The stigma divide: Why young Indian women struggle to seek mental health help

Pertaining to the mental health of young women, we might be living in two Indias, with two distinct kinds of problems. In one, women are silent sufferers, with shame, disillusionment and depression being well-kept secrets. This is the India in which the gap between the onset of a mental health issue and the time it takes a person to seek help is eight to 10 years. This is the India in which women have been treated as second-class citizens for centuries. “From the brutality of sati to the social exile of widows, women’s suffering has often been ritualised, normalised and silenced,” said child, adolescent and family psychiatrist Dr Zirak Marker during a session on the ‘silent distress of young women’ at the second edition of the Mpowering Minds summit in Bengaluru. “From barring menstruating girls from kitchens and temples to the crushing weight of the dowry system that still exists in our society, distress has been inherited silently.” So why do women still feel shame in voicing that distress, which manifests as depression, anxiety and self-harm? Why this stigma in reaching out for professional help?

According to Dr Shyam Bhat, psychiatrist and founder of the Nirvikalpa Foundation, this gap is a result of young women not being able to articulate what they are feeling. There may be feelings of dissociation, numbness, irritability and fatigue, but a lot of this is normalised, attributed to adolescence and hormones. “In male mental health circles, we talk about stoicism, but I actually see a lot of that in women,” he said. “They have to be the ‘good person’ and conform to a certain role where their feelings cannot be expressed. And these are critical years of identity formation. So, it can take a long time before the person admits to something being wrong.”

The problem might even be systemic, said Dr Jasmine Kalha, co-director and senior research fellow at the Centre for Mental Health Law & Policy, Indian Law Society, Pune. “I think it is a mental health sector problem, and we are to be blamed,” she said. “Help has become extremely inaccessible, and we are not providing the solutions that people want.” As a result, said Kalha, part of her work involves co-designing solutions with people from the community who don’t want to accept the help of professionals.

But there is another India that is silently growing in significance, an India that takes its cues from the west. This is the India in which girls want to be ‘woke’ and, instead of being silent, take pride in diagnosing their own mental health conditions. There is much over-labelling and over exposure. Marker spoke about a 12-year-old girl coming to him and expressing her dissatisfaction with her body. She wanted to know about breast reduction surgery. She knew about gender terminology and the dynamics of being transgender.

This is, of course, nothing new in the west. According to one study published in JAMA Pediatrics, one in four US adolescents in grades 9-12 reported their sexual identity as non-heterosexual. Another survey found high rates of sadness, bullying and suicide attempts among transgender and gender questioning teenagers. Bhat said that this western concept of labelling your gender at a young age is dangerous, and something we should dissuade our young people from copying.

From his 12 years of experience working as a therapist in the US, he is of the view that the American mental health system is a failed one. “Let’s be clear, America spends more on mental health than anyone else,” he said. “There is accessibility to mental health services and no treatment gap. They have plenty of psychiatrists and therapists, but suicide, homicide and divorce rates are at an all-time high there. So, let’s not replicate their system which is essentially about paying a lot of money and getting poor results. What you call hope I call the toxicity of hyper individualism that has seeped into the therapeutic language. It tells young people to quickly define themselves. The last thing you want is to intrude on their sense of being. Let them be who they are without having to hyper-label themselves even before they have any idea of who they are. The western idea of liberation is to label the hell out of yourself. They believe that inflexible, rigid identity is their highest self. That will never work for our country, and we are in danger if we adopt that system of psychotherapy.”

Dr Meenakshi Kirtane, founder and director of Maanas The Inside Story and founding president, Indian Psychodrama Association, added that India should follow its own example. “As a culture, we have always been rooted in wisdom,” she said. “We should be attuned to our own existence and celebrate ourselves just as we are. Body image issues, just like social media and the cosmetics industry, are an absolutely fabricated problem. If we can make every girl child feel that she is beautiful as she is, half our population won’t need to go to social media for validation.”