatings, starving and burning of certain parts of their bodies in the process of exorcism apart from injuries a number of them sustain through uncontrolled seizure attacks.  When these children exhibit some behavioral problems as a result of poor judgment or antisocial behavior, such a child is often treated with grave physical abuse tending towards ostracism while the parents are made to feel guilty for having brought such a child into the world. Some individuals actually rape such children, use them to commit crimes and take advantage of their deficits rather than support them to maximize their available intellectual resources.  This unfavorable position in the society has affected government and relevant health agencies that should have been supportive in giving these children the best. The care of such children consumes not only enormous   financial resources but a lot of emotional resources especially on the part of the parents. Policies that can support, protect and encourage professional care of these children should be encouraged. Corporate institutions can rise to this challenge by setting up a highly equipped educational and vocational centers for these children in a multidisciplinary setting as social network of their children should be encouraged.

BEREAVEMENT AND MENTAL WELL-BEING

The central theme in bereavement is LOSS; but not loss in a general sense.   It is the specific, personal loss of a loved one through death.  It is a final exit of a loved person from the physical space where all forms of previous interpersonal contacts become absolutely impossible again.  This picture attempts to capture in graphic terms the impact of this loss on the human mind and the consequent activation of the coping mechanisms.  The involuntary emotional and behavioral reactions to this loss are often described as grief while the traditional, voluntary ,social expressions  to this loss is mourning which may overshadow  all the other aspects of bereavement  especially in Africa. 

It is normal for human beings to express this involuntary grief reaction by an initial phase of shock, protest and disbelief followed by preoccupation with the thoughts of the deceased which is often characterized by searching for other intrusive thoughts about the dead.  As a process of resolution, there is a stage of reluctantly accepting the reality of the loss which is then followed by outright rejection of attitudes of guilt or self-pity with respect to the deceased. 

Where adverse bereavement- related symptoms persist for more than 6months or when there is the absence of expected grief symptoms or the avoidance of painful symptoms within the first 2 weeks; a situation of abnormal grief reaction ensues that require psychiatric consultation. The human cognitive template has valuable recordings of memorable interactions with the loved one that cannot be switched off as can be done to a television. To view the human mind at that mechanical level is to have a poor understanding of how the human mind functions. The grief reaction state may come out in close resemblance to depressive illness except that guilt and suicidal ideations are not free floating if they ever exist as they will always be in the context of the deceased. There are usually no associated feelings of worthlessness, hallucinatory experiences or prolonged functional impairment.  The grief reaction may initially appear mild until the one year anniversary when manifestations may become more intense.  To mask this; some may take to alcohol and substance abuse. 

 Frank stress reactions to the loss especially when the death is sudden, unexpected or violent may present with re-experiencing and flashbacks of the circumstances of the death of the deceased. Folks with previous history of psychiatric illnesses may be more prone to committing suicide following bereavement.  There is a demonstrable higher rate of hospital admission and increased medical consultation among those bereaved especially if they are parents, children or spouses in relation to the deceased.  The women may present more with frank psychiatric disorders while the men would develop more medical complications as a consequence of bereavement if they do not remarry.  Some of the subtle but potent factors that can facilitate complications of bereavement are social and emotional isolation, absolute loss of social role, unemployment, financial hardship and loss of supportive social networks. Some bereaved individuals may have low self esteem, ambivalent or dependent relationship with the deceased or previously unstable personality profiles.  The women  especially become more vulnerable and destabilized following bereavement just as men show less acceptance of their loss and turn to other romantic relationships sooner.

  Mourning as a conscious, voluntary socio-cultural facility could have a creative and profound positive impact on the grief reaction by ameliorating factors that can get it complicated. 

In Africa where a widow is viewed more as   property of the deceased husband and by extension of the extended family; prospect of remarriage is usually marred by family gossips and persecution as obsolete cultural practices whereby a sibling of the late husband may be  expected to take over the widow of his late brother without her consent. Properties acquired jointly are oftentimes seized by the extended family if she does not comply with the family directives. Some mourning practices can take several months which may foster social isolation, loss of self esteem and disconnection from supportive social networks and means of livelihood. Both religious and cultural practices should ensure that those who harbor guilt feelings following the death of their loved ones are reassured so that they can have enhanced mental capacity to bear the loss rather than wallow in self pity. Memories of our loved ones can be devoid of pain when we immortalize them with projects that can serve the good of the community especially the vulnerable ones. As a consequence of suicide bomb attacks, air disasters, increasing road traffic accidents and reduced life expectancy generally; there is definitely an increasing population of widows, widowers, orphans that would require a robust social welfare program from our government at all levels because their bereavement would  have taken a negative toll on their socioeconomic standing.

WHAT WOMEN LIBERATION DOES TO THE MENTAL HEALTH OF MEN

Recent years have witnessed significant awareness on the issues of gender and human rights in standard setting and to some extent application of those standards through international and domestic legislation and jurisprudence, and in institutional programming and development. Some international and regional human rights bodies now go beyond just including women in a list of vulnerable groups, and have begun to incorporate women’s experiences and perspectives into recommendations for structural changes needed to bring about file enjoyment of human rights by women and girls. Despite this progress, many challenges remain. Domestic violence appears to be on the increase as tensions rise in the global economic crisis. Gender based discrimination persists in the work-place,  housing, education, disaster relief, political life, inheritance ,health care, access to food, and countless  other areas.

Access to justice continues to be hindered by a range of obstacles, including restrictions in some countries on freedom of movement, discounting of evidence given by women and lack of training of prosecutors. Religion, tradition and culture continue to be used as   shield for violating women’s rights, despite, strong and persistent statements adopted by states in United Nations’ fora that they are not a valid justification for such violations. This brief presentation of problems usually from the academic, civil rights groups and most reports from our international developmental agencies may illustrate some of the problems but the paradigm adopted in tackling these culture-sensitive issues may be flawed. Gender refers to the socially – constructed differences between men and women as distinct from sex which refers to their biological differences. In all societies, men and women play different roles, have different needs and face different constraints. Gender roles differ from the biological roles of men and women although they may overlap. These roles demarcate responsibilities between men and women in social and economic activities, access to resources and decision making authority. These roles can and do shift with social, economic and technological change.

In essence, the very substrate that gives definition to gender is the culture. Gender is the cultural value ascribed to the biological differences ascribed to men and women. This paradigm is very crucial in understanding gender issues and proffering solutions to them. The world over, people generally think that they perceive reality and approach problem solving in a way that is objective, accurate and culture-free. The survey of the history of development theory shows that western economists propose interventions from their sociocultural, historical and economic realities in their countries to interpret evidence.  This mismatch between their analysis and the reality make for some bad policy especially in a good number of our developmental programs because intervention should have a cultural paradigm to be effective.Pre-colonial Africa was a patriarchal society with rigidly defined authoritarian roles for men and supportive roles for women.  However with the advent of colonialism and globalization of values; gender roles are changing with strong implications for our mental health. Our women for instance are no longer passive merely supportive partners in the marital relationship but strong contributors. This has had a profound implication for marital relationships with attendant challenges on the mental health of the husbands especially as their traditional autocratic roles are being challenged because women are gainfully employed hence more financially independent with robust social capital. Older men in retirement are lonelier as their wives move from one continent to the other to nurse their grandchildren.

Harmonious leadership roles are disrupted as the men become incapable of coordinating the family life because women are getting more empowered and less adapting. The children suffer from this gender warfare as they grow up in an atmosphere of discordant authority voices.

Contemporary advocacy from the western world overemphasize the discrimination against women without considering a subtle but profound incapacitation of manhood in the developing countries. A good number of our men suffer from depressive illness masked by alcoholism, abuse of psychoactive drugs, erectile dysfunction just as they develop high blood pressure mostly before 40 years. The challenge to sustain leadership by being financially buoyant to survive the emotional combat may be responsible.

There is increased marital conflict characterized by gender violence especially when men get frustrated by the challenge posed by their combative modern wives. Some of the men carry their reservations about women into the work place and entrench the campaign of gender discrimination as they seek to disempower women by blocking their promotion, refusing to encourage their education once married or outright sexual abuse of women subordinates. The ultimate resolution of this gender warfare cannot take place unless our cultural values are interrogated so that our gender conventions and declarations can be creatively domesticated. Reckless challenge of the existing cultural values from a purely western paradigm can only worsen the existing gender discrimination with attendant mental health challenges.

ERECTILE DYSFUNCTION, CULTURE AND MANHOOD.

Sigmund Freud remains one of the most creative, dramatic and significant contributor to the field of modern psychiatry especially through his famous theory of psychoanalysis in explaining varied forms of abnormal behavior. Of particular relevance to this discourse is the dual – drive theory in relationship to human sexuality. He described sexual drive as the ultimate premise of biological motivation for human behavior just as instincts serve similar purpose for animals. Under the dominance of the sexual drive and guided by the primary process thinking; the libido exerts an ongoing pressure towards gratification operating in accordance with the pleasure principle.  The aggressive or ‘death’ drive which is profoundly self-destructive is responsible for the development of depression and suicide and runs counter the pleasure principle of the libido. A basic inference from this theory is that the sexual drive is the energy of life and when it is frustrated could result in unconscious self- destructive psychological strategies that may end up in depression and suicide. This explains the central role that mental health experts play in sexual dysfunction. Men and women have always been curious about sexual life; its inherent mysteries, drives, intentions, oddities and common sexual problems. Treatment rituals, folk remedies, advice, and sex manuals have been discovered among the writings of the ancient Greek physicians, Islamic and Talmudic scholars, and Chinese and Hindu practitioners. Even today the public’s insatiable curiosity about sexual life, especially how to enhance,improve,restore,or cure problems, is the focus of every monthly women’s magazine, television and radio programmes,books and videos.

Biographers have observed that most of our great leaders and inventors have been peculiarly endowed with enormous libidinal energy creatively harnessed and plugged into their particular creative outlets rather than wasteful dissipation in consonance with the concept of sexual transmutation. For the love of a woman; a man can perform essentially animated by the energy of the libido. 

I think it is in agreement with Freud’s theory of libido that guided our culture to define manhood among other qualities in the context of sexual agility.  The African society is essentially patriarchal and sexual agility is considered a resource for man to take full control of his emotional and psychological territory just as the women are expected to derive security in the enjoyment of this facility. However changes in the dynamics of the modern marriage with the attendant psychological challenges may explain an apparent increase in incidence of sexual dysfunction among men especially erectile dysfunction and their patronage of local culturally compliant remedies. The women because of the cultural and religious inhibitions may never admit to their sexual dysfunction.

From basic psychology; the sexual response cycle can be divided into 4 phases of functioning: desire, arousal, orgasm and satisfaction. Sexual dysfunction in clinical practice follows this theoretical model including the sexual pain disorders. Erectile dysfunction is a disorder of sexual arousal characterized by persistent or recurrent inability to attain or to maintain erection until completion of the sexual activity. The dysfunction may occur as full erection occurs in the early stages of love -making but declines when intercourse is attempted; or erection does occur, but only when intercourse is not being considered; or partial erection, insufficient for intercourse occurs but not full erection. And for women; there is the persistent inability to attain or sustain adequate lubrication-swelling response of sexual excitement Significant enough to cause distress and interpersonal difficulty. Couples or individuals who discover that they do not have optimum sexual satisfaction should  seek medical advice since some medical conditions like diabetes, hypertension,  some  surgical conditions and some medications like the  antihypertensive.  Depressive illness presenting  with reduced libido,   antipsychotics and some drugs of abuse may be cause erectile dysfunction.

  

However, strong cognitive and emotional factors may be responsible for the majority of cases.  Until recently; clinicians used to consider performance anxiety to be responsible for the development and maintenance of life long and acquired erectile dysfunction. However, recent findings are showing that the cognitive processes interacting with anxiety are responsible for sexual dysfunction.

The challenge for the mental health expert is to elicit deep seated psychological and relational barriers usually fed by faulty cultural and religious paradigms and defective communication patterns. The African man’s definition of manhood as sexual conquest of his partner readily makes him vulnerable to sexual dysfunction especially when his partner demands to be treated with respect rather than conquered. The quality of the couple’s non- sexual relationship is examined such as conflicts emanating from work, finances, partner’s health, and difficulties with parents and children. Partners could provide useful information that the client is concealing like bereavement, indebtedness, not getting promotion or a son’s drug problem.  The goal of therapy is to assist couples to accept changes in their lives such as menopause, disability, and other life stresses.

ARISTO SYNDROME AND CHALLENGE TO WOMANHOOD

If you live in Nigeria, this topic will not be strange as the aristo coinage comes   from the word ‘’aristocracy’’ which in this peculiar context connotes a group of individuals considered to be superior to others .It describes the relationship between the young, vulnerable young ladies and the economically advantaged men. This social phenomenon is very common in Nigeria although with some religious and cultural rationalizations in certain quarters but not without enormous medical and psychosocial consequences that impact negatively on the mental capital development of the victims.

Nigeria is a developing nation but the oil wealth has made us acquire social class designations   that are not articulated on   productivity but crass opportunism.   The character of this primitive upper class is not only opportunistic but comes with a reckless orientation to violate their victims with impunity.  The middle class that is a natural custodian of egalitarian values barely exists in its true character since the Nigerian society is enmeshed in a chaotic, continuously evolving class segregation and struggles premised on opportunism without a pedigree of creative productivity.  The aristo cohort in context comprises of those men who occupy some position and   have enough economic means to secure the attention of a younger, vulnerable lady for reckless self-gratification.

Borrowing   strongly  from  the pre-colonial rulership  cultural  software of the elite class; the modern elite class take pleasure in the violation  of these  vulnerable , economically deprived girls . It is also important to note that these girls are from homes where their parents have been rendered poor through the misrule of this aristo clan directly or indirectly.  A good number of them have parents that cannot pay their school fees, secure accommodation and cannot feed them.  These impacts negatively on family cohesion as a number of these ladies have grown up without a father figure in the home. They have had to survive the murky waters of the real life out there without requisite support from home through destructive maladaptive coping mechanisms. As a consequence of their damaged self-esteem; they learn to parade their bodies in a modified form of prostitution for economic gain. This explains their exhibitionistic mode of dressing and manipulative tendencies.  The aristo men also are aware of their economic deprivation which serves as the premise of bargain such that some of them can have sex with 2 or more at the same time as a demonstration of superiority and opulence. 

This practice is very common in our political outings, higher institutions as we saw lately in sex for grades scandal, our corporate environments and even in religious organizations. Every girl needs a father or a father- figure as a maturation template   especially through the teenage years which could explain the healthy attraction of the oedipal complex. This relationship facilitates the creative channeling and focusing of the chaotic emotional experiences of adolescence in a way that confers healthy self-esteem and identity. The Aristo syndrome in context is an unconscious quest by these vulnerable ladies for a father figure to mentor them into womanhood apart from the economic gain.   A quick check of the ladies in this cohort suffer from poor self-esteem, victims of rape, child-labor and chronic economic deprivation occasioned by an absentee father. It is a vicious cycle of oppression, deprivation and violation. Their parents are oppressed with resultant economic deprivation that renders their children to be vulnerable to be violated by their oppressors. The aristo syndrome should be a social facility for engaging these valuable girls in creative mentorship so that they can become balanced and well-adjusted adults.  Any relationship between an older, more advantaged man and a younger, vulnerable girl should have this goal and could be articulated as a development initiative. When they are recklessly violated; they end up as single mothers, unemployable school drop outs, victims of HIV-AIDS and damaged womb resulting in infertility, serial divorcee, multiple drug abusers and could end up as criminals .A good number of them invariably come down with mental illness of different types. A few years back, I was at the inauguration of a non-governmental development initiative specifically dedicated for equipping girls to make informed choices. Precious Jewels; as a development initiative is intended by the initiator to mentor these vulnerable girls to become successful in their career pursuits, responsible mothers and accomplished wives.  This coincided with the initiator’s   40th birthday who is   already at the peak of her career with a great marriage and mother  of two lovely children. She is from a   basic family in Nigeria and has risen steadily through the ranks in a balanced way. This is the opportunity that the aristo syndrome presents rather than the reckless violation of the potential womanhood in these vulnerable girls.