Why we need more family level policy changes
In April last year, the "two-finger test" on rape victims was banned by the High Court of Bangladesh stating it had no scientific or legal basis. Rights activists have long been insisting that the "two-finger test" was irrational and tantamount to a second rape of the victim.
While the prohibition of such a procedure was long due, it brings to light the ignorance and negligence of mental health care for victims of violence. In a country where patriarchy is a way of life and victim-blaming is commonplace, this comes as no surprise. But now, more than ever, it is necessary to think about mental health.
The first problem with finding a mental health remedy for victims of violence is that two of the most common kinds of violence against women—domestic abuse and rape—carry a huge amount of stigma. Mental health in the context of Bangladesh is extremely stigmatised and a neglected public health issue. In general, people tend to give importance to physical health, so most victims only seek treatment for physical wounds, whereas the longer term impact of violence is psychological. It is only when it turns into post-traumatic stress disorder that it is given any importance.
That violence is only the physical manifestation of dominance that results from a bad social and psychological environment has only recently begun to be brought to light. The Lancet Psychiatry, one of the most prestigious medical journals in the world, in 2016 highlighted that little research has been done on how to improve identification and treatment of victims and perpetrators in terms of mental health services. This is disconcerting because mental health services can not only help heal victims but also play a major role in primary and secondary prevention of violence against women.
Poor state of mental health is both a cause and consequence of violence against women. Men who have been emotionally repressed and abused themselves are prone to wield violence and become perpetrators, while women who are often belittled, and develop low self-esteem as a result, are more prone to be victims and suffer for long periods without speaking out.
This in fact is the second barrier to seeking mental health support for victims of violence. In an article titled "The Burden of Proof" published on November 23, 2018 in the Star Weekend, a victim of rape relates how the ayah at the hospital where she went for medical examination said, "If people wear clothes like this, then it is entire [sic] possible for them to be raped." Faced with such reactions, it is thus no surprise that victims are reluctant to seek psychological help. Despite clinical guidance on the role of mental health professionals in identifying violence against women and responding appropriately, poor identification persists and can lead to non-engagement with services and poor response to treatment.
Due to mental health being a very neglected and stigmatised topic in Bangladesh, there is no national policy for mental health care and the national budget allocation for mental health is not even one percent of our health budget. There is a lot more to be done and there's a need to address the problem of a dearth of knowledge and resources for developing effective psychosocial interventions.
With the rise of the #MeToo movement and the emergence of stories of millions of women, we seem to have drawn attention to the scale of the problem. Understanding the gravity and scale of violence against women is a necessary first step. That so many women have been affected speaks volumes about the deep psychological wounds that these women have had to live with. It questions the psyche of the society itself that has allowed such violence to take place, without demanding accountability, for ages.
While most of us see it positively that women are starting to speak up about assaults, be it physical or psychological, we have only begun to scratch the surface of "objective violence". Current interventions to prevent violence against women have started to address systemic violence and discrimination such as unequal pay for men and women. The more difficult form of violence to address is "symbolic violence". It is important to identify symbolic violence because, for too long, we have not been able to put mental abuse and manipulation in the context of violence. Where this gets scarier is when it all originates from a supposedly safe place called the "family".
Our perceptions of gender, through the roles our parents play, are the first indications of how we understand gender. Sadly, especially in the context of Bangladesh and some other places in the world, these gender roles have not changed, particularly in the perceptions of men. So we see more women pursuing higher education, getting jobs, and speaking out about unjust circumstances; yet they increasingly feel the situation has not changed for the better. More women today work in offices and factories but has that reduced their workload at home? Has it increased their decision-making capacity at home? Has it reduced domestic violence and, more importantly, symbolic violence?
Many educated girls and women in Bangladesh are employed by choice and not by necessity; they are not the natural breadwinner of the family. Even when they earn money to provide for their families after marriage, they move into the man's home to be provided by him, hence the decision-making power is the man's. While this has changed in practice and many women today are equal contributors to household incomes, the authority of the house is still the man. Men's understanding of gender roles has not changed significantly. So, a large proportion of young men still devalue the wants and expectations of women because in the homestead gender roles have not changed. Women are to take care of children, cook and clean because their economic contributions to the household are responsibilities they took on by choice. A choice that requires permission from the authority of the house, the man. This dominion comes from the understanding of those gender roles and to maintain the status quo, men sometimes take to coercion and symbolic violence, i.e. mental abuse.
Women who want to pursue a career are expected to do that only if they are able to manage the household on their own, too. That the maintenance of the household has to be the man's responsibility as well so that women can pursue a life and career outside the homestead, as is their right, is yet to be socially accepted. This, along with the whole gender disparity phenomenon, cannot be addressed by counselling women alone; men must be brought into it as well and it has to start from the family level.
In Sweden, this cultural change is happening through systemic changes such as parental leave policy. The policy entitles parents of both sexes to 480 days (16 months) of paid parental leave at about 80 percent of their salary and both the parents must share the responsibility. Swedish dads must take some of those 16 months. This has given more prominence to the role of men in the household and changed stereotypical gender roles and perceptions; hence this family-level intervention helps to prevent both systemic and symbolic violence.
Shamsin Ahmed is founder and director of Identity Inclusion, which works towards breaking the mental health stigma and promoting social inclusion of people with psychosocial disabilities.