 Yes, good evening all of you, those present here and our viewers, the online viewers, I'm glad to be here once again. I can see this topic is a nice one, people have come and I want to take this opportunity to sincerely thank those who gave feedback from yesterday's. It was just a foundation and I hope that those of us who watched yesterday, we are going to continue from where we left. We are looking at a mind, mental health as part of the family life. I just want to start by saying that indeed yesterday we were able to see how closely the mental health, your state of the mind is related to the state of your family. Let me put it like that. Many at times, yes, we know that the mind really inferences a lot and yesterday I said that we will be looking at why mental health is so important and why mental health, why your mind needs to be healthy even for the gospel. Allow me to whisper prayer. Precious Father God of Words and King of Kings, we lift your name high and adoy you. Thank you for bringing this topic within the midst of the family life. In a way that Lord your people may be aware, they may accept and act because for a very long time we have not been knowing and understanding the role of our minds in all that we do. As we start, we welcome your presence, start with us until we finish. In Jesus' name we pray. Amen. Sometimes the Bible refers the mind as the mind and sometimes also the Bible refers the mind when it's trying, actually it implies the mind when it's talking about the heart. But in the book of Matthew 22 verse 37, when Christ is actually summarizing the law, He puts it into two, which I know is the relationship between man and man and the relationship between God and man in the Ten Commandments. He says that love your God with all your heart, with all your soul, and he uses the mind. Very, very explicit. You cannot love God with all your mind if your mind is not okay, no wonder then the church. And I really want to appreciate that we are actually trying to appreciate the role of the mind even in our salvation, even in our work with our God and even in this journey of hope. So as we look at the hope for families, that hope will make sense once we understand our minds and the role it plays. Yesterday we looked generally, we tried to demystify what the mind is and we realized that many times when we talk about the issues of the mind or the source of the mind we have always thought about madness and it is not equivalent. At least those who were here, we were able to understand where the mind is and what it is. I say the mind is not just something that does not exist. It exists and I use the analogy of the computer which has got two parts, the hardware and the software. And we realized that the mind is actually the software of the brain and as the computer cannot be a computer until there is a software that is exactly who we are. Physically we cannot really say we are human beings or we are living souls without looking at our mind. And as yesterday I promised, we really want to see why is it so important that we understand and appreciate the role of the mind in our lives. I know many of us may not have appreciated what actually the functions or the functions of the mind, if I may call it like that, until you realize that you are nothing but what actually the mind is. And I said, I want to start by saying that many times as I will be going through this, the role of the mind and what it controls, you will be surprised that that will also be touching on actually how you find or you will know the signs and symptoms or mental disorders or mental illnesses. At the same time it is going to tell us in that part of awareness that oh we can actually pick some of these changes in behavior, changes in all that we will be looking at the aspects and therefore if I can't do anything and if I can be able to help you, be able to know when you are spouse, when you are child, when your friend is looking or appearing differently to the extent that you can be able to help them, then I will have done something, I will have done justice. Yes, now many times as I said that we do not diagnose mental disorders or mental illnesses in the laboratory or in X-ray, our diagnosis mainly actually based on what you call the mental status examination. And we are looking at the mental status, we want to understand how is your mind in the various aspect and that is what I am going to look at. As you enter my room, even when you are coming to greet me, many times people say psychiatrist read you from inside out. So when I look at you like this, your appearance tells me a bit of it, it will tell me whether you are actually okay in your mind, I will be looking at your smiles, I will be looking at how you have dressed, I will be looking at your demeanor in general and it will be able to give me whether we are okay. In appearance we look a lot, we say a lot, yaan we say a lot. There is a state where you find somebody is so restless that you are just pacing up and down. And in the appearance as you look at somebody, there are those who will actually avoid eye contact, it tells you a lot about what is going on in that person. Sometimes when I teach about substance abuse and we talk about how one can pick change of behavior, you start by looking and therefore what am I trying to say? No your people, no your spouse, no your child, no your friend so that when things are changing even if they appear you are able to help and say my friend, I have been with you for so many years but something is actually happening even the way you appear. There are people who will be very confident and all of a sudden you find even that confidence of theirs has gone. You start wondering what has happened and of course there is a way we sometimes label people in terms of all is the company and all that. But I want to tell you that we can be able to pick these signs of a problem with the mind if we are keen by looking at how people appear. But many times we are so busy to even be able to appreciate how somebody is appearing. And you by the way for example in a family you find children can actually change completely, go wayward and nobody has noticed why we have not been keeping keen on how they actually appear. So in this appearance sometimes we actually look at people appearing bizarre. You know you look at the person is actually doing a few things maybe moving their hands and you have seen some people actually walking when they are a little throwing their hands and everything. That is how they appear and it will tell you something has changed. So I am praying that at the end of this week that we be able to actually pick them up of these things and we be able to say so and so for my friend, my child, my neighbor has actually changed in terms of even the way they appear. So that is how you look at them and therefore the mind controls our appearance which has got many aspects. The second very important thing that our mind controls is the speech. The speech can be altered because of the mind that has changed. How? Sometimes you find people speaking so fast we call it pressure of speech. People will talk non stop. You will say this is not normal. It is the mind that controls that speech. The problem is not with the mouth. It is not with the muscles of the tongue. It is somewhere. It is coming from somewhere. So don't tell that person to stop because they can't stop on their own. And sometimes on the extreme you find somebody who has been okay has what we call poverty of speech. They can't talk. You ask them they have what we call monosyllabic kind of language. They can only say yes, no, oh you see they are just one word at a time. That also should ring a bell in you that this is different from the way this particular person has been speaking. So in the speech you can have the extreme where somebody has pressure of speech. They speak non stop and I think you have seen this one in a condition we call mania. And then or in depression people tend to be slow in speech. Even when they are talking they just see like you are really disturbing them. What is your problem? Just leave me alone. I want to talk. And because of that sometimes they actually want to stay alone. They lock themselves in the rooms. They don't want to be disturbed. And somebody they say ataki kusumbuliwa, no, there is a problem. That is one of the things that we need to do. We need to pick. So speech usually we know how we speak and if we are keen then we can be able to see when somebody's speech changes. And that should ring a bell in you. Sometimes as you appear I say it about their contact. Many people when they are suffering from the like maybe stressful, depression and other disorders. They would actually not want to even look at somebody. If somebody has what you call pathological grief. This is somebody who actually has what you call sometimes young people are calling balancing tears. They may not want to look at you because when they look at you they might actually start crying. So they will avoid the eye contact. Somebody with an unsteady mind will not want to interact because many times they have what you call avoid the kind of personality. They really want to be left alone. It is a good thing to be left alone but not when it is a condition. So when we look at that then we are likely to pick that appearance of the person. There is another aspect where in terms of motor activity somebody is not settled in one place. You look at somebody is here, they want to be here, they want to be always and yet it is not like they are really going to do anything meaningful. Even when they are seated they will always be changing. There is a lot of reach around them. That is not normal. Then the problem is not about the legs to tell them to stop. The problem is coming from the mind and that is how we actually diagnose. Another aspect that the mind controls so much is what you call mood. I am not talking about where we talk casually. I am not in the moods. I am talking about significant change in somebody's mood to the extent that it is clinically important. What are we talking about? You and me the way we are, I am not very sure that it is all of us. In a normal way we are what we call euthemic mood where you appropriately respond to the environment as it calls. When people are sad you become sad. When people are happy you become happy. But in a state where you find somebody is so low in terms of regardless of the jokes you made. It means that there is a problem without the mood and that one we call it the low mood where nothing excites this person. Nothing really is important and of course the accompaniment of this low mood is a place where somebody works with a lot of guilt, a lot of hopelessness and generally inside they are very very sad. That is the change of mood. In other words in the other extreme you can have what we call expansile mood or rather elated mood where somebody is happy regardless of the negative environment that is at that person. In this one you find somebody so excited full of energy he loves or she loves and that doctor is most of the time infectious. You will find yourself laughing with the person even without knowing why you are laughing because they are very excited. They are not being moved but they are actually from the mind. The mind is the one which has that in it. Sometimes you get what you call the mood can be very irritative. Somebody say that now it is so irritable. Yes, it is irritable because things have changed. And if you have been very keen for example with your partner you will be able to note and say this one I think I have seen a change even in their moods because the mood is a function of the mind. This mind can be affected even when you have for example having physical illnesses and of course that is the connection you will be looking at. There is a very close connection between the mind and the body such that when one is sick the other one cannot be well at all. Sometimes irritability can come because of the physical illnesses but many at times it is associated with the changes in the mind and more so when we have not slept well. Sleeping is one of the early signs we will be looking at that will always raise an eyebrow that is always not well in your mind. How else can you find a mood change? The mood can change into a depressed mood which I have talked about. A depressed mood which is usually a sign of depression and as I said the mood is so low that no amount of excitement does not change this person. And sometimes this is what is most of the time noticed in people with depression or with some mental illnesses and this can cut across all the other disorders. We will be looking at the types of mental disorders that we see and you find that honestly the mood is controlled by the mind. The state of the mind can be diagnosed through the mood that is what we use. The other aspects that are so key in the mind is what you call cognition. Cognition this is the cognitive function of the mind or the brain and it has mainly four aspects one of it is orientation. What does it mean? Many at times when somebody has a problem with the mind or mental disorder the person does not know whether it is morning or evening so the person is just oriented in time. The person may not be able to recognize somebody when the person they have always known and therefore they are disoriented in person. If it is in the hospital you expect the person in a normal mind in a state of mind that is what you call normal somebody can be able to say this is a nurse depending on how they are dressed. You remember that but if you ask when the mind is not okay this person might tell you that one looks like an accountant because they don't know because at least they are those like in uniform. When you talk about the place many at times people are disoriented when the minds are not okay people may not know where they are. They might give you a totally different answer when you are asking do you know where you are? Yes I know where are you but I am in my home and this person could be in the hospital, could be in the market, could be somewhere else. So that is another aspect of what the mind controls orientation. People and that one you can also refer to it a person gets confusion. The confusion is a result of a sick mind and therefore we assess that and it is able to tell us the severity or even the condition that the patient is presenting with. Now in terms of that stellar orientation you may find that people may have a problem identifying objects because they are not able to associate the object with what it is. Now the other aspect that is in cognitive function is the memory. Many of us talk about nowadays I forget a lot. Sometimes when you have for example severe stress many times memory may fail you. You might find that whatever you use to recall so easily it is becoming very difficult to remember. And this one of course we have the aspects of memory which is the immediate, the remote and the long term. We find that in mental disorders or when the mind is not okay you have problems with this memory and depending on which kind, which disorder some actually have the immediate one have the long term and the other one have the short term. And that one we are able to actually understand what the problem is in the mind. At the same time the memory can actually come because of age. So don't always imagine that this when the age when somebody is very old and is able to forget one, two, three. Don't always imagine that the person has a mental disorder. Yes age can actually affect memory in some way and also this memory can also be affected by a medical condition. But in that one is because the medical condition can easily also cause a mental disorder. There is a disease called dementia which is a mental disorder mostly for old age. But it can also come in young people depending on the problems they have had especially even in substance abuse. And therefore one of the characteristics of dementia is memory problems. The other aspect in the cognitive function is what we call the judgment. And the judgment rather sorry affect where an affect is when you how you respond. For example a situation where you are supposed to be excited you actually you are flat or you are indifferent or you inappropriately respond to that. What is expected in your mood. The other aspects of the mind is what we call perception. And this is usually one of the signs that at least even a layman has been able to pick when things are not so well. When people talk about hallucinations perception is a function of the mind such that when you have a problem with the mind you are going to have a problem in terms of your senses five of them. And many of us say the person sees and hears things that are not there. Who told you they are not there. Those things are there as far as that person is concerned because they are real. And many times when we tell them no you are not seeing your own things the person will look at you and wonder what is your problem. I am actually seeing. I remember one time one man was getting sick and so when they are seated in the family setting he responds to questions that has not been asked. So the children looks at us and say daddy what is happening. And the wife is like and then he is so much annoyed they say what do you mean it's happening. You ask me a question when I ask you are telling me what is happening. And that is real because him is answering a question which he has had. But nobody asks a question. So when he was brought he said you know they are telling me that I am hearing things and they are the ones who are asking me questions. A friend of mine brought the brother and the brother was having those hallucinations. But this was all correlated. So as we were standing he started saying fire fire you know he sees himself burning. And then I tell him can you put it off and then he puts it off he puts until it is over and I say is it over yes. So the sister is like what is happening doctor I said yes there was fire he has put it off and it is over. What happens in perception when you have a problem with the mind because of the neurotransmitters. What we call it hallucinations is not seeing things which are not but it is a perception without a stimulus. If I was to raise my Bible for those of you who are sitting here you will see a Bible. Why have you seen a Bible? It's because the light has hit the Bible has come to you and your mind has interpreted that it is a Bible there and therefore you are able to say yes there is a Bible there. But when there is a problem with the mind in these perceptual disorders you perceive without a stimulus because this is a stimulus. And that is what you call hallucination. So please don't tell people that they are not seeing anything. Hello because they are isn't it respond to them. And this one also contributes to what we see some of these ones when it is so bad their behavior which we will be looking at the change of behavior is actually related to what the perceptual disorder they have. Many at times they will see you that you want actually you want to attack them and therefore they will fight you back before you hit them. And in this one some of them has caused people to cause harm for example asonimada and everything but because they were not in the stable mind. One guy we had in the hospital he woke up at night and he was having the hallucinations and we know back home we share beds so much. Now this is when we try so much to give each one his or her own bed but it is a tradition that people would share the brothers and others. So he woke up in the night they were staying with the brothers sleeping and because of the hallucination he saw a snake in the bed and obviously don't think that when somebody has a problem with the mind or perception that everything is lost. No he was able to know that if there is a snake I have to go for something and kill the snake and that is exactly what he did. So when he came he hid the snake and he killed the snake but you know what the snake was it was the brother. So it was real for him was killing the brother when we are telling you the snake. So the following morning of course he had killed and because of mother that is how he landed in Madara because when you do that there is a rule we call McNaughton's rule whereby if it is proved beyond that you committed that crime when you were insane then you are committed under what you call special category. So sometimes people can do things in self defense because of the state of their mind and that is what you call perceptual disorders that is how we assess them and the other one is what you call in the third disorders the thoughts. You know many times when I am teaching and sometimes I want to understand if people understand what the mind is always people say the mind is about thoughts. I said no thought is not equivalent to the mind but we have also the mind controlling the thoughts no wonder that people think that the mind is equivalent to thoughts. Yes it controls the thoughts and therefore the thoughts can be different when the mind is not okay. This is where we have what we call suicidal thoughts and ideations. We always ask this if all those who have committed or completed suicide. I am told nowadays we don't say committed suicide we say who have died from suicide because we are trying to destigmatize that. So they don't commit suicide they die from suicide hello are we together. So when those who have tried and maybe have not succeeded in valuably they have these thoughts we call them negative thoughts and they are usually not easily forthcoming. You must know how to ask and therefore you start from far as live been so meaningless that even you have no reason to continue living and they look at you and they say how did you know hello. And then they say sometimes have you tried to actually even actualize it and make it right and they tell you know some it is not a big deal they say yes I have done it three times I have done it but I have not succeeded. So those suicidal thoughts is a thought disorder that actually is controlled by the mind and therefore we assess that and this one many times will tell us the severity of the mental disorder. You can have suicidal thoughts in schizophrenia but they are very very common in depression and that doesn't mean that somebody is depressed is one who is so gloomy. Yes we talked about low mood but not every person has that low mood we can always fake and actually overcome that low mood because sometimes one is self aware. The other thing is under the thoughts are delitions. Delitions these are thoughts of sometimes of so much importance attached to yourself. In people with mania they are what you call delitions of grandeur. They will tell you they are the most important in fact they are the next presidents of the country and you know you look at them and say you have never even campaigned how are you going to become a president. They will always tell you in fact they have been sent to save the world because they are actually Christ and they mean that. I remember one of my patients was telling me you know these guys are very jealous of me they are talking about the brothers who have come. They are very jealous because they know I am a lawyer I am a doctor and you know they can't compete with me. So you know I was even in a relationship you saw me seeing patients now what you tell that person is actually a lawyer is a doctor and is everything and he feels big. Those are delitions of grandeur and you can have other delitions you can have thoughts of aggression you can have thoughts of all even in some thoughts that one may think that people are against them and therefore they want to secure a good place. And this is how you find people withdrawing from others and living in isolation. This is a problem of thought. The other thing that really controls our mind is now the whole body how you behave. You know sometimes we think we are behaving a certain way because of our physical and all that but that is the control that the mind is the one determines on how you are going to have. So this is how I want us to be aware. Let us understand our friends, our family members behavior so that when they change we are able to help them. And this behavior can be as valid as possible that one can decide to be overtly behaving abnormally. But then it is the small, small ones that I want you to note. When somebody who we have been engaging and relating very well gets easily annoyed and just walks away maybe in your discussion think about it. Just what has happened. Somebody who can not relate a few of the things that they have made and therefore they walk away, they will be done violent, they will be verbally violent. That is something to note. Behavior and the mental illness that might be the only presentation. I have a patient that we have worked with over 10 years now. He was just behavior change and people thought that he was just difficult in behavior. He married three times. The first wife left with two children and said no this is enough so she left. He married the next one and he said this one I can't. She left with one child and the guy looked at himself and said now what could be happening. He decided now to marry in church the third one but you know the behavior had not changed. So even that one said no enough is enough so he left. And when he came to my place there was a poster that we have written. Of course sometimes you read and look and say and I looked at it. This looks like me. This is how I feel. He didn't know that there was a problem. The three ladies not even pick it. So he came and asked is there a doctor who treats this. Is this a problem and is there a doctor who can treat this one. They will say yes she comes in the evening and when we started and I started on medication. And of course the problem was not the behavior. The problem was the mind. It changed and he was able to appreciate and said wow. This is why my family has not been working three times. When he became better. Now he had to reach out to the youngest. He said you know what. I have been told I was sick and I can appreciate I am sick because now I am better. The lady said no no no you are better good for you please continue. So and she actually even asked her to come and see me so that I can explain. But the lady said no what I saw I don't want again. But of course the man had changed because he had been treated. And when he came he came to me asked doctor now what do I do. Because even the first ones will not come they can't. And they told me of course now somebody who is a girlfriend who is my girlfriend. And they said fine what do you do go ahead and match that one. So the one who married him when he had been treated. They have been together for 10 years now. And they have three children and she has not left. Mental health is also treatable. It only takes a what a behavior to notice that all is not well. So many of us have ever associated even the problems we have in families to do with the mental health. None. We will always talk about difficult children. And by the way even those things Doctor Mutai will tell you the tantrums are actually part of the mind. This is of the mind. Children also have mental health issues when they are young. And the changes and the pressures that we have exposed our children with are likely to present in different ways. Now there is also what we call the bizarre behavior. And I think this is what most of us will pick. Bizarre behavior is abnormal. Where people are talking on the streets and themselves. When they are just behaving somebody comes and he goes to the toilet. And instead of going to the toilet he puts it aside and you go and you can say what is happening. You know those are bizarre behavior isn't it? And some will come you give them food if it is fruits even if it's an or and is it a lemon. I remember the guy that we were you give a lemon you eat everything. You know it doesn't even know that they are actually has those are bizarre behaviors. That is part of behavior change. And by the way they help they help. Did you know that majority of us miss out this behavior specially in substance abuse? They will definitely be changes in behavior once either a child or a spouse or whatever has started indulging in substance abuse. They will start avoiding you. They will always be locked in their rooms. They will always want to have perfumes and all those you know. This girl or this boy has never been so close and so excited about perfumes all of a sudden they have. Has it ever occurred to you to ask son how come nowadays you use perfume so much? Hello and they will brand on you and they will never see that. Let us be keen on behavior because it will tell us what is happening in our loved ones minds. There is another one that actually we call judgment. Judgment is decision making when somebody has a problem and I think you noted this. It starts as earlier as stressful situation even before the mental health disorder sets in. Somebody finds it very difficult to make decisions. Very indecisiveness in terms of you are told this is wrong. This is not right and then another person say no it is not wrong. So somebody is not independent. Difficult in decision making and of course the other aspect that I want to finish in speaking that we always miss is what you call concentration. Thank God that all of you are very keen. I believe both the online and those who are seated. When you see this child of yours dropping in class dropping in performance. What comes through your mind? He has joined the wrong company through all falls. Maybe I started drugs or something is not serious. Have you ever imagined that actually this could be a problem with the mind and the person and the boy or the girl is not concentrating in class and therefore he just goes down. I pray that you will be able to be aware of this so that we are more keen. One lady I talked to and whom I thought I said that I wish all of us could be like that. She was so keen. Whenever the children come from school is very keen what was your performance and everything. But from nowhere the children started dropping and she was like no. Instead of concluding that it could be maybe they are playing along a lot in school or some other company. She actually you know that was really very very strategic. She decided I want to go up to check professionally what's happening. And when the children were assessed there's what you call indigenous depression that runs in families. Maybe we have time I'll be talking about it. So the children were actually developing depression. And indeed they already had moderate to severe. And when they were assessed and they were treated and the graph just picked like this. These are things that we can control. Let us not demonize our children and always think the obvious that maybe the child plays a lot in school or whatever. Can you actually pick that one and if possible take the child to a professional to be able to assess. If there is nothing picked then we can be able now to look at the environment and say what is it. Is it that this child doesn't like the teacher and you know it is all about the mind. And if it is the school and whatever it is tell the mind. But what is important let us not be fast in actually concluding. Finally there is what we call the insight I talked about the mind controls whether the person knows whether he is sick or knows. I talked about the inside yesterday and the inside is that the person who is sick has no capacity to appreciate that the mind is unwell. And therefore it needs you and me to be able to appreciate to actually looking at all these aspects that the mind controls. And be able to say yes I can see a difference in this person in terms of the way nowadays appears. How do you use to be very neat they don't care anymore how their hair looks how even the dress looks you are just there. Some of the things the appearance and loss of interest they actually they avoid even going to gym. You know people were very keen in terms of you know keeping their weight so somebody doesn't care whether he's weighing a hundred or whatever. Those are the telltale signs that we need to pick and therefore when we find that our loved ones have an issue and they cannot be able to accept it is us to be able to accept on their behalf and take action. I think I want to thank you so much. Thank you the online viewers and thank you and I believe that we should be having a station for Q&A and if you have any question you can already tried I will always answer those who are watching online. You can always write it on the chart. May God bless you. Can we say thank you to God for being with us. Yes gracious father we thank you so much for the privilege of gathering here and the listening and understanding the role of the minds in our lives. Even Lord you tell us to love you with all our mind heart and soul. I pray that we may continually develop our health mind that will help us even this Christian work. Thank you because you've accepted in Jesus name we pray.