Sociology of Mental Illness: The Study of the Un-institutionalized Mentally Challenged in Abeokuta, Ogun State. Nigeria



BY


DR. J. O. SHOPEJU*; DR. C. A. ONIFADE* AND DR. A. DIPEOLU**

joshopeju12@yahoo.com; drcaonifade@yahoo.com; waledipe@gmail.com

*DEPARTMENT OF GENERAL STUDIES
UNIVERSITY OF AGRICULTURE
ABEOKUTA

**DEPARTMENT OF AGRICULTURAL ECONOMICS
UNIVERSITY OF AGRICULTURE
ABEOKUTA

CONTACT: E-mail address: joshopeju12@yahoo.com

Mobile phone 08037125917

Sociology of Mental Illness: The Study of the Un-institutionalized Mentally Challenged in Abeokuta, Ogun State. Nigeria

The focus of this paper is on the poor/economically disadvantaged, non-institutionalized and socially classified as mentally challenged (or considered to be mad) people who roam the streets of Abeokuta, the capital of Ogun State, Nigeria. It attempts to address the issue of mental illness as a social construction. It is felt that the ability of these people to survive without formal care, should be a source of study that will assist in shedding some light into the problems confronting several individuals and groups within the society. For example, if we consider the fact that majority of these people live as isolated selves, it will focus our minds into the need to understand, appreciate, and come to terms with the fact that, as Erickson (2001) says, “. . ..the inability of some people to come to terms with their own isolated selves is counter-pointed by their inability to relate with others on interpersonal one-to-one basis.” The point is that many of these people took off at one time or the other from societies, which exerted pressure on them to tow the line of social expectations. These expectations, as defined by the social institutions (religion, family, economic, political — both the civilian and military, and education), govern their lives and also serve as the support system, and that it is the failure of the same system to continue to provide the so much needed support that has assisted in boxing them into a corner and thereby severing them from the existing conventional social relationships. It is also felt that with better understanding of the underlying factors influencing the behaviours and the lives of these people, and with a little assistance from the rest of us, they would cope better with some of the problems confronting them. In short, we feel strongly and agree with the view of Carol Gill, a Ph. D. holder, wheelchair user and co-organizer “Bioethics Symposium” who expressed the view that “we should be examining the barriers society has erected that demoralize people to the point that they find it too difficult to live with their disability, when the focus should be on our inability to muster the resources they need to live” (Nugent, 2005).
Literature Review
The more one reads about mental illness, sees or interacts with some of the mentally challenged, or those whom society considers as mentally ill, the more the question about the reality of the problem comes to the mind. Also the more the question crops up the harder it is to arrive at a conclusion regarding what mental illness really is. An attempt to define mental illness helps to expose the ambiguity and the futility involved. This fact guided the thought of Mechanic (1980) in his book, “Mental Health and Social Policy.” For example, Webster’s Third New International dictionary defines insanity as, “such unsoundness of mind or lack of understanding as prevents one from having a mental capacity to enter into a particular relationship, status or transaction or as excuses one from criminal and civil responsibilities.” One can infer from this definition that the law has been assigned the role of determining what behaviours and who fits into this category. Of course, the law is manmade and influenced by the types of behaviours identified, compiled and classified as “unsoundness of mind or lack of understanding.” In short, the law can only ruminate on what is already in existence. Thus, the law in response to the evidence adduced before fits them into this predetermined categories. The point here is that the law, is culturally determined by the society or the social structure. That is, the social structure, in one way or the other determines who is mentally ill, cured, and who should continue to bear the label. Another question is how does the law conclude that one person is sane while the other is not? This point needs some clarification. That the social structure determines what falls into the category of mental illness is a source of concern because it introduces subjectivity into the meaning, definition and interpretation given to the “behaviours” in question. Let us assume that people within the social structure know what the normal behaviours that are expected of their members are. We can garner this from the fact that we all operate within the boundary of the “assumptive world.” The concept “assumptive world” relates to the fact that our behaviours are continuously being evaluated by others and by ourselves - relative to others. That means that the reactions (real or perceived) of the people to our behaviour(s) will determine/influence how we feel about ourselves, the nature of the world around us, our ability to predict what to expect from others and the resultant effect of our actions (Frank, 1974:27-29). The factor that should be noted is that the assumptive world varies and depends on the culture. For example, it is assumed that shoes are to be worn on the feet, not on the palms. Again, the type of shoes worn depends on the setting — bathroom slippers (depending on the social class) are not expected to be worn to formal functions. Eye contact should be made while discussing with somebody not for one to continue to stare at the other’s ears — the Yoruba culture makes a further restriction, it does not expect a child to maintain eye contact with an adult. This shows that even though these norms are not codified or written into law, they exist and people through socialization are expected to acquire/learn them in conjunction with the appropriate cues. In fact, most of the times we do not know that some of them exist until we have violated them - but we are always prepared to make appropriate amends. Despite this, we are subjected to and we subject ourselves to the reactions of others as to whether our behaviours are positively or negatively responded to. A positive reaction could mean that the behaviour is acceptable within the context in which it occurs and we can thus afford to repeat it. For instance, in some churches, a spiritualist who goes into trance while devouring the wrong doings of others, or while claiming to have seen God if praised for the revelations made is apt to repeat the behaviour following the prescribed cue. However with the interpretation of the Bible today, particularly by the Pentecostal Churches, such persons could be ostracized or marked out for deliverance — for according to this faith or new interpretation, no human being (because of sin) can ever see God but could see His son Jesus Christ. Also, going into trance is not the order of the day but speaking in tongue is the current norm. This being the case, it becomes risky or too expensive of behaviour for any member to repeat the unmerited. The above reinforces the view that a particular behavior in different setting will elicit different reactions and responses from people as dictated by cultural interpretations, definitions and understanding (Frank, 1974; Mechanic, 1980; Henslin, 2002). These definitions and responses are also influenced by factors such as the person involved his/her personality, and the where and when of the behaviour. A good example is an incident that occurred while a hungry Nigerian musician who was in a foreign country was “bowling” down some “akpu/fufu” (a Nigerian meal made from cassava) at a station. Somebody called the police claiming that a Blackman was trying to commit suicide. In summary, all of the above reactions exert influence on the actors and the observers and the decision as to whether to continue with the specified behaviour or not. The key factor is for the person to know the cues and to respond appropriately, else, it draws unwanted attention.
Mental illness is a concept that is very intriguing to study. This supposedly bizarre behaviour has always been of interest and concern to people. For example, during the pre-industrial times, in Europe, the “mentally ill” were professed to be afflicted by demons (Szasz, 1961; Conrad and Schneider, 1980) and therefore to save society, they were burnt or starved to death. Today, the view is much different. Post-industrial revolution produced some people who say that it is the disease of the mind (in the head) caused by sin and as retribution for sin (Ackerknecht, 1968). In the Chinese society it is believed that all diseases are caused by an imbalance of two forces Yin and Yang. These two forces based on supernatural conceptions, represent good/bad, positive/negative, male/female, the moon and the sun. Therefore, an imbalance between the two forces results when people deviate from the “Tao” or the “way.” Tao is regarded as the ethical superstructure which provides for all eventualities in life and for all essential types of interpersonal relationships (Veith, 1955; Sidel, 1975). Thus in this culture, the afflicted is removed from the cause/source of the problem and as such is not held responsible for any behaviour committed while mentally ill.
Just like in the Chinese culture, the Nigerians perceive mental illness as resulting from a person’s misalignment with the social system. Thus the illness is seen as punishment from the gods or supernatural beings, witches and evil people. In the ancient times, the mentally ill, when not ignored, were usually taken care of (sheltered or exorcised) by traditional medicine men, priests and spiritual healers. The etiology of mental illness for the Nigerian can be summarized as: evil spells and witches, failure to adhere to the cultural taboo, action or inaction of the person if considered offensive by the gods, inheritance, natural causes or physical illness, drugs e.g. marijuana or Indian hemp and environmental factor e.g. adversity.
According to Sow (1980), fewer cases of chronic mental disorder occur in the rural-non-literate group than among the urban-literate group. This is attributed to the fact that family/kinship bond which serves as an important ameliorator of socioeconomic and psychological conditions of rural Nigerians is weaker or impossible in the urban areas (Sow, 1980; Asuni, 1968).

Two different approaches, the traditional and the orthodox (western), are used to control mental illness in Nigeria. The choice of approach depends on the belief system of the users. The major difference between these approaches lies in their belief as to the etiology of mental illnesses and diseases in general. The traditional approach is the “medical” practice which existed among the people of Nigeria before they had European contact. Some form of spiritual healing can also be grouped under this approach. Common to virtually all the religions is the power of the spoken words whether in form of incantations, orders to the spirit to leave their patients, spells, exorcism, prayers or penitential formulas asking the forgiveness of the offended deity. Often this is accompanied by rituals, ritualistic movements and dances. Other therapeutic measures include application of drugs of plant or animal origin (as it is believed that they work in accord) often prepared according to secret formulas to cure the patients. Some traditional healers restrain their patients by tying them with ropes or chains in extremely unhealthy conditions. The orthodox (western) approach to mental illness in Nigeria follows the western medical model by locating the causes of mental illness in natural factors such as somatic organs, nervous systems or stressful situations (Erinosho, 1979). The early belief that some people develop psychological problems due to the use of Indian hemp and other psychoactive drugs (Lambo, 1981), is still being strongly adhered to. The method of treatment employed today has tilted more toward psychotherapy and drug therapy while shock treatment and psychosurgery seem to be of the past. There are evidences to show that asylums existed in Nigeria, wherein psychoanalytically-oriented methods were used (Erinosho, 1979; Laosebikan, 1973; Lambo, 1963; Shopeju, 1983). However, the general types of care facilities available today are located in the neuro-psychiatric hospitals, with both in and outpatient facilities. In addition, psychiatric facilities are also available in various university teaching hospitals throughout the nation.
In recent years, medicine has succeeded in bracketing mental illness into one of its areas of specialization — psychiatry (Szasz, 1961; Conrad and Schneider, 1980; Henslin; 2002). Unfortunately, while there is no doubt that some behavioural disorders can be controlled with drugs (Lickey and Gordon, 1983:75-104) psychiatry has not been able to come up with unquestionable definitions, and very successful methods/cure to prove its expertise on this subject (Szasz, 1961; Scheff 1974; Henslin, 2002). The mystery which mental illness presents is further revealed by the fact that mental health professionals do not always agree as to what the definition is. For example, the psychiatrist, psychiatric social worker, clinical psychologist, and other mental health professionals define it differently. While not denying the fact that some iota of consensus occurs across some professions (for example, there is an approved and certified diagnostic manual for mental illness), the idea is that one would have felt more convinced if the difference in diagnosis can be narrower. Further flaws in psychiatric definitions were revealed by the Rosenhan experiment. The experimenter had referred some sane people to mental health experts for diagnosis, they were all diagnosed “insane” (Rosenhan, 1973). Another concern is in the area of over-diagnosis and consequently over-prescription of drugs (Diller, 2006; Eisenberg, 2007). In fact, some psychiatrists admit that little is known about mental illness and some like Szasz (1961; 1996; 1998) do not agree that it exists. Rather it is believed that there are some people who have difficulty in living and that such behaviour should be called “problem behaviour” not mental illness, insanity or other self serving labels. The summary of the above is that the definition of mental illness is socially constructed depending on, the political, economic and social inclination or conception of reality and the resultant effect of unsuccessful socialization (Berger and Luckmann, 1967: 165-166).
One is tempted to suggest that the definition of mental illness should include input from those who are classified as mentally ill. However, the definition so attained will also have its flaws. If we accept the social learning/societal-reaction perspectives, the definitions arrived at will be influenced by their conception of reality and the stereotyped views of mental illness these people have learned (Scheff, 1974; Yarrow, et al, 1968), and those arising from stigma based on social definitions (Berger and Luckmann, 1967:165-166). This is reflected in that the observation of these people in Nigeria shows that they do not seem to have difficulty understanding or speaking the local languages (Pidgin English or Yoruba). They also behave in the ways people around them expect them to behave. The following illustrations serve to make the point clearer. Ajisoro, a supposedly madman, decided to show his displeasure by hauling missiles at his tormentors, unfortunately, he hit and broke the windshield of a parked car. The mob descended on him and gave him a thorough beating, had he not taken to his heel yelling (in Yoruba) “mo gbe o” (meaning I am in serious trouble), he probably would have been lynched. Another case is about a man who feigned madness to escape the wrought of vigilante groups. The man had arrived very late (1.30 A.M.) from Lagos and knowing fully well that there was no way any sane person would be allowed to walk the streets during that period, decided to strip leaving only his underpants on. He proceeded on his way carrying his clothes neatly folded on his head, continued to talk loudly and incorrigibly as he proceeded. According to him, none of the several vigilante groups that he met showed interest in him. Of interest is that even one of his neighbours, in one of the groups, only stared at him without saying a word. On getting home, the actor, after dressing up, sat on the pavement in front of his house. About thirty minutes later, he received the vigilante neighbour as visitor. The visitor expressed his amazement at the actor’s behaviour but agreed that he would not have been able to assist him had he appeared as a sane person. In short, the visitor only wanted to affirm if his neighbour had really manifested the expected behaviour as socially defined for the insane. Worthy of note is that nobody noticed that his clothes were neatly folded and balanced on his head for it is only a mad or “harmless” person would break the curfew. This further shows that the social structure creates and encourages people to act the way it deems fit for varying social, cultural, political and economic situations while also taking into cognizance the statuses of the actors. Also implied is that people are generally judged against the backdrop of behaviours that are already in existence and that are considered to be normal, abnormal or bizarre. In short, all types of behaviours have antecedents for the sane and those classified as mentally ill or insane and that the social structure carves out our reality world and we cannot simply wish it away (Berger and Luckman, 1967:1-3).

The perceived functionality of the behaviour also influences its categorization. For example, we had the opportunity to witness people speaking in “tongues” in some churches. Some had laid flat on the floor on their chests while slapping the ground with their palms and shouting in the name of Jesus”, some rolled on the floor ‘in the name of Jesus”, in other cases, members walked about babbling and singing praise words to the Lord. In the white garment churches, we observed that some designated members go into trance while also prophesying. These people’s behaviours were neither seen as bizarre nor unacceptable, but as socially acceptable under the prevailing circumstances. The major source of differences, however, is in the interpretations we the normal people give to behaviours as influenced by our perception of their functionality. For example, when Alhaja Sheidat Mujidat Adeoye, a female trader in Osun State in the southwestern Nigeria suddenly had a “spiritual” encounter, the initial interpretation of her behaviour was that of the manifestation of insanity. However, today because she was able to manage the behaviour by prophesying and healing people, a behaviour that is directly related to the perceived functionality of the manifestation, Alhaja Adeoye is now highly respected in her community. She is now a Muslim missioner, spiritual healer, leader and founder of a religious group called “Fallullah Muslim Mission” in Osogbo community in Osun State, Nigeria (Ogungbile, 2004).
Methodology
This paper results from approximately several years of observing and studying the mentally challenged people who have been labeled “mad”, insane or mentally ill. The study also involved having discussions with the “sane” as a way of getting more information about the targeted group. Despite the fact that inquiring about these people usually elicited some kind of curious gaze and expressions from those questioned, our informers were aware of the purpose of our inquiries. Surprisingly, respondents seem to know almost all the mentally challenged people roaming the streets of Abeokuta. For example, discussions by one of the researchers in a beer parlor, patronized by taxi drivers, mechanics, welders etc, were revealing. We were informed that Casa was deported from a foreign university, when he developed mental problems and Talia was the female beer parlour owner’s primary schoolmate and childhood neighbour. Please not that all the names used are fictitious invented for the purpose of this study and cannot be traced to the participants.
A seven item questionnaire which served as the instrument (henceforth referred to as guide instrument) for selecting the subjects for this study was administered to twenty randomly selected university students. The area of focus is Abeokuta, the state capital of Ogun State, in the southwestern (Yoruba speaking) area of Nigeria. By virtue of the fact that these people roam the streets, it is assumed that they are either from very poor or what we have chosen to call “economically challenged” backgrounds or families and must have been deserted. This assumption is sanctioned by the fact that two public neuro-psychiatric hospitals and a community (out patient) psychiatric centre exist in the state capital which provide both the in and out patient cares for a fee. The normal practice requires that family members or caretakers deposit up to thirty thousand (N30000.00) Naira (or about two hundred and fifty US dollars) to cover boarding and medication for one month. Both the traditional and spiritual healing centres also exist in addition to the Western Orthodox mental health care facilities (Shopeju, 1983). Also and interestingly, the Yoruba people patronize any type of treatment regardless of their origin and cost, the major determining factors are the perceived efficacy of the type and that the sick recovers (Shopeju, 1983) – embedded in this is the hope that the sick will eventually recover from the ailment. As stated earlier, regardless of the approach chosen, treatment or care requires some financial commitment and there seem to be no guarantee that there is an end to this and other forms (social and psychological) commitments. Despite the fact that many of them still go home to sleep and some family members monitor and sometimes ensure that they are fed and have clean clothes, some family members expressed their frustration in that caring for these people is time and money consuming and traumatizing. Based on the above we are inclined to assume that: (a) the cases have been considered hopeless by their families; (b) they were simply abandoned because their caretakers lacked the funds to start or continue to pay for psychiatric care, whether orthodox or traditional; (c) the families or caretakers lacked the ability and capacity to continue to care for them.
The sample for this study was restricted to twenty-five subjects chosen using the guide instrument from every odd number mentally challenged persons encountered by driving through the major streets. Incidentally, the subjects either seem to prefer frequently used streets or feel less threatened to ply public/commercial sectors (we are inclined to adduce the later as the determining factor). For example, we observed that the residents of housing estates, where the majority of the middle and upper income classes reside, ensure that they (subjects) are discouraged from roaming their streets by physically removing them. In fact, they are often labeled as people who pretend to have mental problems during the day but become agile criminals at night (garnered from the researchers’ experiences at meetings in their neghbourhoods). During the period of the study, three of the subjects disappeared to reappear elsewhere, a search was always conducted and they were replaced only when they could not be located. Three fell into this category. Method of identification of each entailed assigning numbers and fictitious names while also keeping notes with the description of the chosen subjects. The major identification factor is the physical appearance of the subjects. The following coded (0 for low rating and 1 for good/high rating) features were used to determine the suitability of subject for the study:
Stage A:
(1) mode of dressing – dirty/rags=0, clean/not rags=1;
(2) condition of hair- dirty/dreadlocks=0, clean/dressed=1;
(3) footwear- no shoes/not matched shoes=0, matched shoes=1;
(4) general appearance- dirty=0, neat/clean=1.
A person is expected to consistently score an average of below 2 points in ten encounters with the researchers to be finally chosen for the next stage of the selection process. This approach is necessary in that some of them return to their homes (or are forced to return by their relatives), to get refreshed (bath and change their clothes – even with this, many of them do not their clothes often or on daily basis). Also, we need to distinguish those whose jobs do not permit them to wear clean clothes while working such as mechanics, bricklayers and other odd jobbers.
Stage B:
(1) Association: a loner=0, in contact with other people=1
(2) Conversation with other people: nil=0, able to hold coherent discussion=1
(3) bland/far away look=0; aware of the presence of other people=1.
An average of 1 or below qualifies the person for this study. Finally, the “sane” people confirmed the state of the participants.
Periodic visits were made at an interval of three months to establish the stability of the condition of the selected subjects. Chance encounters (with the selected subjects) were also taken into consideration. For example, some stray into petrol stations, drinking joints or parties (particularly open air) and or the markets to beg for money or food. Virtually all the subjects have their routes and meticulously keep to them. The method of observation adopted by the researchers include, (1) sitting in their cars, (2) visits to the markets and beer parlours (male researchers). The latter method provided the opportunity to elicit responses from the “sane” about the subjects and (3) strolling/driving past the subjects’ “homes.”
Gender-wise the sample consists of seventeen males and eight females. Only small number (5 or 20 percent) of the population under study is willing to or is able to speak or interact “reasonably” with other people. Beyond sporadic and mostly expressionless stare at people, they do not seem to notice or perhaps feel disturbed by anybody. This poses problems to the ability to study this category of people using the conventional methods of study, such as the survey, interview and questionnaire participant observation techniques. These methods require that the researcher intrude into the social setting they are attempting to describe and, “they create as well as measure attitudes”. The methods also elicit atypical roles and responses and are limited to those who are accessible and will cooperate, and the responses obtained are produced in part by dimensions of individual differences irrelevant to the topic at hand (Webb et al, 1966:1). Strictly random sampling technique does not also seem to be appropriate for selecting the subjects in that some of the subjects disappear to reappear after some time (the point being made here is that we feel compelled to replace subjects who disappear for more than three weeks). Finally, the focus of this study is more on our perception of these people rather than on how they perceive us.
From the forgoing, it is evident that an unconventional approach is desirable for this type of study - thus, we used the unobtrusive technique. This method allows the researcher to observe people’s behaviour (who in the real sense do not care) without them knowing that they are being studied (Webb et al, 1966; Henslin, 2001; Barbie, 2005). The major advantage of this approach is that it does not require strict physical or verbal interaction between the researcher and the subjects. This method has proved to be most relevant to this study in that, as mentioned earlier, a greater proportion of the sample will neither speak nor react coherently to questions if posed to them. We are mindful of the effects of prolonged discouragement or lack of social interaction with the sane (see Coleman, 2001). Again, since the focus of this study is on our perception of the way of life of the subjects, their survival mechanisms and how the rest of us can better assist them, the method of data collection used does not necessarily call for active participation of or interaction with the subjects. Another factor which gives credence to the use of the unobtrusive technique emanates from the observed reactions of some of the subjects to perceived intrusion into their normal activities. For example, when school children taunt them, they tend to respond violently by chasing the kids or hauling missiles at them. Some tend to proceed into long and incoherent tantrums – Talia (discussed below) falls into this category. Casa, also discussed below, tries the eye contact approach before approaching the “client” he wishes to beg for money from. Sha, or “madam sanitation” who takes shelter at night in front of a local government owned shopping centre (which is also situated opposite a drinking joint), verbally cautions people from urinating in front of the centre. These examples show that any attempt to get their real or natural behaviour must not intrude into their natural settings except we are interested in the reactions to the intrusions. Since our study is about how these people live on a day to day basis, our interests are about how they are able to survive and what can be done to assist them to live better lives under more hygienic and safe conditions.
Ethical issues
Some ethical issues arise regarding the method adopted in this study. For example, is it ethical to draw inferences when the subjects who are also helpless do not know that their actions are being recorded? Is it ethical to elicit information about other people without revealing our mission? The response to the above questions is hinged on (1) the need to get unbiased true life state of the subjects. We are aware that the behaviours of the mentally challenged are often misdiagnosed or misinterpreted, wherein some are labeled as pretenders. Some have been maltreated, subjected to public ridicule or even killed. The condition these people live in is fraught with danger. They have no shelter from harsh weather and harassment from other human beings. There are cases of rape, since some of the mentally challenged females have been impregnated by unknown people, words have it that some have been killed for ritual purposes, (2) our attempt is a honest concern for the plight of these people and is meant to be a channel for revealing this to concerned and philanthropic bodies, the alternative is to continue to behave as if they do not exist and allow them to continue to live in squalor, (3) there is no doubt that these people have been neglected and rejected by the government, nongovernmental organizations and the rest of us. Whether we wish to admit it or not we have contributed to their state of mind through societal rejection and isolation and driven them further into inner minded people. (4) Society has never really been fair or kind to them or reckoned with them. In fact, these people have never been accorded any form of human rights. Even though the last Nigerian census claimed to want to count the mentally challenged, no figure has been released and the purpose was not to provide benefits to these people. In short, the rights of these people have not been guaranteed because nobody has bothered to study them. We also feel our attempt will create the much needed awareness by collecting useful information which we hope will accord them recognition and perhaps help to improve their lot. There is the need to know what the effects of societal rejection have done to these people. Finally, (5) the