India Struggles with a “Silent Killer”: Depression

INDIA - India is the world's second most populous nation with some 1.4 billion people.  But the ex-British colony that once spawned transformational figures like Mahatma Gandhi has also gained global notoriety for a host of glaring social problems, including poverty and air pollution.

 Less well known is India’s dubious honor as the country with the highest percentage of citizens suffering from depression.

International agencies and the government's own national mental health care body estimate that 10% of India’s population -- or 140 million people -- suffer from moderate-to-severe depression, including 2% that suffer from depression severe enough to require hospitalization.  

But those figures probably underestimate the actual size and scale of the problem because studies show that millions of Indians, especially in rural areas, have never been diagnosed and may not even know that they suffer from mental illness.  

Some analysts estimate that as much as 36% of India suffers from a mental disorder.

India, with its plethora of traditional ethnic, religious and linguistic groups, shares with many other countries a deep resistance to modern psychiatry which has helped reinforce a deep social stigma about mental illness.   

Many families are still ashamed to admit that their parents, children or siblings have a debilitating psychiatric disorder, and may try to hide or disguise it, fearing that it suggests a weakness in their lineage or care practices.  

There is also a pervasive belief, especially in rural areas, that mental illness constitutes a curse or a form of karma that only supernatural intervention can "cure.”

In central and southern India lower-caste Indians still make pilgrimages to Hindu "healing temples" to beseech their favorite deities to assist their mentally ill loved ones.  Some also bring their relatives to local exorcists in the hopes to freeing them of “demon possession."   

Mental health officials that try to discourage these practices – even sending teams of psychologists to the temples -- have often been met with fierce resistance.

Many scholars believe that the real fault for India’s ongoing depression problem lies with the national government which has failed to develop a comprehensive mental health care system and whose medical establishment suffers from the same depression sigma afflicting the general populace.

In 1983, the government established a National Mental Health Program (NMHP) with headquarters in Bangalore.  It soon pledged to devote significant diagnostic and treatment resources to depression and a host of other mental disorders, including schizophrenia.                       

But despite steady increases in annual funding, the NMHP has largely failed to integrate mental health services into India’s primary care system, studies show.  For example, more than 60 per cent of people with mental disorders still access specialized care at poorly funded district hospitals.  In addition, there are extreme regional disparities in the government’s mental healthcare infrastructure. 

India has 443 public mental hospitals, but six states, mainly in the northern and eastern regions with a combined population of 56 million people – a third of the country -- are without a single mental hospital.

Demographic disparities are also wide – and growing.  A 2015 study among 1,000 hospitalized mental health patients found that mental illness and depression rates were much higher among the nation’s poor.  Elderly Indians are especially subject to depression and depression stigma, as are women, especially pregnant women and those suffering from HIV/AIDS.  Some scholars believe female depression rates – and their comparatively high suicide rates – are linked to domestic violence, conflict with relationship partners, and confining social roles.                                          

Some notable bright spots exist in India's approach to depression and mental illness in specific locales and among some social groups.  Sikhs in the northern Punjabi region have long viewed depression as a “natural” part of daily life and prescribe meditation, yoga and other practices to help relieve it.  Muslim Sufis have also approached depression with a greater spirit of acceptance than other groups, analysts say.

And there have been sporadic experiments in mental health outreach led by non-governmental organizations and specially-trained “lay counselors” that have demonstrated what committed professionals can achieve, with sufficient resources, even in the most forbidding of environments. 

But the number of mental health clinicians in India continues to lag far behind most of the world’s nations, including other countries in the developing world.   For example, the median number of psychiatrists in India is only 0.2 per 100,000 population compared to a global median of 1.2 per 100,000 population.

The median figures for psychologists, social workers and nurses working in mental health in India are almost as severe, according to figures compiled by the World health Organization (WHO).

While the national government, egged on by the WHO, continues to debate new grassroots policy initiatives, depression sufferers have begun receiving support from an unlikely source:  Bollywood.

Last October, after several of the nation's top film actors went public with their struggles against depression, a coalition of health advocacy groups, including two of India’s leading psychiatric associations, joined with them to launch the country’s first nationwide mental health awareness campaign. 

The Bollywood initiative has spawned a separate campaign by Indian college students and their counterparts at American universities to raise depression awareness among adolescents and youth.  Photographs of students holding placards with depression awareness messages are disseminated through Instagram, Twitter and other social media sites.

Many scholars believe it’s long overdue that India embraced social marketing techniques of the kind that have proven successful in the West in reducing stigma toward HIV/AIDS and other taboo illnesses, including mental disorders.

But time is running out.  Depression-related suicides are skyrocketing in rural areas, with the highest rates recorded among younger Indians who often lack the family and community supports their parents had.  Without an extraordinary social intervention, coupled with institutional reform experts fear that India’s debilitating depression syndrome could get even worse in the years ahead.

The Resurgence and Spread of Child Marriage in Modern Asia

ASIA - The phenomena of child marriage, the taking or marrying off a girl at an age that is well below what modern society deems socially acceptable, sounds like a practice that belongs in a history book rather than in the twenty-first century. However, though hard to believe, the practice not only exists in these modern times, but also that it is thriving. In fact, emerging evidence indicates that the marrying off these child brides is becoming more widespread in many parts of the world. Whether due to socioeconomic pressures or to cultural preferences, the world is witnessing a steady resurgence of the practice of child marriages in places such as Africa, the Middle East, and now more prevalent in Asia.

Asia - India Gujarat, Photo by RURO

One country in particular which has experienced an increase in the number of child marriages is poverty-stricken Bangladesh. This country has been identified in a report by the International Center for Research of Women (ICRW) as number 3 on a list of the top 20 countries with the highest incidents of child brides. This is because nearly 68.7% of all Bangladeshi girls under the age of 18 are married off to older men. The drastic rise in the practice has become so prevalent in recent years that researchers describe it as a full-blown “epidemic”. According to current estimates, nearly one third of girls in the country are married off before they reach the age of 15. This figure is staggering, and girls who are married off at such a young age often face high rates of domestic abuse, increased risks in childbirth, and the prospect of life-long poverty. Unfortunately, in many rural areas of countries with emerging economies young women are often considered a burden. It is these societal standards which is sanctioned and even encouraged that families use to justify pressing their young daughters into marriage to older men.

Concomitant factors such as poverty, lack of education, and the destabilization of the economy from natural disasters like typhoons, which are known for causing widespread destruction in Southeast Asian countries, also play a role in propagating acceptance of this practice. Parents often resort to marrying off their daughters in order to save money to pay for the education of their sons who are seen as better able to support the family once they reach the age of maturity. Bangladesh is not the only country to face the ever increasing problem of child marriage. Afghanistan is another country in the region known to the world as a region of innumerable human rights abuses.

Many of these abuses are due to complex forces, such as the oppressive patriarchal culture, the violent influence of the Taliban, and the subjugation of women who are often publicly executed. Given these influences the marriage of young girls to older men seems a foregone conclusion. Here, and most notably in the country's north-eastern province of Badakhshan, women experience the most extreme lack of independence. In this nation plagued by chronic food shortages, brought about by decades-long conflicts in the region, girls are being sold and traded off at an alarming rate. The money that the families get for the sale of their daughters enable them to purchase food, livestock, or other necessities.

The situation is particularly bleak in Badakhshan which according to a report by the United Nations (U.N.). Young girls experience some of the highest rats of abuses and death at the hands of their husbands who are often decades their senior. These men repeated and violently rape their young brides, who once they become pregnant do not allow them to access prenatal care with the intention of isolating these girls. According to the ICRW young girls are most afflicted by the following.

• Premature Pregnancy: Child brides almost always bear children before they are physically - or emotionally - ready.

• Maternal Mortality: Girls younger than 15 are five times more likely to die during child birth or pregnancy than older women. Pregnancy-related deaths are the leading cause of mortality for girls aged 15 to 19 worldwide.

• Infant Mortality: Mortality rates for babies born to mothers under age 20 are almost 75% higher than for children born to older mothers. The children that survive are more likely to be premature, have a low birth weight, and are more at risk for contracting HIV/AIDS.

• Health Problems: Premature childbirth can lead to a variety of health problems for mothers, including fistula, a debilitating condition that causes chronic incontinence. Girls with fistula are often abandoned by their husbands and ostracized by society. There are approximately 2 million girls living with fistula, and 100,000 new cases every year.

• HIV/AIDS: Married girls may be more likely to contract sexually transmitted disease, including HIV/AIDS, than unmarried girls. Young girls are more physically susceptible to STD's, have less access to reproductive education and health services and are often powerless to demand the use of contraception. (Source: ICRW)

Girls under the age of 15 are most at risk to this tragic outcome because of their physical immaturity. These young girls also face the specter of contracting HIV from infected husbands. Experts are in agreement that the best way to counter this growing trend is by working to alleviate the country's desperately crippled economy.

While the prevalence of the practice is closely associated with poverty and destruction, this is not true in every country. China, for example, has experienced steady economic growth in the past several decades. Despite its overall financial stability, the country is also experiencing a rise in the number of child marriages. The increase in this practice is largely driven by political factors such as the long-standing one-child policy. This policy, first enacted in the late 1970's to alleviate China's issue with unchecked population growth, has in fact resulted in a problematic and wide scale gender imbalance. Thus, the country now has approximately 33 million more men than women in the country. Despite this, the cultural bias toward boys remains, particularly in the rural areas where parents routinely force their daughters to marry young so that they aren't a financial burden to the family.

Additionally, China’s gender gap has led to a dramatic rise in the rates of human trafficking. Young girls are being sold or kidnapped then smuggled out of the country to neighboring Vietnam. Those who aren't 'lucky' enough to be sold for purposes of marriage, face the horrifying specter of sex slavery. These girls, as young as 13-years-old, are sometimes sold by their parents who have been solicited by the smugglers to sell their daughters who are subsequently drugged as a means of controlling them while they are removed from their homes. The girls are then marketed to potential buyers and sold for the deplorable price of $3,000 or less.

Sadly, with the continued growth of China, and the growing need for increased human capital to produce low costs products which the West is increasing dependent upon. This has resulted in the rise of another type of enslavement of girls and women in the manufacturing sectors found in cities like Shanghai, Beijing, Tianjin, Guangzhou, and Shenzhen. Often chained to their work stations for up to 16 hours a day, they are not even allowed bathroom breaks in order to maximize high production at low costs.

The documentary 'Santa's Workshop' provides a chilling look into the abuse of the laborers in many Chinese factories. The majority of these workers are children and women. Thus, it is unfortunate and disheartening to realize that for a female to make it to adulthood having escape sexual enslavement or child marriage, is not a guarantee of avoiding future exploitation. There are many organizations dedicated to advocating for the rights of child brides, women, and forced labor, but this abuse, irrespective of the fact that it is occurring in locations quite foreign to us, should in no way inure us to the suffering these girls and women face. Nor to our obligation to remain engaged in trying to make a difference, even if this difference is as simple as sharing these statistics and stories with friends, family, and associates. In so doing we may become more conscious and conscientious, two things which help to complete us as human beings.

Contributing Journalist: @JonEizyk
LinkedIn: Jon Eizyk

Battered Men. Fact, Not Fiction

Man in Silhouette, Photo by Chairman 7w

UNITED STATES - According to statistics provided by the U.S. Department of Justice, Bureau of Justice Statistic in June 2013, an estimated 85% of women and 15% of men are the victims of domestic abuse.

According to the statistics listed on the American Bar Association's website, the aggregate number of female and male victims of domestic abuse is estimated at 2.2 million victims each year in the United States.

Of this number, 1.3 million women and 835,000 men are physically assaulted by an intimate partner annually. (Source: Patricia Tjaden & Nancy Thoennes, U.S. Dep't of Just., NCJ 183781, (2000) Read Full Report)

In crunching the numbers based upon these figures, the physical abuse suffered by men at the hands of their female partners is actually closer to 42% of the estimated annual domestic abuse cases in this country. Part of the gap in these statistics is probably due to under-reporting of female against male domestic abuse.

Even when statistics seem to support an increasing trend in women physically abusing their intimate male partners, people remain resistant to the idea. It is easier to accept men abusing women because this is often the norm in many countries and cultures throughout the world, including the United States. In an attempt to present fair and balanced reporting, we often note that not all women are victims or all men abusers.

But somehow, it is easier for people to accept a woman being victimized by a man than the converse. This bias was starkly illustrated in an ABC News undercover program in which two actors in a public park feigned domestic abuse in which the women hits, curses at, and otherwise abuses her male partner.

With one exception, when a group of three women decided to intervene and call the police, everyone else walked by as the woman continued to violently strike the seated man. Most of the witnesses passed without so much as a glance, and many who were subsequently interviewed admitted that they believed the man deserved the violent treatment being meted out by the woman.

[youtube=https://www.youtube.com/watch?v=LlFAd4YdQks]

This role play caught on camera, seemed to illustrate that women who have long been victimized, either felt empowered by witnessing another woman “turning the tables” on a man, or sympathized with the female abuser because she was expressing her outrage at the man who must have “cheated” on her.

If in fact infidelity were the cause of this abuse, which it was not, this does not take into account the fact that it takes two people to cheat and neither should get a pass. Nor does cheating give anyone the right to physically or verbally abuse their intimate partner. But this article is not addressing marital infidelity or its causes, but rather, why people in this video felt that it was okay for a woman to physically assault and verbally berate a man in public without consequence.

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Published: 19 March 2014 (Page 2 of 2)

Why isn’t there more of an outcry? Is this payback for millennia of abuse women have suffered at the hands of men? Or is it that the victims remain silent because they have been emasculated in their homes and fear being further diminished by public admission of this fact? Whether it is all, some, or none of these reasons, many men don't report physical abuse at the hands of women because they are supposed to be strong enough to "keep their women in check."

This is a patently sexist assumption which further reinforces conditions that foster an environment in which ordinary and not-so-ordinary men silently endure abuse at the hands of their female partners. In America alone, there are famous athletes, musicians, actors, a scientist, and two American Presidents who are suspected of having been the victims of domestic abuse either through anecdotal evidence or court documents. (Source: 11 Famous Men Who Were Beat Down By Their Women, by Sam Greenspan) 

Though informative, even the tone of the aforementioned article belies the seriousness of the issue. It is yet another reason why men won’t admit to being abused, preferring to keep the abuse a secret even from their closest friends and family for fear of ridicule. But even more serious is the threat and fear of retribution by the woman they accuse, as she may subsequently report to the police that she was merely defending herself against his aggression.

Many people may find this difficult to believe, but I know a man whose former wife hit him, threw a drink at him, and when he left the house to avoid getting into a more heated altercation, he returned a few hours later to find two police cars parked in front of his house, with policemen waiting to arrest him. Though he tried to present his version of events, and even though he never had a complaint of domestic abuse lodged against him, in fact he didn’t have any arrest record at all; he was jailed.

He was subsequently subjected to a restraining order barring him from the house for nearly 2-months until the court date. His wife subsequently dropped the charges and apologized in open court for overreacting, and admitted to her ‘part’ in the altercation; however, this man now has a permanent criminal record. Whereas she has severe anger management issues which were never addressed nor resolved during their 18-year marriage, he was forced to attend court mandated psychological treatment.

Though his story is hard to believe, one need only look at the ABC News video to see how probable his case is, and the likelihood that somewhere, at this very moment, a man continues to be abused by his wife because he has chosen to stay for any number of reasons. Some like the man I know had small children and he knew that his wife would be punitive and keep him from seeing his children.

She also had a history of physically abusing the children by slapping and cursing at them, and thus he felt it would be better for him to remain in the house where he could at least protect them from the brunt of her anger. “Studies show that women who commit violence against the men in their lives have anger management issues, are likely to abuse their children, yet courts still favor giving the custody of the children to the female even after domestic abuse has been proven.” (Source: Domestic Violence: Men Being Abused by Women)

There is such a thing as a “Battered Man,” and there is such a thing as a "Woman Batterer/Abuser," and the sooner we de-stigmatize this type of abuse, the easier it will be for the victims and the victimizers to get the help they need to break the cycle of violence.

If you need support, please call the National Domestic Violence Hotline at (800) 799-7233 or the Domestic Abuse Helpline for Men and Women at (888) 743-5754.

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Afghan Girl's Nose Cut Off By Abusive Husband

Ayanna Nahmias, Editor-in-ChiefLast Modified: 11:37 AM EDT, 13 February 2012

AFGHANISTAN - Most often, we in the West are exposed to and challenged by an increased number of news stories of the heinous, misogynistic treatment of women and young girls all in other parts of the world.

Thankfully, there are a cadre of people and organizations dedicated to bringing greater public awareness to these gross injustices and when possible physically intervening in the lives of these women to improve their conditions or alleviate their suffering.

In an earlier post Nujood Ali a young Yemeni girl speaks of her ordeal as a child bride and the abuse she suffered. Now, we are privy to the suffering of another young teenager; an Afghan girl who was horribly mutilated by her husband under Taliban rule. Last year Bibi Aisha was horribly disfigured by her husband who cut off her nose.  Last week, there was report of another Afghan girl who was beaten for refusing to submit to prostitution.

Unfortunately, these stories are becoming more common, but Aisha, 19, has become the face of this heinous behavior.  In the summer of 2010, she shocked the world when she appeared on the cover of Time Magazine vividly displaying her severed nose. When Aisha was 12, her father promised her in marriage to a Taliban fighter to pay a debt. She was handed over to his family who abused her and forced her to sleep in the stable with the animals.

When she tried to run away, she was caught by her husband who brutally hacked off her nose and both ears, before leaving her for dead in the mountains. Subsequent to her return to consciousness, she crawled down the mountain to her grandfather's house. Later, her father arranged to have her treated at an American medical facility where she remained for the next 10 weeks.

Once she was stable, she was transported to a secret shelter in Kabul and in August she was flown to the U.S. by the Grossman Burn Foundation to stay with a host family. Last week she returned to the public stage wearing a new prosthetic nose - one that gives her some idea of how she will look after having reconstructive surgery.

Aisha received the Enduring Heart award at a benefit for the Grossman Burn Foundation - the Los Angeles-based organisation that paid for her surgery. She was given the award by California first lady Maria Shriver. Arnold Schwarzenegger's wife told the audience: 'This is the first Enduring Heart award given to a woman whose heart endures and who shows us all what it means to have love and to be the enduring heart.'

This month after extensive counseling for her traumatic experience, she finally received a prosthetic nose fitted at the non-profit humanitarian Grossman Burn Center at West Hills Hospital in California as part of her eight-month rehabilitation. Dr Peter H. Grossman said they hoped to reconstruct Aisha's nose and ears using bone, tissue and cartilage from other parts of her body.

Dr Grossman's wife Rebecca, the chair of the Grossman Burn Foundation, said Aisha was just one of the thousands of women who are treated with appalling harshness. She said: 'Aisha is reminded of that enslavement every time she looks in the mirror. But there are still times she can laugh. And at that moment you see her teenage spirit escaping a body that has seen a lifetime of injustice.'

The UN estimates that nearly 90 per cent of Afghanistan's women suffer from some sort of domestic abuse.

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Related articles

• Afghan Girl Who Had Nose & Ears Cut Off By Taliban Husband Shows Off Reconstructed Face, Talks Life In U.S. (radaronline.com)
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• Afghans hold anti-U.S. rally following abuse claims (Reuters) (newsdaily.com)