Anxiety, revolution, abduction: the therapeutic secrets of the whole world | Society

"People with psychosis are usually found in a healer": Nigeria

Oye Gureje, professor of psychiatry

Banditry, terrorism and kidnappings are increasing in Nigeria and life is becoming less chaotic in our cities. These are predisposing factors to mental health problems, and although we do not have good survey data on this, we probably have more problems than other countries.

We have 250 psychiatrists serving 200 million people. It's barely one in a million – an incredibly low number.

For most Nigerians with common mental disorders such as depression, anxiety, PTSD or some degree of substance use disorder, there is a good chance that they never receive treatment

If they suffer from the most serious mental disorders such as psychosis, most of them will end up with a religious healer – usually Pentecostal or Islamic – or a traditional healer.

They use herbs and apparently some of them are effective. They use rituals, sacrifices, prayers, fasting, sacred oil and holy water, as well as potentially dangerous objects such as chaining, beating, prolonged fasting and scarification. .

We found that in Ibadan, city of about 2.5 million inhabitants, endowed with enough resources, we had about 90 places for mental illness, while the healers had a little over 400. So regardless of what we think of what they are doing, we need to see how we can improve the service they offer.

Not recognizing a mental health problem does not prevent it from manifesting itself differently, and there seems to be a growing wave of suicides across the country. I do not know if there are really more suicides or if it's just considered more relevant at the moment.

We can not train hundreds of additional psychiatrists overnight. But the government needs to pay more attention to improving policies and implementing programs, and it can do so with the resources already available. And we need to train our primary care providers to recognize and treat common mental disorders. As told to Ruth Maclean

• Oye Gureje is Professor of Psychiatry at the University of Ibadan and Director of the WHO Collaborating Center for Research and Training in Mental Health, Neurosciences and Addiction.

"A psychologist recommended the reading of Tolstoy": Russia

Vitaly Sonkin, psychologist

There is a lot of skepticism about psychiatry in Russia because it is considered used for official purposes. People are worried that you will be put on a government register [of those with psychological issues]. This is badociated with formal procedures – whether you serve in the military or driving – or even as a means of punishing people for dissent.

But thanks to the media and a large number of popular movies and books, psychotherapy is becoming more commonplace and less marginalized here. Especially among hipsters, young creatives, it is perceived as a sign of self-care. I work with very motivated patients and I have a long list of waiting.

It's still a small slice of society. For many other Russians, psychotherapy remains a curiosity. Therapy is much more popular and available in big cities like Moscow than in the most remote areas of Russia.

I hear a lot of stories. A client told me that she had gone to a psychologist who had started recommending books for reading: clbadics like Tolstoy and Chekhov. The doctor said that it would tell the story of his life and could serve as a model to behave. Obviously, it does not work.

Antidepressants are becoming more popular and their use is increasingly chaotic. Because people do not really trust psychiatrists, some prescribe antidepressants themselves. It is not difficult to get their hands on them via the Internet.

I studied abroad in the west and I do not think the Russians require a different approach. But I think the Russians got used to a harder way of being treated by doctors. And then, when you use a more humane approach, they immediately say, "Yes, that's what I wanted." As told to Andrew Roth

"Social Media Raises Anxiety Levels": Egypt

Salima Barakat, psychologist, Cairo

The treatment of mental health in Egypt is still stigmatized. The first is that once you start a treatment, it will open a Pandora's box and you will never be able to escape. Another possibility is that following a treatment makes you weak or "crazy" in a way that could affect your job or your chances of getting married. But these decrease with time.

The state of mental health in Egypt has changed a lot since I graduated in 2001. I do not want to use the word better, but it certainly evolves in terms of training of practitioners and nurses for treatment in hospital .

The main problem that I tend to deal with is anxiety, and this number is steadily increasing. There are several reasons for this. One is the 2011 revolution in Egypt and all that followed, but also the invention of the smartphone. Globally, the increasing use of technology and social media is dramatically increasing their level of anxiety.

My observation is that there is a clear generational division in the patients I see. Younger patients tend to be more aware of therapies. While being pro-revolution or not does not determine if he is anxious, the young pro-revolution generation that wanted to make a difference has focused more on his mental health over the past eight years.

There is certainly a need and a demand for mental health services in Egypt. It is not an easy place to live, especially at a time when the country is under severe austerity measures. But there is a whole range of talking therapies ranging from CBT to existential therapy.

There are public and private options. Nevertheless, it is safe to say that I see people who can afford to pay, and although the sessions are not cheap, I operate on a sliding scale depending on what people can afford. I think a lot of suppliers are doing the same thing here.

In the end, it is not how much money someone has. Sometimes I see rich people where their level of awareness of mental health is limited because of their education and their mentality, while someone with fewer means is more exposed because it is online more or younger. As said to Ruth Michaelson

"We have many absent parents": China

Dr. George Hu, Head of Mental Health, Pudong Hospital of Shanghai United Family

I see almost everyone, but more than half of my patients are children and adolescents. They most often exhibit anxiety, depression, and suicidal behavior, which can manifest as learning problems, attention and hyperactivity problems, as well as behavioral problems. These symptoms come from various sources, but they often come from a difficulty in their relationships with their parents. We have many absent parents who have not been able to prioritize their relationship with their children.

In China, we now have a large middle clbad, as well as very poor people and very rich people. We find that the two tails of the bell-shaped curve come closer to mental health issues. Obviously, there are galactic differences in income and lifestyle, but whether you are a CEO or a migrant worker, if you live separately from your children and only see them twice a month, it will cause the same stress. . In an effort to provide a lavish and beneficial lifestyle, the rich are inadvertently posing many of the same problems as the poor.

There is certainly a change in attitude towards mental health, which was a taboo subject. China's public system has extended access to resources to 1.4 billion people in unprecedented ways. Access to psychotherapy as a valid mental health treatment, in addition to psychiatry, is also to be improved. It's a lot on radars, but psychotherapy takes time and training, there are a lot of moving parts.

I think technology will pave the way for increasing access to psychotherapy. Attitudes towards technology are much more open in China and there is no old, well-established way to lobby. I was able to establish a distance psychotherapy practice that would face significant obstacles in the United States.

There is a lot of work to be done, but we are in an exciting place. As told to Andrew Killeen

Public hospitals often run out of psychiatric drugs »: Argentina

Juan Tenconi, former president of the Argentine Association of Psychiatrists

Argentina far exceeds every country in the world with its number of psychologists. According to the World Health Organization, we have 223 psychologists per 100,000 population, while the Netherlands ranks second at only 123, Germany 50 and the United States 30.

This means that if you suffer from a mild neurosis, if you want to know yourself better or if you are looking to improve yourself, you are in a fantastic situation in terms of mental health care.

On the other hand, if you have a low income and a serious mental state and are forced to use the public health system, you may end up in a problem that depends to a large extent on your health. place of residence.

The public health system is overburdened and underfunded. Some provinces have very good mental health, but far from everything. Public hospitals often run out of psychiatric drugs, just like penicillin or medical gauze.

One of the main problems is that there is no separate service for patients with mental illness. Thus, a person with schizophrenia may be in the same room as a patient who has just had a heart attack, with all the trauma that can cause both patients.

So, if you live in a slum and suffer from a serious illness, you may find yourself interned in inadequate facilities.

The problem could soon be compounded by the new national health law, which will see the closure of old psychiatric hospitals in 2020. It will throw a large number of patients on the street: many of them will be left homeless.As told to Uki Goñi

"Prejudices against psychotherapy are still rooted"

Alberto Pellai, psychotherapist and researcher, University of Milan

Mental illnesses are on the rise among Italians. The most widespread and widespread disorder is depression. However, despite the intermediate ranking of Italy among the European countries, the figures do not reflect the real scale of the problem. The statistics do not consider people who continue to believe that seeking the help of a psychologist or psychiatrist is for the "crazy". In Italy, cultural prejudices about psychotherapy and antidepressants remain ineffective or are deemed ineffective or reserved for people who have lost their minds.

The use of antidepressants is also increasing, as are mental illnesses in adolescents. In adolescents and their European cohort, the syndrome of social isolation is increasing. Their lives are entirely in their rooms. They live in a virtual world, glued to the screen of their computer or their mobile phone. This has resulted in a growing challenge for youth to socialize.

Unfortunately, there is no diversification of psychological illnesses on the basis of severity and so many requests for care or consultation that the waiting period can last for months. If a man who tried to commit suicide goes to the hospital, the doctors automatically speed up the process and receive immediate psychological badistance. But what if men and women who suffer from depression [haven’t got to that stage yet]?

… People with less serious disorders, such as attention deficit disorder or hyperactivity, may avoid people with severe signs of depression. The risk is that someone with suicidal tendencies will go from thinking to action before receiving psychotherapeutic help in a public institution. As told to Lorenzo Tondo