Nilanjana Bordoloi
The public health narrative on mental health care access in India revolves around infrastructure, implementation challenges, cultural stigma and resources. This record misses the capture of a deeper issue, the gendered influence on mental health care access.
From working extensively in the community for the past 4 years, my experience points towards the presence of ‘gendered stigma’. On one hand, women speaking on self-care often mention the need to prioritise the household chores, their husband, children and in-laws’ care before their own; on the other hand, men’s silence is often reflective of hegemonic masculinity. Such practices are learned or ingrained. Through the lens of gender perspective, the psyche is not a universal human structure but shaped through gendered socialisation and cultural power dynamics.
The internal world of men and women is patterned through differentiated expectations. Our gendered identities become internalised cognitive frameworks guiding self-concept, emotional expression, and perceived capabilities (Gender Schema Theory, Sandra Bern’s 1981). In reflecting on becoming a woman, I am reminded of the times my voices of refutations and revolts were shut down with the popular saying ‘a girl should not raise her voice’.
Rebuked for keeping my legs open as a girl since it was a sign of a ‘bad girl’. Such psychic formations are a psychological imprint of patriarchal structures in the society (Carol Gilligan, 1982 and Michelle Fine, 1988). The experience of this split between the authentic feeling and socially learned self-presentations penetrates its way into my very being, and into my practice as a psychologist and researcher.
The cultural construction of gendered mental health reinforces social hierarchies and maintain status quo (Prilleltensky and Nelson, 2002). It results in structural silencing as mentioned by Bhugra and Mastrogianni, 2004 wherein women’s emotional pain and men’s emotional needs remain unadressed due to prevailing cultural script of appropriate-ness or validation. This is to say, gender and mental health are co-constructed.
Research studies (Addis & Mahalik, 2003; Seedat et al., 2009) show men’s reluctance to seek help is internalised norms of masculinity, while women’s higher rates of depression are linked to socially reinforced self-blame and over-responsibility. The WHO World Mental Health Report (2023) shows gender differences in service utilisation, with men underutilising mental health services and engaging with non-medical support systems instead of clinical services.
The inquiry challenges the silent assumption and absence of gender consideration in the making of national mental health policies and practices. Herein, we need to be mindful because gender does not operate in isolation. Local cultural meanings of distress determine whether a woman or a man is undergoing a medical concern, a moral failing or a spiritual imbalance. Anchored in Bacchi’s framework, I intend to explore the ‘problem’- gender hierarchies that structure who can seek care without fear of shame, whose cries are valid, who has control over resources and whose suffering is to be deemed ‘serious’.
A national-level study by Douglas Wendt and Kevin Shafer’s (2016) found that men are significantly less willing than women to seek professional help for mental health concerns, even when controlling for socioeconomic and demographic variables. Their work echoed the concept hegemonic masculinity- where emotional suppression and self-reliance are observed as virtues, and seeking help is framed as weakness. For women, structural inequalities in the form of limited mobility, caregiving burdens, economic dependence and fear of social stigma form barriers to care. If we are to think of a tribal woman in a remote village, her health experiences are shaped by economic constraint, accessibility, class, caste and gender, thus layered form of exclusion veiled to gender-neutral policy designs.
The effects of this framing are profound. It justifies gender-neutral budgets, blinds health workers, distancing them from recognising cases of gender constraints or moral obligations or intersecting inequalities in mental health concerns, while focusing on service uptake. In assuming that all citizens face the same barriers, policy frameworks inadvertently reinforce the current trend of mental health help-seeking behaviours. The silence of India’s National Mental Health Programme (1982) and the District Mental Health Programme (1996) on gender-specific pathways can have far-reaching consequences if it goes without revisions.
The question is, are the services reaching out to the ones who are in need of them? If not, why? And how? In the context of mental health policies- they are to be reimagined through gender-sensitive lens in order to acknowledge the lived realities of both men and women, challenging masculinities and dismantling the socio-cultural constraints binding woman. As researchers and policy makers, the challenge is to ensure that mental health services see the people they aim to serve.
References-
- Anand, M. (Ed.). (2019). Gender and mental health: Combining theory and practice. Springer, Singapore. https://doi.org/10.1007/978-981-13-1395-6
- Bacchi, C. (2009). Analysing policy: What’s the problem represented to be?. Pearson.
- Bem, S. L. (1981). Gender schema theory: A cognitive account of sex typing. Psychological Review, 88(4), 354–364.
- Bhugra, D., & Mastrogianni, A. (2004). Globalisation and mental disorders: Overview with relation to depression. British Journal of Psychiatry, 184(1), 10–20.
- Connell, R. W. (2005). Masculinities (2nd ed.). Polity Press.
- Crenshaw, K. (1989). Demarginalizing the intersection of race and sex. University of Chicago Legal Forum, 1989(1), 139–167.
- Kleinman, A. (1980). Patients and healers in the context of culture. University of California Press.
- Prilleltensky, I. (1994). The morals and politics of psychology. State University of New York Press.
- Shweder, R. A. (1991). Thinking Through Cultures: Expeditions in Cultural Psychology. Harvard University Press.
- Wendt, D., & Shafer, K. (2016). Gender and attitudes about mental health help seeking: Results from national data. Health & Social Work, 41(1), e20–e28. https://doi.org/10.1093/hsw/hlv089
About the contributor: Nilanjana Bordoloi is a Mental Health & Adolescent Reproductive and Sexual Health Counsellor at Child in Need Institute (CINI), India. She is a fellow of the YWLPPF 3.0 – Young Women Leaders in Public Policy Fellowship, Cohort 3.0.
Disclaimer: All views expressed in the article belong solely to the author and not necessarily to the organisation.
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Acknowledgement: This article was posted by Rashmi Kumari, a research intern at IMPRI.
