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Mental Health of Women in India Authors: Juhi Vajpayee and Kritika Makkar (2014) Department of Psychology University of Delhi
Abstract
This research focuses on the multidimensional social model of mental health of Women in India. It explores the various aspects of society physiological, family, socio-economic status, cultural and media and the interaction of these factors with women's psychological wellbeing. The main purpose of the study was to identify and analyze the social stigma attached to these factors and create awareness about them. The method used for this research was the analysis of the secondary data collection, movie analysis and literature review. Implications are discussed in the conclusion.
Problem: The problem of the present study is to analyze the current status of mental health of women in India and how the society contributes to it.
Introduction
"You can tell the condition of a Nation by looking at the status of its Women." Jawaharlal Nehru, Leader of India's Independence movement, and India's first Prime Minister.
The World Health Organization sees health as multidimensional and espouses a social model of health. It defines health as ‘a positive concept emphasising social and personal resources as well as physical capacities.’ ‘Mental health is the capacity of the individual, the group and the environment to interact with one another in ways that promote subjective well-being, the optimal development and use of mental abilities (cognitive, affective, and relational), the achievement of individual and collective goals consistent with justice and the attainment and preservation of conditions of fundamental equality.
WHO predicts that 20% of the Indian population will suffer from mental health illness by the year 2020. Barely 1-2% of the health budget is dedicated to mental health in comparison to 10-12% in other countries (Fortis, 2013). In India, the prevalence of mental disorders ranges from 10 to 370 per 1000 population in different parts of the country. The median conservative estimate of 65 per 1000 population has been given by Gururaj et al. The rates are higher in females by approximately 20-25%.
This research focuses on explaining how the different dimensions of the society affects the women of India and creating awareness of mental health to reduce the stigma against it. A woman's mental health and psychological wellbeing is deeply affected and influenced by her society and the roles she plays in her society. Whether it is the role of a daughter, a wife, a mother, a sister, a homemaker, a manager, a teacher, etc., all influence her quality of life.
Stigma, discrimination and awareness can seriously affect the health,
welfare and quality of life of women with mental health problems. Stigma is rampant in Indian communities all over the world. The ignorance, fear, misunderstanding and prejudice that surround mental illness deepen the severity of the illness as individuals withdraw further from the world around them. These are a result of a combination of negative stereotypes (often from the media in some form: either movies or news reports) and a lack of new, more positive and sympathetic view points to replace these schemas. Gender influences the control men and women have over the determinants of their health, for example, their economic position and social status, and their access to resources. Gender configures both the material and symbolic positions that men and women occupy in the social hierarchy, and shapes the experiences that condition their lives. Gender is a powerful social determinant of health that interacts with other variables such as age, family structure, income, education and social support, and with a variety of behavioural factors. India is strongly a man-centric society. The structural hierarchy of Indian society, which puts patriarchy at the top of gender cycle, has been predominant in deciding how women lead their lives in India and
elsewhere across the globe. The method used for this research was secondary data collection. Secondary data is data collected by someone other than the user. Common sources of secondary data for social science include censuses, organisational records and data collected through qualitative methodologies or qualitative research. The technique used for interpretation is content analysis and movie analysis. Content analysis is a technique for systematically describing written, spoken or visual communication. It involves media, print, television, video, movies and internet.
Objectives
1. To analyze the social stigma against mental health and illness that exists in the society of India 2. To analyze the role of physiology and its effects on mental health of women in India. 3. To analyze the role of family and its effects on mental health of women in India.
4. To analyze the role of socio-economic status and its effects on mental health of women in India. 5. To analyze the role of culture and its effects on mental health of women in India. 6. To analyze the role of media and its effects on mental health of women in India.
Stigma
“I wish my son had cancer instead of depression,” an Indian mother told Gayathri Ramprasad (author of Shadows of the Sun: Healing from depression and finding the light within)
“If he had cancer, all my friends and family would sympathise with us. How can I tell them about depression? They won’t even understand [what that means]…What kind of future will he have?" said the mother. Conditions such as diabetes and heart disease are viewed differently than clinical depression and other mental illness. They’re often treated with much more compassion, care and understanding. And people
aren’t ashamed to seek help. However, with mental illnesses and health its another story.
Mental health disability is something which takes on a very different meaning in non-Western cultures. In India, people with severe mental illnesses often turn to temples and shrines, not to doctors. It is a serious issue related to mental health where it is believed in rural areas that the symptoms of mental illness are caused by visitations and wrath of spirits, demons and ghosts. Consequently, it is believed that religious, magical and other traditional methods by God, men and traditional healers can elevate the symptoms. The basis of these structures have to be examined in the context of the oppressive social structures in which there is widespread illiteracy and ignorance.
In India, there is a tremendous social and cultural pressure to marry. It is of paramount importance to discuss the relationship between marriage and mental illness in Indian scenario as marriage is perceived to be a panacea to mental illness by many. Marriage is a socially acceptable way to satisfy the basic human need for sexual gratification.
It thus forms the basis for procreation and building up of family. Other reasons for marriage could be legal, emotional, economic, spiritual and religious. Marriage is an important institution in human society and particularly so in Eastern countries, including India. In India, it is almost compulsory for every individual to marry and “settle down.” Not being married is considered a stigma, particularly in case of women whereas being married translates into elevation in social status.
Movie analysis: The movie Maine Gandhi Ko Nahin Mara highlights the issue of social stigma against mental illness and how it affects not just the sufferer but also other members of the family, especially the women. Anupam Kher's character, Uttam Chowdhary who is a professor suffers from dementia. His daughter, Trisha whose character is played by Urmilla Matondkar is shown as a caring and loving daughter who takes care of her father even at the cost of sacrificing her personal life which includes her romantic relationship and her career. In one scene when her boyfriend and his parents visit her father to talk about marriage, Uttam has an episode where he goes hysterical and starts
shouting at his parents. Later in the scene, its shown how his parents react to this situation. They ask her if its a genetic condition and suddenly become very worried that she might also have inherited the condition from her father. It is later shown that he breaks all contact with Trisha and starts a new life where he marries another woman. This is a classic example of the stigma that exists in our society against mental illness and how the women suffer even when she is not directly affected by it. She is rejected as a viable marriage partner solely based on the fact that she could be carrying the same genes as her father that would result in dementia.
In our society, words such as "Pagal" are commonly used and casually thrown around in normal conversations. The word means 'crazy' or 'mentally ill'. Such words create more stigma and desensitizes the society towards people who are suffering from psychological distress and dysfunction.
Role of Physiology
Hormones can affect a woman's mood throughout her lifetime. Sometimes the impact on mood can affect a woman's quality of life. Once a young woman starts menstruating, she may begin to experience emotional changes around the time of her period. 75 percent of women with regular period cycles report unpleasant physical or psychological symptoms before their periods. Premenstrual Syndrome or PMS, affects 30 to 80 percent of women. Psychological symptoms of PMS include anger, depression, irritability, anxiety, sensitivity to rejection, sense of feeling overwhelmed, social withdrawal. In many parts and cultures of India, menstruation is celebrated since a girl finally become a 'woman' and is ready for marriage and childbearing. In Punjab it was believed that Mother Earth (‘Dharti Ma’) ‘slept’ for a week each month. In some parts of the Deccan after the ‘navaratra’ goddess temples were closed from the tenth to the full moon day while she rests and refreshes herself. In Malabar region, Mother Earth was believed to rest during the hot weather until she got the first shower of rain. Still today in the Kamakhya temple of Assam and in
parts of Orissa the rituals of the menstruation of the goddess are celebrated during the monsoon season. Both the fertile earth and woman must rest be venerated and celebrated (Chawla, 1992). This process gives a positive outlook of a difficult and different phase of a girl's life and helps her associate positive emotions with menstruation. However, there is taboo related to menstruation as well. Whether it is not touching the pickle, not participating in any pooja or god related rituals or ceremonies, not eating meals with other members of the family. This, on the contrary, may have a negative impact on the young girls and make them feel rejected, depressed or anxious or confused about the impending menstruation. Feelings of inferiority might also develop.
Depression and anxiety are the most common mental health problems in pregnancy. These affect about 10 to 15 out of every 100 pregnant women. Women also experience many other mental health problems during pregnancy, just like at other times. Many women have good mental health during pregnancy. How your mental health is affected during pregnancy depends on many
things. These include: • the type of mental illness you have experienced • whether you are on treatment • recent stressful events in your life (such as a death in the family or a relationship ending) • how you feel about your pregnancy. You may or may not be happy about being pregnant. You may have upsetting memories about difficulties in your own childhood. Symptoms of mental illness in pregnancy are similar to symptoms you have at other times. Some symptoms might focus on the pregnancy. For instance, you may have anxious or negative thoughts about your pregnancy or your baby. You may find changes in your weight and shape difficult, particularly if you have had an eating disorder. According to a study, the incidence of post-partum depression was 11%. Low income, birth of a daughter when a son was desired, relationship difficulties with mother-in-law and parents, adverse life events during pregnancy and lack of physical help were risk factors for the onset of post-partum depression (Abraham et al., 2002)
Women may experience a wide range of feelings, from anxiety and discomfort to release and relief, upon menopause. Most adapt to the changes and continue to live well and remain healthy through these transitions. However, Some women, although not all, will experience significant depression before perimenopause. Perimenopause marks the time when your body begins the transition to menopause.When women go through menopause, some may feel badly at the loss of their ability to bear children. However, some women look at menopause as a time to expand their work and social activities, and to dedicate more time to their spouse or partner. Having a positive attitude about this life change may help.
Role of Family
India is a secular and pluralistic society characterised by tremendous cultural and ethnic diversity. In India the family is the most important institution that has survived through the ages. Unlike the West, in India, family is the key resource of good mental health. Since ages, the Indian family has been a dominant institution in the life of individuals. In
India, overwhelmingly, families adhere to a patriarchal ideology, follow the patrilineal rule of descent, are patrilocal, have familialistic value orientations, and endorse traditional gender role preferences. In the ‘restrictive’ environment of the joint family, women are expected to observe more restraint, all must be subject to command of the ‘elders’, which leads to interpersonal maladjustment. The various roles that a girl/woman plays affects her mental health differently. Below we explore these roles and the role expectations that the family has, and its effects on her psychological well-being.
As a daughter Being a daughter implies that there is a mother or a father. It suggests that being a daughter entails expectations about a female's behaviour vis-à-vis a parent and a parent's behaviour vis-à-vis the daughter. As a daughter, women's role is very limited and restricted to certain level. Their freedom is controlled and disciplined by their parents. In the majority of Indian families at every level of socialisation, a distinction between sons and daughters is commonly observed. In middle class families, a strong discrepancy is found in the education of
female as compared with the male child. In many families, the education of male offspring takes precedence over the education of female child (Jain, 1988). This situation often brings frustration and conflict among the aspiring female offsprings. The same level of discrimination was shown by many families in sending their daughters and sons to employment which further affects their confidence, self esteem, and handicaps them to reach their potential. Sometimes, in the extreme cases, this oppression many lead to psychological distress, depression, conduct disorder, defiant disorder etc.
As a wife As long as a woman lives with her parents as a daughter her roles are limited, and as soon as she gets married and enters into her husband's family, it brings new status to her and this achieved status demands quite different types of roles to be performed by her. As a wife her relationships and obligations with her husband and with other members of the family are expected to be more or less in tune with traditional relationships of women. Traditionally, the expectations of every
member of the family are to be fulfilled by her and further with her behaviour and activities, she has to earn the appreciation and approval of not only of her husband but also of other members of the family. If the woman is working, she has to make adjustments between her traditional role in her family that cannot be totally neglected, and new roles outside the family. In a study by Dudhathra and Jogsan, 2012 there was a significant difference in mental health among working and nonworking women. Results indicate the non working women have better mental health as compared working women.
India Today survey shows us that 79.3% men believe that marital rape is okay. Despite the fact that marital rape receives little public and scholarly attention, it is one of the most serious forms of violence. In a study it was indicated that women who are raped by their husbands are likely to experience assaults and often suffer from long-term physical and emotional consequences (Bergen, 2006). The experience of being raped can also lead to suicidal tendencies, depression, post traumatic stress disorder, anxiety, poor self esteem, neurosis, chronic pain, odd sexual behaviour and substance abuse disorder.
As a mother As soon as a woman attains the status of mother, additional roles will add to her usual roles. In hindu society, a woman as a mother has a unique place. Despite her inferior position as a daughter and a housewife, she has a supreme position in the society as a mother. At the same time, this is not practiced. She has no voice in family and social matters. Her ignorance and illiteracy were the responsible factors of her inferior status in the family. The higher education of women and their entry into employment has brought a radical change in the concept of child rearing and these factors are remarkably influencing the socialising role of a woman as a 'mother'.
Movie Analysis In the movie English Vinglish, Sridevi's character Shashi Godbole is a housewife who sells laddoos as a home run business. Her husband, Satish and daughter, Sapna take her for granted, mock her poor English skills and generally treat her with disrespect making Shashi feel
negative and insecure. However, the protagonist enrols in an English speaking course to stop her husband and daughter from humiliating her constantly. She quickly becomes a promising and committed student and gains confidence and explores her identity.
Role of Socio-economic Status
WHO report on mental health states that mental disorders occur in persons of all genders, races and background. No group is immune to mental disorder but the risk is higher among the poor, homeless, unemployed, persons with low education. Socio-economic status (SES) is often measured as a combination of education, income and occupation. It is commonly conceptualised as the social standing or class of an individual or group. When viewed through a social class lens, privilege, power and control are emphasised. SES affects the overall human functioning including development across the life span, physical and mental health. Variance in SES including disparity in distribution of wealth, income, and access to resources affects everyone. However, women are over-presented among those
living in poverty. Women are more often responsible for raising children and are more likely to raise children alone. This fact is one of the main reasons that socio-economic standing of women is of great importance to the well-being of future generation. (Fact sheet: women and socio-economic status, APA)
Because of the stigma and ignorance attached with mental health, rural communities without access to trained specialists tend to lack an adequate understanding of it. Many cases go unrecognized and untreated. The ailed, however, often remain unable to work or marry and therefore become chained to their position at the bottom of society. The gender insensitivity and discrimination only makes this situation that much more harder for women. In a study by Patel, 1999 it was shown that low education and poverty were strongly associated with common mental disorders in women.
The urbanization brings deleterious consequences for mental health through the influence of increased stressors and factors such as overcrowded and polluted environment, dependence on a cash
economy, high levels of violence, and reduced social support. There is considerable stigma attached with mental health and ignorance regarding information about mental health and available help and treatment. The mental health care in urban areas is at present limited to psychiatric hospitals and departments of psychiatry in medical colleges. Mental health problems at early stage remain unrecognized and untreated (Kumar, 2005)
Role of culture South-East Asia is the most heavily populated and amongst the poorest regions in the world. It faces enormous social, economic and health challenges, including pervasive inequality, violence, political instability and high burden of diseases. Marked gender discrimination in South Asia has led to second class status of women in society. Their mobility, work, self-esteem and selfimage, in fact their worth and identity, seem to depend upon the male members of a patriarchal society. Women's lack of empowerment and both financial and emotional dependence have restricted their self-
expression and choices in life. This, along with family, social and work pressures, has a definite impact on women's mental health (Niaz and Hassan, 2006).
The Indian constitution grants women equal rights to men, but strong patriarchal traditions persist in many different societal parts, with women's lives shaped by customs that are centuries old.
A tradition that was highly prevalent in India was the dowry tradition in which women were married to men based on the condition that they get money, property, gold or other assets to the man's family at the time of marriage. Although, dowries were made illegal in India in 1964, women are still treated as a commodity. it is deeply seated in the Indian culture. In our epic mythology, The Mahabharata, even Draupadi was legally wedded to Arjuna who was shared by other four siblings as a commodity and later on staked by her husbands in a game of dice.
Rape in India is the fourth most common crime against women. Rape culture is a term that is used to describe a culture in which rape is
pervasive and normalised due to societal attitudes about gender, sex and sexuality. It is highly prevalent in India. It is a direct infringement on the rights of women. Victim blaming and slut shaming are common features of the rape culture, where after a woman is raped, she is blamed for it and the society and sometimes, even the family brands it as her fault. The length of her skirt, the colour of her lipstick and the depth of her blouse decides whether she is "asking for it". If these things do not fit the 'appropriate' category, it is considered to be her fault. In a video by Kalki Koechlin on Youtube called, Rape: It's your fault, these issues are highlighted by her in a sarcastic and satirical manner makes a bold impact and brings out the issue of rape culture. This has a very negative repercussion on women. It affects their perceptions and how they view the male gender as a whole. They are constantly suspicious of the intentions of all males and form a stereotypical image of men in which they start viewing them as potential rapists. It also handicaps their independence since they start fearing leaving the house.
Role of Media
"Baar baar dekho …hazzar baar dekho …yeh dekhne ke cheez hai humara dilruba……."
Sexual objectification is the act of treating a person merely as an instrument of sexual pleasure, making them a "sex object". Objectification more broadly means treating a person as a commodity an object, without regard to their personality or dignity. Objectification is most commonly examined at the level of a society, but can also refer to the behaviour of individuals.
Media is a very important medium for broadcasting information to a large population and when misused it can have a very negative impact. The influence of film industry is a strong example of objectifying women in our society. It has almost become a norm to have an item song performed by an item girl for a movie to get its publicity. 'Item' literally entails an object.
Gender discrimination is a form of discrimination that still exists in India. Although it may be more subtle than some other forms of prejudice, gender inequality can have significant negative mental health effects. Whether it is the male actors getting a higher salary in film industry, or how an actresses is ostracised when she is wearing revealing clothes as compared to an actor who happens to be shirtless.
In a recent case of India’s top newspaper Times of India making a post’s headline “OMG: Deepika Padukone’s cleavage show" news story out of Deepika Padukone’s cleavage revealing clothing has not gone down well with the actor. It has also invited sharp criticism from the media as well as other netizens, particularly on social networking sites such as Twitter. To which she replied , "Yes! I am a woman.I have breasts and a cleavage! You've got a problem!?" She further said, "Don't talk about women empowerment when you don't know how to respect women!"
Women are usually portrayed and given a barbie doll role with the characteristics: attractive, submissive, meek in the film and television industry most of the time. But in the rare cases where a woman gets to
be on the front seat and run a show, as was the case in the movie Mardaani where Rani Mukherjee's character Shivani Roy, a cop whose interest in the kidnap of a teenage girl leads her to uncover secrets about human trafficking by an Indian mafia. She is portrayed as an independent and strong character. However, to end on sad note, the movie's name "Mardaani" brings out the hypocrisy by implying how 'manly' and 'masculine' it is to be a strong, powerful and brave woman.
Conclusion
The study indicates that mental health in India is attached with strong social stigma against it. Most people are still unaware or ignorant about the importance of mental wellbeing. Terms such as 'pagal', 'mental' and 'crazy' should not be thrown around casually. Awareness of mental health in general and that women in particular, should be spread even in the remote areas of India where there are people who still hold the notions of spirits and demons when the explanation lies in understanding of a mental illness.
The physiological changes cannot be controlled but the way we deal with that can be worked on. Women going through phases such menstruation, pregnancy or not being able to conceive and menopause are biological changes that cannot be manipulated but therapy can be used to help women cope with the stressors related to it.
In the role of family, a woman plays several roles that affect her mental health differently. Applying Erikson's Psychosocial stages of
development, as a daughter, the stages 4 and 5, that is, Autonomy Vs. Inferiority and Identity Vs. Confusion play a major role in shaping and forming schemas about themselves and the surroundings. It gives her a weak picture of herself that could result in her inferiority complex which leads to the male dominance in the society and so this cycle. Her role as a mother is considered the main purpose of her existence. Her identity is reflected in the fact that she would one day get married and produce children. Although the current situation is slowly but surely changing, as implied in our movie analysis of English Vinglish in which the character of Shashi is inspired by the real life of Gauri Shinde's (director of the movie) own mother. Women as well as men are recognising and giving an equal stature to women in all aspects, but still have a long way to go. There are maternity leaves for women for a year during pregnancy and ranging from 6 months to 2 years even after the birth of a child. This gives them job security and able them to aim for higher levels in the management.
Because of the lack of education, nutrition, exposure to knowledge, and other important facilities also contributes in the ignorance and stigma
that is attached with the mental health. There is a strong need to eradicate poverty and create awareness of mental health, especially in the remote and rural areas of India. Putting up posters is not enough, we need to reach out and help with their everyday issues by putting up weakly camps where psychologists listen and provide help to the people. In urban areas, life is fast paced. Women, in particular, deal with taking care of the family as well as focusing on their careers. Monthly therapy sessions and positive programmes such as 'Thank you Therapy' could be introduced in workplace.
Our culture has features of collectivism and individualism. Although in the constitution, women have equal rights, India is a very patriarchal society. Strong stereotypes that are gender specific exist. For example, when thinking of an 'ideal' family, we have an image where the male goes for work and the woman's job is to take care of the home and the family. Women have a specific code of conduct that the society expects them to follow, which, if broken by them, has serious repercussions. The youth, however, is realising these strong ideologies need to change and that women are not to be treated as a commodity anymore. Also,
many women empowerment programs are introduced which help them raise their voices and be assertive about their choices in life and stand by them independently. Rape culture in India induces lack of confidence in woman rather than supporting the victim. We choose to practise victim blaming and slut shaming which shatters their will power to fight against the wrong thus such response of the society which needs to be changed now. It is very important to change the outlook of the society in such cases. For example, thousands of people follow Baba Aasa Ram Bapu, believe in him, build their own values and beliefs on his sayings, so if our society thinks calling someone bhaiya will help us to stop the rape then the direction of our thinking is to be questioned and needs to change.
The role of media and how it portrays women influences the thinking and attitudes of the entire country. The biggest problem here is how the media objectifies women. It is very important to show that there are also women out there like Indira Gandhi, Kiran Bedi, Mary Kom and although not India but even Malala Yousafzai who are strong female characters, instead of women as living barbie dolls.
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