Prakriti Sharma
Symbiosis School for Liberal Arts

Abstract

This paper aims to explore the relationship between specific social conditions and the extent of their influence in determining psychological outcomes. Conditions and norms established by a society on the basis of gender have resulted in an uneven distribution of psychological distress between sexes. This paper has deliberately limited its exploration to the gender binary. It assesses the principal contributing factors, as identified by existing research, and applies them to the Indian context. The objective is to demonstrate the linkages between social structures and functionality in influencing mental health outcomes. Social networks and support systems have illustrated how the difference in gender-specific social structures can result in impaired coping abilities. The discussion of gendered social roles outlines the importance of considering how men and women interpret these responsibilities and fulfil their role functions. The research revealed that it was not the frequency of negative events that mattered, but rather how much they could emotionally affect the individual. Gender-related violence like hate crimes suffered by women provides evidence of the direct impact of gender inequality on the increase in psychological disorders. The exploration of these ideas allowed an understanding of the practical issue they present in the fields of research and treatment. It was observed that a clear gender bias issue can be identified within research and treatment that deterred the efficiency and reliability of both. The research has identified a definite correlation between gender inequality and their effect on mental health even though these effects cannot be studied in isolation of other social factors. The paper concludes by making an effort to suggest preliminary recommendations to combat this.

Introduction

Gender equality is one of the seventeen Sustainable Development Goals (SDGs) of the United Nations. This goal is well known as a critical tool to advance public health, boost life chances, and encourage economic activity in low and middle-income countries. Gender remains the most rudimentary way for a member of a society to identify themselves and others. An individual’s identification with a gender creates specific social conditions that largely define the structures they function within. This functionality and structure in turn have a significant effect on the individual, creating a bilateral relationship. The challenge of tackling gender inequality, continues to remain a daunting one, given that this disparity has been entrenched at both – institutional and individual levels of the society. Gender is being increasingly recognized as an essential consideration of contemporary research for its pervasive influence in determining the mental health of individuals. The World Health Organization views gender as a critical determining factor in the diagnoses of mental illness. The linkage of broad structural factors to mental health outcomes require both micro and macro-level processes that contribute to building an understanding of this relationship.

This paper will focus on the macro-level social structures, as established by existing literature, to further explore how these structures can be connected back to inform mental health status. It seeks to establish a sociological basis for an issue that is often singularly interpreted as a psychological concern. These sociological structures are established based on rigid gendered norms and stereotypes. Gendered norms govern what is deemed to be acceptable behaviour for the sexes, and become the basis upon which these structures are overarchingly determined. The norms embedded within these structures form the foundation for the rigid definitions of social roles. At its core, gender-based violence is an act propagated by an unequal distribution of power and control. When such disparities are condoned, propagated, and reinforced by political and legal systems, women and girls, not only become powerless to protect themselves from harm, but also become additionally vulnerable to mental health disorders. This is summarized in the guiding research question of this paper: to what extent do the social conditions of the gender binary influence mental health?

The technical terms used in the paper have been operationally defined below. This allows for a more focused understanding as many of the terms used have multiple meanings specific to the context in which they are used. ‘Social condition’, is an overarching term, used for the macro-level social structures, roles, and life events that are used as parameters for this investigation. The term ‘influence’ has been used as the goal of this paper is to determine the extent of impact of these social conditions on mental health. It provides an opportunity to look at the extent of a sociological condition in a psychological state. The ‘gender binary’ specification in this question establishes another parameter. While the understanding of the term gender has grown outside the binary understanding into a more pluralistic term, much of the established literature on this topic is still limited to the former understanding. This forces the focus of this paper to the classification of gender as two distinct, opposite forms: masculine and feminine (male and female). 

Methodology 

This paper uses secondary research methodology to answer the research question — to what extent do social structures influence mental health outcomes, research and treatment? The paper is divided into three distinct parts. The first part of the paper will focus on condensing the wide expanse of literature that identifies and defines social conditions that influence mental health. The subsequent analysis will expand on understanding this influence, with examples from the Indian context.  From this theoretical foundation, the paper will attempt to apply these understandings to the areas of mental health research and treatment, and propose appropriate recommendations.

The effect of gender specifically on mental health cannot be looked at singularly, as social factors do not operate in isolation. The intersectionality of other social factors is incredibly important, as they too affect an individuals’ psychological state.  This paper acknowledges that it does not, and practically cannot, address the multitude of social factors. Rather, it attempts a focused assessment of one factor – gender. This methodology was chosen as it allows for an in-depth and detailed understanding of the social conditions through a gender-sensitive perspective. This helps create a strong baseline to build linkages with mental health outcomes and identify issues in their practical application. The methodology’s strong reliance on existing literature implies that the latter’s limitations will consequentially restrict this paper’s scope. 

Literature Review 

There is an extensive body of literature on the subject of gender and mental health that has clearly outlined the social conditions that must be analysed in order to understand mental health outcomes for individuals. A broad limitation of the literature, is its restriction to the cis-gender binary model. While the academic world struggles to accommodate gender’s growing plurality, most established literature is still limited by the same oversight. Additionally, much of the research on this subject is specifically rooted in Western contexts. This makes it very hard to adapt these conclusions and observations to different cultural contexts. There also seems to be a lack of research looking deeper into the detrimental effects of these factors identified in men, leaving unconvincing explanations. Most of this research was done in the 1970s to the early 2000s and our social context, to some extent, has changed since then. So, this research is likely not applicable to our current social scenario. 

Previous research (Stoppard,1999; Wade et al., 2002; Kuehner, 2017) has established that women are more likely to be affected by anxiety and depression. Sexism and gender-based abuse are commonly found in these cases. It was initially believed that women were more susceptible to these illnesses because they were more ‘sensitive’ or more ‘socially conscious’ than men. However, women have many psychosocial reasons to be depressed and anxious. It is no surprise that many of those reasons are linked to inequality, gender-based violence, and harmful gender stereotypes. It is also important to note that it is not only women who are affected by this social condition, but men as well. Men are more likely to be diagnosed with substance abuse and anti-social and confidence disorders, suggesting that the societal structures we have in place negatively impact both parts of the population (Iacano et al.,1999; Hodgins et al., 2008). Instances of gender inequality increase an individual’s exposure to negative social conditions, consequently increasing their susceptibility to mental health problems. This suggests that a holistic perspective of mental health can only be developed if emphasis is drawn towards understanding social structures and their subsequent impact. 

Social Networks and Support Systems

The first social condition that research identifies as a significant parameter in the mental health consideration is social networks and support systems. A social network refers to the social structure of people and organizations that an individual regularly interacts and communicates with (Albert, 1998). When an individual does this, they become a participant of that social network. One function of this network is to act as a support system when a member is in need. The network provides people, known as confidants, that the member can depend on and seek emotional support from in times of distress. It increases the member’s ability to cope with the situation. Not only does the quantity and availability of the support matter, but the quality of it too. Research has shown that provision of quality support has shown significant improvement in mental wellbeing (Cohen, 1985; Olsen,1994). Men and women have very different social networks, and each network provides distinctive supportive functions. These differences also extend to the roles that men and women play within their systems and whom they identify as their confidants. 

Women seem to have a larger, more multifaceted network, i.e. a larger variety of people in their network who serve multiple functions. In contrast, men appear to have a more minimal network, made up of predominately a single person – usually the wife, who performs most of the supportive function they need.  A study done on women in college revealed that the amount of social support networks an individual access to and the satisfaction received from these networks had a negative relation with depressive symptoms and conditions (Stokes, 1983). 

These networks have different uses for men and women. As Lowenthal & Haven (1968) found, women are more comfortable than men in reporting a confidant relationship and acknowledging the need for one. While men are likely to identify their wives as confidants, women were not equally likely to identify their husbands as confidants – showing that women have wider social support options such as children, relatives, and/or friends. Women report asking and receiving more support than men, though this support does not necessarily come from their spouse alone, but rather from this large network of confidants they have access to. This range can be attributed to the fact that women might actually be part of more network crises than men, and therefore form more supportive relationships.

Women tend to provide more support than men, which can lead to what is termed as a ‘support gap’ (Belle, 1983). This results in an unequal dependency between a wife and her husband, providing one explanation for why widowhood is much more damaging for men rather than women (Belle, 1983; Stroebe,1983) The loss of the support structure’s focal point makes it much harder to cope for men. Alternatively, for a woman, the role that the husband plays in her supportive system is diluted because of access to multiple confidants (Belle, 1983; Stroebe,1983). This explains why men report more satisfaction from marriage while women seem to feel more pressured to ‘take care’ of their spouse.

Social Roles

Social roles refer to the part an individual plays within a social group. Each social role comes with expectations of behaviour from the individual playing the role. These expectations are set by the society, within which, the individual is functioning in. Women are more likely to define themselves through the wellbeing of others such as their spouses or children (Campbell et al., 1976; Bordy, 1998; Monaghan, 1978). In other words, they have an interdependent understanding of the self. Women tend to form a morality that stresses the caring of others and therefore are more likely to be aware and feel responsible for fulfilling the needs of others (Miller,1976). Men, on the other hand, define their role as providers based on economic outcomes (Badgett, 1999).  Hence, men’s conception of their social role is independent of others. Men seem to form a morality that emphasizes individual rights and responsibilities. This may reflect gender inequality in domestic relationships that entrusts more power and authority to men, and exposes women to the vagaries of their partners’ support. 

Prior research has only considered social structure factors when understanding the sex-distress relationship and has not accounted for what roles men and women had in society. Gove and Tudor (1975) argued that females had more mental health problems because they had fewer, and less prominent roles, than men. This is inconsistent with other research (Simon, 1995) which has found that women who held multiple roles, such as office workers and homemakers, had more mental health problems than men who held the same roles. Researchers then started to consider what these roles meant to both men and women. Gender inequality present in these roles is the reason why women have higher psychological distress than men. This may explain why having multiple roles is helpful for men but harmful to women.

Marital status is an important facet of how individuals view their social roles. Ibrahim (1980) found that married women experience higher rates of mental disorders than men. Married women have higher admission rates to mental health facilities than unmarried women. Gove and Tudor (1973) hypothesized that women were feeling psychological distress because their roles in society were i) less satisfactory than men ii) based on a single source of gratification – the home and iii) contained in one environment. This was contradicted by research that found that the rate of psychological distress was higher for women, who were employed (Kessler et al.,1982; Simon, 1995; Das et al., 2012). This gave rise to the ‘role accumulation hypothesis’, according to which women are likely to feel more psychological distress when given multiple roles because they felt the roles were conflicting with each other, and therefore found it difficult to keep these independent (Kessler et. al,1982; Simon, 1995; Das et al., 2012). 

Undesirable Life Events and Gender-Related Violence

Undesirable life events refer to situations that cause individuals to feel negative emotions and stress. This parameter cannot be ignored when evaluating the societal impact on mental health. Researchers hypothesized that a possible explanation for increased mental health problems in women was because they were exposed to more undesirable life events. This hypothesis was found insufficient, as subsequent research revealed that both genders are equally vulnerable to the occurrence of undesirable life events, though they may be affected differently by similar occurrences (Kessler et al.,1984) Women are more sensitive to the needs of those around them (Gilligan, 1982) and have more empathic orientation than men (Eisenberg and Lennon, 1983). This makes them more likely to be emotionally affected by undesirable life events. Evidence in case studies on crisis coping does show events where men are more vulnerable than women. For example, when it comes to the loss of a spouse (Stroebe and Stroebe, 1983), men adjust better in the initial stages of marital separation and divorce (Wallerstein and Kelly, 1980). However, women deal with financial instability better than men (Kessler et al.,1982). 

An important part of undesirable life events is the consideration of the occurrence of gender-related violence. These happen exceedingly more to women than to men, because of their subordinated position in society. Gender-related violence refers to the targeting of specific groups because of their gender. This violence can be physical, sexual, psychological, and includes threats and coercion. These forms of violence are causally related to high rates of comorbid psychopathology, dissociative disorders, substance use, and suicidality (Roberts et al., 1998). These can have serious long-term effects on psychological wellbeing. The physical act is not a necessary condition for the individual to experience the mental ramifications simply, the possibility of the act alone can cause severe psychological stress. Research indicates that mental health issues in women are triggered by situations that include elements of both entrapment and humiliation as they relate to the possibility of gender-based violence (Brown, Harris and Hepworth, 1995). Female victims make up the single largest group of those suffering from post-traumatic stress disorder (Calhoun and Resick, 1993). Women, as compared to men, are at greater risk of being assaulted by someone in their intimate circle (Kessler, Sonnega, Bromet, et al., 1995). 

The definitions and understanding of these social conditions provide insights into factors affecting mental health. These conditions will be further explored in the next section with examples specific to the Indian context. 

The Indian Context

The disparity in the effect of social conditions on the mental health of men and women is found in the nature of their interpersonal relationships (Maccoby and Jack, 1974; Troll, 1986). A large social network can benefit the psychological health of women by providing sufficient support to help them develop better coping strategies. However, these multiple sources of support tend to diffuse individual responsibility to a group, rather than an individual. The cost of being a member of this system is therefore high and is likely to outweigh any benefit it can provide. Such social networks are likely to cause negative effects; negative network events could impact women more because they are more invested in the emotional wellbeing of their network members (Fischer, 1982; Gove, 1984). The roles of different women in these networks are not very proportionate. Often it has been found that women in most need of support from social networks are the least likely to receive it but bear equal costs of network involvement. For example, women without the ability to effectively help other members, a condition of their participation, may do more harm than good.  

Another condition that makes an individual more prone to the detrimental effects of social networks is when the provider of support is already overwhelmed with many demands for nurturance. Therefore, their capacity to keep emotional distance breaks down and, as a result, they are more affected by others’ situations. Choler and Lieberman (1980) found that some social networks become so demanding that female members are in better mental health when separated from other members of the group. 

In contrast, the male system seems to concentrate all of its supportive needs on a singular individual, placing undue pressure on the person to be constantly available, capable, and responsive, possibly accumulating the detrimental psychological effects. This indicates that the current structure of support men depend on is falling short of meeting their needs. Men are also more hesitant to ask for support, leaving them to deal with these issues on their own. This isolation and insufficiency may explain why the cases of substance abuse, as possibly a coping strategy, are higher in men than women. The lack of access to a wider, more capable support system may mitigate this disparity.

The collectivistic design of Indian society further emphasizes both the positives and negatives of these social network structures. Indian women create a strong network of female peers like family members, friends and neighbours. This bond is forged through shared experiences and hardships that necessitate a high volume of support. This also means they are equally responsible to put in the work to maintain these bonds. Therefore, it is commonly seen that women do household chores or other social activities together. The influence of masculinity in Indian society can also be clearly observed. The idea that a male should not show signs of distress or weakness is very prominent in the Indian society, the maintenance of a conformative social image becomes paramount. Indian expressions of this distress become privatized – with a high prevalence of domestic violence and substance abuse. In Indian society, men do not ask for the help they need, lack the ability to communicate the extent of their need and are unwilling to accept support. 

Conflicts in social roles is an essential parameter to observe when identifying sociological sources of psychological distress. There is greater interdependence in the professional and private sphere for men than women. This suggests that men possibly equate their success in work as success in their familial role. The converse is also true; failure at work – not being unable to provide economic stability – is taken to mean that they are unable to fulfil their role in a family. This forms a singular, quantifiable source of fulfilment of the male social role that is perhaps easier to achieve.

Women’s family roles are defined by nurturing and are less tied to emotional stability but vary depending on how people are feeling around them. This is a volatile, qualitative, and divided source of fulfilment that is much harder to achieve. Women are more prone to suffer from role conflicts and guilt from combining the two. This makes them view themselves as less successful than their spouses, and as bad parents, leading to a negative self-image and greater insecurity. 

India is a society that holds tightly to the traditional division of social roles. A strong emphasis is placed on the importance of marriage for the Indian woman.  Only a small minority of women believe that their contributions as an office worker are as important as their contributions as a homemaker (Das et al., 2012). Many women view employment as an added responsibility and feel guilty that they have multiple roles, which prevents them from effectively fulfilling the primary role of a homemaker. These multiple roles that women have, become competing factors resulting in psychological distress. Societal norms in India also place a higher responsibility on women to maintain a marital relationship. In the traditional model of social roles, this is their only responsibility and therefore a direct measurement of their individuality. These feelings of disproportionate guilt occur when women feel they are not meeting the normative behavioural expectations of this imposed social role. If social norms are more accommodative of different roles for women, they would not be experiencing such psychological distress. Thus, unequal distribution of responsibility between men and women in their social roles is likely to cause negative social conditions for women, leading to detrimental mental health outcomes. 

The above discussion suggests that both genders become vulnerable to the effects of life events when such occurrences affect something that they include as part of their social roles. This explains why women are more vulnerable to negative life events that surrounding children, family, and reproduction, whereas men are more vulnerable to negative life events relating to finances, work, and monetary stability (Kessler, 1982). Additionally, it can also be connected to how why women are disadvantaged by network events. Women not only report more events that men, but are also more emotionally sensitive to them. Women are emotionally responsive to a wider field of concerns then men. The outcomes of these occurrences play a determining role in their wellbeing. This stems from the idea that women have a wider field of concerns than men, making them more emotionally responsive to these occurrences as their wellbeing is interdependent with them. The damage that network events can do to women’s mental health with their constancy and ability to overwhelm an individual, is much worse than isolated emotional effects. 

A clear relationship can be seen between social conditions and their effects on mental health. The interlinkages between these factors cannot and should not be understated. These interlinkages are an indication of why only a holistic systematic change is the solution to improve the conditions for men and women to function better. The literature discussed suggests that these conditions need to incorporate a level of flexibility that current structures do not possess. Incorporating these changes would allow individuals to seek and receive help. Men need to have the ability to widen their support circle to diffuse the responsibility of their mental well-being to more than one person. Women need to have less demanding support systems so that their participation in the network does not become counter-productive. This could be adjusted by having men play a more significant role in their spouse’s support system. The social role of men needs to be widened in order to include proportional responsibility for family life and success. Society must reinterpret their social roles to be adaptable to individual circumstances and choices, and allow for the plurality of roles in the modern world. 

Implications for Future Research and Clinical Interventions 

This paper discussed and contextualized the relationship between social conditions and mental health. An observable example of the effects of these norms and stereotypes, outside its sociological effects, can be seen in the research and treatment of mental health disorders. 

Research on the effect of gender on psychological distress has always taken a one-sided perspective towards finding explanations for the prevalence of these problems. While the relationship between women’s reproductive ability and their mental health has been well studied (Soliday et al., 1999) researchers, for the most part, have ignored other aspects of women’s health, and have also seldom included women outside reproductive ages. Current research has revealed that emotional and psychosocial factors affect women’s mental health more than reproductive functions.  In contrast, the effect of male reproductive function on their mental health has not been well studied, though some studies show that men are as emotionally responsive as women when related to reproductive function.  Both genders show depressive symptoms after the birth of a child (Soliday, McCluskey-Fawcett & O’Brien 1999). Despite this, most health programs are typically directed towards women and their concerns about reproductive health and fertility (Avorti & Walter 1999) 

Currently, there is a disparity between genders with respect to the treatment and diagnosis of mental health issues, and this difference is rooted in social stigma and stereotyping. Women seek out more help and report more mental health problems than men do, while men are more likely to reveal a substance abuse problem to their doctor (Allen, Nelson, Rouhbakhsh, et al., 1998). Research in mental health diagnosis found that though both genders are equally susceptible to it (Callahan, Bartakis, Azari et al., 1997; Stoppe, Sanholzer, Huppert et al., 1999), doctors are more likely to diagnose women with depression, even if men present identical symptoms. Men are more likely to seek out a mental health care specialist while women use their primary physician (Simoni-Wastila, 2000). Researchers (Vlassoff, 2002) found that women receive more services in primary care than men do.  

Women’s susceptibility to emotional problems and substance abuse problems in men reinforce social stigma associated with these issues, and prevent help-seeking behaviour from both genders. Despite these differences, both genders go through periods of emotional and psychological distress without consulting a mental health therapist, indicating that the social stigma relating to admitting to a mental health problem and getting help is still quite strong today. This investigation has demonstrated how stereotypes associated with gender can limit research and treatment of mental health issues. 

Conclusion 

The survival of traditional gender stereotypes and norms in the modern world makes the proposing of solutions a dangerous and often insufficient endeavour as very rarely are these practically valued and applied. Looking back to the research question ‘To what extent do the social conditions of the gender binary influence mental health?’ this essay has evaluated and discussed how gender affects mental health. This was reinforced with possible applications of these ideas in the Indian context, which can be the basis of recommendations to deal with mental health issues. 

There are two possible solutions to this issue. The first is a gender-neutral approach, a popular notion in the current world. When the problems are gender-specific and embedded in an inescapable gendered society, how can the solutions be gender-neutral? Taking into account an individual’s background is very important for them to receive appropriate help. The presence and reinforcement of stereotypes deter people, including professional practitioners, from allowing others to obtain the help they require. The second approach is built on the principles of gender sensitization. Gender-sensitivity cannot be restricted to research and treatment, but sociological structures must become more accommodative. This perspective will allow for inclusion of identities outside the gender binary and the plurality of modern sociological conditions and psychological needs.

The problems identified in the previous section highlight the importance of gender sensitization in both academic and therapeutic spaces. Numerous programmes developed by bodies such as the Ministry of Rural Development have been designed for this purpose but are often overlooked and undervalued as many people assume that this does not require guidance. This false idea is the reason that many professional and academic spaces still have these underlying biases. The gender sensitization programs must be adapted to a cultural environment in order for them to provide individuals with better awareness of their own biases. Research often informs treatment, which in turn directly impacts the mental health outcome. The extent of existing bias in both research and treatment, therefore makes these areas crucial to start developing an informed perspective.  

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