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The index episode of mental illness

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Dr Adeoye Oyewole 

Consultant Psychiatrist

The first-time someone is diagnosed with mental illness is usually a major life event laden with excruciating emotional experience for the patient and even members of his family.

Mental illness invariably gets reported by the patient’s family members, unlike other diseases where certain signs and symptoms may readily lead the patient to seek medical attention, which is clarified through history taking, clinical examinations and investigations.

The illness occurs when an individual comes up with a pattern of behaviour that causes distress to such an individual, as observed by the close relatives who may organise some form of medical attention. In this part of the world, when it comes to mental illness, orthodox medical practitioners are not immediately considered.

Although the patient may explain the distressful behaviour away as normal, the obvious distress is not only noticeable but it also constitutes a very devastating experience for the patient, enough to impair his or her basic responsibility to self, immediate members of his family and the society at large.

Many times, at the onset, the relatives no matter how educated some could be, may support the patient to sustain the denial. At this point, close relatives may collaborate with the patient to put forward cultural and religious explanations for the distressful behaviour, which invariably undermines the help- seeking strategy in the direction of the orthodox medical intervention.

The majority of the index episodes of mental illness do not get to the hospital since the alternative practitioners are almost always the immediate contact of intervention even for the educated ones.

The patient can only receive proper orthodox intervention as promptly as the significant others can snap out of the denial, accept the symptoms as due to mental illness and come up with empirical strategies of intervention.

Our cultural beliefs override our empirical understanding of the illness and leads us into many other places before we snap out of the cultural hypnotism to seek orthodox medical intervention.

I think the denial that leads us into the waiting hands of culture and religion is traceable to the painful, not easily admissible experience of having a loved one come down with mental illness.

The illness alters and dislocates the behavioral pattern of the patient that relatives have been acquainted with over time. It is a nightmare to discover that someone you have had a wonderful relationship with over time is now estranged and can no longer interact intelligently again. It deals a painful blow to the overall experience of companionship with that individual. This becomes more traumatic when the illness is directed against the loved ones through persecutory ideas and delusion.

It is not a funny experience for a mentally ill husband to accuse a faithful and committed wife of infidelity in a very graphic and extremely persistent manner, although without a rational basis that may require a professional and clinical experience to identify.

A number of our untrained and religious marriage counselors may have been misled by delusions of mental illnesses in a marital conflict. Unfortunately our culture feeds our religion with paranoia, which invariably spill into our daily life experiences. Some wonderful and extended family relationships have been destroyed on this premise.

Beyond the personal painful experience is the shame that the stigma of having a loved one with mental illness confers. Deriving from the sick role, there are certain embarrassing sanctions and discriminations that the family apart from the patient experiences. There are implications for marital and occupational opportunities where the discovery of history of mental illness may halt a marriage plan in our African culture. There are other leadership opportunities that may also be jeopardised as a result.

These reasons and many others affect the type of intervention that relatives organise for the first episode of mental illness in Africa. The relatives of the mentally ill and other stakeholders in their care wriggle through strong cultural software that distracts from seeking orthodox help early enough. Mental health advocacy should be directed towards this tendency of misdirecting the first episode of mental illness into the wrong hands. The earlier the orthodox medical intervention, the better be the outcome for such a patient.

Great populations of our mentally ill patients are locked up in spiritual homes and herbalist dens in sometimes dehumanising conditions. When there is no prompt intervention, the symptoms of mental illness impact adversely on the personality, leading to a poor sense of self, loss of motivation and extreme withdrawal from social interactions, such that the patient becomes a ghost of his or her past, which should not have been so if prompt and orthodox intervention had been promptly instituted at the first episode.



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