6760.pdf
Media
- extracted text
-
A REPORT OF A MEETING ON WOMEN,
VIOLENCE, AND MENTAL HEALTH
India Habitat Centre, New Delhi
April 11 TH & 12TH, 1999
n
IT)
mo
THE CREATIVE AWAKENING
Interventions for Support, Healing & Awareness
■
4^
A REPORT OF A MEETING ON WOMEN,
VIOLENCE, AND MENTAL HEALTH
India Habitat Centre, New Delhi
April 11TH & 12th, 1999
/
4
hl?
mu
THE CREATIVE AWAKENING
Interventions for Support, Healing & Awareness
><
A Report of Meeting on Feminist Research Methodologies
Prepared by IFSHA (INTERVENTIONS FOR SUPPORT, HEALING & AWARENESS)
May 1999
IFSHA (Interventions for Support, Healing & Awareness)
J 39, 1st Floor
South Extension Part 1
New Delhi 110 049
India
IFSHA (Interventions for Support, Healing & Awareness) is a Delhi-based NGO
working with and for victims of child sexual abuse and sexual violence, through
counseling, research, training, and awareness raising programs.
The witness Sakshi' is the genesis of TFSHA \ IFSHA, which means the 'creative
awakening', or 'to dawn' in Urdu, captures the creative consciousness bom in
journeying through the NGO Sakshi'. TFSHA' is about healing, about looking at
women's lives as a whole world of infinite possibilities, about making men partners
in recreating that world, and moving the feminist world view from the periphery to
the mainstream. IFSHA is therefore a spatial relocation of the perspectives intrinsic
to Sakshi'.
W H |^o
06760
Tf
TABLE OF CONTENTS
Introduction
1
Part 1: Presentations on Women, Violence
& Mental Health'
3
Part 2: Interventions in Addressing Women’s
Mental Health
30
Part 3: Recommendations
40
Part 4: Evaluations
43
Notes on Contributors
46
Appendices
48
Participants' List
Agenda ofthe Meeting
1
THE REPORT OF A MEETING ON WOMEN
VIOLENCE, AND MENTAL HEALTH
4
India Habitat Centre, New Delhi
April 11-12, 1999
Introduction:
IFSHA’s first international conference on Women, Violence and Mental Health was
held in New Delhi on April 11th and 12th, 1999, involving researchers, mental health
professionals, NGO activists, and academicians. The main purpose of this meeting
was for IFSHA to table a report based on a three year long research on this subject,
and thereby begins dialogue with the various institutions and functionaries directly
involved in women’s mental health.
The need for dialogue and an exchange of perspectives was apparent through the
course of our research project. Violence as a life event of women goes unrecognized
by most institutions women come in contact with, and therefore its effects on their
mental health remain invisible. As an NGO, and as researchers we came to
recognize and acknowledge the many expressions of women’s anger, pain and
frustration at their violent and stifling lives. Research and clinical practice in the
West has already acknowledged and created interventions to address the significant
impact violence has on women’s behaviors, emotions and thoughts, but in India this
has rarely been a focus of inquiry from within the mainstream. Therefore, this
meeting hoped to bring together professionals who could discuss and debate the
impact of violence on women’s mental health, and collaborate on improving services
for women clients.
This report summarizes the presentations and deliberations made at this meeting. All
presentations have been condensed, and the issues raised for discussion after each
presentation follow in brief. The report is organized into four parts.
■ Part I deals with presentations and discussions around research on violence
against women, and women’s mental health.
2
■ Part II incorporates interventions that have been made from around the world,
either in the form of therapeutic techniques and initiatives, or community
programs, or screening procedures, to detect and address violence against
women.
■ Part III deals with the recommendations and suggestions for collaboration that
were made at the meeting.
P Part JV encapsulates the evaluations of the conference macle by the participants.
3
PART 1: PERSPECTIVES ON WOMEN, VIOLENCE AND
MENTAL HEALTH
Integrating Feminist Ideas within Mental Health Practice and Advocacy
Dr. BhargaviDavar
This presentation, based on existing research and academic writing both from India
and abroad, examines the negotiations between feminist perspectives on mental
health and psychiatric practice from a macro point of view. The gendered reality of
violence and women’s experiences of mental health and ill health within mainstream
psychiatry are looked at through a feminist lens. The broad goals of this work are to:
■ Examine gender bias within the mental health profession
■ Question diagnostic practices relating to women, to shift the discussion from
women’s ‘madness’ as a form of protest, to understanding the role of diagnosis
within the larger context of mental health practice.
■ Reconstruct women’s own experiences of body, mind and soul using a feminist
phenomenology to describe women’s distress.
■ Sensitize mental health services to empower women rather than control them.
So far, the feminist movement has been able to achieve, and is still working towards,
some shifts in perspectives on mental health. There is a move to demystify the
existing psychiatric practice, and conceptualize mental health/ill-health based on:
■ A focus on common mental disorders, which affect women much more
frequently, and are much more common in the population. Most resources are
channeled to severe mental disorders.
■ A social etiology of mental health/ill-health, as opposed to a bio-medical
etiology.
■ An interdisciplinary approach to mental health including public health and
epidemiology, consumers’ rights perspectives, human rights, community mental
health etc.
4
■ Psychology, rather than the medical profession Psychiatry.
Feminists have studied and critically examined the prominence of violence in
women’s lives. Violence is seen as a larger social, political problem rather than a
clinical issue. The social, cultural, and legal sanctions for male violence are so deeply
entrenched in our society’s collective unconscious, that the prevalence of violence
and its far-reaching effects on women’s mental and physical health create numerous
problems for interventionists. Male violence has not been viewed in its context
therefore leading to a number of lacunae in therapy: men don’t feel subjective distress
at being violent; there is no sense of responsibility for the violence; and it is seen as
an inherent part of their masculinity. The downside is that mainstream interventions
target the- more pliable-women, diagnose their responses (often to male violence),
and leave them to face the medico-legal and social consequences of diagnostic
labeling.
The questioning of diagnostic procedures and paradigms from within the women’s
movement is riddled with debate. The feminist movement has questioned the process
of diagnosis, which exists in a vacuum without a mental health advocacy program
that addresses policy makers and the law. The movement has tried to enable women
to recognize their experiences of the body and emotion as “normal” by creating safe
spaces. At the same time, the movement has not been open and accepting to
diagnosed women per se. The global shift towards recognizing common mental
disorders as needing more intervention in terms of prevention and care, has led to a
range of behaviors now being open to labeling. While CMDs are an important
gender issue within the profession, the flip side has to be recognized as well.
Diagnosis has not been sensitive to realities of gender, thereby moving in to
appropriate behaviors that were once thought to be culturally acceptable. For
example, it was once thought to be of great importance and pride for an Indian
woman to have a clean and neat home; now, this behavior could be labeled as an
Obsessive Compulsive cleaning Disorder, for which even drug therapy is being
advocated. What are the criteria for diagnosis based on? Are they culturally relevant
and “scientific”? The socio-political and market driven issues surrounding the
emphasis on CMDs also needs to be recognized; drug companies have a great deal at
stake in this particular issue. Therefore, diagnostic procedures have to be placed in
their social, political, and economic context.
Feminist questioning and analyses vis-a-vis mental health advocacy so far have
pointed out the loopholes in the Mental Health Act, which ignores the rights of the
mentally ill, especially in admissions, discharge, power of the mental health officer
etc. Ethics in mental health are institution-based and are not established norms yet.
And there is little state support for the community mental health movement.
5
Involving mental health professionals and activists in a national level mental health
advocacy program may ameliorate the situation. Systems and structures for
transparency, protocols for screening, policy level support, a shift towards
community based initiatives, and a social etiology within mental health practice and
service delivery, are some of the outcomes that may be achieved by such an
integrated consultative process.
Discussion:
1. The labels and ignorance that diagnosis spawns: As opposed to a changing,
dynamic sociological diagnostic process that is culturally rooted and sensitive to
gender realities that is being advocated here, Psychiatry’s link with medicine has
led to the medicalization of illness and diagnosis. Diagnosis cannot be wished
away, and that is not the debate at present. It is more to examine the process of
diagnosis and recognize where it needs to be improved and informed. It is
important to strike the balance to know what ‘symptoms’ are sociological in
origin, and those that are medical- “medicalization as humane”
2. There is a need for community based allied services that will ease the load on a
small, and struggling population of 5000 mental health professionals for a
country of one billion people. If common mental disorders should move away
from the domain of psychiatric diagnosis, there have to be more grassroots health
workers who are equipped to address the prevention and care of common mental
disorders in the population.
6
Women and Depression
Dr. Rajesh Sagar
The prevalence of depression in women has to be seen in context of their inequality
in society and the many stresses that operate in women’s lives. This process of
inequality begins in childhood where girls and boys are socialized differently, and
girls’ status is seen to be dependent on alliances with men. The direction of selfesteem is therefore external. Such lifelong inequality creates dilemmas and conflicts
in marriage, family relationships, reproduction, child rearing, divorce, aging,
education, and work. Violence in the form of sexual and physical abuse and coercion
also create a great deal of self-blame, shame and stress for women. The alienation
and powerlessness that these situations create have been shown to underlie mental ill
health for women.
The examination of women’s illness and help-seeking behavior also indicates why
they may be more prone to a diagnosis of mental illness. Gender-specific behaviors
complete this picture, which according to Gold (1998), reflect real differences.
Women are generally more sensitive to any discomfort, and tend to translate (and
label) their specific feelings of distress into physical/emotional problems. They are
more likely to consult a health professional for their problems and are generally more
willing to talk about their symptoms, often being able to recall and elaborate upon
details of even minor health complaints.
The factors associated with depression in women are:
1. Biological Factors
■ A genetic vulnerability for affective disorders.
■ Use of oral contraceptives increases the risk for depression.
■ Female sex hormones influence the central nervous system structure and
functioning, resulting in changed behaviour.
/
7
2. Personality Profile: Increased risk for depression in women who:
■ Have difficulties in adapting to change.
■ Have a tendency towards anxiety in the face of threats, which leads to ineffective
coping behaviors.
■ Have an increased level of interpersonal sensitivity.
■ Have decreased resilience factors to negotiate risks, and act as a protective factor.
3. Life Stress and Social Vulnerability
■ Women’s status and social reality in Indian society may exacerbate life stressors.
■ Gender based discrimination results in helplessness, dependency, low self- esteem
and low aspirations, and ultimately the risk for depression.
■ Learned helplessness: Expectations of powerlessness, and the inability to control
one’s destiny prevents effective action.
■ According to Brown and Harris (1970), there are four vulnerability factors: lack
of a satisfying marital relationship; lack of employment outside the home;
presence of three or more children under that age of 14 years; and parental loss
before the age of 17 years.
[These life stress factors are not adequately represented in assessment scales
commonly in use. The scales focus on personal stressors, while women tend to view
their stressors in terms of significant others. Direct stressors such as violence are
usually not included in such scales. Additionally, life stress scales emphasize discrete
and acute changes and events rather than chronic conditions such as poverty,
discrimination, health problems etc.]
4. Marriage, Family Roles & Relationships
■ Marriage per se could act as a protective factor, whereas marital discord puts
women at risk.
■ Women working within the home only feel unchallenged, undervalued, and have
no alternate sources of gratification.
■ Women who work outside the home have excessive demands and have to
accomplish multiple roles and tasks.
8
5. Violence
■ Women are extremely likely to experience physical or sexual violence at any
point in their lives, within the family, and such victimization may predispose
them to mental health problems later in life.
6. Reproductive Roles and Events, and Depression
■ Pregnancy is a critical role transition, motherhood represents a major change at a
biological, psychological, social and cultural level.
■ Pregnancy losses due to abortion, miscarriage etc. could result in a loss of status
and self-esteem, and represents a (symbolic) loss of the future. This could result in
anger, feelings of inadequacy, guilt, marital, and sexual disturbances.
■ Post Partum blues, and Post Partum Depression -a bio - psycho - social model of
etiology.
■ Disorders arising out of the mother-infant relationship: delayed attachment,
obsessional thoughts of hostility, rejection of the infant, neglect, infanticide.
■ Pre-menstrual Syndrome.
■ Infertility and the cultural beliefs that condemn women for being barren, infertile
etc.
■ Hysterectomy and the unique stress associated with the loss of reproductive
organs that have connotations for female sexuality and feminine identity.
■ Other gynecological illnesses.
■ Menopause and the changes in self-perception, cultural beliefs and attitudes etc.
Discussion
1. Women’s access to mental health care limited to when there is a total breakdown
of all capabilities. Therefore, how is ‘help seeking behavior’ defined and
evaluated in clinical practice?
9
Spouse Abuse and Depression in Women - An Etiological Approach to Depression
in Women
Dr. Thomas John
There is enough evidence to suggest that there exist connections between stressors in
women’s lives and depressive illnesses. Within the marital relationship, women are
subject to significantly greater stressors, and marriage per se can be both a putative
risk factor as well as a protective factor. Western studies do imply that marital
violence affects the mental health of the wife more adversely.
1. Aims of the Study:
■ To evaluate the significance of spouse abuse as a possible etiological factor in the
causation of a depressive episode in a married woman, and assess its prevalence
and severity.
■ To assess the factors that make a woman more vulnerable and those empower
her.
2. The Methodology:
■ The sample included 30 cases that were married for at least 6 months and had
come to the Psychiatry department OPD with a depressive illness, as well as 30
controls matched for age and socio-economic status from the same community as
the cases.
■ Women with a history of depression, or with psychotic symptoms, or other
psychiatric/medical co-morbidity were not included in the sample.
■ The scales of measurement used were a socio-demographic profile, Hudson’s
Spouse Abuse Performa, and the Hamilton and Beck Depression Scale. The
research design was cross-sectional and descriptive
■ Chi-Square/t Test/Pearson’s Correlation/ ROC curve and Bivariate Analysis
were used in the statistical analysis of the data
3. Results & Discussion:
■ The cases and controls were socio-demographically similar
IO
■ There was a significant difference in the husband’s abuse of alcohol and extra
marital affairs between cases and controls, and a significant level of spousal abuse
in the cases as compared to the controls.
4. Risk Factors for Abuse and Depression:
■ Lower socio-economic status
■ Husband’s use of alcohol and involvement in extra-marital affairs, and his
unemployed status
■ Lack of other social supports for the wife
5. Empowering/Protective Factors:
■ Women’s employment outside the home
■ Women’s possession of independent finances
6. Limitations of the Study:
■
■
■
■
Reporting biases.
Halo effect.
Small sample size.
Methodological and subject issues.
Discussion
1. This is one of the few studies on women's mental health and violence that has
been conducted within a mainstream teaching hospital in India. According to
psychiatrists, research on violence against women is rarely taken up by
mainstream institutions because of the following reasons: there are few culturally
relevant tools, procedures and theories; most time is spent in dealing with
patients with severe mental disorders; psychiatrists rarely take on proactive roles
that cases of violence against women necessitate; a lack of time and numbers of
patients are overwhelming; and, the underreporting of violence by women.
11
2. Spousal abuse is the ‘best known secret’, and is rarely seen in mainstream
assessment and screening procedures because it’s effects are not recognized as a
serious health issue. It was the feminist movement that first began to recognize
domestic violence and is trying to mainstream it in clinical procedures and
therapies.
3. An important training aid that could be further developed is the creation of
videos that compare techniques of screening, intake, and assessment by
psychiatrists and NGO counselors since the experiences and techniques are so
different.
4. While there is qualitative data on women and violence, there is no large survey
based on hard numbers. Statistics of domestic violence in India will be available
shortly, after the INCLEN (International Clinical Epidemiology Network) study
is completed. It includes a survey of 8400 women in India.
5. The reality of violence against women cannot be undermined by media portrayals
that reflect social prejudice; a number of movies, docu-fictional pieces, and media
reporting depict women as perpetrators of violence. This is an unhealthy trend
and an inappropriate time for a backlash when the enormity of the problem in
India has not yet been acknowledged.
12
Women's Experiences ofMental Violence in the Family
Ms. AnjaliDave
The recognition of violence against women has been half-hearted in that the physical
effects and signs of violence are the only forms of violence against women that are
recognized by the legal and medical professions. Validating psychological and
emotional abuse of women is extremely difficult in a court of law, where violence is
perceived as physical assault, rather than control and coercion as well. 57% of
women accessed in this study, conducted at the TISS (Tata Institute of Social
Studies) run crime cells in police stations, spoke of their life experiences and the
preponderance of mental violence, which was defined as verbal abuse, restriction of a
woman’s sexuality, and reduced access to economic resources.
The main aspects of this form of violence were:
■ The romanticization of a heterosexual union-marriage-as a relationship that will
be a panacea for all ills, and the stifling confines of the natal home. This is often
not the case when the husband is physically and emotionally abusive. The
woman has always believed that she would ‘love her husband so much that he
would never beat her’. The violence begins very soon after marriage and during
sexual initiation. This comes as a rude shock, and is the death of her dream.
■ The husband and in-laws can be emotionally and verbally abusive making the
woman feel demeaned.
■ The husband indulges in extra-marital affairs and does not create the ‘perfect’
home the woman is looking for. There is no companionship or emotional
bonding between husband and wife.
■ If the woman is unable to produce a male child, or is infertile, it is a cause for
more ostracism and abuse from within the family.
■ There is psychological control underlying the supposedly “loving” and
intimate words and situations that are used by the husband creating confusion
and a double bind for the woman.
There is a lack of therapeutic and legal interventions that recognize and address this
form of violence, leaving women feeling that their experiences have not been
validated.
13
Discussion
1. How can mental and emotional violence be classified and categorized for the
purpose ofscreening, testing etc. ?
If this is seen as a “soft” aspect of violence, it has to be understood in its socio
cultural context. A socio-psychological perspective has to be incorporated into testing
and diagnostics for these cases by operationalizing what mental cruelty and
emotional abuse mean. This would call on the skills, and experiential understanding
of different groups of professionals, like activists, NGO counselors and mental health
professionals. This multi-disciplinary effort is essential when we are working with a
social reality like violence that is so enormous in its proportions. There would need
to be generalized systems of testing and assessment, which would have to be used
even in specific instances. These are the dilemmas of working within an imperfect
situation and within imperfect systems, so some solutions are bound to be imperfect
before they evolve into ones that are more efficacious.
2. The only way to recognize the effects of mental violence is proactive research that
validates women’s experiences. This would also be a process of creating and
refining existing tools and procedures for assessment of violence in women’s
lives. Research from the United States shows that the psychological effects of
emotional violence are great, and in comparison to a war veteran, a DV survivor
is just as likely to experience the horror of the situation even years after the abuse.
14
The Diagnosis ofPosttrauma tic Stress Disorder (PTSD) in Domestic Violence
Dr. Mary Ann Dutton
The conceptualization of sexual and domestic victimization as trauma is over a
decade old in the United States, and is perhaps the most concrete way developed so
far to validate women’s experiences of violence. PTSD or Posttraumatic Stress
Disorder was first developed to describe the fall-outs of combat situations of war
veterans, and later used to show the similarity of women’s reactions to domestic and
sexual violence. Such a diagnostic category places the etiology of psychological
symptoms with the traumatic event rather than personal psychopathology, which
was how reactions to DV were initially classified. The diagnosis is also inclusive
enough to incorporate the effects of multiple types of trauma. The main trauma
related diagnoses used in practice are:
■ Posttraumatic Stress Disorder (PTSD).
■ Acute Stress Disorder.
■ Dissociative disorders like depersonalization, derealization, amnesia and
multiple personality disorder.
■ Complex PTSD- Disorders of Extreme Stress Not Otherwise Specified
(DESNOS).
The impact of trauma resulting from intimate partner violence is:
1. Intrusion of thoughts related to the traumatic event(s), and avoidance of
situations that resemble the traumatic situation, and symptoms of physiological
arousal.
2. Depression, anger and anxiety.
3. Self-dysfunction such as low self-esteem, self-harm, and sexual dysfunction
15
The diagnostic criteria that have to be met before a diagnosis of PTSD is made are described in the
diagram below.
PTSD
POSTTRAUMATIC
STRESS DISORDER
Criterion A:
Traumatic
stressor
■ Experienced,
witnessed or
confronted
with
■ Actual or
threatened
death,
serious
injury or
threat to
bodily
integrity
■ The reaction
to this
involves
intense fear,
helplessness,
or horror
Criterion B:
Intrusive
symptoms
(1 symptom
required)
■ Recurrent
dreams,
recollections or
nightmares of
the event
■ Acting or
feeling that the
event is
recurring
■ Distress at
exposure to
situations that
resemble the
event
■ Physiological
reactivity
Criterion C:
Avoidance
symptoms
(3 symptoms
required)
■ Efforts to avoid
associated
thoughts or
feelings
■ Efforts to avoid
people,
activities that
recall event
■ Inability to
recall specific
incidents
■ Diminished
interest
■ Detachment or
estrangement
■ Restricted
range of
affect/emotion
■ Sense of
foreshortened
future
Criterion D:
Arousal
symptoms
(2 symptoms
required)
■ Sleep
difficulties
■ Irritability or
outbursts of
anger
■ Difficulties in
concentration
■ Hyper
vigilance
■ Exaggerated
startle
response
16
What we do know about trauma disorders is that the more severe and chronic the
stressor, the greater is the likelihood that a diagnosis of PTSD will be relevant. Also,
the experience of a prior trauma increases the vulnerability to PTSD upon exposure
to a new trauma. In cases of PTSD, social support is a key factor in healing. Despite
the advantages of using the diagnosis of PTSD, there is a caveat:
■ It bestows upon the patient the stigma of a psychiatric diagnosis.
■ PTSD is associated with other labels that may be harmful to victimized women,
like ‘Battered Woman Syndrome’, which may in fact confound the healing
process, by suggesting that there is something inherently ‘wrong’ with the woman
because she is labeled as such.
■ The field of trauma studies is rapidly evolving and therefore it is important to
keep abreast of the latest developments in order to be up to date.
Discussion:
1. In making a diagnosis of PTSD, one has to be aware of the other symptoms and
illnesses that could either accompany it, or confound the diagnostic process. For
example, there is an overlap between the diagnosis of PTSD and depression.
Additionally, confusion could occur between the manifestation of the dissociative
symptoms of PTSD and psychosis, which could interfere with the diagnostic
procedure. It is also significant that a diagnosis such as psychosis can be so
damning and yet be so easily confused with PTSD.
2. Different interventions for treating PTSD have been developed, such as:
medication for sleep difficulties; behavioral techniques to address phobias and
panic; EMDR. One of the most effective techniques has been to let victims come
to terms with the trauma by telling their stories, either in a public forum, or just
to vocalize their experiences. This form of a ‘public testimony’ was used with
survivors of the Bosnia crisis, who found it very therapeutic to have their
emotions validated. Counseling for PTSD is also commonly used in clinical
practice in America, and began with therapy for war veterans, and the same
techniques have been extended to include victims of interpersonal violence.
17
3. The use of the PTSD diagnosis in India and South Asia: it is a more common
diagnosis in situations of disasters, as at the time of the Latur earthquake of 1994,
or war situations as in Sri Lanka’s decade old ethnic conflict. It was not used at
the time of the Bhopal Gas Leak tragedy, but would have been relevant. PTSD is
not used in clinical practice to describe the effects of intimate partner/sexual
violence because it is “not really within the consciousness of the system.”
4. PTSD as a diagnosis is broad enough to include different kinds of family violence
such as elder abuse, or to describe the effects of communal violence and
terrorism. While there is no epidemiological data in this area, it would be
relevant to use the diagnosis in all these different situations because of the nature
of trauma per se.
5. The legal implications of a diagnosis: can a diagnosis of PTSD be a legal liability
for a victim of Domestic Violence (DV)? In the United States, there is more
awareness of the PTSD diagnosis and there are specific laws to protect the
therapy/counseling documentation and its use in court in a DV case. For
example, unless the woman victim herself wants to use the material from
counseling sessions, it cannot be demanded by a court of law for perusal. The
legal system’s general lack of awareness and understanding of mental health
issues is apparent in the situation in India where a label “of unsound mind” can
be the ground for an ex-parte divorce. There is no qualification of this term, there
is no medical evaluation or ratification of this criterion, so it is often used against
women to prevent them from getting custody of children, access to property,
employment etc. This general lack of awareness is applicable to any diagnosis
that is made, even if it is one that recognizes her trauma, such as PTSD. The legal
system has also not set a precedent of asking professionals to appear in court and
clarify these issues in an individual case. In the United States, it is common
practice to hire a testifying psychiatrist to make an evaluation of the case in
question. In the United States there is dilemma regarding people who are on
medication; if the individual is not on medication, he is said to be “of sound
mind”, but that would make him/her liable to criminal or civil penalties. If the
individual is on medication, he/she will be seen as lacking in credibility because
of the label “of unsound mind”. This is how the rights of the mentally ill can be
violated in the legal system. The question of diagnosis and labeling arises in the
case of the term ‘Battered Woman Syndrome’. It is not used in cases going
through the legal system anymore, because the connotations of the term suggest
that the woman herself is sick, based on personal psychopathology. Her reactions
because of domestic violence are ignored and the focus is on traits that are
supposedly within her. Therefore, the diagnosis PTSD is favored for its
etiological focus on the traumatic event(s).
18
6. Re-traumatization of victims within the legal system: The effects of the legal
system on trauma victims are a cause for concern. The legal process is often
extremely harrowing and can even re-traumatize the victim. Though counseling
and therapy may help ‘shift’ and move the client emotionally and psychologically
to a safe space, the entry into the legal system can undo everything. Court
procedures, prejudice, gender bias, and ignorance within legal procedures and
systems often force the victim to re-live the trauma. In the United States there are
Victims’ Advocates whose role it is to prevent the possibility of re-traumatization
as far as possible, to ameliorate the effects of the court process, and help victims
make their way through the labyrinth of the law. So, when the legal system does
work in favor of the victim it can be an immense source of validation, but in
India, there is a paucity of systems and understanding to assist victims of
violence.
19
Contextual Issues ofMental Health in Domestic Violence
Dr. Nimesh Desai
The mental health professional dealing with victims of domestic violence has a
number of professional and professional dilemmas to address, including the nature of
the therapeutic relationship. The standpoint that the professional takes in dealing
with a DV victim is also open to debate. Psychiatrists are trained in the medical
model where the power dynamics and privileges are clear, so moving into an
‘interpersonal’ space with a client is problematic, as is bound to happen with victims
of abuse. With victims of domestic violence there is an impact on the mental and
emotional well being of both client and service provider.
Some forms of psychological dysfunction occur due to chronic violence. Somatoform
disorders are common in women survivors of domestic violence. Depression is
prevalent in abused women owing to the effects of DV as well as alcohol abuse in the
husband. It is also possible that the personality of a woman will be seriously affected
to the point of change, due to abuse, making her excessively angry, bitter and
cynical. Substance abuse is another common problem amongst violence survivors,
especially tranquilizers; a recent global study confirmed that 227 per thousand
abused women take tranquilizers in excess.
Different perspectives on mental health/ill-health provide different models to explain
the action and impact of abuse. The social ecology model seeks answers and
explanations in the socioeconomic-cultural reality of the individual. In this context,
common mental disorders (CMD) are prevalent in DV victims. Long term exposure
to domestic violence can result in severe morbidity for both somatic and mental
illnesses. Within abusive relationships, the model of circular causality is currently in
use to describe the nature and effects of the relationship. In rehabilitating the victims
of a recent fire disaster in a large Delhi slum cluster in the Yamuna Pushta area, it
was found that there was a very high rate of domestic violence and it was closely
linked to their social-economic realities. The differing realities of women need to be
evaluated in context of their political realities as well. In a needs assessment survey
conducted in Kashmir, it was expected that levels of PTSD (Posttraumatic Stress
Disorder) would be very high owing to political unrest and militancy. Poverty was
found more of a relevant stressor in the perception of the women than the loss of a
spouse to militancy, or domestic violence.
20
Discussion
1. Batterers in Therapy: Men and couples do approach the psychiatrist for help in
cases of domestic violence, and it is important to remember that the batterer is
also “in pain”. The experience is that couples do change in terms of the levels of
violence that decrease. In working with a batterer, it is therapeutically relevant to
see them as ‘diagnosable’ with a mental illness, but this may be at odds to the
established fact that abusive men are often ‘normal’. Thinking of batterers as ‘ill’
would also imply that approximately 50-60 % of men in the society are mentally
ill. The experience of some NGOs has been that when a man is indeed
diagnosable, he does not believe that there is anything wrong with him and resists
visiting a psychiatrist.
2. According to some NGOs the “insensitivity” of mental health professionals is
reflected in clinical practice and is reinforced by the absence of gender sensitivity
in medical training. It was also noted, by psychiatrists themselves, that perhaps
the mental health professionals at the meeting are not really the ones who need
‘exposure’, because they have shown interest in attending such a meeting, but
there is a large population of clinicians who are in need of training. There is a
need for a “flavoring of gender in medical curricula” because there are lacunae in
psychiatrists’ responses to victims of violence. According to a psychiatrist in the
group, the process of exposure and sensitization may lead to a ‘backlash’ amongst
the professionals who are more aware and sensitive.
21
Issues ofAssessment of Common Mental Disorders in Lower Income Urban
Women with Gynecological Morbidity
Dr. Surinder Jaiswal
This study sought to assess women’s experience of gynecological morbidity, and the
presence of common mental disorders in women who report symptoms of
gynecological morbidity. Women with gynecological morbidity did experience
distress but did not receive treatment, either because they sought help only when the
problem was chronic, or because health workers did not carefully examine women’s
reports, leading to even greater distress in women at not being heard. Gynecological
morbidity includes conditions like PID (Pelvic Inflammatory Disease), white
discharge, reproductive tract infections, and urinary tract infections etc.
Sensitive issues about women’s health reporting and help seeking behavior, lead to a
culture of silence, which entails the development of carefully designed tools for data
collection. Since the study would use women’s own accounts of their experiences,
the tools would also have to record their feelings and thoughts in their own language.
It was considered important to derive emic tools that were based on women’s
experiences, which would lead to the development of (culturally centered) etic tools,
rather than impose constructs from existing Western or etic tools. The tools used
were participatory which would be respondent driven, rather than more formal or
structured; this would also allow emic data to be recorded. Narratives and Case
Studies were used to record women’s voices, along with the use of Freelisting,
Ranking, and Body Mapping. .
The study used SRQ-20 (The Self-Report Questionnaire), in which some categories
have been validated in the local language (a derived etic). ICD-10 was used to
diagnose CMDs, which is an imposed etic, for its criteria of anxiety and depression
are Western. Different methods were used to re-validate the in-depth interviews/case
histories (triangulation).
Yi
06760
\
S V o'0i/*
22
Findings
■ Gynecological and psychiatric morbidity were not associated with respondent’s
and spouse’s education, family monthly income, and sterilization history of
respondent
■ Both morbidities were associated with the presence of a major illness in
respondents
■ 17.9 % respondents reported minor psychiatric morbidity
■ 27.5 % and 21.3 % of the respondents who reported at least one or two
gynecological morbidity symptoms also reported psychiatric morbidity.
■ Psychiatric morbidity was associated with respondent’s age (36-45 years),
religion, and employment (not employed).
■ Gynecological morbidity affected: women’s physical health; changed their sense
of self-worth and personal dignity; and affected their social mobility.
■ Respondents felt that gynecological morbidity was part of womanhood that had
to be quietly endured, and they feared that the morbidity was terminal.
■ Women respondents felt alienated from the health provision system, and had
often been told that there was ‘nothing wrong with them’, even while the illnesses
did exist.
The intersection of gynecological conditions with other major illnesses and common
mental disorders is widespread and largely goes unaddressed. Standard assessment
procedures, when used, do not inquire about the woman’s health situation in a
“complete” manner, as she experiences it linked to many aspects of her life.
Gynecological symptoms are addressed in isolation, the situations that create them,
and the subjective distress caused by them is ignored. If the health provider were to
ask the crucial question that would provide an opportunity for the woman to talk
about her problem holistically, she would do so.
23
In Search ofher Spirit: A Presentation on the Report on Women, Violence and
Mental Health
Ms. Indira Ganesh (IFSHA)
The case study of the client, who brings with her a history of violence and
discrimination and resultantly low self-esteem, inconfidence and fear, is the exemplar
of trauma that all women are vulnerable to. It is within the context of gender that
violence is a baseline experience. From birth throughout the life span, a woman has
to virtually battle for her survival; the very basics of existence are denied young girls,
from food to education to emotional and physical security. This perspective on
gender is central to the rehabilitation and counseling provided for victims
approaching IFSHA for assistance. A woman victim of violence will speak out only
when the situation is beyond control or physical endurance. Rehabilitation from
domestic violence or child sexual abuse means that her entire life has to be
reconstructed and recreated, from addressing her scarred psyche, to the very essential
necessities of physical relocation.
Counseling victims of violence focuses on understanding patterns of behavior and
making connections with her history of violence. Deflection, denial, suppression, and
projection, are some of the mechanisms violated women use to make sense of what
they experienced and how they reacted, and to ‘manage’ rather than ‘resolve’ feelings
of guilt, shame or fear. In this process, there were women who displayed behaviors
that were difficult to address, like excessive crying, extreme suspicion, over
talkativeness etc. While there is an intellectual understanding of the emotions and
trauma underlying the behaviors, practical and sensitive measures were not always
available. Additionally, family members, police, lawyers, and neighbors would call
her mad, or crazy based on these expressions. Considering that violence is pandemic,
if only a thousandth of the population of traumatized women approached a small
NGO, where did the others go? The answer came in the form of clients who had
already accessed the entire range of available mental health professionals, before
finding that their services were in some way inadequate. They largely felt un
understood, were often medicated for their behaviors called ‘symptoms’, which led to
their suppression rather than resolution. They were led to believe that there was
something innately wrong with their own functioning, which caused their varied
reactions to trauma and even the trauma per se.
These clients found that the NGO experience gave them more space to express their
trauma in a non-judgmental space, work towards rehabilitation, and source the pain
and fear. The two differences in the approach to the violated woman led to the
crystallization of the aims of the research:
24
■ The connections between the psychology of violence and mental illness (our
definition of violence is described in Box 1).
■ The prevalence of abuse in mentally ill women.
■ The manifestations of sexual and domestic trauma.
■ To dialogue with mainstream mental health professionals on the experiences of
abused and diagnosed women, their understanding of trauma and behavior and
its treatment, and the problems in mental health practice and service delivery.
Methodology
Tools
■ Biographic details of the client, onset of illness, symptoms, and treatment
measures for which the medical records were consulted
■ In-depth interviews with women clients on their life histories of violence and
illness.
■ Semi-structured questionnaires for interviews with psychiatrists
Sample & Sampling
To avoid any biases, the population of clinically diagnosed women was found to be
the most suitable, rather than studying NGO clients; additionally, as an NGO we did
not possess the facilities or expertise for diagnosis either.
Since each in-depth interview took 1-2 hours, and at least three interviews per client
were essential, there was pressure to have a large sample. Nevertheless with 300
respondents there was enough data that could be generated. To make the sample
more representative of the diversity of India, five centers for data collection were
chosen: Delhi, Bombay, Calcutta, Tezpur, and Bangalore. We accessed diagnosed
women from government hospitals, private clinics, and halfway homes. The final
sample of the research is outlined in Box 2.
Box 1
Definition of Violence:
Inlhe natal home:
Inlhe marital home:
- Child sexual abuse
- Child marriage
- Physical abuse
- An alcoholic father
- Male child preference and related
discrimination.
- Domestic violence
- Sexual coercion
- Reproductive burden
- Abusive in-laws
25
Box 2
Sample:
Total number of cases not used in analysis (either organic disorders
Or where no diagnosis has been made):
17
Total number of cases where respondents were incoherent due to medication:
38
Total number of cases used in analysis with violence as a primary or secondary
factor:
245
300
Number reporting violence as secondary factor in life history (Prior to illness):
88 (35.9 %)
Number reporting violence as primary factor in life history*
(Prior to illness):
157 (64.1 %)
Of this
Anxiety:
Depression:
Psychosis:
46 (29.3 %)
65 (41.4%)
46 (29.3 %)
Main Findings
The Women Respondents:
Since the data was largely qualitative and in the form of narratives, it was analyzed
accordingly. The findings briefly outlined here relate to the sample recording
violence as a primary factor. ’
* These were the respondents who reported violence as a primary source of stress and upheaval in their life
histories; women who reported violence as a secondary factor were unable to share the details of their own
lives because of a recent crisis in the family, or who were incoherent on the 2-3rd interview due to
medication
26
Women with Depression:
■ Prevalence of depression highest in ever married sample (41.4 %)
■ The connection between the theoretical underpinnings of depression and
women’s experiences of violence in marriage comprising low self-esteem, feelings
of powerlessness, learned helplessness, and a nihilistic view of the future.
Women with Anxiety-Neuroses:
■ Prevalence of anxiety generally lower in the sample, with distinctions relating to
specific categories of violence
■ Identical levels of anxiety neuroses in child marriage and child sexual abuse
cases, and a similar link in cases of sexual coercion in adults and children rather
than depression
■ Anxiety related illnesses correlated with loss of control, as opposed to depression
which was correlated with hopelessness.
■ More diagnoses of somatic disorders in women with early histories of sexual
trauma, displaying more unexplained pain and somatic complaints.
Women with Psychoses:
■ Highest level of child sexual abuse in the entire sample in the group of women
diagnosed with psychoses.
■ Hardly any assessment or psychological testing was used in cases of psychoses;
diagnosis was made on the basis of symptomatology and the accompanying
informant’s reports.
■ Diagnosis of psychosis does not always acknowledge the occurrence of violence
in women’s lives.
■ 98 % of treatment measures adopted for all forms of psychotic illness was
medication, psychotherapy was hardly visible
27
Main Findings
The Psychiatrists
■ 102 clinicians were interviewed, and most of them ran private clinics and their
clientele was generally middle/upper middle class. The clinicians from
government hospitals, where most of our clients were from, refused to be
interviewed for reasons of client-confidentiality. Additionally, private clinicians
had more scope and resources to use a range of assessment and treatment
procedures that was the main focus of the interviews
■ 60 % of clinicians believed that child sexual abuse was a significant issue for
mental health, but only 8 % routinely checked for it in practice
■ 43 % of clinicians interviewed believed that domestic violence was a significant
issue for mental health, but only 12 % routinely checked for it.
■ The stark differences between the high perceived significance of these two forms
of violence, and the extremely low prevalence in practice reveals a contradiction,
it underscores the lack of emphasis on inquiry around women’s experiences of
violence
■ Common mental disorders are most prevalent in a given population, and 58 % of
the sample felt that CMDs were most amenable to psychotherapy, but only 15 /o
used psychotherapy regularly in treating CMDs. 23 % reported that the
progresses in pharmaceutical technology would make psychotherapy redun nt.
Questions
1. Are the assumptions underlying diagnostic frameworks culturally sensitive, and
relevant?
2. A diagnosis such as -----PTSD captures; the effects of sexual and domestic
victimization, but has hardly been used in this country. Why?
3. The connotations implied by diagnosis for women viz. that it affects life, liberty
and personal well being of women have never been seriously considered, and go
largely unrecognized by the mainstream. Why?
4. How is medication as the only form of effective therapy in cases of violence
against women?
28
5. How does the language and practice of medicalization of illness affect women
victims of sexual trauma?
Recommendations
■ Partnerships with mainstream mental health practitioners, and other NGOs in
assessment, research, and therapeutic interventions for women
■ A sustained effort towards developing Feminist Therapy in India.
Discussion
1. A certain number of cases of women who were diagnosed with organic disorders
(mental retardation and epilepsy) were not included in the analysis of data, which
was challenged on the grounds that it amounted to exclusion of an important
segment of women, who are usually ignored in most research anyway. This
situation has to be viewed in light of constraints and hurdles that the research
process had to contend with, as well as the location of IFSHA in its context as an
NGO. Access to institutions, and communication with the mainstream was so
limited, largely due to IFSHA’s position as an NGO researching a “mainstream
issue. With deference to recognition and incorporation of the research in the
mainstream, a more conservative and safe approach was adopted, and the
exclusion of these cases signified that a condition such as mental retardation
would introduce more variables than could be addressed within the scope of the
research.
2. The intensity and enormity of the experience of violence can often make a
clinician feel overwhelmed by her inability to tangibly make a difference, given
her tools and resources. In this regard, without it being as a defense for the use o
medication, it is perhaps the only ‘active’ way to alleviate the symptom. At least
the woman sleeps better a night.”
3. According to some clinicians, the apparently direct connection that was made
between violence, and mental illness requires further research, and the vaned
perspectives and inputs of different disciplines and professionals could be
incorporated in such a research. Other social and community issues that operate
beyond the individual’s personal experience have to be explored as well.
29
4. The gendered experience of violence in this research, according to clinicians,
ignores the violence that men experience at the hands of women, or that which is
perpetrated by women on each other. In this context, the ground realities of the
prevalence and effects of violence against men and women have to be recognized,
and the differences in how men and women are violated are equally important.
The relationship between the perpetrator and-victim and the effects of intimate
partner violence comes more within the lived reality of women rather than men.
5. The origins of psychiatry and psychology in medicine have led to the
medicalization of psychological illnesses, and the often-excessive use of
medication as treatment. Nevertheless this does not imply that counseling or
psychotherapy is the only suitable form of treatment for mental illnesses, as was
thought to be the point of the IFSHA research and presentation. The expectation
of clients also follows here, that they generally expect to be ‘cured1 soon by a pill
or drug. Clients do not always accept ‘talking1 as a form of therapy because the
origin of dysfunction is constructed as being biological. In response to this, it was
suggested that “wellbeing11 as a concept could be kept central, and the most
effective form of therapy be advocated in keeping with the situation of the
individual client.
k
30
PART 2: INTERVENTIONS
MENTAL HEALTH
IN
addressing
WOMEN'S
The Identification and Assessment ofDomestic Violence in Health Care Settings
Dr. Mary Ann Dutton
Health care providers can play a significant role in identifying do,pe^ vl°1““
their women clients. The prevalence of violence in the lives of psychiatric inPa^e^
underscores the need for better assessment and care for survivors ( as shown in t
box).
100 Consecutive adult female
admissions
■ History of childhood abuse
- 95% childhood physical abuse
- 96% childhood sexual abuse
- 97% childhood emotional abuse
■
20-56 years (M = 39 years, SJ2. = 8.2)
■ Race/Ethnicity: 88% Caucasian,
10% African-American
■ Education
- 37% college and/or graduate or
professional degree
- 43% some college education
- 10% high school diploma
- 10% less than high school education
The effective identification of violence and
abuse in a clinical setting means that there
would have to be universal screening
procedures, for any woman could be a victim
of violence. For want of time and resources
the identification procedure would have to be
quick, therefore questions would have to
focus on specific behaviors. If the clinician
feels that there is a need for a more in-depth
assessment of the woman s violence
situation, some procedures could be used viz.
■ Narratives'. Asking the woman to tell her story the ways she feels most
comfortable.
■ The Scenario Interview method where the woman is asked about the sequence of
specific incidents.
■ Structured Protocols: To assess physical, sexual and psychological abuse or
violence, stalking etc.) like: the Conflict Tactics Scale-2 (CTS-2), the Spouse
Abuse Index, and the Psychological Maltreatment of Women Inventory.
31
Assessment procedures can help.1^nt1^e^h^r^pro^ideTi^planning the entire
barmIXS Se ebiidTfamUy a'd'friends. risks that threaten the relationship,
loss of financial and other tangible resources etc.
There are wo scales used to assess the intensity and nature of risks battered women
and the Spousal Assault Risk Assessment
face: The Danger AssessmenuScale^^---------Guide.
There are a number of issues for health care providers to be aware of when dealing
with women survivors of violence:
■ Universal screening and identification by the health professional.
■ Follow-up violence and risk assessments.
f^ors
.
.
edua,non and m,nmS ,o deal md, secondary Paumanc
stress and continued developments in Feld
Discussion
1. Revictimization in women survvorc of
outline the processes underlying revictimization T
py
nattems and
becoming aggressors themselves, and girls becoming vulnerable to further abu
violence.
k/H RO
06760 ^3 (
V oO0'5*
J
32
Reaching the Un-reached: An Approach to Develop Mental Health Care for Women
in Distress
Dr. R. S. Murthy
Before examining the status of mental health in India, the history of the
British built all existing mental hospitals, and after 1966, there were no more mentol
health centers. There are only 20, 000 psychiatric beds for approximately 4 /o o a
population of 1 billion who are mentally ill, and only 5000 mental health
professionals to address them.
In a four-village study conducted by NIMHANS over a nine-month period 8C) % of
the depressed population were women, and despite the availability of mental healt
services 50 % were not treated. For three months, the NIMHANS team provided
improved services, development etc., resulting in clinical and economic
improvement, but there was 20-30 % of the community who did not access mental
health services. What does exist at present are improved assessment methods,
different forms of therapy, changes in the diagnostic procedure, and drugs are
cheaper and more accessible. The mental health profession today is centralized, over
professionalized, and the quality of care is de-humanizing. The negative
connotations in this scenario need to be transformed to a more positive stance^ This
process plus the resource crunch makes it most logical to suggest a pub ic health
approach and interventions in mental health. The process of change will have to
therefore incorporate a holistic view, and medication or counseling alone cannot
ameliorate women’s mental health, but social change is also, if not more, crucial.
Public health interventions and de-professionalizing the practice has begun in some
measure by NIMHANS, where treatment procedures have undergone change.
Mental health services have become more innovative, simplified, and broad-based as
some PHCs (primary health centers) in a district of Karnataka have been trained to
address common mental health problems in the community. Specifically, it is a
‘partnership with families’ that is sought in this process. The specific groups/issues
who have been addressed through educational manges
programs are.
•
•'
•
•
•
Caregivers
Medical professionals
Social, activists
Primary health centers
Working women
33
Such community resources include educational materials, training, focussing on
social etiology, minimizing gender stereotypes, and creating spaces where the client
feels empowered rather than victimized. The development of protocols for better
clinical practice is another step that can be worked towards. The main aim of such
community approaches to mental health is to make the shift from mental ill-health
to ‘mental health’.
Discussion
1. If the aim of community mental health is to broadbase service delivery by de
professionalizing’ the existing mental health system, who are the caregivers, apart
from psychiatrists, who will take it on? Many individuals claim to be mental
health professionals, but often don’t have the requisite training, experience, skills
etc. The distinctions between non-professional and para-professionals in the
mental health system have not been clearly defined either. The hierarchies in the
mental health profession are very clearly established. Protocols of assessment,
treatment, and the purview of these caregivers do not exist. In light of these
ground realities, how ethically viable is it to call upon these diverse groups to
participate in the community mental health movement?
I.
34
Theoretical and Methodological Issues in Therapeutic Interventions for Women and
Children in Domestic Violence: The Feminist Approach
Dr. Irma Saucedo Gonzalez
Domestic violence is pandemic and its effects on victims’ psychological, emotional,
sexual and physical health are significant. Such victimization also has a profound
impact on victims’ worldview and constructions of themselves, and human
relationships. The theoretical and methodological issues underlying therapeutic
interventions emphasize a new meaning and approach to the emotional turmoil
resulting from intimate partner violence. This re-definition of beliefs is central to
recovery. Rather than focus on a medical, reductionist approach to the individual s
health and psyche, it is important to address the contextual issues of self and self
image that keep victims in violent situations, or that prevent recovery from abuse.
The centrality of power and the entrenchment of power relations as they exist are
reviewed through a feminist lens in these new interventions. Culture and scientific
disciplines produce and reinforce knowledge about the concept of power relations,
the construction of gender identities, and the culturally fashioned meanings of
masculinity and femininity in specific contexts. These have never been subjected to
deconstruction and analysis from a feminist perspective for the purpose of
therapeutic interventions. Deconstruction of power and gender systems throws light
on how and why traditional psychological theories have played a significant role at
normalizing women; on the cultural contexts that construct masculinities and
femininities with violence and coercion as regulators of these constructions, and, the
normalization and acceptance of male violence.
Knowledge about women’s responses to, and recovery from, domestic violence can
be re-constructed from a feminist perspective. For example, the Stockholm
Syndrome Theory can be useful in understanding the way in which women can de
construct the emotional bond that exists between themselves and the aggressor.
When clients themselves develop a consciousness about their behavior, they are able
to re-construct more positive emotional bonds, and allows them to feel more secure
when they take important decisions, such as leaving the violent relationship. This re
constructive approach to knowledge also enables therapists to understand the
anguish and setbacks that women face in therapy, and when they try to distance
themselves from the violent relationship.
t
35
Approaches to re-constructed knowledge such as this underlie the reflection groups ,
the specific therapeutic intervention for DV victims. These groups are for women to
identify with each other and to engage in discussions on the relationship between
violence, socially approved femininity, and the feelings of terror and pain. The
emotional fallout of violence is diminished by the deconstruction of individual beliefs
regarding its cause.
Thereon, it is possible for women to construct a new meaning to the feelings they
experienced due to violence, and begin to design strategies to protect or free
themselves from a violent situation. The reflection group process allows women to
make connections between violent acts and femininity as being obedient, sexually
constrained etc. Results of this process show that women do change and are able to
deconstruct the concepts of femininity, sexuality, and motherhood that exacerbated
situations of violence. Additionally, this group work has shown that the symptoms
that women experienced reduced or completely disappeared. Reflection groups are
not support/encounter groups, they are a source of emotional support, but not
necessarily rehabilitation. There is more of an emphasis on discussing relevant
themes, and not necessarily on behavior change per se. Coordinators who are
trained to engage the participants in the process of analyzing and deconstructing
power imbalances in their immediate relationships run the groups.
The relationship between the mental health professional (the ‘specialist’) and the
client (woman) often replicates the power structures existing in society, between
partners etc. The specialist takes on a position of resolving the violent situation
without the client being able to control her own destiny, or design her own strategies
which are validated (or not) through trial and error. Empowerment can occur when
women victims have the intellectual and psychological latitude to analyze and
deconstruct the power imbalance that exists in specialist-client relationships.
Domestic violence is a complex phenomenon. Its complexity shows that is not easy
to talk about ’’ending it’’ in the near future. However, we can begin to de-structure
the mechanisms that guarantee its reproduction.
»
36
Discussion:
1
Problematic issues in running reflection groups: in forming these reflection
groups, the main problems have been middle class women’s resistance to taking
domestic violence from the private to the public sphere. The power of silence is
often the starting point for the process of deconstruction of power relations.
Other NGO experiences have found that class differences make it essential to
organize women of similar classes together. Yet, once there is a structure in place
that recognizes these issues, they have run extremely smoothly.
2. By entering a support/reflection group, a woman has to re-look at herself an
take stock of her situation. This can be an emotionally rigorous experience, and a
very isolating one. The group becomes the main source of affection, friendship
etc., but is not always effective in providing an ‘alternate supportive community
for a battered woman. The process of introspection is a painful one and there are
multiple pressures to address: isolation from the partner, self-doubt, distance from
other social relationships linked to the spousal one, and a total lack o
understanding or empathy from anyone except the NGO.
3 The power dynamics between the facilitator (of the reflection groups) and the
client are also a concern. The existing dynamics are registered and observed, and
are incorporated into the themes the group takes up. The dynamics are
recognized rather than ignored, which is often a preventive check on
relationships within the group becoming imbalanced.
4. Non-medicalization of domestic violence: what this means is that a case of DV is
not immediately referred to the mental health center. Treatment per se is not the
only way to address DV, and this is what the reflection groups try to emphasize.
The Mexican experience with these reflection groups has led to the suggestion
that medical and mental health settings should make provisions for reflection
group style processes.
B
37
Mental Health Matters Too: Expanding the scope ofReproductive and Women's
Health Research
Dr. Vikram Patel
This presentation aims to highlight the need for reproductive and women’s health
research in developing countries to incorporate psychosocial factors and mental
health as an integral component of its agenda. The intersection of reproductive and
mental health has been rarely researched although there is growing evidence that
mental illnesses play a significant part in the disease burden of developing countries.
Common Mental Disorders (CMDs) such as depression and anxiety, in particular,
have been identified as one of the commonest and most disabling disorders and
women are at a higher risk to suffer this disorder. Being economically weaker, and
having little or no education, which women often are, increase an individual’s
vulnerability to CMDs. CMDs, by virtue of their seemingly innocuous
manifestations, are not commonly diagnosed, are dismissed, or are seen as sleeping
disorders that are treated with the ubiquitous ’tonic’. A consistently ignored CMD
often becomes chronic, leading to greater problems for the woman. The presentation
reviews the existing research evidence to demonstrate the relevance of mental health
by examining six key areas:
• Gynecological/reproductive symptoms and psychological disorder.
•
Postnatal depression: The cultural ethos underlying childbirth in India is geared
towards a celebration of the child and its survival, rather than the mother. There
is very little space for women to express the emotions related to childbirth, so
there is little space for them to access any form of support.
• Adolescent sexuality and mental health: adolescent suicide attempts are one of
the top three causes for hospitalization in India.
•
Violence and women’s mental health: Apart from the impact of violence on the
women’s psyche, it has also been shown that DV translates into reproductive
symptoms as well.
•
Treatment of common mental disorders with counseling and antidepressants.
• The mental health of older women: the myth of the cozy joint family is debunked
by the prevalence of elder abuse, and older women are even more disadvantaged
by their poor social, health, and economic status.
38
Using this evidence, a range of research questions and hypotheses and their
implications for reproductive health services and policy can be suggested. The broad
basing of service delivery and inclusion of health workers to address CMDs is an
important step towards prevention, enhanced care, effective services etc. There is
not enough data from developing countries that show how prevalent certain
conditions are, or how effective different kinds of treatment are; there is no ’truth'
about assessment, planning, treatment etc. that can be passed on to health workers.
There is still a trial and error method used when it comes to addressing these mental
health issues. It also suggests that mental health issues need to be incorporated into
reproductive and women's health programs at a governmental level. In conclusion,
this work undertaken by Sangath aims to broaden the scope of reproductive health
research by acknowledging that it is inextricably linked to mental health.
Discussion:
1. The benefits and costs of counseling and pharmaco-therapy for mental illnesses:
The benefits of both can be argued for, but there are opposing views on how they
can or should be compared, if at all. At one level, the two approaches appear to
be so totally different, to the extent that comparisons are impossible. A differing
view is that if counseling versus pharmaco-therapy is at the heart of the conflict,
then a scientific experiment would have to establish the advantages of one over
the other.
39
Addressing Violence against Women and Children in Family Therapy
Dr. Apurva Shah
Within the psychoanalytic tradition, addressing family violence means that the
concepts and skills that guide therapy will diverge from other schools of thought in
psychiatry, and in family therapy specifically. So, it is important to recognize the
different context that psychoanalysis operates in, and the different data and
experiences it generates. The different languages and beliefs within different schools
of psychology and psychiatry lead to knee jerk reactions; essentially, difference is to
be recognized and respected.
In the case of domestic violence, the psychoanalyst enters a therapeutic alliance with
the entire family. Psychoanalytic therapy is a long-term process with families and the
clients are encouraged to attend the entire process, so there is enough time for them
to establish a level of comfort to disclose and open up. This occurs by the 25th to 30th
session. After this, the therapist works with the abuser on slowly reducing the level
and frequency of violence in the marital relationship, by entering a moral contract
with him. The analyst does not, except in rare cases, try to stop the violence
completely. On the other hand, in cases of violence against children, the analyst
takes a definite stand that violence has to be stopped immediately.
As a clinician, it is essential to remain truly non-judgmental in such cases as it may
interfere with the helper’s role. For example, NGO spaces for women victims are
non-judgmental because the counselors take moral stands on violence, the victim, the
abuser etc. Perpetrators of violence have to be addressed in as non-judgmental a
fashion as possible, for they experience helplessness and loss of control as well. Just
as the victim should not be classified as ‘mad’, the perpetrator should not be
classified as ‘bad’. In the process of psychoanalysis, one method of empowerment is
locating the locus of control internally, within the self. If the outside situation cannot
change, at least the victim can be empowered to deal with the violence.
While therapy, research, and interventions are important in cases of DV and CSA,
there is a larger goal that cannot be ignored. Social problems such as violence against
women and children are based on a reigning cultural ego ideal that shapes and is
shaped by the media, popular culture etc. This in turn affects how domestic violence
and child sexual abuse are viewed. In this regard, in working with children and
communities psycho-education is particularly useful.
[Discussion following this presentation was not possible owing to time constraints.]
40
PART 3: RECOMMENDATIONS & SUGGESTIONS FOR
COLLABORATION
This section summarizes the suggestions and recommendations made by the group
towards collaboration on mental health issues and practice. While collaboration per
se may seem the most logical outcome of such a colloquium, what it means at a
ground level needs to be thoroughly debated first, where there must emerge a sense
of ownership of the process. The alleged ‘confrontational’ attitude of NGOs is more
a myth than reality; the differences in the bodies of knowledge based on mainstream
practice and NGO experience have to be respected for what they are. And a process
of collaboration is based on un-leaming and re-learning of attitudes, perspectives,
skills, and practice.
A panel of NGO representatives, academicians and psychiatrists made the following
recommendations:
Recommendations from NGOs
Ms. Jasjit Purewal (IFSHA, New Delhi)
Dr. BhargaviDavar(Bapu Trust, Pune)
Dr. Surinder Jaiswal (TISS, Mumbai)
1. Awareness-raising on gender issues within the mental health community
2. A ‘support community’ of mental health professionals and NGOs to provide
training, exposure etc. for institutions/individuals working with violence victims.
3. Research partnerships between mainstream mental health clinicians and NGOs
on issues of violence against women and mental health
4. A ‘de-professionalization’ of skills and perspectives used both within and outside
of mainstream clinical practice, and the inclusion of ideas and practices from
other allied professions. The intellectual and professional seclusion that mental
health practice enjoys needs to open up for alternative perspectives in light of the
varied experiences of other groups working on women’s health.
5. The development of assessment protocols for cases of abuse that can be
incorporated in mainstream clinical practice
41
6. Ethical committees to vet research done by NGOs and clinicians on women's
mental health and violence.
7. The de-stigmatization of mental illness, through media campaigns for example,
based on collaboration by mental health practitioners and NGOs.
8. A working group of clinicians and NGOs on issues of violence against women
for debates, training, exposure etc.
Recommendations by Psychiatrists:
1. Dr. R. S. Murthy (NIMHANS, Bangalore)
n intellectual and emotional shift away from a qualitative judgment that views
perpetrators of violence as “bad”
Research conducted by NGOs, specifically the raw data of the IFSHA report ‘In
Search of her Spirit: Women, Violence & Mental Health’, should be reviewed by
psychiatrists who were not interviewed in the study, to see if they would react in
quite the same way as the psychiatrist-respondents did.
A joint session including psychiatrists and NGOs to discuss perspectives in the
assessment and treatment of women victims of violence under the aegis of a
forum such as the Delhi Association of Psychiatrists, or the Indian Association of
Psychiatrists.
Mainstreaming the assessment and treatment of common mental disorders to
ensure that non-mental health/para- professionals can take on the care of CMDs.
Different methods and interventions in cases of abuse can be developed jointly by
NGOs and clinicians and would need to be thoroughly evaluated before being
implemented.
42
2. Dr. Nimesh Desai (Institute of Human Behavior and Allied Sciences, Shahdra,
New Delhi)
More dialogue between mental health clinicians and NGOs on addressing
violence against women. This process might lead to the development of alternate
models and perspectives within which DV, CSA etc may be viewed, in order to
prevent an unilinearity of perspective that currently exists.
More research on women’s mental health and violence.
The inclusion of DV, CSA etc. in education, training, assessment and training
procedures as a form of collaboration at the service delivery level.
A space for professionals to reflect and introspect on the nature of clinical
practice, treatment philosophies etc., and to increase awareness about gender
issues. Within a specific institution such as 1HBAS, Shahdra, the post graduate
program should include gender issues in the curriculum.
5. Dr. Mohan Isaac (N1MHANS, Bangalore)
Since different professionals use differing languages to communicate similar
themes related to women’s mental health, it may be useful to evolve a “common
language” to ensure communication that is reality-based and valid.
Documentation of the process of therapy, assessment etc. by non-mainstream
groups like NGOs in addressing violence victims for periodic assessment, review
and training.
Debating the legal implications of mental health issues, and working towards
concrete interventions.
A directory of NGOs and mental health professionals organized city-wise for the
reference of both groups, and networking.
43
PART 4: EVALUATIONS
Though there was space for participants to share their experiences of the conference,
we provided a written evaluation form as well, which is reproduced here. There were
a number of issues that we felt could be elaborated upon through a written
evaluation form. Generally, the participants had a number of ideas to share,
extended offers to work together, and were impressed by the level of debates and
lateral thinking that the conference stimulated.
Questions in the written evaluation form:
1. How would you feel about a collaborative effort between yourself and any other
agency/individual working in a different professional sphere i.e. psychiatrist,
clinical psychologist, activist, feminist therapist? What areas, if any, would you
like to collaborate on?
2. What are the key areas that came up in this meeting that need further inquiry,
examination, application etc.?
3. Are there any issues that you think should have been included/elaborated upon
4. Other comments?
5. Would you like to attend any other meeting by IFSHA?
Participantsf Responses:
A broad overview of the written evaluations shows that participants were able to
specify the issues that either needed greater inquiry, or collaboration, rather than
share their views, apprehensions, and ideas about collaborative efforts. Of 45
participants who attended the conference, we received only 18 evaluation forms, so
the views listed here cannot be assumed to be representative of the entire group.
44
1. The areas that participants' would like to collaborate on are:
■ Research: sharing research and psychiatrists wanted to conduct research with
activists; working on joint projects on law and mental health.
■ Therapeutic Interventions: developing ‘reflection group’ style interventions for
battered women; for elder abuse, and violence against children in the family;
begin groups for domestic violence victims with the assistance of IFSHA;
developing specific counseling techniques for domestic violence; developing the
concept and practice of feminist therapy in India; a collaboration on a case-bycase basis for therapy and evaluation.
■ Education & Advocacy: incorporating gender issues and violence against women
in undergraduate and postgraduate medical education; mainstreaming disability
issues in gender and mental health; advocacy for legislative awareness and
change.
2. Areas thatparticipants felt need more examination, inquiry, and application:
■ Research: creating a qualitative and quantitative database on violence against
women; the need for scientific data aimed at influencing policy; the scientific
rigor of the IFSHA research; gender specific and gendered research methods;
women’s resilience and coping mechanisms; the interface of domestic violence
and mental illness.
■ Therapeutic interventions: sharing different practices; intervention and
assessment protocols for violence cases; developing training curricula for mental
health professionals; organizing a community based task force on violence
against women comprising a team of professionals; defining and examining
counseling as therapy
■ Education & Advocacy: gender-sensitization of mental health professionals;
mainstreaming an understanding of feminism; disability issues in mental health
of women; mainstreaming the care of CMDs into allied disciplines like primary
health care settings, or gynecology services.
45
3. Issues that participants felt were left out ofthe meeting:
■ Working with and researching perpetrators’ behavior and construction of
masculinity
Descriptions of community based services working on women’s issues and
violence
The credibility and competence of NGOs to work in the absence of mental health
professionals
The needs and services of rural women
The role and inputs of psychologists and psychiatric social workers in addressing
violence against women
Violence at a state level, communalism, terrorism etc.
■ Disability issues in women’s mental health
What feminism is and how it is practiced, and its role in mental health care
Relationships between children and parents coexisting in situations of violence
Questioning the gendered sensitivity of mainstream mental health research
The Depth Psychology of the victim of violence
The overlaps and intersections between child sexual abuse and domestic violence
The role of illiteracy and poverty in preventing women from dealing with
violence.
The preceding sections signify that the conference threw up a number of issues for
intellectual debate, discussion and further working relationships. As IFSHA, this is
in fulfillment of our aims in organizing this workshop. Other comments from
participants show that they enjoyed being part of this forum and gained many useful
ideas, and insights, and that they looked forward to more meetings organized by
IFSHA. It also makes us more hopeful that women’s experiences could gain visibility
in mental health forums and practice. The level of debate, involvement and passion
at such a meeting was of very high quality, and reinforces our commitment to
collaboration on women’s mental health. It is also significant that we were able to
organize a gathering of diverse professionals to discuss and share points of
convergence and difference towards the larger goal of gender justice.
46
NOTES ON CONTRIBUTORS
Ms. Anjali Dave: is a Senior Lecturer at the Department of Family and Child
Welfare, Tata Institute of Social Sciences, Mumbai. She has worked extensively in
the area of women and violence and pioneered the Women’s Cell in Mumbai Police
Stations.
Dr. Apurva Shah: has trained at the Albert Einstein, and New York City in
psychiatry, child psychiatry, psychoanalytic psychotherapy, and systemic family
therapy. Dr Shah is in private practice in Ahmedabad, and is director of Antamad
Foundation (Ahmedabad), a non-profit organization whose activities include: a three
year graduate training program in psychotherapy, a low cost psychotherapy clinic,
community outreach programs, a therapeutic nursery for autistic children, and a
psychoanalytically oriented film club.
Dr. Bhargavi Davar. is a Ph.D. in the Philosophy of Psychiatry from the, Indian
Institute of Technology in Mumbai. Her Post Doctoral work comprised of. Project
work on women and mental health in the Indian context - some secondary data and
review'; writing on consumer perspectives in mental health; advocacy and policy
research; feminist psychology and women’s mental health. Presently she is a trustee
for Bapu trust, a forum interested in the sociological aspects of mental health
practice, policy and advocacy related issues. Dr. Davar has published two books.
Psychoanalysis as a Human Science: Beyond Foundationalism, and Mental Health
ofIndian Women: A Feminist Agenda
Dr. Irma Saucedo-Gonzalez: is a Masters in Social Sciences from the University of
Chicago. She is a researcher, and Professor in the Women’s Studies Department in
the College of Mexico. She is also the coordinator of the Working group on
Domestic Violence and Women’s Health in the College of Mexico.
Dr. Mary Ann Dutton: is currently a Research Professor at the George Washington
University in Washington DC, USA. She is a supervisor for Doctoral and Masters
theses and dissertations and research in the area of interpersonal violence, and since
1996 has been the Director of the Research Program and Staff Development at the
Institute of Post Abuse Studies and Treatment, Psychiatric Institute of Washington.
Dr. Dutton holds the post of Research Professor at the Department of Emergency
Medicine at George Washington University Medical Center. Dr. Dutton has a large
number of publications, and affiliations to professional organizations to her name.
47
Dr. Nimesh Desai: is currently Professor and Head of the Department of Psychiatry,
and Medical Superintendent at the Institute of Human Behavior and Allied Sciences,
Shahdra, Delhi. His areas of interest are drug abuse prevention and treatment, HIV
prevention and management, community-based work and NGOs, and the
psychological and social aspects of health care.
Dr. R. S. Murthy: got his basic training in Medicine and Psychiatry from CMC
Vellore, and NIMHANS (National Institute of Mental Health and Neurological
Sciences), Bangalore. He is currently the Dean of NIMHANS, and is a WHO
consultant on Psychiatry and community mental health issues. He has pioneered the
community mental health movement, and has published widely on this subject.
Dr. Rajesh Sagar: is an Assistant Professor of Psychiatry at the All India Institute of
Medical Sciences at New Delhi, India.
Ms. Surinder Jaiswal: is a reader in the Department of Medical and Psychiatric
Social Work, Tata Institute of Social Sciences. Dr. Jaiswal’s area of interest is
research on women’s health, particularly public health and policy, reproductive and
sexual health, and the use of participatory qualitative research techniques for
researching ‘sensitive’ issues.
Dr. Thomas John: is an alumnus of the Christian Medical College and Hospital
(CMCH), Vellore, India, where he currently works at the Department of Psychiatry.
Dr. Vikram Patel: is a psychiatrist and epidemiologist working with an NGO in Goa'Sangath', which focuses its activities on emotional and developmental health
problems affecting children and families. He has been the recipient of a number of
research awards including the Rhodes Scholarship. Dr. Patel is a MacArthur
Foundation Population Program Fellow, and holds an appointment as Senior
Lecturer at the Institute of Psychiatry of Kings College, London. He is currently
writing, “Where There is no Psychiatrist”, a manual for village health workers.
WOMEN, VIOLENCE & MENTAL HEALTH MEETING
INDIA HABITAT CENTRE, APRIL 11-12, 1999
PARTICIPANTS LIST
1. Ms. Irma Saucedo Gonzalez
El Collegio De Mexico
Camino Al Ajusco No. 20
Codigo Postal 01000
Mexico, D.F.
MEXICO
2. Ms. Lynn Madalang
Cordillera Task Force on Violence
Against Women
362, EDNCP Building
Magsaysay Avenue
Baguio City
PH1LLIPINES
Tel: (52-5) 645 5955 ext. 4158
Telfax: (52-5) 573 2034 (R)
Email: isaucedo@colmex.mx
Telefax: (63-74) 445 4395
Tel:
(63-74) 443 7328
Email:cmjw@bgo.cyberspace.com.ph
3. Ms. Anusheh Hussain
Sahil
House # 3, Street 32, F-8/1
Islamabad
PAKISTAN
Tel: (92-51)260636/252534
Fax: (92-51)254678
Emaikahussain^comsats.net.pk
info@sahil.org
4. Ms. Sadia Iqbal
Sahil
House # 3, Street 32, F8/1
Islamabad
PAKISTAN
Tel: (92-51)260636/252534
Fax: (92-51) 254678
Email: sahil@comsats.net.pk
5. Dr. Halida Hanum
‘BIRPERTH’
House No. 105
Road 9/A (New)
Dhanmondi R/A
Dhaka, 1209
BANGLADESH
6. Ms. Le Thi Quy
Centre for Family and Women’s Studies
6, Ding Cong Trang
Hanoi
VIETNAM
Tel: (880-2) 9113034, 9110792 (O)
Tel: (880-2) 814 542 (R)
Fax: (880-2) 912376
Email:birperht@citechco.net
Tel: (844) 825 23 72 (O)
Fax: (844) 933 28 90
Email: ltquy@netnam.org.vn
7. Ms. Safia Azim
Naari Pokkho
91 / N, Road 7A
Dhanmondhi R/A
Dhaka 1000
BANGALADESH
8. Dr. Mary Ann Dutton
5507 Spruce Tree Avenue
Bethesda
Maryland
USA 20814
9. Ms. D. Jean Veta
Dy. Gen. Counsel
Office of the Gen. Counsel
US Dept, of Education
400, Maryland Avenue
SW Room 6E339
Washington D.C. 20202 - 2110
10. Dr. LaurieS. Ramiro
Padre Faura St.
Ermita
Manila
PHILIPPINES
11. Dr. M. Hafizur Rahman
BIRPERHT
House No. 105
Road 9/A (New)
Dhanmondi R/A
Dhaka, 1209
BANGLADESH
12. Dr. Bhargavi Davar
Bapu Trust for Research on Mind and Discourse
Brig. Grants Bungalow
1st Floor, Soona Lodge
16/A Shanker Shet Road
Pune 411 042
INDIA
Tel: (880-2)819 917
Fax: (880-2)816 148
Email:convenor@office.pradeshta.net
Tel:
(1-301)530 5657(0)
(1-301)530 1776 (R)
Fax: (1-301)530 1499
Email: mad@gwis2.circ.gwu.edu
Tel: (1-202)401 6000
Fax: (1-202) 205 2689
Email: Jean_Veta@ed.gov
Tel: (63-2) 939 1506
Email: lsramiro@pworld.net.ph
Tel: (880-2)9113034/9110792
Fax: (880-2) 812376
E-mail: birperht@citechco.net
Tel: (91-20) 659 969
Email: davar@pn2.vsnl.net.in
13. Dr. Anita Ghai
J 12/85 Rajouri Garden
New Delhi 110 027
INDIA
.Tel: (91-11-542 0507)
Email: anitaghai@vsnl.com
14. Ms. Anuradha Kapoor
Swayam
11 Balu Hakkak Lane
Calcutta - 700 029
INDIA
Tel: (91-33) 280 3429 / 280 3688
Telfax: (91-33)247 7906
15. Ms. Ruchi Sinha
Criminology and Correctional Administration
Tata Institute of Social Sciences
Post Box no. 8313, Sion - Trombay Road
Deonar
Mumbai 400 088
INDIA
Tel: (91-22) 556 3290-96
Telfax: (91-22) 556 2912
16. Ms. Piyali Mukherjee
Paripumata
5-B Maharani Swamamoyee Road
Calcutta
INDIA
Tel: (91-33)
17. Ms. Josefina Y. Oraa
# 36, First Floor, Block V
Eros Gardens, Charmwood Village
Surajkund Road
Dist. Faridabad
Haryana
INDIA
18. Dr. A. K. Shiva Kumar
21, Sultanpur Estate
Mehrauli
New Delhi 110 030
350 4073
Email: j_oraa@usa.net
Tel: (91-11)680 6492/647 3
Email: akshiva@unicef.delhi.nic.in
19. Dr. Rachna Johri
E- 70 C, Gangotri Enclave
Alaknanda
New Delhi 110 019
Tel: (91-11)622 7462
Email:ashrach@hukrit@axcess.net.in
20. Ms. Sagri Singh
The Population Council
India Habitat Centre
Ground Floor Zone5 A
Lodi Road
New Delhi 110 003
Tel: (91-11) 464 2901 / 464 2902
Fax: (91-11) 464 2903
21. Ms. Poonam Muttreja
The MacArthur Foundation
Core C, First Floor
India Habitat Centre
Lodi Road
New Delhi 110 003
Tel: (91-11)464 4006/461 1 324
Fax: (91-11)464 4007
Email: macarth@giasdl01.vsnl.net.in
22. Ms. Jill Clement
UNIFEM
228, Jor Bagh (Ground floor)
New Delhi 110 003
Tel: (91-11) 469 8297/460 4351
Fax: (91-11) 469 8297/ 462 2136
23. Ms. Leela Kasturi
CWDS
25, Bhai Vir Singh Marg
New Delhi 110 001
Tel: (91-11) 336 5541 / 3345530
Fax: (91-11) 334 6044
24. Ms. Urmila Bendre
Jagori
C-54, South Extension-II
New Delhi 110049
Tel: (91-11)642 7015
Fax: (91-11)645 3629
25. Ms. Geetanjali Misra
The Ford Foundation
55, Lodi Estate
New Delhi 110 003
INDIA
Tel: (91-11)461 9441
Fax: (91-11)462 7147
Email: sagri@pcindia.org
4
26. Dr. Vikram Patel
Sangath Centre
48, Defence Colony
Porvorim
Goa 403 521
INDIA
Tel: (91-832)214 916
Fax: (91-832) 215 244
Email: vpatel@bom2.vsnl.net.in
27. Dr. Apurva Shah
Tel: (91-79) 407 773
Email: antamad@usa.net
A Block, 2nd. Floor, Nobles Building
Opp. Nehru Bridge
Ashram Road, Navrangpura
Ahmedabad
INDIA
28. Dr. Deepa Braganza
Dept, of Psychiatry
Christian Medical College & Hospital
Ida Scudder Road
Vellore 632 004
Tamil Nadu
INDIA
Tel: (91-416) 262 603
Fax: (91-416) 262 268 / 262 788
Email:deepa@mhc.cmc.ernet.in
29. Dr. Shubhangi Parkar
Dept, of Psychiatry
The King Edward Memorial Hospital
Dr. Borges Road
Parel
Mumbai 400 012
INDIA
Tel:
30. Dr. R. Srinivasa Murthy
Prof, of Psychiatry & Dean
NIMHANS
Post Bag No.: 2900
Bangalore 560 029
INDIA
Tel: (91-80) 664 2121
Fax: (91-80) 665 2023 (R)
31. Ms. Ratnaboli Roy
Forum for Mental Health Movement
93/2 Kankulia Road
Flat A 302, Benubon
Calcutta 700 029
INDIA
Tel: (91-33)440 2241
Email: ssraha@cal.vsnl.net.in
(91-22)413 6051(0)
(91-22)410 1299 (R)
Fax: (91-22) 269 2806
(91-80) 663 1830(0)
Email: rnurthy@nirnhans.kar.nic.in
32. Dr. Thomas John
Dept, of Psychiatry
Christian Medical College & Hospital
Ida Scudder Road
Vellore 632 004
Tamil Nadu
INDIA
33. Ms. Sarah George
The Richmond Fellowship Society (India)
‘ASHA’, 501,47th Cross, 9th Main
Jayanagar V Block
Bangalore
INDIA
Tel: (91-416) 262603
Fax: (91416) 262268 Z262788
Email: tj@mhc.cmc.ernet.in
Tel: (91-80) 664 5583
Fax: (91-80) 664 5583
(91-80) 663 4138
Email: rehab.rfsindfeaworld.net
34. Ms. Yamna Satgunasingham
The Richmond Fellowship Society (India)
‘ASHA’, 501,47th Cross, 9,,’ Main
Jayanagar V Block
Bangalore
INDIA
Tel: (91-80) 664 5583
Fax: (91-80) 664 5583/6634138
Emaikrehab.rfsindfeaworld.net
35. Dr. Debashish Chatterjee
‘Mon’ Foundation
VIP Road, Kaikholi
Calcutta 700 052
INDIA
Tel: (91-33) 559 0887 / 559 0886
(91-33) 5516502 B
36. Dr. Mohan Isaac
NIMH ANS
Post Bag No.: 2900
Bangalore 560 029
INDIA
37. Dr. J.S. Bapna
Institute of Human Behaviour
& Allied Sciences
G.T. Road, Jhilmil
Delhi 110 095
INDIA
Tel: (91-80) 664 2121
Fax: 6652023 «■/ 6631830
Email:murthy@nimhans.kar.nic.in
Tel: (91-11)211 2136
Fax: (91-11)229 9227
38. Dr. Nimesh Desai
Institute of Human Behaviour
& Allied Sciences
G.T. Road, Jhilmil
Delhi 110 095
INDIA
Tel: (91-11) 211 3395
(91-11)686 4851 (o)
(91-11)616 6036 (r)
39. Dr. Rajesh Sagar
Astt. Prof., Dept, of Psychiatry
ARMS
Ansari Nagar
New Delhi
INDIA
Tel:
40. Dr. Veena Kapur
‘Samvedna’ Clinic
S-325, G.K.-II
New Delhi 110048
INDIA
Tel: (91-11) 647 1990
41. Ms. Akhila Sivadas
Centre for Advocacy & Research
1/3, Kalkaji Extension
New Delhi - 110 019
INDIA
42. Ms. Naina Kapur
Sakshi
B - 67, South Extension Part I
New Delhi - 110 049
INDIA
43. Shalini
Tarshi
49, II Floor
Golf Links
New Delhi - 110 003
INDIA
Telefax: (91-11)621 6345
Tel: (91-11)462 3295
Telefax: (91-11)464 3946
Email: sakdel@sakshi.unv.emet.in
Telfax: (91-11)461 0711 (admin.)
Email: tarshi@vsnl.com
44. Dr. (Ms.) Surinder Jaiswal
Reader, Dept, of Medical
& Psychiatric Social Work
Tata Institute of Social Sciences
Post Box no. 8313
Sion - Trombay Road
Deonar. Mumbai 400 088
INDIA
Teh (91-22) 556 3290-96
Telfax: (91-22) 556 2912
45. Dr. Anjali Dave
Dept, of Family & Child Welfare
Tata Institute of Social Sciences
Post Box no. 8313, Sion - Trombay Road
Deonar, Mumbai 400 088
INDIA
46. Ms. Jasjit Purewal
IFSHA
7540
J - 39, South extension Part I
New Delhi - 110 049
Tel: (91-22) 556 3290-96
Tel/Fax: (91-22) 556 2912
Telfax: (91-11) 464 8782/464
Email: ifsha@vsnl.com
The IFSHA team:
Ms. Srijata Sanyal
Ms. Indira Maya Ganesh
Ms. Devi Bhuyan
Ms. Javita Narang
Ms. Damini Narain
Ms. Saloni Puri
Ms. Advaita Marathe
Ms. Kavita Sharma
Ms. Ruma Gope
IFSHA
Interventions for Support Healing & Awareness
J - 39, South Extension Part I
New Delhi - 110 049
INDIA
Telefax: (91-11) 464 7540 / 464 8782
Email: ifsha@vsnl.com
WOMEN, VIOLENCE AND MENTAL HEALTH
"
April 11-12, 1999
The India Habitat Center New Delhi
Agenda
DAY ONE
11/04/1999
08:30 a.m.
Registration
09:00 a.m.
Introduction to the Workshop: IFSHA
SESSION I
CHAIRPERSON
Dr. Mary Ann Dutton
09:30 a.m.
Ms. Indira Maya Ganesh: ‘In search of her
spirit: Women. Violence & Mental Health! A
Report by IFSHA. Followed by discussion.
10:30 a.m.
Dr. Bhargavi Davar: ‘Impact of Violence on
Women’s Mental Health: Research Findings’.
Followed by discussion.
11:30 a.m.
Tea/Coffee
11:45 a.m.
Dr. Shubhangi Parkar: 'KEM’s Interventions
with Women Clients: Associating Violence with
Mental Health Issues.' Followed by discussion.
12:30 p.m.
Lunch
SESSION II
CHAIRPERSON
Dr. R. S. Murthy
2:00 p.m.
Dr. Sagar: ‘ Women & Depression
Followed by discussion.
2:30 p.m.
Dr. Mary
Ann
Dutton:
‘Using
Measurement Scales to Identify Domestic
Violence’. Followed by discussion.
3:30 p.m.
Dr. Thomas John: ‘Assessment of
Domestic Violence and its Correlation
with
Depression,
Followed
by
discussion.
4:00 p.m.
Tea/Coffee
4:15 p.m.
Open Session
DAY TWO
12/04/1999
SESSION 111
CHAIRPERSON
Ms. Irma Saucedo - Gonzalez
10:00 a.m.
Dr. Mary Ann Dutton: ‘Posttraumatic
Stress Disorder, Affectiyitv in Cases of
Domestic
Violence’, Followed by
discussion.
11:00 a.m.
Tea/Coffee
11: 15 a.m.
Dr. R. S. Murthy: ‘Reaching the Uit
reached - Approach to Devcloo Mental
Health care for Women in Distress’.
Followed by discussion.
11:45 a.m.
Dr. Nimesh Desai: ‘Contextual issues of
Mental Health in Domestic violence’.
Followed by discussion.
12:15p.m.
Dr. Surinder Jaiswal: 'Common Mental
Disorders in Low Income Urban Women
with Gynecological Morbidity'
Followed by Discussion
Dr. Anjali Dave:' Mental Violence in the
Family'
Followed by Discussion
1:00 p.m.
Lunch
SESSION IV
CHAIRPERSON
Dr. Mohan Isaac (NIMHANS)
2:00 p.m.
Ms. Irma Saucedo - Gonzalez:
‘Theoretical and Methodological Issues in
Therapeutic Interventions for Women &
Children in Domestic Violence: The
Feminist Approach'- Followed by
discussion.
3:00 p.m.
Dr. Vikram
Evaluation
Patel: 'Development &
Psychological and
Pharmacological
Interventions
for
Common Mental PisorderS-iiLjCeneral
Health: A ddressmgGender Issues^
3:30 p.m.
Dr. Apurva Shah:: Addressing Violence
against Women &
•*-. Children m Family
TherapyC
4:00 p.m.
Tea/Coffee
4:15 p.m.
Discussion on presentations
SESSION V
MODERATOR
Ms. Jasjit Purewal
4:45 p.m.
Recommendations:
Course ofActigm
5:15 p.m.
Chalking
out
a
that
Outstanding
Issues'.
Issues
participants think should have been
included in this process.
5:45 p.m.
Evaluating the Process.
6:15 p.m.
Vote of Thanks from JFSHA.
Position: 4702 (1 views)