'A woman's mind is its own place...'

Several case histories reveal that women’s mental health continues to be a truly global health concern, for women are biologically different from men due to their hormonal profile, made up of oestrogen and progesterone.

According to psychiatric statistics, right from pubertal age (around menarche, that is from the age of 11 or 12 years) to the age of menopause (that is, 50 to 55 years) and a few immediate years after menopause, nearly 20% of women at one or the other stage of their lives, suffer varied degrees of mental illnesses. A woman becomes psychologically more vulnerable due to her changing hormonal profile in each of these phases.

A teenage girl who hits puberty may experience vague headaches, loss of interest in studies, mood swings and is prone to crying spells almost every month, a week before the onset of her menstrual cycle. This is due to the pre-menstrual syndrome (PMS), attributed to hormonal fluctuations, which settles down soon after the monthly cycle gets over. Medical experts say that the intake of vital nutrients like vitamin B6, primrose oil capsules and restricting salt intake in the diet, along with a family support system, would help her overcome the emotional turbulence that is often associated with PMS.

Perinatal Psychiatry, which deals with the mental and emotional aspects of pregnant women and new mothers, has gained prominence in the last decade in India. If a woman has had undiagnosed depression before conceiving, it may manifest itself as a mental illness during pregnancy and may continue as “post-natal depression”. Hence, at reputed institutions like NIMHANS, pre-pregnancy counselling sessions are being conducted, to diagnose and treat mental-health problems if a psychologically disturbed married woman complains of symptoms and yet desires to become a mother.

The dual role played by the working woman may put the mental resilience of the new mother to test. Depressed mothers often show impaired mother-infant bonding. Sometimes, it can also become a challenge for the relatives to prevent any self-harm or harm to the infant by the mother who is suffering from post-natal or puerperal psychosis.

Postpartum blues, or PPB, can be treated successfully by counselling and providing adequate support to the new mother. PPB refers to a transient period of altered attitude, energy and interest levels in first-time mothers. Postpartum depression (seen in 10-15% of new mothers), postpartum psychosis (1 or 2 cases per 1,000 deliveries) need more evaluation, individualised treatment sche­dules, where a new mother may even need to be hospitalised.

A woman is also more prone to suffer a ‘deprivational stress’ due to widowhood or divorce. Psychiatrists opine that the ‘mind dilemmas’ which a woman goes through and her response to stress are different from the dilemmas which a man experiences and reacts to. Many married women also experience the ‘denial of self’ and may also go through ‘trapped wife syndrome’, which results when a woman resents her ‘role adaptation’ or if she broods over her ‘role incompetence’. Due to her bottled-up emotions, she may tend to compare her ‘un-acknowledged’ duties with her husband’s career graph.

Except the type of depression called ‘endogenous depression’, which is a result of the deficiency of neurotransmitter chemicals like dopamine and serotonin, which needs to be treated primarily by anti-depressant medications, most cases of disturbed emotions of a woman should be dealt with by aiming to revive her spirits through family support or a self-help group. The aim is to transform the disturbed emotions into proper, positive and motivated emotions.

A woman is also more vulnerable to PTSS (Post-Traumatic Stress Syndrome) after going through an episode of ‘sexual assault’ either at the workplace or at any outing with friends, or an enforced incestuous relationship by a male relative. Consequent to sexual violence, the woman experiences sudden, agonising, graphic memories of the traumatic episode weeks or months after the painful incident. These recollections may sometimes trigger suicidal tendencies.

Psycho-analysts advise ‘Mental Catharsis’ (which is a form of medical confession) as a form of therapy to several of the mental dilemmas of the woman. As psychiatrist Sir Ross has said about the therapeutic value of mental catharsis, “A skeleton in the cupboard is a gruesome and fearful thing, but if we look at it often enough, it will become only a bag of old bones!”