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Indian Women’s Mental Health Scenario Is Full Of Unseen Battles, Unheard War Cries…And A Ton Of Stigma

Women hold up half the sky. But the horizon of mental health for them is different from that of men! As we observe #WorldMentalHealthDay2021, let's explore the rocky landscape of women's mental health.

Women hold up half the sky. But the horizon of mental health for them is different from that of men! As we observe #WorldMentalHealthDay2021, let’s explore the rocky landscape of women’s mental health.

Trigger warning: This deals with mental health issues, domestic violence, emotional violence and violence against women, and can be triggering for survivors.

Since time immemorial, ‘hysteria’ was recognized as a mental illness, and linked by Hippocrates to the uterus, and in more recent times by Freud. Finally, as late as 1980, the concept was finally deleted from the DSM -III, the 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders that is close to the 21st Century understanding of Psychiatry.

But the stigmatization of mental disorders in women continues to take different forms. Biological and sociological factors, coupled with oppressive systems embedded in patriarchy also put them at a significant disadvantage in availing care and concern and affecting the outcomes.

Many diseases show different prevalence rates among men and women, but amongst psychiatric disorders, most large-scale studies report an almost equal incidence of schizophrenia and bipolar disorder. But women may experience these illnesses differently – certain symptoms may be more common in women than in men, and the course of the illness can be affected by the gender of the individual.

Women’s mental health vulnerable to social and biological factors

For many other disorders, like depression and anxiety, however, it is women who are affected much more than men. This is the result of the intersection of women’s biological and social vulnerabilities.

The socialization of genders often puts women in situations where they have little control in decision-making. This lack of autonomy, and its acceptance by society, is determinantal to self-esteem and emotional resilience.

Gender-based violence with its repeated distress is an important psychosocial risk factor for mental disease. Not limited to domestic and sexual abuse, this also encompasses human trafficking, female genital mutilation, forced and early marriage, honor crimes, war crimes, migration.

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All these experiences are associated with an increased prevalence of post-traumatic stress, anxiety, and depressive disorders. Eating disorders are more common and severe in women as compared to men, as is suicide ideation in teenage years.

Social factors also affect how mental disorders are experienced and early diagnosis difficult in women

Social experiences colour how mental disorders are experienced.

It is a common observation that while women internalize negative emotions, men might externalize them leading to aggression and psychopathic traits, or take recourse to substance abuse.

The stigmatization that women face is also different from that of men. In many societies, mental ill-health of the woman usually has a direct bearing on her marital and family life leading to further abuse and vilification if she isn’t the perfect daughter wife, and mother.

Social norms deeply embedded in patriarchy where the man is the unquestioned superior devalue the woman; a devaluation that she often identifies with without her own realization. The importance and burden of maintaining interpersonal relations set the stage for conflict avoidance and repeated self-silencing and anger suppression.

Social constructs in the mind of parents, educators, and health care professionals influence diagnosis, health care, and outcomes at every stage. One example of this is how the diagnosis of Attention Deficit Disorder is commonly missed in girls.

Linked to women’s reproductive health but stigmatised

There are also certain types of disorders that are unique to women. For example, some women may experience symptoms of mental disorders at times of hormone change, such as perinatal depression, premenstrual dysphoric disorder, and perimenopause-related depression. The burden of sexual violence is also much more in women than men, especially in adulthood.

Reproductive health and the agency, or lack of it, that women have in this critical area of their lives is an important determinant of women’s mental health. Unplanned and multiple pregnancies, miscarriage, and fertility issues, forced sterilizations or abortions, are issues where the impact on mental health is never accounted for.

That said, many women, especially in disadvantaged scenarios may have access to only primary or basic level facilities; or only sporadic exposure to gynecologists/obstetricians. This is because traditionally women’s health has been equated to reproductive health.

Sensitization of health care professionals at primary level facilities to different manifestations of psychiatric disorders is essential for early diagnosis and treatment of women’s mental health issues. Women often complain of body symptoms like fatigue, chronic headaches, or just heaviness. Awareness of the health care practitioners and their own conditioning can also become a factor. It is known that many heart attacks in women are often missed or initially passed off as anxiety or neurosis.

Social expectations and mental health disorders

Conforming to the rigid expectations and having their identities based on their status as mothers or their marital status is often so important for women that they continue this internalization, gradually eroding their sense of authentic self, without being conscious of it.

The pressures of having to live up to social expectations of ‘mothering’ rather than parenting puts the burden on women. This is amplified for the working mother, the single mother, or the lone mother. In a society where the identity of women is often equated with that of being a woman, many choices regarding mothering are made as a result of societal pressure and expectations and may be rooted in the giving up of goals and dreams. The psychological effect of these is not even considered important enough to show up and be counted.

Silencing of women further exacerbates the problems

How women avail, and experience, mental health care is also different from men. In most societies, it is the woman who is the designated caregiver at different phases of her life; yet she does have the same care available when she herself needs it.

Help-seeking behavior is often actively discouraged in women, and they often present late to facilities, at points where they cannot participate in decision-making about their own selves. This is substantiated by the documented lower utilization rates of mental health facilities in India by women.

A recent report reveals that there are more women institutionalized than men in India. This can be attributed to the lower hierarchy traditionally accorded to women, causing them often to be ‘discarded’ by their families.

The complexities that determine the mental health of women are gender-specific; and will need to be addressed through a gender-sensitive lens. Experiences of self-worth, competence, autonomy, adequate income, and a sense of physical, sexual, and psychological safety and security, so essential to good mental health, are systematically denied for a large number of women. This puts them at significant risk for mental comorbidities; as does violation of their reproductive rights and oppression.

Image source: a still from Anamika/ Pocket Films on YouTube

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About the Author

shalini mullick

Shalini is a practicing doctor with more than 20 years of experience in her chosen specialty-pathology. She is also a writer and has a keen interest in medical humanities. She has published 5 short read more...

32 Posts | 51,886 Views

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