Keywords: Depression, Nigerian culture, belief system, Dibia ara, coping, pathway of care.

Introduction.

 Depression and the Nigerian Culture. What do Nigerians believe about depression? Does culture affect the symptoms and pathway of care of depression in Nigeria? This topic is to highlight the good and the bad aspects of culture on depression.

Depression is a mood disorder which makes the person feel sad, loose interest in things he/she once enjoyed and loss of energy. Depressive symptoms and treatment methods differ among cultures and religions. And the way Nigerians make their complaints on depressive disorders to their doctors differs from the orthodox method. Thus the need for this topic on Depression and the Nigerian culture.

What are the perspectives of depression and the Nigeria culture?

1. The belief system:

In Africa in general, Nigeria inclusive, someone with depression is seen as being a morally weak. He/she is also seen as being lazy and a coward.  Depression is also seen as a failure in upbringing from childhood, and a form of not being matured.  It is also believed to be due to evil possession from the enemy. They claim that evil spirit attacks are sent by people who are against them.

Some people believe that mental illness is from God as punishment. Even the Yoruba people, see it as a curse from the gods. And this curse can move from one generation to another. There is the belief also that it can be due to the abuse of hard drugs.

Nigerian men via their upbringing are made to be strong in the mist of emotional challenges. So, depression should not exist amongst Nigerian men, according to culture.  Shame can prevent these men from accepting being depressed. Depression is not culturally accepted as an illness but seen as an emotion that one can control.

2. The depressive symptoms cultural presentations:

Being sadness, losing interest in things one once enjoyed and loss of energy, are not common complaints among Nigerians. These symptoms, even though they are there, they are not volunteered out by the patient.

Many a times, depressive symptoms are expressed outwardly. So the person can become angry, irritated, and abusive verbally. They can also be physically aggressive. These outward expressions of depression are culturally accepted.

Many a times, the symptoms of depression are expressed as complaints on the body. These complaints include, frequent headaches, heat awareness in the head and body and crawling sensations on the body.

The person may complain of having excessive bad dreams as well as poor sleep. Some may sleep too much, and the adolescent may stay in bed the whole day. One also feels as light as a feather, as if his blood has been drained out of her.

He or she may be unable to concentrate in discussions or reading. So remembering what one read or heard becomes very difficult. Other complaints may include getting lost in thoughts, losing appetite or eating too much. So the person may not remember to eat, or maybe picky while eating. But for some, they eat too much. Doing house  chores or work, becomes a problem.

3. Stigmatization of the depressive illness:

The issue of mental illness is unmentionable and causes stigmatization or dishonor in Africa.

In Nigeria, people deny the existence of depression because of the shame attached to it. So culturally, no one wants to be seen as suffering from depression or any mental illness.

This dishonorable branding not only affects the person that is suffering, but also the entire family, be it nuclear or extended. So the diagnosis can prevent the person and the entire family members from going into any form of intimate relationship.

4. The cultural treatment of depressive illness:

Culturally, most Nigerians, don’t believe that the orthodox treatments for mental health conditions work. They do not believe in the psychiatrist who makes use of medicines or a psychologist who uses psychotherapy to treat. The treatment of a member of the family with any mental health condition follows some pathways.

a. The social pathway –

Members of the family make efforts to get opinions from other people about culturally accepted treatment options. Presently relatives can go online. They use  groups on Facebook, go through Google search, Twitter, or WhatsApp groups, etc. seeking for available help. Some may ask from the extended family members, friends or even colleagues, on the best actions to take. But in all, they seek the most culturally accepted methods.

In Igbo culture, the decision to go for treatment is a family decision. The decision to treat or not to treat is a joint effort, from the family and even the extended family members. Sometimes, friends maybe asked to help in the decision making.

The social pathway helps to reduce stress and anxieties. It helps to suggest treatments that are culturally accepted, and also provides supportive care. This pathway, increases compliance to treatment.

b. The traditional pathway –

The social pathway, may decide that the person having depression will receive treatment from the traditional pathway.

The traditional pathway is the first line of treatment for most Africans, including Nigerians. This is because of their belief system that mental health conditions are due to spirits or supernatural beings, etc. The members of the community show concern and care to those who receive treatment from traditional healers.

These traditional healers use prophesies or soothsaying, and offering sacrifices, to placate the spirits. Incantations are used, so are ritual casting out, charms, and herbs. Those suffering are confined, flogged, and restrained with chains. They can also receive counseling.

In Igbo language, the traditional healers are called Dibia. There are different types of Dibia, each specializing in a particular field. The Dibia Ara, who treats mental health conditions, makes use of enchantment and magical powers to call forth the spirits. He also makes use of herbs from roots, leaves, etc. Sometimes small pen knives or sharp razor blades are used to make scarification marks on the ill person, for many purposes. Their patients are housed in special homes called healing homes. In these homes, the patients are encouraged to get adequate sleep and rest. Here also, music is believed to help keep them happy and engaged in team work. Among the Hausa people, they call their traditional healers by different names, depending on their mode of treatment. They have the Bola, that use ceremonial acts or rituals and possession tactics for treatment.

In Nigeria, those who treat mental health conditions, sometimes use combine methods such as incantations and herbs.

c. The religious pathway.

Spirituality and religion are common ways by which depression is treated. Here, prayers, fasting, whipping, and even chaining of hands and feet are used. The whipping or beatings are used to cast out the demon(s) believed to posses the person. Prophesies, casting out evil spirits and binding them, and using deliverance are practiced. Some make use of Holy water, Holy oil, incents, etc. to keep the evil spirit away. The Holy Bible, the Koran, and other Holy books are also used to give comfort, give hope and reduce negative thoughts. Some Clerics can visit the home of the ill. At this home, the Cleric will use prayers to destroy any evil item present in the house. The evil item(s) is then burnt or taken away by the Cleric.

These spiritual methods of treatment help in giving comfort and support to those who are suffering. It uses the idea of shifting one’s problems and challenges to a Supernatural Being, who is unseen. It is believed that the Supernatural Being (God) is all powerful. Members of the church give social support. The time used in worrying and ruminating is spent on praying, singing and sometimes dancing.

These Religious or faith healers are seen among churches that have their origin in Africa. These churches include the Aladura churches e.g. Cherubin and Seraphin group, the Celestial Church of Christ, etc. Also the Faith healers are seen among the Catholic and the Protestant denominations. 

Most Muslims believe that mental illness has spiritual origin. Among the Muslim community, who believe solely that the mental illness has a religious origin, will consult the Mallam taurari. This Mallam makes use of prayers, etc. Those who believe that it is due to witches will consult the Boka

5. Cultural coping methods to stressful issues and depression:

Coping strategies are methods used to overcome stressful issues in life. There are positive and negative forms of coping.

a. Positive coping methods for depression used by Nigerians include –

The use of religion. This includes making use of prayers, which could be private or public. The readings from the Holy books, gives comfort and hope. Then receiving religious counseling from the Ministers of God, like the Priests, Pastors, Imams, etc. The Ministers give them listening ears, are non judgmental and offer soothing words or advice. They can assist in positive restructuring of the thoughts, so the person sees the negative issues in positive ways. These counseling sessions help the ill member manage the challenges. Some will join some societies in the church and participate actively, like the choir. These help in reducing worrying and give social support.

Getting involved in community activities. These include joining some tradition women or men groups and participating actively. Also joining in the village politics and playing leadership roles, can be helpful.

The family members and friends of those who are depressed or under stress, give social support. This social support can come as daily help in decision making or house chores. Some can come as financial help, etc. Having a good companion, someone to confide in, is a positive way of coping. In the African setting, Nigeria inclusive, the extended family system is a means of coping with stressors. The aunts, uncles grandparents, cousins, nieces, nephews and even in-laws, are always ready to render any form of help. Family social support is paramount.

b. Negative coping methods for depression used by Nigerians –

Pretending – here, the person knows that he/she is ill, depressed or stressed. But before others, or to the public he/she will present a front that all is well.

In denial, the ill person refuses to accept the illness or depression as truly existing. This will lead to avoidance of treatment.

Displacing or acting out frustration on other people by being abusive. Unfortunately, this is culturally acceptable.

There is the projecting and rationalizing. Here, there is  blaming others or the enemy for the illness.

Then there is withdrawal. The person keeps away from others and keeps to self.

He/she may abuse hard drugs, such as cigarettes, alcohol, cannabis, kolanut, ‘nzu,’ etc. Nzu is called Calabash chalk or Calabash clay in English. It causes addiction and dangerous to health. Kolanut, from the kola tree in West Africa, contains caffeine, a stimulant. It is also culturally accepted in different parts of Nigeria.

What are the negative effects of cultural practices on depression?

1. The belief system and the negative coping:

Even though these methods are wrong, but they help one to maintain self esteem. In the short term, they may be helpful, but on the long term they are detrimental to health and prevent treatment seeking.

2. Symptom presentation:

The cultural methods of symptom presentations can be quite misleading. Many of the symptom presentations are not specific to depressive disorders alone. So proper treatment may be delayed.

3. Stigmatization:

Stigmatizing all forms of mental illness will prevent those who are ill from seeking help and treatment. It can also lead to suicide.

4. Treatment methods:

The treatment methods of social support and spirituality can be quite helpful. They provide good coping methods and problem solving skills.

All forms of physical abuse during treatment are detrimental to health and mental health.

The treatment via divination is a type of psychological help, which works in milder forms of depressive disorders. But not on the moderate and sever forms of depression.

In general traditional treatments are available, affordable and accessible. And because these methods of treatment are in agreement with the people’s belief system, compliance is high. For this reasons many people shy away from orthodox treatment for mental illness.

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