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"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


“The ache for home lives in all of us, the safe place where we can go as we are and not be questioned.” - Maya Angelou

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


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