If you take up any basic abnormal psychology book and open the first chapter, it will describe the etiology of mental illness or what causes mental illness. The study of the same started what is known as a medical model of psychopathology, where it is stated that mental disorders occur due to an imbalance of hormones, malfunctioning genes, or faulty brain structures.
While all mental disorders and mental health concerns have a strong biological base (for example, a low level of serotonin and dopamine is found in depression), the medical model fails to acknowledge the role of one’s socio-cultural environment in causing psychopathology. Factors like poverty, race, caste, and sexual identity all affect one’s mental health. It has been observed that an excessive focus on the medical model impairs a clinician’s ability to ensure a holistic perspective of a patient’s concerns. It makes their view narrow and fails to acknowledge the barriers that arise from socio-cultural limitations.
A multicultural perspective in psychiatry has recently emerged that explains how characteristics such as culture, race, ethnicity, gender, and others affect behaviour and thought. It suggests that psychological differences exist among people of various cultures, races, and genders. The model posits that an individual's behaviour, whether normal or deviant, is best understood when considered in the context of that individual's specific cultural setting, including the cultural values and the external constraints that members of that setting must deal with. In studies conducted in the USA, the groups that have been an area of focus include ethnic and racial minority groups (African American, Hispanic American, Native American, and Asian-
American groups) and groups such as economically disadvantaged persons, LGBTQ
individuals, and women (although women are not technically a minority group). Each
of these groups is subjected to special pressures in American society that may contribute to feelings of stress and, in some cases, to abnormal functioning.
Meyer (2003) came up with what is known as the sexual and gender minority stress model which identifies four categories of minority stress factors-external prejudice such as prejudice events or acts of discrimination (for example, being denied an apartment), stigma consciousness or negative attitudes from non-queer people (not being accepted in the workplace), outness degree or identity concealment (whether one is hiding one’s sexuality), and internalized homophobia or internalization of negative social value about one’s sexuality. This model was developed primarily to explain the queer community's susceptibility to mental health concerns. Stigmatisation leads to alienation, a lack of community integration, and issues with self-acceptance, and is positively correlated with a wide range of disorders including depressive symptoms, substance use, and suicidal ideation. The approach demonstrates both direct and indirect relationships between proximal and distal minority stress variables and mental disorders.
MENTAL HEALTH CONCERNS OF THE QUEER COMMUNITY
Since the 2000s, there has been more research on the mental health of the LGBTQ+ community, prominently but not exclusively in the USA. Gay men, lesbian women, and bisexual men and women have presented with more psychological distress, depressive symptoms, panic attacks, generalised anxiety disorder, and substance use issues than heterosexual people, according to numerous national American surveys that used representative samples. Additionally, generalised and social anxiety, depression, psychological distress, eating disorders, and suicide ideation appear to be more common among transgender people than cisgender people. Particularly, it appears that genderqueer individuals and bisexual women are two of the populations most susceptible to mental health issues. They also experience a wide range of adverse traumatic experiences (discrimination, abuse, neglect, and familial violence) that make them more vulnerable to developing mental disorders.
At the same time, clinicians who lack such a nuanced understanding of socio-cultural determinants of mental health are more likely to misdiagnose queer people, which is just as detrimental as not receiving treatment for a disorder. For example, the medical fraternity has been observed to be notoriously transphobic in the absence of gender and sexuality awareness in medical education, which has led to doctor visits being a frequent traumatic experience for transgender individuals. Members of the queer community also avoid going to healthcare professionals for fear of being harassed, abused, or judged, as those in power fail to provide the safe space that members of a minority group require. Queer individuals are also less likely to have limited educational or professional opportunities and face discrimination in all walks of life, which leads to economic instability, which is another significant determinant of mental health.
MENTAL HEALTH CONCERNS OF WOMEn
Gender is a critical determinant of mental health and mental illness. Analysis of mental health indices and data reveals that the patterns of psychiatric disorders and psychological distress among women are different from those seen among men. Symptoms of internalizing disorders like depression, anxiety, and eating disorders are two to three times more common among women than among men, whereas externalizing disorders like substance use disorders are more common among men. As per a report published by the World Health Organization (2001), depressive disorders account for almost 41.9% of the disability from neuropsychiatric disorders among women compared to 29.3% among men. Leading mental health problems of the elderly—depression, organic brain syndromes, and dementia—appear mostly in women. An estimated 80% of 50 million people affected by violent conflicts, civil wars, disasters, and displacement are women and children.
Studies of suicide and deliberate self‑harm have revealed a universally common trend of more female attempters and more male completers of suicide. Moreover, the lethality of suicide attempts is higher for men, which leads to more men dying by suicide. It has been observed that girls from nuclear families and women married at a very young age are at a higher risk for attempted suicide and self‑harm. Experiences of violence are strong predictors of suicide attempts The common causes for suicide in India are disturbed interpersonal relationships, closely followed by psychiatric disorders and physical illnesses. Violence perpetrated by one’s spouse has been found to be specifically associated as an independent risk factor for attempted suicide in women. According to a report by the United Nations, around two‑third of married women in India were victims of domestic violence and one incident of violence translated into women losing 7 working days in the country. Furthermore, almost 70% of married women between the ages of 15 and 49 years are victims of beating and sexual coercion.
The effects of gender-based violence include poor reproductive health, post-traumatic stress disorder, and emotional distress. Depression, anxiety, post-traumatic stress disorder, insomnia, alcohol use disorders, as well as a variety of somatic ailments, are common mental health issues faced by abused women. Compared to non-abused women, women who are abused are far more likely to need mental health services and to attempt suicide. A link between violence and a variety of self-reported gynecological symptoms, low body mass index, depressive disorder, and attempted suicide was found in cross-sectional data from a recent study in India.
In conclusion, women experience a staggering amount of violence throughout their lives, and the consequences are dire. South Asia's sociopolitical climate, which includes India, is worse than that of the West as far as gender inequality is concerned. The predicament of women is made worse by dowry customs, a strong patriarchal household structure in which the woman has less influence and fewer prospects for jobs and education. Women's mental health frequently suffers because they are ill-equipped to handle the stressors to which they are exposed.
CATERING TO THE UNIQUE MENTAL HEALTH NEEDS OF SEXUAL MINORITIES AND WOMEN
Studies have found that members of minority groups tend to show less improvement in clinical treatment than members of majority groups and also make less use of mental health services.
In some cases, economic factors, cultural beliefs, language barriers, or lack of information about available services may prevent minority individuals from seeking help. In other cases, such persons may not trust the establishment, relying instead on traditional remedies that are available in their immediate social environment.
Clinicians must equip themselves to cater to the needs of minority communities. A therapist’s effectiveness with minority clients can be improved by ensuring practices that are gender sensitive. This includes understanding how oppressive power structures affect mental health, being an ally to clients while they advocate for themselves, and taking an active political stance in the face of human rights violations. Clinicians must also be well versed with existing government welfare schemes that have been designed for sexual minorities and women and most importantly they must be aware of their own biases and how they might get in the way of ensuring effective treatment to those who need it.
REFERENCES
Malhotra S & Shah R. Women and mental health in India: An overview. Indian J Psychiatry (2015); 57:205-11
Fedele, E., Juster, R.-P., & Guay, S. (2022). Stigma and Mental Health of Sexual Minority Women Former Victims of Intimate Partner Violence. Journal of Interpersonal Violence, 37(23-24), NP22732-NP22758. https://doi.org/10.1177/08862605211072180