Chiadi Ndu was called to the Nigerian Bar in 1987 and holds a Doctorate degree in Psychology. She founded BTH Integrated Wellness and Therapy in 2012 and has since completed over 10,000 hours of professional counselling and psychotherapy. A member of the Nigerian Psychological Association, the American Psychological Association and a Chartered member of the British Psychological Society, she is an ardent believer in holistic wellness, actively incorporating various aspects of nutrition, physical wellness and lifestyle into her practice. In this interview, she identifies the gaps in the provision of mental health support services in Nigeria and proffers practical solutions.
What inspired the pursuit of a career in psychology, and mental health and therapy, especially having initially studied law?
With a deep sense of modesty, I was just an intelligent arts student, and back in my days you were encouraged to do a ‘professional’ course meaning something that made you self-employable. Parents would recommend Law for the arts student and if you were a science student, you would be steered towards a career in medicine or engineering, which were also considered ‘professional’ courses. So, I simply followed that path of the arts student but a year after I was called to the bar, I had a personal experience which made me realise that I was not on the right path. Law was not what I wanted to practice.
Why did I choose psychology? The human mind has always intrigued me, especially my mind- the way my thoughts, my emotions and my behaviour are linked to each other. I often say that a lot of study and research should be re-named ‘me’-search, not research. My study of psychology began with me- self-discovery, self-exploration and navigation of personal obstacles. Psychology helped me quite a bit.
What were the gaps you set out to fill through your organisation, and how has the experience been?
There were specific gaps I wanted to fill. BTH is an acronym for “Behind the Heart.” I know the human mind to be very dynamic and powerful. Many things stem from the mind. You hear a lot of phrases like ‘mind over matter.’ I just thought that if one could get to the ‘heart’ behind this mind, one could unravel the reasons we behave the way we do.
In fact, a lot of the problems we face in Nigeria, my country of origin and my frame of reference, would be unhinged if we could get to the ‘heart’ of the Nigerian mind. For instance, everybody goes on and on about corruption, and my mind tells me that there is no way corruption can be stopped in Nigeria except we get behind the mind of most Nigerians.
Many Nigerians have seen their parents work very hard, serve the nation very diligently, and then end up standing in very long queues to get miserable pensions that cannot do anything for them. With those images and memories clipped to their minds, the pain of the humiliation, would propel the average person to ensure they do not end up on those same kind of queues. The idea of selfless service for the betterment of the nation wanes and self-preservation kicks in. The state of mind towards diligence, hard work and patriotism becomes similar to the Pidgin English phrase ‘who e help?’ In my work, I accept my client’s thoughts and reflections then I go behind their heart to find out what is happening there. Why is this person voracious for wealth? Why is the average Nigerian bent on making money at all costs? Why is there this dog-eat-dog approach to accumulating wealth? There is often a ‘why’ and except one is able to go behind the heart and unhinge these things, the problem is likely to persist.
From your experience with diverse people, how would you describe your approach to therapy and how they differ from other methods?
Therapy is collaborative. It is an alliance between the therapist and the client. The first thing I try to do every time is to determine the goals and aims of the therapeutic intervention. What is the change the client is looking to effect with therapy? Ialways 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 change is effected- the most valuable experience for my client. This is what is called the integrated approach. However, I often add self-disclosure, I tell my stories. Because in this part of the world, therapy is a new experience for most people, I try to normalise what they are feeling by showing them that other people including me have felt and still feel the same way too. I permit myself to be open with my clients, not necessarily from 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 poor mental health persisted in Nigeria?
In my opinion, mental health is not paid much attention to in Nigeria because we have more unmet basic needs. According to Abraham Maslow’s hierarchy of needs a lot of the basic physiological needs of food, shelter, clothing etc. have not been met by most Nigerians therefore addressing mental health issues would seem ludicrous where survival needs are yet to be met.
Then, there is the cultural and social element where certain health conditions are a taboo subject and can lead to the stigmatization of the sufferers and their families. Unfortunately, a lot of mental health disorders fall under this category.
Most Nigerians do not also understand the concept of mental health. They assume that once you mention the word mental health, it means they have gone off, gone crazy or insane. So, a lack of understanding is essentially responsible for the persistence over the years.
Generally, people try to avoid things they are uncomfortable with until they can no longer avoid them. The Nigerian is no exception. We do not pay attention to things that are uncomfortable until we are forced to. Otherwise, it should be clear by now that most of us here are struggling with our mental health. Why would anyone want to own 86 cars, what will he do with 86 cars? Something is clearly going on behind the heart and mind of such an individual. Why would someone not pay their children’s school fees and choose to have a flamboyant funeral for their dead father? Something is clearly off.
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- T.E.B- which stands for Thoughts, Emotions and Behaviour. This is the bedrock of the Cognitive Behaviour Therapy (CBT) which I use extensively in my practice. I teach people to identify their thoughts, notice them and learn to treat thoughts as nouns, as objects that come at you. I think a lot of us look at thoughts as verbs, something we are doing. I teach my clients to look at thoughts as nouns. I explain that thoughts should be questioned. I help my clients explore their thoughts, otherwise these thoughts could impact their emotions and ultimately affect their behaviour. For instance, if I have thoughts like, “Look at you, you are hopeless, what are you ever going to make of your life?” It will immediately affect my emotions if left unchecked. I am likely to begin to feel downcast and perhaps unworthy. I may begin to feel that there is no sense in trying and I could just curl up and refuse to get out of bed. But if that same thought comes to me 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 I not been able to accomplish… blah blah blah blah? How can a worthless person have achieved that?” I have challenged the thought. I have contradicted the suggestion of the thought. Honestly, once you can hold your thoughts captive, you can constrain, disarm and conquer them. If you are able to do that, your emotions will pick up and the bounce will return to your step. Your behaviour will align with your feelings and pick itself up as well. These are the skills I try to teach people when they are dealing (especially) with anxiety and depression.
Technology plays a huge role in various fields. How has technology influenced mental health treatment and therapy practices?
In my opinion, technology has made a lot of administrative work in therapy practice easier. It can be used to generate your client’s notes and summarise your sessions effectively. It can be used to formulate treatment plans and you can conduct most assessments using Artificial Intelligence(AI). However, there is only so much one can do with AI. The human element is still crucial. AI cannot develop rapport, AI cannot empathise, AI simply cannot be human…at least not at the moment. Even though technology has enhanced and made our work easier it cannot provide the core therapeutic conditions of genuineness, empathy, and unconditional positive regard. This may sound shortsighted but I do not see how ‘humanness’ can be replaced by technology.
Could you highlight the factors that predispose Nigerians to mental health issues and how they can best handle the challenges?
Well, the case speaks for itself. I do not think that anybody needs to over-emphasise the peculiarities of being Nigerian. The most destabilising and mentally stressful situation in Nigeria is the lack of predictability and structure. It is an environment where anything can happen at any time without any prior notice. One is constantly hyper-vigilant… on high alert waiting for the next worse thing. As a result of this, most Nigerians are chronically stressed. They cannot make serious plans for their future because so many things are outside their control. You can go and buy food today with N20,000, then the next time you want to buy the same amount of food the price has tripled. One does not know what to expect. This is an extremely stressful way to live and stress is a huge factor is disease causation especially poor mental health.
My recommendation may sound like a cliché but learning to take it one day at a time is vital. We must learn to live in the moment. There are various skills to help us cope and stay grounded, like the diaphragmatic breathing and mindfulness skill. There are many videos available on YouTube and other social media handles teaching these skills. They are quick to learn and practising them can go a long way in helping with these challenges.
