"Marginalized groups that hold lower positions within social hierarchies experience greater levels of mental distress than those who hold more advantaged or higher positions."
- Emma Salem
Who are the marginalized groups in India?
The
term ‘marginalization’, literally meaning exclusion, was coined by Robert Ezra
Park, in his article, ‘Marginal Man’ in 1928. Marginalized groups are therefore
living on the fringes of society, excluded from mainstream communities. India’s
society is built on hierarchies. No matter where in India, all things living,
from people to social groups, are ranked based on a variety of essential
qualities. People are categorized according to caste groups, religion, social
class, socioeconomic status and gender. So, which communities are seen as
marginalized in India? These include those in the scheduled castes, scheduled
tribes, women, children, non binary or sexual minorities, Indian Muslims, and
so on. In India, these marginalized groups make up the majority of the
population. Dalit, a term that symbolizes oppression, represent the scheduled
castes in India. There are currently over 160 million Dalits living in India,
and around 80% are living in rural areas, and are more exposed to poverty than
other castes. Thus, these marginalized communities in India are subject to more
mental distress or mental disorders than those in more privileged positions,
due to the segregation they face on a daily basis, the subjugation from upper
castes and classes, and the lack of opportunities available. Moreover, it is
also notable that the lack of knowledge, education and awareness of mental
health and mental disorders is prevalent within these disenfranchised groups.
Many may not even be aware they are suffering from mental illnesses, nor have
the means to access medical help, making it difficult to treat and pinpoint.
WHO estimates that about 56 million Indians suffer from depression, and 36
million have anxiety disorders; if further action isn’t taken, the problem will
only worsen.
Power
struggles throughout Indian history
Throughout
Indian history, those at the bottom of society’s hierarchy are, and have been,
subject to subjugation, suppression and inequality. Within the caste system,
the Dalits, or ‘untouchables’, are forced to live on the margins of society for
reasons that are out of their control; one’s purity and pollution. Similarly,
other outcast groups, like scheduled tribes, women, non binary people, Indian
Muslims and children face this prejudice and exclusion regularly. Therefore,
India’s hierarchical system has continually created tensions and problems
within society, as it perpetuates unjust treatment towards lower castes and
groups, leaving them vulnerable to mental distress. Caste-based conflict stems
from the practice and custom of ‘untouchability’, literally meaning, those of a
higher caste would be polluting themselves if they had physical contact with
such person. This conflict is rooted in the beliefs that the Dalit's and upper
castes should remain segregated, in personal and occupational settings. The
disenfranchisement of scheduled tribes is of a similar root to scheduled
castes. This marginalized group faces segregation based on ethnicity. Scheduled
tribes represent around 84.3 million of India’s population, and the majority of
this community work as agricultural laborers, industrial laborers or casual
laborers. The clear separation of the Hindu upper classes and castes, and the scheduled
tribes and castes has resulted in poverty, lack of education, poor mental and
physical health conditions and limited access to treatment. Due to this
oppression felt by these marginalized communities, mental distress levels are
higher and more pervasive, than those coming from a privileged group. Power
struggles between Hindus and Muslims are also strong and prevailing in India’s
society today. Despite many Indian Muslims being Hindu descendants that have
converted to Islam, the majority of Hindus in India view Muslims as outsiders,
and feel they do not belong on Hindu soil. Tensions between these two religious
groups have continued to grow, and Muslims feel increasingly marginalized in
India. Hate crimes and attacks on Muslims have increased over the recent years,
alongside Islamophobia. It is no surprise that Indian Muslims, who experience
social and economic discrimination, are at risk of mental health problems.
Mental trauma of marginalized communities
As
noted earlier, those in marginalized groups, such as scheduled castes,
scheduled tribes, and Indian Muslims, face exclusion in their social and
occupational lives, due to having ‘undesirable’ traits. Discrimination and
disenfranchisement deprive these communities of accessing basic human rights, such
as education and healthcare treatment, to name a few. 40.6% of scheduled tribes
have been found to live below the poverty line in India, and 41% are
illiterate. Moreover, 1/3 of people in scheduled castes remain poor. A lack of
education, literacy and also poverty are all significant contributing factors
as to why these groups are more exposed to mental illnesses. Gupta and Coffey
conducted research in May 2020 on ‘Caste, religion, and mental health in
India’. Their participants included higher caste Hindus, scheduled caste
members and Indian Muslims. Their research concluded that: “About 41% of higher
caste Hindu respondents, 46% of Scheduled Caste respondents, and 51% of Muslim
respondents reported being mildly, moderately, severely or extremely depressed
in the last month. 57% of Scheduled Caste respondents, and 60% of Muslim
respondents reported facing anxiety in the last month.” It is evident from
Gupta and Coffey’s findings that those that suffer from marginalization in
Indian society have a higher risk of mental distress disorders, such as
depression and anxiety, than the higher caste Hindu community. In addition, 25%
of Dalit students in India have committed suicide over the last decade due to
caste discrimination. According to reports, for marginalized groups, the
difficulty of preventing suicide is twofold; not only are marginalized
communities at a higher risk of committing suicide, they also have limited
access to therapy, support and healthcare to help prevent suicide, especially
as therapy costs on average 800-1500 rupees per session. Moreover, within the
scheduled tribe community, research has found that above 50% of men consume
some sort of alcohol, and in a separate study conducted in Arunachal Pradesh,
5% of the participants used opium. Other studies found that opium abuse was to
relieve stress and anxiety during non-harvest seasons, due to crop failure.
Therefore, the consumption of alcohol and other substances predisposes
scheduled tribes to mental illnesses and intensifies mental health disorders.
The cycle of marginalized groups and mental distress are two factors tightly
woven together in India that cause further exclusion and multidimensional
poverty; social mobility and healthcare is limited; thus, the cycle is
extremely difficult to break, and only continues. A lot of the members in
marginalized communities end up suffering in silence with untreated mental
illnesses; what is the difference between destitution and mental distress?
Mental trauma and Women
Like many places in the world, women, despite
class, caste or religion, remain at the bottom of society’s pyramid. Women face
double marginalization; marginalization by society as a whole, and
marginalization within socially excluded groups. This isn’t different for
Indian women. A lot of the causes of mental disorders stem from gender-based
violence (GBV); 21% of women in India have experienced domestic violence, and
one out of five women have suffered rape, or attempted rape, in their lifetime.
Studies indicate that women are on average two to three times more likely to be
more susceptible to common mental disorders (CMDs), such as depression and
anxiety, than men in India. Throughout a woman’s life, there are many factors
that heighten CMDs, regardless of class, caste or religion; childbirth and
maternal roles, abusive marriages, a lack of independence, and so on. As
predicted, women in the lower castes, classes, or religious groups are more
vulnerable to mental distress than upper class/caste Hindu women. This is
closely tied to social status in India; being marginalized as a woman within
the ‘less desirable’ groups leads to less education or opportunities than men,
financial instability, poverty, and mental distress. The feminization of
poverty refers to the notion that women experience more poverty than men, and
this poverty experienced by women is more severe than for men. This is a
consequence of lack of opportunities, gender biases and low, or nonexistent,
income. According to a United Nations report, factors such as spousal violence,
infertility, sexual trafficking and child bearing are linked to female suicide
in India. Biswas et al. found that women married at a very young age are
at a high risk for attempted suicide and self-harm. The stressful events in a
marriage, such as miscarriages and economic stresses, are mainly gender
specific; studies indicate higher feelings of distress in married women than
married men in India. Furthermore, women labeled as ‘mentally ill’ in India are
more likely to be abandoned by their husband than women who suppress their
mental health, or are not aware of it. This fear of abandonment, and the shame
attached to this, encourages women to further deny themselves of treatment or
help, which only exacerbates mental distress.
Stigmas and systemic barriers
In
India, people with mental illnesses tend to seek help from temples or shrines,
rather than professionals or doctors, perhaps due to the feelings of disgrace
and shame attached to mental disorders. In conjunction with the shame or burden
of mental distress, those in marginalized communities face multiple barriers
that prevent them from accessing treatment or professional care. The biggest
barrier being inherent systemic discrimination, dependent on class, caste,
religion and gender. Those at the bottom of the caste system, Dalits and
scheduled tribe members, are at the mercy of upper caste Hindus. Upon receiving
a diagnosis of mental illness, those from scheduled castes, tribes, or women,
are less likely to obtain help or treatment, than those with a higher social
status. Due to the discrimination and stigmas of being ‘untouchable’, those who
are aware of their mental health status cannot afford treatment, nor easily
find treatment available to them. If you, a member of a marginalized community,
are constantly reminded of your worthlessness, impurity, and the burden you
place on society, these thoughts will begin to affect all areas of your life,
specifically causing mental distress, anxiety and suffering. Consequently, stigmas
and systemic barriers are another factor that increase, and continue the cycle
of mental distress in marginalized communities. Therefore, those from
privileged positions in Indian society have easier access to treatment and
therapy, as a result of financial means, and having a desirable status, if they
choose to seek external help. The stigmas associated with being from a
marginalized community augment and reinforce the chances of suffering with
mental illnesses. You are not only separated from society; you are also denied
treatment and support. Muslims in India are terrified of stating their
identities, due to the stigmas attached, and the prejudice against Muslims;
“the fear of getting arrested purely due to our religion never stops”, voices a
Muslim woman in India. Even if one was able to find and fund a mental health
professional, it would be a challenge to find someone who would understand the
mental distress institutionalized and systemic oppression causes. Thus, many
members from marginalized groups refuse to seek help.
Indian government and NGOs actions
Over
the years, India has recognized that mental health problems are a profound
issue, especially among those in vulnerable, or marginalized groups. In April,
2017, the Mental Healthcare Act was passed, and came into force during May,
2018. The law has been described as, “An Act to provide for mental healthcare
and services for persons with mental illness and to protect, promote and
fulfill the rights of such persons during delivery of mental healthcare and
services and for matters connected therewith or incidental thereto”. The law
also decriminalizes suicide, and helps create awareness of mental health
illnesses among society. The government’s acknowledgment that mental health is
a big problem in society shows that these initiatives are just the beginning of
what needs to take place in order to reach those living on society's margins.
NGOs in India have also taken steps to bridge the gap between disenfranchised
groups and healthcare. The Blue Dawn, a mental healthcare support group, aims
to connect those in marginalized groups (scheduled castes, tribes etc.) to
affordable and accessible mental health providers. This organization states
that they connect “Bahujan people [scheduled castes/tribes] in need of mental
health counseling with counselors who understand the intersection of mental
health and caste/minority issues”. The ability of matching the clients with the
right counselors allows those from vulnerable positions in society to be fully
understood by their healthcare professional, and to not be dismissed and
stigmatized, like many before. Moreover, the MINDS foundation, which is a
Telangana based nonprofit organization, has objectives to remove stigmas
surrounding marginalized groups, and raise awareness of mental health, and
provide education on this topic and support. Through the Indian government’s
initiatives, alongside NGOs objectives, there is a real opportunity for
socially excluded people to find help, and for society as a whole to be more
conscious of mental distress.
Further actions needed
Despite
the changes happening in India regarding mental health, there is still a long
way to go before everyone has equal access to support, treatment and
healthcare. Approximately 130 million people in India require therapy for
mental illnesses, and only 30 million people seek help. These statistics are
alarming, and indicate action is still needed. The budget for mental healthcare
facilities is just 0.05% of the total healthcare budget in India, leaving many
vulnerable people suffering in silence. India is seriously lacking in
psychiatrists and mental health professionals, as there are only 3,500
currently employed. Gandhi famously said, “Education is the basic tool for the
development of consciousness and the reconstitution of society”. This quote is
applicable to the mental health crisis happening in India today. In order to
erase mental health issues, education and awareness must be implemented into
society; education regarding mental health, and awareness about the danger of
stigmas attached to marginalized groups in India. Hopefully, with the
assistance of the government and local NGOs, those in need will have equal
access to mental healthcare treatment and therapy.
“The
future depends on what we do in the present.” - Gandhi
Comments
Post a Comment