Women and Mental Health

May 1-7 has been Mental Health awareness week.

One in three Americans struggles with mental illness but the rate is much higher in women.  Research shows that women are 40% more likely to develop depression than men.  It is not clear why mental illness is more common among women but doctors have come up with a number of possibilities.

Discrimination, Trauma and stressful life experiences

Trauma is common among women with half of them experiencing some form of trauma in their lifetime.  One in four women have faced an attempted or a completed sexual assault.  Reportedly, one in three are abused by a domestic partner.  Gender discrimination, violence and mistreatment undermine a woman’s mental health.  Stress is a predictor of mental illness.  Women juggle housework, kids even while working fulltime.  They report that they have to work harder to get the same credit as men and worry about the gender wage gap.  They have to deal with sexual harassment and discrimination in workplaces where these are commonplace.  These challenges can significantly affect a woman’s ability to cope and her self-esteem.

Hormonal Issues

Women produce lower quantities of serotonin than men due to differences in hormone levels and this deficiency can lead to mental health issues such as depression and anxiety.

Pregnancy, Birth and Parenting

41% or women suffer from some form of postpartum depression.  Some of them are overwhelmed by the demands of parenting, especially in the early days.  I remember that there were times when I felt that I was drowning–in over my head.  Once I even cried out while I was holding my toddler.  Thankfully I had God and a very supportive partner.  It helped when he came home and I had an adult to talk to. Not all women are as blessed.  Research shows that women who don’t have supportive partners, experience traumatic births, live in poverty or a highly stressed will most likely develop postpartum depression.  

Gender bias is another problem women face.  Some research suggests that doctors tend to label women’s symptoms as emotional while taking the men’s symptoms more seriously.  So, a woman who reports that she is experiencing chronic pain to her doctor might be labeled as depressed.  This happens because we live in a world where gender discrimination exists and women are seen as more emotional and less rational.  

In many countries, the way health workers spoke to the women made it difficult for them to disclose their psychological and emotional distress.  And when they worked up the courage to disclose their problems, they were either over-treated or under treated by many of the health workers.

I read in an article in The Globe And Mail that women are getting the prescription that is available more often than the treatment they need.  They are getting medication to solve their problems even when science finds that treatments such as psychotherapy is equally or in some cases more effective without the side effects.  Bias in mental health care is a hindrance to women, preventing them from getting the proper help they need.  Not much effort goes into researching how drugs affect female patients.  While drug companies like to bombard women with their pills, most of their clinical trials have been dominated by men.  And the ironic thing is that the disorders most commonly diagnosed in women such as depression, anxiety and insomnia are the ones most likely to respond to therapy.  Most women are likely to prefer therapy over drugs.  

According to Dr. Marina Morrow, a Simon Fraser University psychologist who studies gender and mental health, “Women aren’t getting access to the range of care they need.”  She believes that an effective approach to this would be to include medication when necessary but in also offer therapy, peer support and pinpoint what social circumstances lead to the illness.

It has been argued that therapy is the safer, more effective and cheaper choice.  The authors of a 2015 study by Canadian and U.S. researchers concluded that, “There remains no sound justification to prescribe drugs without first trying therapy.  Dr. Cara Tannenbaum, scientific director of the CIHR Institute of Gender and Health, believes that “the way we fund therapies in Canada does not make sense right now.”  She wrote a letter to Quebec’s health minister to make the point that even if 20 per cent of seniors with insomnia received Cognitive Behavioral Therapy (CBT) with is used to treat insomnia, the cost-savings to the system could be in the hundreds of millions, based on the potential falls that would be avoided.  Therapy saves on costly and debilitating falls and hip fractures.  

We live in a country where medication is favored over psychotherapy and women are more likely than men to be prescribed antidepressants and sedatives as seniors and as a result they are at a higher risk of suffering from adverse effects.  Hopefully more women and those in the medical profession will speak out against the bias that is prevalent in the mental health care.  Doctors and those in the health care system need to give women more choices when it comes to treatment.  It’s their health so they should have the right to determine how they want to proceed once they have been diagnosed.

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Service: When Women Come Marching Home

Last month, my husband and I watched this documentary about women veterans who bore the scars of war.  They suffered from post traumatic stress syndrome, sexual assault, rape and homelessness.  CPL (ret.) Sue Downes lost both of her legs and was struggling to get the help she needed to integrate back into life.  She had her legs blown off above the knees and she got no support from the government.  We watch these women as they struggled to regain their lives–normalcy.  There was nothing there for them.  There were no jobs–most of them are incapable of finding jobs.  They had psychological problems.  They were physically disabled.

It was hard to watch these women who served their country–the double amputee went through both Iraq wars–not getting the support in integrating back into civilian life.  One woman who had a psychological problem and it took three months for her to be assigned to an officer who would actually listen to her case.  One woman who was physically injured and didn’t want to be a burden to her husband, was yelled at because she had a service dog in a grocery store.  Sue Downes encountered problems when she went into a fast food place with her service dog.

It was heartbreaking  to see that one of these incredible women still felt like a failure in spite of the fact that she was doing her Masters after completing her Undergraduate Studies.  It was encouraging though, to see two of the women who suffered from psychological problems take charge of their lives by venturing out instead of being isolated in their homes.  One of them who graduated from college.

I watched a documentary on the rape and sexual assault of women in the US military on Independent Lens and the lack of support they receive.  They are treated like they are the criminals and it broke my heart to see one woman’s husband actually break down and cry because his wife was raped by her commanding officer and his friend.  The women who tried to file reports on what happened were made to feel that what happened was their fault.  One was criticized for the way she was dressed.  Another was told that she would ruined the life of the man who raped her–he was married.

Many of these rape victims find themselves forced to choose between speaking up and keeping their careers.  Very few cases that are reported are prosecuted.  Women are left with the shame of what happened to them and not being taken seriously.  Their rights are violated again when they come forward with their stories and they are reprimanded or treated like the enemy.  These women who gave their lives to serve the military have to struggle to rebuild their lives and fight for justice.

I hope that bringing to light this shameful secret of the US military and the stories of these brave women in the Oscar and Emmy nominated documentary, “The Invisible Warwill make a difference.  “We hope the film will affect lasting changes in the way the military investigates and prosecutes sexual assault crimes and supports and cares for assault survivors,” said Kirby Dick. To that end, “The Invisible War” is a call for our civilian and military leadership to listen — and to act.

To find out more about the makers of this movie, check out their website at http://servicethefilm.com/filmmakers.php

I hope that those of you who have not watched the movie, will find a way to do so and spread the word.

Source:  http://www.marketwire.com/press-release/the-invisible-war-premieres-on-independent-lens-on-monday-may-13-2013-on-pbs-1789562.htm

Rape in South Africa

I barely caught the headline about a South African girl who was raped and badly beaten.  I searched for the story on the Internet and came across some startling information.  Apparently South Africa is known as the “rape capital”.  According to Women’s groups, a woman is raped every 26 seconds.  The rate of sexual violence in South Africa is among the highest in the world.

For the period 1998–2000, South Africa was ranked first for rapes per capita according to the United Nations Office on Crimes and Drugs for the period 1998–2000.  It is estimated that over 40% of South African women will be raped in their lifetime and that only 1 in 9 rapes are reported.  It is also estimated that 14% of perpetrators of rape are convicted in South Africa.  According to a survey that questioned rape victims who did not report the crime to the police, 33.3% of victims cited they feared reprisals, 9.6% cited that they felt the police would not be able to solve the crime, and 9.2% cited embarrassment as their reasons for not reporting the crime.

There are several different forms of sexual violence, including, but not limited to: rape or sexual assault, child sexual assault and incest, intimate partner sexual assault, unwanted sexual contact/touching, sexual harassment, sexual exploitation, revealing one’s genitals to another without consent, public masturbation, and voyeurism.  There are several types of sexual violence cases in South Africa that have specifically garnered a significant amount of international attention:

South Africa has the highest reported incident of rape in the world.  While men are also subjected to sexual violence and 3.5% of men have been forced to have sex with other men, the majority of sexual violence is against women.  The South African government reports that one of these reasons is the culture of patriarchy in South Africa. Its report states that patriarchy is firmly rooted in the country and fighting it is seen as attempting to destroy African tradition or Afrikaner ideals.  The danger from rape and sexual assault is compounded because of the prevalence of HIV/AIDS in South African townships. A woman being raped over the age of 25 has a one in four chance that her attacker is HIV positive and more women than men are affected from HIV/AIDS.   The perpetrators of rape in South Africa tend to be men known to the victim.  It is reported that a husband or boyfriend kills a woman every six hours in South Africa.  Many men and women say that rape cannot occur in relationships; however, one in four women reported having been abused by an intimate partner.

Corrective rape is prevalent in South Africa.  More more than 10 women per week are raped or gang-raped in Cape Town alone because of their sexual orientation.  31 have been died from their attacks.  Two years ago Noxolo Nogwaza , 24 years old was raped, beaten and stabbed to death on her way home from a night out with her friends in the South African township of Kwa Thema on 24 April 2011.  Her brutalised body was dumped in a shallow ditch.  It is believed that the motive was her sexual orientation.  Little progress is made on her case and her attackers still remain at large.

There is also the problem of sexual violence in schools.  girls from all levels of society and ethnic groups have been subjected to sexual violence at school in bathrooms, empty classrooms, dormitories, and more. Police, prosecutors, and social workers have also complained that many incidents of sexual violence in schools are not reported to them because schools often prefer to deal with it internally, thus hindering justice against the perpetrators. The danger of sexual violence in schools has created a barrier for girls to seek education. HRW also reported that South African girls’ school performance suffers after an incident of sexual violence.

Societal attitudes contribute to this epidemic.  The Medical Research Council states, “Many forms of sexual violence, particularly sexual harassment and forms of sexual coercion that do not involve physical force are widely viewed as normal male behaviour.”

Among children, a survey by CIET found 60% of both boys and girls, aged 10 to 19 years old, thought it was not violent to force sex upon someone they knew, while around 11% of boys and 4% of girls admitted to forcing someone else to have sex with them. The study also found that 12.7% of the students believed in the virgin cleansing myth.

In a related survey conducted among 1,500 school children in the Johannesburg township of Soweto, a quarter of all the boys interviewed said that ‘jackrolling’, a term for gang rape, was fun.  Furthermore, more than half the interviewees insisted that when a girl says no to sex she really means yes.  It is also noteworthy that those in this study were school children as age is significantly associated with rape. Men from ages 20–40 are more likely to have raped than younger or older men.

Market Research Africa, a Johannesburg-based market research agency, reported in 1994 that 76% of men felt that women had a right to say no to sex, one third thought that women could not decide for themselves on abortion, and 10% condoned a man beating a woman or his wife.

I can’t imagine why anyone would think a woman means “yes” when she is fighting off the man’s unwanted attention.  “No” means “no”.   No woman wants to be forced to have sex with anyone.  Sex is supposed to be consensual.  And rape is not sex.  It is an act of violence.  The 17 year old girl was brutally raped.  The Cape Town newspaper, Cape Argus newspaper stated that she was sliced open from her stomach to her genitals and then dumped as if she were trash on a building site in the town of Bredasdorp, 130 km (80 miles) east of Cape Town.  What is going to become of this?  Will there be justice for this victim in a country where rape has lost its power to shock?  The government of the Republic of South Africa is aware of this problem of sexual violence against women and there is a law which is supposed to ensure rights of all of the people in South Africa with the democratic values of human dignity, equality and freedom.  Furthermore, it calls for the right to freedom and security, including freedom from all forms of violence by either public or private sources and the right to bodily and psychological integrity, including reproduction and bodily security.

It seems to me that the law has very little effect on the violence it is supposed to be protecting its women  from.   The harsh reality is that women are being brutally raped and abused and are not receiving adequate psychological, social, or medical care.  There are few places rape and abuse victims can turn.  The Simelela Centre is one of those places.  It was established in 1998 in response to a case involving the rape of a 1-year-old girl at the hands of her father in Khayelitsha’s Site C.

Something needs to be done and fast.  Women should not be living in fear.  Imagine the fear of your son growing up and one day raping your neighbor’s daughter?   The way men view women has to change.  The law has to do more to protect women and girls.  It’s time for the lawmaker to fulfill their promises.

Outrage grows over the incident, according to a news report on CNN.  Many marched the streets of Bredasdorp toward the crime scene, chanting, “No violence! No violence.”  Residents say that this attack is uncharacteristic of the rural town.  I read that the girl’s injuries were so horrific that the hospital staff who battled to save her life needed counseling.  She was able to identify one of her attackers before she died.  He was a family friend. The victim’s aunt had this to say about him, “He was a lovely child to have in the house.  He was her friend, and it’s just incomprehensible.”

He and two others have been arrested.  More arrests are forthcoming.  Two of the men arrested have been charged been charged with murder and rape, the same charges the third will face.  Let’s hope that they all will be brought to justice.  It’s unfortunate that it had to take this young girl’s horrific ordeal and subsequent death to spark outrage.  There was the case of a mentally handicapped girl, same age as this last victim was raped by seven men, aged between 14 and 20 and the attack was recorded on a cell phone video which later went viral.  The men are on trial.  Unfortunately, this incident failed to gain the same outrage and attention as did the gang rape in New Delhi.  Columnist Rachel Davis of the online publication, Daily Maverick, raised this disturbing question:  “If the gang-rape of a mentally handicapped 17-year-old failed to get thousands on the streets in protest, what will?”

The men of South Africa need to stand up with the women and speak out against this epidemic.  The perpetrators of these crimes need to be brought to justice and women and girls need to feel safe in their communities.  Girls should be able to go to school and learn in a safe environment.  Their education is important.  They should not be forced to stay out of school because they are afraid of being attacked.  Girls should not have to live in fear of being brutally raped by strangers or even men they know.  Women should not be treated as if they have no value.  Violence against women and girls needs to be taken seriously and the public needs to make as much noise as possible, letting the government and the perpetrators know that they have had enough.  Let us join the men and women of South Africa and say, “No more violence!”  In the words of one of the women from Bredasdorp, “…we must do something.”  No more silence.  It’s time to take action!  Let the death of Anene Booyson count for something.

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Sources:  http://en.wikipedia.org/wiki/Sexual_violence_in_South_Africa; http://www.ndtv.com/article/india/south-africa-girl-dies-after-rape-comparison-made-to-indian-case-327511; http://www.guardian.co.uk/world/2013/jan/06/ana-matronic-backs-amnesty-write-for-rights-campaign; http://www.asafeworldforwomen.org/domestic-violence/dv-africa/dv-safrica/1386-violence-against-women-in-contemporary-south-africa.html; http://www.cnn.com/2013/02/08/world/africa/south-africa-gang-rape/index.html; http://www.reuters.com/article/2013/02/06/us-safrica-rape-idUSBRE9150VZ20130206

Hymen Reconstruction

This week on the Ricki Lake Show, I learned about women having their hymen reconstructed.  I never knew such a thing existed.  Check out this clip from the show.

Melody Meozzi, an Iranian-American Muslim writer and attorney, is a staunch opponent of hymen reconstruction.  She believes that it further contributes to violence against women.  She goes head to head with with Dr. Robert Moore, an internationally recognized Laparoscopic and Vaginal Reconstructive Surgeon who has operated on patients from all over the US and the world.

Hymen Repair Surgery, termed as Hymenoplasty is a simple surgery to restore virginity of women owing to the religious, cultural and ethnic reasons. The surgery repairs the hymen after it has been ruptured during sexual assault, agreed intercourse, sports, falls or insertion of tampons.

The Hymen Restoration Surgery takes up to 30 minutes to an hour. The surgery is performed under local anaesthesia with sedation or general anesthesia. It involves stitching of the edges of the remaining hymen together. Soon after this the hymen heals and the ruptured hymen grows back to a hymen similar to one in virgin girls. With hymen restoration, vaginal walls also tighten up.

Such procedures are not generally regarded as part of mainstream gynecology, but are available from some plastic surgery centers, particularly in the USA, Japan and Western Europe, generally as day surgery. The normal aim is to cause bleeding during post-nuptialintercourse, which in some cultures is considered proof of virginity.

I came across an article on the BBC News website about women in Asia and the Arab world who risk being ostracized or death because they had sex outside of marriage.  Many of them are undergoing surgery to reconnect their hymen so that there is blood on the sheets on their wedding night.  Others have committed suicide because of the unbearable pressure and the fear of being found out.  Read their stories.

Hymen reconstruction surgery is performed in China as sexually active Chinese women are pressured by their new husbands.  This procedure is also done in Canada.  There were lots of websites promoting hymen repair, reconstruction.  There was even a website called Hymen shop where they sell artificial hymen.

There is so much information out there about hymen reconstruction.  If you or someone you know is considering this procedure, educate yourself first.  Seek counselling.  Don’t let anyone pressure you into having the surgery.  This decision is yours alone.

Sources:  http://en.wikipedia.org/wiki/Hymenorrhaphy; http://www.weirdasianews.com/2010/09/14/hymen-reconstruction-surgery-price-virginity/; http://www.indicure.com/articles/hymenoplasty-procedure-outcomes-cost-hymen-restoration-surgery-in-top-hospitals-clinics-in-india.html; http://www.rnw.nl/english/article/hymen-reconstruction-doesnt-work;