“Why do you make these regular visits? Is it because you like me? Do you really want to have an intimate relationship with me? Please lock the door before we make love. If others see us while being intimate, they will punish us. Be quick and don’t worry about my feelings. If you want me to say I love you, okay, I am ready to do that. I love you.”
Well, this is not a piece of fiction.
Health Foundation Nepal, a nonprofit organization, is running an integrated mental health care and psychiatric rehabilitation center in collaboration with Movement for Inspiration Nepal (MOFIN) to provide mental health services to poor and homeless patients. As a medical in-charge of the center, I got a call from the watchman that Akshara (name changed) needed to be evaluated. She was exhibiting some strange behavior despite taking antipsychotic medication. It was already late that day, but I could not stand doing anything, so I went to the rehabilitation center as soon as I could. She has had a mental illness for almost two decades.
Tale of woe
Akshara was happily married, but her marriage did not last long. All the misfortune happened to her, said her mother, stating that she had undergone three miscarriages. The watchman came near me, whispering in my ear: “Did you know doctor? Her family even once attempted to get rid of her by sending her to India on a bus so that she would not be able to return on her own to home.” That sentence was particularly difficult for me to hear. Akshara had to face so many challenges that were much for her age.
Akshara entered my room. She was shy. I asked her to take a seat, she carefully dragged the chair closer to me, and with a smiling face and flushed cheeks she asked me if she could sit.
Akshara wants to get married again, or it can be said she wanted to be in an intimate relationship. I was aware of the fact that people with psychosis are usually confronted with issues such as hyper-sexuality and unsafe sexual behavior. If people around such patients remain unaware of this pathological condition, the patient may have to pay a huge price for possessing it. Akshara developed hyper-sexuality when she was still a teenager. Her intensely flirty behavior left a negative impression on her elder brothers, who were unaware of her disease condition. They arranged her marriage when she was still a teenager. I felt bad for her—a young girl who could not even take care of herself had to take care of her entire in-laws’ family. It was difficult for me to comprehend the struggles she had to endure throughout that traumatic time.
Akshara’s flirtatious conduct persisted even after her marriage, putting her marriage in trouble. Meanwhile, she went through three subsequent miscarriages, which acted as the last nail in the coffin, and her marriage to her husband came to an end. She returned to her parent’s house with an empty hand after her divorce. However, her mistreatment escalates to the point where family members are looking for ways to get rid of her. Being mentally ill doesn’t preclude you from the feeling of love and warmth of someone, but Akshara was precluded. Akshara feels the same way, but her desperation puts her in danger of being abused and harassed.
Ruchi (name changed), after suffering from severe depression with psychosis, had become a victim of domestic violence. Every night, her husband would come home after heavy drinking and beat her. But she kept silent. How could she resist him? The person who she loved the most in the world had started turning on her and begun to hate her. Her disease had made her lose confidence and live in excessive guilt. After such misconduct from her husband, she was evicted from her own home, the home she has been decorating with the memories she had since she got married. Following the event, she was transported to our rehabilitation center, where she has been getting treatment for months now. Since that day, she has not seen her daughter’s face. The drugs we gave could only soothe her pain but not the grief she was experiencing after being separated from her little angels and the home she thought was her own. Every time I met her, she would ask me with tears in her eyes: “Do I ever get a chance to meet with my two little daughters?” And I did not have the answer to her question.
Being mentally ill doesn’t preclude you from the feeling of love and warmth of someone, but Akshara was precluded.
Sundhara (name changed) does not have a warm relation with her family members because of her socially unacceptable behavior most probably caused by a degenerative disease of her brain. She exhibits symptoms related to frontotemporal dementia, a neurodegenerative disease that presents with neurological and psychiatric manifestations. She argues with family members and neighbors repeatedly, uses obscene phrases, begs for money in the streets, and spends nights in open public places like Chautari and temples. Unfortunately, her husband and sons blame her for doing these things purposely to ruin the family’s pride. It was their neighbor who suspected her of having a possible psychiatric problem, and then her son brought her to the center. When I told them about the chronic and incurable nature of her most probable diagnosis they reluctantly expressed their wish not to spend money on such an incurable disease and refused to take her to a higher center. For the families who strive just to have two meals a day, such excuses are understandable. I wonder how she has been fighting with her disease, familial neglect, and social stigma simultaneously.
Suffering in silence
Above mentioned examples show how mentally ill women are suffering. Usually, people suffering from mental illness are at risk, and if relatives of patients themselves become hostile towards patients, the risk of being abused and maltreated increases significantly. One research conducted in India in 2008 has shown that among women with mental illness, who participated in the qualitative interview, 34 percent reported sexual coercive experiences. Mentally ill women with symptoms of hypersexuality similar to that of Akshara are at the highest risk of sexual exploitation.
People with severe depression have low confidence levels and excessive guilt. In this scenario, they cannot raise their voice against violence happening with them. Most of the symptoms of mentally ill people put them at a higher risk of being abused, harassed, and exploited sexually. Additionally, our social structure is not favorable toward women. Women with mental illness, therefore, are more vulnerable.
Another high-risk group for abuse and sexual exploitation includes girls with intellectual disabilities. We are all aware that a few years ago an intellectually disabled girl was abducted and was raped multiple times by several assailants at Kathmandu. Even after being raped, she told her guardians about the incidents only after a couple of days.
Enhanced safeguards are necessary to prevent abuse, maltreatment, neglect, and sexual exploitation of girls and women with mental illnesses.
A study done by Joan A Reid has revealed a disproportionately increased risk of exploitation of intellectually disabled girls in juvenile sex trafficking. The intellectually disabled girls usually lack awareness of exploitation and its endangerments. Their inability to self-identify, and the relative ease with which traffickers manipulate these girls put them at enormous risk of being abused and sold.
In a country like ours political turmoil never allows concerned bodies to concentrate on these issues. Therefore, unfortunately, several innocent souls have to suffer from undeserving abuse and exploitation every day. Although every person with mental illness is at risk of maltreatment and neglect in a country like ours where mental illnesses are severely stigmatized, women are especially at greater risk because of the patriarchal social structure. Therefore, enhanced safeguards are necessary to prevent abuse, maltreatment, neglect, and sexual exploitation of girls and women with mental illnesses.
A delay of every second provides a golden opportunity for an assailant to abuse the victim and several innocent souls will be harassed just like that.
Dr Hari Neupane is Medical in charge of Integrated Mental Health Care and Psychiatric Rehabilitation Center at Kuirepani, Dang.