Bourdain and Spade: Incantations and Invocations (Part 1: History)

Power through, young man. Pain is for p*ssies.

—Lori Silverbush (writer, filmmaker, activist, spouse of Top Chef head judge Tom Colicchio) on the expectations of celebrity “bad boy” chefs

Earlier this month, Anthony Bourdain ended his life just three days after Kate Spade ended hers. Both suffered from depression. So many words have been written about both of them. So many words have reminded us of the dangers of depression, that mental health can be a strong determinant of suicides, that mental illness needs more attention. So many words have acknowledged the dangerous gateway effect that celebrity suicides have on already troubled minds and most have pointed to help—help that’s out of reach for the vast majority of Nigerians. With only about 250 practicing psychiatrists serving a population of almost 200 million, with fees that are decidedly unaffordable for most, the “help” almost everyone gets is brutally simple: Power through. Pain is for p*ssies.

But this “help” is at odds with alarming stats. Complete data on depression and suicide in Nigeria is hard to come by (contrary to recent erroneous headlines that have since been debunked), but it’s clear from the numbers we do have that both constitute a significant problem:

• 4% of the world’s population suffers from depression, but 20% of Nigerian heads of households exhibit depressive symptoms
• Depression is common in developing countries, with a vicious cycle of poverty, depression, and disability, according to the British Medical Journal.
• Almost 800,000 people across the world succeed in killing themselves every year. (That’s a rate of 10.7 per 100,000. That’s a suicide every 40 seconds). Many more attempt it and 78% of suicides occur in low- and middle-income countries
• With a suicide rate of 9.5 per 100,000, Nigeria ranks 13^th out of 47 African countries that average 7.4 per 100,000
• At a rate of 20.3 per 100,000, Nigeria’s men are much more likely to commit suicide than her women are at 9.9 per 100,000
• Nigerian women are generally more likely to suffer depression than her men are, according to M.O Afolabi et al.
• Nigeria has fallen to 91^st in 2018 from 47^th in 2012 out of 156 countries on the World Happiness Report

We clearly have issues.

Despite these numbers, however, most people see both depression and overcoming it as a choice. We don’t like to acknowledge these kinds of problems; cultural predispositions towards mental health issues prevent us from doing so, assumptions that blend long histories of traditional practices with religious belief systems. Not surprisingly, the average interpretation of mental illness oscillates between dismissal and preternaturalism. Dismissal tags psychotic conditions (like schizophrenia and bipolar disorder) as “crazy” and files non-psychotic conditions (like depression and anxiety disorder) under “abeg”. Preternaturalism assigns causation and cure to the spiritual. Both, however, cannot provide a complete or accurate understanding of mental health or mental illness. Common treatment options are scary and mostly ineffective. Good treatment options are few and far between. It’s always been this way.

Flashback

In pre-colonial Nigeria, mental illness was generally only applied to psychosis, while all other forms were simply considered undesirable personality traits. Most cultures believed that psychotic mental illness had four possible causes: it was inflicted by angry gods and spirits, witchcraft, physical accidents, or bloodlines. Whatever the cause, those suffering from mental illness were somehow responsible for their conditions. They became outcasts, untouchables who couldn’t marry within, or reproduce with, the community. But if the gods willed it, they could be cured by spiritual means.

The dominant Bori religion of northern Nigeria, which preceded Islam, saw Bori spirits as soul healers, so they were the remedy for mental illness; sufferers would become devotees in order to be possessed by the spirits and be healed.

As Islam spread through the North from the 14th century, khalifahs (or Muslim scholars) became the region’s medical care providers. Alexander Boroffka asserts that to treat a sufferer, a khalifah would write Quranic verses on a slate, wash off the ink, and have the individual imbibe the ink and, therefore, the healing words. In the south, which Islam and Christianity were yet to penetrate, traditional healers treated sufferers with rites and incantations, during which they used herbs and concoctions. Some herbs had antipsychotic properties, like poison devil’s-pepper (aka wada in Hausa, akanta in Igbo, and asofeyeje in Yoruba), but many just made things delicious, like uziza, alligator pepper, and palm oil. Traditional healers also had less savoury methods. Shackles to restrain the unwilling patient. Beatings to torture and drive out the possessing spirit. Food deprivation to control both.

Not much changed with the arrival of the British.

Colonists didn’t at first believe that indigenous peoples were self-aware. Ethnopsychiatry, which existed somewhere between psychiatry and anthropology, studied the psychology and behaviour of African peoples. It deemed Africans infantile, unable to reason for themselves, too unsophisticated for introspection. Psychiatric care was therefore a low priority, which turned out to be a good thing, since Victorian psychiatric care was pretty much a horror show.

So the country’s first mental institution wasn’t established until 1903, but this Calabar Asylum and the Yaba Asylum in Lagos that followed were both designed for containment, segregation from the general population, not treatment and had no psychiatrists on staff. It took another 51 years for the country to get its first proper mental health care facility, the Aro Mental Hospital in Abeokuta, led by scholar and Nigeria’s first Western-trained indigenous psychiatrist Dr Thomas Adeoye Lambo. But the country’s severe shortage of care professionals and facilities persisted.

And Nigerians continued to patronise traditional healers and still do.

Next time: exploring the mental health care landscape today and poking around for solutions. Part 2 of this article will be available on Omenka Online on July 6, 2018.