Women Mental Health: Reflections from India

Women constitute half of the World's population so women's health is as important as men's health. God gave to the woman the special gift to procreate. She gets pregnant, delivers, breast feeds and nurses the baby almost exclusively during its early years of life. Thus reproductive health of women becomes extremely important and so needs special attention. There is also recognition of gender dissimilarities existing in a wide range of medical conditions and that the boundaries of women mental health extend far beyond reproductive system to all other systems. It is important to mention that India is a country where gender roles are specified and many social traditions are prevalent that discriminate against women such as dowry (’bride price’), patriarchy and other. Marriage and family dominate the lives of most people, but more of women. Recent years have witnessed a surge of working women. Many women are discarding the traditional primary roles of child bearing and child rearing and are taking on professional careers. This is leading to changes in roles of both men and women. The impact of these social changes in health and disease, especially with regard to gender dissimilarities, should be the subject of intense study. Similarly, the effects of adolescence, aging, as well a multitude of psychosocial factors in relation to health in women are also important.

In the early years of the Indian Psychiatric Society pioneering work was done by some of the stalwarts in psychiatry on women mental health issues. Ajit Chakraborty, way back in 1978-80, carried out a field survey in Calcutta; the largest survey in the world at that time.[1] She reported about purity mania or “suchibai”, a culture bound syndrome, in elderly widows; and also about the stresses of women unique to Bengali culture. The study of Shiv Gautam,[2] Postpartum psychiatric syndromes: A study of 100 consecutive cases is commendable. 7 years later AK Agarwal drew attention to the implications of the new legislation (IPC 304B) on dowry death.[3] In the subsequent year Deepali Datta in her presidential address on “Where has the golden childhood gone” projected the problems of the “Girl child”.[4] After 3 years Malik in his Presidential Address[5] on “Women mental health” aptly elucidated the gender differences in the epidemiology, biology, and clinical aspects of mental disorders. Then after a span of 12 years S. Nambi highlighted the tragedy of the married women with severe mental illness. He categorically stated in his presidential address that there should be an express legislation so that concealing mental illness prior to marriage should not be taken as fraud for nullity of marriage.[6] Despite such endeavors, research on women's mental health issues were relatively dormant and many areas remained neglected apparently because of the shortage of psychiatrists in the country. It is gratifying to note that in the past decade women mental health is fast picking up in the country. This is evident by the 1 Presidential address, 2 editorials, 2 position statements and several research papers on topics related to women's mental health. Although women mental health has not been formally approved as a super specialty of Psychiatry, many psychiatrists throughout the country are now engaged in research, teaching and clinical work (specialty clinic, liaison psychiatry etc) in a variety of areas in women because they find it to be important, challenging and interesting as well.

Concerted efforts are needed to take the super specialty of women mental health forward. The work done in the country needs to be compiled for future planning with respect to the current priorities and future directions. This supplement on women's mental health is a step in the right direction. The Committee of Women Mental Health, chaired by Indira Sharma and Sonia Parial, deserves to be complimented for consolidating the work done in various corners of the country. The efforts of Indira Sharma and Abhishek Pathak, guest editors of this supplement, are appreciated. I understand that many stalwarts have made valuable contributions and I would like to thank them profusely for the same. A wide range of important areas have been covered in the supplement like: Overview of women mental health, Indian girl: psychological perspective, post-partum and postmenopausal disorders, psychotropic medications during pregnancy and lactation; pharmacological and non-pharmacological treatment of bipolar disorder; women and schizophrenia; eating disorders, depression, suicide, substance abuse in women; issues of sexuality and rehabilitation of women with mental illness. In addition, important areas like social and legal aspects of marriage; marriage, mental illness and law; and violence against women have been included. The latter have assume much significance after the “Nirbhaya” episode in 2012 and subsequent incidents of sexual assault against women across the country, despite the enactment of The Criminal Law (Amendment) Act, 2013 (Act no. 13 of 2013). This supplement will provide the platform for further work in many areas of women's mental health. This is the need of the hour, to meet the challenges with which the many psychiatrists are likely to be confronted in the years to come.