|LETTER TO THE EDITOR
|Year : 2016 | Volume
| Issue : 4 | Page : 337-338
Impact of culture on gender roles: A mental health perspective
Sujita Kumar Kar1, Suresh Yadav2, Vivek Agarwal1
1 Department of Psychiatry, King George’s Medical University, Lucknow,Uttar Pradesh, India
2 Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
|Date of Web Publication||9-Nov-2016|
Dr. Sujita Kumar Kar
Department of Psychiatry, King George's Medical University, Lucknow - 226 003, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kar SK, Yadav S, Agarwal V. Impact of culture on gender roles: A mental health perspective. Indian J Soc Psychiatry 2016;32:337-8
Women have higher rates of depression and anxiety disorders which are attributed to some gender specific risk factors such as gender based violence, poor income, inferior social status, and burden of responsibility and care of others., In one survey covering 6500 women in 21 developed and developing countries, it was found that Indian women are most stressed in the world, 87% of Indian women felt stressed most of the time, and approximately 82% of Indian women had no time to relax. It is seen that women have more mental distress in South East Asian countries and sociocultural factors have a major contribution to the stress. In the developing countries such as India, the major burden of care of the family falls on the female members and they accept responsibilities being the wife or mother or daughter. However, as these are culturally accepted practices, these cultural factors do not figure as possible stress factors in the assessment of patients and are missed. This case report highlights the effects such cultural practices have on the psychological well being of an adolescent Indian female.
A 16 year old adolescent girl studying in intermediate was brought for psychiatric consultation with complaints of reduced interaction, withdrawn behavior for the duration of 3 months, and fearfulness and marked agitation for the last 3 days. During this episode, family members noticed gradual reduction in her interaction with others, reduced physical activity, preference to stay alone and aloof, reduction in sleep and appetite leading to significant decline in her day to day functioning. There was history of one suicidal attempt during this episode. Three days prior to consultation in the psychiatric outpatient services, the patient developed increased agitation and fearfulness and she tried to run away from her house.
For these problems, she was taken to different physicians and psychiatrists and was prescribed antidepressants or antipsychotics at different points of time during the illness without any relief. Prior to hospitalization, she was shown to a psychiatrist, who diagnosed her as a case of acute and transient psychotic disorder and prescribed her olanzapine 20 mg/day and lorazepam 4 mg/day in divided doses which she took for 2 weeks. There was no improvement in her symptoms, so injection haloperidol 10 mg and injection promethazine 50 mg were added as and when to control her agitation. This continued for another 2 weeks till hospitalization.
Past medical and psychiatric history was not contributory. Patient's mother had an episode of major depressive disorder during which she committed suicide by self immolation 1 year back. The patient belonged to a nuclear family of middle socioeconomic status. She was living with her brother alone as her father was working in a distant city. After the death of her mother, she had to look after all household works and studies. She had to wake up early in the morning to complete the household work including cooking, sweeping, washing utensils, and clothes before going to school. After returning from school, she had to look after the household chores and studies. She had a little time for recreational activities. Premorbidly, she was social, outgoing, and was well adjusted. The patient was uncooperative in the initial days. She had reduced psychomotor activity. Her predominant mood was depressed and had suicidal ideas. The patient had partial insight about her illness. Her routine hematological investigations were within normal limits. A provisional diagnosis of “major depressive disorder” was made.
The patient was hospitalized in child and adolescent psychiatry ward. Family members and nursing staffs were asked to keep strict vigilance on patient's behavior. She was prescribed sertraline 25 mg/day and clonazepam 0.5 mg thrice daily. Efforts had been made to establish rapport. In subsequent interviews, she expressed her worries related to the burden of household works and lack of time for relaxation and her studies. As her father was not staying with her, she was unable to express her distress. Her brother was busy with his studies and was not supportive to her. Patient's father and brother were counseled about her difficult role in the family. Emphasis was given to the need to reduce her workload and options such as hiring a maid for household chores and sharing of responsibilities by her elder brother were discussed.
In the hospital, the patient was involved in occupational and recreational therapy. Within 3 days, the patient had started feeling better and at the end of 1 week, there were no signs of depression. She regained her appetite. Her sleep had improved. She became cheerful and hopeful for the future. The patient was discharged after 1 week with the diagnosis of “adjustment disorder with mixed disturbance of emotions and conduct” as per International Classification of Diseases 10 criteria. Following which, she was in regular follow up and was doing well. In the follow up visits, her medications were gradually tapered off.
In this case report, the patient was an adolescent, school going female who lost her mother at a young age. After death of her mother, the household responsibilities fell on her shoulders for which, she was not prepared enough. If she would have been a male adolescent, then the family might have thought about sharing responsibilities. Despite her illness, nobody in the family thought of her being over burdened with work and responsibilities. Treating doctors did not address this issue in prior consultations. There was dramatic improvement in her symptoms after the psychosocial stressors were addressed. In majority of Indian families, adolescent females have to look after their studies, assist their mothers at household work, and meet a lot many expectations. Multiple roles and household work increases the level of stress and may lead to psychiatric disorders as seen in this case.
Although at initial evaluations she appeared to be suffering from major depressive disorder as she also had positive family history of depression; however, after exploring the psychosocial environment of the patient, her problems became apparent.
In busy clinical practices and overloaded outpatient services, such psychosocial issues are often missed or ignored, especially if they are culturally acceptable. Therefore, during clinical assessment, it is important to know that a culturally acceptable gender role itself can be a stressor for the individual like this patient.
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Conflicts of interest
There are no conflicts of interest.
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