In my clinical work with young women across urban and rural India, one pattern repeats with disturbing consistency. Distress is present, often intense—but it rarely arrives in words. It arrives in silence, in the body, in withdrawal, in self-punishment, and sometimes, in self-harm.
We speak today about rising anxiety, depression, and suicidality among young women. Yet, we continue to miss the deeper question: why does so much suffering remain invisible until it becomes dangerous? What we are missing is not awareness, nor intent.
What we are missing is the ability—and the willingness—to recognise how young women experience distress, how they express it, and why our systems consistently fail to respond in time.
Silent distress is not absence. It is adaptation
The phrase 'silent distress' is often used casually, as if young women simply do not speak up. In reality, silence is rarely passive. It is strategic. It is learned early, reinforced daily, and often essential for survival.
From early adolescence, many girls are taught—explicitly or implicitly—that their discomfort is inconvenient, their emotions excessive, their bodies subject to scrutiny and control. Early puberty brings unwanted attention. Body image becomes a site of constant evaluation. Self-worth is shaped not internally, but relationally—by approval, compliance, and performance.
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In this context, silence becomes safer than disclosure. Not because distress is absent, but because speaking carries consequences: disbelief, blame, restriction, or moral judgment. When a young woman learns that naming pain only invites further control, silence becomes a form of self-protection.
The body becomes the language
When words are unsafe, distress moves into the body. Young women present not with sadness or anxiety, but with fatigue, pain, appetite changes, sleep disruption, menstrual distress, and emotional numbness. Conditions such as PMS and PMDD are often minimised, despite their significant impact on mood regulation, impulse control, and vulnerability to self-harm.
Our clinical systems, however, are poorly equipped to read these signals. Somatic expressions are frequently dismissed, normalised, or mislabelled as stress or adjustment issues, rather than recognised as meaningful indicators of psychological overload. What is interpreted as low insight is often deep contextual intelligence: the body speaking when speech is not permitted.
Self-harm is not always pathological. Sometimes, it is protest
One of the most uncomfortable truths we must confront is this: not all self-harm among young women is driven by individual psychopathology alone. In many cases, it reflects an attempt to regain control in environments where autonomy is repeatedly denied.
Self-harm may emerge alongside emotional or silent abuse—constant surveillance, moral policing, relational coercion, and the erosion of agency within families or intimate relationships. In such contexts, self-harm becomes an embodied expression of distress when no other form of resistance is available.
Yet our dominant frameworks continue to treat self-harm as a behavioural problem to be extinguished, rather than a signal demanding deeper inquiry. When interventions focus solely on symptom reduction without addressing the relational and cultural conditions that produced the distress, recurrence is inevitable.
The Indian context: where gender, stigma, and structure collide
India’s young women do not experience distress in isolation. Their mental health is shaped by intersecting forces: stigma around sexuality and menstruation, sexism normalised as culture, misogyny embedded in everyday interactions, and limited control over decisions related to education, relationships, marriage, and reproduction.
Help-seeking is rarely an individual choice. It is negotiated—often contested—within families. Fear of being labelled difficult, unstable, or unsuitable silences many before they ever reach care. Even when services exist, they may not feel safe, confidential, or culturally responsive.
This is not a failure of young women. It is a failure of systems designed without their realities at the centre.
What are we missing?
We are missing several critical shifts.
We are missing clinical frameworks that honour context, not just symptoms—frameworks that recognise relational harm, gendered stressors, and cultural constraints as central to diagnosis and care.
We are missing early, gender-sensitive interventions that address puberty, body image, self-esteem, and menstrual mental health as legitimate clinical concerns, not lifestyle issues.
We are missing safe relational spaces—in schools, families, and communities—where young women can speak without fear of punishment or erasure.
And we are missing accountability for silence. When large numbers of young women do not seek care, the question is not “why don’t they come?” but “what makes our systems feel unreachable?”
Where do we go from here?
As mental health professionals, we must move beyond treating distress in isolation from lived experience. Care must expand to include family engagement, community mediation, and advocacy—not as add-ons, but as core components of treatment.
We must train ourselves to listen differently—to hear silence as information, the body as narrative, and self-harm as a signal that something deeper is structurally wrong. Most importantly, we must centre young women not as passive recipients of care, but as experts of their own lives.
Continuing the conversation
These are not issues that can be resolved in clinics alone. They demand collective, interdisciplinary dialogue—between clinicians, educators, policymakers, families, and young women themselves.
This is precisely why Mpower is convening the Mpowering Minds Women’s Mental Health Summit in Bengaluru, where we will engage in deeper, evidence-informed conversations on young women’s mental health, silent distress, self-harm, and the social realities that shape them.
If we are serious about prevention, dignity, and equity, we must stop asking young women to adapt to broken systems—and start redesigning systems that are capable of truly seeing them.
(Dr Zirak Marker is a child, adolescent & family psychiatrist and chief medical adviser, Mpower)
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
