Women, Violence and Mental Illness - Essay Example

?Women, Violence and Mental Illness Introduction In the long story of humanity, women have been relegated in the periphery of the human story, her voice, and story stifled and hidden, while history has been written. In fact, until the seventeenth century women are not considered as human beings as they lack the energy that makes the human being a human being –rationality, thus; they are not human enough (Gilligan, 1982). The continued exclusion of women as equal to women has become one of the primary factors that have contributed to women’s experience of violence in the home (Sokoloff and Dupont, 2005). Although there is already a rising awareness of violence against women, fact remains that almost a 12.9 million of women have experienced domestic violence in UK (Walby and Allen, 2004). In addition, 44% of victim of domestic violence are involved in more than just one (Dodd et al, 2004) and that women are assaulted by men they know (Walby and Allen, 2004). These data only represent the reported violence committed against women. It is assumed there are still more cases left undocumented because violence is generally perceived as underreported (Flink, Paavilainen, and stedt-Kurki, 2005). In this scenario, the continued experience of violence against women is an attestation of the unremitting struggle of women for inclusion in the public sphere (e.g. Jaggar & Young 2000; Tong 2000). In this context, this study will attempt to address the issue of how socio-political factors influence mental health. Several identified socio-political factors affect mental health. It includes race, ethnicity, gender, and other similar concepts that have been constructed to distinguish and differentiate one person from another (Giddens and Sutton, 2010). For this study, it will focus one pivotal socio-political factor – gender. Being a woman is in itself entails being excluded in one form or another and experiencing oppression in varying degrees (Tong, 2000). One almost becomes insubstantial, dehumanize, or reduce as an object of gaze, an object (Firestone, 2003). The continued violence committed against women by their partner who is also known as the intimate partner violence (IPV) is one of the leading violence committed against women (Watts and Zimmerman, 2002). Intimate partner violence includes physical and sexual violence, threats of violence and psychological and emotional abuse. The perpetrator may be a current or former spouse, boyfriend/girlfriend, or dating partner (Watts and Zimmerman, 2002). Numerous studies have shown that women abused by partners or by other perpetrators are more likely to suffer from depression, anxiety, headache, gynaecological and sexual problems, PTSD, eating and digestive disorders, infections, musculoskeletal disorders, and chronic pain; they are more likely to attempt suicide, to abuse alcohol and legal and illegal drugs (Campbell, 2002; Koss et al., 2003; Krug et al., 2002). Battered women or women suffering from violence are also women subjected to psychological illness or distress. In this situation, women become the “embodiment of a “problem” which must be resolved or eliminated” (Tremain, 2008, p 102). Gender as a factor that affects mental illness increases the stigma of mental illness, widens, and deepens the experience of discrimination and injustice, if it is experience by a woman. As such, women become more isolated and left voiceless because socio-political factors have become the instruments that perpetuate her continued oppression and dehumanisation as she suffers from. It is a triple burden that women carry alone and in isolation for, they have become “the deviant Other which in turn eliminates the possibility of mutuality (Stocker, 2001, p 49). The Woman’s Voiceless Call The life of a woman is permeated by concerns associated with psychiatric disorders, from her menstruation, through her pregnancy, in her post-partum period until her menopause (Kornstein and Clayton 2002). Prejudice and stereotyping are typically associated and created base on the gender of the person (Tong, 2000). Social expectations are made on women. These are based on gender functions construed by society and are constrictive of the women’s being (Brown et al, 2000). Being a woman with mental illness creates a vulnerated condition for women (Kottow 2004) which society considers as undesirable; unfit (Garland-Thomson 2005). In this regard, there is a need for all health care providers, to come up with health care plans that will address the ‘triple burden’ experiences of women. There is urgency to reframe the mental health approach for these patients from their perspectives, from their narratives and in their own context. However, there is immense disparity regarding this position. Although care providers agree that there is urgency to see patients from their own paradigm and as a human person with dignity, unfortunately, only a few are truly and authentically practising this ethos (Griner and Smith 2006). Western Psychiatry, which is the dominant frame in mental health (Burr and Chapman 1998), asserts that mental illness is associated with physiological incapacity (Burr and Chapman 1998; Rose et al. 1984). P1, a Christian shares, “I thought when we get married everything will be ok. But I have soon realised I did not marry a man. I married a beast lower than a beast. He would hit me for no reason at all. He would repeatedly hit my head against the walls if I refuse. I was his sex- slave, doormat, a piece of furniture. He was the king and I was nothing. I do not know anymore, everything was shattered. Everything is lost.” Women’s meanings and being are not removed from the various relationships she creates and establishes as she lives her life. These meanings are not removed from her lived reality but are intrinsically embedded in her notion of self (Gilligan, 1982). The search for ‘balance’ is complex and cumbersome as P1 negotiates the reality that she is a battered woman that suffers from mental illness. P1 has opened the door wherein she is calling for help. Her experiences are not easy to share because they are very private. The medicalisation of her mental illness will only confound her situation and will not alleviate the fear, the anger, the guilt, the distress and the helplessness that P1 feels. In this context, the nurse is challenged to bear witness to the authenticity of reality and pain of P1 (Naef 2006). Being not taken for granted, being listened to, and being there for P1 establish the fertile ground for the development of a trustful nurse-patient relationship (Naef 2006). In order to bear witness to P1 context and reality, the nurses tried to be there when she needs a carer and a person that is truly willing to listen. This is done by showing genuine concern on her plight, by taking the time to be actually there for her, re-affirms her humanity and dignity. In this way, mental health nurses, become the respectful nurse as they see the patients not as ‘deviant others’ but persons in vulnerated condition. Considering the triple burden that P1 is experiencing, it becomes apparent that the manner in which the patient conveys her feelings and sentiments may not be as succinct and definitive others. With the experience of violence, many women find it difficult to trust and open up (Swan and Snow, 2006). Recognising this limitation, one approach that has been adopted was to use other means of communication when words become inadequate to describe their condition. Drawings were encouraged, writing stories, and poems, paintings, composing songs or allowing them to play the instruments that they like and other similar ways in order to reach out to her. In one discussion with P1, P1 wrote. Sadness overwhelms me Sadness overwhelms my being Yet I have to embrace This sadness in me For it is me In this poem, the internal struggle of P1 becomes evident and in response to this call for help, the team has to face the challenge of creating the caring and safe space for P1 (Covington 2005). The idea of caring space is providing the patient with the caring presence of the nurse and other health care providers as P1 undergoes the anguish and the pain cause by her psychological illness resulting from being a victim of IPV. The caring presence and bearing witness to the authenticity of the patient’s context and reality (Covington 2005; Naef 2006) provides a theoretical foundation wherein nursing care in mental health may be founded. It is a monumental challenge, but the team realizes and knows that caring presence and bearing witness do not require heroic acts. Rather, it can be manifested by a simple pat on the shoulder, by being honest and true to the patient as we asked them how are they feeling, by not being afraid to open one’s self to the patient and by being personal. In this way, the nurse and the patient encounter becomes “supreme test of solicitude, when unequal power finds compensation in an authentic reciprocity of exchange, which in the hour of agony, finds refuge in the shared whisper of voices, or the feeble embrace of clasped hands.” (Ricoeur, 1992, p 191). Finally, the ‘triple burden’ that P1 is carrying places her in a further vulnerated condition wherein she suffers from an increase risks of mistreatment and misdiagnosis (Gary, 2005). Likewise, due to prejudice and discrimination, there is also the increase risk of not seeking mental help since, it seems, nobody honestly tries to understand (Swan and Snow, 2006). In this regard, the ‘triple burden’ aggravates the situation of patients like P1. Its negative effect to the patients includes mistreatment, misdiagnosis, and unequal access to quality health care, discrimination, and injustice. As such, patients like P1 choose not to avail the health care services offered and decides to solve their anguish and pains by themselves. Thus, failing the people who are in most need of the actual health care service. The case of P1 is the empirical evidence for the necessity of caring presence and bearing witness to the authenticity of the patient’s pain. However, the caring presence and bearing witness can be fruitfully undertaken if the care encounter is suffused with honesty, an open communication and respect (Gallagher, 2007; Tuckett, 2005). Respect is manifested by “being true to the person” (Naef, 2006, p. 49) and by caring behaviour which entails significant technical skills, activities and attitudes as nurses provide the caring and safe space that P1 needs ardently (Gastmans, 1999). Conclusion Being a woman with mental illness is a ‘double burden’. The person is discriminated because of two factors –gender and mental illness. A battered woman with mental illness is in greater risks of being relegated in the periphery of the society because nobody is willing to understand genuinely the context and condition of the person. Discrimination and prejudice that leads to mistreatment and misdiagnosis creates a wider divide that continues to stifle the voice of the ‘deviant other’. Women in this vulnerated condition are left without a choice, to suffer their pains and anguish all alone. In this regard, nurses’ caring presence, bearing witness, and respect support the arena wherein the possibility of women carrying the ‘triple burden’ be heard. This is no easy task as experienced, but turning into reality caring presence, bearing witness and respect do not require enormous heroic acts. It only asks for simple and caring encounter that is genuinely taken with a sincere smile, with honesty, with openness, and with the appropriate skills, talents and activities that ensure the patient’s holistic well-being. It is in this way that nurses can authentically respond to the call of patients that are suffering from ‘double burden’ and give them the opportunity to be genuinely heard and be treated as an equal in the arena of friends. References Brown, T., Williams, D.R., Jackson, J.S., Neighbors, H. W., Torres, M., Sellers, S.L., & Brown, K., 2000. 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