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Sunday, August 15, 2021

WOMEN AND MENTAL HEALTH: A SOCIO-CULTURAL PERSPECTIVE

- Nighat Gandhi

 

                  image credit U Chicago Medicine

 

WOMEN’S health is inextricably linked to their status in society. It benefits from equality, and suffers from discrimination. Today, the status and well-being of millions of women world-wide remain tragically low.

                                                                                                   WHO World Health Report (1998)

 

Why such double standards when it comes to mental health?

The WHO warned us more than two decades ago about the emerging mental health crisis for women. But as a society we haven’t done much about it. Physical health deteriorates and we blame external factors like pollution, poor diet, overwork, aging etc.  But if our mental health goes for a toss, the blame is laid on the woman: personality problem, adjustment problem, emotional immaturity, hormonal changes, menopause, etc. Implying that if they simply exercised their will power, they could balance their mental health. If they can’t, it’s a sign of feminine weakness. This is especially the attitude if a woman has been depressed and/or anxious for a long time.  She’s advised to stop being over-reactive and learn to cope with circumstances. Pull herself together.   We tend to blame the sufferer rather than suffering-causing culture—the toxic social and cultural context in which most women live.  Why do we ignore women’s low social rank and their lack of economic independence, their repeated exposure to violence of all kinds, inequality and discrimination? We see, and yet we don’t see the impact of these key determinants on women’s overall mental well-being.  

Others global factors such as poverty (70% of the world’s poor are women and children), hunger, low wages, unemployment, domestic violence, wars (an estimated 80% of people affected by violent conflicts, civil wars, disasters, and displacement are women and children), forced migration, climate change-caused displacement, sexual abuse, rape, overwork, unpaid work, all these additionally impact women’s mental health adversely. These factors impact men’s mental health also, but not to the same extent. Common mental health problems such as depression and anxiety disorders, post-traumatic stress disorder, are much more commonly diagnosed in women.  It’s not hard to connect the dots: greater the social distress, greater the mental distress.

 

Gender-based Violence and Mental Health

 

Gender based violence and mental health



                                         image credit Monash University

 

       Women grow up in a climate of fear and violence. Violence overrides differences in cultural background, social class, education, occupation etc. Violence is a reflection of, and a result of unequal power relationships between men and women.   Two-thirds of women in India face domestic violence in some form. Multiple roles stress, gender discrimination and associated factors of poverty, hunger, malnutrition, overwork, domestic violence and sexual abuse, combine to account for women's poor mental health. There’s a direct relationship between mental distress and social circumstances.  Depressive disorders cause 41.9% of the disability worldwide among women but only 29.3% among men. (https://www.indiatoday.in/lifestyle/health/story/world-health-organisation-depression-largest-contributor-disability-mental-health-lifest-962749-2017-02-26)

       India recorded an average of 87 rape cases daily in 2019.  One Indian woman gets raped every 16 minutes.

       Every four minutes a woman experiences cruelty at the hands of her in-laws.

       Maximum number of rape cases were reported from Rajasthan and Uttar Pradesh.

       7% rise in cases of violence against women over past  year according to government data for Sept 2020. shttps://thewire.in/women/average-87-rape-cases-daily-over-7-rise-in-crimes-against-women-in-2019-ncrb-data

 

OBJECTIFICATION OF WOMEN  AND MENTAL DISTRESS

 



Objectification Theory Model of Body Shame and Eating Disorders

 

Sexual objectification of women in advertising, videogames, and movies, and portrayal of perfect beauty as unnaturally thin, tall and fair-skin has been linked to common mental health problems—such as

       Depression and anxiety

       eating disorders [90%  affected are women],

       poor body image

       low self-esteem

       low self-confidence

       One in four Indian teenagers (mostly girls) are affected by eating disorders. Anorexia, bulimia, binge eating followed by purging are becoming increasingly common among young women and girls.  https://scroll.in/magazine/863540/over-25-of-teenage-indian-girls-suffer-from-eating-disorders-this-art-project-shows-how-they-feel

       If you want to see the pervasive negative effect of advertising on women’s self-image, watch the short, 4 minute video clip: Killing us softly: Advertising’s image of women by Jean Kilbourne  https://www.youtube.com/watch?v=jWKXit_3rpQ

 

    Negative impact of the pandemic on women’s mental health.

 


80% young adults surveyed admitted their mental health has suffered during the pandemic. (https://www.thehindubusinessline.com/news/science/)



Poverty, as I have already mentioned, impacts women more than men, and this negative impact has worsened during the Covid-19 pandemic.

Women are facing more financial insecurity globally, more hunger, more job losses than ever before.  55% women reported Covid-related job loss as opposed to only 34% men, 41% women reported worsened hunger. Women’s unpaid care work skyrocketed during the pandemic, increasing by 41%. Women traditionally are expected to take care of the sick, children and elderly in the family. These findings are based on a 40-country first person survey conducted on more than 6000 women and 4000 men in September 2020. (Https://www.care.org/news-and-stories/press-releases/financial-insecurity-hunger-mental-health-are-top-concerns-for-women-worldwide). Not surprisingly, almost 1 out of 3 women respondents reported worse mental health during the pandemic compared to only 1 out of 10 men. 

When it comes to the mental health status of Indian women, the situation is understandably bleak: they are working more, earning less, and facing even greater financial insecurity during the pandemic, according to another survey done in October-November 2020 that included 17000+ women respondents from 10 Indian states. Half the women who lost paid work during pandemic have not yet regained employmentWomen from marginalized communities are even worse off---Muslim women, migrants, transwomen, sex workers. (https://www.hindustantimes.com/opinion/women-work-more-earn-less-and-face-greater-health-risks-101626262199540.html).

       The pandemic has hit female sex workers hard, the most marginalized and maligned women in our society. Watch this hard-hitting video by Mumbai Live on the plight of Mumbai’s sex workers during the pandemic. https://www.youtube.com/watch?v=Zk2M8MugyNc

       


       Sex work came to a standstill during the pandemic. Of the 9 lakh Indian sex workers (including transwomen), most are are in debt, jobless, homeless, and at risk of contracting Covid, and not getting vaccinated in time. https://www.thehindu.com/society/from-debt-to-depression-the-pandemic-has-hit-indias-sex-workers-hard/article35113988.ece Traumatic enough, right? No surprises then if women in general, and sex workers in particular, have precarious mental health. There’s a mental health pandemic in the making and its effects will be worse than the Corona virus pandemic because there is no vaccine for mental distress.

                                              

We need more Community-based mental health services for women:

       special mental health clinic timings evenings and weekends for working women;

       Locating clinics on public transport routes for easy access

       imparting caring /basic counseling skills to community care-givers; especially in rural areas

       health caregivers must spend more time with patients, listening to patients concerns, and their families;

       group psycho-education of patients and their families;

       integration of mental health care as primary health care.

       public institutions such as PHCs must offer subsidized or free mental health care services

 

WOMEN’S VALUES ARE CRITICAL FOR BETTER MENTAL HEALTH

We have to question the on-going privileging of masculine values in society. These values seem to be the reference point for successful living, to the exclusion of more feminine values and principles. Neither set of values is superior, both are needed for human survival, so why not opt for a balance between both sets of values?

What are masculine values?  Autonomy, decision-making, rationality, individuality, self-interest, efficiency, competence, competition. Machismo is a form of masculinity that emphasizes the exercise of strength and power of men in every situation. What are feminine principles and values? Feminine values include empathy, emotion, relatedness, caring and care work such as taking care of children, the ill, and the elderly. These are the very values that have been undervalued or even devalued in society.

Women (in general) are perceived as having a broad awareness, are more empathetic, nurturing, compassionate, process-oriented, focused on personal relations and concern for justice. One reason that women’s mental health is suffering more during the pandemic is because they are doing more of what they have been doing in terms of unpaid care work, but that care-work itself is devalued and taken for granted. 

Feminine values for women and masculine values for men is no solution. Values and principles that ensure a well-balanced society have to be adopted by everyone. If men learn to become better listeners, better care-givers for children and the elderly, more empathetic and more emotionally expressive, women would love it. But won’t that benefit men too? If women become more independent, assertive decision-makers, good for women!

But won’t that benefit men too?

 

PS- (This article is a summary of a zoom talk given on Women and Mental Health in July 2021.)

 

 

 

                                

  

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