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Original Paper

Psychopathology 2002;35:362366
DOI: 10.1159/000068594

Brain Fag Symptoms in Apprentices in

Olufemi Morakinyo a Karl Peltzer b
a Department of Mental Health, College of Health Sciences, Olufemi Awolowo University, Ile-Ife, Nigeria;
b Health Behaviour Research Unit, University of the North, Sovenga, South Africa

Key Words learning by observing the boss at work). The implica-

Brain fag symptoms W Theories W Apprentices W Nigeria tions of these findings for two of the theories advanced
for the pathogenesis of the brain fag syndrome were dis-
Abstract Copyright 2002 S. Karger AG, Basel

The brain fag syndrome, which was first reported from

West Africa in 1960 among students, has been shown to
occur very widely in African students in western educa- Introduction
tional systems south of the Sahara. This study investi-
gated the distribution of its symptoms in a group of Prince [1960] first described the brain fag syndrome
apprentices chosen by convenient sampling from Ile-Ife, in Nigerian students. The main features of the syndrome
a university town about 240 km northeast of Lagos in are: (1) unpleasant head symptoms (pain, burning, crawl-
Nigeria. The subjects who (in contrast) were training ing sensations, vacancy feelings), (2) visual disturbances
under an indigenous form of education the African (dimness of vision, pain in the eyes and tearing), (3) cogni-
apprenticeship system consisted of 183 (69.8%) males, tive impairments (inability to grasp the meaning of writ-
and 79 (30.2%) females, in the age range of 1326 years ten and sometimes of spoken words, inability to concen-
(mean B SD 18.2 B 3.0 years). Questionnaires were trate, poor retention), and (4) a variety of other symptoms
interview-administered to collect data on the sociodemo- such as weakness, dizziness, writers cramp, and bodily
graphic, economic, and family background, English lan- sensations of crawling, burning or migrating pains
guage proficiency, and the degree of the presence of [Prince, 1989]. Brain fag is also listed as a diagnostic cate-
brain fag symptoms. Results indicated a generally low gory in the DSM-IV of the American Psychiatric Associa-
rate of brain fag symptoms among these different types tion [1994]. The peculiar (in European eyes) somatic
of apprentices. A relationship between proficiency in symptoms such as heat, pain, burning and crawling sensa-
English, but not socioeconomic status, with brain fag tions in head and body are not restricted to brain fag, but
symptoms was found. In the case of the Nigerian appren- are very common in all psychiatric syndromes in Africa
tices investigated here, brain fag symptoms were not south of the Sahara. Cognitive difficulties associated with
significantly associated with the method of training study and the bodily symptoms are the distinguishing fea-
learning (which is dependent mainly on verbal instruc- tures of brain fag.
tions in the vernacular from their bosses, and vicarious

2002 S. Karger AG, Basel Prof. Karl Peltzer

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All these symptoms occur or are exacerbated while (nonwestern) or noneducational. The Psychophysiologi-
reading or occasionally, while listening to lectures. The cal Theory, on the other hand, links the syndrome with
onset of the condition is usually gradual, the somatic learning in a second (foreign) language per se. The link is
symptoms in the head commencing before intellectual traced through self-imposed sleep deprivation by the stu-
impairment. The patient notices the burning in the head dent, using stimulants to stay awake and spending more
while reading heavy material, but is able to read newspap- time on study if necessary, in order to keep abreast of the
ers and other light material without difficulty. Later, syllabus. The theory emphasizes the language as the me-
symptoms occur with intellectual activity of any kind. dium of instruction rather than the content or knowledge
Finally the symptoms may be present continually and the which the instruction seeks to impart [Morakinyo, 1980a,
patient may isolate himself/herself from all intellectual 1990].
activity. Prince [1960] initially described the illness as The apprenticeship system has been an age-long (tradi-
partaking of both hysterical elements and of the somati- tional) form of education in Africa [Burton, 1987; Galla-
zation of conflict. Mild early cases may respond rapidly way, 1964; Morakinyo, 1990]. In earlier times, apprenti-
to treatment; some severe chronic cases persist in spite of ceships involved activities such as woodcarving, cloth
intensive treatment and force the patient to give up fur- dying, house building, pottery, and weaving. This system
ther study. Many authors (including Prince lately) have is still being widely practiced and is used in the training of
argued that it could be described as a depressive equiva- artisans. e.g. automobile repair workers (mechanics, panel
lent or a masked depression with anxiety as an important beaters, electricians), tailors, or shoemakers. The trainees
accompaniment [Prince, 1989]. learn by observing their masters at work and acquire their
According to Prince [1983], the brain fag syndrome is skill in the process of assisting the master and undertaking
exceedingly common and often incapacitating among stu- simple and, later, more complex tasks themselves. The
dents in Africa south of the Sahara. It is as though a black period of apprenticeship depends on the type of trade or
depressive cloud descends upon perhaps one quarter to vocation. It has been known to vary from 3 to 7 years in
one half of adolescent high school and university popula- most vocations, with an average of 45 years. Usually, the
tions, blocking their educational progress. Various au- apprentice (trainee) neither receives any stipend from his/
thors [Prince, 1962; Jegede, 1983] reported 3258% of her master/mistress nor does he/she pay any fees other
secondary school students with brain fag symptoms in than providing service in contributing to the work and
Nigeria. On the basis of clinical studies, brain fag has been running errands. There may or may not be a written con-
reported as much commoner in males than in females tract. However, before the apprentice can graduate, some
[Peltzer and Woldu, 1990; Prince, 1989]. stipulated obligations must be met. The language of ver-
Virtually all epidemiological studies that have been bal instruction is in the vernacular, e.g. Yoruba, and not
conducted on this condition have been done on students. in English, as it is the case among secondary or university
For example, Prince [1960, 1962] in Nigerian secondary students.
school pupils, and Guinness [1992a] in Swaziland second- The aim of the present study was to estimate the preva-
ary school students. This concentration of studies on stu- lence of brain fag symptoms among such apprentices and
dents probably derived from Princes initial theory insin- identify some related factors like age, gender, socioeco-
uating an etiological association with the western type of nomic status, and acculturation in the form of English lan-
education (study) or brain work. Prince [1983, 1989] has guage proficiency, which may assist in advancing our
elaborated this theory and named it the Forbidden knowledge and elucidating the pathogenesis of the syn-
Knowledge Theory. According to this theory, the genesis drome. If the Forbidden Knowledge Theory were true,
of the brain fag syndrome is an unconscious process sig- then one would expect brain fag syndrome symptoms to
nifying a rejection of western education and the knowl- be associated with learning in the apprenticeship system
edge which such education seeks to impart. Acquisition of of education since the content of the learning is main-
western knowledge amounts to a betrayal of the knowl- ly western automobile mechanic or tailoring involv-
edge embedded in indigenous African educational sys- ing dealing with European-made machines and materials
tems. The development of the disturbing symptoms of the for example. In this study, the level of intelligence and
brain fag syndrome is therefore construed as an uncon- academic ability were excluded since it has constantly
scious mechanism to debar the learner and thereby reject been shown that no relationship exists with brain fag
the new knowledge. This theory implies that the brain fag [e.g. Guinness, 1992b; Minde, 1974; Morakinyo, 1980a,
syndrome cannot develop in other contexts, educational 1980b, 1983].

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Method Table 1. Types of apprentices and frequency

Sample Types of apprentices Frequency Percent

The sample included 262 apprentices in Ile-Ife and its environs.
One hundred and eighty-three of the apprentices (69.8%) were males, Hairdresser or barber 34 13.0
and 79 (30.2%) females, in the age range of 1326 years (mean B SD Sewing or shoe making 31 11.8
18.2 B 3.0 years). The ethnicity was as follows: 251 (95.8%) Yoruba, Mechanics 29 11.1
9 Igbo (3.4%) and 2 Edo (0.8%). Carpenter 27 10.3
Electronics 26 9.9
Instruments Printing or painting 19 7.3
The questionnaire included 10 items on the socioeconomic and Panel beating 17 6.5
sociodemographic background: age, sex, religion, ethnicity, occupa- Weaving 16 6.1
tion, English language proficiency, education and income of parents, Battery charging 15 5.7
and a slightly modified version of the 7-item Brain-Fag Syndrome Iron bending 13 5.0
Scale developed by Prince and Morakinyo [Morakinyo, 1990]. The Brick-laying 11 4.2
modification was done to adapt the scale to the context and method Refrigerator repair, plumbing, photographer,
of education being undergone by the apprentices, which entailed vulcanizing, surveying 24 9.2
rephrasing some of the items. For example, listening to instruction
was substituted for read in item 2, learning for studying in item 3.
Each item is scaled: 2 = often, 1 = sometimes, 0 = never, except item 6
which is scored in the reverse (see table 2 for the modified version).
Apprentices were asked about complaints they sometimes have when
they listen to instructions or are learning. There was no time frame burning, heat or pain, or other unpleasant sensations in
given such as past month or past year. the head while doing their job, and 35.6% who get spells
It was a pilot questionnaire tested on 30 apprentices and re- of complete exhaustion related to work. Unpleasant bodi-
administered after 3 weeks. Test-retest reliability of 0.78 was found. ly sensations were experienced only sometimes. Item 5,
Cronbachs alpha as well as split-half reliability coefficient for the
which is the key symptom distinguishing the brain fag
modified scale was 0.7 for the sample studied.
syndrome from other somatic complaint syndromes, was
Procedure experienced by only 13.7% of the sample. There were sig-
The questionnaires were interview-administered to apprentices nificant gender differences regarding two brain fag symp-
at their respective work places after informed consent was obtained. toms. Men had more difficulty in listening to the instruc-
Anonymity and confidentiality were assured.
tion of the boss and they got more spells of complete
exhaustion than women did.

Results Factors of Significant Relationship with Brain Fag

The findings are categorized into (1) type of appren- Table 3 indicates the relationship between different
tices, (2) frequency of brain fag symptoms, and (3) factors independent variables and brain fag symptoms.
of significant relationship with brain fag symptoms. Proficiency in English (spoken, reading and writing)
but not demographic and economic status was associated
Types of Apprentices with brain fag symptoms.
The types of the apprentices studied are shown in
table 1.
The five most common types of apprentices were hair- Discussion
dressers or barbers, dressmakers or shoemakers, mechan-
ics, carpenters and electronics. This study did not find a high frequency of often expe-
rienced brain fag symptoms among these Nigerian ap-
Frequency of Brain Fag Symptoms prentices. Prince [1983] had indicated that the brain fag
Table 2 indicates the frequency of brain fag symptoms syndrome is a stereotyped psychiatric syndrome that
and sex differences. affects 2040% of secondary school and university stu-
Apprentices reported frequent experiences of brain fag dents in diverse cultures across Africa south of the Sahara.
symptoms: 43% said that they were never satisfied with In earlier reports, brain fag syndrome symptoms were
their general efficiency in learning and with retention of found to be present in between 32 and 58% of students
what they have learned, followed by 34.4% experiencing studied [Prince, 1963; Jegede, 1983]. Similarly, high or

364 Psychopathology 2002;35:362366 Morakinyo/Peltzer - 7/1/2017 1:14:53 AM
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Table 2. Brain fag symptoms by frequency in percent

Brain fag symptoms Often Some- Never Sex, 2


1 I get spells of complete exhaustion (i.e. feeling very tired or 35.6 3.8 60.5 7.324*,1
very weak)
2 When I listen to instructions from my boss, I feel that they 7.7 1.9 90.4 9.821**,1
dont make sense
3 I find it difficult to concentrate (i.e. pay attention) when 8.8 1.9 89.2 0.398
learning from my boss
4 I experience burning, heat or pain or other unpleasant 34.4 7.8 57.8 0.024
sensations in my head while doing my job
5 These unpleasant sensations (burning, pain, heat) make it 13.7 1.2 85.2 0.053
difficult for me to learn or assimilate what my boss teaches
6 I am satisfied with my general efficiency in learning and with 46.9 10.2 43.0 3.111
retention (assimilation) of what I learn
7 I suffer unpleasant sensations in my body 7.4 87.5 5.1 4.312
related to my work

* p ! 0.05; ** p ! 0.01.
1 Significantly higher in males than in females.

nearly high prevalence rates of brain fag symptoms have Table 3. F ratios from ANOVA showing the significance of brain fag
been reported in most other studies among secondary stu-
dents [e.g. Guinness, 1992a, Peltzer et al., 1998; Prince, Independent variables F p
1983] and university students [e.g. Anumonye, 1980].
Recently, Fatoye [1998] has found a prevalence rate of Age 1.500 n.s.
52% for the syndrome among secondary school students Sex 0.618 n.s.
Fathers occupation 0.566 n.s.
at Ilesa, a town 30 km east of Ile-Ife where the present
Fathers schooling 0.699 n.s.
study was conducted. Number in family 0.518 n.s.
This study shows that brain fag does not only occur in Position in family 1.217 n.s.
students in the western (didactic) system of education, but Proficiency in spoken English 3.087 0.001
also in those in the apprenticeship system. In 1983, Prince Proficiency in reading English 2.172 0.020
Proficiency in written English 1.874 0.049
had noted: If we are to take brain fag students at their
Time since fathers death 0.587 n.s.
word, the usual series of events is (a) hard intellectual
work, (b) the appearance of brain fag symptoms, and
(c) only later, anxiety or despair over continuing with
their education because of their inability to study. With
the western student, on the other hand, the order is much drome symptoms among the apprentices. In this respect,
clearer: disturbing interpersonal event, emotional up- the psychophysiological theory seems more plausible rely-
heaval, and only subsequently study inhibition or inter- ing mainly on stress and sleep deprivation, and identi-
est disorder. fying the language of instruction as the key factor rather
In the case of the Nigerian apprentices investigated than the content or knowledge which the instruction seeks
here, the brain fag symptoms were found to be significant- to impart. For clarification, we would identify two com-
ly associated with writing, reading, and speaking the ponents in any pedagogical system: the medium of in-
English language (table 3), but less with verbal instruc- struction (the language used, use of modeling/vicarious
tions (in the vernacular, Yoruba) and the vicarious learn- techniques, practice-oriented or didactic), and the con-
ing situation (table 2, items 2, 3, and 5). These findings tent/material to be learned. Burton [1987] has observed
may seem to support Princes theory. The snag is that that the textbook is a principal imperative in the western-
there still remains an appreciable degree of brain fag syn- type schools (called Ile-Iwe or House of Books) among

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the Yoruba, whereas the apprenticeship system centers on ing that the frequency of brain fag seems to vary directly
the do and watch of what is happening in the traditional with the level of westernization of the culture in the area
school of pottery Ile-Ebu or House of Pots. With from which the pupil comes [Prince, 1983; Guinness,
respect to the aim of the present study, this is the impor- 1992b]. In this sample this has been supported by a signif-
tant basic distinction between the two systems of educa- icant relationship between the proficiency in the English
tion. language as a measure for westernization and brain fag
An odd finding in this research is the clear association symptoms. This may also support Princes [1983] theories
between brain fag and proficiency in English. A possible about forbidden knowledge and lack of ego energy for
explanation is that certainly in some subjects, such as elec- those who are more collectivistic, shifting from the collec-
tronics and mechanics, the reading of books or other writ- tive and cooperative culture of their childhood to the
ten materials is quite likely to be involved. Reading in highly individualistic and competitive requirements of
English would provide a good reason for the linkage western education.
between brain fag and English proficiency a proportion The finding that age is not related to brain fag symp-
of reading subjects would develop brain fag in the usual toms concurs with the findings of other studies [Guinness,
way. It is possible that the questionnaire would not have 1992b; Prince, 1983]. Further, no significant sex differ-
distinguished this group from a nonreading group. Infor- ence was found in brain fag symptoms, which agrees with
mation about whether or not apprenticeships require the findings of Jegede [1983]. There are other studies,
reading would be an important subject for investigation in such as those of Anumonye [1980] and Prince [1989],
future apprenticeship studies. Perhaps a better design for which indicate a 60% higher incidence of brain fag symp-
future studies on this subject would be to assess appren- toms among males. These studies, which do not concur
tices who are training in completely indigenous vocations/ with the finding of this study, are clinical. It may also be
trades like blacksmith and traditional medicine. possible that females in the Yoruba society are similarly
A second explanation for the association between brain seen in a competitive and economic context of familial
fag and proficiency in English would be the previous find- responsibility [Peltzer and Woldu, 1990].


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