 Yes, it is another nice evening that God has given us. Thank you so much for those who have made it possible to be here physically. Those who have joined online, you are most welcome and you've already been welcomed. I am happy to be here once again. And before we continue, shall we pray? Gracious loving Father, God of Gods and King of Kings, give of life. We lift your name high. We adore you and honor you for who you are. Recognizing that Father, this nothing takes you by surprise. You knew even that you will be here. You are all powerful and always present. Father, as we start, we welcome you. Forgive us any iniquity, transgression and sin that we have committed, which will make you know to come in with us. And my Father, we may start with you until we finish. Thank you because you have accepted. In Jesus' name we pray. Amen. Yes, I'm glad again to join, to be in front of you, to be able to continue with our series on mental health. And if you are joining us for the first time, indeed you have missed that bit and it might disorient you a bit, but I believe that you'll be able to know where we are. I had said that I'm not making health a psychiatrist or mental health experts, but I just want to make, I want just to create a population, a critical mass that is aware of mental health issues. I say that at least if you don't know anything, please know that the mind exists. And once you are aware of it, just accept because for a very long time people have been thinking it's a myth and once you are actually allowed to accept, then take action for yourself and even to help those who are around you. So we have already come a long way. We started by appreciating the mind and we started by first understanding why we have to emphasize on mental health and we realized that indeed is one dimension that is said in the WHO definition of health. So if you are not having that state of the mind that is acceptable, then it means you are not healthy. So because it says it's not just a mere absence of disease, but the state in which you are physically, mentally and socially well-being. We also tried to understand and appreciate the difference between the brain and the mind and I believe that we are able to appreciate why diseases of the mind cannot be diagnosed using the conventional investigations like the MRI, the blood, whatever name it. That it is actually a software that is diagnosed in what we called a syndromic approach and we use signs and symptoms. And therefore today we are going to pick a few signs and symptoms. Sorry, before that we are looking at the causes of mental disorders. Just the same way we look for causes of physical illnesses. The diseases of the mind also have got their causes. And if you look carefully, they could actually be almost the same, but of course there will be just slight differences. The first one which we know, the genetics, this is what you don't choose because nobody chooses where to be born and who to give birth to you. I don't think there is anybody who just, when, where to be born, but the Lord himself decided that this will be your parents and this is what they have. So many times we come up with a package that we are given for our parents or our lineage. And therefore genetics, we are talking about issues that are beyond us, but we find that we have been born with. And this is where I always say that sometimes we make a mistake whereby we condemn somebody that you know what, you are a Christian, you are a what and why are you having depression? Excuse me, it's like asking why were you born with this particular problem? The person will not have an answer. Genes, we are talking about some diseases which are actually running in families because of the genes and the hereditary, what we call hereditary. Some of these ones, especially the ones we always point our fingers, schizophrenia, it has been demonstrated that it runs in families. Some anxiety disorders, I think I said it before, and depression whereby depression has got two types. We have the social and this social is one which is hereditary or it runs in families and there is nothing you can do about it. It is not about how much peace you have, it is not about how much money you have and how much of a Christian you are. It is something that you are carrying in your genes and for sure they will express themselves. So, brothers and sisters, when you see somebody struggling, don't ask, is it your husband who is really causing you to have this depression? Please understand that sometimes the course may not necessarily be secondary. So, those which are related with the genetics are the ones we cannot... Did you know that even we have genes of alcoholism? Some people may not believe it. Yes, there are people who are born with that gene, what does it mean? 15% of the population, by the way, have got that disease, that gene of alcoholism, which is also, as you can see, substance abuse, as a cause of mental illness. If this person has a gene of alcoholism and he doesn't touch the alcohol, you will never know that that gene is there. But the moment they touch the alcohol, then of course it will show itself because you will easily be addicted. You will not be the person who will decide, I want to be a social drinker, I will go and take my two beers and go back. When others are saying two is enough, you will just say bring more. Why? Because it is beyond your control. The only way that you can be saved. And even when we re-abritish them, we always tell them it is all or nothing. You either stop completely, not about reducing. Those are hereditary diseases, the causes of mental diseases. We have the environmental, that is the surrounding factors like stress, pollution and social interactions. And of course these are the majority. If I have time, I will actually deal with stress as one of the key prevention of mental diseases. Stress is good, but also stress can be very bad if we are not managing it well. So, what are these environment that causes? Secondly, depression actually has a lot to do with the environmental factors. Sometimes we are working very stressful work, difficult bosses, at place of work you are not understood well and a lot of it at home, the griefs that we go through. By the way, let me ask you, how many of us have ever imagined that when a child has lost maybe a parent or a sibling they need to be assisted in terms of counselling? Every time I ask those ones, it is assumed that children have no problem. By the way, we have also mental health disorders that affect children. But then these environmental factors, sometimes we are so hard on our children we call them names and those ones stick, which end up causing mental diseases to these children. Imagine one time I was dealing with one guy and he is really into substance abuse and very difficult and he says, you know what? I have suffered trauma, trauma. What is it that trauma? Then he asked, he told me, you know, it was not, it was not of what coming. He said, Dr. D, if your father tells you what you are carrying his feces and not the brain, how do you imagine? What would the feces do? That is why I am acting the way I am acting. Hello? There are some words which we speak without knowing. And of course somebody says, when you tell your child you are stupid. Now who is stupid? Because this child came from you. Anyway, some of those factors are the ones which, even though they are not well negotiated, they are even going to affect some of the diseases we saw, like eating disorders. Remember I said it is especially in culture where people adore slimness and all that and therefore when a child is fat, you say chakunono and that is not taken well with the mind. It ends up with various diseases of the mind. Many other things, social dynamics, how do you interact with the social enemy? There are some people as we saw yesterday with personality disorders which are uncomfortable, which are not welcoming to the society. How they relate? Then it means you are either going to affect the person interacting with you because of the environmental or even you yourself who has that kind of personality. Those are the social interactions and of course the issues of even the social class comes in and how you have taken it. I remember one time I was talking to a young man who was conversing and when I discussed with him it is just about what he sees other people having in school vis-à-vis what he has. And you know he is not able to appreciate that people don't come from the same social status. Substance abuse, the drug misuse wasn't and sometimes needs to poor mental health. This one is not leading. They actually cause any type of mental diseases that we saw, the types of mental disorders that we saw yesterday, the other day that substance use or misuse can induce any of the mental health disorders. Starting from mood disorders you can have substance induced mood disorders, substance induced anxiety disorders, substance induced somatiform disorders and all that we talked about including sexual disorders and even sometimes eating disorders. So when you are looking at substance abuse especially the psychotic form where I started my mental health practice in western in a ward that called ward 9, those who come from Kaka-Mega one time I had patients in that ward 75% were coming from one area and you know I was curious to find out why. I don't want to say the place but you see they look one at another and say the way you are actually you were taking that thing, that is bangi, I knew we land here. You see they were taking and they could identify themselves. 75% of them was as a result of actually the use of bangi and they were coming from an area where it is acceptable. Those from western I think I can see them smiling so they know the place I'm talking about. So they have, they come with psychosis, others come with mania, others come with depression, everything. Substance abuse can cause all the mental health and including especially the alcohol invariably causes depression and that is why you find very difficult people not able to come out of it because unless you treat what has been induced it is difficult. You take somebody into rehabilitation they will come back and they will go because there is still something that has been induced by that substance that you have not addressed. Medical conditions I think I mentioned this what do I mean? Mental health conditions can actually come as a result of some diseases that have actually affected people for a very long time. Unfortunately it doesn't only even affect the person who is suffering it also affects the caregivers and those who are actually in that for example in that family. And I think you've seen that somebody has been on treatment maybe for example diabetes but it is a point and then people are saying nowadays so and so has really changed. He's very irritable, the temperament has changed or he's very very low, even the appetite has gone, he doesn't sleep nowadays. Please think about the mind think about what this disease now has actually caused and sometimes these diseases they become worse because you have not addressed the connection. Remember we talked about the mind-body connection. We are struggling trying to adjust maybe it is the dosages for insulin and all those things but we are forgetting that there's an area that this person is also part of it which you have not addressed. And you realize that maybe when this person is given nice medication you address their depression, you address their anxiety then even the sugars comes down without necessarily even adjusting the doses. So medical conditions and this can be any medical condition especially which is we have heard about even cerebral malaria, it's because of malaria and you find somebody actually behaving with mental health signs and symptoms. We have what we call trauma and this is real. This is the end thing nowadays and we don't understand. I'm not talking about trauma from head injury. I'm not talking about trauma because you have broken your leg, yes it might be associated but I'm talking about psychological trauma. Somebody said that sometimes it is better if somebody was to actually hit you, slap you or do whatever than actually psychologically torturing or traumatizing you. Psychological trauma come as a result of the traumatic events that people go through in life and sometimes they not negotiate well. What are some of the traumas? They can be physical, they can be psychological. Physical assault. Sometimes we have violent relationships which touches not only on couples but it also spreads to the children. Sometimes apart from the physical injuries that we see this trauma as a result of that psychological could be actually more than what you are seeing. When you see this eye which is swollen and red there is more beyond that. Another trauma we talk about is actually like sexual traumas and I did a thesis on this. I was looking at psychiatric mobility among the sexually abused, you know the sexual survivors and I realized actually it was 74% despite the fact that there is a lot of counseling and interventions that has taken place. So psychological traumas are real. Some of the traumas may show much much later and you may not be able to explain why somebody is behaving like that at that time. I have shared this before that there is a girl at 13 years, I don't know whether it's here that I said that it was actually punished, corporal punishment by her teacher in class 2 and when she was in class 8 she started having convulsions which were not being controlled by her teacher and convulsions and they tried she had gone from hospital and many doctors they could not actually see the course. So when she came to me all I said was I know your problem and she said few, finally there is somebody who understands what I am going through and she poured to me what that teacher was doing and for the first time ladies who are here the mother was able to see the marks where that girl was being beaten inside there inside the thighs and she had never known and of course when this child was home she was being told that you are refusing to go to school so she is taken back so she kept it, it came to show in convulsions. That is trauma what happens when we have losses? That is also psychological trauma. Many a times we try to be very tough especially I think you have seen people who played very tough for example in funerals later on those guys we actually died because of psychological trauma because of the loss then those people were able to grieve and sometimes we refer them as pathological grief as one of the traumas there are many many other traumas it starts from just those abusive to manipulation remember the personality disorders we talked about those who go through that there is a time that they would actually suffer from a mental illness of one or the other type psychological traumas then the next one is endocrine imbalances in frances or mental conditions this can cause and I think we are aware of things like those in the medical tuberculosis postpartum depression it's because of the changes in hormones related to pregnancy some hormones like cortisol actually determines so much on the mental status of people and therefore when there is a problem you are likely to have mental mental illnesses. The other hormones thyroid hormones when you have low thyroid hormone we call the hypothyroidism majority of the patients will present with depression and that is now what we call secondly but now it is related to the hormones the various glands that we have if the hormones there is an imbalance it is likely also to be to be shown in the mental status. By the way there are many and these are just by the way and just to really emphasize that you cannot sometimes label a cause in a mental disorder but it is a question of maybe putting them together. I have had some challenges where somebody comes and is having mental disorders but there is nothing to do with you know you cannot relate to the mind case in mind one of the young girls who had been you know I am talking about who had been you know there is a way you socialize people and you are putting the people's minds that they are people when they look at you you are likely to be you know they bewitch you. So this girl there is an old lady and from where I come from you know what is happening with old guys and what they are associated with. So this grandma everybody talked about she is a witch. So one day this lady meets the lady and she says hi grandma and of course the lady might have said hi and she didn't hear so according to her she kept quiet meaning she was not happy with her and when she went ahead so she started hearing that lady talking in herself the cause of mental illness. Now which one is that so from there she started collapsing so whenever she can't even eat you try to put something she collapses and you see what happened you can guess what happened to the two families they could come to hospital and they are looking at each other and like you know you are the cause the other one looks you know you are the cause and I listen to them I said which kind of witchcraft is this and I said this is a mental disorder they said no no no no and the girl was convinced and he says I want to talk to you doctor you know my problem started this and this time and this is what happened I smiled and I said no this is a problem of the mind said how and because where it was not easy I used what you call easy time I would explain and the girl worked well so I sat down and they said I am not a witch doctor what happened I didn't remove any witchcraft from her causes of mental illness can be so diverse and because many at times we don't want to appreciate we will always have something to blame I am here today if you cannot take anything home please appreciate that the mind can be sick and there is a reason why it is sick so it is not about witchcraft it is not about demons it is not about many other you know the myths and misconceptions I am here to affirm that the mind can also be diseases and we can trace the cause and treat it let me talk about those myths and misconceptions because many of us believe that there are no causes we are very fast in telling these people you don't have to take medication that's why I am emphasizing that there are causes and by the way when we are giving you medicine it is because we know that you will benefit from it so some people especially and with all the respect with my colleagues please don't tell them stop the medicine I don't think you are still sick and that is very common with the medical fraternity there are causes and we are treating the causes when give you medication may God help us so that even as we continue learning more about mental health issues today let us also appreciate that when you are given whatever to treat whatever medication to take please take it I am saying this with a lot of pain that one time I have given a patient medications which was helping a lot and you know it was because of substance induced problem and a colleague of mine the mother decides no now you are okay the guy was doing very well and had stopped actually drinking for 8 months what was supporting that is because I was addressing the underlying problem remember what had been caused causes of mental illness and at the time it was too much for this guy he said now that mommy has said that everybody has said that I am well let me stop the medicine with no reference to the doctor and they stopped and after 2 months he was back the guy was never brought back to normal until many many years I am saying a practical it was after again I say I told them we must go back to the drawing board and start treatment we started the treatment the young man was in the rear and you know the other day was smiling and you know what I have gone beyond where I had gone the 8 months clean why because he is taking his medications well because I insisted and told him now you are the one we seek not your mother not your father now listen to me we will work with you please mental health issues are real they have a course and they can be treated discussed and appreciate and as we continually get aware of these issues accept that they exist and do what and be able to take charge by taking action and please don't take a negative action by discouraging them and by condemning them and telling them you can do better you know you are a Christian please try lead them to where they can find help may God bless you