Patriarchy and the Patient

Roughly 6 months ago I was invited to an inter-discplinary conference on mental health, gender and social activism. I have been a longterm proponent of multi-modal approaches to addressing mental and emotional health challenges both locally and globally, so this idea was a welcoming change of season to me. The fact that this conference aimed to discuss and interconnect gender in mental health with community-oriented pathways to working for folks with mental disabilities and illnesses was of particular significance to me as a clinical practitioner and survivor. Upon arrival, I was guided to a packed hall that resembled a can of sardines and was politely given a comfortable spot in a slightly less crowded part of the auditorium. The panel seemed erudite and adept, at least on paper. The first couple of speakers were suitably discerning and well-versed with their subject matter. An early discussion about queerness and enabling better community driven resources for providing mental health care in those specific demographics was quite heartening to hear. This initial glee turned out to be short-lived as the panel changed hands and the next presenter — a surly psychiatrist whose self-veneration was quite evident from the 14 pages long bio that was read before he took the stage. The fossil in question had apparently headed a heavy truck load of prestigious mental health institutions and spoken at a parade of national and international fora, symposia and the ilk. He seemed chuffed to bits at the echoes of his own achievements when loudly described by the moderator and even waited for a few minutes to accommodate space for the anticipatory crackle of claps. After a somewhat tepid reception, he proceeded to show us, the audience, a slide that contained a photograph of an old Bollywood woman actor. He followed this with some inane metaphor about gender, women’s “fragility” and the role of women in this world. If my memory serves me right, the photograph was possibly Nargis from the iconic film Mother India. After the eponymous slide, the rest of the show was a study in anti-climatic conferral of shoddy medical generalizations and unbridled sexism. The room, which was more than 70% composed of women/woman-identified folks, was starting to lose its patience. Eventually the skullduggery reached its finale and then began the most delicious round of Q&A between a stringent, emotionally and mentally inelastic apologist for patriarchy and a roomful of angry, disenchanted and visibly agitated social workers, psychologists, counselors, therapists who, in Ru Paul’s words, had Come to PLAY, Mother!

The callouts flowed easily and without hesitation. Many of the audience members, including a psychiatrist and an anthropologist who just happened to be a guy, were shaking their heads as the good doctor adopted a staunch, unreasoning posture that basically involved a tut-tutting smirk at anyone who dared point out the minefield of inherent contradictions in his presentation. During the span of his speech, he had variously indicated that women had a limbic system that of course made them prone to depressive phases more so than men. Women were “emotional creatures”. Women could find satisfaction and happiness in the caverns of traditional family roles and motherhood was an utter, undeniable gift. Each of his truisms was accompanied by some irrelevant photograph or anecdote about Bollywood’s most famous women actors whom he claimed to have “loved” in his youth. Any of us in the audience could legitimately make room for an old man and his reminiscences if they weren’t so frought with sexist apologia. This entire discourse — using the word as loosely as the waistband on a pair of pregnancy pants— became more intensely squalid when he refused to address the concerns raised by women in the audience or even pay heed to some of the constructive feedback. The proverbial straw for this rather tense camel turned out to be him grabbing the mic and insisting that ECT was the most valid and reliable method to treat depression in women. This was done without affording a trigger warning or even establishing a linear narrative for why it needed referencing.

I wish this was a one-off occurrence within the mental health community. I wish we had more men in this field who while holding tremendous influence, are equally conversant with the requisite awareness for how gendered diatribe impacts their patients, clients, peers and colleagues. The field of study in itself is riddled with archaic and misogynistic constructs being passed off as valid theoretical propositions. After watching A Dangerous Method, a client texted me straight from the movie hall about her abject horror at the so-called forefathers of classical & analytical psychoanalysis, asking for personal views on the history of this discipline. I escaped answering her directly by a cat’s whisker on account of a really bad network connection inside the theatre. Full disclosure : I didn’t have an answer and it was one of the few occasions where Airtel came to my rescue. As a WoC in this discipline, you have to teach yourself the fine art of cognitive and emotional compartmentalization even as you recognize the stark need for intersectional syllabi. Jung was seminal in my formative years and yet, as a person of Rroma lineage, I had to confront the fact that someone whose work meant a lot to me, was also a Nazi sympathizer. Later, as I found humanistic-existential schools more matching to my ethos, this new fondness for gestaltian methods was marred by discovering Fritz Perls’ tales of misogyny in his autobiography. Freud himself has been simultaneously called misogynistic, his concepts seem centered in white maleness, one the one hand and yet on the other, his widely debunked theories which still seem to inspire cultish following have also been labelled as “feminist” . Debates sprawl eternally on this spectrum and I have dissociated from analytical methods so it doesn’t quite draw me in as much as it used to. That said, one can’t disengage that easily from the implicit as well as explicit sexism and patriarchal imprint so evident in psychiatric and psychological echelons.

There were more girls than boys in my psychology class and the textbooks often indicated a pandemic skew towards female-identified demographics in categorization for almost all “ mental health disorders”. Another therapist friend and I recently exchanged notes on the subtle micro-aggressions of a professor who prefaced his introduction to “personality disorders” (Axis II in DSM), with how we would now be talking about more “womanly conditions”. In short, he meant to say that women were more likely to have maladapted personalities and this thread of random generalization extended through most of the semester especially during the explanations about Narcissistic Personality Disorder and Borderline Personality Disorder. He would make indirect suggestions about how it was always more plausible for women to experience these conditions because they were “hyper-emotional”. It almost sounded criminal to have emotions if you were a woman. The correlation was poorly articulated and irrespective of— and in the absence of — guided learning that lead us to valid, substantiative research, all that we were exposed to were these underhanded gestures and sneering as if to say — of course women are always more mentally ill. He rarely ever bothered disseminating the socio-cultural and systemic origins of these conditions. His whole approach was to pin the blame squarely on this archaic trope of women’s “emotionality”. Just like the supposedly experienced psychiatrist at the helm of affairs during my conference.

Gender is a direct and impossible to ignore variable within the Indian — or any — mental health system and by association, the care that is needed to make it a safe space for disclosure and healing. Young girls are shamed for binaried responses they learn by way of social coding. If an adolescent girl experiences early onset panic or depressive phases and responds with crying, she is labeled “emotional”, asked if she has started her periods till the point where she starts to perceive crying as a kind of slur. If the same girl responds with aggression or anger, the label shifts to “uncontrollable” or “mental”. Popular media is complicit in extending these unfortunate biases. India needs a desperate rehaul in how we approach mental health in public conversation. Our statistics are revealing as well as alarming. It is very telling when culturally we can invest in tropes about “quirkiness” of being “crazy” but almost have no active and widely reaching government-aided or even private bodies to help mentally ill homeless folks in urban and especially, rural areas. Our textbooks do not account of how caste and class impact mental health in this country. There is no denying that women constitute a disproportionate section of this population. Women with prominent depressive cycles have come to me after years of being secretly gaslit by male psychiatrists/psychologists who almost managed to convince them that their mental health was tumbling downhill and it was solely their fault, not a function of larger psychosocial causes. A client with Bipolar II recently broke down and detailed how her first psychiatrist refused to acknowledge her presence at all and instead chose only to address her father with a stern rebuke about sparing the child, spoiling the rod sort of tired, repugnant advice. She was 28 at the time of this incident and in her own words “….felt crushed, shattered to dust. I know I have problems but he didn’t even ask me to sit when we went to his office.” Another bright young woman in therapy recollects how her original diagnosis of Adult ADHD was accompanied with her male psychologist shrugging his shoulders and asking her to bring in her father so he could have a “proper conversation with the man of the house”. This client was 26 at the time of this episode. Yes, it is a mandate to involve parental figures or closest of kin but we can differentiate between ethical concerns and outright sexism.

I don’t have to look far when stacking up the more debilitating and misogynistic experiences with institutional psychiatry and psychology. I am a survivor of Major Depressive Disorder and I also have PCOS. For years I feared approching a psychiatrist because I knew how quickly the death knell on my survival would be sounded the moment they added these two conditions together. It is not just the words but the whole exhausting expression on a person’s face that shakes you like a geriatric cypress in its last autumn. I was repeatedly told that I had to just learn to live with depression because I had a faulty body and an equally faulty mind. My other option was a high dosage anti-depressant and/or the notorious recourse of ECT. I know that ECT can alleviate depressive symptoms and has proven useful to a select group of patients but I don’t subscribe to it as an imposed “option”. The first time when I truly felt a mental health practitioner understand my specific dissonance as well as the accompanying traumas, was a professor who taught us Therapeutic Methods. She was non-judgmental, easy to talk to and always indicated deeply reflective listening skills without a need to offer me prescriptive or platitudinal solutions. I experienced a whole new level of comfort within that therapeutic relationship and for the first time recognized that a good therapist will not enforce on me their own limited and partisan views of my condition. She didn’t downplay or ignore the gendered dimensions of my challenges in surviving MDD. She engaged with them and asked me to explore my mental health from those specific vantages. In her presence, being a woman and experiencing depression wasn’t a vapid generalization or a taboo. I have since encountered affirming and gender-aware therapists/psychiatrists/psychologists frequently. They have been men, women, NB, trans but what still leaves a bitter taste in my mouth is the matching frequency of meeting incredibly sexist and misogynistic men who continue to wield power and somehow use it in injurious, self-serving ways.

Technology in general and social media in particular can help facilitate a greater degree of awareness for mental health and its multi-vectored tangents. Our silos are no longer as water-tight as before. Whether by will or by osmosis, we are often placed in the path of new information that can help remodel older, more unyielding traceries of our knowledge base. Information is readily available and there are fewer excuses someone can furbish for their ignorance about intransigent opinions. Patriarchy in mental health is an immense roadblock to deepening its reach and truly easing patients/clients into a sustained form of holistic wellness. The mind doesn’t exist in isolation from the body and the body isn’t insulated from the environment it derives nourishment from, whether physically, emotionally, cognitively or behaviourally. Gender in mental health is not your putty, or a pet you preen about only out of circumstantial closeness. Whether you view it as innate, as a construct or even as performance, it is valid and irrefutable in experience. The patient can longer mute your patriarchy or swallow its toxicity in silence, and should never have been made to do so to begin with.

The brilliant Chicana writer and theorist Gloria Anzaldúa wrote about the need for overcoming the tradition of silence. That is exactly where we need to start.

Scherezade Siobhan is a psychologist, writer and a community catalyst who founded and runs The Talking Compass — a therapeutic space dedicated to providing mental counseling services and decolonizing mental health care. She is an award-winning author and poet whose work is published or forthocming in Medium, Berfrois, Feministing, SPR, Jubilat, DATABLEED, Nat Brut, Winter Tangerine, Cordite among others. She is the author of “Bone Tongue” (Thought Catalog Books, 2015), “Father, Husband” (Salopress, 2016) and “The Blues Kali” (Forthcoming, Lithic Press). Send her chocolate and puppies — nihilistwaffles@gmail.com