Popular culture often misleads us into believing that mental health is more of an individual issue than anything else. But is that really the case? What if I were to tell you that mental health is a social issue; that to address mental health issues is to address patriarchy, sexism, casteism and class discrimination as well?
The truth is that mental health is a privilege, one that is often denied to women, especially if they hail from marginalised communities all because of patriarchy.
It’s 2021 but mental health still remains a taboo topic in India. According to the National Mental Health Survey undertaken by National Institute of Mental Health and Neurosciences (NIMHANS) in 2016, mental disorders affect more than 14% of the Indian population, 10% of which require immediate intervention.
However, the number of people who are able to seek help is much lower, caused mainly by the stigma surrounding mental illness, lack of awareness and the paucity of available and affordable resources.
In a country which has long been governed by patriarchal norms, the diagnosis and treatment of mental health issues too, remains highly gendered.
The problems faced by women: stringent gender norms, sexual harassment, domestic violence, restricted access to basic resources such as education and lack of financial and social freedom, are widely different than those faced by men.
These structural issues restrict the individual space of young women, thereby stunting their emotional growth and often lead to poor mental health. A study concluded that women are twice more likely than men to suffer from major depressive episodes.
And it’s not just depression either. Various studies have come to the conclusion that more women suffer from common mental disorders, with gender differences being observed in the course of the disorder, frequency of psychotic symptoms and long term outcomes.
Common sense would suggest putting more focus to tackle this gender bias but real life paints a grim picture. For centuries, medical professionals have written away symptoms of mental illness in women as hysteria, a very convenient explanation that continues to haunt psychiatry.
In fact, hysteria was thought to be exclusive to women and recommendations for cure included herbs, sex or even sexual abstinence.
A visit to the therapist takes a lot of courage, especially for women whose distress is often ignored or assumed to be just stress. But their struggle to get a correct diagnosis doesn’t just end there; doctors too sometimes do not take their symptoms and complaints seriously until it’s too late.
The Constitution of India may have done away with the caste system, but casteism has somehow managed to survive. A simple Google search turns up tens of articles about the caste based violence still practiced in India.
Consequently, casteism becomes an important factor in the current mental health epidemic in the country. Years of discrimination and inter-generational trauma culminate in a lower economic and social standing for these marginalised communities, making them all the more susceptible to mental illnesses, while simultaneously making it harder to access resources.
Women from these marginalised communities not only have to deal with casteism, but also the sexism running rampant in their own families.
Women from the transgender community have their own woes to count, especially when they belong to lower castes. Their own struggle with gender dysphoria is worsened by social exclusion from society and a highly restricted access to resources and opportunities due to social stigma.
Mental health professionals in our country have a very poor understanding of gender themselves and fail to provide the support that they should be able to.
The problem with the nation’s mental health framework is that it perceives mental health from an upper-caste, upper-class point of view. In a society where a Brahmin man is at the top of the ladder, a poor trans Dalit woman runs the risk of being oppressed to the highest degree.
Studies indicate that women from rural communities or from lower social backgrounds find local healers such as ojhas more accessible while men, in general, find it easier to access modern mental-health care systems.
However, even this gendered access does not benefit people from lower castes. The culture-blindness of psychiatry has given birth to mental health professionals insensitive to caste-based structural oppression.
Neither are they trained to take socio-economic realities and political histories into account during treatment. Such a de-contextualised approach to mental health obscures the necessity of addressing the social and economic causes of mental distress.
It is a sad reality that not enough research has been done to figure out the perfect way to navigate caste, class and gender in mental health. The existing policies put forward to reduce this treatment gap remain redundant.
The crux of the issue centers on the individualisation of mental distress which doesn’t really work in the Indian context. The need of the hour, thus, is to sensitise mental health professionals towards the systemic oppression faced by these communities, especially women and their various social locations and develop effective measures to deal with the same.
Such resources must also be made easily accessible to different communities. Blue Dawn, a mental health support group for Bahujans, is a flag bearer in facilitating professionals to those in need and paves the way for others to follow.
The psychometric tests used for evaluation too, do not factor in the social and political landscape of India, and must be developed keeping in mind the unique problems that plague the subcontinent.
Mental health is a human rights issue, and it is critical that psychiatry as a discipline becomes more inclusive and welcoming towards vulnerable communities. The need is no longer individual self-awareness but to create safe spaces for vital dialogues to take place.
Women have been grossly misunderstood and sometimes even erased in India’s mental health discourse and the world at large. Such stereotypes, appropriations and wrong diagnosis can assume dangerous proportions with the already entrenched patriarchy.
What becomes crucial is a gender sensitive process that not only understands structural factors but also takes remedial steps to eliminate them.
It is only when mental ailments begin to be treated as physical ailments that the burden of mental distress can be alleviated from the citizens.