Chiadi Ndu, PhD, is a lawyer and mental health expert. She founded Behind The Heart (BTH) Integrated Wellness and Therapy in 2012 and has completed over 8, 000hours of professional counselling and psychotherapy. A member of the British Psychological Society, British Association for Cognitive Behaviour, Psychotherapists and the American Psychological Association. Ndu is an ardent believer in holistic wellness, actively incorporating various aspects of nutrition, physical wellness and lifestyle in her practice. In this interview, she identifies gaps in mental health awareness and treatment in Africa and Nigeria, speaks on why health condition persists across the continent and proffers practical solutions.
What inspired the pursuit of a career in Psychology, and Mental Health and Therapy, especially having initially studied Law?
Honestly, I didn’t plan to study Law. I was just a brilliant art student. And back in my days, if you were an art student, you had to do a professional course, like your parents would say. It had to be Law or something professional. If you’re a science student, you may be interested in pursuing a career in medicine or engineering, which are considered professional fields. So, what could I do?
A year after graduating, I realised that I was not on the right path, that Law was not what I wanted to do. Why did I choose psychology? The human mind has always intrigued me, especially my mind – the way my thoughts, my emotions and my behaviour correspond. I often say that a lot of study and research should be “Me-search”, not research. My study of psychology began with self-discovery, self-exploration of personal obstacles in my life that I needed to unravel. Psychology helped me quite a bit.
What were the gaps you set out to fill through your organisation and how has been the experience?
There were specific gaps I wanted to fill. BTH is an acronym for “Behind the Heart”, I know the mind is a very powerful psyche. You hear a lot of statements like “mind over matter.” Many things come from the mind. I just thought if one could get the heart behind the mind, we can unravel the reasons we behave the way we do. In fact, a lot of the problems we face in Nigeria, my country of origin, which is my frame of reference, would be unhinged. For instance, everybody goes on and on about corruption, and my mind tells me that there’s no way corruption can be stopped in Nigeria except in the mind. Many Nigerians have seen their parents serve diligently, work very hard and then end up standing in very long queues to get miserable pensions that can’t do anything for them.
With that kind of mindset, do you think such a person would not want to make sure they don’t end up the way their parents ended up? So, I accept those images and thoughts, and one goes behind the heart to find out what is happening here. Why is the appetite of the average Nigerian voracious? Why is it that dogs eat dogs? Why are people bent on making money at all costs? There is a reason. And unless we go behind the hearts, we may not unravel these mysteries.
From your experience with diverse people, how would you describe your approaches to therapy and how they differ from other methods?
Basically, in my opinion, therapy is collaborative; it’s an alliance between the therapist and the client. The first thing I try to do every time is to determine the goals and aim of the therapeutic intervention. What is the change the client is looking to effect with the therapy? I place my client in the centre. Whatever is needful and useful for my client is the approach that I would use. Whether it is the humanistic approach, the psychodynamic, the cognitive, the behavioural or the existential approach, whatever works for the client is what we are going to use. All I am concerned about is that the change effected the most valuable and all-encompassing experience for my client. I guess that’s what you call the integrated approach. However, the difference that I usually add, is what I call self-disclosure? Because in this part of the world, therapy is a new experience for most people. I try to normalise what they are feeling. It’s almost like a taboo subject. It’s almost as though people who go for therapy are wackos. So, I normalise by self-disclosing, telling stories that are true about myself. I permit myself to be open with my clients, not necessarily to the point of vulnerability, but from a place of strength, just to normalise and explain to the client that what they feel is legitimate.
From your engagements with various stakeholders over the years, why has the health condition persisted?
I would say, if I’m permitted to be very honest, that mental health is not paid much attention to. And this is basically because, according to Abraham Maslow’s hierarchy of needs, a lot of the basic physiological needs of food, shelter, and clothing haven’t been met by most Nigerians. So, going higher to where mental health comes into play is more difficult because physiological needs have to be met first.Then, there is the stigmatisation of mental health. Most Nigerians do not understand that mental health is critical for everyone. They assumed that once you mention the word mental health, it means they have gone off, gone crazy, insane. So, lack of understanding and the Nigerian factor are partly responsible for the persistence over years. We never pay attention to things that are critical for us to pay attention to. I always say that most Nigerians are struggling with their mental health. And that’s why lots of things persist. Otherwise, the analogy is always used when somebody steals 86 cars, what will he do with 86 cars, something is wrong with the person. Also, why would someone not pay their children’s school fees and choose to have a flamboyant funeral for their dead father? Some things are off. I guess it’s an environmental thing, and many of us are avoiding this environment. We avoid things that are important until we can no longer avoid them.
In terms of treatment and therapy, what are some effective strategies you recommend for individuals struggling with anxiety and/or depression?
I have an acronym I strung into TEB, which represents thoughts, emotions, and behaviour. I teach people to identify their thoughts, notice their thoughts, and learn to treat thoughts as nouns, as objects that come at you. I think a lot of us look at thought as a verb. I teach my clients to look at thoughts as nouns, this thought that I may feel is coming at me. Then, I address the thoughts because if I don’t question the thoughts, they will ultimately affect my emotions, and once it hits my emotions, my behaviour will be affected. So, say for instance, if thoughts come to me – “Look at you, you are hopeless, what are you ever going to make of your life? It immediately affected my emotions, and I began to feel lifeless and apathetic. What’s the point of trying? And then I just scroll up in bed and go to wait for nothing to happen. But if that thought comes up to me and says to me, look at you, you’re worthless. And I treat the word as a missile that has come to attack me and say to the thought, “Why would you say I am worthless? Have you not seen me accomplish blah blah blah blah? Why would anyone who is worthless have done this? You know, I questioned the thought. I counteract the thought. Honestly, once you’re able to hold your thoughts captive, you can capture, stand against them and speak to them. Immediately, you’re able to do that, your emotions will pick up, and once your emotions pick up, the spring will come back to your step. Your behaviour will pick up as well. In short, that’s what I try to teach people when they are dealing with anxiety and depression. This is the essence of Cognitive Behaviour Therapy. The evidence-based approach to therapy.
Technology plays a huge role in various fields. How has technology influenced mental health treatment and therapy practices?
Everybody is well aware of the advent of Artificial Intelligence (AI). In my opinion, it has made a lot of administrative work in therapy easier. AI can be used to generate your client’s notes; you can use it to summarise your sessions. It can be used to formulate treatment plans; you can do your assessments with AI. You know, there’s so much you can do with AI. Thankfully, the human element is still very important. AI cannot become a human being. AI cannot develop rapport; AI cannot empathise, AI cannot be human, at least not at the moment. Even though technology has enhanced and made our work easier, technology cannot be human, and it is the coreness of counselling – genuineness, empathy, and unconditional positive regard. Technology has not been able to supplement the human element and the human aspect. And I don’t see how it will be supplemented.
Could you highlight the factors that predispose Nigerians to mental health issues and how they could best handle the challenges?
Well, the case speaks for itself. I don’t think anybody needs to over-emphasise the peculiarities of Nigeria. The most destabilising and mentally stressful situation in Nigeria is the lack of predictability, lack of stability. It’s an environment where anything can happen, and there is not going to be any consequence for it. There is a lot of unpredictability that may cause instability. You’re constantly hyper-vigilant, high alert, not to mention the insecurities. You can go and buy food today with N20,000, then the next day you want to buy the same amount of food and it has tripled. You just don’t know what to expect. These are the basic things. It is quite dysfunctional to thrive in that kind of environment.
