Friday, November 27, 2009

Women and depression:

Over the recent times a lot has been happening to boost the status of women in the society. Women now shoulder greater responsibilities and are capable of doing almost anything that men can do. In spite of these social advancements women still remain vulnerable to number of mental illnesses and depression is the most common one. Women mostly present with unexplained physical symptoms, such as tiredness, aches and pains, dizziness, palpitations and sleep problems.

The common symptoms of depression are Persistent sad or low mood, Loss of interest or pleasure in usual activities, including sex, Restlessness, irritability, or excessive crying, Feelings of guilt, worthlessness, helplessness, hopelessness, pessimism, Sleeping too much or too little, early morning awakening, Appetite and/or weight loss or overeating and weight gain, Decreased energy, fatigue, feeling "slowed down", Thoughts of death or suicide, or suicide attempts, Difficulty concentrating, remembering, or making decisions, However, not everyone with depression experiences all of these symptoms, and the severity of the symptoms may vary from person to person. In order to consider depression as a disorder, the symptoms must persist for more than two weeks and should interfere with one’s work or family life.

Major depression and dysthymia (chronic depressed mood) affect twice as many women as men. This two-to-one ratio exists regardless of racial and ethnic background or economic status. Many factors unique to women are suspected to play a role in developing depression. These can be reproductive, hormonal, genetic or other biological factors. Abuse and oppression due to gender biases and certain psychological and personality characteristics are also some other factors. However, it has not been possible to pinpoint any the specific cause for depression as many women exposed to these stress factors do not develop depression.

Scientific studies done in many other countries show that higher incidence of depression in females begins in adolescence. This is due to the fact that roles and expectations change dramatically during adolescence. Other stresses of adolescence include forming an identity, confronting sexuality, separating from parents, and making decisions for the first time, along with other physical, intellectual, and hormonal changes. These stresses are generally different for boys and girls, and may be associated more often with depression in females. It is also suggested that men and women differ in their expression of emotional problems. While men choose to self medicate by taking alcohol or drugs, women tend to express these through emotion, thus becoming depressed.

Adulthood has its own share of stresses for women. These are major responsibilities at home and work, single parenthood, and caring for children and aging parents. Even in a married relationship women carry a greater share of child care and household responsibilities. Role conflict sometimes becomes an issue too. Women at times need to choose between family and work responsibilities, often having difficulty in deciding about which choice is the "proper" one!

Unlike men, women go through many reproductive events. Menstrual cycle, pregnancy, the post pregnancy period, infertility, menopause, and sometimes, the decision not to have children are various reproductive events they go through. All of these events can bring fluctuations in mood which can include depression in some women. Although the specific biological mechanism explaining hormonal involvement in depression is not known many researchers have confirmed that hormones have as effect on the brain chemistry leading to changes in emotions and mood. Because of this many women experience certain behavioral and physical changes associated with phases of their menstrual cycles. In some women, these changes are severe, occur regularly, and include depressed feelings, irritability, and other emotional and physical changes called premenstrual syndrome. During the post delivery period women are more likely to suffer from depression. Postpartum depressions can range from transient "blues" following childbirth to severe, incapacitating, psychotic depressions.

Pregnancy, if desired, does not lead to depression and having an abortion does not appear to lead to a higher incidence of depression either. However, women with infertility problems may be subject to extreme anxiety or sadness, most of the time aggravated by cultural beliefs where infertility is considered ominous. Teenage pregnancy or young motherhood is also a risk for depression due to the increased stress. Housewives who depend on their husbands for financial needs can become uncertain especially when they have abusive husbands. Frequent domestic violence and apathetic attitude of parents and siblings towards married daughters or siblings can lead to helplessness and hopelessness.

Untreated depression can lead to suicide but even severe depression can be highly responsive to treatment. Of course, believing one's condition as "incurable" is often part of the hopelessness that accompanies serious depression. Indeed, treatment is not to eliminate life’s inevitable stresses and ups and downs but to enhance the ability to manage such challenges and lead to greater enjoyment in life.

Silence behind domestic violence

Domestic violence is also known as domestic abuse, spousal abuse, child abuse or intimate partner violence. It can be broadly defined as a pattern of abusive behaviours by one or both partners in an intimate relationship such as marriage, dating, family, friends or cohabitation.

The commonest form of domestic violence seen in Bhutan is spousal abuse, particularly, violence against the wife by her husband. In the recent times we have been seeing an increasing number of such cases. Many women visit the forensic unit and the psychiatric OPD of JDW NR Hospital for various problems which include physical injuries and mental trauma.

The Royal Government of Bhutan has been doing a lot lately to elevate the status of women in the society and alleviate their sufferings. There are now a number of agencies taking care of the needs of the women. The National Commission for Women and Children, RENEW (Respect, Educate, Nurture and Empower Women), and the Child and Women protection unit of the Royal Bhutan Police are such organizations.

In absence of a scientific study, it becomes difficult to pinpoint one single cause for spousal abuse in Bhutan; however, it is not so difficult to guess some of the possible causes. Alcohol seems to be the most important cause followed closely by gambling. The other causes would be personality mismatch, jealousy, financial dependence of a woman on her husband, emotional factors, helpless situation etc.

Alcohol is not only the main culprit by itself, it is also an indirect cause for other mental illnesses leading to more abuse and violence. Most common form of mental disorder in alcoholics is morbid jealousy, also known as pathological jealousy or “Othello syndrome”. Persons suffering from this condition can have unshakable belief that their partners are unfaithful; it can be so severe that the sufferer may even kill the spouse for this.

Even though we have so many organizations to protect these victims of abuse and violence, why are not all coming out to seek help? Although it is appropriate to find the cause for domestic violence, it is also equally important to find out the reasons for their helplessness. What could be the reasons for them to be so secretive? Why do they prefer to hide and weep behind closed doors?

While I may be wrong, I feel these are some of the reasons for the silence behind the domestic violence:

1. Financial dependence:
Due to disparity in education in the past more males are employed in Bhutan than women, thus women are more dependent financially on their husbands. Financial dependency makes women vulnerable to feel obliged to their husbands. Men take advantage of this situation and victimize their wives to comply with their wishes, be it unreasonable and unjustified.

2. Social customs:
In some ethnicity, especially in a patriarchal society, the girls once married belong to the in-laws. They will have nothing to do with their own parents and siblings except for some emotional attachment. In Hindu society, for example, the daughter becomes the “property” of the in-laws. The girl will relinquish her “clan name” to adopt the one from her husband. Such customs can make the women highly susceptible for abuse and violence. Even when the relatives know that their daughter or sister is abused they hardly offer help to mitigate the problem. She is not even welcomed to her parental home when she is thrown out by her husband thus making her helpless and hopeless.

3. Emotional factors:
Women tend to be more emotionally attached to their children because of which they would not mind to continue the relationship for the sake of their children even though there is constant oppression from the husbands. Many women take the role of protector for their children from the abusive husbands, in the process suffering more and more.

In contrary to the general notion that Bhutanese women have equal status and rights as their male counterparts, they are more dependent on their husbands for almost everything. That is why most women suffer silently without even mentioning about the abuse and violence to anyone, not even to their treating doctor. Some women even go to the extent of concealing the real cause of their physical injuries with which they come for treatment. Even though they may be going through severe mental depression, they will rather complain about physical symptoms, such as aches and pains, chronic headaches and insomnia.

Unless we take care of the factors leading to the “silence” women will continue to suffer quietly within the four walls of their houses. They will continue to be the victims of violence and abuse. If we don’t protect our daughters, sisters and our women relatives from their abusive partners, we will never be able to empower them!