Arts, Politics and Mental Health

Full text of the 2015 Thomas Lambo Lecture delivered by renowned Psychiatrist and author, Dr. Femi Olugbile

Protocols
This is a ‘double-barreled’ assignment. One barrel is for the lecturer, representing an area of abiding interest and the other for Professor Adeoye Lambo, distinguished Psychiatrist, and erstwhile Deputy Director General of the World Health Organisation, whose life we are celebrating through this annual activity.

DEFINITIONS
Arts (‘The Arts’)
Antonyms: craft, profession, dexterity, artistry, knowledge, adroitness, ingenuity, mastery, imagination, know-how, aptitude, inventiveness.
Wordweb (based on latest edition of Chambers dictionary) ‘The products of human creativity; works of art collectively. The creation of beautiful, significant things.
From ancient times, Arts, and the people with ‘artistic’ talents, have played a prominent role in the lives of society. The importance of the Arts transcends the life of the artist (there has been more money paid on Picasso’s works since he died than in all the years of his life). It transcends the life of society itself. When societies, cultures and civilisations die, such as ancient Pompeii, the Roman Empire, or ancient Egypt, the Arts – in the form of architecture, artifacts, paintings, sculptures and implements are taken as the evidence of the quality of life and level of attainment of the society.
‘The creation of beautiful significant things’ can cover a very wide area in different cultures. It covers oral and written literature, drama, poetry, music, drawing, painting, and sculpture. It covers design, which in the present day has been interwoven into virtually every aspect of life, including electronic and mechanical devices that functionally would not normally be related to ‘Art’. One of the prime selling points of the Apple brand is the ‘minimalist’ art design that is reflected in every item it produces. It is reflective of the importance and ubiquity of ‘Art’ in modern life, that ‘smart phones’ are now no longer ‘just’ phones, but works of art that in some future age will provide information to curious generations yet to come about the lives and times of the present generation.
The connection between all creators of Art – whether it is a Picasso and his giant paintings, or an Achebe and his literature, is the possession and expression of ‘Creativity’.
We may seek to explain the concept of ‘Creativity’ as a situation involving the possession and display of a quantity that may be described as talent, inventiveness, ingenuity, genius, originality, inspiration.
It is easy to mistake the concept for ‘brilliance’ – a factor which is reflected scientifically by the measurement of ‘Intelligence’. And yet they are not quite the same. While most people with strong creative talent have Intelligence Quotients of 120 and above), the ‘superior’ performance of the writers tends to be in the WAIS vocabulary subtest. (Andreasen et al, 1988).
It is natural to expect that people who create beautiful things, and who bring pleasure to other people and enhance the culture of humanity by their works should be held in high esteem by society, and should generally live happy secure fulfilled lives, based on the value of their outputs. Indeed many creative people are able to make huge incomes from their works, and many have all through time enjoyed celebrity status. However, on casual inspection an even larger number appear to have lived or to be living troubled lives ravaged by penury, social dislocation, broken relationships, and isolation and illness, especially mental illness. Many have committed suicide or various acts of deliberate self-harm. School children, learning Art, are mystified when they are told the story of Vincent Van Gogh, who cut off his own left ear and handed it to a prostitute with an instruction to ‘preserve this package carefully’, before returning home to collapse from the attendant haemorrhage. The famous writers Ernest Hemingway and Virginia Wolf committed suicide in what are assumed to have been states of disturbed mental functioning.
Such observations have led some scientific enquirers to look for evidence of a putative relationship between Creativity and Mental illness. There are depictions in the media about famous individuals who had evidence of formal mental illness. An example is ‘A Beautiful Mind’ – a major Hollywood movie, based on a biography of John Forbes Nash, a mathematical genius who won the Nobel Prize in Economics even as he battled with Schizophrenia. The book is written by Sylvia Nasar, and the film stars Russell Crowe. Such works have tended to imprint in the popular perception the notion that there is an association between innovative, creative talent and Schizophrenia. For some time there were romantic notions – especially in anti-Psychiatry circles, that Schizophrenia, far from being an illness, could be a ‘cool’ condition – a higher state of perception and experience that ordinary mortals disparaged because they failed to understand it.
Is there any Science at all to this line of thinking?
Much of the early research interest was actually focused on exploring a putative relationship between Creativity and Schizophrenia.
In a study published in 1926, Ellis (Ellis, 1926) selected 1,020 eminent people in the UK. They included politicians, scientists and artists. They were actually selected more for their fame than any proven creative talent. He found that 4.2% of his sample were ‘insane’, 8% were ‘melancholic’, 5% had ‘personality disorder’.
Brain (Brain, 1948) observed that ‘geniuses’ were more ‘nervous’ than other people. When they broke down, the diagnosis was often ‘cyclothymia’.
Juda (Juda, 1949) in a paper titled ‘The relationship between high mental capacity and abnormalities’ examined the medical records of 113 artists and 18 scientists. He found personality disorder as the commonest diagnosis. Artists who had abnormalities tended to show alcoholism and schizophrenia, while scientists appeared to suffer more from affective disorder.
Lumbroso (Lumbroso, 1981) introduced the idea of ‘hereditary taint’ to describe the relatively frequent appearance of ‘genius’ (defined as exceptional talent) along with ‘madness’ (psychotic illness).

More recent work
It is an exciting area of research.
A Danish adoption study (McNeil, 1971) measured psychopathology in some creative people who had been adopted away from home at an early age, and in their biological and adoptive relatives. It found that 3% of the creative sample had psychiatric diagnosis. 28% of the biological parents had a diagnosis of some kind of mental illness, while only 5% of the adoptive parents were ill. The commonest diagnosis was ‘Reactive Psychosis’)
Rust (Rust et al, 1988) found a relationship between creative originality and the positive cognitive aspects of schizotypal thinking. However their findings have not been reproduced since.
In a study reported in 1988, Richard (Richard, 1988) in Harvard set out to discover if there was a compensatory advantage in ‘Manic Depressive Illness’. His model was Sickle Cell anaemia, where the heterozygote is supposed to enjoy relative immunity from Malaria.
He selected a sample of people with diagnoses of Manic Depressive illness, Cyclothymia, as well as normal first degree relatives, along with matched controls. He measured their Creativity, using a ‘Lifetime Creativity Scale’.
His finding was that creativity was higher among the test sample than the controls. Remarkably, there was more Creativity among normal first degree relatives than even among the ill patients themselves. Those with diagnosis of ‘Cyclothymia’ came in between.
Andreasen in Iowa (Andreasen,1987) carried out a survey of 30 writers from all over who came to work in the University faculty. (famous African writers have been on the Iowa programme), and compared them with matched controls. She also studied their first degree relatives. Her finding was startling. 80% of the writers had had an episode of Affective Illness at some time. This was compared to 30% in the controls. 43% of the writers had Bipolar disease. There was also a higher incidence of illness and creativity in the writers’ first degree relatives.
The same researcher has gone a step further to establish from neuro-imaging studies that highly creative individuals have more intense activity in association cortices when performing ‘creative’ functions (Andreasen, 2011).
A British researcher (Jamison, 1989) took a sample of 47 famous British writers and artists who had won major awards such as the Booker Prize, or who were distinguished members of the Royal Academy of Arts. She found that 38% of them had received treatment for Affective Disorder (antidepressant, Lithium and/or hospitalization). Poets and novelists were particularly prone to mood swings, whereas visual artists were apparently less vulnerable.
More recently, a team working in Lagos (Olugbile et al, 2011) compared samples of patients in two Psychiatric Units (Lagos State University Teaching Hospital and Federal Neuro-Psycbiatric Hospital Yaba) who had diagnoses of Affective Disorder and Schizophrenia on the basis of their ‘Creativity’. No significant difference was found between the two populations, although the study was confounded by a number of factors, including small sample size.
Let us leave the discussion of the Arts for a moment, and focus on the other ‘barrel’ of our agenda. As I said earlier, this is The Lambo Lecture – created in honour of Professor Adeoye Lambo – founding father of Nigerian Psychiatry, and mentor and inspiration to not one but several generations of African Psychiatrists, among which I count my own. I had the privilege of enjoying some proximity to Prof Lambo in the days after his return from his assignment with the WHO. He was a man with an impeccable sense of dress, and unflappably gracious manners. I was a young man who often wore his emotions on his sleeves. Sometimes I could not understand why he was so cool. I once tried to draw him out on the subtle racism of some European psychiatrists of his generation who implied, for instance, that Africans could not experience depression. To my mind, they were similar to writers such as Joseph Conrad and the Oxford-Cambridge historians of the ilk of Hugh Trevor Roper who saw Africa as ‘the dark continent’ where there was nothing before the advent of the European. It was the work of people like Lambo that subsequently opened up the eyes of the world to the mental experience of the African, and situated his illness in pretty much the same diagnostic context as the rest of humanity, in a similar fashion to what Chinua Achebe did in Literature by writing ‘Things Fall Apart’.
Prof Lambo was an exceptionally brilliant man, the scion of a privileged Egba family, married to a very beautiful English wife Diane. He was perfectly comfortable in his skin.
Those who knew Prof Lambo would remember that he was virtually always dressed in formal suit, complete with pocket square. The only time I remember seeing him in agbada (of course complete with elegantly tilted cap) was the day he graciously accepted to be chairman at the public presentation of one of my novels – BATOLICA.
He had insisted on getting a copy of the book a week before the event, and, thorough man that he was, he had read it with close interest. He told me he liked it. The plot of the book centred around a group of idealistic but naïve students and lecturers in a university, disgruntled with their corrupt society, locking the gates of their University and declaring it an independent Republic. This was in a country under military rule. Predictably, dire consequences would follow.
Prof Lambo directed the book presentation from the podium at NIIA in Victoria Island that morning with practiced elegance, talking familiarly about the idealism of youth and the need for people, including Psychiatrists, to be socially conscious.
Which leads me to the crux of the reference. Prof Lambo was not only socially conscious. He was socially involved. The repeated political failings of his country – Nigeria was a thing that got him hot under his elegant collar.
He was normally loath to criticize people, but towards the end of his life, his criticisms of the Nigerian political class became a recurrent strident theme in his conversation, to the point where it received very wide press coverage. He began to advocate that politicians should undergo mental state examination before they could be eligible to hold public office.
I had the privilege of discussing this matter with him on a couple of occasions.
He of course was a Professor of Psychiatry, a leader in his generation. He knew all the pitfalls attached to the position, beyond the emotional desire to have a cleaner politics in his country. He wanted psychiatrists to champion the cause. I therefore took it upon myself to explore the precedence and seek evidence for his position.
The Evidence
Mapping a relationship between the holding of political office and the existence of mental illness is a scantily explored field, even now. And yet convincing evidence of such a link would be the minimum requirement to commence a discussion of the utility value of carrying out mental state evaluation of politicians.
Davidson (Davidson et al, 2006) published a review that showed that of the 37 Presidents of the USA who served between 1776 and 1974, 18 (49%) met DSM IV criteria for different diagnoses. Of these, 24% suffered from Depressive syndromes, 8% Bipolar Affective Disorder, 8% suffered from Anxiety, and 8% met criteria for Alcohol abuse/dependence. Somewhat alarmingly, 27% of the cases started while the President was actually in office, raising the possibility that they might have affected their on-the-job performance, including major decisions such as taking the country to war!
A review article by Hugh Freeman in the British Journal of Psychiatry (Freeman, 1991) speculated that Kemal Ataturk (founder of modern Turkey), as well as Benito Mussolini suffered from neurosyphilis, which was at that time a debilitating condition with neuropsychiatric complications. Woodrow Wilson, Winston Churchill, General Eisenhower, Leonid Brezhnev are known to have suffered from cerebrovascular incidents during their active public lives. General Franco and Adolf Hitler are said to have shown evidence of Parkinson’s disease. The extrapolation can be extended back to biblical times. King Nebuchadnezzar of Babylon suffered from what was obviously a psychotic condition. ‘Emperor’ Jean Bedel Bokassa of the Central African Republic who declared his impoverished African country an ‘Empire’ with himself as ‘Emperor’ over it was the subject of much speculation about what seemed to be grandiose and paranoid symptoms he exhibited in office.
What Value – the ‘Evidence’
Much of the ‘evidence’ is not based on definitive clinical information but is anecdotal. There is no implication, for instance, that the rate of various mental disorders is higher in people in political office than it is in the general population.
There is a subjectivity to speculation about other people’s mental health based on their public image or behaviour. The observation may be coloured by the attitude and political sympathy of the observer. A writer (Vertzberger, 1990) described how some ‘experts’ speculated, based on his behavior and pronouncements in office, that Kwame Nkrumah suffered from a paranoid condition. Obviously, many Africans with a pan-African passion, including psychiatrists, would have disagreed with such people.
This ‘psychological speculation’ in fact has become a genre of literature, with the advent of the ‘psycho-biography’. Interestingly it was Sigmund Freud who started the trend, working with a collaborator to write a psycho-biography of President Woodrow Wilson. In like manner, a British psychiatrist, tried to explain the enigma of Winston Churchill (Storr, 1989).
What the psychobiography does is try to use the principles of Psychology, including formal Psychoanalysis to explain retrospectively the life and actions of a public figure. It is meant to provide a depth of insight that the ordinary biography cannot match. However it has become controversial in the recent past. The fundamental assumption that the psychiatrist who is writing the script is himself without bias is not always a correct assumption. The biased opinion of a writer, even one who is a psychiatrist or a psychoanalyst, may camouflage as ‘scientific’ fact.
Another notable example of this controversial trend is provided by a writer (Abse, 1989) who wrote a book purporting to ‘explain’ the phenomenon of Margaret Thatcher. It was widely applauded by people who loved Margaret Thatcher, and widely denounced by people who hated her.
Other Issues pertaining to Mental State Testing
Would, or should – even the confirmed presence of a psychiatric illness automatically bar a person from eligibility for political office?
Some years ago, in the run-up to a local government election, there were sensational newspaper headlines about a politician who was accused by a rival of ‘once being a patient at Aro’.
The issues to be considered here include the anti-stigma campaign championed by all mental healthcare workers, and the fact that people with histories of formal psychiatric illnesses (like John Nash) have won Nobel Prizes and are holding down sensitive jobs in Industry, in the Judiciary, as well as in Medicine and the Arts.
Where is testing currently being employed?
Work: A major area of current use is in pre-employment screening, especially for senior executive/management positions in some industries. These tests are usually conducted by psychologists, and are not looking for pathology but focused on such things as Aptitude, Judgment, Personality types/temperamental attributes. They are used by Recruitment firms to select between eligible candidates.
Some people are rightly skeptical about the value of such tests. What, for instance, is the ‘right’ personality type or attitude for a Chief Executive of a car manufacturing company? Are they different from those required for the head of a Nursing Home? Is there a place where Science stops, and Instinct takes over? In any case, the test instruments do not purport to determine that one candidate is ‘normal’, and the others ‘abnormal’. The final choice is still left to the panel. The spectre of the ‘rejected’ candidate at one executive placement interview going on to flourish visibly in another company is a very familiar one.
Adoption: The statutes require that a couple requesting to adopt a baby should undergo a test of ‘mental fitness to adopt’. It is very loosely interpreted.
Legal and Forensic: In situations where it is necessary to establish Mens Rea (either due to a plea of ‘Not guilty by reason of Insanity’ or at the instance of the court on account of the nature and circumstances of the case), or to establish ‘Fitness to Plead’.
Airline Industry
There has been a clamour lately, based on the experience of the Germanwings flight 9525 that was taken down in France by a 27 year old suicidally depressed co-pilot – Andreas Lubitz, leading to the deaths of 144 passengers and 6 crew members, that compulsory and regular mental state testing should be instituted for airline pilots. This arrangement is not yet universally in place. Even where a pilot is receiving treatment privately from a psychiatrist, the protocols that would created an obligation to report feared ‘dangerousness’ to an employer without the consent of the client is still under discussion, a case of the doctor-patient confidentiality potentially clashing with the larger good of all.
What Value – the Test?
In the Legal and Forensic area, the outcome of the test may be literally a matter of ‘life and death’. In the airline industry, the stakeholders are still groping for the right solution that would protect everybody’s interests, including the passengers, without violating the rights of the pilots themselves. In some of the other areas, the value may be somewhat more dubious.
Why the clamour for Psychiatric Testing for Politicians?
While Prof Adeoye Lambo may have provided a professional face to the clamour in Nigeria for politicians to be tested, the perception that some politicians are ‘mad’ is a widely prevalent one, even now. The real issue, in taking this attitude, is that there is a perception that people are driven into politics not by an altruistic desire to do good and improve society, but by a selfish desire to amass wealth and power. The real complaint therefore is about Ethics and the tendency of a class of people all through the past years of military and civilian rule to behave persistently in ways that are detrimental to the public good. Apart from this, some politicians dislike other politicians intensely and would often label them ‘mad’. A good example is how Mummar Ghaddafi was labeled ‘schizophrenic’ by his Egyptian counterpart President Anwar Sadat because they never agreed on anything.
Mental Health, Ethics, and Political Conviction. The issue of ‘Personality’
One of the foremost figures in Psychology (Eysenck, 1956) wrote on the peculiar fact that there were observable similarities in the personalities of politicians who held extreme political views at both ends of the ideological spectrum – Fascism and Communism. It would have been very fascinating to learn if he would make a similar pronouncement about the personality of the religious extremist such as Boko Haram or IS in the present day.
Hugh Freeman (Freeman, 1991) quotes the anecdotal observation of another writer – Dixon, that people ‘who are unfettered by moral scruples, who are prepared to lie or cheat their way to the top, who will make promises they cannot keep and may even assassinate their rivals have a huge advantage over those held back by moral scruples’.
It sounds like a page out of Machiavelli!
At a surface level, if Freeman’s source is to be believed, a certain streak of Sociopathy may come in handy in the struggle for political office. Unfortunately, after attaining the office, the requirement for a successful public service is described in such words as consideration, empathy, transparency, and commitment to the public good, which are very different from the attributes that facilitated the attainment.
Politics and the Psychiatrist – a slippery terrain
If psychiatric testing were to be accepted as policy, who would be the candidates? Is it ALL politicians? (Unwieldy, unmanageable, in the light of existing dearth of manpower). Is it only those vying for high office? (Governor, Senator, President?)
Any level of testing would automatically make Psychiatrists the ‘gatekeepers’ of the political space, with all the dangers and temptations this embodies.
The Dangers and Temptations
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.
In the same way, in the area of Politics, psychiatrists are not necessarily dispassionate specialists practising an objective science, and passing judgement on their clients. To give but one example, during the Nazi era there were well-known German psychiatrists who supported the Nazis and labored to justify the ‘eugenic’ experiments they were carrying out on live human beings in scientific terms. In the same way, in the old Soviet Union, there were allegations that psychiatrists diagnosed illness in people who held dissenting views and forcibly admitted them into hospital ‘for treatment’. Western Psychiatry, vociferously led by the Royal College of Psychiatrists, UK, rose in protest that was heard all over the world. There were allegations about unethical practice in apartheid South Africa. And my own experience working in newly independent Zimbabwe revealed that there had been racial segregation and official discrimination in the handling of patients by the ‘white’ mental health work force.
Limits of the Psychiatric Test
1. It will not show conclusively who will steal from the public purse, and who will not deliver on his promises. It may show attributes of personality which suggest that an individual may not be motivated by ‘social interest’. However destroying a career on the basis of ‘personality’ is getting into very murky waters, and will be certain to excite controversy.
2. A formal test will turn up information on family history, and past psychiatric history. It will make a judgment on the individual’s present mental state. All of this will reveal if a person has been ill in the past, or if he is currently ill. Illness ranges in a spectrum from the transient ‘minor’ Anxiety disorder to the ‘severe’ Psychotic disorder. The implications for function and recovery vary across the spectrum, and so no generalization can be made. If a person is ill currently, he obviously needs to be treated. What about the person who had an acute psychotic episode five years ago, and has been well since? What about the person who has Bipolar Affective Disorder, and is stable on treatment? What about the person who falls ill in office, is declared temporarily unfit, is treated, and gets well (like Nebuchadnezzar!).
What is to be done with the information?
After the rigmarole of testing, what indeed is to be done with the information? Is there any bond of confidentiality between the doctor and the patient? Is the person who is ‘ill’ or prone to major illness to be ‘banned’ or quietly advised to withdraw, or advised to get treatment and stay on it? Is the information ‘private’, or is the public entitled to it in order to make an informed choice?
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.
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!
Discussion/Concluding Remarks
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.

And I thank you for listening.