Violence, subordination and women's mental health. (Consequences of Gender Violence).

All signs seem to indicate that women suffer more "mental problems" than men. We are the primary consumers of medication, psychotherapy and other treatments related to mental health (Dio Bleichmar, 1990), and our risk for depression is two to three times higher than men's.

In many countries more women than men are admitted to psychiatric hospitals. Even the so-called psychosomatic disorders--in which an intense emotional experience is manifest through a physical symptom--appear more frequently in women.

However, the apparent feminization of mental health problems is related to our socio-historical context. Discussing women's mental health implies examining how women's subjectivity is constructed by society: while there are obvious biological differences between women and men, our identities and psychological states are not products of nature (Dio Bleichmar, 1990).

In the health-illness process, the so-called "mental problems" of the female population may represent a response to our living conditions. These "problems" may mean that something is happening in our bodies, and this "something" may go beyond the strictly mental or biological.

What makes women "sick"? What do our illnesses and "psychological problems" tell us? What role do social expectations and gender roles play in women's illnesses? How does society influence our life process and make us ill? What impact do the all-too-common experiences of violence and subordination have on women's health?

In order to answer these questions, we must recognize the existence of norms, values and behavior which are socially defined for each gender, which determine what it means to be men and women in society. In other words, women's health status is directly linked to their culture and the position they occupy within it (Londono, 1993).

For example, a study carried out in the United States by Gloria Bachmann (cited in Northrup, 1994) found that 38% of all the adult women surveyed had been sexually abused during childhood. Another study by the U.S. Federal Bureau of Investigation (FBI) estimated that one out of three women is likely to be raped at some time in her life. In reality, the figures are probably higher, since crimes of this sort are often unreported.

Another area of women's lives that reflects a situation of inequity is the double workday of most of the world's women. This burden of work and responsibility has a tremendous impact on women's physical and mental health (Northrup, 1994).

It is no coincidence, then, that some authors have postulated that in our culture women become ill and die because they are women. For this reason, women's "mental health" problems cannot be separated from the conflicts and crises resulting from the oppressive conditions of their existence (Burin, 1992). In this respect, Concepcion Fernandez Cazalis (1984) has suggested that each and every one of the components of women's socially-constructed destiny is responsible for generating intense feelings of rage; lack of power; limited opportunities for self-expression; dependency; passivity; sacrifice; and servitude. According to Fernandez Cazalis, "women's status ... provides the perfect infrastructure, not only for illnesses such as depression, but every sort of disease and disorder"

Gender-Based Violence

What happens to women's mental health when they experience situations of domestic and/or sexual violence, when they live in situations of power and control? We must remember that domestic violence does not imply physical violence alone. It also may include tactics of intimidation, threats, economic privation, sexual and psychological abuse (Rios, M.; Caceres, V., 1999). It comes as no surprise then that in Puerto Rico nearly 64% of all abused women are also suffering from some form of mental illness. Other studies show that 50% of all women referred for psychological services in Puerto Rico assert that they have been physically abused. At the same time, approximately one-third of all attempted suicides are women victims of domestic violence.

Abused women may also suffer other consequences, such as alcoholism, drug dependence or eating disorders. Nonetheless, a significant number of women's mental health problems are incorrectly diagnosed as psychoses, neuroses or personality disorders when they are really reactions to frequent and prolonged violence and emotional torment (Mullender, 2000). On the other hand, many other symptoms that accompany women's mental illnesses seem to be behavior through which the women react to problems in their daily lives. As a result, we must understand how women's "female" behavior is constructed before we evaluate their mental health.

Unfortunately, many professionals fail to recognize the effect that violent partners have on women's lives. Rather, they attribute women situations to individual factors, and in this fashion, the women themselves are frequently blamed for the abuse they receive.

The impact that social "labels" may have on women's lives is also ignored. Indeed, stigmatization has a decisive impact on whether or not a woman is permitted to maintain custody of her children or whether she is able to keep a job, for example.

Bearing this in mind, the treatment of women's mental health problems must start from theoretical or practical approaches grounded in women's own experiences. Clinical care must provide an atmosphere of security and protection in which their empowerment is promoted and the real causes of their illnesses are addressed, in which the physical, psychological and social factors that condition their lives are acknowledged. At the same time, we women must demand and examine new models of mental health that are able to respond to the ways in which we express our "female" malaise (Burin, 1991).

Real healing has to be obtained on various levels--physical, emotional, mental, spiritual--and demands that we work for the transformation of our personal-social history and the living conditions that cause our "health problems." The information that we acquire in this process must enable us to make decisions that are best for our own interests (Londono, 1993).

References

Burin, M. 1991. El malestar de las mujeres: La tranquilidad recetada. Buenos Aires: Paidos.

Burin, M. 1992. "Nuevas perspectivas en salud mental de mujeres," in Las mujeres en la imaginacion colectiva: Una historia de discriminacion y resistencias. A. Fernandez, ed. Buenos Aires: Paidos.

Dio Bleichmar, E. 1990. "Prefacio: Hacia una feminizacion de la norma," in El malestar de las mujeres: La tranquilidad recetada. 1991. G. Burin, ed. Buenos Aires: Paidos.

Fernandez, Cazalis, A. 1984. "Mujeres: Infraestructura de la Locura y el Silencio." Revista FEM 35:25-30.

Londono, L. 1993. Mujer y Salud en el Contexto Politico. Diosas, Musas y Mujeres. Caracas: Monte Avila, pp. 161-170.

Mullender, A. 2000. La violencia domestica ... Una nueva vision de un viejo problema. Barcelona: Paidos.

Northrup, C. 1994. Women's Bodies, Women's Wisdom: Creating Physical and Emotional Health and Healing. New York: Bantam Books.

Rios, T. and V. Caceres. 1999. "La violencia domestica desde la perspectiva sindical." Rio Piedras: El Exento, pp. 6-7.

The author is a Puerto Rican psychologist specializing in social and community psychology and issues of older persons and aging.