Mental illness is a condition that involves changes in emotion, thinking or behaviour, that leads to distress and problems functioning in social work or family activities.

Mental health is the foundation for emotions, thinking or communication/learning, resilience, and effective functioning in daily activities including productive activities- such as work, school, and caregiving, and the ability to adapt to changes and cope with adversity.

Therefore for any behaviour, habit or attitude to qualify as mental illness, it must be capable of destroying the capacity to be a) resilient, (b) self-aware, (c)productive and (d) also make the individual a nuisance to society. Mental illness has both spiritual and socio-economic implications.

There is a growing mental and emotional ill-health burden across the world with alarming statistics, especially in developing countries like Nigeria. Reports show evidence of various mental illnesses such as depressive illness, anxiety disorders with strong hypochondriacal preoccupations, suicide, psychotic diseases, post-traumatic stress disorders and other psychological impairments/masked with religious and cultural flavours such as maladaptive coping mechanisms to stressful life events, burnout syndromes and personality disorders.

The preponderance of predisposing factors such as socioeconomic challenges, workplace stress, dysfunctional family life, faulty parenting styles, crime, violence, availability of psychoactive substances, unstable marriages, strong peer group influences and globalization of values provide a breeding ground for the development of varied forms of mental illness. The family, the society and our congregations are challenged just as the pastors are doubly challenged as human beings and spiritual leaders who, apart from their challenges, are expected to discharge duties expected of their calling such as caregiving, problem-solving and spiritual healing.

1. Prevalence

In Nigeria, psychiatric morbidity in the community ranges from 16 to 43% of users of General Medical Practice. The most prevalent mental disorders are depression-5-20%, generalized anxiety disorder -4-15%; harmful alcohol use and dependence -5-15% and somatizationdisorders-5-11%.

It has been observed that more than 60 million Nigerians are suffering from mental illness and the availability of care is grossly deficient although there is a preponderance of alternative care especially spiritual homes and traditional healers. There is a popular opinion that there is no family without someone with a mental health challenge which shows how common these disorders have become in our society although we may not be aware of them.

Predisposing Factors

There is no known specific cause but rather an interplay of several related factors the more prominent being social-economic disruptions and the various implications.

Socio-Economic Factors/Economic hardship

There has been a near total collapse of the world’s economy precipitated by the COVID-19 pandemic and with great implications for our local economy; subsidy removal leading to an increase in the cost of living; inability to pay children school fees, children distracted from schooling due to economic reasons serving as breeding ground for habits that damage their mental health and also failure to meet up with basic financial responsibilities can predispose parents to developing certain mental illness.

Disruptions in family life: Our homes have become workplaces rather than places of rest as the pressure of work has distorted basic work-life balance with work phone calls round the clock while job losses are ongoing and privately owned businesses are not doing well either. Fathers are finding it difficult to meet their basic financial obligations leading to a loss of status in marriage and society predisposing them to depression masked with alcoholism and others.

Apart from economic loss, there could be political loss and social loss as we have in divorce or separation, sudden unplanned retrenchment or poorly planned immigration to other countries and unplanned retirement. Our marriages are challenged; intimate partner violence has become very common and family life has become dysfunctional with an increase in the number of single parents thereby providing a breeding ground for mental illness. Loneliness resulting from the death of partners, or children leaving to form their own families; elderly singles who never got married and also retire, may also be predisposed to mental illness.

Apprehension, fears and anxiety: There is anger and hunger among our youths facing a bleak future that is difficult to plan since unemployment is on the rise which could explain the rise in the abuse of substances among them. There are situations associated with fear of being kidnapped, fear of relocating to a new country, especially teenagers/young adults schooling abroad, apprehension associated with getting a new job or even promotion or even getting married or having a new baby as it is common with first-time mothers.

Traumatic social experiences

Incidences of loss of properties or fortunes can be traumatic, especially for people living in the northern part of the country who have survived terrorist attacks or robbery attacks ladies who may have been sexually assaulted or individuals who may have experienced one form of abuse or the other.

Background chronic medical conditions

Some chronic medical conditions could be stigmatizing apart from being incapacitating such as epilepsy and sickle cell disease. These can lead to mental illness. Stroke patients, who have lost the functional use of their heads and whose future career options are compromised are also prone to emotional ill health. The traumatic birth process is a major risk factor for certain mental illnesses too. Individuals that lose the use of their senses such as sight, and hearing or even have head injuries or limbs through amputation may be prone to developing mental illness.

Doctrinal philosophy, heresies and religiosity

The influence of strange beliefs and new age movements or Christian heresies through globalization and peer group influences can predispose vulnerable individuals to mental ill health.

Genetic/biological factors: There is a relationship between some mental health disorders and variations in the genes notably in depressive illness, bipolar disorders and schizophrenia. Such variations are called mutations and can be inherited from one or both parents. However the presence of such genes does not necessarily cause mental disorders, but it can enhance the likelihood of the disease. Environmental and societal factors as given above are crucial to the development of mental ill health.

2. Manifestations

There are various ways the dysfunction of the mind manifests as stated thus:

Unhealthy lifestyle and Behaviors

The impact of stress on the mind could be physical illness through the development of unhealthy lifestyles such as maladaptive coping mechanisms leading to unhealthy diets, bizarre eating habits, disturbed sleep patterns, burnout syndromes and abuse of psychoactive substances, especially alcohol.

Depressive disorders

When emotions become low depression can set in the form of undue sadness, loss of interest in usual activities, loss of sexual drive with profound feelings of guilt about past events, feelings of hopelessness about the future and feeling worthless about the present. This may be masked by religious beliefs that are abnormally focused on hellfire, death, guilt and overstretched restitution. Among members, there could be abnormal grief reactions due to the loss of loved ones associated at times with suicidal ideations and some symptoms of depression. This can be associated with early morning waking often converted tonight vigils. Depressive illness is quite common but often masked.

Anxiety Disorders

When fear or anxiety dominates the mind, sleep can be disturbed with various kinds of incoherent dreams, abnormal awareness of heartbeats, crawling sensations from the head to the feet, internal heat while the body is cold, peppery sensations all over the body, experiencing vivid images of past traumatic experiences, abnormal preoccupation with minor or unsubstantiated symptoms that keep changing location and a history of several consultations with different doctors and arguments with them. This is the family of disorders known as anxiety disorders.

Extreme Anxiety State (Manic Phase)

When the emotion is characterized by undue elation and excitement, such individuals may parade flamboyant lifestyles, unreasonable generosity and giving, indulge in grandiose projects, and come up with defensive and egocentric leadership. They are usually hyperactive with various ideas rushing through the mind associated with decreased need for sleep. They may parade a version of faith that is unusual, and boastful and lay claim to spiritual powers and pre-eminence comparable to God and the apostles. Some of them may have issues with the law, give out properties or take over properties that are not their own, sexual scandals are common because of increased sexual drive and lack of discretion. This is Mania, although it can move to another pole of a depressive phase hence called the bipolar disorder-manic phase.

Schizophrenia

This is when the structure of thoughts is distorted in terms of not being able to take full possession of one’s thoughts and their boundaries; a thought pattern dominated by rigid beliefs that cannot be substantiated leading to accusing others even close relatives of planning evil. This may be reflected in prayer requests, accusing others of knowing their thoughts or folks inserting ideas into their thoughts or controlling their thoughts without their permission. They may claim that radio or television or even total strangers refer to them without valid evidence.

They usually come up with spiritual experiences that are abnormally dominated with overemphasis on hearing voices and undue suspicion. They can become very passive and abnormally withdrawn from daily activities. This is a major disorder known as Schizophrenia. There is a minor variant of this disorder where the individual may not be hearing voices and thought patterns ‘not as disrupted but the individual has a strong belief system without evidence – a delusion -possibly like being married with children or being pregnant and every attempt to convince otherwise is not accepted. Such individuals could lead a ‘normal’ life in other domains of existence until this encapsulated belief is touched. It is called a delusional disorder. There is also simple schizophrenia where there are no abnormal beliefs and no hearing of voices but there is this gradual decline in the capacity to achieve life goals over the years while the individual is not mentally incapacitated.

Cognitive disorder

When the memory begins to fail, basic interactions become difficult. This is quite common in old age when elderly people may wander away and not know their way back home. Some may start accusing their spouses or housemaids of stealing their money while such items are recovered after a simple search. The immediate recall of information becomes difficult while memories of several years may remain for some time before they are completely lost. Some try to hide this defect in conversations by substituting events of yesteryears for an immediate answer and when pressurized can become very irritable. Over time they may not remember how to control their urine and faeces and even fail to recognize their children. This can occur in younger age groups who suffer stroke, head injury or growth in the brain and those who have abused alcohol. This is the family of cognitive disorders.