Dear friends
While 90% of my letters get published in publishaletter, this one did not. I wonder why
As a person who was not depressive the first 28 years of my life (worked in a grass roots constructive development NGO called MYRADA from 22 to 26 years, and then went to study abroad) and now at age 48 I am more or less out of depression, I wonder why there is little concern in MDGs about mental health or addressing its underpinning causes.
To use neo liberal language so many 'life years' are lost due to mental ill health. I lived 20 years in mild depression, now it is tapering down. Is mental health missing from MDGs because it is perceived as a private good, and not a communicable disease?
The WHO Mental Health Atlas, 2005 which covers 192 countries does show a slight increase in the total number of psychiatrists from 3.96 to 4.15 per 100 000 people worldwide, distribution across regions ranges from 9.8 in Europe to just 0.04 in Africa. This disparity has increased since 2001. The Atlas notes that many countries continue to spend only a very small proportion of their total health budget on mental health. One fifth of the more than 100 countries supplying figures to the survey spend less than 1% of their health budget on mental health. This is in stark contrast to WHO's estimate that 13% of all disease burden is caused by the wide range of neuro-psychiatric disorders http://www.who.int/mediacentre/news/notes/2005/np21/en/index.html
Causes of mental health, apart from genetic include several environmental factors. This includes living in a highly competitive world and internalizing competitive norms.
There are gender differences in mental health. Unipolar depression, predicted to be the second leading cause of global disability burden by 2020, is twice as common in women. The lifetime prevalence rate for alcohol dependence, another common disorder, is more than twice as high in men than women. In developed countries, approximately 1 in 5 men and 1 in 12 women develop alcohol dependence during their lives.Men are also more than three times more likely to be diagnosed with antisocial personality disorder than women.There are no marked gender differences in the rates of severe mental disorders like schizophrenia and bipolar disorder that affect less than 2% of the population (WHO, N.d, Gender and Mental Health http://www.who.int/mental_health/prevention/genderwomen/en/).
The social expectations of men to be the bread winner does put pressure on them, and crisis in masculinities amongst the very poor men (blacks, dalits, agricultural labourers, marginal farmers, unorganised workers etc) leads to depression, substance abuse which in turn enhances depression. It is a vicious cycle. Violent and high risk behaviors are higher amongst men than women
On the other hand women have their own set of issues. As a south Asian upper caste women married to a mulsim- highly patriarchal- the socially expected roles of being a good daughter, wife, daughter in law, sister, sister in law, mother etc are indeed enough to put pressure on any woman. The invasion on privacy is high, while of course social support system is good. Questions were raised when on facebook I put " in a relationship" while living and loving Mustafa whom I am married to. As far as I went it was nobody's business. Questions were raised when we named our child Armaan Ranjani Mustafa- after all I gave birth to him. Patriarchal expectations are also high of women in Japan, Republic of Korea, China and several Latin American countries, and resurfacing in transition economies. Not that the problems of women are any less in developed countries. . Broken families and single parenting create their own problems.
Renegotiating these relation positions and claiming my humaneness from its margins has indeed helped in the last one year. Further, the schism of working on international development (for 10 years) where one saw poverty and inequalities and came back to high material comforts was too much, as well as earning in dollars. Having quit paid work except to pay my capital appreciation taxes and putting my experiences and education gained due to upper caste and class privileges to just causes, I am now able to sleep better with clearer conscience and much reduced medicines. The dichotomy between poverty, inequalities, injustices lack of economic rights and violence against poor women (heterosexual and of people diverse sexual and gender identities) and liberal feminist discourses on sexual pleasure, dancing in nude if India wins a cricket match and right to pubs was another chasm
But one can change only what is under one's control -when my child after age five came back and said "I am a boy, do not dress me in pink" (whatever be my ideology), when the census came and asked " who is the head of the household", when I see people being sacked overnight from jobs by corporates, when I see poor women harassed and told to sell their bodies and repay loans which I get much cheaper, dalits denied common burial ground or entry into temples, slum dwellers evicted for projects funded by the World Bank, and communal fights breaking out for no reason and so on I am left to wonder how much cause of mental ill health is genetic, how much due to society and its institutional norms and how much is due to personality disorders.
Ranjani.Kamala Murthy
Researcher and Activist
Dedicated to poor women and men who live with depression due to construction of gender, caste, and other injustices they face; to my mother, Mustafa and Armaan for loving me unconditionally; to mustafa's parents and my family members for calling me yesterday and wishing us on our civil anniversary and coming to grips with my <$2 a day feminist views; to Fatima, Geeta (unorganized workers) and Arul National Alliance of People's Movement who are my new friends; to Gandhimathi, Mercy, Visthar and MYRADA present/alumni my old friends; to ARROW for wanting me on their Advisory Committee irrespective of my position on <2 per day feminism and SRHJ, and to my inter-faith spiritual sujourns (Anurakta, Soka Gaki International, Beulah, Meera Bhajans and Sufi music) Last but not the least to Dr Rangaraj for acceptance and telling me when my thinking was right and wrong and my acupuncturist Radha and Malini my qi gong teacher.
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