In the past few months, we’ve seen how a barbaric incident of gang rape in Delhi caught the attention of the world, including Nepal. Cases of violence against women within our own borders were being reported in the media left and right, bringing the issue to the public in a big way. The subject has since taken up residence in op-ed articles in various newspapers, and demonstrations by different groups on the streets have continued, to the point where it has even come to overshadow the usual political bickering—a positive sign that all sectors have taken such an interest. Of course, we must hope that all these consistent efforts result in visible change, and don’t just simmer down without any outcome—as just another transient media sensation.
There are, however, some misconceptions floating around regarding the issue that need to be addressed. There is a popular belief that perpetrators are strangers, and always male, and that such heinous acts occur only in backward patriarchal societies. This was duly disproved by the 2002 WHO multi-country study on women’s health and domestic violence, which clearly established that violence against women is a universal phenomenon that is seen in all countries of the world, including affluent societies where gender discrimination appear to be minimal. And the violence isn’t just restricted to distinct sexual acts, but there are also many cases of general physical and emotional abuse. As for the perpetrators, they are usually not strangers, but those the woman is in close contact with, like partners and family members, among others. And these are certainly not limited to males, either. Not long ago, for instance, a 17-year-old girl was admitted to the orthopedic ward at the Patan Hospital for having suffered multiple bone fractures, and she was also additionally recommended a psychiatrist’s consultation for acute psychotic breakdown. It was found out later on that she had been kidnapped and tortured inhumanely by a neighbour—a woman in the 40s—with the help of two other women, because she had believed the victim to be having an affair with her husband. More importantly, it was discovered that the three women would abuse her under the influence of alcohol.
Most people who are part of the VAW campaign appear to be harping on two points—strong punitive legislation for perpetrators, and increased demand for gender equality as panacea to the problem. But if we dig deeper into these cases, we will find that in most instances, the problem is less about patriarchal values or lawlessness: it is, in fact, substance use disorders or mental disorders that play a huge role in cases of VAW.
The contribution of psychoactive substances, particularly alcohol, is almost the rule, rather than the exception, when it comes to such behaviour, from what we can tell from those who come to seek help for mental health consequences in Nepal. Even in the Delhi rape case, the perpetrators were said to be drunk when the crime was committed. A little searching will reveal that perpetrators often suffer not only from alcohol dependence, but also serious mental disorders like paranoid schizophrenia, psychotic depression and delusion disorders, among other conditions. The heavy use of alcohol often triggers a state in which the drinker develops pathological delusions of infidelity. The 2002 WHO report also sheds light on the personality of partners who become abusive. They are generally controlling; they will try to restrict a woman’s contact with family and friends, will insist on knowing where she is at all times, and try to control her access to health care. All these point towards pathological jealousy and belief in infidelity. Surely, such cases cannot be curbed with harsh law enforcement alone.
Likewise, punishing the perpetrators alone will not bring the victim much peace. There are several mental health issues that exist in the aftermath of VAW, not just for victims, but also family and friends. Acute stress reaction, adjustment disorders, post traumatic stress disorder, acute psychosis, anxiety disorders, depression, suicidal tendencies, and substance use disorder are just a few on the list. All these cannot be discouraged without preventative and curative interventions to do with substance use/mental disorders.
The WHO has clearly defined 15 points as a guideline in this regard, out of which, strengthening the response from the health sector is one of the most crucial. It recommends developing a comprehensive health sector response to the various impacts of VAW, and in particular, addressing the barriers and stigmas that prevent abused women from seeking help. This includes supporting mental health services to address VAW as an important underlying factor in women’s mental health problems. It has also suggested using reproductive health services as entry points for identifying and supporting women in abusive relationships and for delivering referral and support services.
Instead of just going by the popular demands of some agitating bodies, stakeholders should consider the scientific evidence available worldwide for implementing a more comprehensive strategy.
Dr Shakya is the Associate Professor and Chief of the Departmentt of Psychiatry at the Patan Academy of Health Sciences and the General Secretary of the Psychiatrist’s Association of Nepal
Posted on: 2013-02-11 09:40