Traditional Therapies in Psychiatry in Nigeria

Key Points

• About 70% of Nigerians live in rural areas
• 70% of health facilities are in the urban areas
• To ensure good access to mental health, there must be an increase in manpower (increase the number of health institutions or train those available and trainable)
• Nigerian health policy allows for collaboration between orthodox and non-orthodox therapies

Treatment Modalities in Psychiatry

• Orthodox:
  • Biological
  • Psychological
  • Social
  • Physical
• Non-orthodox:
  • Traditional
  • Spiritual
  • Spiritism

• Referred to as:
  • 'Folk'
  • 'Indigenous'
  • 'Ethno'
  • 'Unorthodox'
  • 'Fringe'
  • Even 'Unofficial Medicine'
• An integral part of the people’s culture and used by most people in the rural areas. It may be cheap, acceptable, and accessible to the people.
• Based on the available resources and technology relevant to the culture of the people.
• A total combination of knowledge and practice, whether explicable or not, used in diagnosing, preventing, or eliminating a physical, mental, or social disease, and which may rely exclusively on past experiences handed down from generations verbally or in writing.

• A person recognized by his/her community as competent to provide health care by using vegetables, animal and mineral substances, and certain other methods.
• Methods are based on social, cultural, and religious background as well as the knowledge, attitude, and beliefs that are prevalent in the community regarding physical, mental, and social well-being and the causes of diseases and disability.
• This definition was adopted at the 3rd symposium organized by the Scientific, Technical and Research Commission of Organisation of African Unity (O.A.U.) held in Cote D’Ivoire in September, 1979.

• Divination
• Herbalism
• Aryuveda
• Acupuncture
• Ayurveda: Ayurveda is rooted in cultural, social, and philosophical background prevailing in India during the period 600 B.C. and 700 A.D. It is based on the principle that man is a miniature universe which consists of five gross elements (fire, earth, water, air, and ethereal parts of the sky). It defines a healthy man as one with balanced body humors, proper functioning of all body elements, and has a pleasant disposition of mind, soul, and body organs.
• Acupuncture: Acupuncture is a traditional form of medicine which has been practiced in China for over 2000 years and believed to have originated during the stone age, when arrows, stone, knives, and other sharp instruments were used. It involves insertion of thin siliform needles into various parts of the body for treatment of diseases. The needles are left in position for 15 - 30 minutes but can be longer during surgical operations. It was introduced to Japan about 1000 years ago.

Classification of Traditional Healers in Nigeria

• Diviners
• Herbalists

N.B:

• Most diviners are also herbalists.
• Due to the influence of religion, some traditional healers also practice some form of religious healing.

How it is Done

• The Usual Setting: Unhygienic environment and substandard housing.
• The Practitioners: 'Traditionally trained' practitioners (men and women but mostly men who are usually knowledgeable in the treatment of other medical diseases).

Treatment Method

• Identification of causation/aetiology through divination (Ifa, sand cutting, 16 cowries (Ejidinlogun) etc.)
• Interview
• Application of drugs through oral concoctions (e.g. rauwolfia vomitorium), scarification sites
• Application of herbal preparations into orifices (ears, eyes)
• Physical methods e.g. use of chain/shackles as restraints, beating
• Sacrifice
• Counseling - individual, family, marital
• Home visits
• Follow-up/Final rites

How Effective Are They?

• Neuroses: Achievement is worthy of note through the use of various methods to achieve a reduction in anxiety levels, which is key to treatment in neuroses.
• Psychoses: Very poor achievement, thereby worsening the prognosis (NB that some surreptitiously use neuroleptics).

Prospects of Traditional Mental Health Practice

• Studies show they are trainable.
• Most viable aspect is herbalism.
• Availability of more lower cadre health workers especially in the rural areas (compare with Traditional Birth Attendants).
• Roles will be limited to identification of disorders, promotion of mental health, early referral.

Problems

• Use of harmful methods of treatment e.g. shackles (resulting in bruises, infection, tetanus), scarification (risk of HIV/AIDS, hepatitis), and beating (dehumanizing).
• Lack of documentation of herbs.
• Improper dosaging.
• Concerns regarding toxicity of herbs.
• Lack of belief in follow-up, leading to relapse.

What to Do

• Train them and make them safer practitioners, just as we did for Traditional Birth Attendants (TBAs).
• Understudy, modify, and adopt the good aspects of their practice and incorporate them into orthodox medical practice.

• Do you now appreciate there are alternate modes of treatment in psychiatry?
• Do you now understand what traditional therapy is?
• What are the prospects and problems of traditional mode of treatment of mental disorders?