Friday, January 30, 2009


after one month of being on the web I felt it appropriate to briefly share my purpose for this site. Like u already know I'm a psychiatrist in training and my passion is to enlighten people about issues on psychiatry and also share some non psychiatry thoughts (you could call it psychology, philosophy, motivational...whatever) which could inspire someone out there and promote a healthier mind set and foster stronger human relationships which are necessary for a fulfilled life. Feel free to ask questions, share a story, make comments or share your on perspective.
Thank you so far for your comments. I hope to make this site educating, hilarious and inspiring...simple put a fun site to visit.Cheers


It is more important to get along with people than to get ahead of them
John Maxwell

People tend to become what the most important people in their lives think that they will become. You can literally change people's lives by your attitude and expectations of them.
also John Maxwell

WORSE THAN HIV/AIDS...notes from a concerned psychiatrist

When I was a medical student I went to the dermatology (skin) department of the university’s teaching hospital for treatment of a skin rash that had lasted for some months. As I walked in I met a nurse who knew me and we exchanged pleasantries. To save time I quickly got a house officer (junior doctor) to help me send my folder to the consultant. The same nurse came back and wanted to help out so she asked me which of the consulting room my folder was placed? Not wanting to say much I just replied the house officer was with my file… Oh! You should know that the dermatology unit also doubled as a HIV clinic and the folders of HIV positive people were handled by house officers.

This nurse hurriedly scrambled away as she looked at me like I had turned into a horrible creature. As I was leaving the clinic, I saw her again and waved but this time she ignored me. Then it dawned on me she must have mistakenly “tagged” me and was now avoiding me so she won’t get “infected”. Even though she wasn’t a close friend, that day, she definitely taught me the meaning of feeling “stigmatized”.

There is already so much talk against the stigma of HIV/AIDS so I’ll prefer to discuss a stigma that is arguably worse than that of HIV/AIDS; the stigma against the mentally ill.
Stigma actually means placing a “mark” on someone not necessarily based on their personal qualities but rather on the basis of a label which implies that this individual should be feared or classified as a member of a group that is not favoured. Not only are the affected individuals discriminated against, their loved ones also bear the brunt of the stigma… Like the saying goes; “mad man no dey shame na im people dey shame” i.e. it is the relations of the severely mentally ill that feels the brunt of the stigma.
The statement below beautifully captures the issue of stigma

“Stigma is not just the use of the wrong words or actions. Stigma is about ‘disrespect’.
It is the use of negative labels to identify a person living with mental illness. Stigma is a barrier and it discourages individuals and their families from getting the help they need due to the fear of being discriminated against. An estimated 50million Americans experience a mental disorder in any given year and only one fourth of them actually receive mental health and other services”.

People would not usually make fun of people with breast cancer or most of the other physical illnesses but that is not usually the case for mental illness. The basis of stigma associated with mental illness arises from fear and misconceptions, some of which are listed below:
Misconception #1: People with mental illness brought it upon themselves by their choices and actions.
Misconception #2: People with mental illness feel different from the rest of us.
Misconception #3: It is hard to talk to them because they are usually violent and dangerous.
Misconception #4: Mental illness can not be cured and they don’t recover.
This reminds me of an old saying that “once a mad man gets into the market square there is no more cure for his mental illness”.
The fact is, all of these assumptions are wrong.

The effect of stigma is profound and it limits the extent of contribution that the individual can make to the society. There are various forms of mental illness and the discrimination vary from one to another for example it is less for depression compared to schizophrenia however building a new and better Nigeria, amongst many other things, will also include changing our attitude towards the mentally ill. “Inclusion” rather than “exclusion” is the approach imbibed by developed nations.
Starting from the home of the common man to the assembly of policy makers there has to be a review of our attitude towards the mentally ill. Measures that can be taken to reduce the burden of stigma include

1.INFORMATION: The cure for misconception is information. Information about the true nature of mental illness, about the low frequency of dangerous behaviour among the mentally ill, and about the availability of treatment.
2.DON’T EQUATE THE INDIVIDUAL WITH THE ILLNESS: Instead of saying she’s depressed, say she has depression; don’t say he’s schizophrenic rather you should say he is a person who suffers from schizophrenia.
3.GIVE/RECEIVE SUPPORT: If you know someone who has suffered or suffers from a mental illness show love and support but if you suffer from any mental illness rather than isolate yourself surround yourself with supportive people.
4.THE GOVERNMENT COULD IMPROVE THE COMMUNITY MENTAL HEALTH SERVICES whereby treatment is taken to the community as practiced in developed nations rather than only wait for them to come to the hospitals.
5.GIVING FACE TO MENTAL ILLNESS just like it has been done for HIV/AIDS; people who suffer from mental illness should come out and talk about it. It was once impossible for people to come out and say they are HIV positive but, today, the story has changed. I believe one day it will be so for mental illness in this nation. It won’t be an easy task but it’s already happening in the western world.

True, like in HIV/AIDS the stigma cannot be completely discarded but I daresay it can be reduced. Below is a poem I believe must have been written by someone fed up with the rejection;

We are your friends, neighbours, and family
We improve and recover
We are major contributors to life
We deserve dignity and respect
Know me as a Person and not by my Mental Illness

Remember people with mental illness could live better lives…talk to a professional!

Sunday, January 18, 2009


My third child was about 2 months old when I started having this recurrent disturbing thought to harm him. The thought was so intense I started avoiding knives in the house because I feared I might carry out my thought. I also couldn’t share this problem with my husband or any one else least they would think I was either loosing my mind or that I was a witch.
Pat, Nigeria.

What Pat was experiencing is called an Obsessive-Compulsive disorder (OCD). It is an abnormal anxiety state. Obsessions are recurrent, persistent, repulsive thoughts, images or impulses that come up in the mind of an individual despite efforts to ignore or suppress them. They are usually alleged to be personal, but, inappropriate thoughts and are associated with fear that the thoughts may likely be carried out. They are not just excessive worries over life problems. Compulsions are repetitive behavior carried out in response to obsessions. The obsessions and/or compulsion are time-consuming (takes more than 1 hour in a day) or significantly interfere with the individual’s normal life; their academic, occupational or social functioning.
It is the 4th commonest psychiatric illness after phobias, drug abuse and depression and it cuts across various cultures. The incidence (new cases seen) is same for both sexes and is said to occur in about 0.5-2% of general population. A larger percentage of those with this condition develop the problem before 25years but it could occur after 35years. This condition could also occur in children and adolescents. Though most patients have both obsessions and compulsions, some could have just obsessions without compulsions.

The pattern could overlap in an individual and may also change over time. There are four major patterns:

· Recurrent thoughts about dirt and contamination: this is the most common pattern. The person has the idea of harm to self or to others through the spread of disease. The person may go ahead and repeatedly wash their hands or may be scared of leaving home because they believe that contamination is spread by the slightest contact.

· Recurrent thoughts of doubts for example, “did I forget to turn off the gas”? This is followed by a repetitive checking and cross checking behavior. This checking behavior would normally last longer than is reasonable. This ranks second.

· The third most common pattern is the type that Pat had it referred to as intrusive obsessional thoughts and they occur without compulsions. It is characterized by repetitive repulsive thoughts usually bordered on sex or aggression.

· Recurrent thoughts about orderliness: maybe about the way objects are to be arranged or work is to be organized. The individual is overwhelmed with the thought of doing things in a particular way which could lead to being slow. Patients could literally spend hours shaving or eating meals.

All these various disturbing thoughts could normally occur occasionally in healthy people but when it becomes recurrent, intense, disturbing and associated with anxiety, and sometimes avoidance of certain situation for fear that you will be compelled to carry out the act, it is then a disorder.

Like most psychiatric illness it results from several factors: There are proofs it runs in families, it also could occur due to some physical illness and some have said it is due to some inner psychological conflicts which started from childhood. There are also proofs supporting that there may be slight malfunctioning in the brain of individuals with OCD. It is also known to have started following stressful events like loss of a loved one or child birth.

This condition usually occurs with depression hence if depression is properly treated the condition improves. Certain antidepressant medications like clomipramine and the SSRI’s have been found to be effective in reducing these symptoms. Some forms of psychotherapy and behavioral therapy have also helped and some argue that this is the most effective form of treatment. In severe persistent cases, where both medications and psychotherapy have failed, a form of brain surgery may have to be carried out.

A large number of those with this condition, about two-thirds, resolve within a year but few may suffer from this condition for years with some having these symptoms come and go with varying intensity whereas others will experience their symptoms persistently with the symptoms possibly getting worse. The chance of it recurring after medication is stopped is high. Those who had good social and occupational functioning before they developed the illness, who have the illness waxing and waning and who had stressful events which led to the illness tend to do better in the long term.

Just in case you have this condition or know someone who does, be rest assured that the fear that these recurrent, repulsive thoughts, impulses, images or actions point to an early sign of madness is not true. Also know that help is available if the condition has been persistent, just talk to a psychiatrist.

Saturday, January 17, 2009


A husband and his wife went to see a marriage counselor after 15years of marriage. The counselor asked what the problem was.
The wife then went on and on listing every problem they had experienced in their 15years of marriage. After a while the counselor got up, went round his desk and gave the wife a very warm hug and a passionate kiss. The woman shut up and sat quietly in a daze. The counselor turns to the husband and says “that is what your wife needs at least three times a week. Can you do that“?
The husband thinks for a moment and replies, “well, I can get her here to your office on Mondays and Wednesdays but Friday I golf”.

Tuesday, January 13, 2009

why bother chasing them in this 21st century when you can just shoot them down...after all, it is still hunting.

STRANGE BUT TRUE...nature vs. nurture

One of the oldest debates in psychology is that ‘what determines an individual’s behavior’? We all agree that both our nature (inherent makeup gotten from our parents, which they also got from their parents and so on), and our nurture (environment, life experiences, style of upbringing etc) play a role in the final outcome of our behavior but the question is ‘do we owe our behavior more to nature or to nurture’? Interestingly, we tend to attribute most of the behavior of nonhumans to their nature but readily attribute human behavior almost exclusively to nurture. However, recent data as shown without a doubt, that nature plays equally, if not more importantly, in determining someone’s behavior.
The best way to have researched on this is finding out the outcome of identical twins separated in infancy and raised in different social environment. If nurture is stronger they will turn out differently if it is the other way round, i.e. nature stronger, each will closely resemble each other. Several hundreds of such pairs have been analyzed; the results were quite similar, check out some of the findings

Bessie and Jessie, identical twins separated at 8months of age after their mother’s death, were first reunited at age 18. Each had had a bout of tuberculosis, and they had similar voices, energy levels, administrative talents, and decision making styles. Each had had her hair cut short in early adolescence. Jessie had a college-level education, whereas Bessie had only 4years of formal education; yet Bessie scored slightly higher than Jessie in an intelligent quotient test, 156 and 153 respectively. Each was an avid reader which may have compensated for Bessie’s sparse education; she seemed to have created an environment compatible with her inherent potential.

Jim L. and Jim S. were reunited at age 39. They were identical twins but reared apart since infancy by different adoptive families in Ohio unaware of each others existence. As children, each twin had a dog named Toy. Each bit his fingernails and, since age 18, had suffered from mixed headache syndrome. Each had been married twice, first to a Linda and then to a Betty. One twin had named his son James Alan, and the other, James Allen. Each had put a circular bench around a tree in his garden. Each had worked in a gas station and later part-time in law enforcement as a sheriff. Each chained smoked Salems and preferred an occasional Miller Lite beer. Each scattered love notes to his wife around the house. Every summer, unknown to the other, each had driven his family in a light blue Chevrolet from Ohio to the Pas-Grille Beach in St. Petersburg, Florida, for their summer vacation. They had similar voices, hand gestures, and mannerisms

Jerry L. and Mark N., identical twins separated in infancy, were first reunited at age 30. Each was nearly bald and had a bushy mustache. Each was a volunteer firefighter and made his living installing safety equipment. Each wore aviator glasses, big belt buckles, and big key rings. Each drank Budweiser with his pinky hooked on the bottom of the can and crushed the can when he was finished.

Like it is written in the bible…in the mouth of 2 or 3 witnesses let a word be established…nature clearly emerges as a key determinant of human behavior. By the way the life of Jim L. and Jim S., living in the same city!? Imagine the confusion they would have caused an unsuspecting everyday guy if they both had crossed his path. It will pass for a movie; either comedy, best-seller or horror film, depending on your perspective…lol.
I will truly like your comments on this one. Cheers.

Friday, January 9, 2009


David, Nigeria.

This is often asked and the fact is, among psychiatrists, there is an ongoing argument about the existence of BPD. I will like to keep it simple and spare you all the medical jargon, they both share a lot in common but the subtle differences are

FEATURES: a borderline is far more unlikely to sustain a relationship because of their unstable personality, they shift between extremes of “I love him…I hate him” and this goes on and on. This is not so for the bipolar patient. So finding out how the individual’s relationships (both romantic and otherwise) over a long period can be a simple test for differentiating them.

TREATMENT: though treatment is similar, medications (including mood stabilizers, antidepressants etc) and psychotherapy, the emphasis of treatment is different. BPD emphasizes more on psychotherapy than medication while the reverse is the case for BAD. Also antidepressants which are normally very helpful in BPD can cause a manic phase in BAD.

Now, with these few words of mine, I hope I have been able to confuse…sorry, clarify the difference. Like I said before it’s subtle but you can check out for more information on their differences.


One out of four people in this country is mentally unbalanced. Think of 3 closest friends... if they seem okay, then you're the one.

During a visit to a psychiatric hospital, a Guy asked the Director what the criterion was which defined whether or not a patient should be institutionalized.
'Well', said the Director,'we fill up the bathub, then we offer a teaspoon, a teacup, and a bucket to the patient and ask him or her to empty the bathub.'
'Oh, I understand,' said the Guy. 'A normal person would use the bucket because it is bigger than the spoon or the teacup... "NO", said the Director, 'A normal person would pull the plug. (Pause) Do you want a bed near the window?'

Saturday, January 3, 2009

BIPOLAR AFFECTIVE DISORDER …that extreme excitement could be a tell tale sign of an imminent mental breakdown.

John really felt good with himself because he thought he had finally overcome his shy nature. He could now walk up to any lady and chat with them because he felt he was irresistibly charming. He was full of energy and had earlier disclosed to me that he had discovered that “great men don’t have need for much sleep”. He was so excited about all the great ideas rushing through his mind and he went on and on talking… like forever. None of this new behavior stared up any need for concern from his family members until he did something…something really embarrassing and he had to be admitted into a psychiatric ward…

John has a condition called BIPOLAR AFFECTIVE DISORDER, which refers to a disturbance in the mood of an individual. Though we don’t have the exact figure here in Nigeria the lifetime prevalence (will occur at some point in a person’s life) is between 0.3 and 1.5% of most general population.

What Is Bipolar Affective Disorder?
Like the name implies “Bi” meaning two… there are 2 poles or sides to the illness, the individual with bipolar affective disorder is either sometimes “manic” or at other times “depressed” hence it’s commonly called a Manic Depressive Disorder.
There are two major variants of bipolar affective disorder; bipolar I and bipolar II. In bipolar I the individual experiences one or more manic episodes with or without obvious depressive episodes in between while in the bipolar II variant the individual experiences repeated episodes of major depression interspersed with hypomanic episodes. Bipolar disorder generally shares the same incidence (rate of new cases) between both sexes however the bipolar II variant is more common in women.

How to recognize it?
Though there are two poles to this condition, in this edition I’ll be focusing on recognizing the manic pole.
Mania is characterized by elated (happy) mood which would have lasted for at least one week with three or more of the following
  • Self esteem: highly inflated, grandiose; believing their ideas and works are exceptional
  • Sleep: decreased need for sleep, rested after a few hours
  • Speech: They are usually talkative; talking loudly, rapidly and endlessly making it impossible to interrupt them.
  • Thoughts: racing thoughts moving very fast from one topic to another.
  • Attention: easily distracted. They start many activities but would usually leave them unfinished as new ones catch their fancy.
  • Spend extravagantly
  • Display over familiarity even with strangers
  • Sexual desires are increased and behavior may be uninhibited; may neglect precautions against pregnancy without the slightest awareness of the consequence of the behaviour.
Hypomania is a milder form of mania with all the above symptoms however the duration for the elated mood or irritability could just be as short as 4days. In milder forms of the illness the manic individual feels they are having an exhilarating experience; a feeling of being invincible, all powerful, and all-wise however the situation often worsens and then the condition becomes frighteningly out of control.

The Cause
Genetic and family studies show it runs in families however it could be triggered by environmental stressors and there is also evidence that depriving oneself of sleep could trigger it especially in those who are already vulnerable to this illness.

The course
For bipolar patients, the mean age the illness shows up for the first time is about 18years this is usually mild and may go unnoticed, the individual may get better without treatment. The mean age for first treatment is about 22years, and the mean age for the first hospitalization is about 25years. 25-50% of people with this illness also usually attempt suicide at least once especially during one of their depressive episodes.
In between episodes of the illness these individual are perfectly okay and can carry out their usual duties effectively. It has affected many creative people in the past and present hence it is nicknamed ‘creative madness’, though those who battle with this illness would rather live a ‘normal life’ and be free from the unpredictable mood swings.

Self Help Tips
These few tips could help reduce the chance of frequent reoccurrences in those already diagnosed with the illness and generally improve their quality of life
  • Setting and maintaining a standard bedtime and wake time this is to prevent sleep deprivation which may trigger the illness
  • Practicing relaxation or meditation exercises regularly
  • Reducing work and family stress as much as is practical
  • Eating a healthy diet at regular times each day as excessive fasting tends to trigger it too
  • Regular participation in communities including religious communities; community participation helps prevent depression
  • Taking medication at the same time everyday
  • Regular attendance at clinical appointments and regular self-monitoring
  • Avoidance of mood-altering drugs, including alcohol

Coping with those with the Illness
Like every chronic illness there is a lot of emotional and financial strain placed on family and friends. The spontaneity of the reckless behaviour of these individual in terms of excessive spending, suicidal attempts, promiscuity and general odd behaviour may cause a form of embarrassment and anxiety.
To cope with the ones with the illness and also better assist them one should
  • Get information about the nature of the illness so they can help monitor the individual’s mood thereby being able to detect early onset of the illness and possibly initiate intervention when necessary.
  • Encourage these individuals to comply with medication since most of them have a tendency to stop their drugs complaining that they don’t like the way the drugs make them feel.
  • Develop an ongoing relationship with a family therapist who can provide advice and crisis management services.
  • Limit the patient’s access to large money possibly by introducing co-signatory modalities.
  • Long acting birth control methods can be used to reduce the risk of unwanted pregnancy.
  • Regular testing for sexually transmitted disease for patient and spouse when sexual promiscuity is involved.
  • Find a support group (could be a religious group) that could always give the needed support when you feel like giving up.
Please bear in mind that these individuals did not bring the illness upon themselves so be gentle on them and if you suffer from this illness I encourage you to comply with your medication and maximize your quality of life.