Thomas Adeoye Lambo was among the first African physicians to specialize in the treatment of mental disorders. In the 1950s, he created an innovative community approach to psychiatric treatment.

The Early Life of Thomas Lambo

Born in 1923, Thomas Lambo was the son of a Yoruba chieftain, who was the leader of the ancient Nigerian city of Abeokuta. Lambo’s father sired more than thirty other children with twelve wives. Lambo later spoke of the extended kinship ties and relationships in the large compound in which they lived.

“Even today there are people there whose relationships are so ill-defined I can’t trace them. My cousin … is a traditional healer. Even in grade school he was interested in herbalism, which he practiced on all of us.” These early experiences would prove influential later on. (Bass, 1992)

In high school, Lambo attended a Baptist missionary school, Lambo’s required Sunday chores going into nearby villages to collect masks, idols, and other signs of indigenous worship to burn them as part of the school’s campaign to convert the villagers. But the so-called lessons of the missionaries didn’t poison his appreciation for traditional ways. Lambo’s relative privilege allowed him to study medicine at Birmingham University in England and obtain an advanced degree at London University’s Institute of Psychiatry. He married an English woman during this period. The two of them had four children.

While in London, the colonial government back home asked Thomas Lambo to study the mental health problems of Nigerians studying in England. Despite their higher education, these students expressed deeply held beliefs in the influence of spirits and other supernatural forces. Lambo soon came to believe indigenous elements would need to be part of any successful psychiatric intervention. And when Lambo returned to Nigeria in 1950, he used his own funds to hire traditional healers to collaborate with conventional psychiatric staff. He would also maintain professional ties back in England. When at home, Lambo began to film the traditional healers at work in order to better analyze their methods. In 1954, the colonial authorities in charge appointed him to be superintendent of the new psychiatric facility being built near his birth city of Abeokuta, The Aro Hospital for Nervous Diseases. (Bass, 1992)

Once in that role, Lambo began writing about paranoid schizophrenia among the Yoruba, who represented the majority of the hospitalized patients under his care. Dissatisfied with traditional European approaches, Lambo soon implemented a new and innovative model of treatment, transforming the institution from a locked facility to one of open community whenever possible. In this more community-oriented model, Lambo insisted that a patient be accompanied to the treatment facility by a family member who cooked for them, washed their clothes and otherwise provided support. In this way, their cultural milieu was not as severely disrupted. Lambo also saw to it that cultural beliefs were not ignored and indeed respected, however much such methods might seem “primitive” to European observers. Traditional healers were actively engaged and spent long hours with the patients, if the patients endorsed it as their preferred form of treatment. At the same time, the patient received what Lambo called social psychiatric treatment in the form of guidance from the staff as well as medications for their disorder. (Boroffka, 2006).

Thomas Lambo identified his approach as the Aro-Village System model and over the years found the traditional healers he employed to be “remarkably effective.”

Regardless, the colonial powers were aghast. They wrote him a letter, Lambo explained, the gist of which was, “We have just built the most modern psychiatric hospital in Africa. What are you doing hiring witch doctors? If one of your schizophrenics kills someone, His Majesty’s Government will take no responsibility.” (Bass, 1992)

Notwithstanding his culturally-grounded adjustments, Lambo placed himself firmly in the cross-cultural psychiatric tradition. Based on the observation of his patients, he asserted an essential similarity between psychiatric disorders found in Nigeria and the rest of the world.

The Emergence of Cross-Cultural Psychiatry

Being a Nigerian educated in medicine and psychiatry in England and then returning to his home country, an interest in cross-cultural psychiatry was a natural outgrowth of Thomas Lambo and his lived experience. It had the potential to address the question of what elements of his “western” medical education did and, more importantly perhaps, did not apply to clinical practice in his home country.

Cross-cultural psychiatry was very much a new discipline. Pow-Meng Yap of Hong Kong wrote an opening salvo in a 1951 journal article discussing psychiatric disorders that were specific to certain cultures, such as running amok and koro.   Considerable interest and discussion had followed, sufficiently that Eric Wittkower, a psychiatrist at McGill University in Canada, took concrete action on the matter. In collaboration with an anthropologist named Jacob Fried, Wittkower established a program of study in transcultural psychiatry in 1955. He initiated a newsletter on the topic the following year. This provided a place where researchers from different countries would have a better chance of getting their cross-cultural research published. The newsletter evolved into a journal, Transcultural Psychiatry.

When Wittkower organized a transcultural conference in 1957, Lambo knew that he needed to attend. Held in Zurich, Switzerland, the event brought together psychiatrists from 20 different countries to explore questions of mutual interest. In addition to Lambo, attendees included Morris Carstairs, an English psychiatrist interested in culturally appropriate treatment in India, Carlos Alberto Seguin, a psychoanalyst from Peru interested in what he called folklore psychiatry, and the aforementioned Pow-Meng Yap. (Carlson, 2013)

After Lambo attended the conference, he felt a strong pull to conduct cross-cultural research, but exactly how he might do so remained an open question.

Lambo’s Cross-Cultural Research Project

It would not take long for Thomas Lambo to find an amenable collaborator. Raymond Prince, a Canadian psychiatrist who worked with Lambo at Aro Hospital, described him as having “immense personal charm” and a “genius for interesting the ‘right people’” in his projects. (Boroffka, p. 451)

Both his charm and his intellect must have been in full display when American psychiatrist Alexander Leighton came to visit Abeokuta to see Thomas Lambo’s innovative approach to treating mental health disorders in Nigeria in June of 1959. Leighton was a professor of psychiatry and anthropology at Cornell University in Ithaca, New York. Upon meeting for the first time, the two men discovered a mutual interest in conducting a cross-cultural study that would explore the frequency and severity of psychiatric disorders and their associated impairment in American and Nigerian inpatient and outpatient settings.

Subsequently Lambo and Prince travelled to New York in March 1960 to make concrete plans for the joint project. Approval to launch the study was received from their respective organizations, hospitals and clinics and the earliest date to launch the project was set for January 1961. (Leighton, Lambo, et al., 5-7, 11)

While all of this was transpiring, Nigeria finally achieved independence from Great Britain in October 1960.

The First Pan-African Psychiatric Conference

In 1961, amidst the flurry of research activity, Thomas Lambo also helped organize the First Pan-African Psychiatric Conference which was held in November of 1961 in Abeokuta. A total of 85 mental health professionals attended from 13 different African nations.

Among the attendees and speakers at the conference was Tigani el Mahi, who has been identified as the first Black African trained in psychiatry. As a Sudanese physician then practicing in Egypt, el Mahi wrote as early as 1956 about the history of mental health issues in North Africa. He was one of the first psychiatrists to offer a psychological perspective on zar, a dissociative state in which an individual is thought to be possessed by a spirit. Relatedly, el Mahi posited the regional relativity of concepts of health and stated explicitly that he believed that definitions of mental health were dependent on cultural values.

Also in attendance was Henri Collomb, a French psychiatrist based in Dakar, Senegal. In the 1950s Collomb had identified an indigenous disorder he called bouffee delirante, an acute reaction characterized by disorientation, agitation and aggression. Collomb went on to establish the journal Psychopathologie Africaine in 1965. It would provide a French language outlet for works in comparative psychiatry in West Africa in particular.

Bouffee delirante and zar would both later be identified as so called culture-bound syndromes. That said, it is worth noting that while French psychologists observed and diagnosed boufee delirante in both North and West Africa, Anglo-Saxon trained English practitioners typically did not. It would appear that culture-bound syndromes may be “bound” both by the culture in which the disorder occurs and the culture in which the diagnosis originated.

Naturally, Raymond Prince, who had been practicing in Nigeria since 1957, and Alexander and Dorothy Leighton, the American psychiatrists working with Lambo, were in attendance. Other conference notables included Alexander Boroffka, the German psychiatrist to whose account of the history of psychiatry in Nigeria this article is indebted, and Eric Wittkower, who would have not missed it for the world.  

Probably the least progressive (and frankly racist) thinker at the conference was John C. Carothers. An English physician who practiced in colonial Kenya, Carothers had published two articles on East African psychology in 1947 and 1950 and a book on the topic in 1953. In them, he concluded that the rate of insanity among Africans living in tribal settings was remarkably low and only increased when Africans lived amidst Europeans. Even if his findings were accurate, Carothers never entertained the possibility that the stress of oppressive colonial contact was the source. Rather, in a decidedly biased fashion, he believed that the “primitive” African mind was relatively untroubled by emotional distress, unreliable and irresponsible, more like that of a child or a European psychopath. He had, however, introduced an influential concept of frenzied anxiety that he did see as troubling some Africans.  

Indeed, one of the points of disagreement among attendees at the conference was the relative frequency of depression in Africa compared to other regions of the world. Lambo had asserted in 1960 that colonial psychiatrists had underdiagnosed depression in Nigerians because they didn’t recognize more somatic manifestations of the disorder, such as pressure in the chest, pain in the extremities, and insomnia, or a more general sense of difficulty in thinking. But emotional symptoms went unexpressed. Indeed, there was apparently no Yoruban word for depression in the Western sense. (Hinton, pp. 318-319)

Lambo was gratified by the turnout, which included fifteen women. Of those, one was a psychiatrist, nine were nurses, two were volunteers, one was a social worker and two were guests. Notably, no clinical psychologists were present. None were even being trained in sub-Saharan Africa until the 1970s.

The Results of Thomas Lambo’s Cross-Cultural Collaboration

Published in a 1963 book entitled Psychiatric Disorder among the Yoruba, Lambo, Leighton and their colleagues shared their findings. In their book they compared results from systematic interviews with inpatient and outpatient clients in Yoruban southwestern Nigeria and a comprehensive survey conducted in a rural area of Nova Scotia in Canada in the forties. Multiple methodological limitations were inherent in such a comparison, but the Canadian survey was the only existing and extensive data set available that insured the project was doable.

Lambo and Leighton summarized the following findings as noteworthy. In general, they concluded that while the Yorubans expressed more symptoms than the Canadians, the Yoruban sample had fewer individuals with evident psychiatric disorder. Among the Canadians, women expressed more symptoms than the men, while this pattern was reversed in the Yorubans. Given higher rates of malnutrition and poverty, the Yorubans displayed more psychiatric symptoms commonly related to malnutrition or disease. (Leigton, Lambo, et al., pp. 273-274)

The two researchers also looked at the cultural health of specific communities. In Nigeria this was assessed by a series of factors including cultural change, poverty, lack of education, and lack of cultural outlets. Different communities were rated culturally integrated (stable), intermediate, and disintegrated (unstable). Lambo and Leighton found that both traditional and acculturated communities might be rated stable by these parameters. They concluded that the culturally troubled or unstable communities in the Yoruban and Canadian samples had “in many respects, more in common with each other than with the well- integrated communities of their respective cultural group.” (Leighton, Lambo, et al., p. 275)

Acculturation Stress as a Source of Pathology

Only a year prior to the Pan-African conference, Lambo’s associate Raymond Prince had identified a syndrome he attributed to the stress of Nigerian children experienced adapting to Western culture. Symptoms included headaches, lack of comprehension of lectures or readings, reduced concentration and memory loss. Prince called this cluster of symptoms brain fag syndrome, a now unfortunate term derived from the then current slang of “fagged out” for someone who was exhausted. Prince noted that this phenomenon was widespread amongst Nigerian students attending secondary school or universities. Prince hypothesized that the imposition of European teaching approaches, with their emphasis on individual effort, personal responsibility, discipline, and written assignments were inconsistent with the Nigerian student’s upbringing, which he suggested placed an emphasis on group activities, oral communication and a general permissiveness. Later writers suggested the syndrome wasn’t just limited to schools. Implications of intellectual inferiority were still in evidence, though the blatant racism of earlier writers was generally absent.

In the meantime, Thomas Lambo continued to be the preeminent psychiatric researcher in Africa during this period and wrote about his own perspective on acculturation. By 1962, he had begun to write with an increasingly clear perspective about the mental health problems created for Africans by the loss of traditional values and practices as many adapted to a new and unfamiliar urban environment. Lambo didn’t see such struggles as inevitable, but rather felt they arose out of a lack of compensatory cultural supports. The lack of such supports, Lambo believed, led variously to symptoms of depression, anxiety, malaise and sometimes irrational outbursts of anger.

In 1965, building on this perspective, Lambo suggested a new diagnostic category he labeled “malignant anxiety.” By this he meant individuals whose aggressive criminal acts were preceded by a period of severe, acute anxiety. This what not unlike Carother’s and Collomb’s earlier concepts of frenzied anxiety and boufee delirante respectively. Lambo theorized that the behavior of those suffering from malignant anxiety was not the result of psychosis or mental deficiency, but rather changing cultural and societal conditions, among other factors. At the time of his article, he had documented 29 such cases in Nigeria.     

Lambo felt that these changes in cultural setting resulted in numerous disorders not typically seen in traditional, non-urban African settings. He noted that same year that the use of barbiturates and amphetamines was now occurring in male students, young migrant workers, male bachelors, and polygamous men.

Two years later, in 1967, Lambo further observed that uprooted adolescents brought up in traditional village settings were now presenting with a greater frequency of mental health problems, psychosomatic disorders and behavior problems such as aggression, delinquency and prostitution in major urban centers across the continent. Lambo felt the loss of traditional hierarchies and transitional rituals without any new supportive social structures in place were likely the cause. And in 1969 Lambo expressed his belief that many male migrant workers had also started engaging in atypical homosexual behavior due to similar cultural dislocations. (Boroffka, 2006)

All things considered, Lambo wrote, “the most disturbing aspect is the inability of these men to enjoy normal heterosexual relations with their wives again” (Boroffka, p. 311).

John Dawson, a Scottish psychologist, explored some of these same issues in a study in the West African nation of Sierre Leone in 1962. Members of different ethnic groups in the country could choose five characteristics out of 21 to describe their people. Three of the most common self-ratings of the Temne ethnic group were “always want to fight,” “strong-minded,’ and “hot tempered.” In contrast, the most common self-ratings of the neighboring Mende group were “very friendly,” “hard workers,” and “good farmers.” Then, in a survey of the country’s lone mental hospital, Dawson determined that even though the more even tempered Mende were the largest ethnic group in the country, they only constituted 17% of those hospitalized. In contrast, while the Temne represented a smaller part of the total population, they represented 29% of those hospitalized. Dawson hypothesized that the self-identity of the Temne was inconsistent with the demands of urban life and that their values of aggressive masculinity were grounded in the tribal past. He felt the Mende, in contrast, had either adjusted better to the transition or were intrinsically more amenable to modern urban life.

While a more nuanced writer than many of his contemporaries, Dawson did not address the impact of Sierra Leone’s colonial history and the related demands on both the Temne and Mende to be politically and socially acquiescent to the English.

Transcultural psychiatry in the 1960s proved to be a culturally more sensitive enterprise in studying mental illness across the glove than its predecessors had been. The lens through which it looked at these psychiatric disorders, however, remained a decidedly European/American one. Western writers often failed to underscore the increasing realization of many researchers, namely, that a clash of cultures appeared to be at the center of many contemporary disorders. The precise nature of that clash, however, remained open to dispute.

For his part, Lambo left the Aro Hospital for Nervous Diseases in 1963 to head up the new department of psychiatry at the University of Ibadan, ultimately becoming dean of the medical school and vice-chancellor of the entire institution. (Bass, 1992; Heaton, 2018)

Thomas Lambo and the World Health Organization

Lambo’s rise to prominence continued. He left Nigeria in 1971 to take a position with the World Health Organization and their work on global mental health in Geneva. Both effective and insightful, Lambo was promoted in 1975, becoming the Deputy Director-General of the organization. During this period he helped organize the World Association for Psychosocial Rehabilitation as well as being instrumental in completing an influential cross-cultural study of Schizophrenia.

There was one area in which Lambo experienced less success. That was in changing American and European attitudes towards traditional healers. Many years before, Lambo had realized how traditional healers utilized many of the techniques of psychotherapists, establishing rapport, obtaining relevant histories, and interpreting dreams, often dancing for their “clients or performing powerful rituals. (Bass, 1992)

Lambo might have added instilling hope.

Writing in 1973, Lambo encouraged his colleagues to show a little humility in acknowledging that “thinkers from the Third World could offer positive challenge to the established institutions and practices in the West.” (Lambo, 1973, p. 147)

But the good he was able to accomplish surely outweighed such frustrations. In 1989, Lambo retired, returning to the country of his birth in 1989.

Back in Nigeria

In a 1991 interview, the 69-year old psychiatrist reflected on his life’s work. While still optimistic about the future, Lambo feared that as Nigeria became increasingly urban, his unique approach to treating mental illness might become no longer feasible.

“Once a country is industrialized—people living in nuclear families in city apartment, moving here and there at the whim of their employers—it becomes difficult to tie yourself down caring or relatives … The hypothesis I tested so successfully at Aro may not survive these present developments.”

Lambo lamented how he would meet one Nigerian president after another, given the frequent coups in the country, telling him of the mental health needs of the people. But even if the man meant well, the massive problems he encountered too often thwarted progress in that area.

But Lambo resisted arguments that old belief systems needed to be swept away by the new, hoping the role of ancestral spirits remained strong in Nigeria. Lambo found such beliefs a source of resilience, though allowing that no culture was free of neuroses.

“I hope it will go on for a long time. The ancestors support you. You go to their graves when faced with making an important decision. The mechanism is similar to confession in the Catholic Church.”

Thomas Lambo grew thoughtful. “In Africans, the gods are still alive.” (Bass, 1992)

Mark Carlson-Ghost

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References

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Bofoffka, A. (2006). Psychiatry in Nigeria: A partly annotated bibliography. Kiel: Brunswiker Universitatbicjhandlung.

Carlson, M. (2013). From colonial constructs of abnormality to emerging indigenous perspectives. In T. Plante, Ed., Abnormal psychology across the ages: Volume 1 History and conceptualizations, pp.51-72. Santa Barbara, CA: Praeger.

Corothers, J.C. (1953). The African mind in health and disease: A study in ethnopsychiatry. Geneva: World Health Organization.

Dawson, J. (1964). Urbanization and mental health in a West African community. In A. Kiev, Ed., Magic, faith and healing, pp. 305-342. New York: Macmillan Publishing.

Heaton, M. M. (2018). The politics and practice of Thomas Adeoye Lambo: Towards a post-colonial history of transcultural psychiatry. History of Psychiatry, 29(3), 315-330.

Lambo, T.(1973). Changing patterns of mental health needs in Africa. Contemporary Review 222(1286), 146-154.

Leighton, A.H., Lambo, T.A., Hughes, C.C., Leighton, D.C., Murphy, J.M., & Macklin, D.B. (1963). Psychiatric disorder among the Yoruba. Ithaca, NY: Cornell University Press.

Prince, R. (1960). The “brain fag” syndrome in Nigerian students. Journal of Mental Science, 106, 559-570.