Keywords: Schizophrenia, psychosis, vagrancy, ara, delusions, hallucinations, neologism, word salad, Nigeria.
Living with Schizophrenia on Nigerian streets. Who are the vagrants suffering from psychosis in Nigeria? Is there any hope for them? How common is schizophrenia in Nigeria?
An Igbo adage, says that when someone suffering from “Ara” ends up in the market, there is no more hope. This is equivalent to those living with Schizophrenia on Nigerian streets. This means that when a person with “madness”, i.e. schizophrenia, ends up on the streets he cannot be treated. This is not entirely correct. But unfortunately in this modern era, most major cities in Nigeria have many mentally ill persons roaming the streets.
Vagrancy is a condition of being homeless, unemployed, living in poverty while supporting oneself by begging. They also do scavenging, and even engaging in low scale theft. Among Nigerian vagrants, there are those suffering from psychosis.
Who are those suffering from vagrancy and psychosis?
These are those suffering from mental illness called psychoses who are vagrants. Psychoses are illnesses that affect the way the brain processes information. These people lose touch with reality and have delusions and hallucinations. Ninety five percent of vagrants with mental illness in Nigeria have schizophrenia, while other may have schizoaffective disorder or mania.
They are alone, cut off from the members of their families and without any social network. And they also roam the streets aimlessly and dressed in rags. Without properties of their own, except some carrying load containing dirty and irrelevant things, they wonder from place to place.
Majority of them are males. They are from the low socioeconomic group or poor and are unemployed. Most have low level of education.
They are actually pushed out by their family members because of the severity of their illness. Especially those who have delusions and hallucinations and those who are dangerous. Many of these families cannot afford the treatment required and the cost of the follow up treatments. The cost implications plus the behaviors of those that are ill, makes care giving burdensome.
Vagrants suffering from schizophrenia in Nigeria.
These are vagrant with psychosis of schizophrenia type. They are those living with Schizophrenia on Nigerian streets.
1. What is schizophrenia?
This is a severe psychotic and chronic mental illness that affects the way a person thinks, feels and perceives things. There is distortion in the person’s thinking and perception. Even the emotions, the language, the behavior and sense of self are also distorted. And these affect proper functioning in life.
2. How common is schizophrenia in Nigeria?
The prevalence rate for schizophrenia globally is approximately 1%. In one research in Nigeria, it was stated that 2 million people in Nigeria are suffering from schizophrenia.
But how many are vagrants in Nigeria, is not fully known. In parts of Akwa-Ibom, 37.5% of the vagrant suffering from psychosis had schizophrenia in 2016.
The disorder affect both males and females, but more in males. And it starts quite early in males in their teens and early adulthood. While in females it can starts around their mid 20s. One research study in Nigeria showed that about 4% of cases can start before age 18 years. So in Nigeria many of those with the disorder are young in age. And because the onset of the illness is more on the young people, many end up being single.
3. The cause of schizophrenia.
Schizophrenia is genetic. This means that it runs in the family.
Malfunctioning of chemical in the brain is another cause. These include neurotransmitters such as dopamine, serotonin, nor-epinephrine, glutamate, GABA ( Gamma Amino Butyric Acid), etc. So dopamine is high, serotonin and norepinephrine are also high as well as glutamate. But GABA is low.
There are also brain structural problems at the prefrontal, temporal, hippocampus, etc. There is reduced brain volume.
Environmental factors such as head trauma, pregnancy issues and birth traumas are risk factors. And so are substance abuse issues, Adverse Childhood Experiences (ACEs) and other forms of stress, etc.
4. What are the types of symptoms characteristics of schizophrenia?
Persecutory delusions – The person believes that other people are against him. He/she believes that others do not want his/her progress in life. So he believes that others have taken away his destiny in life. The person may also believe that others want him/her dead. So he may believe that his food could be poisoned. And for this reason will refuse to eat any food or drinks brought to him by his suspected enemies.
Delusion of reference – He believes that others discuss him unnecessarily. Sometimes, he may believe that even the topics on television, radio or the internet are referring to him.
Thought broadcast – The person believes that other people have access to his or her unspoken thoughts. That is, believing that others could read his mind.
Delusion of control – Here the person believes that his actions are being controlled by external forces. In Africa and in Nigeria, such a person may believe that his actions are being controlled via witchcraft. With the wireless age, some of these people may believe that their actions are being controlled with the use of the internet.
Delusion of grandeur – Such persons will believe that they are better than others in what they do. Or that they have special abilities that no other person has.
Auditory hallucinations can come as voice(s) of unseen persons in clear consciousness. This means that they hear the voice of people they do not see. These voices than tell them what to do and they just may carry out the actions. So if the voice tells them to kill or to steal, they will do so. As a vagrant psychotic, the voice may tell him to throw a stone at a passerby, and he will obey. Sometimes the voice may just be commenting on the actions of the person. So if the person with schizophrenia is brushing his teeth, the voice will comment to the person that he is brushing his teeth. Occasionally, there may be many voices heard talking among themselves and the person with schizophrenia will just be a listener. The person may also hear the singing of birds, etc.
Visual hallucinations presents as the person seeing things that others do not see in clear consciousness. So the person may see spirits, God and other religious beings. He or she may also see different animals, etc.
Hallucinations may come via other senses like the skin, the sense of smell and taste.
c. The speech could be disorganized or irrational.
The person could be talking to himself or herself. And as the person is talking, he may be making gestures with his hands. And most people will believe that he is talking to a spirit.
He could be talking off context. That is out of the discussion point.
The words could be so mumbled up, that the speech makes no meaning to the listener. They can use what is called word salad. Or they can invent their own words with the meanings only known to them. This is called neologism.
d. Abnormal behaviors.
This can include physical and verbal aggressions towards others. He may set fire on his clothes or on properties. So they may quarrel, abuse or even fight others for no just cause.
The person could strip himself or herself naked in public. But of course those who are vagrants are already either half naked or fully naked while roaming the streets.
While talking to them, you will discover that they have poor eye contact. That is while speaking to you the person may have problems looking at you. This is part of the social problems the illness causes.
Such a person may decide to be collecting rubbish, including rocks and be hording them. And as a vagrant such a person may be carrying these collections everywhere he goes.
As someone suffering from schizophrenia, he prefers solitary life style. He is happy being alone, moving and wondering about alone, etc.
The mood could be happy or sad. So he could be laughing to self, or occasionally crying. They could also be seen dancing to self. Many a times he is apathetic about things happening around him.
There could be poor sleep. So that the person may not sleep at all or have multiple wakes at night.
Sometimes the person with schizophrenia may be seen standing or sitting in one position for hours. And being a vagrant, this is done under the scourging sun or the pouring rain.
Many people suffering from schizophrenia do not like bathing. And for the vagrant psychotic, he is seen wearing very dirty clothes and smelling.
5. Complications for the vagrant suffering from schizophrenia.
Among these people are those who abuse substances, such as cannabis, cigarettes, alcohol, etc. They use in an attempt to self medicate their symptoms.
They can suffer from heart conditions and raised blood pressure, as well as diabetes, etc. And because of their exposure to diseases and their reduced immunity, they are prone to suffer pneumonia, diarrhea diseases, etc.
Such people have shorter life span. And they can succumb to any of these medical conditions and die.
Can the vagrant with psychosis be treated?
Majority of vagrants living with schizophrenia on Nigerian streets have been ill for years. And the delay in treating their conditions will have caused more damage to the brain, thus severe symptoms. This is the reason that the Igbo adage says that these vagrants can not be treated. So their treatment outcomes are usually poorer, than for those who were treated early.
Treatment is possible, although the recovery will take longer. Their treatment process is like those for non vagrant, and includes treatment with medications. Psychological and social treatments are also very important.
Medication treatment is for life. And the person must remain compliant with the medications.
Skills rehabilitation is also very important. Having spent years away from work and education, whatever skills that was acquired before the illness maybe lost. So the person needs to relearn the job or learn a new skill. This will enable the person fit effectively back into the society. Besides, it is usually advised that the person gets into a simple, less stressful occupation. And this occupation must be the one he or she enjoys doing.
Living with Schizophrenia on Nigerian streets. Share to friends.