Many health personnel are involved in the treatment of mental and emotional disorders and diseases. Authorities like Lambo, Osuntokun and Jegede of Nigeria and Lee R. Steiner of the U.S. who have studied for many years the question of where people take their mental and emotional disorders point out that they take them not only to the psychiatrists who are medically trained, but also to clinical psychologists, psychoanalysts, social workers, ministers of churches, priests, marriage counsellors, fortune tellers, traditional doctors and miscellaneous assortment of self appointed experts.
One of the reasons why many people needing psychiatric help in Nigeria go to those not qualified for the job stem from ignorance on one hand and from the dirth of qualified personnel on the other hand.
The outcome of any psychiatric treatment seems to depend more upon the rapport or personal relationship established between the patient (client) and his “healer” (therapist) than other factor.
The most important mental health personnel is the medically qualified psychiatrist, although he also needs other psychiatric personnel in the effective discharge of his duties as a patient goes through the various stages of his treatment either as an outpatient or a hospitalized patient. The cause of psychiatric disorders vary considerably from the purely psychological to the organic and traumatic. As a result of this knowledge, any method of treatment, if it is to be of any use, will have to be based on an understan ding of the etiological process.
Consequently, such a treatment may be medical, surgical, endocrinological, psychological or in fact as it is very often the case, a combination of these. However, many of the general principles involved in the treatment of the purely functional psychiatric disorders can be employed in other psychiatric con ditions but in conjunction with the specific treatments indicated
THE DIFFERENT TREATMENT METHODS
They are different method of treating a Mental ill patient which would be discussed in this section. The mental ill patient should be attended to with a suitable method health discussed below instead of leaving them stranded on the street.
Psychotherapy is the art and science of treating mental and emotional disorders and diseases through changing ideas and emotions thus bringing about a more favourable psychic equilibrium.
It is known that almost every physician except perhaps the pathologist uses psychotheraphy to some degree with greater or lesser skill in the treatment of mental and emotional diseases. Described simply, is any method utilized to remove or alleviate the results of emotional conflicts and improve psychic adjustment.
The person who needs psychotherapy is one who has failed to adequately meet his life situation. For such a person, in considering his problem, both his external situation and the structure and function of his personality must be taken in to account. Also, the person who may be in need of psychotherapy is one who as a result of his childhood years experience has formed a faulty personality structure which still retains many of its infantile
characteristics. For example a person who still has much of his childhood dependency will find the adult world a difficult and frustrating place to live in. In pursuit for security, he may form dependent relationship with various important people in his environment such as his wife or boss at work place; or may continue to manifest his dependency upon his parents.
There are several psychotherapeutic methods for the treatment of mental and emotional disorders. With the exception of group therapy all the other methods are basically a relationship between two people: The patient and the psy chotherapist. The patient knowing he has mental or emotional health problem goes to the physician for assis tance in understanding himself in order to reach a more mature level of personal adjustment. When this hapPpens, the psychotherapist must do two things; firstly, he attempts to evaluate the patient’s true condition, and secondly, he attempts to find a medium of giving this information to the patient in a way that will not only have meaning to him but also produce the desired benefit.
Psychotherapeutic methods include the following:
Persuation: A method in which the therapist presents to the patient in an authoritative way the necessity for over-coming his symptoms. The effectiveness of this method is limited, although successes have been recorded in its use when dealing with the secondary gain from chronic incapacitating neurosis which some times require the application of an authoritative attitude of formm pressure upon the patient.
Suggestion: Success with suggestion as a therapeutic methodis based on the fact that most human beings will acceept as valid the statements of someone to whom they attribute omnipotence. The physician holds such a position in the world day especially when one desperately wants to regain wanning health, whether physiological or psychic.
Hypnosis: This is an extreme form of suggestion in which the patient literally gives up his own voluntary controls over himself and accepts a state presided over by the hypnotist. The hypnotist first of all reassures the patient about any misconceptions he may have concerning hypnosis before putting him in a state from which evaluation of the cause of the problem is carried out. The limitations of this approach is the fact that not every person is amenable to hypnosis.
Confession: This is a method which has long been used by religion. It involves the therapist listening to a patient’s confession of things he had done, thought of or felt about, which he either has or feels guilt of. A person under such a guilt state often welcomes a chance to confess and feels certain relief not withstanding whether the
listener metes out punishment or adopts an attitude of acceptance and understan ding. Reassurance: This is the most common psychotherapeutic method by which the therapist attempts to communicate to the patient a less pessimistic and fearful attitude towards his problems and to help him feel the problems are really not too serious.
A person with palpitation of the heart due to anxiety may develop fear that he has a heart disease. Such fear may increase the anxiety which may in turm increase the palpitation. Such a vicious circle may best be broken by an assurance that there is nothing wrong with the heart and that the palpitation is probably due to emotons.
Psychoanalysis: is a type of therapy developed by Sigmund Freud. It involves the in-depth study of a patient from the time of his earliest memories until the present. This type of therapy often takes many years of intensive work by the psychiatrist and patient.
The patient is helped to better unders tand and cope with his personality through these sessions.
Group therapy: is based on the concept that people find it easier to relate to others who have similar problems. In group therapy, a psychiatrist, psychologist, or other trained leader guides the group in talking openly about their problems.
Family therapy: involves an entire family unit being treated at the same time. Often, when a member of the family suffers from a mental disorder it affects the whole family. Also, the way the family reacts to the person may be helpful in the treatment of the individual. Family therapy is often led by psychiatric social workers, psychiatrists, or psychologist.
Psycbodrama: is a method of acting out one’s feelings through scenes, plays, or other relevant play situations. The “players” act out hostility, aggression, and other problems. They are better able to cope with these problems once they are out in the open. Individual therapy: Individual, face-to-face, interview therapy is carried out on a patient by a psychiatrist or psychologist in his office or a room in the hospital. There are a number of different schools of thought as to the best way for a therapist to identify the patient’s problems and to talk through these problems. The patient usually talks with the individual therapist for an hour or so at a time, over a period of weeks, months and at times, years.
Between the interviews the patient tries to change his behaviour to that decided upon by himself and the therapist. The patient can gradually achieve mental health through re-education and a clear understanding of how to meet his emotional needs. There are other forms of therapy which include transce dental meditation, screaming, encounter groups, behaviour modification, and a variety of other “therapies” Some are legitimate and have experienced leaders. Others are money-making schemes that take advantage of the therapy craze.
It is also true that most forms of psychotherapy can be carried out by people without medical training. Warmth, compassion, understan ding, and intelligence are what is needed for helping disturbed persons. Therapists with these qualities, plus the ability to unders tanding human behaviour, can be successful no matter what their training.
B. Drug Therapy:
There has been much research in recent times with drugs that can affect mentally ill patients. The drug that are used to day with the greatest success are tranquilizers and antidepressants. The tranqulizers are used to quieten extremely disturbed patients so that other forms of therapy can be used. They help to relieve symptoms of anxiety and tension and have been successful in relieving psychosomatic symptomns.
Antidepressants are drugs that help to elevate the mood of a severely depressed individual. These drugs enable the therapists to work with the individual once he is free from some symptoms of depression.
Many other drugs have been used, either experimentally or on a proved basis of value, in the treatment of the mentally ill. There is no single drug, however, that can be counted upon to cur mental illness. Relief from symptoms and signs of emotional disturbances is the major effect of this type of medical treatment.
C. Brain Surgery for mental illness
Egas Monix of Portugal begain to experiment in the field of brain surgery as a new treatment for mental illness in 1936. Moniz later received the Nobel Prize for the development of that type of brain surgery known as lobotomy. Lobotomy, also known as prefrontal lobotomy, is a type of brain surgery in which certain nerve pathways are cut after holes have been drilled through the skill. It has been found that emotional tensions are released after this type of surgery in many patients. In other words, the patient is apt to be happier after his operation even though he has not been cured of his illness.
The general conclusion in respect to lobotomy, or brain surgery for mental illness, seems to be that it has some limited use in the field of treatment of the mental diseased. Its value is restricted to certain types of disorders in which there are strong indications of severe tensions and antisocial behaviour, and even then the operation appears advisable only in extreme cases. Surgery itself is not without risk and there fore, to be avoided if possible.
D. Electric Shock for mental illness
Electric shock treatment for mental illness was apparently first used in Rome in 1938, and has been used in the U.S. since about 1940. Electric shock treatment sometimes works in treating patients with severe depression and other forms of mental illness. The shock treatment is painless; but there could be a temporary loss of memnory. The treatment must be given by an experienced psychiatrist. used in A combination of drugs and electric shock may be addition to other therapeutic treatment or by themselves. In general, electric shock treatment has tended to replace other forms of shock therapy, although insulin shock is still used by some psychiatrists. This form of treatment is relatively safe and does bring considerable improvement in many patients, although its value depends upon the type of mental illness concemed In short, electric shock treatment is one of the modern and effective ways
of treating the mentally ill patient.
E. Nutrition and mental health
It is a well documented fact that nutritional deficiencies may result in a disturbed mind. When this is the case, it is obvious that the best possible treatment is correction of the nutritional deficiency. It has been established that food may be relate d to the mental health. Many cases in which the brain has been affected because of allergy to certain foods have been reported in recent years. For example, Wilfred D. Langley of Pennsylvania, U.S.A. reported a case of a 28 year – old woman who had epileptic seizures within afew hours after drinking the juice of a single orange. When she avoided oranges for four yeas, she was entirely relieved of her convulsions.
Severe migraine headaches have been repeatedly traced in particular instances to an allergy to a particular food Some specialists in allergy have reported symptoms which indicate a possible relationship between allergies and the nervous system, restlessness at night, crying out in sleep, nightmares and bed wetting. In specificc cases all these signs and symptoms disappeared when the food allergy was controlled. It is the contention of these specialist that child psychiatrists should give greater attention to the fact that inflammation of brain due to an allergic reaction can cause emotional changes.
Obviously, if this is the case, and the available evidence seems to be quite convincing on this, the treatment of certain emotional disorders should be directed against the particular allergy involved. In most cases particular foods will be found to be the cause of the disorder. The value of vitamin B complex in contributing to the stability of the nervous system has been demonstrated repeatedly. One should remember, of course, that not all cases of mental illness stem from the same cause. In particular cases, however, mental illness has sometimes been cured with dramatic rapidity when vitamin B complex has been used in the treatment of the disease.
From time to time it has been claimed by food specialists that a particular kind of food has been found to be intimately associated with intelligence and mental health. This has not been conclusively demonstrated to be the case; however, research has shown that there is no specific food that improves the I.Q, or cures mental disease. It has been shown consistently, however, that a deficient diet may adversely affect emotional health. An important part of treatment in most diseases of the mind is therefore, a well balanced diet.
Hospital Treatment for Mental Illness
The degree of disturbance experienced by psychiatric cases may vary from a mild neurotic reactions to a severe psychotic state. When the incapacitation is much less as to allow the patient go about his/her business, he/she may be treated on the outpatient basis, whereby he reports to the hospital for evaluation and dnug prescrip tion periodically. But when the incapacitation is sufficientl , it becomes necessary to remove the patient and hospitalize him where he will not be able to harm himself or others. Several health workers are involved in psychiatric treatment. These include the following:
1. Psychiatrist A medical doctor, holding a medical degree from and approved medical school. After the general medical qualification, he then undergoes additional years of specialist study in psychiatry.
2. Clinical psychologist – A person who has training in clinical psychology. He is trained in the theory and techniques of research and in psychological treatment and evaluation. Like a psychiatrist, he is qualified to practice either in his office or in a hospital.
3. Psychiatric socal worker The psychiatric social worker keeps in close touch with the patient and the patient’s family. He attempts to help the family understand what is happening to their loved one and helps the patient in making his adjust ment back into the family and the community when he is ready to go home. He also monitors the patient’s progress while at home.
4. Psycbiatric nurse A psychiatric nurse is a registered nurse with special training in caring for the mentally ill. The psychiatric nurse and her assistants are probably more closely associated with the daily lives of patients than are other members of the hospital staff. Her observations are valuable to both the psychiatrist and clinical psychologist.
5. Occupational and recreational therapists An occupationa therapist teaches patients to knit, weave, draw, paint, or make things. The recreational therapist arranges sports activities, entertainments, and social events for the patients.
Prevention of Mental Illness
Mental illness can be prevente d. Many symptoms of mental illness are easily recognizable to a trained personnel in their early stages. Too many lay persons are unaware of these symptoms in themselves and others, until it is too late. Mental illness must be considered not only a personal problem but also a family, community and public health problem. Friends and relatives can play a vital role in helping a disturbed individual to overcome his emotional and mental problems.
As an individual, you can make conscious efforts toward leading balance life, including work, play, love and worship, and toward understanding yourself, which means accepting the fact that there is a worse side to your own nature, as there is indeed to everyone’s. As a parent, you can help prevent mental illness in your children by bringing them up wisely with a balance of tender, loving care and consitent discipline that sets limits for action. Some roots of mental illness are set in childhood; emotional patterns are crystallized before intelligence takes over. Hence mental health become a family affair.
The prevention of mental illness is related to some of the factors concerning personality development and emotional growth and health. Mental illness, is, after all, an illness, not a shame or disgrace. All in all, security and love are essential to the preven- tion of mental illness.
What is Needed to Improve Nigerians’ Mental health
All societies of the world should be concerned and be aware of mental health and mental illness of the people in their respective areas. Strains and stress,, occasioned by economic and matrimonial problems, are some of the major causes of mental disorder in Nigerian society.
The increased permissiveness of the society and easy accessibility to dangerous drugs such as cocaine by adults and youths have caused delinquency and mental illness in both youths and adults. Several measures are needed to improve the level ot mental health in Nigeria in the 1980’s and beyond, A specitic pro &Tamme of “Action for Mental Health” is proposed to reduce mental illness in the society, Key points for the improvement of mental health and the prevention of mental illness (or at least its disabling effects) are briefly summarized:
1. Leadership in Mental Health Medical doctors to whom the patients bring their health complaints must join more vigorously in the national effort to promolte mental health. They must assume leadership in keeping their patients and their families, as well as the community at large more accurately informed about how the mentally ill persons can be helped.
The lack of public unders tanding which result from mis-information about psychia tric illnesses are basic causes of rejection of the mentally ill and the failure of many programmes intended to aid them. Medical doctors in general practice and those in specialities other than neurology and psychiatry can do much to change this unfortunately climate by educating their patient on how to prevent mental disorder .
2. Increase in the number of mental health personnel The country needs more psychiatric social workers, trained psy chiatric nurses and aides, psychiatrist , clinical psychologists, and volunteer workers in mental hospitals. This will go a long way in off-setting the acute shortage of psychiatric health personnel as well as lighten the load of the over-burdened small number available personnel.
3. Research in mental health and mental illness There is need for adequate budget allocation for research and training of personnel in the treatment and rehabilitation of mental illness patients. Research in this area must be encouraged in our universities with medical schools, and other mental health agencies.
4. Provision of more mental health services facilities There is an acute shortage of facilities for the care and treatment of the psychiatric patients. Effort must be made through budget allocations to improve as well as expand existing facilities.
through Efforts must be made through appropriate agencies through educational institutions and the communicating media to create awareness of the effect of the rapid changes in social and cultural systems, and their consequent impact on the mental and social health of the people.
Mental retarda tion often referred to as mental deficiency or feeble mindedness which is specific problem and considered a chronic brain disorder is quite different from mental illness. It is a condition in which an individual shows a difficulty in learning, reasoning or in abstract thinking. It is a general misconception of consider mental illness as synonymous with mental retardation. Also it is necessary to distinguish between mental deficiency patients from those individuals who have once attained a normal level of mental ability but have subsequently suffered some injury or disease which has robbed them of this capacity.
Mental deficiency (retardation) is divided according to the degree of severity of the handicap into mild, moderate and severe. The group labelled severe includes those persons whose I.Q.s are less than 50. We cannot run away from the problem of mental retardation because it presen ts a major challenge to any society, to find causes, seek solutions, and provide the best possible assistance for the maximum development of their potential. Mental retardation has been defined as a condition, characterised by faulty development of intelligence, which impairs an indivi daul’s ability to learn and to adapt to demands of society.
The falure of intelligence to develop normally may be due to disease or conditions occuring before or at the time of birth, or in infancy and childhood, that damage the brain. The retardation may also be due to factors determined by heredity that affect the development of the brain.
However this is not mental illness. The mentally retarded person is unable to learn to varying degrees the mentally ill individual is intellectually able, but is unable to cope and adjust to the world around him. As indicated previously, some mental health authorities preter describe mental illness as an emotional illness rather than ,a mentall one. In this way they avoid any misunderstanding concerning mental retardation and mental illness.
Mentally retarded patients can get some care in public hospitals, Other services required by the mentally retarded and their familiesinclude:
1. diagnostic and clinical services
2. special education for the
3. preparation of professional
personnel in many areas
4. vocational rehabilitation
5. parent counselling
6. social services and
This article has been devoted to two major subjects, mental illness and mental retardation, which are related but essentially different and separate problems. We have described mental illness as the abnormal exageration of personal feelings, and we have discussed the types, causes, extent, and improved treatment of mentalillness. With psychotherapy, new drug therapy, hospitalization and other treatments, the outlook for the cure of those mentally ill Patients who can obtain adequate treatment is indeed good.
The outlook for the “cure” of mental retardation is at present less favourable, primarily because much less is known about the causes of mental retardation. Nevertheless the problem is now being attacked with vigour in some advanced societies of the world.