“A woman’s life is tension”: A gendered analysis of women’s distress in poor urban India

Abstract

The mental health of women living in poverty is a growing public health concern, particularly in India where the burden of illness is compounded by critical shortages in mental health providers and fragmented services. This was an exploratory study which sought to examine low-income women’s perceptions of mental illness and its management in the context of urban poverty in India. This research was prompted by the lack of empirical studies documenting how women in marginalized sections of society understand mental illness. Data were collected through a combination of 10 focus group discussions and two individual interviews with a total of 63 women residing in low-income areas of Mumbai. Social representations theory was used to explore shared meanings of mental illness among women in this setting. Thematic analysis of the data showed that women use the expression “tension” to talk about mental illness. Tension was described both as an ordinary part of life and a condition having its origins in more profound gender-related stressors, particularly pressures surrounding motherhood, chronic poverty and domestic conflict. Approaches to managing tension were pluralistic and focused on the resumption of social roles. Findings are consistent with other studies in similar cultural contexts, suggesting a shared, transnational character to women’s distress and the need for scholarship on women’s mental health in low-income settings to be more attuned to gendered forms of marginalization.

A Call to Action. A Critical Review of Mental Health Related Anti-stigma Campaigns

“…A focus on increasing the public's MHL is particuarly pronounced in low to middle-income countries (13), and simliar effects have been found have been found in these places (7,11,74,75). Whilst, earlier reviewers pointed to common issues in low-evaluation follow up [e.g., (7,13)], more recently researchers have noted there is a serious need to give greater consideration to the local contexts which situate understandings of mental health and illness (75,76). Namely, around only 1 in 10 interventions have been developed "within" the country of intervention, and almost all interventions included some form of educational component (75).…”

“…Broadly, Kalampalikis and Haas (131) define the Other as a belief that guarantees, orchestrates, or institutes difference, something that may often involve descriptions of being uncommon, non-familiar, strange and fundamentally "not-me." Cross-culturally, this treatment ranges from its media portrayal to the beliefs expressed in professional and lay communities (76,104,122,(132)(133)(134).…”

“…This is of key importance as, rather than mental illness being fully "unknown" or "incomprehensible" to the public, beliefs about mental health and illness constitute an important form of selfknowledge. For example, the public often refer to personal experiences when asked to explain their beliefs about mental health and illness (76,104,122). Furthermore, whilst the public often legitimize fears of contact by contrasting the perceived unfamiliarity of schizophrenia with the perceived familiarity of depression (19,104), population-level surveys suggest that up to three-quarters of the public have at some point experienced psychotic-like experiences (153,154).…”

“…In addition, as these sense making processes are rooted in the everyday task of living, it is important to pay serious consideration to the structural influences which locate understandings of mental health and illness (136). For example, in the Indian context, it has been found that women living in low-income settings, who have an increased likelihood of experiencing gender-based violence, understood the psychological and behavioral experience of distress in terms of family relationships, social roles and poverty, themes also considered to cause mental illness or "madness" (76). However, despite their shared causes, mental illness remained Othered, with participants considering someone with experiences of "madness" to be qualitatively different, a representation achieved through beliefs of danger, difference and more extreme social consequences (76).…”

“…For example, in the Indian context, it has been found that women living in low-income settings, who have an increased likelihood of experiencing gender-based violence, understood the psychological and behavioral experience of distress in terms of family relationships, social roles and poverty, themes also considered to cause mental illness or "madness" (76). However, despite their shared causes, mental illness remained Othered, with participants considering someone with experiences of "madness" to be qualitatively different, a representation achieved through beliefs of danger, difference and more extreme social consequences (76). Similarly, in the British context, where the likelihood of experiencing mental ill-health is structured by socio-economic status, groups who have increased levels of familiarity through personal experience, are also more likely to consider mental illness as unfamiliar (167), suggesting mental illness is distanced at the level of representation.…”