Mental health can roughly be conceptualised as an individual’s inner experiences linked to interpersonal group experiences. It entails cognitive experiences (thinking processes), affective experiences (feelings and moods), and relational experiences (how people interact with their environment). Lately, the concept of mental health has got broadened with the increasing recognition and inclusion of the importance of external forces such as interpersonal relationships, social and economic factors, and organisational and physical environments on mental health. We can all assuredly agree that women across the globe are overtaxed and undervalued. Their subordination in a male-dominated society makes it gruelling for them to cope with all the implicit social, physical, or mental demands made upon them. It is indisputable that women are more vulnerable than men to violence, all forms of exploitation, be it economic, social, sexual, or emotional. They are also prone to poverty, malnutrition, chronic diseases exacerbated by early pregnancy and forced motherhood, thus worse mental health issues into the bargain. Furthermore, men’s self-seeking and nonchalant attitude only adds insult to injury.
Early psychological theories of sex differences entailed prescriptive traditional sex roles that could control female behaviour. As a result of this, women were viewed as maternal and domestic. Additionally, hygiene manuals describe a cause-and-effect relationship between female sexual “transgression” and their bad health. It bolsters the connection between women’s social role and health status. Other regressive psychological theories emphasised the equivalence of “insanity” with “femininity”, as a result of which the concept of “hysterical woman” was born. Unfortunately, the culturally ascertained patterns of women’s behaviour led to situational anxieties normalised in the name of gender stereotypes and gender norms. As Plath rightly said, “as a woman, you are dammed anyway; if you are normal, you are mad by implication, and if you are abnormal, you are mad by definition.”
The stresses imposed on women deteriorate their mental well-being. There is enough epidemiologic evidence to highlight the link between women’s powerlessness and alienation and mental health issues. These issues mostly appear in adulthood, but their source can often be traced back to early childhood. The girl child grows up to closely observe, hence, internalise the somewhat fixed gender roles and identities around her and processes information based on gender-typed knowledge. The cognitive theory of gender schema given by Sandra Bam explains these processes. This theory can explain the subconscious obsession of a lot of girls’ parents and eventually girls themselves with how they look or how much they weigh, for example. It paves the way for self-esteem and body image issues in girls at an early age that predisposes them to more “weighty”, deep-rooted issues and mental disorders in the future.
Another example is girls passively or directly observing violence towards their mothers at home, which could internalise their mothers’ agony. They will find it difficult to cope with similar unpleasant situations in the future. Additionally, mothers who are victims of domestic violence cannot care for their children properly. Often, they transmit their feelings of low self-esteem, helplessness, and inadequacy to their children.
While the subconscious internalisation of societal expectations characterises childhood, explicit demands for the emotional availability of women start to get evident during adolescence. Since girls are already at a relatively vulnerable stage in their lives because of the sexual, emotional, and physical changes brought about by puberty, their mental well-being further gets compromised. The mobility and autonomy of girls during puberty wanes due to increasing restrictions on clothes, appearance, conduct, speech, and interaction with the opposite sex. In some Indian cultures, girls are even isolated in a separate room for certain days when they are menstruating and are hence “untouchable” during this period. As a consequence of this, girls often see themselves as impure and dirty. In some extreme cases, this practice could lead to generalised anxiety disorder, psychological isolation, depression, and social anxiety in the future.
A typical Indian household imposes “womanly” expectations on the young girls of the house, an example of which is the implantation of the importance of learning how to run a household, cook, and sew in the minds of girls from an early age. Most times, girls end up inheriting their mother’s domestic chores and adopt conventional gender roles because this is the only option available. After marriage, the husband and in-laws control her life. In specific communities, girls are taught to walk with a downward gaze. Consequently, the girls enter a state of “learned helplessness”, wherein girls may accept and remain passive in negative situations despite their evident ability to change them. This happens when they are repeatedly subjected to aversive stimulus to the extent that they stop thinking about escaping it. As a result of these negative expectations, other consequences may accompany the inability or unwillingness to act, including helplessness, low self-esteem, chronic failure, sadness, and physical illness.
Women also face violence at the hands of their husbands, fathers, brothers, and uncles in their homes. The abuse is generally overlooked by social custom and considered part and parcel of marital life. It may also include rape and sexual abuse. Psychological violence includes verbal abuse, harassment, confinement, and deprivation of physical, financial, and personal resources. All types of abuse and violence can lead to mental health issues. Still, when someone from the family perpetrates it, the consequences cage the victim with problems that become extremely hard to battle. Such issues mostly go unresolved because they happen within the family setting. They are followed by mental disorders like Post Traumatic Stress Disorder (PTSD) and feelings of excessive shame, guilt, and episodes of anger. It may also contribute to dysfunctional behaviour, depression, anxiety, eating disorders, somatisation disorders, etc. Discrimination and neglect can result in lowered self-expectations, negative attitudes towards self, lack of initiatives, and so on. On probing further, the symptoms can often be conceptualised as exaggerations or stereotyping of female gender roles and sex-typed behaviours. It is also documented that girls tend to somatise and dissociate more owing to their status in an authoritarian patriarchal society. Women are often not able to escape abusive interpersonal relationships. When they hear about a case, the first question is, “why didn’t she just leave?” even when she had the financial resources and external support to leave. This is where learned helplessness comes in. The repeated cycles of trauma make them habituated to it, as a result of which it is mentally impossible for them to break free from the shackles of abusive marriages.
Based on experiences and observations, whenever girls tend to open up to their family about their inability to cope mentally for whatever reasons, they express the need to seek professional help. Parents often brush it off on the pretext that “this is what girls do.” Thus, combusting into tears, inability to control emotions, feeling overwhelmed, getting short of breath, which are all symptoms of anxiety disorders, would be accounted as the usual “tantrums” girls throw. Sometimes, women learn to extinguish their symptoms as a coping mechanism, resulting in high-functioning anxiety.
Although policies have been introduced in India, recognising the importance of mental health, they did not bring about a paradigm shift in how it is viewed in Indian society. For instance, the Mental Healthcare Act was introduced in 2017 to provide mental healthcare services for persons with mental illness and ensure these persons have the right to live a life with dignity by not being discriminated against or harassed. However, since Savarna Hindu men centrism is ubiquitous in the Indian society, it is crucial to introduce a new policy reform with an intersectional approach that acknowledges the fact that women, the queer community, and other economic and caste-based minorities have it worse and hence need more attention under the policy framework. Incorporating group therapy sessions that include having liberating discussions on patriarchy and sexism in general and having women personally relate these social phenomena to their own lives based on their past experiences can promote gender-sensitive mental healthcare services in India. As the awareness about mental health is increasing, the demand for a feminist approach to therapy is also shooting up. This kind of therapy also entails gay affirmative therapy principled in non-judgemental and validates people’s choices, which may be beyond what’s considered ‘normal’. This therapy is centered around the client and has a narrative-based nature in many ways. It is important to note that feminist therapy should not solely pertain to providing therapy to well-off cisgender heterosexual upper-caste Hindu women but universally to women considering the existence of societal oppression in India. The Mental Health Act does condemn discrimination of people seeking help based on gender, caste, sexual orientation, and so on. Still, the fundamental stumbling block is the lack of monitoring failures in execution that overlap with the genuine lack of mental health professionals in India.
Thus, women’s mental health cannot be addressed in isolation to social and economic issues. A woman’s health must incorporate both mental and physical health across the life cycle and get beyond the narrow perspective of reproductive and maternal health, which is often the focus of most health policies in India.