Entangled pathways: navigating mental healthcare dynamics in Abeokuta

Abstract

Mental healthcare among the Yoruba in Abeokuta, Nigeria, extends beyond hospitals to encompass a range of traditional and faith-based practices. This study examines the various forms of mental healthcare available in Abeokuta, the motivations behind their use, and how engagement with multiple treatment systems shapes recovery experiences. Drawing on nine months of ethnographic fieldwork across purposively selected biomedical, Ibile (traditional), and Aladura (faith-based) mental health facilities, the study employed standard ethnographic methods (interview, observations, and discussion) to gather qualitative data. Participants included psychiatric doctors, nurses, therapists, social workers, traditional healers, faith-based practitioners, caregivers, and care recipients. Findings highlight the integral role of a “multiple care” approach. This approach, which combines physical, social, spiritual, and moral dimensions, reflects a holistic understanding of mental healthcare. By triangulating data from care providers, caregivers, and service users across the selected traditions of care, the study demonstrates that biomedical hospitals alone cannot address the complex needs of mental health patients. Instead, people intentionally seek multiple care options, driven by their interpretations of mental illness and the psychological relief and hope these alternatives provide—relief often lacking in biomedical treatments. These findings advance discussions on medical pluralism and syncretism, emphasising that no single system of care can fully encapsulate the complexities of mental healthcare in Abeokuta.

Introduction

Mental healthcare provision and utilisation have long been concerns in Nigeria, including among the Yoruba, due to the limited resources and support compared to other healthcare services. Healing practices, including mental healthcare, are indigenous to the Yoruba, as in many other African settings [1, 2]. In other words, psychiatric practices existed long before the establishment of psychiatric hospitals in the Yoruba region of Nigeria in the twentieth century [3–5]. Yoruba healing practices were holistic, addressing all forms of illness, including mental health, though few practitioners specialized solely in mental healthcare as a distinct field (ibid). Healing was deeply intertwined with religion and social activities [6–9].

Several studies (e.g., [5, 10–12]) have documented the role of psychiatric hospitals, such as the one in Abeokuta. However, it is essential to acknowledge that mental health services extend beyond biomedical settings to include traditional psychiatry and faith-based centres, both of which are widely accepted forms of treatment among the Yoruba in general and in Abeokuta specifically [3, 4, 13]. Studies have reported a preference for traditional healers in diagnosing and treating mental illness across Yorubaland, including Abeokuta [14–18].

Early scholars suggested that the preference for traditional healing stemmed from a shortage of biomedical psychiatric resources and low levels of Western education [2, 10, 19]. However, despite improvements in biomedical psychiatry, industrialization, and education, non-biomedical psychiatric practices, particularly traditional healing, remain central to mental healthcare in Yoruba society [14, 15, 20, 21]. This persistence suggests that the coexistence of multiple forms of healthcare cannot be fully explained by earlier assumptions.

This paper, therefore, addresses the following questions: What forms of mental healthcare exist in Abeokuta, Nigeria? What are the reasons people use them? and How does the use of multiple mental healthcare practices shape recovery experiences in Abeokuta? It explores the various sources of mental healthcare in Abeokuta, highlighting how experiences of mental illness extend beyond the hospital environment into a landscape of diverse treatment options. The ethnographic materials presented in this paper also provide insights into the concepts of medical pluralism [23–25] and medical syncretism [26, 27] which I will discuss latter.

Nigeria’s mental health burden in the literature

The burden of mental illness in Sub-Saharan Africa is significant, yet mental healthcare resources are extremely limited and underutilised, creating a substantial ‘treatment gap’ [28–33]. According to the 2010 Global Disease Burden report, the burden of mental illness in Sub-Saharan Africa is projected to increase by 28% to 198% by 2050, with West Africa disproportionately affected [34]. In Nigeria, Gureje and his colleagues [35] have earlier estimated the prevalence of mental illness among Yoruba adults as one in 17 annually and one in eight over a lifetime, thus exacerbate morbidity and mortality rate in this region.

The consequences of untreated mental illness is huge and spread across all other spheres of life. Individuals with mental illness are 40% to 60% more vulnerable to other morbidities, disabilities, and premature death [36]. Studies from 29 countries, including Nigeria, reported more than double the mortality rates for those with mental illness compared to the general population [37]. The economic, social, and psychological impacts of untreated mental illness are substantial [33, 36, 38, 39].

Despite this burden and consequences of untreated mental illness, adequate and effective mental healthcare is scares, unevenly accessible, and selectively used. Studies have shown that prompt access to quality mental healthcare can reduce this burden, as early recognition and management are essential [40–43]. In several African settings, including Nigeria, many in need of mental healthcare do not receive it, especially in rural areas known asl ‘treatment gap’ [44–50]. Many studies have explored the barriers and facilitators of mental healthcare provision and utilisation in low- and middle-income countries (LMICs) [51]. Factors contributing to the untreated mental illness include unavailability of modern mental care resources such as human resources and psychotropic drugs [52–55]. Lack of supportive national mental healthcare policies [29, 31, 56–58], unequal access due to social stratification [59–61], poor mental health literacy [62–66], and poverty. Okechukwu [60] highlighted the shortage of psychiatrists, poor facilities, and lack of funding as main barriers in Nigeria. Despite the challenges facing the biomedical mental healthcare system in Nigeria, recent studies indicate that other sources of mental healthcare, such as traditional healing and faith-based practices, continue to coexist and provide care to the general populace across African settings, including among the Yoruba of Nigeria (see, e.g., [21, 67]). This coexistence is commonly referred to in the literature as medical pluralism.

Medical pluralism and syncretism in contemporary healthcare practices

The effectiveness and quality of healthcare are closely tied to the medical systems in place [68] and the methods used to sustain them. Medical anthropologists have long relied on the concept of medical pluralism to analyse healthcare practices in diverse settings. Medical pluralism refers to the coexistence of multiple medical systems, treatment traditions, or institutions of care to deliver health care for a given population [23]. Coined by Charles Leslie in the 1970s through his work on Asian medical traditions, medial pluralism has since become a key framework for examining the coexistence and interaction of multiple healthcare system within a society, such as biomedicine, traditional healing, and alternative therapies [23, 24, 69]. Initially, medical pluralism was used to describe various healing practices within a geographical region, including practitioners of the same tradition—such as traditional birth attendants and bone setters—as well as different medical systems, such as Ayurveda and allopathy. The global dominance of biomedicine has, however, framed medical pluralism as the coexistence of biomedicine with other healthcare systems, often reducing these traditions into binary categories: biomedicine versus "others" [23, 69, 70]. This approach highlights how individual practitioners practice and mark different their practices and services within diverse systems of care to address the health needs of their society.

Medical pluralism has been instrumental in analysing healthcare dynamics, power relations, and the negotiation of meanings among different healing traditions [70]. It has provided insights into the historical evolution of medical traditions and the internal boundaries within societies' medical systems [23, 71]. Scholars have emphasised the importance of understanding the diversity of medical practices in a population and the relationships among practitioners [72–74]. However, the concept has faced criticism for oversimplifying the impact of colonialism and the hegemony of biomedicine, often neglecting the nuances among non-biomedical care traditions [23]. Additionally, scholars such as Leach and colleagues [75] and Muela and colleagues [76] argue that the concept presumes clear boundaries between healthcare traditions, which rarely exist in practice. Instead, the meaning and function of healthcare practices—regardless of form—within a population are often more significant than their differences.

Globalisation has further complicated the concept of medical pluralism, challenging traditional boundaries between medical systems. The global spread of technology and transnational healthcare practices, facilitated by the Internet, has transformed how healthcare services are provided, accessed, and consumed [77, 78]. These changes have led to greater hybridity in healthcare practices, as demonstrated in ethnographic studies. For example, Hampshire and Owusu [77] observed traditional healers in southern Ghana incorporating biomedical and Chinese therapeutic knowledge into their practices, creating hybrid approaches that blur local and global healthcare distinctions.

In response to these complexities, scholars have shifted from professional-centred frameworks, such as medical pluralism to user-centered concepts like ‘medical diversity’ [70, 79], ‘medicoscape’ [80], ‘therapeutic landscapes’ [75, 81, 82], and ‘medical syncretism’ [78, 83]. While these concepts overlap, each emphasises distinct aspects of healthcare. ‘Medical diversity’ focuses on integrating ideas and methods from multiple health traditions [79], while ‘therapeutic landscapes’ explore the holistic nature of care, including resources and spaces, as shown in studies like Leach [75] work on infant healthcare in Guinea. ‘Medical syncretism,’ on the other hand, examines how individuals blend disparate medical traditions into cohesive care practices, recognising the fluidity of boundaries among medical systems [78]. In other words, medical syncretism, as explored by anthropologists, refers to the blending of diverse medical systems, such as biomedical, traditional, and spiritual practices, within a single therapeutic process. This phenomenon reflects cultural adaptability, where individuals draw on multiple healing traditions to address complex health needs, often incorporating spiritual, social, and physical dimensions for holistic care.

Despite extensive studies on medical practices in Africa, few works juxtapose medical pluralism with syncretism to deepen our understanding of contemporary medical practices, particularly in mental health. This paper, in addition to its objective also addresses this gap, offering insights into how these frameworks can be applied to evolving healthcare landscapes.

Study sites and methods

This study draws from ethnographic fieldwork conducted in Abeokuta, Nigeria, the capital of Ogun State and home to the Egba people, a Yoruba subcultural group. Abeokuta is notable for hosting the first psychiatric hospital in southwestern Nigeria [10, 84]. I conducted nine months of fieldwork between September 2018 and May 2019 in various mental healthcare facilities, including The Neuropsychiatric Hospital, a government-owned psychiatric hospital, as well as two (traditional) healing and three faith-based centres.

In the Neuropsychiatric Hospital, I observed wards, emergency units, and administrative areas, interacting with medical staff, including doctors, nurses, psychologists, and social workers. I participated in activities such as ward rounds and occupational therapy. Data collection methods included participant and non-participant observation, informal discussions, and the use of audio recordings and photography [85–88]. My participation ranged from active involvement in daily hospital routines to passive observation. In other facilities (which I will describe later), my role was limited to non-intrusive tasks like organising materials without interfering with treatments. Conversations took place in Yoruba or English, depending on the setting.

I selected traditional and faith healers based on their popularity. To identify other sources of mental healthcare in Abẹokuta for the study, I visited various popular community hubs, including viewing centres where football matches like the English Premier League and La Liga were shown for a fee, newspaper stands, private hospitals, and recreational places commonly referred to as ‘beer parlours’ in the area. These hubs were located in neighbourhoods surrounding the Aro Neuropsychiatric Hospital, such as Ita-Oshin, Olomore, and Abule Aro. These locations were frequented by individuals from nearby communities, who often engaged in discussions on topics like politics, sports, and economics, making them ideal for initiating conversations.

During these visits, I observed ongoing discussions and gradually joined conversations, tactically steering the topics toward mental illness and its perceived causes in the region. I then inquired, often with groups of two or three people, about local sources of mental healthcare beyond Aro Hospital. Within a week, I compiled a list of these sources and asked participants to rank them based on perceived popularity, treatment efficacy, and location. Aro Hospital was consistently ranked the highest, but I selected two traditional healers and three faith-based healers for the study as they were the most frequently mentioned facilities in Abẹokuta.

Participants included individuals receiving care or those caring for patients at the selected facilities during the fieldwork. Ethical approval was obtained from Durham University’s Ethical Committee and the Neuropsychiatric Hospital in Aro. Due to the sensitivity of the study, verbal consent was secured, following guidelines from the Association of Social Anthropologists, which emphasise context-appropriate consent practices. Verbal consent alleviated concerns about confidentiality, particularly for patients and caregivers. Consent was renegotiated as necessary throughout the fieldwork, acknowledging the importance of continuous ethical considerations in ongoing interactions. Additional details about the methodology and ethical considerations are documented elsewhere [89]. The ethnographic data were analysed using the grounded theory approach [90, 91].

The role of biomedical hospital (aro neuropsychiatric hospital) in Abeokuta’s mental health landscape

Mental illness in Abeokuta is understood within the context of social relations and personhood [92]. Personhood in this setting is multifaceted, encompassing elements such as parenthood, friendship, employment, and financial status. Mental illness is often perceived as the breakdown of one or more—though not necessarily all—of these facets of personhood (ibid). As a result, the appropriate mental healthcare is seen as involving multiple practices, i.e., a diverse healthcare system that can address and repair the different aspects of personhood that have been compromised [92, 93].

As in other Yoruba settings, Abeokuta is characterised by the coexistence of various mental healthcare traditions, including biomedical psychiatry, traditional healing, and faith-based systems. In this study, the Neuropsychiatric Hospital, Abeokuta, represents the biomedical system. The belief that effective mental healthcare must address multiple dimensions of a person’s being underscores the distributed notion of personhood in the study location [92]. This perspective is reflected in how mental illness is explained, diagnosed, and treated, with caregivers often consulting all available treatment options to repair specific aspects of personhood damaged by the illness [93].

The Neuropsychiatric Hospital, for instance, primarily provides a treatment approach focusing on the biomedical aspects of care, with some elements of moral support. The staff at this hospital are broadly categorized into clinical and non-clinical roles. Clinical staff include those with medical qualifications or certifications related to healthcare who are directly involved in the treatment of patients, such as doctors, nurses, psychologists, and therapists. Non-clinical staff are responsible for administrative duties and do not directly handle patient treatment.

At the Neuropsychiatric Hospital in Abeokuta, mental illness is typically viewed as a natural phenomenon with biological explanations, and non-scientific interpretations of the illness are often discouraged. However, the clinical staff also recognise that mental healthcare affects multiple aspects of a patient’s life, necessitating the need for 'multidisciplinary treatment,' which they believe is offered at Aro Hospital. The multidisciplinary treatment at the Neuropsychiatric Hospital, however, focuses primarily on the biological aspects, particularly the brain, thus emphasising pharmaceutical interventions as the main treatment approach.

Further details on the Neuropsychiatric Hospital, Aro Abeokuta, have been published elsewhere [93]. Nevertheless, the perceived appropriate mental healthcare in this context extends beyond the biomedical model and incorporates social, spiritual, and moral dimensions, which are believed to be best provided by other traditions of care, necessitating syncretic practices.

Traditional healers, faith-based practitioners, and biomedical professionals contribute to an interconnected system of care that addresses the diverse interpretations and treatments of mental illness. While caregivers and patients derive psychological relief from these treatments because they align with their beliefs, they also appreciate the choice offered by such a system. Traditional healers and faith-based practitioners often promise a "complete cure," a promise that is absent in the biomedical approach, where patients may remain under lifelong care.

In what follows, I present the traditional and faith-based healers and demonstrate that each group of practitioners including the biomedical practitioners earlier presented, maintains distinctions in their practices—leading to what can be described as medical pluralism. Medical pluralism (boundary demarcation of practice) was often emphasised by the practitioners because it highlights and reinforce practitioners’ social status. However, there is also significant overlap in the usage of the services rendered at these facilities as patients and caregivers blend various treatments to manage mental illness in the study location, thus suggesting medical syncretism. This paper also highlights that mental healthcare in Abeokuta is characterised by ambiguity and complexity, both in the understanding of mental illness and the therapeutic approaches used. Although each of the practitioners (traditional healers, faith-based healers, and biomedical personnel) frame their practices as distinct systems, boundaries between these traditions often blur, especially when practitioners adopt elements from other systems. For instance, some Aro hospital staff recognise supernatural causes of mental illness and accept religious practices like prayer, reflecting a form of syncretism even within a care system.

The role of Ibilẹ (traditional) psychiatry in Abeokuta’s mental health landscape

In Abeokuta, psychiatry and Aladura (Faith-based) healing practices represent distinctive healthcare traditions deeply rooted in Yoruba cultural beliefs and Christian religion respectively. The term , meaning "born on the soil," reflects the indigenous nature of this tradition, while Aladura, (which I will discuss in detail later) which translates to "the praying one," is used for faith-based healing practices. These terms, frequently employed by both practitioners and users, encapsulate the local understanding of “traditional” medicine. psychiatry, in particular, embodies a healthcare system founded on Yoruba epistemology, religion, and ancestral practices. Other terms used by participants to describe these traditions include abalye or adayeba (from the ancestors or forebears), t’ile (the indigenous, of home, or “ours”), and ‘Yoruba science’.

The two mental healthcare practitioners discussed in this paper, Chief Fag and Chairman, represent this tradition. Both had minimal formal education—primary and secondary school, respectively—but were highly respected in their communities for their healing abilities. Their lack of biomedical training was seen as predestined, enhancing their credibility within their communities. They believed that traditional healing was inherited and divinely appointed, and this belief was reinforced by their success, measured through financial stability and social recognition. Their healing knowledge was passed down from their fathers, and continuous learning was regarded as essential to mastering the craft.

Unlike psychiatric hospital Abeokuta, which is located on the outskirts of the city and separated from the community by a tall fence, Chief Fag’s and Chairman’s facilities were integrated into the heart of Abeokuta. Their facilities were situated among residential buildings, schools, and other community spaces. For example, Chairman’s facility was a rented apartment adjacent to a church and a popular recreational hall, while Chief Fag’s facility was bordered by several unfenced homes and a public primary school see Fig. 1. This proximity to the community is a distinctive feature of psychiatric care, embedding the healing process within the social fabric of Abeokuta.

Fig. 1.

Chief Fag’s Facility built similar to and situated among other residential homes at the heart of Abeokuta City. Photo Credit: Authour's Fieldwork 2018

practitioners like Chief Fag and Chairman exclusively utilised indigenous methods such as divination, dream interpretation, and confession of possible wrong deeds to diagnose and treat mental illness. They rejected pharmaceutical drugs, often referred to as “oyinbo” (Whiteman’s) medicine, believing them to be ineffective compared to traditional remedies. As Chief Fag once explained, “That was what weakened my bond with one of them [a biomedical psychiatrist]; he wanted me to use t’olooyinbo – ‘Whiteman’s drugs’ for my patients, and I told him that I did not see my father doing such, and I cannot start it.”

The practitioners used herbal remedies and local materials, creating medicines from plants, water, animal products, and semi-processed local items such as (black soap) and gin. Their equipment ranged from mud and iron pots to wooden mortars, pestles, and grinding stones see Fig. 2. The treatments they offered could be broadly divided into "tangible" and "intangible" methods. Tangible treatments included the use of oogun (medications or charms in various forms such as powders, liquids, creams, or ornaments). These were administered through methods like incision, oral ingestion, burial, wearing, sniffing, or bathing. Intangible treatments consisted of prayers, warnings, and rituals of appeasement, reflecting the practitioners' belief in the power of spoken words to both cause and cure illness.

Fig. 2.

Chairman parking one of the prepared medications for storage.

Source: Author's Fieldwork, 2019

Regarding the aetiology of mental illness, both Chief Fag and Chairman identified natural causes, which they attributed to physical injuries affecting the head. They mentioned auto accidents, falls, and violence as the major predisposing factors. Both also acknowledged the possibility of genetic transfer, emphasising heredity. More importantly, Chief Fag and Chairman highlighted the influence of 'metaphysical forces,' particularly curses like epe Ijebu,1 as commonly believed causes of mental distress in the region, as Chairman noted below:

“You too consider this scenario: imagine a lady dating a young man and taking money from him for a long time, only to suddenly come back and break up with him without any tangible reason—perhaps because she has met another, wealthier man. That's when she would realise that her former boyfriend is neither educated nor handsome. She will just find some flimsy excuse to leave him. So, what do you expect the jilted boy to do? He would seek revenge, of course. He might cast a spell on her (laughing)… Epe Ijebu! Because many people have access to it, he will just curse her with epe Ijebu…' (he continued laughing). Chairman

The two healers also noted that treating mental illness caused by curses and bewitchment is beyond the reach of biomedical treatment. Like Chairman, Chief Fag expressed that only mental illness caused by natural factors can be managed by the biomedical approach. According to him, curing mental illness caused by heredity is almost impossible because it is already 'in the blood.' However, they can treat each episode, and at best, assist the person with such challenges by identifying the triggering factors through Ifa divination and advising them to avoid those factors to prevent relapse.

Chief Fag was very optimistic that they could cure mental illness caused by bewitchment. At this point, he made a distinction between treatment and cure. According to him, treatment involves taking medication to control an illness, while a cure is total healing, after which the patient requires no further treatment for the same condition. To Chief Fag, biomedical psychiatry differed because it often treats, but the patient must continue receiving such treatment for a long time. The healers also emphasised the strength and efficacy of their medications, both tangible and intangible, which they believed allowed them to address both the natural and supernatural aspects of an illness. They noted that their intangible methods of healing, such as incantations or prayers, were not only effective but also reliable and no resistance can be developed against it as pharmaceutical drugs often encounter. Chief Fag's assertion, "Ilẹ ki su ohun," which literally translates to "darkness cannot hinder the power of spoken words," means that neither the natural conditions e.g., weather, location/place or person nor social circumstance can prevent the efficacy of intangible medications.

Both Chief Fag and other practitioners believed that their methods offered a complete cure, unlike biomedical treatments, which they felt only provided temporary relief. Chief Fag referred to this as asepari (the complete cure) or ika (the grand finale), a form of healing that would prevent relapse unless new illnesses arose. He elaborated:

‘The only thing I can say in that regard…the western psychiatry believes that once anybody has a mental health challenge, such a person would be on the medication until his/her death. That is what I heard. But that (Ibile healing) of Yoruba, if the person or the caregiver can afford it, there is what we called asepari – the full course. Once asepari is done for a sick person, that person would not be taken any mediation further and cannot relapse except a new one (new illness) comes because there are numerous predisposing conditions to psychiatric disorder. That is what we called asepari or ika. But I don’t know if the western medicine now stops their patients from taking medicine at a point too… That is the difference between our own [Ibile healing] and the Oyinbo’s [white people’s]. The second difference is that we [traditional healers] do tell our clients some times to avoid taboo. For instance, we do forbid some of them from eating beans, chicken…it may even be type of cloth or colour and so on.’ healers - Chief Fag

Ibile care also differed in costing and ethics of the healing services. Unlike the standardised fees of about six thousand naira for registration and over around another hundred naira for an admission at psychiatric hospital, Aro [92], the cost of treatment at facilities was flexible, determined by the patient's condition and the caregiver's financial capacity. Both Chief Fag and Chairman considered various factors when determining their fees, such as the materials required for treatment and the patient's ability to pay. Some treatments involved no major medications, while others required offerings such as goats, pigs, or even cows. Both healers also considered their personal relationships with clients or their caregivers, often reducing fees or treating patients for free in certain circumstances. Fees ranged from ₦20,000 to ₦150,000 (£40 to £300), but capturing aggressive patients and providing meals for those whose caregivers were unavailable incurred additional costs.

The role of faith-based healing in Abeokuta's mental health landscape

In Abeokuta, some religious figures and organisations were actively involved in interpreting and treating mental illness. While not all religious organisations in the region engaged in this practice, those that did took pride in their methods, describing them as the best available. Faith-based healers differentiated themselves from other practitioners by claiming their practices were based on a divine calling from God. This section outlines the factors that distinguished faith-based healing from other forms of care, including the source of healing, treatment methods, cost, and perceived effectiveness. However, I must state here that conducting fieldwork in faith-based facilities and with their healers may be challenging. In several cases, healers were reluctant to share details about their practices, and some declined to participate altogether. Among those who did participate, evasive responses were common, and they often refused to provide direct answers or permit me to observe certain practices.

I relied heavily on interviews, as participation in the healing activities of these organisations required rites that may take several months to complete. I was also not allowed to photograph the church environments or record discussions, and many practices remained unexplained to me. One notable example was the use of objects such as a coconut bound with candles and palm fronds, found near the entrance of one of the churches. On many occasions, I saw people carrying candles wrapped in palm fronds and walking around the church in a ritualistic manner. When I inquired about these practices, the response was typically dismissive or vague. Despite these challenges, faith-based healers enjoyed wide acceptance in the community, including from some staff at biomedical settings as will be seen in this section.

Faith-based mental health care in Abeokuta included practitioners from both Christian and Muslim backgrounds, with Christian healers predominating. Of the two Muslim clerics I encountered during the research, only one had an established facility, but he declined to participate in this study. In contrast, numerous churches and pastors, primarily of syncretic denominations (often regarded as "white garment" churches in the region), were involved in mental health care. Residents frequently identified churches such as Oba's Church, Cherubim and Seraphim (Odu's Church), and the Celestial Church as well-known centres for mental health care in Abeokuta.

Out of approximately seven churches commonly mentioned by residents in Abeokuta, I purposively selected four being the closest to The Neuropsychiatric Hospital. One was later excluded because it was not fully involved in mental illness treatment. The other three churches—Oba's Church, Odu's Church, and Caplar's Church—were independently founded and owned. Oba's Church was founded and registered under the Federal Government of Nigeria by its founder, Prophet Obaf, who was the eldest, being over seventy years old. He was followed by Most Reverend Prophet Odunm, in his mid-sixties, who founded Odu's Church, which was registered under the Cherubim and Seraphim Church of Nigeria. Superior Shepherd Caplar, who was fifty years old, founded Caplar's Church, registered under the Celestial Church of Christ (CCC) of Nigeria.

In all three churches, the facility was referred to as a "church," situated at their permanent sites, each with at least one other building regarded as the mission house. All of the churches were located among clusters of buildings, accessible by at least an untarred road. The healing settings at these churches varied in size and structure, but all claimed that God had called them to provide healing, particularly for mental illness as demonstrated in Obaf’s own words during one of our discussions that “Healing people living with mentally ill also started the same way. It was the spirit of God that told us to be treating the mentally ill people.”

Becoming a faith healer in Abeokuta did not involve formal training, such as enrolling in a school like in the biomedical tradition, nor did it involve inheriting skills from a predecessor, as is the case with traditional healers. Instead, faith-based healing was described as a "talent" or "spiritual gift." The healers could not differentiate between how they became healers and how their ministries began. The founders attributed the ownership of the church, the power of healing, and the methods of healing to God, describing themselves as mere ‘ministers’ of and "tools" used by God. However, during some discussions, I noted phrases like "I established," "our church," or "his church" from the founders and their members, suggesting that they also claimed ownership of both the church and the healing abilities.

The faith-based healers' causal explanations of mental illness were similar to those of traditional healers, focusing on malevolent spirits or the actions of wicked individuals. For example, Obaf described mental illness as a sudden loss of consciousness, often caused by bewitchment or an attempt to thwart one's destiny by evil forces. Similarly, Carplar and Odum viewed mental illness as resulting from enemies, curses, or divine wrath. He also believed that mental illness could be the repercussion of an evil or immoral act or caused by the wrath of God, but in most cases, he believed it was caused by bewitchment by Aye (evil forces) or (enemy). He further noted that out of their wickedness, enemies usually inflict mental illness in an attempt to thwart Gods’ plans or the destiny of the victim or intended either to punish the victim or their relatives. Other causes for mental illness they identified were curses and inherited conditions. According to Carplar, treating all forms of mental illness was not an easy task, but it became more difficult if the cause was inherited. Carplar also claimed that he could treat all forms of mental illness except the one inflicted by God, which he believed was incurable except by God Himself.

Healing methods varied among the faith-based healers. Obaf relied solely on prayers, fasting, and the reading of psalms to treat mentally ill people. Patients were subjected to fasting, often for several days, during which prayers were offered, and psalms were read into water for the patient to drink or bathe in.

It all started when God instructed me to be assigning them birirbiri [marathon fasting). They will neither eat nor drink anything some for seven days, some fourteen days. But it is God that would determine how many days. Before you know it, the sickness would vanish away. We will prevent them from eating and drinking and we will be praying for them continuously. Yes, all we will be doing is to put them in a room and be praying for them.’Prophet Obaf - Faith-based healer

Carplar, on the other hand, mentioned an array of materials they used, such as names (personal, family, mothers, and fathers etc.), place, animal products, plants, different waters (rain, tube well, river, and ocean etc.), coconut, meaning light but denoting candle, soap, anointing oil, prayers, and songs. Other significant aspects affecting healing that was mentioned were time (night or day), utterance or voice, place, and processes. Some of the items mentioned were often found within the church environment, however, both pastors obscured from me actual purpose of these different materials and the ways they were used.

Faith-based healers, like traditional healers, claimed their treatment resulted in a permanent cure, as opposed to the temporary relief offered by biomedical approaches. Obaf and his wife, for instance, insisted that clients never experienced a relapse after being healed, although they acknowledged a few cases where people left without being cured, often due to non-compliance with instructions as reflected in the below:

‘I don’t think that such scenario [being discharged without being healed] was more than one or two cases. That usually happened to those that their caregivers would not follow the protocol. For instance, they will be told that no food should be offered to the sick person maybe for like seven or fourteen days. The relative may considered it too grievous thing to do, or may consider it threatening his/her life and then be giving him/her food secretly. So, people like that did not have faith in the process.’Mrs Obaf – Faith-based healer, Abeokuta.

Like in the Oba’s church, Carplar also ruled out the possibility of relapse in anybody he had healed Carplar also said he was very confident in the treatment he offered and explained that they sometimes asked some of their clients to go back to the hospital for a check-up to confirm that they have been cured. He said ‘…look at you, if it is what I cannot handle I would have rejected the person immediately. In fact, after they are healed, I would also encourage them to go and confirm from their doctors. I usually asked people to go and confirm at OKE Hospital (another government owned hospital in Abeokuta).

Faith-based healing was generally considered more affordable compared to biomedical and Ibile care. At Oba's Church, the initial process involved filling out a form, and treatment came with no fixed charges. Instead, patients or their relatives were asked to make a pledge, which they fulfilled after being healed. She explained that they required that a relative stay with the sick person to provide the necessary assistance and basic needs, especially reading the Bible to them. However, Obaf claimed that accessing care in his church did not involve a direct financial commitment. Each individual caregiver and sick person would be asked to make a pledge of what they would do should God heal them of their illness.

‘I don’t charge them. Once they brought them, we will put them in a room, and when it is time, they will go to the alter themselves to make a vow of what they would do when they are healed. It is the family member or caregiver that will buy him/her a bible. Then when she [referring to his wife] goes there to treat them, she will inform the relative to buy a Bible for him/her so as to register it in the person that s/he is in the church. This she usually do once she has realised that the person is getting better and can no longer destroy thing or tear Bible into pieces. Once the person is healed, it is a must and compulsory that he/she be taught the way of Jesus and Baptised before he or she is allowed to leave. We have even seen about three or four among those that we healed that have become ministers of God (pastors) and are very fervent in the ministry. So, it is after they were healed that they come for the thanksgiving that they would pay whatever they have promised. The way we operate is this. Thank God that despite healing numerous with mental illness, till today we have not recorded any mental illness among our children in this family.’Pastor/Prophet Obaf S., Faith-based healers

Carplar also mentioned that the cost of treatment was minimal, covering only necessary materials. However, he noted that many people in the region were reluctant to spend on their health. Despite this, faith healers were highly respected by their members and clients for being both compassionate and effective. For instance, in the Carplar church, people would often stop what they were doing to welcome him whenever he arrived at the church premises. Women would greet him on their knees, while men, even those older than him, would prostrate in respect. Beyond the financial aspects, participation in healing practices elevated the social status of faith healers. Many of these churches were renowned for their work in mental health care, with healers often attributing their successes to miracles and divine interventions, which drew people seeking solutions to various problems. Moreover, faith-based healing remained an important part of mental healthcare delivery in Abeokuta and was a socially accepted provider of care.

In this and previous sections, I demonstrated what distinguished the healing practices of the three prominent psychiatric traditions in Abeokuta, as well as how each differed from the others. The practitioners within each tradition identified and explained these differences. Interestingly, each practitioner viewed their practice as superior to the others. However, it is important to note that the distinctions between these traditions were primarily identified by the practitioners themselves and pertained only to the methods of treatment they offered. In contrast, the patterns of psychiatric care utilisation by patients were entirely different from the care practices of the healers. Patients did not necessarily differentiate between these healing traditions in their use; rather, they accessed all available mental healthcare facilities, choosing different sources of care for various needs and reasons. In the next section, I will discuss how biomedical and non-biomedical sources of mental health care interact.

The preceding sections have outlined the available mental healthcare systems in Abeokuta and demonstrated how each reflects medical pluralism. The findings of this study illustrate that mental healthcare in Abeokuta is characterized by a diverse system, where multiple healthcare traditions coexist, each contributing distinct approaches to the treatment of mental illness [23]. Individuals in Abeokuta often view appropriate mental healthcare as encompassing more than one tradition, since mental illness is generally understood through a holistic lens that integrates biological, social, and spiritual dimensions [92]. This pluralistic approach highlights the coexistence of biomedical, traditional, and faith-based practices, which together address the complexities of personhood in Yoruba society.

Each tradition of care—biomedical, traditional, and faith-based—offers unique strengths that collectively contribute to what is considered holistic treatment. The Neuropsychiatric Hospital in Abeokuta (Aro) represents the biomedical system, which focuses primarily on pharmaceutical treatments and a clinical approach to mental illness. However, biomedical psychiatry, though critical, is often perceived by locals as insufficient on its own. Practitioners of other traditions see it as foreign and lacking the local knowledge required for a full understanding and treatment of what they consider to be "local illnesses." Similar observations have been made by scholars both in Nigeria and across other African settings. For instance, [94] found that among rural Yoruba dwellers in Osun State, mothers believed there were certain illnesses that biomedical practitioners could neither fully comprehend nor treat effectively. Comparable cases have been observed with mental health conditions such as Ogun oru2 among the Yoruba and Eemuwengu3 among the Ovambo people in Namibia, which are considered to have spiritual explanations and require spiritual treatments [39, 95, 96].

Despite the prevalence of medical pluralism, each tradition of care in Abeokuta establishes boundaries to maintain its unique identity, often driven by social status, recognition, and economic benefits. Traditional healers, for instance, ground their authority in indigenous knowledge passed down through generations, claiming that their methods offer not only treatment but also cures for conditions that biomedical practices cannot address. Chief Fag, a leading traditional healer featured in this study, emphasised the efficacy of traditional methods in treating both natural and supernatural causes of mental illness, such as curses and bewitchment, which are believed to be beyond the scope of biomedical psychiatry. This is consistent with findings across Africa, where traditional healers maintain a strong presence in mental healthcare due to their cultural legitimacy and perceived success in treating conditions with spiritual causes [3, 22, 97–100].

Faith-based healers in Abeokuta, like their traditional counterparts, claim divine inspiration for their healing practices and often assert that their methods lead to permanent cures, in contrast to the ongoing management typical of biomedical care. These religious healers also maintain the boundaries of their practice by attributing their healing power solely to spiritual authority, reinforcing their distinctiveness and social standing within the community. Their prominence, along with the socio-economic benefits they derive, reflects the complex interplay between healing, religion, and social hierarchy—similar to findings from studies on faith healing across Nigeria [16, 101–103].

The motivations for protecting the boundaries of each healthcare tradition are not purely ideological; they are also deeply intertwined with social and economic considerations. Practitioners from all three systems—biomedical, traditional, and faith-based—derive social status and economic benefits from their roles, which encourages them to safeguard their practices from external encroachment. For instance, traditional healers and faith-based practitioners often emphasise their ability to provide a complete cure, a claim not typically made by biomedical professionals. This enhances their appeal and fosters client loyalty, creating a competitive healthcare market where each tradition offers distinct advantages, whether through promises of permanent cures or divine intervention [98].

In conclusion, medical pluralism provides some insight into the nature and diversity of mental healthcare facilities in Abeokuta. The practitioners within these systems are fundamentally different from one another in terms of both training and practice. However, the caregivers do not always make such distinctions when seeking treatment, often patronizing multiple traditions for the same episode of illness. This phenomenon, which medical pluralism alone cannot fully explain, will be explored further in the following section.

The interplay between biomedical and non-biomedical psychiatric healing and its implications for medical pluralism and syncretism in Abeokuta

Care-seeking practices in Abeokuta are characterised by the pursuit of multiple forms of care, with caregivers often seeking help for relatives living with mental health challenges from more than one source. I encountered patients from Aro Hospital who continued to receive treatments from other sources, either sequentially or simultaneously, in addition to the hospital’s care. Healers from both the Ibile and faith-based traditions often mentioned that some of their clients were also Aro Hospital patients. The two Ibile healers I previously discussed claimed to have treated several Aro patients after their hospital discharge, as these patients continued to suffer from illness.

Chief Fag shared that Aro Hospital patients had been coming for treatment at his facility since the time of his late father in the 1970s. He added that people would return to him with their sick relatives after spending significant amounts of money and time on Aro treatments without achieving the desired results. Interestingly, Chief Fag also claimed that even some staff from Aro Hospital patronized his services:

"…A few of them [Aro Hospital staff] know that I can cure mental illness. Those who have tried Aro for a long time and realized there was no substantive change, after trying white medicine or church remedies without desirable results, bring their patients to me." — Ibile healer, Chief Fag.

Chief Fag recounted the story of one Aro Hospital staff member from about 20 years before my fieldwork. This man’s wife had been mentally ill and treated at the hospital, but she kept relapsing. In desperation, the staff member brought his wife to Chief Fag. According to him, this experience introduced him to traditional birth attendance because the woman, who was pregnant, was experiencing severe mental illness that even her husband, a hospital worker, couldn’t manage. Not only did Chief Fag treat her mental illness, but he also assisted in the delivery of her child.

Similarly, many of Chairman's clients had also visited Aro Hospital at some point before returning to him for care. Almost everyone I met at Chairman’s facility claimed to have been to Aro Hospital and/or retained Aro patienthood. Chairman was aware that many of his clients had sought care from other places, including Aro, before coming to him. He explained that people often came to him or sought Ibile care because they were poor or had spent all their money elsewhere with little success. Chairman illustrated this point with the story of a woman named Jugbun, who was brought to him in late October 2018. According to him, Jugbun’s mother had previously brought her to Chairman after she was discharged from Aro Hospital:

"…That same lady, she was brought here after they had spent so much at Aro, and when they discharged her… her relatives saw that there was no significant difference. When they brought her here, she was so dull and just looked blank." — Ibile healer, Chairman.

Although Jugbun relapsed and was brought back to Chairman’s facility in 2019 by her younger sister, Alhaja, Chairman claimed that she didn’t spend more than two weeks in his care before fully recovering and resuming her normal life. Prior to this, Jugbun had spent about two months at Aro Hospital without much improvement. Alhaja confirmed this during our discussion about her sister’s condition.

Another reason for combining Aro Hospital treatment with traditional methods was the belief that healers had a better understanding of the patient’s problem. Both healers and caregivers described Ibile mental health care as -ile abalaye and tiwa-n-tiwa, expressions suggesting that this care was deeply rooted in their cultural life. Caregivers seemed to believe that traditional healers could understand their conditions better than biomedical personnel, while healers assumed they had a profound understanding of local people and their health challenges.

For example, a 50-year-old woman named Iya Biu brought her 70-year-old mother, Iya Nut, to Chairman’s facility in October 2019. Iya Nut was talking incoherently, restless, and sleepless. At night, she would leave the house and wander down the street, so her children began locking the doors to prevent her from wandering. The problem had started months earlier, and Iya Nut’s children had already taken her to Aro Hospital, where she was able to answer all the doctor’s questions correctly. After a few days of medical examinations, the staff concluded that nothing was wrong with her and only prescribed medication, which made her dull. Despite this, her sleepwalking persisted. Following advice, Iya Nut’s children sought out indigenous remedies and consulted Chairman, who diagnosed her with , or male measles. According to Iya Biu, Chairman's acknowledgment that her mother was indeed sick, and his ability to name the illness, was seen as a sign of his superior understanding of the condition.

Many caregivers also combined Aro treatments with traditional medicine because they sought a "complete" cure for their sick relatives. Almost all of the caregivers I spoke with mentioned having gone to Aro Hospital before consulting either Chairman or Chief Fag. However, instead of receiving a cure, they felt that Aro kept prescribing medications that would be required endlessly.

More importantly, some caregivers expressed the view that mentally ill individuals often suffered from multiple conditions, each requiring a distinct tradition of healing. As I have demonstrated elsewhere [92], people in the study location believed that mental illness was multifaceted, and as outlined, mental healthcare must be similarly diverse. One way these beliefs manifested was in the practice of combining different healing methods to ensure a full recovery, as Merci’s case will illustrate.

Merci was admitted to Chairman’s facility on Saturday, November 17, but I met him on Monday, November 19, 2018. In my observation, Merci interacted well with others, appearing much like any "normal" person in both speech and gestures. He was coherent in conversation, well-dressed, and carried himself with composure. When I met him, he was lying on a small, locally-made mat, with shackles on his legs. He wore a polo shirt over a cloth wrapper (traditionally worn by women), explaining that he had been forced to remove his trousers to prevent him from running away (See Fig. 3). Despite his confinement, Merci seemed happy—singing various Christian songs, thanking God, and occasionally clapping from his mat.

Fig. 3.

Mr. Merci sleeping on his mat with shackles on his legs during his admission at his healer's facility at Chairman’s facility, Abeokuta.

Source: Author's Fieldwork, November 2018

According to Merci’s father, he was admitted to Chairman’s facility because of his excessive alcoholism, smoking, wandering, and unwillingness to work. His father emphasised that Merci had been a problem for the family for about eight years. Describing the onset of Merci’s illness, his father recalled that in 2011, Merci developed a high fever, stopped talking, and began vomiting. They took him to a private hospital for treatment. Later, however, Merci started "talking nonsense" and, if left unattended, would roam the streets. He was then taken to Aro Hospital, where he spent several months before his condition stabilised. His father confirmed that Merci still had some medication prescribed by Aro. However, even after leaving the hospital, Merci had not stopped smoking, wandering, or refusing to work. He also spent money carelessly, regardless of who it belonged to or what it was intended for. This prompted his father to take him to Chairman’s facility, hoping to “”—remove the spell from his eyes.

Merci confirmed that he had been to many places and had taken different medications, but he stopped because he did not believe he was sick and saw no reason to continue. He also feared the effects of the drugs. Merci felt that his time at Aro Hospital was wasted and boring since he was confined there without anything to do. Despite this, he expressed his belief that coming to Chairman’s facility was beneficial and would alleviate his ‘problems’. Merci further explained that he had attended various church programs and participated in numerous prayer sessions in an effort to solve his ‘life’s challenges’. He did, however, request that Chairman remove his shackles, as he wasn’t a criminal and the restraints were causing him injury.

The above highlights the interplay of biomedical and non-biomedical psychiatric healing in Abeokuta, revealing its profound implications for recovery. Patients often combine treatments, reflecting beliefs in the multifaceted nature of mental illness and the necessity of diverse healing approaches. Recovery in this context goes beyond improved social behaviour or interpersonal relationships to include regaining all aspects of personhood damaged by mental illness, such as the capacity for gainful employment, economic independence, and self-worth—outcomes often beyond the reach of hospital-based treatments [92]. Traditional healers address cultural and supernatural dimensions overlooked by biomedical care, catering to these broader needs. This underscores the importance of integrative, culturally grounded mental healthcare strategies in fostering comprehensive recovery outcomes in Abeokuta.

Discussion

This study explores the forms of mental healthcare available in Abeokuta, the motivations behind their use, and how engaging with multiple practices influences recovery experiences. The data demonstrates that mental healthcare in Abeokuta operates within a complex framework of medical pluralism and syncretism, encompassing biomedical, traditional, and faith-based systems. These traditions address the multifaceted nature of mental illness, reflecting local understandings of personhood that integrate biological, social, spiritual, and moral dimensions [92, 93].

Mental healthcare provision in the study location demonstrates clearly defined boundaries, with each care tradition distinguishing itself through its training, causal explanations, treatment methods, facility ownership, and focus of care [104]. The Neuropsychiatric Hospital in Abeokuta, for instance, represents the biomedical model, emphasizing pharmaceutical treatments and clinical management of mental illness. In contrast, traditional healers use indigenous knowledge systems, divination, herbal remedies, and rituals to address both natural and supernatural causes of illness, while faith-based practitioners rely on spiritual authority, prayer, and fasting to address moral and spiritual disruptions. These distinctions highlight the pluralistic nature of care provision, with each tradition asserting its unique role in addressing specific aspects of mental illness [3, 98, 104, 105].

However, mental healthcare utilisation in Abeokuta reflects medical syncretism, where patients and caregivers pragmatically combine treatment options across traditions. This syncretism is driven by cultural beliefs that mental illness is multifaceted and by the limitations of any single system in addressing all dimensions of personhood. For example, the case of Merci illustrates how families integrate biomedical care for somatic symptoms with traditional and faith-based practices to address moral and spiritual concerns. Such blended approaches reflect a desire for holistic recovery, where each tradition contributes to restoring disrupted aspects of personhood[92].

Recovery in this context extends beyond symptomatic relief to include the restoration of social roles, financial independence, and moral integrity—core elements of Yoruba personhood. Biomedical care, while critical, is often perceived as insufficient in achieving this holistic recovery, particularly for illnesses attributed to spiritual or metaphysical causes. Traditional and faith-based healers address these gaps by offering culturally resonant explanations and treatments, such as rituals to counter curses or prayers to restore spiritual balance. This comprehensive understanding of recovery underscores the importance of integrating diverse care practices to meet the complex needs of patients [22, 99, 106].

Economic and cultural factors further shape care-seeking behaviours and recovery trajectories. The high cost of biomedical care often limits its accessibility, driving caregivers toward more affordable and flexible alternatives, such as traditional and faith-based healers. These alternatives are not only financially accessible but also culturally aligned, resonating with local beliefs about illness causation and recovery. For instance, caregivers frequently turn to traditional healers like Chief Fag for conditions perceived as metaphysical, such as spirit possession or curses, which are considered beyond the scope of biomedical psychiatry [92, 107].

The findings also highlight the implications of medical pluralism and syncretism for recovery in Abeokuta. While care providers emphasise the boundaries of their practices to preserve professional and social identities, patients and caregivers traverse these boundaries fluidly, assembling diverse treatments to achieve comprehensive recovery. This duality underscores the adaptability of mental healthcare systems in Abeokuta, where cultural imperatives shape both care provision and utilisation. Moreover, even within these defined boundaries, elements of syncretism emerge, such as biomedical practitioners acknowledging the role of prayer and faith-based healers incorporating moral counselling into their practices [92, 108].

The implications for recovery are profound. By engaging with multiple care traditions, patients and caregivers in Abeokuta actively reconstruct disrupted aspects of personhood, addressing not only physical symptoms but also social relationships, spiritual well-being, and moral integrity. This holistic approach to recovery reflects a culturally embedded understanding that health is inseparable from broader dimensions of identity and community. It also highlights the limitations of singular care systems and the need for integrative healthcare models that draw on the strengths of biomedical, traditional, and faith-based practices.

Summarily, the findings from this study emphasise the interplay between medical pluralism and syncretism in Abeokuta’s mental healthcare landscape. While care provision reflects pluralism through distinct and bounded practices, care utilisation reflects syncretism, as patients and caregivers pragmatically blend traditions to achieve holistic recovery. These insights highlight the importance of culturally informed mental healthcare models that integrate diverse practices to address the complex needs of patients and caregivers. Such models are essential for fostering comprehensive recovery outcomes in Abeokuta and similar contexts, where mental illness is deeply entwined with local understandings of personhood and health.

Conclusion

The study of mental healthcare in Abeokuta reveals a complex landscape shaped by medical pluralism and syncretism. Patients and caregivers navigate a system that blends biomedical, traditional, and faith-based healing practices, reflecting a holistic understanding of mental illness that encompasses physical, social, and spiritual dimensions. While the biomedical model provides essential pharmaceutical interventions, it is often perceived as insufficient by locals who seek additional care from traditional and faith-based practitioners to address the cultural and supernatural aspects of illness. This blending of care traditions underscores the Yoruba belief in a "complete cure," which goes beyond symptom management to address the root causes of illness from multiple perspectives.

To improve mental healthcare outcomes, policy frameworks should formally recognise and support the integration of traditional, faith-based, and biomedical practices in a collaborative and regulated manner. However, beyond the clinical and spiritual domains, mental health services must also encompass the psychosocial dimensions of care. As evidence from Ghana demonstrates, Pentecostal clergy do not merely engage in spiritual healing but also provide crucial social support, emotional care, and informal counselling, a functions which may be absent in biomedical systems yet essential for holistic recovery [101]. Policies should therefore encourage structured collaboration between biomedical professionals and non-biomedical providers, including training programmes that enhance mutual understanding and referral pathways. This approach recognises that effective mental healthcare in pluralistic societies such as Abeokuta must integrate social, cultural, and spiritual realities, ensuring that diverse care systems are not only acknowledged but meaningfully coordinated to improve outcomes.

Given the financial barriers to accessing biomedical care, it is essential for governments and stakeholders to implement subsidy programs or flexible payment models that make psychiatric treatment more affordable and accessible. The financial burden of biomedical psychiatric care often drives patients toward traditional and faith-based healers, who offer more flexible payment options and culturally congruent treatments.

These findings align with broader patterns in sub-Saharan Africa, where medical pluralism and syncretism allow for a pragmatic approach to health and healing, shaped by the cultural and economic realities of the region. However, the study is not without limitations. Its focus on Abeokuta as a single case study limits the generalisability of its findings to other regions in Nigeria or sub-Saharan Africa, where cultural, economic, and healthcare dynamics may differ. While the study advocates for integrating traditional and faith-based practices with biomedical care, it does not explore detailed frameworks or strategies for achieving this integration, which could be an area for future research. Additionally, the study prioritizes understanding care-seeking behaviours and syncretic practices but provides limited analysis of patient outcomes, particularly the long-term efficacy of combined treatment approaches. Addressing these limitations could be a focus for future studies, which might expand the geographical scope, develop practical integration models, and analyse patient outcomes more comprehensively.

Lastly, the study highlights that neither medical pluralism nor syncretism alone can fully explain mental healthcare practices in Abeokuta—or likely in other African contexts. Instead, both frameworks together provide deeper insight into the complexities of healthcare practice and care-seeking behaviours in the region.

Author contributions

This is a single authored paper. The Author conducted the fieldwork, data interpretation, and wrote all the parts of this article as well as the revised version.

Funding

The author declares that no funding was received for this publication. However, the PhD research from which the data for this paper was drawn was partially supported by the Federal Government of Nigeria through TETFund AST&D.

Data availability

Data is available but Only on request that meets that ethical conditions.

Declarations

Conflict of interest

The authors declare no competing interests.

Ethics approval and consent to participate

Two separate ethical approvals were obtained for this study. The first was granted by the Durham University Ethics Committee, ensuring that all research procedures complied with institutional, national, and disciplinary ethical standards, including the guidelines of the Association of Social Anthropologists of the UK and Commonwealth. Additionally, the Research Ethics Committee of the Neuropsychiatric Hospital, Aro, Abeokuta, Nigeria approved the data collection conducted within the hospital and permitted the use of the data. Informed consent was obtained from all participants prior to their involvement in the study. Due to the sensitive nature of the research and the cultural context—where participants are often reluctant to sign formal documents—verbal consent was deemed more appropriate and was obtained in accordance with recognised ethical practices for anthropological fieldwork.

Consent for publication

Verbal consent for the publication of anonymised data was obtained from all participants. To safeguard participant confidentiality, all identifiable information has been excluded or anonymised. This approach aligns with ethical standards for qualitative and ethnographic research, where written consent may compromise participant privacy or create undue concern.