I’m sitting in the psychiatric department of the General Hospital in Broad Street, Lagos, waiting to meet 23 year old writer, Sageera Magaji*. It’s a hot Tuesday evening, and Sageera, dressed in a grey sweatshirt and a black peplum skirt, steps out of one of the offices holding a plastic hand fan.
She pulls up a plastic chair from a corner and joins me in the waiting area. Every Tuesday for the past three months, Sageera has come here to visit a psychiatrist and a psychotherapist, a schedule she began after being diagnosed with post-traumatic stress disorder (PTSD) and mixed anxiety-depressive disorder (MADD).
PTSD is a mental health condition set off by a traumatic event; it comes with fear, anxiety, and nightmares that can manifest immediately after the experience or after many years. MADD is a condition where the individual suffers from anxiety and depression in almost equal proportions.
Sageera’s mental health struggles started in 2013 while she was studying for a degree in Media and Communication. Growing up, she had minor panic attacks but dismissed them and only started paying attention in her second year in University, when the symptoms became more pronounced.
She says she was 15 when she had her first panic attack. “I remember that my dad had just bought me a new phone. I was playing with the phone in the living room when I thought I heard something fall in the kitchen,” she says. “I got so scared my heart was pounding. It was not the usual panic of thinking someone was in my house; I felt overwhelming anxiety like I was going crazy,” Sageera finishes.
She told her parents about the incident, but like her, they had no understanding of panic attacks. “We dismissed it. My mum still makes jokes about it; she says things like ‘Sageera almost died because there was a rat in our kitchen’. It’s funny,” she smiles.
University was tough for Sageera as she found it hard to focus, and according to her, reading was a problem, too. “I also struggled with low self-esteem and a lot of the time I could not sleep at night.”
But the toughest part was living in the same building with her ex-boyfriend. “He used to drink a lot. It began with him throwing things at me and graduated to rape,” Sageera says. She ended the relationship after the abuse but had to put up with seeing him almost every week after that. “He lived in the same building with me then so seeing his face every week after the incident was a nightmare, I had constant flashbacks,” she says, hugging her hand fan.
Sexual abuse survivors are more susceptible to mental health problems, particularly if the assault is never resolved. Rape creates anxiety as survivors fear the attack will happen again, and in some cases, develop a distrust of men who look like their abuser. “I was scared of talking to men because I feared I’d be abused again,” Sageera confesses.
As she struggled, Sageera realised there were not many people she could talk to about how she felt. Many Nigerians have misconceptions about mental health and people who show visible signs of mental illnesses are stigmatised. “I remember talking to one of my closest friends at the time. I told him about my frequent bouts of sadness, and he said I just needed to seek God as the devil was slipping into my life,” she says, and I can sense the anger in her voice.
“I didn’t expect my feelings to be dismissed like that. His words really hurt me,” she says, more calmly. After that, she hesitated telling other people about her debilitating mental health, even her parents. “We’d never really been close, so I didn’t know how to bring up the nightmares,” she adds.
So Sageera suffered in silence with her mental health issues until she went for NYSC in Oyo State, and a friend at camp noticed her mood swings and encouraged her to see a psychiatrist. “I was surprised. I knew something was wrong with me but seeing a psychiatrist never crossed my mind. All that education and I could not deduce that I needed to speak to a mental health practitioner,” she says, with a slight chuckle.
But there aren’t many professionals trained in mental health care in Nigeria. A country with over 180 million people barely has 250 psychiatrists and 10 federally funded psychiatric hospitals.
Eventually, Sageera found a psychiatrist and got her diagnosis. However, she did not make an appointment to consistently see one like she currently does till she moved to Lagos earlier this year.
As Sageera and I talk, she confesses that people still judge her. “The moment someone finds out I have PTSD they start to question my faith in God or make jokes about my condition”. She believes that the key to combating prevailing attitudes towards mental illness is creating awareness of these illnesses.
Most of the negative perceptions of mental health exist because people link the symptoms of some mental health disorders with violence or assume that all mental illnesses are alike. A psychotic person, for example, will occasionally hallucinate and may become aggressive, and society’s response has been to tag every mentally ill person as aggressive or delusional.
And, in Nigeria, anything that is hard to explain—like mental illness—is quickly deemed to be spiritual.
In the past, people with mental health challenges were abandoned, restrained and even killed. These stories shape people’s attitudes and have had a huge impact on the (non)acceptance of people suffering from mental health problems in Nigeria.
However, things are slowly changing as organisations like She Writes Woman (SWW) and Mentally Aware Nigeria Initiative (MANI) are working to give people with mental illnesses, like Sageera, all the support they need. Both organisations focus on creating awareness of mental health and connecting sufferers with mental health professionals.
SWW runs safe place, a support group for women with mental health issues. Under safe place, women are given a chance to speak freely about their experiences without stigma. The organisation also launched the first 24/7 mental health crisis helpline in the country, which has already helped over 200 people in suicide prevention and mental health first aid.
Like She Writes Woman, MANI runs a suicide prevention and mental health support hotline, and for the past two years, the organisation has offered mental health screening tools.
But such groups and initiatives are hindered by the absence of effective policy. In 2013, Nigeria’s National Mental Health Policy was reintroduced to the National Assembly. The policy sets standards for psychiatric treatment in the country, ensures access to treatment for those with mental illnesses, and discourages stigma.
It has not yet been implemented.
Zorbari Nwikobe, a student at the University of Port Harcourt and member of MANI believes that if advocacy reaches the people that occupy positions in government, policies are likely to be better implemented. “It is not just about societal attitudes. Lawmakers have a role to play,” she says, arguing that Nigerian lawmakers are also products of generations of misinformed narratives about mental health and need to educate themselves before any reform will go through.
She concludes that more people need to join the mental health advocacy brigade for things to change, whether through word-of-mouth, social media, or traditional campaigns.
Sageera agrees with Zorbari, and as we wrap up our conversation, she reminds me of the importance of being aware. “If I had known in university that everything I was going through had to do with my mental health, I would have sought treatment earlier,” she sighs. “People need to know; they need to be better informed.”
As our conversation ends, I study Sageera as she returns her chair to its corner. I wonder how many people there are out there that, like she used to, have no idea they are suffering from mental health problems. As Sageera strides away confidently, I smile for the first time. There is help out here.
*Name changed to protect her identity