Fatima, a 15-year-old female secondary school student wrote a love letter to a male teacher to express her love for him. The teacher in question, took the letter to the school principal who then called an emergency school assembly where the girl was called out and her letter was read out to the entire assembly. She was then publicly punished, with jeers of derision from the other students. The young girl went home, weeping from the public humiliation she had received. In her mind, she will never live out the shame and humiliation and would never be able to raise her head in the school or the community ever again. Unfortunately, her parents were not at home when she got back. So, she bought rat poison, locked herself up in her room and in jested the poison. When she was discovered after some hours, she was still alive but she later died in the hospital.
Case 2: South West Nigeria
Tunde, a 4-year-old boy and student of an urban primary school started having seizures that went on for a few minutes. The teachers made a fire and put the boy’s feet over the fire, because they thought his epilepsy was caused by “ile tutu”, meaning ‘coldness of the ground’ according to a Yoruba mythology. The poor boy ended up with significant burns to the soles of both feet. His parents are contemplating legal action against the school but as these things go in Nigeria, it may soon end up a ‘family affair’. ‘They meant well’; ‘let’s just thank God the boy is alive’…..and then the case dies a natural death.
Case 3 South West Nigeria
Iya Tunji is a 65-year-old widow who lives alone in a rural community somewhere in south west Nigeria. Two of her 3 children are dead: one from complications of childbirth and the other from a road traffic accident a few years back. Rumours have been making the rounds that she is a witch and that she killed her husband and two of her children. For the past one year, she hardly comes out of her house neither does she interact with neighbours. Sometimes she comes out of her house crying and begging for forgiveness – even from random strangers on the street. This behavior did not sit well with the neighbours who then organized the youth and broke down her door in a bid to extract a full confession. The crowd demanded she tells them all her sins, and she duly obliged. She was responsible for her children’s death and for all the negative things that had happened in the village over the years, she said. That was all the evidence they needed to set upon her. She was beaten with sticks, clubs and stoned until she breathed her last. Her son reported to the police but they claimed it was a mob action and they could not hold any individual responsible. He was counselled to quietly bury his mother and leave the rest to God.
Case I: The avoidable suicide of this young girl is heart-breaking because it reveals such insensitivity by the teachers towards the developmental realities of adolescence. A phase of life that is characterized by feelings of insecurity, low self-esteem and fragile ego issues – where even the emergence of pimples on the face can be a major crisis that would make them want to hide from peers . It is also a very impressionable age when infatuations can and do occur; and should have been better managed by the school management. The humiliation meted out to this young girl was not only ignorant, but harsh and very cruel.
Case2: The pervasive ignorance about epilepsy is a recurring but very worrying theme. Sometimes, it is from other parents, or from the school. But it again highlights the need for health education (physical and mental health) for teachers in our schools.
Case 3: All over the world, women live longer than men. Secondly, depression is twice more common in women than men. It is also common in the elderly, and may be characterized by feelings of sadness, poor appetite, fatigue, feelings of guilt and confessing to crimes not committed or claiming responsibility for every negative thing that has happened. Thus, it is very likely that Iya Tunji was depressed.
Conclusion: These cases are adaptations of real-life events that have happened in the recent past; and no one knows for sure, how many similar cases go unreported. We all have blood on our hands, on account of the pervasive ignorance and lack of understanding, as well as the associated stigma and discrimination that persists in our society. It is our collective responsibility, you and I, to push back against this costly ocean of ignorance.
Stress is a concept borrowed from physical nature that connotes the application of a force, which may be internal or external, on an object. In Physics, factors that determine outcome, in such instances, include the internal characteristics of the receiving object (strength of material), the amount of external force being applied, the duration of the applied force, and the circumstances around the interaction – such as application of heat, which may change (weaken or strengthen) the original strength of the receiving object. The object may break or be elastic and stretch without breaking; it may also tear, explode, or it may become stronger (such as steel, from raw iron ore); or become more valuable, such as the purification of impurities from gold via smelting at extremely high temperatures.
In terms of human relationships and functioning, stress connotes situations where individuals are subjected to forces that places them under pressure. It should immediately become apparent from the analogy in the opening paragraph, that stress, by itself is not necessarily always a bad thing. What determines the outcome of a stressful situation is our inner strength of material (resilience or vulnerability); duration of the stressful situation; the amount of the applied stress; as well as the milieu in which the stress is being applied (environment – work or family; as well as the available social support system).
It is best to perhaps briefly explain the concepts of resilience and vulnerability at this juncture. The best analogy I have come across for illustrating these two concepts is to think of them as having two balls, made from different materials. One ball is plastic and the second ball is made from ornamental glass. If you were to throw the ornamental ball against a brick wall with force, it will shatter into pieces. This ball depicts vulnerability. However, if you were to throw the plastic ball, really hard, against the same brick wall, it will bounce back to you, none the worse for the impact. Repeat the exercise a million times and the plastic ball will keep bouncing back. This captures the essence of resilience.
It is important to appreciate from the get go, that every human being is a unique admixture of resilience (to certain types of stress and situations) and vulnerability (to other types of stress). We all have our strong points/areas as well as our weak/vulnerable points. This is an important concept to keep in view, as it is pivotal to understanding stress and stress management in the different facets of our lives.
Some degree of stress provides us with the impetus to strive to do more and to overcome challenges. The fear of failure, for instance, drives us to study hard for an examination; to work hard at our jobs in order to succeed and justify our position; to manage our family life and derive satisfaction from it and so on. However, overwhelming stress which persists for very long durations or become pervasive may eventually cause health challenges – both physical as well as mental health challenges.
Thus, stress can occur in every setting of human interaction: home/family; work; community; religious setting/organization; interpersonal relationships etc. Stress may also be physical (manual physical strain/work load, having a chronic and severe physical illness such as cancer or HIV, caring for a sick relative, having many young children to look after and housework with no assistance, physical abuse etc.); psychological/emotional (verbal and emotional abuse, bereavement, work place bullying and intimidation, sexual harassment, divorce, changing jobs or moving house etc.); financial stress (bad deals, being swindled, insolvency, unemployment, inability to pay bills etc.); Relationship or marital stress (misunderstandings, clash of values, infidelity, etc.); Religious stress (loss of faith, questioning long held beliefs, or becoming very religious that distorts previous relationships) and so on.
What happens when you are stressed?
The body has an in-built protective mechanism which automatically kicks in when we are confronted with danger. It responds by releasing stress chemicals, such as adrenaline and cortisol, which gets the body tense and ready to fight for your survival, or to enable you to escape. Thus, these chemicals cause your heart to start beating very fast, in order to pump more blood to your muscles; the muscles themselves become tense; your brain starts to have racing thoughts and burns energy by going into overdrive; your stomach produces acids and knots; and you feel the urge to eliminate waste from your body (sudden and urgent feelings to void or use the toilet). In the short term, these are helpful to overcome danger…such as the sight of a snake in your room or office. But when these changes in your body continue for a long time as a result of pervasive stress; your body interprets it as a threat to your wellbeing, and the negative consequences of longstanding stress will appear.
Symptoms of stress
These may be physical symptoms, emotional symptoms, and behavioural symptoms. The common symptoms are listed here. Physical symptoms may include stomach upset, difficulties with sleep, frequent headaches, excessive tiredness, loss of interest in sex, and change in appetite. Emotional effects include anxiety, irritation, anger outbursts, heightened frustrations, feeling weighed down and overwhelmed, emotional exhaustion or burn out, reduced motivation and lack of zest. Behavioural problems may include turning to alcohol and drugs to reduce tension and help relaxation, temper tantrums, unwarranted violence, becoming reclusive and avoiding social interactions, or becoming completely disinhibited and engaging in high risk behaviours such as gambling, and sexual indiscretions. These symptoms tend to have a multiplier effect on the individual, loved ones and family, as well as work colleagues.
Over the long term, prolonged stress may cause physical disorders such as increased exposure to infections (from weakened immune systems), hypertension and cardiac problems, ulcers etc. It may also cause mental health problems such anxiety disorders or depression, or lead to suicidal behaviours.
How can we manage stress?
If you identify that you are feeling stressed, the most important consideration is to identify that you ALWAYS have options. Start by evaluating the situation and decide if it is something within your control to influence (such as relationship difficulties) or if it is outside your control (such as a toxic work environment). If it is the former, then you can appraise your options and apply problem-solving techniques to engage and resolve the issues. However, even if it is the latter, you are still not helpless: you can weigh your options and may decide to walk away….if you can afford it. Or begin to seek employment elsewhere, or plan your exit. Or you adapt and learn to cope and not take things too personal. Thus, mitigating the personal impact on you and your life.
Other very helpful strategies for overcoming stress include regular physical exercise (releases feel good chemicals that promote relaxation); employing humour to diffuse tense situations and to keep the big picture in view; investing and nurturing relationships – with family, friends and colleagues; taking breaks – not necessarily expensive vacations but may be a visit to the beach for a quiet stroll and meditation alone. Spirituality or religious activity may also provide solace and comfort for some people. Engaging in a charity cause for altruistic reasons is also helpful to provide balance…and it evokes a deep sense of satisfaction and well-being, when we do something for a good cause.
Relaxation techniques such as deep breathing exercises are also very helpful – when you feel stressed and tense, simply place your hands on your abdomen, and take a deep breath (intake for 4 seconds); hold it in (for another 4 seconds); and then exhale slowly through your mouth (for about 6 seconds). You can practice this with your eyes close. Complete 10 – 15 cycles and you will immediately feel calmer and more relaxed.
Stress is an unavoidable component of daily living as human beings. However, it is within our control to ensure that we are not subjected to overwhelming stress that may break us down. There are many simple, inexpensive strategies for managing stress levels to ensure we do not suffer harmful physical and emotional consequences from stress. It is therefore, not the stressful situation or nature of the stress alone that determines outcome; but how we allow it to affect us is critical – and this is entirely in our hands. We can always deflect, cope better or remove ourselves from the situation.
A good work environment enables people to realize their full potential, helps them to cope with the normal stresses of life, to work productively, and to contribute to their communities. In such work environments, staff enjoy good self-esteem, they have positive social interactions with colleagues and their productivity is enhanced. Thus, it is a win-win situation which allows a happy employee to also improve earnings thus leading to a happy employer.
A toxic work environment, as we see with Tunde and Musa above, on the other hand, is very unfriendly, enforces rigid working hours, has poor remuneration with irregular salary payments, no job security, high levels of mutual suspicion, and bullying behaviour from superiors – sometimes including sexual harassment. These conditions ensure that the staff will not be motivated to put in their best.
What can you do?
This year’s theme (as at the time of writing) is pertinent to encourage us to discuss these issues. Since mental health challenges can affect anyone, including the head of human resources, or the Chief Executive Officer, should we sack anyone who suffers from these disorders? We all need to raise awareness about mental health in the workplace and its effect on productivity.
Even more importantly, we need to reduce the stigma surrounding mental illness, and encourage people to seek treatment. We should provide support and encouragement for persons with these challenges, and not be seen to make fun of them publicly or behind their backs in private.
Every work environment should make effort to reduce work-related risk factors. Speak nicely to people and promote good inter-personal relationships. Don’t insult, harass or threaten people as a habit, in your work place. Recognize and praise people when they do things well, and correct them in a humane manner, when they err. We all have a role to play in our respective work places. Will you play your part?
Tunde and Musa work in a Department where the new Head (Mr Ojo) is always screaming at everybody and insulting the staff members for any and every offence you can imagine. If he meets you standing, you are in trouble. If he meets you sitting down and not appearing busy, you are very lazy and indolent. If you ask him for clarifications regarding assigned tasks, it means you are too stupid to use your own brain. ‘Or do you want me to come and do your work for you? What am I paying you a salary for?’ He would scream.
Everyone now lives in terror and become anxious when they have to come to work every day. When he travels on official assignments, everyone usually heaves a sigh of relief and are able to relax. Indeed, Tunde is contemplating resigning from the office and starting a business on his own. ‘It will be better for my peace of mind’, he told Musa. ‘I cannot continue to function in such a tense atmosphere again. I am even developing hypertension. Worst still when I get home every day, I am so irritable that I sometimes shout on my wife and children. I have had enough, and I can’t take any more.’ He concluded.
The World Health Organization defines health as a state of complete physical, mental and social well-being, and not just the absence of disease or infirmity. However, the mental component of health is often neglected and forgotten. The 10th of October every year is set aside to commemorate the World Mental Health Day, and this year’s theme is Mental Health in the Work Place.
There is a bi-directional relationship between the mental health of the employees and the efficiency or productivity of the work place/organization. We know that 1 in every 4 adults will have mental health challenges. And 20% of all employees in the work force may experience a mental health condition. Indeed, the estimated cost to the global economy of depression and anxiety alone is $1trillion US dollars…and this may be an under-estimate.
So, it is not an unusual problem for people to have mental health challenges at the work place. But you may wonder why you don’t readily identify those with these problems in your work place. For one simple reason only: It is often hidden and viewed as a source of embarrassment and shame. This is unfortunate. Estimates show that up to 70% of those with mental health problems hide it in their work place for a variety of reasons. There is shame and fear of being stigmatized, but there is also the real fear that they may lose their jobs or fail to ever secure one if it is known that they have had a mental health challenge.
Sadly, we have recently witnessed various publicly reported cases of suicide in some National Dailies, which has sparked widespread discussions. Some of the expressed views appear to consider suicide as a strange and new development. But is this truly new or are we witnessing an epidemic of suicide deaths? Traditional folklore has it that the legend of Sango, the god of thunder in Yoruba history committed suicide, following a tragic sequence of losses. A similar pattern is described by Chinua Achebe, with reference to Okonkwo in his classic work of fiction, ‘Things Fall Apart’. Thus, the concept of death being a preferable option to shame, humiliation and feelings of hopelessness in the face of adversity is not completely new. It is also very likely that these events have always occurred but were not widely reported.
The World Health Organization (WHO) estimates that 1 million suicide deaths occur every year. This number is staggering, especially when we appreciate that there are several regions of the world – such as Nigeria and other developing countries, which do not have accurate death records and a reporting system. Thus, this WHO figure is undoubtedly a gross underestimate. To put this in perspective, this figure translates into one suicide death, every 40 seconds. And in the time, it has taken for you to read this article up until this point, at least 2 human beings somewhere on this planet, would have intentionally taken his or her own life. The number of attempted suicides annually, is about 20 times the number of completed suicides – estimated at 20 million cases worldwide.
Why would anyone consider ending his or her own life?
Several risk factors predispose to suicide, but what is consistent is that such individuals experience such intense and overwhelming emotional pain that they simply feel that they can no longer cope. The commonest risk factor is depression. This is a mental health disorder, which occurs when certain levels of chemicals in the brain are very low. The chemicals involved, are responsible for improving our mood and making us feel good about ourselves. Thus, when the levels are low, affected individuals feel sad, miserable, hopeless and worthless. They may also feel overwhelmed by the problems (real or imagined) that confront them and therefore, begin to imagine that they have become a burden to their families and loved ones. It is with the background of these types of thoughts, that death becomes an appealing outcome, in the face of such overwhelming problems.
Other risk factors include negative life events such as job or financial losses, death of loved ones, shame and public loss of dignity, loneliness, impulsiveness, and access to means. Males are also at greater risk, as suicide is thrice as common among males as compared to women. Mental illness, chronic physical illness, alcohol or drug abuse, and overwhelming emotional distress may also increase the risk for suicide.
Impact of suicide
It has a devastating impact on surviving family members, friends and colleagues. They often undergo a lot of emotional turmoil, with feelings of guilt, betrayal, regret and feelings of inadequacy – with thoughts such as “if only I had been a more observant/caring/prayerful/dutiful parent, spouse, friend or colleague; perhaps this would not have happened.” Thus, in addition to the grief of mourning their loved ones, they also have to cope with these feelings of regret and inadequacies. Their misery is often worsened by the stigma and shame of being ridiculed as the family member of someone who committed suicide. Moreso, as some people will insinuate that the spouse/friend/family/colleagues must have done something to push them to their wits end, or at best, were not supportive enough. These sorts of insinuations are not helpful at all and should be actively discouraged.
How can we help?
The family and friends of individuals who have completed suicide are going through a lot of emotional stress and require us to show empathy and understanding, as well as provide emotional support to help them come to terms with the tragedy that has befallen them. We should help to ease their pain; and not compound it. If their symptoms of distress do not abate after a few weeks, they may need to see a mental health professional for expert help.
Suicide is a common but tragic occurrence, which negatively affects everyone connected with the affected individual. Several risk factors acting together may increase the chances of suicide occurring. However, it is preventable and in the next session, we shall be focusing on prevention strategies for suicide.