Bridging gender gaps in mental health

More than 30 years ago, American professor Kimberle Crenshaw coined the term “intersectionality”. She used the word to explain how identity is often the expression and overlapping of many characteristics such as race, class, and gender. The term languished in legal obscurity until it became viral a few years ago. But intersectionality is more than a buzzword. More than a passing social fancy.

Today, intersectionality, as it relates to mental health, has become relevant for us to understand and recognise how differences in experiences of people from different genders, castes, and classes can affect our mental well-being. Gender bias can affect all areas of our lives, including, as the WHO says, the treatment of psychological disorders.

Gender differences in mental health

Rachita Sharma, gender activist and the CEO of Girl Power Talk, which provides mentorship and learning for young men, women, and non-binary individuals, says that gender stereotypes and conditioning reinforce social stigma and restrict people from seeking help. In India, mental health is a fledgling industry, but in a country that often closets mental illness, gender differences in mental health are very real.

Richa Vashista, Chief Mental Health Expert of AtEase, a mental health platform that works at the intersection of gender and mental health, agrees that gender bias exists in psychological treatment in India. It’s why she says that the therapists at AtEase are careful not to over-diagnose mental health disorders in women and LGBTQIA+ individuals. “We are mindful that diagnostic labels can stick with the person, and some people may not even want to be associated with such labels. Therefore, our treatment focus is more on their unique lived experiences and the systemic factors that contribute to their issues,” she adds.

There are many small and big ways in which gender affects day-to-day life, Richa notes. This includes gender biases at work, unequal pay and opportunities, long-standing patriarchy, the additional burden of housework, and experiences of stigma and violence in public and private spaces.

Nilom Shah, a consulting psychotherapist from Mumbai, believes that gender bias can occur in the treatment depending on the therapist’s awareness level and inherent reporting biases from individuals. “Gender roles, patriarchy, and other societal practices conditioned women to be passive about their own needs, and women conformed at a very young age. Over the years, the pile-up, suppression, and built-up frustration can result in depression,” she says. Nilom also adds that gender biases have resulted in marked under-reporting of depression in men as they do not come forward and speak up. Rachita has noted this as well in the course of her work.

Internalising disorders

Given the stigma around men’s mental health, male members of any society are less likely to seek therapy or get formally diagnosed with depression, making the number of women with depression seem higher. Numerous studies point to marked differences in the diagnosis of mental health disorders. Symptoms of depression, anxiety, and unspecified psychological distress are 2–3 times more common among women than among men. And addictions, substance use disorders, and psychopathic personality disorders are more common among men. Social factors such as vulnerability to sexual abuse, abandonment, homelessness, and stigma contribute even more to the gender gaps in mental health. Rachita notes that such gender differences happen not just because of social factors but also internal factors. “Women are more prone to suffer from internalising disorders like depression and anxiety, while men are more prone to substance abuse and antisocial disorders, which are externalising. This divide is caused by the power structures in society, where women earn less, have less power and autonomy, and a greater degree of dependence and reliance on social ties.” And the gender gap extends beyond women. Achieving gender equality and ensuring good health and well-being by 2030 are two of the United Nations General Assembly goals, part of its 17 Sustainable Development Goals. In this, the LGBTQIA+ community was identified as one of the 12 groups least represented in health equity research in India. Although comparisons are difficult, prima facie depression and suicide rates in LGBTQIA+ individuals are higher than overall population estimates for India.

“LGBTQIA+ individuals face many unique stressors such as exploring, accepting, and affirming their identity, coming out to others, ensuring their physical and psychological safety after they come out to others, navigating the landscape of intimacy, and reaching out to other queer individuals for social support,” explains Richa. Nilom agrees, saying that her clients from the LGBTQIA+ community often feel exhausted living two identities. “So much of their time and energy is consumed with seeking validation, support, and trust.”

Comprehensive and quality mental health support means therapists must be aware of and use gender-nuanced language and approaches. Rachita advises therapists to get rid of unconscious biases that hinder the therapy process. This process is a must to encourage a safer space for individuals across identities and genders.

And safer spaces are emerging. Queer-affirmative therapy, based on affirmative therapy, is increasingly coming into its own to validate the needs of sexual and gender minority individuals. “Queer affirmative therapists affirm one’s identity, validate their lived experiences, and address systemic injustices using an intersectional lens,” Richa explains. Today, in India, a few startups and mental health professionals are working at the intersections of gender and mental health, helping recognise gender biases and break down stereotypes. Apart from AtEase, other queer affirmative and inclusive counselling centres in India include the Tangent Mental Health Initiative, Alternative Story in Bengaluru, and the intriguingly named Guftagu Therapy in Mumbai.

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