Objective:
This article aims to understand why women’s mental health technological age needs special and targeted care by understanding how the causes and consequences of mental issues in women are different from those in men.
Statement :
Technology is a boon or a bane depending on the socio-cultural context it is in. The demand and supply sides of mental health care and technology need to be released from the grip of patriarchy. Also, mental health and technology in particular and development in general must be gender sensitive.
A) Why Does Women’s Mental Health Need Special Attention?
Common mental disorders (CMD) are depression , anxiety and somatic complaints. Women are two to three times more vulnerable to CMD than men.
Leading mental health problems of the elderly are depression, organic brain syndromes, and dementia. Majority of the sufferers of these are women.
Ladies and children are around 80% of the 50 million people victims of violent conflicts, civil wars, disasters, and displacement.
Lifetime prevalence rate of violence against ladies ranges from 16% to 50%.
Depression is expected to be the second leading cause of disability burden by 2020. The number of women suffering from depression is around double that of men. It is the most common women’s mental health challenge.
Anxiety disorders are twice or thrice multiplied in women when compared to men. Women have a greater severity of symptoms. They usually have a comorbid depression and a more complicated course.
Women and men suffer from bipolar disorder differently. Women experience higher depressive episodes and seasonal mood disturbances.
A study conducted in India revealed 0.8% to be the one year incidence of attempted suicide by women, among which 37% had baseline CMDs.
The precipitants for suicide wr.t. Following causes, according to Indian government statistics, among women compared to men are as follows:
Dowry disputes (2.9% versus 0.2%);
Love affairs (15.4% versus 10.9%);
Illegitimate pregnancies (10.3 versus 8.2);
Quarrels with spouse or parents-in-law (10.3% versus 8.2%).
B) Factors Causing Women’s Mental Health Issues:
A person’s sex is an operation of nature and their gender is an operation of socialization or nurture. Factors influencing women’s mental health have been divided into biological and social factors.
I) Biological factors :
Women mostly internalize liabilities and men externalize liabilities. Crime and aggression are ways of externalizing disorder symptoms.
Hormones related to the reproductive cycle may be the reason for women’s increased susceptibility to depression.
Premenstrual and menstrual phases make women more susceptible to irritability, restlessness, anxiety, tension, migraine, sleep disturbances, sadness, dysphoria, and the lack of concentration.
Mental disturbances frequently occur during late pregnancy and in the postpartum period. Postpartum blues is the most common and least severe postpartum illness affecting between 50% and 80% of new mothers. One in six pregnant women and one in five women who have recently given birth experience a CMD.
Menopause is a time of change for women not only in their endocrine and reproductive systems, but also their social and psychological circumstances. It has long been known that menopause is accompanied by depression and other mental disturbances.
II) Social factors :
Social model of health and the concept of a health field : The concept of health field, promoted by WHO, emphasises the importance of following individual behavioral ,material, economic, psychosocial factors and the complex reciprocal relationships of the above in determining health.
The effect of biological vulnerability is increased by the social disadvantages that women have. A person’s gender affects the control they have over their lives in general and mental health in particular. Since India is still not able to accept women as equal to men, women with mental illness are doubly insecure.
The Declaration on the Elimination of Violence Against Women, adopted by the UN General Assembly in 1993, defines violence against women as “any act of gender-based violence [GBV] that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life”.
Social factors contributing to mental illness:
These are multiple roles ascribed to women such as the unremitting responsibility of caring for others, gender discrimination, poverty, hunger, malnutrition, overwork, sexual abuse, severe life events that cause a sense of loss, inferiority, humiliation or entrapment, wrath of dowry practices, a firm patriarchal family system with the woman having little say, lesser opportunities for education and employment, alcoholism of their partners, domestic violence, divorce /separation, lesser support from relatives especially while suffering from mental illness or separation from their partners, life stressors like delivery of a baby, nurturing children, old and the sick, weariness of crossing social lines with education and employment and the pressure to live up to societal expectations, belonging to nuclear families, marriage at a very young age, etc.
1) Violence in technology :
Technology, like democracy, needs to be used responsibly and is a power that must be given into trained hands. Cyber-based GBV discourages women from using technology and thus exacerbates the gendered digital divide and further disempowers them. This needs to be addressed while we seek technology led development.
Education , technology and economic growth are empowering women in a way. However, they have not addressed patriarchal socio-cultural factors that perpetuate gender inequality and thus affect women’s mental health.
37% of women in tech industry in U.S. are victims of sexual assault.
According to a UN Broadband Commission report, 73 per cent of women are abused online worldwide.
2) Negative effects of social media:
a) Pressure to be ‘perfect’:
Other social media sites like twitter, Facebook, Instagram and snapchat caused bullying and negative impacts on quality of sleep and body image. Friends only post pictures of achievements and good times. This may cause comparison and fall in self esteem. With the availability of so many photo editing options and the increasing focus on outer appearance regardless of whether or not it is accurate can undermine one’s self worth.
b) Increased indirect communication:
Language over social media can be indirect. It can cloud the tone and intent of communication. This may cause stress and confusion about how honest and forthright communication is, thus threatening the ability to form stable relationships if there is a lack of in-person communication. A combination of in person and tech based communication can strengthen bonds. There is a positive relationship between the frequency and severity of such social factors and the frequency and severity of mental health problems in women. Women's mental health tends to suffer as they are faced with such stressors and are ill-equipped to cope with the same.
C) Gender Based Impacts Of Mental Illness In Women:
1) Social problems:
Rehabilitation of women who have suffered mental health problems is difficult due to the reasons such as marital abandonment, homelessness, vulnerability to abuse and to sexually transmitted diseases, women with mental issues are doubly inflicted by abuse when compared to women in general.
Whereas women are required to be the primary caregivers of their husbands who are mentally ill, it is themselves who still need to carry on with the role of care-giving to the family despite their problems.
Care services for a mentally ill women are calleds for irregularly and late.
A mentally ill woman is socially ostracized and may go through separation from her husband. She is made responsible for her illness. Being mentally ill after being a woman is a dual curse. Rather she is blamed for the illness.
The responsibility of her care is usually ascribed to her own family rather than her marital family.
The stigma of separation from her husband is more sharply experienced than the stigma due to mental illness
The caregivers of a mentally ill daughter become more miserable upon contemplating her future.
2) Structural problems: Problems in service provision and utilization:
Service provision: Indian mental hospitals appear to primarily provide services to men in distress as there is sex-based discrimination regarding access to beds. In government hospitals which have only service the male female percentage ratio for allotment of beds was 73:27. Similarly, it was 66:34 in those with service, research and training.
The Mental Healthcare Act (MHCA), 2017 aims to protect the rights of people affected by mental illness in India. However, there is no provision to specifically meet the needs of mentally ill women. The present mental health care system in India focuses on psychiatric services. It can better meet the needs of women if it focuses on provision of counselling, support structures, creating awareness and reducing stigma.
Utilization : The male female ratio of attendance in public health psychiatric outpatient’s clinics in urban India is 3:1. This ‘under-utilization’ is attributed to the comparatively higher stigma attached to women’s mental illness and the general neglect towards women’s health.
D) Solutions:
The following outlook shifts are required:
1) Change in mental health policy:
Currently policies towards women’s health focus on reproductive and maternal health. This scope should be increased to include the mental and physical health of women across their life cycles.
If we divide all factors affecting women’s mental health into two, they would be a) individual lifestyle factors and b) socio-cultural factors.
Often focus is on the individual lifestyle risk factors. However, this has the following repercussions: Firstly, it ignores the sociocultural factors that bring the lifestyle into place and in which it is embedded. Secondly, it places the entire responsibility of the ill health and healing on the woman alone. Little is in a woman’s control, given her lack of agency. The real answer lies in social change.
2) Social media as a mental health tool:
Opportunities to empathize. : The needs for self-identity, communication, empathizing, sense of community and emotional support are met by social media in general and YouTube in particular. YouTube provides a platform to empathize with unknown people as people learn about personal health experiences. YouTube, in particular, decreased the levels of depression, anxiety, and isolation.
Expanded access to mental health resources. :Given the stigma of mental health therapy and it’s inaccessibility, technology has made mental health resources and therapy more accessible. Many relevant apps are free or economic.
Some tools such as Crisis Text Line gives people access to text trained volunteers to deescalate a moment of crisis. Anxiety Coach helps people track daily progress for long term health management.
Such resources make individuals more accepting towards in-person treatment or provide supplementary support. In fact many professionals are using such aids.
Opportunities to engage: Texting is associated with lower levels of same-day depression and anxiety. People suffering from depression tend to isolate themselves and thus social media is a great avenue for opening up.
Understanding social media better can aid us in using it as an effective health care tool.
3) Gender sensitive ICT
Integration of the gender perspective into technology and a discussion of their complex relationship is needed. The following five fold approach is suggested:
The gendered nature of ICT should be addressed. Currently, most technology makers are men. More women involved in the industry and gender neutral technology development will make ICT gender sensitive.
Socio- cultural and economic environment within which ICT is based needs to be made equal for women. This will increase the number of women consumers of ICT.
Closure of the gap between health and wellness.
Generation of supportive relationships and not competitive ones.
Creation of a positive relationship between women and technology.
Keeping the above in mind the following actions are required:
Education, training, and interventions targeting the social and physical environment.
Maintenance of data about women’s issues.
Awareness among primary care providers about women’s issues. They must routinely maintain dialogue about women’s mental health on an individual and community basis.
Women’s issues at the workplace must be studied and addressed through interventions.
Improvement in the criminal justice response to violence against women.
Movements to fight prostitution, sexual abuse, and domestic violence.
Women experiencing circumstances like domestic violence need support to self manage their condition. Keeping the above biological and socio-cultural factors in mind, web based applications can be used as interventions for this purpose.
Real-time support through online chats, safety apps and wearable tech that act as a rape whistle activated with a press of a button.
Conclusion
To rescue gender from the poverty trap, we need poverty-independent gender analysis and policies. There is no substitute for a gender analysis, beyond other social and economic cleavages. Thus, instead of taking action specifically for women empowerment, there is an urgent need for a re-examination of development through a gender perspective. Gender equality is a social reform ideal which has to be pursued from within the society. It is not a product of the technological age. Technology and State policies must tend to the aforementioned gender specific needs and vulnerabilities in their socio-cultural, economic, political, legal and psychological contexts to improve women’s mental health.
References:
Malhotra, S., & Shah, R. (n.d.). Women and mental health in India: An overview. Retrieved February 22, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539863/
Department of Mental Health and Substance Dependence World Health Organization, Geneva. (n.d.). Women’s Mental Health: An Evidence Based Review. Retrieved February 22, 2020, from https://www.who.int/mental_health/media/en/67.pdf
Northwest Primary Care. (n.d.). 5 Ways Technology Impacts Young Women’s Mental Health - NWPC. Retrieved February 24, 2020, from https://www.nwpc.com/5-ways-technology-impacts-the-mental-health-of-young-women/
Das, K., & Das, B. (n.d.). TECHNOLOGY AND WOMEN IN INDIA With Special Reference to the Rural Sector. Retrieved February 21, 2020, from http://www.helsinki.fi/iehc2006/papers1/Das.pdf
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Rao, R. (2019, March 1). Mental Healthcare Act, 2017, and addiction treatment: Potential pitfalls and trepidations Rao R, Varshney M, Singh S, Agrawal A, Ambekar A - Indian J Psychiatry. Retrieved February 18, 2020, from http://www.indianjpsychiatry.org/article.asp?issn=0019-5545;year=2019;volume=61;issue=2;spage=208;epage=212;aulast=Rao
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