Managing Public Expectations
The clamour for psychiatric testing has never been driven by public concern for the politician’s health for its own sake. Rather, the interest of the public is to minimize the danger posed to the public by errant politicians.
As stated above, the prescriptive value of psychiatric testing in meeting this public concern is minimal, at best. And the cost, the dangers, and the controversies would be humongous.

Femi Olugbile:
“One of my teachers during my years studying to be a Psychiatrist was a charismatic, world-famous psychoanalyst in the Freudian tradition. Every so often, this great teacher would be caught shop-lifting in the city of Edinburgh. This was a sad failing of his, and one day because he knew the rumour had spread round, he actually mentioned it in class, ending on the note that every time it happened it showed him that he needed still more intensive psycho-analysis himself to deal with his underlying problem. What this taught me was that psychiatrists were themselves potentially flawed human beings like the rest of society, and not necessarily disinterested observers dealing with the frailties of other people.”

So What Are We The People To Do – Throw Up Our Hands?
Having said all this, it is certainly conceivable that there would be circumstances in which the psychiatrist is required to come in to protect the public good.
Case Study: There was the case of a state governor in the last dispensation who suffered severe head injuries as a result of a plane crash that occurred in a plane he was piloting while in office. He suffered severe concussion, was unconscious for a long period, was spirited abroad for a protracted period for ‘treatment’ and ‘rehabilitation’. His deputy took on the role of acting Governor. When he returned, it was quite clear that he had suffered such severe neuropsychiatric impairment that he was unfit to carry on the functions of a Governor. In a civilized society where important professional matters are not trivialized or politicized, a medical board, by whatever description, led here by a psychiatrist and a neurologist would be constituted to examine His Excellency and quietly pronounce on his fitness to resume office. In our own case, it became a tug of war between his family along with powerful supporters, and his deputy and the rest of society. When the Nigerian Medical Association weighed in and offered to constitute a team to carry out a test, the story got even more bizarre. It turned out His Excellency, apart from being an amateur pilot, was also a Pharmacist. The pharmacists, who had their own grouse with doctors, sent a group of pharmacists to pay a courtesy call on His Excellency. Coming back from this journey, their leader pronounced to the whole nation that they had done their own evaluation of the Governor and he was fit to resume his duties!

Approaching the end of our engagement in this Lecture created in the memory of the man who, along with that remote figure – Sigmund Freud, stimulated my desire to study Psychiatry, having taken a cursory journey through a subject that is a personal passion for me – to wit – What can we say about the mental health of our Chinamandas and Soyinkas and Osofisans, and Odia Ofeimuns – a group in which I am proud to count myself? And having side by side, taken a journey through the logic of a subject that became a passion for Prof Thomas Adeoye Lambo in his last days, what conclusions can we make that would be scientifically justified?

Writers and other Artists
The evidence appears quite strong that there is a linkage between the presence of creative talent especially in writers and poets, and the tendency to develop affective disorder. Some of the experience of the ‘creative rush’ of the writer is described as being akin to the internal experience of a ‘hypomanic’ spell. Despite the colourful stories of people like Van Gogh and Ernest Hemingway, for the most part the existence of this tendency to mood disorder does not seem to significantly impair the creative ability. Some would even claim that it is enhanced in certain circumstances.
Although the small sample survey carried out in Lagos in 2012 to look for a differential rate of Creativity between clients with Schizophrenia and Bipolar Affective Disorder did not show significant difference, a great deal of local research is needed to explore this area.
It is also clear that first degree relatives who manifest no illness manifest increased creative capabilities.
Finally, what value can Creativity bring to the atmosphere of treatment and recovery for mental illness? It is well documented that a therapeutic milieu, in which drama, role play and literature play an active role has a role in enhancing the recovery of a mentally ill person. Music and art have a similar effect in enhancing recovery.
A young Nigerian psychiatrist in the UK – Akeem Sule, the proponent of ‘Hip Hop Psych’ (Sule et al, 2014) is currently exploring the use of Hip Hop/Rap Music for educational and therapeutic purposes in Mental Health.
There are vast possibilities yet to be explored in this area – and this is not a joke!

Now we come to Politics and the Mental Health of Politicians

Is mental illness more common among politicians than among a control group of other citizens? The answer – we don’t have any such evidence. We have been seen anecdotal evidence and mostly impressionistic accounts from the literature of prominent politicians displaying evidence of illness, whether in our out of office.

It is difficult, but necessary eventually, to systematize the knowledge and distill it into a protocol. What would happen if a person became psychotic in office, but had no insight and refused to quit, or to have treatment? And what if a person became ill in office, was treated, and then became well? As example, King Nebuchadnezzar, who had a psychotic illness in pre-psychiatric times eventually recovered from his psychosis and returned to the throne of Babylon, resuming work as the most powerful king in the world. Clearly, during the active illness, a professional and legal mechanism must have existed in Babylon thousands of years ago to declare the King temporarily incompetent, and after treatment and recovery, a competent authority must have declared him fit for resumption of work and responsibility. It is necessary to look at the existing stipulations in our legal statutes and Public Service Rules concerning ‘Medical Fitness’ and the constitution and function of a Medical Board to see if they fully meet the needs of this situation in all its possible ramifications, or if they need to be expanded and tightened further to protect the public. The example of the State Governor given earlier is very instructive in this regard.

Regarding the tendency to behave in an ethically inappropriate manner, throwing the public good overboard, the best protection against this genre of politics and politicians would seem to be not the psychiatrist, but the painstaking building of institutions that would limit the latitude of office holders to behave badly. Here a quote from Barack Obama comes in handy. ‘What Africa needs is not strong men, but strong institutions’.

The truth of course is that if perfidy is rewarded, if the chances of catching a corrupt official remain next to zero, if people who steal public funds are lionized by their kin instead of being denounced and sent to prison, we would be simply medicalising a social problem by thinking the intervention of mental health professionals can have an impact in the matter.

Mental Health care professionals realizing this need to line up behind the drive to build strong institutions and embark on wholesale behavior change, driven partially by coercion, but also by education and social suasion. Their role could be to help to provide the content that would go into education and social marketing and advocacy to drive this change.

This painstaking collaboration is the only way Psychiatrists, working with others can achieve the dream of Prof Thomas Adeoye Lambo for a political landscape in which the common good is the overriding objective of the majority of the players. I believe we all owe it to his memory to contribute, using our Science, to the institutionalization of that behavior change that will take our society to a better place.

This is the Thomas Adeoye Lambo Lecture 2015, delivered by Dr Femi Olugbile, a psychiatrist, an award winning novelist and former Permanent Secretary, Lagos State Ministry of Health