Original Paper
Psychopathology 2002;35:362366
DOI: 10.1159/000068594
Brain Fag Symptoms in Apprentices in
Nigeria
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
Brain fag symptoms W Theories W Apprentices W Nigeria
Abstract
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-
tional systems south of the Sahara. This study investi-
gated the distribution of its symptoms in a group of
apprentices chosen by convenient sampling from Ile-Ife,
a university town about 240 km northeast of Lagos in
Nigeria. The subjects who (in contrast) were training
under an indigenous form of education the African
apprenticeship system consisted of 183 (69.8%) males,
and 79 (30.2%) females, in the age range of 1326 years
(mean B SD 18.2 B 3.0 years). Questionnaires were
interview-administered to collect data on the sociodemo-
graphic, economic, and family background, English lan-
guage proficiency, and the degree of the presence of
brain fag symptoms. Results indicated a generally low
rate of brain fag symptoms among these different types
of apprentices. A relationship between proficiency in
English, but not socioeconomic status, with brain fag
symptoms was found. In the case of the Nigerian appren-
tices investigated here, brain fag symptoms were not
significantly associated with the method of training
learning (which is dependent mainly on verbal instruc-
tions in the vernacular from their bosses, and vicarious
2002 S. Karger AG, Basel
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learning by observing the boss at work). The implica-
tions of these findings for two of the theories advanced
for the pathogenesis of the brain fag syndrome were dis-
cussed.
Copyright 2002 S. Karger AG, Basel
Introduction
Prince [1960] first described the brain fag syndrome
in Nigerian students. The main features of the syndrome
are: (1) unpleasant head symptoms (pain, burning, crawl-
ing sensations, vacancy feelings), (2) visual disturbances
(dimness of vision, pain in the eyes and tearing), (3) cogni-
tive impairments (inability to grasp the meaning of writ-
ten and sometimes of spoken words, inability to concen-
trate, poor retention), and (4) a variety of other symptoms
such as weakness, dizziness, writers cramp, and bodily
sensations of crawling, burning or migrating pains
[Prince, 1989]. Brain fag is also listed as a diagnostic cate-
gory in the DSM-IV of the American Psychiatric Associa-
tion [1994]. The peculiar (in European eyes) somatic
symptoms such as heat, pain, burning and crawling sensa-
tions in head and body are not restricted to brain fag, but
are very common in all psychiatric syndromes in Africa
south of the Sahara. Cognitive difficulties associated with
study and the bodily symptoms are the distinguishing fea-
tures of brain fag.
Prof. Karl Peltzer
Health Promotion Programme, School of Psychology
University of Durban-Westville, Private Bag X54001
Durban 4000 (South Africa)
E-Mail peltzerk@mweb.co.za
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 All these symptoms occur or are exacerbated while
reading or occasionally, while listening to lectures. The
onset of the condition is usually gradual, the somatic
symptoms in the head commencing before intellectual
impairment. The patient notices the burning in the head
while reading heavy material, but is able to read newspap-
ers and other light material without difficulty. Later,
symptoms occur with intellectual activity of any kind.
Finally the symptoms may be present continually and the
patient may isolate himself/herself from all intellectual
activity. Prince [1960] initially described the illness as
partaking of both hysterical elements and of the somati-
zation of conflict. Mild early cases may respond rapidly
to treatment; some severe chronic cases persist in spite of
intensive treatment and force the patient to give up fur-
ther study. Many authors (including Prince lately) have
argued that it could be described as a depressive equiva-
lent or a masked depression with anxiety as an important
accompaniment [Prince, 1989].
According to Prince [1983], the brain fag syndrome is
exceedingly common and often incapacitating among stu-
dents in Africa south of the Sahara. It is as though a black
depressive cloud descends upon perhaps one quarter to
one half of adolescent high school and university popula-
tions, blocking their educational progress. Various au-
thors [Prince, 1962; Jegede, 1983] reported 3258% of
secondary school students with brain fag symptoms in
Nigeria. On the basis of clinical studies, brain fag has been
reported as much commoner in males than in females
[Peltzer and Woldu, 1990; Prince, 1989].
Virtually all epidemiological studies that have been
conducted on this condition have been done on students.
For example, Prince [1960, 1962] in Nigerian secondary
school pupils, and Guinness [1992a] in Swaziland second-
ary school students. This concentration of studies on stu-
dents probably derived from Princes initial theory insin-
uating an etiological association with the western type of
education (study) or brain work. Prince [1983, 1989] has
elaborated this theory and named it the Forbidden
Knowledge Theory. According to this theory, the genesis
of the brain fag syndrome is an unconscious process sig-
nifying a rejection of western education and the knowl-
edge which such education seeks to impart. Acquisition of
western knowledge amounts to a betrayal of the knowl-
edge embedded in indigenous African educational sys-
tems. The development of the disturbing symptoms of the
brain fag syndrome is therefore construed as an uncon-
scious mechanism to debar the learner and thereby reject
the new knowledge. This theory implies that the brain fag
syndrome cannot develop in other contexts, educational
Brain Fag
(nonwestern) or noneducational. The Psychophysiologi-
cal Theory, on the other hand, links the syndrome with
learning in a second (foreign) language per se. The link is
traced through self-imposed sleep deprivation by the stu-
dent, using stimulants to stay awake and spending more
time on study if necessary, in order to keep abreast of the
syllabus. The theory emphasizes the language as the me-
dium of instruction rather than the content or knowledge
which the instruction seeks to impart [Morakinyo, 1980a,
1990].
The apprenticeship system has been an age-long (tradi-
tional) form of education in Africa [Burton, 1987; Galla-
way, 1964; Morakinyo, 1990]. In earlier times, apprenti-
ceships involved activities such as woodcarving, cloth
dying, house building, pottery, and weaving. This system
is still being widely practiced and is used in the training of
artisans. e.g. automobile repair workers (mechanics, panel
beaters, electricians), tailors, or shoemakers. The trainees
learn by observing their masters at work and acquire their
skill in the process of assisting the master and undertaking
simple and, later, more complex tasks themselves. The
period of apprenticeship depends on the type of trade or
vocation. It has been known to vary from 3 to 7 years in
most vocations, with an average of 45 years. Usually, the
apprentice (trainee) neither receives any stipend from his/
her master/mistress nor does he/she pay any fees other
than providing service in contributing to the work and
running errands. There may or may not be a written con-
tract. However, before the apprentice can graduate, some
stipulated obligations must be met. The language of ver-
bal instruction is in the vernacular, e.g. Yoruba, and not
in English, as it is the case among secondary or university
students.
The aim of the present study was to estimate the preva-
lence of brain fag symptoms among such apprentices and
identify some related factors like age, gender, socioeco-
nomic status, and acculturation in the form of English lan-
guage proficiency, which may assist in advancing our
knowledge and elucidating the pathogenesis of the syn-
drome. If the Forbidden Knowledge Theory were true,
then one would expect brain fag syndrome symptoms to
be associated with learning in the apprenticeship system
of education since the content of the learning is main-
ly western automobile mechanic or tailoring involv-
ing dealing with European-made machines and materials
for example. In this study, the level of intelligence and
academic ability were excluded since it has constantly
been shown that no relationship exists with brain fag
[e.g. Guinness, 1992b; Minde, 1974; Morakinyo, 1980a,
1980b, 1983].
Psychopathology 2002;35:362366 363
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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-
tices, (2) frequency of brain fag symptoms, and (3) factors
of significant relationship with brain fag symptoms.
Types of Apprentices
The types of the apprentices studied are shown in
table 1.
The five most common types of apprentices were hair-
dressers or barbers, dressmakers or shoemakers, mechan-
ics, carpenters and electronics.
Frequency of Brain Fag Symptoms
Table 2 indicates the frequency of brain fag symptoms
and sex differences.
Apprentices reported frequent experiences of brain fag
symptoms: 43% said that they were never satisfied with
their general efficiency in learning and with retention of
what they have learned, followed by 34.4% experiencing
Symptoms
Table 3 indicates the relationship between different
independent variables and brain fag symptoms.
Proficiency in English (spoken, reading and writing)
but not demographic and economic status was associated
with brain fag symptoms.
Discussion
This study did not find a high frequency of often expe-
rienced brain fag symptoms among these Nigerian ap-
prentices. Prince [1983] had indicated that the brain fag
syndrome is a stereotyped psychiatric syndrome that
affects 2040% of secondary school and university stu-
dents in diverse cultures across Africa south of the Sahara.
In earlier reports, brain fag syndrome symptoms were
found to be present in between 32 and 58% of students
studied [Prince, 1963; Jegede, 1983]. Similarly, high or

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 Table 2. Brain fag symptoms by frequency in percent

Brain fag symptoms Often Some- Never Sex, 2

times

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

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