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Stigma Complicates Treatment of Iranian Women's Mental Illness

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Being a mental patient in Iran is a struggle. Moreover, being a female mental patient in Iran is a struggle with stigma. Though Iranians are by no means under-educated when it comes to dealing with mental health issues, women have a bigger challenge to face when faced with this genre of illness. Women are singled out more, left alone more, shunned more. Women have a tougher time finding friends, dating, getting married, and staying married.

Official statistics issued in 2013 by the Iranian government show that 26.5% of Iranian women and 20.8% of Iranian men are living with chronic mental conditions. When it comes to dealing with mental conditions in women, matters become complicated.

Zahra, a 42 year-old librarian who lives in Tehran, recalls her suicide attempt in our phone conversation. She tells me, "When I discovered my husband is having an affair with his secretary after 22 years of marriage while having two teenage boys, I took five Ambien 5 mgs. Then I lay down quietly in the dark, waiting for sleep and imminent death to end all my misery."

Zahra tells me that was hospitalized in a private mental hospital in Tehran after this episode. Her hospital stay lasted two weeks and contained six sessions of electroshock therapy. She tells me, "My husband has, since, assumed the role of a civilized, open-minded, modern man. He did end up firing the secretary and acts as if he regrets the affair, but I'm almost certain that he has either begun another affair or would like to do so. Sexually, he is quite distant. I feel like I'm left with the embarrassment about my outrage and the shame of my hospital stay and undergoing shock therapy. I remember nothing after swallowing the pills, and my mind draws a blank whenever I try to remember the events of my life between my hospitalization and six months ago. Two years of my life were literally lost, and the worst part is that I could not free myself from my husband."

ILNA quotes a Health Ministry spokesman stating facts on women's mental health situation in Iran, and that they are twice as vulnerable toward mental illness compared with men.
Some Iranian psychiatrists and psychologists believe that multiple elements contribute to worsening the symptoms of mental illness among Iranian women. They define the most significant of these elements as these: Most Iranian men's high expectation of their wives for doing the household chores regardless of having a full-time job, the existence of patriarchal laws and rules in the society, also the fact that the younger physicians have not been through practical training by seeing and tending to female patients due to religious limitations in medical schools, and are therefore not savvy enough. Many medical officials are chosen from these same graduates and doctors, who are neither passionate nor experienced enough when it comes to women's health, particularly mental health, and therefore do not implement or enforce rules while keeping considering women's health a priority.

Reza, a 55-year-old psychiatrist whose office has extremely long wait lists for patients--nearly all of whom are women--is very popular among women. In a phone interview, he tells me that deep down, he believes only 20% of his female patients to be seriously ill. When I ask him how he has gained so much popularity among women, he says, "I am very good at matching patients with medications and I'm a really great listener." About the other 80% of his female patients, he says, "There are a lot of women from the middle and upper class demographic who simply can't cope with everyday problems of life and routine stress. These women need to toughen up, some of them could do really well with cognitive and behavioral therapy. But taking medication is easier and often times cheaper, so they choose that. Most of these women are quite capable of getting by without drugs. The rest of my female patients, however, are seriously ill and I often worry about them and their future if they are single, their marital life if they are married."

Dr. Reza tells me he doesn't recommend hospitalization for women unless it is absolutely necessary. He adds, "Some of my colleagues resort to this solution easily. I truly take it as the very last resort, due to the stigma that follows it in the Iranian society. A serious stigma which only women suffer from in Iran. I also refrain from resorting to electroshock treatments, unless, very rarely, the woman is in such a dire condition that it would be a matter of life and death. I don't necessarily bend over backwards to implement such rules and restrictions when it comes to men, who happen to be quite a small crowd in my patients."

If a man decides to divorce his mentally unwell wife, he can easily do so. But things would become drastically different if roles were to switch. If a man pays his monetary dues and is not an addict, however, divorcing him is almost impossible, even if he is mentally ill. Things become over-complicated if the woman is identified as mentally ill.

The Iranian society generally seems to look down upon women's mental illness far more than they would men.

Batoul is a 67-year-old retired schoolteacher who lives in Sari, near the Caspian Sea. In a phone interview, she tells me about the hardship of having two children with mental issues, "My daughter is 43 and has two teenagers, and my son is 40 and has a small kid. They are both married. They both work full-time. They have both been in treatment for years, and hospitalized several times. They have very similar circumstances, yet the way they are treated by their spouses, their employers, and the society in general, differs drastically. When it's about my son, it's "inconvenience and the sad truth". When it comes to my daughter, it suddenly turns into a taboo. The double standard is sometimes intolerable for me as a mother to both of them."