Mental Health in Mumbai

Tracey Morris

            The global health problem that I chose is a broad concept of mental health concerned more with emotional distress and subjective quality of life of poor people living in deprived conditions in a Mumbai slum. Rather than focusing on the medical background of mental health and the drugs used to treat conditions such as depression, I will focus on how the people from Malavani experience mental health in their daily lives. Malavani is a representative slum in the Indian city of Mumbai that has both sanctioned and unsanctioned settlements the first of which is recognized by the government while the latter is considered illegal. By focusing on this particular slum, I can analyze the local problems and practices of these people through gendered experiences within Malavani and also how they deal with people from other slums or areas of Mumbai. The ethnographic work done on this city was very compelling and forced the reader to see the slum environment through both a man and woman’s perspective. It showed the cyclical nature between mental health problems and inequality, how many of the people in Malavani witnessed this cycle and tried to construct ways to break the circuitous series of events. It incorporated information gathered in interviews, observation and from governmental statistics in order to give a thorough explanation or introduction of mental illness there. By using a medical anthropology perspective, I will explain the people behind the diseases and how they understand and explain what they are going through. Particularly, what is causing these disorders whether at the social, political, or economic level and in turn what they may lead to. 

            The article that I am using for this paper is “contextualizing mental health: gendered experiences in a Mumbai slum” by Shubhangi Parkar. The article starts off by providing some statistics about the city of Mumbai in India concerning the social status of its people and the role the Indian government may or may not play. Studies show that about “60% of the people live in dilapidated areas, communities whose residents routinely contend with serious economic hardships and constricted opportunities” which the government terms a slum (2003: 291). While the term slum is meant to demonstrate that the mentioned area needs help in certain aspects of life, it often leads to identities given to the people living there which can potentially deny opportunities for growth and development. These identities given to people in these slums are commonly associated with stereotypes of poverty, squalor, chaos, filth and overpopulation. Many of these social factors are realities for those in Malavani and can contribute to mental health problems by acting as stressors or causes of tension for themselves and their families because of poor resources and opportunities. The social roles defined by gender, for the people in Malavani mediate how they experience the social and physical environments and what it does to their emotional life.

The article further dissects the experiences of this group by contrasting those who live in the sanctioned part of the slum versus the illegal part. Both sectors lack basic amenities such as clean water and sanitation while many outside people identify Malavani as a criminal area making it a culturally undesirable place to live. Many see the migration into this slum as a demoralizing and hopeless reality. Much of the information gathered in this ethnographic study was from focus group discussions split by gender, status of settlement or a combination of the two. These groups helped to demonstrate the different problems and impacts felt by the different genders and contrast how they measured between the sanctioned and unsanctioned parts of Malavani. Men faced economic insecurity, substance abuse and/or dependence, violence mostly inflicted upon family, and extramarital relations while women faced the burdens of employment, infidelity of their husbands, domestic violence, inter-religious and inter-caste marriages, and alcoholic husbands. All of these problems led to or reinforced mental health problems by ‘stressing’ out the individual and often their families as well. Most of the inhabitants interviewed or observed described the loss of their cultural roots as being part of the problem for many of those residing in the slums travelled from the countryside of India to seek opportunities in the big city. Overall, this article demonstrated the impact one’s place of residence had on their overall health and well-being especially for women. Also, how gender plays a large role in one’s everyday experiences leading to the need for gender-specific solutions in order to help alleviate mental health problems.

A medical anthropology perspective would analyze how the individuals experience the problem of mental health and how they understand it concerning themselves and others in their community. This perspective would also look into the difference between the experiences of men and women concerning their opportunities, roles, and types of mental health problems. Men tend to associate mental health with economic and social opportunities, the lack of them resulting in depression, violence towards family and community members, disregard for family responsibilities and disruption in cultural values. Women associate mental health with family circumstances; unemployed husbands require their wives to work and continue to care for the household while controlling their earnings, abusing them, and more often than not being disloyal.  The Global Health Watch Report 3 does not consider the importance of gender roles in their approach to mental health. The GHWR3 defines mental health as the “state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community” (2011: 171). They focus on one’s ability to provide the basic necessities of life and how poor nutrition, financial insecurity, low education levels, and a lack of access to medical care leads to the likelihood of increased mental health problems especially for the poor. Another main focus of the reports is mental health’s connection to drugs and alcohol. Poverty often leads to a sense of hopelessness, shame and increased levels of stress making those affected more susceptible to these substances. Finally, the global health watch emphasizes how for most of the world, access to institutions and medications for prevalent mental disorders is limited, leaving most societies to use traditional healers.

Both the global health report and a medical anthropology perspective require response at multiple levels: political, social and economic. The report focuses on policies and legislation to help decrease the stigmas associated with mental health disorders and isolation that is often a result of this problem.  Their solution includes raising awareness of the causes of mental disorders and requires more than pharmaceutical intervention. While this is all very true, the medical anthropology perspective localizes the solution taking into account the different needs of men and women. Most importantly, this perspective approaches the problem of mental health in the context of the society of the afflicted mixing the social and biological fields to come up with the most complete and relevant solution.

Considering slums like Malavani as a type of culture found within the city of Mumbai redefines the problem of mental illness in many ways. While there may be negative stigmas attached to these slums, in reality they provide basic labor for the population of other middle class families. Because of these opportunities and the prevalence of inequality in almost all urban cities, these slums have become a learned lifestyle with its own set of practices, beliefs and accepted behaviors in the community. This being the case, the prevalence of mental illness in Malavani has become an accepted although not valued part of the people’s everyday life. It is hard for men to find work in the city on a long term basis leading many of them to get into cycles of inactivity eventually leading them to give up and leave the wage earning to their wives. While the wives work, the men turn to bar-girls or prostitutes, drugs and alcohol reinforcing a sense of hopelessness, depression and tension for themselves and their families. These types of cycles develop partially because of the stigmas already placed on the slums as aforementioned but also because of addiction prone environments commonly associated with slums. Many of the people of Malavani described the openly accepted practice of drinking and smoking to the point that they become routine and an ingrained part of ‘slum life’. These practices are even further established in the slum culture because of the easy money that can be made off the retail of such products. These slum cultures may be partially due to the separation many people feel from their cultural roots when they move from their homes to the city for better opportunities. Recognizing slums as a culture helps explain some of the reasons for the prevalence of mental illness in places like Malavani through the establishment of acceptable abusive behavior, unequal gender and social roles and disparate access to resources.

By recognizing the slums of Malavani as a culture, I can now better understand the flexible application of the concept of culture. It does not necessarily have to apply to a group of people in the same place, who share the same religious beliefs or the same race, but can apply to people in the same social status. I had always struggled with the concept of culture because there was no one definition that could be applied to it but could change depending on various things. This slum lifestyle is passed on to succeeding generations because of continued inequalities on multiple levels; although it may diverge due to the different attitudes, beliefs and goals held by the men versus women of the slums. The gender differences also relate to the concept of situated knowledge, meaning there are specific contexts to how people take in information. It is shaped by their circumstances and culture which help mediate their experiences of mental health.  Many of the people in these slums see mental health problems as a social problem rather than a legitimate medical one. The disease that an individual may be facing is often viewed as a stigmatized sickness by the community, especially since addictive substances commonly go hand in hand with mental disorders. The actual illness or experience of the suffering by the individual may be very different from both the sickness and disease understood by the medical and local community. The difference between these concepts was made clear when applying it to the Malavani slum because it was easier to understand these concepts when put into practice. Discerning the different implications of each of these concepts can help an anthropologist fully understand what health problems are and do to the physical body and emotions of a person and the community they live in.  

            On a practical level, approaching mental health in Malavani with a medical anthropology perspective means more than a biological fix is needed. Pharmaceutical drugs can only go so far to help fix the mental health disorders of this community. Also, this perspective determines that these illnesses come from more than biological sources, but from the social and physical environments of the slum. There are many things that play into the mental health of the people living in Malavani such as access to health care, basic resources like food, clean water, and sanitation and crime rates. Realizing that the stressors observed and expressed by women of this community are far greater than those felt by men is important because it means that gender specific solutions need to be implemented in a way that will not worsen the conditions of the women who are already beaten and abused on a regular basis. Disparities in education, employment, the household and community entitlements need to be lessened through raising awareness and possibly more participation by the Indian government through enforcement or funding. Possibly providing places of protection or support groups for those who face physical violence, such as women could help ease the transition so they would no longer feel helpless and trapped in their situation. Establishing a sense of safety and security in the community with local support is a good place to start.

            Mental health in Mumbai is a very tenuous thing that is easily influenced by the social, physical and emotional environment of this slum. Stressors and tension leading to illnesses such as depression and emotional distress are experienced differently by the men and women and by those who live in the sanctioned versus unsanctioned areas of Malavani. By tackling this problem from a medical anthropology perspective, I am focusing on more than the biological aspects of mental health, taking into consideration the affected people, how they react to and how they understand this problem. I am able to have a more holistic approach to this global health problem and understand that inequality is at the root of the problem. With a combination of pharmaceutical, governmental, and social support mental health in this community can be greatly improved resulting in a more productive and stable society.  

Works Cited

Parker, S. R., Fernandes, J., & Weiss, M. G. (2003). Contextualizing mental health: gendered

             experiences in a Mumbai slum. (Vol. 10, pp. 291-309). Switzerland: Carfax Publishing.

Sengupta, Amit, ed. Global Health Watch 3: An Alternative World Health Report3 (2011): Rep.

             London| New York: Zed, 2011. Print.