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Mental illness: Women at higher risk due to subjectivities of environment, social factors

By IMPRI Team

The gendered nuances of mental health have been largely misunderstood. To address these knowledge gaps, #IMPRI Gender Impact Studies Center (GISC), IMPRI Impact and Policy Research Institute, New Delhi, organized a special talk under the #WebPolicyTalk series: The State of Gender Equality – #GenderGaps on the topic Women and ‘Mental Health’. The speaker for the session was Prof Rachana Johri, Director, Centre for Psychotherapy and Clinical Research, Dr B.R. Ambedkar University, New Delhi.
The event was chaired by Prof Vibhuti Patel Visiting Professor, IMPRI and Former Professor, Tata Institute of Social Sciences (TISS), Mumbai. The other esteemed discussants included Dr Amrita Nandy, Researcher and writer on gender, rights and culture and an Adjunct Lecturer, Ambedkar University, New Delhi, Dr Cicilia Chettiar, Head, Department of Psychology, Maniben Nanavati Women’s College, Mumbai, and Dr Aparna Joshi, Assistant Professor, School of Human Ecology, and Project Director, iCALL & Sukoon, Tata Institute of Social Sciences (TISS), Mumbai.
Introduction
The chair for the discussion, Prof Vibhuti Patel began the discussion by stressing the need to understand mental health in relation to contemporary socio-cultural ethos in Indian society and the status of women in the family, community and society. She emphasized the need to seriously reflect on critical social determinants of mental health, measures for promotion and protection of mental health, and the well-being of the people as well as methods to foster resilience to stress and adversity. The notions of femininity, masculinity heteronormativity and gender binary need to be updated.
She highlighted the differential impact of mental stress as per the intersectional inequality. She also discussed how power and control over socio-economic cultural factors can impact the mental health status, treatment in society, susceptibility and exposure to specific mental health risks. Elucidating the meaning of a gender-responsive approach to the mental health of women, Prof Patel says that this approach involves distinguishing between biological and socio-cultural factors while simultaneously exploring their interplay and also being sensitive to how gender inequality affects mental health outcomes. Highlighting the deplorably low work participation rate of 20% in India, Prof Patel mapped out three reasons- glass ceiling phenomena, class cliff phenomena and sticky floor phenomena which lead to low participation by women and how this impacts their mental health.
She asserted the need to be sensitive about intersectional locations of women and multiple burdens of caste, class, religion, gender, geographic location and education, which are shouldered by Indian women. Talking about the etic approach which uses diagnostic categories of mental illness such as neurosis, schizophrenia, psychosis, phobia etc., Prof Patel says that this categorization is detrimental for women as psychiatric labelling doesn’t take cognizance of the material reality faced by women on a day-to-day experiential level and also obscures social realities. Whereas, the emic approach emphasizes cross-cultural psychiatry and evaluates mental illness from within a culture.

The Indian Scenario

The speaker for the session, Prof Rachana Johri drew upon her reflections as a critical feminist psychologist who has been closely associated with those who suffer from mental illness and those working towards the alleviation of such distress. She believes that psychological distress is an inevitable aspect of human life. For women, the feminist slogan, ‘the personal is political’ is nowhere more evident than in their engagements with questions of psychological suffering. Although mental health is often thought to be the purview of psychologists, psychiatrists, neurologists and others, in reality, the terrain can best be understood through a highly interdisciplinary perspective that draws from sociology feminism, psychoanalysis, disability theory as well as movements such as the LGBTQ movement, global mental health movement, disability movement.
Prof Johri began with a discussion by deconstructing the idea of mental health. She critically analyzed the meaning of the terms ‘health’ and ‘mental’. Health has been defined as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Adding to this, mental health is defined as a state of well-being in which an individual realizes his or her own abilities and can cope with the normal stresses of life, s/he can work productively and contribute to the community. She then talked about the role of diagnosis in mental health illness. Prof Johri also elucidated how social constructions affect the production of disorders, for example, homosexuality was considered to be a ‘disorder’ earlier.
Prof Johri also assessed the role played by gender in naming disorders and several have reference to women, examples being postnatal depression. She also highlighted the close relationship between the pharmaceutical industry and the diagnostic framework, which has been a matter of concern, especially for women who have often been medicated for resisting cultural expectations. Explaining the changes in the conceptualization of mental health, Prof Johri asserted the need to move away from the idea of mental illness to that of psychosocial disability. Today, the idea of mental health includes a wide range of experiences ranging from mild time-limited distress to chronic, progressive and severely disabling conditions.
In India, statistics from NMHS indicate that 13.9% of the population suffers from mental illness, while women are at a higher risk due to the subjectivities of the environment and social factors. Prof Johri believes that the women’s movement in India has not accepted the problem of psychological distress and this stems from the belief that an analysis of social oppression is sufficient to overcome this distress. She analyzed how continuous subjection to intentional or unintentional violence, leads women to develop anxiety and depression. Iterating how the self-definition adopted for women as ‘caretakers’ can be psychologically draining, Prof Johri advocates for women to develop a mental health voice within themselves and look for alternative spaces for their ‘self’.
Stressing on the preconditions of safety, freedom, and access, Prof Johri believes that these three crucial factors create the potential for positive wellbeing in women. She commented that The Mental Health Act, of 2017 is in the right direction, however, there is a greater need for clarity on the rights of people with serious psychosocial disabilities. She says that the mental health spectrum involves a whole range of disabilities, so there is a need to orient policymaking towards all issues, while simultaneously focusing on individual issues. The budget allocations on mental health are still far behind, also as WHO indicates, there are 0.7 psychologists per one lakh population.
Access to psychiatric care, good hospitalization, better media portrayal of people with severe psychosocial disabilities, undertaking more research, enhancing community-based support systems, and lastly, not banning spaces which provide healing experiences through spirituality or religion, were some of the suggestions given by Prof Johri.

Reconceptualizing Women’s Mental Health

Dr Aparna Joshi started her discussion by elucidating how the COVID pandemic has brought forth the issue that nobody is spared from the mental health impact. While it was called an equalizer, it was not really so, it brought the pre-existing rifts and the pre-existing disparities of the society and women were one of the most affected members. Explaining how gender intersects with mental health, Dr Joshi conceptualized four ways, firstly, gender is a very critical determinant of stressors that people experience. Secondly, gendered manifestations of mental health concerns; thirdly, help-seeking patterns and utilization of mental health services; lastly consequences of mental health concerns.
Emphasizing the role played by socio-contextual realities, Dr Joshi advocates for a reconceptualization of mental health from biomedical to socio-contextual to disability model, where the society, government and the environment are equally responsible to provide a conducive atmosphere. She suggests a subjective, locally contextualized, “nothing about us without us” method for understanding women’s realities. According to Dr Joshi, this method helps to understand women in their entirety and also addresses the vulnerabilities within vulnerabilities. Suggesting a few policy changes, Dr Joshi says that all future policies must be socio-contextual driven, policies must engage with women’s internal and external realities, there must be an enhanced community-based response, address different stakeholders and also the policies must take caregivers into account.

Being Okay with Not Being Okay

Dr Cicilia Chettiar began by emphasizing the need to make the community-based mental health model into a people’s movement. Talking about her work, she asserted the need to launch emotional skill development programs for the emotional upskilling of women and men. She also calls out on the ‘superwoman’ model, a model where women believe that they have to be good at everything, she says that this idea is a making of the misinterpretation of feminism.
A very important point highlighted by Dr Chettiar was that women have created certain mental blocks for themselves which often raise questions of inadequacy and incompetence, which in turn creates a whole set of disorders. To raise women’s awareness of the ‘self’ is the direction that the mental health narrative must go towards. She also believes that the aim of therapy is to let women know that they are not the best version of themselves and that they are not ‘bad’ if they aren’t following the norm. In the end, she reiterated that it is acceptable to not function in typical ways or norms that other women have already been following, summing up, it is okay to not be okay.

Food for Thought

Ending the insightful and enriching discussion, Dr Amrita Nandy posed some questions by drawing from the insights shared by Prof Rachana Johri, where she says that women’s lives may seem healthy when they go on functioning in the face of very severe violence and abuse, Dr Nandy deliberated on how to light the path for women, how to take off these masks before the struggles become overwhelmingly difficult. She also questioned how one reimagines the politics that marries the feminist, with the spiritual.
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Acknowledgement: Riya Shah, research intern at IMPRI

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