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Cultural Perspectives and Attitudes toward Mental Health in Nigeria: Social

Workers at a Dilemma

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156 Social Work Practice in Mental Health: Cross-Cultural Perspectives

Cultural Perspectives and Attitudes

toward Mental Health in Nigeria:
Social Workers at a Dilemma
Tormusa Daniel Orngu

ABSTRACT: This paper explores the diverse perspectives and attitudes toward mental
illness among ethnic groups, cultures, and societies in Nigeria. It reiterates how cultural and
religious teachings often influence beliefs about the origins and nature of mental illness,
which shape peoples’ attitudes toward the mentally ill. Major findings of this papers how
that most African cultures attribute mental illness to spiritual forces; they also posit that
mental illness runs in a family therefore it is inheritable; and that one cannot be completely
cured from it. This therefore means mental illness being regarded as a cultural based
problem. Since most of the mentally ill persons hardly ever seek treatment it then appears
as if the social work profession is ineffective in helping individuals overcome social
problems. The paper therefore recommends the promotion and integration of mental health
treatment into the various health centers in rural communities. There is a need to also
embark on a wider campaign to discourage families from abandoning mentally ill people.
Keywords: Mental Illness, Cultural Perspectives, Beliefs, Attitudes, Perception, Treatment,
Stigma, and Social Work.

INTRODUCTION
Every society holds unique and different attitudes toward mental illness. This varies
according to individuals’ perceptions, families, ethnic groups and even religious beliefs.
Nigeria, being a multi-ethnic and religious nation, is confronted with various belief
systems which reflect the identity of the various ethnic societies in the country. The religious
and cultural beliefs of the people to a large extent influence their conception of the causes
and effects, the origin and nature of mental illness, which directs their attitudes towards the
mentally ill. This also influences the social stigma the mentally ill individuals experience
as well as their ability and willingness to seek treatment. To attain effective intervention from
social workers, it is therefore necessary to understand the cultural beliefs of the people.
Abdullah and Brown (2011) note that there are a wide range of cultural beliefs surrounding
mental health. Some cultures stigmatise the mentally ill while other cultures select only a
few types of mentally ill cases and stigmatise them. The stigmatisation of mental illness
can therefore be influenced by other factors, such as the perceived cause of mental illness.
When the mentally ill are stigmatised it often leads to discrimination, or the inequitable
treatment of the individual and denial of theirrights and responsibilities that should
Cultural Perspectives and Attitudes toward Mental Health in Nigeria… 157

accompany their full citizenship. By implication, stigmatisation can lead to discrimination,

which occurs when a stigmatised person is directly denied a resource and structural
discrimination, which describes disadvantages stigmatised people experience at the
economic, social, legal, and institutional levels. In addition, stigma can prevent mentally ill
individuals from seeking treatment, adhering to treatment regimens, finding employment,
and living successfully in community settings (Abdullah and Brown, 2011). The World
Health Organization (WHO) (2001) identified stigma and discrimination towards mentally
ill individuals as one of the important barriers that needs to be overcome in most
communities all over the world. To this effect, the WHO’s Mental Health Global Action
Programme (GAP) cited advocacy against stigma and discrimination as one of its four core
strategies for improving the state of global mental health.
Abdullah and Brown (2011, p. 939) also reported that while some American Indian tribes
do not stigmatise mental illness, others stigmatise only some mental illnesses, and other
tribes stigmatise all mental illnesses. In Asia, where many cultures value “conformity to
norms, emotional self-control, [and] family recognition through achievement”, mental
illnesses are often stigmatised and seen as a source of shame.
Saraceno (2007) is of the opinion that limited knowledge about mental illness can prevent
individuals from recognising mental illness and seeking treatment; poor understanding of
mental illness also impairs families’ abilities to provide adequate care for mentally ill
relatives.

CONCEPTUAL CLARIFICATION
1. Mental Illness: It refers to ‘disorders or problems characterised by symptoms expressed
in abnormal thoughts, emotions, behaviour and relationships with others’ (WHO,
2012, cited by Stein, 2013, p. 657).
2. Mental Illness Stigma: It is defined as the devaluing, disgracing, and disfavoring by
the general public of individuals with mental illnesses which often leads to
discrimination or the inequitable treatment of individuals and the denial of the rights
and responsibilities that accompany their citizenship (Abdullah and Brown 2011).
3. Traditional Healing: This refers to the application of knowledge, skills, and practices
based on the experiences indigenous to different cultures. These services are directed
towards the maintenance of health, as well as the prevention, diagnosis, and
improvement of physical and mental illness (WHO, 2008).

STATEMENT OF THE PROBLEM

Mental illnesses affect everyone in some way. Most people are likely to know someone
who has experienced a mental illness at some point in their life. Yet there are still many
hurtful attitudes around mental illnesses that fuel stigma and discrimination and make it
impossible for the affected person to reach out for help in most Nigerian societies. It is
therefore important to look at these facts from the cultural perspective.
158 Social Work Practice in Mental Health: Cross-Cultural Perspectives

Abbo (2011) notes that the World Health Organization estimates that more than 80% of
African populations visit traditional healers for health reasons and that 40%–60% of these
have some kind of mental illness. Abbo (2011) sought to know the profiles and outcome
of traditional approaches to treatment. This study however did not take cognizance of the
likely belief system held by Africans, which influences their attitudes towards mental
health. The study also did not explore other factors that could be responsible for the negative
attitude towards seeking medical attention on mental health. It is therefore necessary to
explore the factors embedded in African belief systems which influence their attitudes
towards mental health.
Although the reasons for stigmatisation are not consistent across communities or cultures,
perceived stigma by individuals living with mental illness is reported internationally. For
instance, World Mental Health Surveys showed that stigma was closely associated with
anxiety and mood disorders among adults reporting significant disability. The survey
data, which included responses from 16 countries in the Americas, Europe, the Middle East,
Africa, Asia, and the South Pacific, showed that 22.1% of participants from developing
countries and 11.7% of participants from developed countries experienced embarrassment
and discrimination due to their mental illness (Alonso et al., 2008). The findings
presented by Alonso et al. (2008) above however, did not state if stigmatisation in any way
affects the way people seek treatment for mental illness. This warranted the need to find
out how stigma influences attitudes towards the treatment of mental illness in Nigeria.
Finally, presenting mental health care services in culturally-sensitive ways is essential to
increasing access to and usage of mental health care services, as local beliefs about
mental health often differ from the Western biomedical perspective on mental illness.
The diverse perspectives of the people living with mental illness could greatly affect the
gap in treatment as some may be hindered by their cultural or religious beliefs regarding
the cause and treatment of mental health. This study evolved as an explanation on how
the belief system of the people could influence attitudes towards mental illness.
It is important when social workers working in the area of mental health seek to address
mental problems in non-western cultural settings, such as Nigeria and Sub-Saharan
Africa in general, where formalised mental-health care is restricted to hospital-based
services in major cities. However, since there are no social work services within health
care centres in rural communities in Nigeria, it then becomes difficult to ascertain their
potential role in helping mentally ill individuals recover from their illnesses.
Notwithstanding, it is important to understand the people’s perspectives and attitudes in
order to find out how social workers could take cognizance of their beliefs in the course
of trying to help the mentally ill individuals. Such knowledge would be of utmost
importance in planning services that ‘make sense’ to these communities and which
problems they should primarily address. Internet search engines were used along with
public and institutional libraries, however, no information was found on any research that
has addressed this issue in Nigeria. Therefore, this study addresses this issue by trying to
focus on the attitudes of Nigerians towards mental illness and how it affects their ability
Cultural Perspectives and Attitudes toward Mental Health in Nigeria… 159

to seek treatment, which in a way challenges the role of social workers in helping mentally
ill persons. It is against this backdrop that the aims and objectives of this paper evolved.

STUDY OBJECTIVE
The main objective of this study is to find out how cultural perspectives and attitudes of
Nigerians towards mental illness affects treatment of mental illness and the role of social
workers in helping mentally ill persons overcome their condition.

METHODOLOGY
Six focus group discussions (made up of 60 participants) were conducted in six senatorial
zones of Benue and Nasarawa States of North-central Nigeria. Each group was made up
of 10 participants. Participants were purposively drawn from the Tiv ethnic groupof Benue
state representing senatorial zones A and B and the Idoma ethnic group representing zone
C. Similarly, participants were drawn from Nasarawa North senatorial zones made up of
Hausa ethnic group; North-central senatorial zones made up of Mada; and Southern
senatorial zone made up of Eggon ethnic group. Each focus group discussion was made
up of participants of the same ethnic groups.
The Focus Group Discussions (FGDs) were conducted in Tiv, Idoma, Eggon, Hausa and
Mada languages. In each of the focus group discussions, research assistants who were
natives of those areas were used. The researcher however conducted the FGD held among
the Tiv ethnic group of Benue state. All the FGDs were held at different times to ensure
the researcher was present to guide the moderators.
Participants were required to discuss their ethnic perspectives on mental illness and
methods of treating mental illness in their various cultures that were different from the
orthodox method. Key informant interviews were also held with 6 native (witch) doctors.
Manual content analysis was used in analysing the data. The researcher read through the
transcripts several times to become familiar with the data. Coding (highlighting ideas,
categories, or themes) of the data was done according to the questions as they were discussed
in the group discussions, and were presented in related themes. Researcher’s observations
were also included in the results.

RESULTS
The findings of the study were presented thematically in order to capture the major ideas
related to the study. The researcher also included observations made from the interaction
with participants in the course of the discussions. These observations were summed up as
group dominant position on every issue discussed. There were remarkable similarities
found in the beliefs, attitudes and treatment of mental illness across ethnic groups in
North-central Nigeria.
160 Social Work Practice in Mental Health: Cross-Cultural Perspectives

DEMOGRAPHIC DATA
All participants were indigenes of the study areas, and were aged between 45–60 years. A
majority of the participants had at least primary education. Although their levels of education
had nothing to do with the research since the local language was used for data collection.
Each FGD had at least four women, and all participants spoke the same language.

CAUSES OF MENTAL ILLNESS

The results of the study shows that the majority of Nigerians are of the belief that mental
illness is caused by spiritual manipulations. A verbatim discussion from one of the
participants from zone C in Benue state, states that:
one cannot just become mentally ill except his people agrees or if he/she commits
an offence against the cultural belief of his community.
A similar statement from another participant states that:
even if an individual takes drugs and becomes mentally ill, the act was an unconscious
one. He was spiritually manipulated into takingdrugs.
Another account from one of the witch doctors from Benue state indicates that:
Majority of the mentally ill cases had some spiritual links. Most of the cases handled by
me could not be treated in the hospital. This is because some spiritual manipulations
were involved.
The major group positions collaborated with the views of the above participants. The
implication of this is that a reasonable number of the people adhered to the belief that
mental illness cannot be attributed to individuals’ behavior or negligence, but it involves
spiritual manipulations. This can be explained further that an individual who is involved
in substance abuse and ended up with mental illness should not be blamed since he/she is
being manipulated from the spiritual realm.
Similarly, a participant from Eggon ethic group states that:
In our culture where individuals who become mentally ill due to an offence against the
gods, may have their family members suffer from mental illness from one generation
to another.
In other words, mental illness can become hereditary by virtue of an offence committed
by one individual.
Participants were asked to discuss if mental illness within their communities is attributed
to individual or societal factors. The dominant group positions of all the six group discussions
show that the majority of the mental health conditions within their communities were not
caused by individuals’ negligence or personal factors but were rather caused by external
factors, especially supernatural factors. This implies that mental illness is not regarded as
an individual problem but rather a problem that is inherent in the society. Although, a
Cultural Perspectives and Attitudes toward Mental Health in Nigeria… 161

minor group position shows that some individuals are responsible for their mentally ill
condition. According to a participant from the southern senatorial zone in Nasarawa state:
youngsters now indulge in drug abuse of several kinds which makes them mad.
This finding contradicts the belief that supernatural forces are the major cause of mental
illness. Observing the position of each FGD therefore, the researcher noticed that a significant
number of Nigerians in the rural areas do not regard individuals as being responsible for
their mental ill-health condition. The people instead attribute the most cases of mental
illness to factors external to the individual. The implication for social work and psychiatric
intervention therefore requires looking beyond the individual. Social factors and
supernatural factors must be taken cognizance of.

ATTITUDES TOWARDS MENTAL ILLNESS

The attitudes of most Nigerians towards mental illness portray some negative tendencies
and stigmatisation. This is reflected in the findings from one of the FGDs conducted in
Benue state. A participant from this group states that:
if a parent has mental illness, one of the children is likely to be affected. This could
affect either the immediate child or the grand children.
A group position reflected in the views of a participant from Nasarawa state holds that:
When you come from a family with a mentally ill individual, any deviant behavior
you exhibit is attributed to the influence of mental illness found in your family. People
feel you have been affected by the mental illness as well. Some people even avoid
interacting with such families because they feel all the family members cannot think
correct.
The result also shows that “when a family member becomes mentally ill, especially the
father, the entire family is regarded as a mentally ill family”. This implies that a whole
family can be stigmatised just because a member is mentally ill.
One of the witch doctors narrated his experience in treating mental illness thus:
For many years I have been treating mental illness, but only few families show
commitment in the treatment of their wards who are mentally ill. Sometimes they
bring them and abandon them with me and go their ways. After treating the person I
trace the family in order to be paid for my services.
Another notable finding from the study shows that in as much as the rural people still link
mental illness to spiritual forces, some participants acknowledge the changes that have
occurred. These changes are attributed to drug addiction, disappointment and stress, death
of a dear relation. According to a participant:
some mentally ill cases around my community are not as a result of any spiritual
attack but can be attributed to individuals carelessness or even poverty.
162 Social Work Practice in Mental Health: Cross-Cultural Perspectives

This implies that there is a changing perspective on the cause of mental illness among
Africans.
In the focus group discussions conducted in Benue state, it was also found out that the
Tiv people of North-central Nigeria believe that it is not possible for one to be completely
cured from mental illness. According to one of the participants,
ihundur ka ki a bee kpa Iyuanev been ga (which is translated as “even when an
individual is cured of mental illness, he/she still shows some signs of abnormality).
This perception therefore stigmatises people who suffered from mental illness and also
leads to discrimination. This attitude is capable of discouraging people from seeking a
cure for mental illness since they are still being regarded as abnormal even after a cure.
The discrimination is further reflected in a statement by a participant, which states that:
those who suffered from mental illness are hardly given leadership positions.
Based on the researcher’s observations, it was noticed that people who had mental conditions
can be hardly re-integrated and restored to normal social functioning even after the cure
due to discrimination. This calls for a serious intervention for social workers and other
agents of change to come into action and correct this anomaly.

TREATMENT OF MENTAL ILLNESS

Results from all the FGDs shows that most of the rural areas do not have facilities and
psychiatrists or social workers forthe treatment of mental illness.
One of the participants from Nasarawa south narrates the ordeal of his community thus:
we are not aware of any hospital that treat mental illness in our community. Most of
the clinics we have around only treat illnesses such as malaria, typhoid fever and
the rest. This leaves us with no alternatives than to patronize traditional doctors,
and it has been working out fine.
A traditional or witch doctor also states that:
There is hardly a time I will have no patients in my house to treat. Even if there
were hospitals around people will still patronize me because not all mental cases
can be treated in the hospital. When the situation is beyond us we also acknowledge
it and make referrals to more powerful doctors. But we only experience this when
the cause of the problem is not clearly identified.
The above account shows the level of patronage of witch doctors in treating mental
illness in most rural areas in Nigeria.
Another witch doctor in Nasarawa south states that:
majority of the patients who seek traditional treatment are those afflicted by some
spiritual forces usually regarded as evil spirits. We possess some supernatural
powers capable of warding off evil spirit that causes mental illness.
Cultural Perspectives and Attitudes toward Mental Health in Nigeria… 163

However, further findings shows that there are cases where individuals violate some taboos
and are made mad by the gods. This situation can only be remedied by appeasing the gods or
after serving punishment.
Another result shows that:
some persons who become mentally ill by virtue of an offence against the gods
hardly survive it. They suffer till death. This makes families of such person not to
even attempt seeking cure for him/her.
Most of the participants in all the FGDs were of the view that the perceived cause of the
mental condition of an individual determines the kind of treatment he/she receives. This
is reflected in a statement made by a Mada participant from Nasarawa state:
if the mental condition of the individual has some spiritual connection, then the
individual seeks a spiritual healing. Otherwise he/she seeks for psychiatric attention
which is mostly found in urban centres only.
The majority of the participants who had their relations or knew anyone treated of mental
illness consulted traditional healers. This is because they believed in the efficacy of the
traditional healers.
Participants in their discussions on care-giving were of the view that it is difficult caring
for the mentally ill person. According to a participant:
if the person becomes aggressive we tie him/her so that he/she does not harm anyone.
Another participant from zone B in Benue state was of the view that:
sometimes the mentally ill persons are allowed to roam the street and fend for
themselves if their conditions is unresponsive to treatments.
This is an indication that it is difficult caring for the mentally ill in most rural areas in
Nigeria. This can explain why there are so many mentally ill people all over the streets in
Nigeria, especially the northern part of the country and many other African countries. The
researcher also noticed the presence of mentally ill persons in most communities where
the FGDs were held. This implies that serious attention has not been given to care for
mentally ill persons.

CONCLUSION
Considering the findings on the belief systems and attitudes of the people, social workers
are seriously at a crossroad on how to help persons who are mentally ill. This is due to
the fact that the belief system of the people and their attitudes already place a barrier for
the social worker to render any assistance, since their problems are mostly given some
spiritual interpretations. Besides, the greatest of all the barriers is that there are no social
workers found in most health centres in Nigeria, except in major hospitals located in
urban areas. The dilemma confronting social workers assisting mentally ill individuals in
Nigeria is predicated on the fact that most health centres do not have provision for them to
164 Social Work Practice in Mental Health: Cross-Cultural Perspectives

assist mentally ill individuals. In addition to that, the absence of psychiatric services in these
areas has even compounded the problem more. This makes it appear as if social workers
do not have any role to play in helping mentally ill people in Nigeria. This is the dilemma.

RECOMMENDATIONS
Unfortunately, mental health care services are not available in most parts of Nigeria and
other rural African societies. This requires urgent steps for international agencies working
in the area of mental health to intervene in developing societies like Nigeria in order to help
rectifythe situation.
There is a need for treatment options for people suffering from severe mental disorders to
be made available to people, preferably within the general health care facilities in local
communities in a subsidised or affordable way. This will to some extent discourage them
from holding onto their belief system which may not be compatible to the treatment of
mental illness.
Beside, in many low- and middle-income communities in Nigeria the high cost of psychiatric
treatment, often due to high medication prices, poses significant financial barriers to patient
care. Considering the high level of poverty in the country, many families cannot afford
psychiatric treatment and therefore traditional healers are their only option. The few
available psychiatric clinics are concentrated in urban centres thereby leaving rural areas
without psychiatric services. This has served as a barrier to the effective accessibility of
mental health services in most part of Nigeria. This paper therefore recommends
decentralisation of mental health care services from urban areas down to rural health centres
where mental health services can be rendered with psychiatric services as well. In
addition, there is need to train and post social workers to rural areas. This will create an
enabling environment for social workers to effectively help the mentally afflicted.
More research is needed into the traditional healing process of mental illness in order to
compliment the orthodox method. Since people believe in this traditional medicine, there
is a need to improve on the process of curing mental illness by inculcating some scientific
method in it in order to make it safer.
There is also a need to introduce community-based mental health care programs.
Community-based programmes with proper management and sufficient funding may
deliver better patient outcomes than institutionalised care considering its closeness to the
people and the link it may have with their belief systems.
Finally, there is a need for community education of the people on the causes of mental
illness. It is due to ignorance that most people wrongly believe that mental illness must have
some spiritual undertone. This belief misleads them into either resigning to their fate or
seeking for help in the wrong place. The people need to know the causes of mental illness,
and where to seek for assistance.
 Cultural Perspectives and Attitudes toward Mental Health in Nigeria… 165

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