Why Mental Health Issues Cause More Suffering In Women

Trigger warning: This deals with depression and suicide, and may be triggering for survivors.

Mental health is not a gender issue.

Or is it? Should it be?

It is so because we have had a lot of discussions in the past years on men and mental health through heated debates and denials, and separate, kind of cute but more infographic style publicity around women and self-care. By doing so, we have made a gendered statement around mental health. Men’s mental health is a serious matter, while women’s mental health is more frivolous.

Therefore, it’s important to understand the gendered nuances around mental health so that we are conscious of the implications of our actions. In addition, we need to know if the solution paths need to be gender targeted, or can they be universal yet effective?

Most cultures in the world are patriarchal in which men having mental health struggles are seen as a lack of strength while women are characterized as emotional and hormonal. Factually, the prevalence of mental health issues is lower in men (NIH, USA) than in women however, the stigma is worse for men than for women which prevents men from seeking help.  The only exception to this is PTSD (and by extension, trauma), owing to its primary association to war (PTSD was referred to for long as ‘shell-shock’)– the soldiers in the Vietnam war in particular. It’s still largely viewed as a war veteran condition. Interestingly, an USA report (Centers for Disease Control and Prevention(2018)) showed men more likely to die of suicide than women.

If we think of variations in mental health condition vs. gender, studies note men to be pre-dispositioned to mental health disorders like ASPD (antisocial personality disorder). For women, it’s depression and bipolar disorder. It is not conclusive on why it’s such and is possibly due to the interaction of complex genetic and environmental factors.

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‘Weak’ women and ‘strong’ men

Obviously there needs to be a cultural context in this as socio-cultural nuances play a big part in mental health but there’s not much that can be easily found on men vs. women mental health statistics out of India. One fairly comprehensive report is out of Lancet Psychiatry. This and another Lancet study finds anxiety and depressive disorders to have a higher prevalence in women in India and men to women ratio for suicide death rate in India to be 1:34. The women are noted to be suicidal in higher numbers owing to biological susceptibility to certain conditions and high prevalence of post-marriage emotional and physical abuse (domestic violence, dowry abuse, emotional abuse by in-laws).

It is very hard to ascertain if such assertions are facts because of two reasons. One, high integrity quantitative data is rarely accompanying or available. Second, bias can be high, even amongst regarded medical professionals (for example: in an Indian Express article I was interviewed for, a credited expert provided the opinion that post-partum depression has to do with women not wanting to be mothers. Research of-course, repeatedly shows such assumptions to be incorrect).

Changing times has something to do with mental health, for both men and women. For example, the US reports cited earlier notes suicide to be rising for both men and women and the India report notes mental disorders increasing in adults steeply between 1990-2017. But again, it is of-course hard to separate the contribution of increased tracking and awareness out of this.

Both male and female suicide death rates in India were found to be significantly higher than the global average.

A cultural ‘acceptance’ of suicide in women?

Reasons aside, it does seem from reports that suicide and affectation, both rates are higher for women in India. This can be attributed to either life being harder for women in India, or to women being biologically pre-dispositioned, or both; but I don’t believe the root cause here is conclusive. For example, life could be harder for men in India than women for completely different reasons (while women are discriminated against, abused, and side-lined, men have no choice but to be breadwinners in a developing economy, bear family responsibilities in a low infrastructure nation, and live with higher pressure of expectation).

So, if women are more affected by mental health disorders and suicide remains significantly higher in Indian women than in both Indian men and global women, why the plethora of articles suddenly on men’s mental health and mental health awareness? I am not saying there shouldn’t be. But we need to understand why.

It is so because of two reasons, both of which are mentioned earlier but are further exaggerated in India.

First,  thanks to historical and cultural references – from Jauhar and mass suicides post-partition to women killing themselves in scores in movies on being violated or tormented – women committing suicide is an easier to accept concept in India. Women – submissive, softer, weaker – having a more difficult life in India – are expected to kill themselves. Men – are expected to fight back and win (unless they are students appearing for high-pressure exams).

Second, awareness of mental disorders in men (and therefore, acceptability) has indeed been zero to minimal in India.

Male celebrity deaths and the emotions people felt

Let’s revisit Sushant Singh Rajput’s death in this context. Sushant’s death in June, 2020 came as a shock to the nation and the reaction was unprecedented, even after accounting for the celebrity factor. Coming in close succession to other celebrity deaths (including the likes of Irrfan Khan and Rishi Kapoor – both of which saw expected bouts of sadness from the nation for a limited amount of time).

Rajput’s death started dominating the nation’s headlines and till date continues to drive public rage (first against Bollywood heavyweights for allegedly having driven Sushant to suicide through bullying and exclusion – Sushant being an outsider had had to fight harder for opportunities competing against celebrity and insider youngsters – and then against his girlfriend for pushing him towards suicide).

Although reports surfaced of him being depressed and bipolar, including chats with his sister that ascertained family’s know-how of him being on medication, India, for the most part, refuses to believe that Rajput could have taken his own life without provocation. He either was murdered (as per one group of speculators) or was pushed and manipulated to kill himself (through drugs and emotional abuse by his girlfriend).

Rajput, being a brilliant student and a philanthropist who didn’t come from much and had made it big in Bollywood, did have a story that resonates strongly with the masses. However, #JusticeforSSR hashtags trending higher than any other matter of pertinence and conspiracy theories obscuring the airwaves for till a year after, is not just because of who he was.

Let’s look at two other celebrity deaths for a comparison. Irrfan Khan, who died a little over a month before Sushant of a terminal ‘physical’ illness, was also an outsider who had made it in Bollywood and debatably had demonstrated much finer acting skills. Irrfan had also starred in British and American films. His death had saddened the nation, but there were no denial or conspiracy theories.

Now, looking at deaths of women celebrities

Actress Sridevi who had dominated Bollywood for over five decades and had risen to legend status, was reported to have died of ‘accidental drowning’ in her bathtub in her hotel room in Dubai. The details around her death are quite questionable. At first, her death was reported to be due to sudden cardiac arrest. Later, that was retracted. Her getting drowned suddenly in a bathtub with no intoxication or incapacitation, or any other reasoning provided, was mostly accepted. Conspiracy theories did float around for a brief while, mostly on YouTube, about her possibly being on antidepressants and such, or her husband having had something to do with her death. But for the most part, there was acceptance.

Similar stories had followed the deaths of actresses Divya Bharti and Parveen Babi (the latter was accepted to have had long-term paranoid schizophrenia).

Sushant’s girlfriend Rhea against whom his father had filed an FIR for misappropriation of funds and abetment was taken into custody, refused bail, interrogated non-stop for days, slut-shamed in all major social media platforms (with memes of her as a witch or a black magic practitioner trending), and hounded by the media. Images of her getting pushed, shoved, and manhandled by the media while she was in visible disarray had surfaced as had troubling details of her interrogation, but for the most part, Indian sentiment stayed the same. That she deserved to be witch-hunted and punished for Sushant’s death. The charges that could be brought against her, despite the involvement of multiple government agencies, were not related to Sushant’s death, but are in connection to recreational drug use and distribution. But India still found the blame to lie with Rhea for Sushant’s troubles – from wrong choice in a woman, treatment choice for mental health, to his death.

The belief that Indian men are ‘manipulated’ into taking their own life

This had happened after the 1990 suicide of businessman Mukesh Agarwal too, following which his wife, Bollywood star Rekha was turned into a national enemy overnight. Rekha was called a murderer and a vamp even though she was out of the country when Mukesh took his own life.

Just like Sushant’s father, Rekha’s in-laws, particularly her mother-in-law, had blamed her publicly for her husband’s suicide.

The disproportionate reaction to Sushant’s death is because he was a man, and because he had died by suicide (CBI report on this, apparently is still pending; previous findings ruled death by suicide).

Indian women, no matter how successful, can get sad, depressed, schizophrenic; and can take their own lives. Indian men must be manipulated, emotionally abused, and drugged to get there.

Bollywood has been long known for being a male fandom driven industry where male stars have enjoyed central characters, scripts written around them, and unacceptable privileges (for example the case of Salman Khan and his acquittals) benefitting from the demigod status assigned to them by the Indian audience (male and female). But Bollywood is just a microcosm mirroring the society.

What is unfortunate for men (and women) in India is the fact that the nation was eager to blame the woman in Rajput’s life for all his alleged missteps channeling the dialogue away from mental health – a tremendous, missed opportunity and a dangerous precedence to set.

Now, it is not false that the manifestation of mental health problems is often gendered or can seem gendered. There’s some physiological and a lot of social conditioning playing a part in that. It’s not just self-harm that’s an outcome of mental health troubles for men. Violent acts like the throwing of acids, gang rape, rioting, and public lynching have a component of claiming back power.

Inadequacies, inabilities, and rejections – men, more often than not, have been known to deal with their anger management and other issues through aggression. One example of that is the increase in domestic violence in the pandemic years globally where men in which the perpetrators were mostly male.

‘A clear sex difference has been documented cross-culturally in the way men and women display aggression’– New York Post, 2019.

Overwhelmingly, the mass shooters in the US (and worldwide), are men. But the point is, that doesn’t mean that it can’t ever be a woman or there won’t be a man who’d take his own life instead of others.

In summary, there are gendered viewpoints around mental health when it comes to men vs. women which worsens the divide and impacts solutions. Also, mental health is not a single condition – it’s a bucket.

Therefore, mental health needs to be looked at with a gendered lens to take away the differentiating myths, understanding the facts, and targeting solutions while accepting the universal, un-gendered prevalence. Men need self-care too, there should be outrage on unusual deaths of women, and articles on suicide prevention should target men and women.

Some parts of this article are covered in detail and excerpted from Beyond #MeToo, 2022, Sage Publications.

If you or anyone you know is feeling depressed or suicidal, here are some of the helplines available in India. Please call. 
Aasra, Mumbai: 022-27546669
Sneha, Chennai: 044-2464 0050
Lifeline, Kolkata: 033-2474 4704
Sahai, Bangalore: 080-25497777
Roshni, Hyderabad: 040-66202000, 040-66202001
SPEAK2us – Tamilnadu 9375493754

Image source: shutterstock

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