Can traditional and faith healers fill Nigeria’s mental health gap?

Tade was 27 and married with a son when he started walking long distances with no destination in mind. His mother was in church one evening when her ex-husband called to tell her that their son had been roaming Computer Village in Ikeja, where he sold hardware. She was able to reach Tade — whose name has been changed to protect his privacy — on the phone and helped him find his way home to her.

“Some things had changed about him,” she said. “His speech was not coherent, he was looking around strangely, and said some people were chasing him. That was when I knew something was wrong.”

At this point, she looked away, sighed, smiled, and sighed again at the weight of the memories. “This problem started around 2016,” she finally said, sitting at their family home in Ifo, Ogun state, with Tade and his sister Banke — whose name has also been changed. He wore a white shirt, head slightly bowed, as though listening to a stranger’s story.

It would take six long years after that phone call to get a diagnosis from a psychiatrist. It was schizophrenia.

Schizophrenia is a mental disorder “characterized by significant impairments in the way reality is perceived.” The Nigerian population estimated to be living with schizophrenia is about 1.86 million.

Alternative treatments

Tade’s mother considered taking him to a doctor but couldn’t afford the 150,000 Nigerian naira (about $345) registration and deposit fee required of them at the neuropsychiatric hospital in Aro, Ogun state.

“There was no support from anywhere,” Banke said. “That was why we went traditional. It’s cheaper and more accessible. When you’re desperately in need of help and the actual solution is far-fetched, you just have to go for something.”

So his mother made a call to her mentor, a religious leader in a white garment church, whose members wear white garments. He told her the solution was “ìràpadà,” a form of deliverance session to “redeem him.” This cost her 35,000 Nigerian naira.

“After the prayer session, he looked calm,” she said. “Everything started to return to normal,” and Tade went back to his life. Two months later, his father called again. The situation was worse this time: Tade was naked in the market.

“I started crying,” she said. They took him to a traditional doctor — who has since passed away — in Itori, a small town in Ogun state. His method entailed flogging and chaining the patients.

“After a while,” Tade’s mother said, “He got better.”

Due to the wide treatment gap in mental illness, patients and their relatives often seek different paths that offer a glimmer of hope.

“When people have mental health challenges, it's assumed to be a spiritual problem,” said Dr. Jibril Abdulmalik, consultant psychiatrist at the University College Hospital, Ibadan, and founder of Asido Foundation, a nonprofit that promotes mental health advocacy. “And so the first place they'll go is traditional or faith-based healers.”

In Ibadan, Baba Elesin Memorial Healing Home is an old residential building that serves as a treatment center for persons seeking traditional intervention. Several calendars of different associations, and one that has a man sitting on a horse, hang on the wall of the healing home’s living room. Baba Elesin, who is popularly known in the area, took over the traditional practice after his father died.

In over 32 years, he claims to have helped restore scores of people to normalcy. According to him, he treats an average of 10 patients every year, and there are usually more women than men.

Baba Elesin belongs to the Association of Atorise Traditional and Spiritual Psychiatric Healers Nigeria — composed of Christians, Muslims, and traditional healers — which he says is registered with the Corporate Affairs Commission, which regulates the registration of private and public companies.

The wellness of their patients is what matters most, so the members collaborate sometimes, bringing in their expertise, he said in Yorùbá.

“The first step is investigating the root cause of the issue,” he said. He does this by speaking to the relatives and carefully observing the patient. He said there are usually three categories: hereditary, self — the intake of illicit drugs — and spiritual attack — perhaps the individual is being punished for offending some persons. This is followed by a series of events that include killing an animal, such as a goat, and having the sacrifice, or ètùtù, delivered to strategic locations to appease the deities.

“That’s using life to buy life,” he said.

After which the patient is administered herbs, and soups. If nothing happens, he added, they carry out another sacrifice. “The whole process takes about 3 to 6 months and costs 200,000 naira.”

“When they are well,” Baba Elesin said, “some of them relocate from the community, even city because they are ashamed of being recognized by those who knew them.”

A survey to gauge views on mental illnesses among Nigerians found that many believed that “‘drug abuse’ is the most common cause of mental health disorder. Possession by evil spirits and sickness of the mind (Brain) ranked as the second and third most common factors. Most respondents indicated a preference for proper medical care in treating a person with a mental health disorder. However, a significant number of respondents in the South-East indicated that they would take the person to a prayer house.”

But concerns about human rights violations in many of these traditional and faith-based centers have been widely recorded. “The beating is said to exorcize the demon that has possessed them,” Abdulmalik said. “It also includes sexual assault. We’ve had cases of female patients being raped or impregnated.”

A report by Human Rights Watch that delves into this widespread practice and its impact on patients found that “people with actual or perceived mental health conditions, including children, are placed in facilities without their consent, usually by relatives.”

“There is no quality control,” Abdulmalik said. “No regulatory agency. We don’t know who is a charlatan or who genuinely knows about herbs that work. Initiatives that attempt to train traditional and faith-based are mainly in the context of research projects.”

The Partnership for Mental Health Development in Africa aims for collaborative approaches between traditional/faith healers and biomedical providers for the treatment of psychosis. With partner institutions across five countries: Nigeria, South Africa, Ghana, Kenya, and Liberia, the research seeks “to inform the development of an intervention package.” However, it also found that the treatment approaches of traditional and faith healers are “sometimes harmful or administered in forms that deny patients their basic human rights.”

Challenges in seeking help

The cause of schizophrenia is unknown, although scientists suggest a combination of “physical, genetic, psychological and environmental factors can make a person more likely to develop the condition.”

Tade didn’t notice any unusual symptoms in the beginning. The only thing he remembers was that it felt as though there was always dirt on his body “and I was always trying to remove it.” His mother added that “There were times I saw him punching the air, the walls.”

“The most difficult moment for me,” Banke said, was during their father’s funeral last year. “I cried. Broken bottles everywhere. He [Tade] was cutting himself. And relatives were laughing at us. … But he’s our blood. We can’t deny him.”

Apart from the largely unaffordable medical bills, considering the country's increasing poverty rate, several factors plague Nigeria's mental health system. The data on mental health professionals is hard to come by, but there are only 250 psychiatrists registered with the Association of Psychiatrists in Nigeria. Meanwhile, 1 in every 4 Nigerian is reported to have a mental illness. There are only eight federal neuropsychiatric hospitals in Nigeria, a country with a population of over 200 million.

Arduous transportation to these few locations and the shame associated with mental illness are some of the factors that prevent people from seeking medical intervention.

Tade’s family met with a psychiatrist for the first time in January this year. According to them, Dr. Lawrence Ige, psychiatrist and founder of Ige Medical in Ifo, has been providing him with treatment.

Tade and his mother still believe the illness was diabolical, an attack from his father's side of the family. Banke acknowledges that though it’s true that there might be some spiritual elements in cases like this, she's leaning toward science.

Looking forward

There is currently no known cure for schizophrenia, it can however be managed through medication, rehabilitation, and different forms of therapy. Treatment is usually lifelong and should not be discontinued even when the symptoms seem to have subsided.

Experts say more awareness by individuals, NGOs, media, and the government on how to bridge the knowledge gap on mental illness should be encouraged. The media contributes to the negative public perception of schizophrenia in Nigeria. According to Abdulmalik, the Asido Foundation has trained media personnel on how to discuss mental illness, responsible reporting of suicide, and so on.

“This year, we launched Project Hope to help homeless persons with mental health challenges,” Abdulmalik said. A diagnosis is done at the University College Hospital, Ibadan, and at most times the results come out as schizophrenia. The foundation takes care of the admission fee and tries to reconnect the individuals with their families.

“So far, we’ve picked up five persons off the streets and hope for more public support.” They’re working in partnership with the state Ministry of Health and the Ministry of Women and Social Welfare and with permission from law enforcement.

However, financial support poses a major challenge. “In terms of local funding, [there are] no big donors,” he adds.

Tade is still undergoing treatment and is hopeful. He plans to pivot to digital marketing at some point in the future. For now, he's focusing on his mental health and looks forward to seeing his son again.

Devex, with support from our partner GHR Foundation, is exploring the intersection between faith and development. Visit the Focus on: Faith and Development page for more. Disclaimer: The views in this article do not necessarily represent the views of GHR Foundation.