I work as a psychiatrist in a district hospital in Goa, India. The hospital also has a crisis centre to respond to women and child survivors of violence. I have the privilege of working with the crisis centre as well as listening to intricate and private lives of women and girls in my Outpatient department (OPD). As a nodal officer managing the day to day functions of the crisis centre, I have also heard several narratives related to violence. It has enabled me to recognize hardships and struggles women go through and their harsh realities. The issue of violence is further exacerbated due to societal structure and norms and these women have to navigate hardships of power and control.

This blog is based on my experiences with my patients and patient referrals I receive from other departments and the crisis centre. These experiences highlight the inextricable links between violence and mental wellness. As health workers we are often too busy to “listen” to patients without interrupting. But women coming to the hospital especially those facing violence want someone to listen to them without being interrupted or judged. I reassure them and provide them support. By doing so, I believe I generate hope in them that they are important, they are believed and that someone cares. Some of them have told me that they felt “good” and relieved after speaking to me.

Many of the stories I have heard have been from older women:

1. An elderly widow was seeking services in my department. She would often come alone. She presented with somatic complaints & headache along with sleep disturbances.  It was only in her subsequent visits and with a lot of reassurance, she opened up about the suffering she is facing from her own sons. Though her sons were well to do and earned well, they did not care for her. She was asked to cook separately in a room attached to the main house and was isolated. The main house is occupied by sons. The loneliness and being abandoned was aggravating her sleep difficulties. Along with counselling and psychiatric medicines she started to feel better. she visits me on a monthly basis and vents out her feelings & experiences. She has found a confidential space in my practice and a confidant in me.
2. A senior citizen (elderly woman) who sexually abused by a very young familiar person was referred to me by a gynecologist at our hospital. She was finding it hard to come to terms that a person whom she trusted had sexually abused her at this age. The gynecologist suspected that the woman had an underlying mental illness. In my interaction with her, she disclosed about the sexual abuse experience.  I helped her to process the incident and discussed that sexual abuse can occur at any age. I counselled her and reassured her about continued support. The non-judgmental environment helped her to disclose the abuse in detail. In fact, after meeting her consistently and providing her structured support, she did not need any psychiatric medicines.
3. A 70 year old elderly lady was brought by her sister to the OPD because she suffered emotional violence at the hands of her husband. He was extremely controlling of her and this has affected her to a large extent. Her sister felt she needed psychiatric treatment. At 52, the elderly woman gave birth to twin sons. Because her husband never paid attention to her, on advice of her sister she took the decision of having children at such late age. The burden of household work, raising kids and continuing to live in violence had taken a toll on her.  She was diagnosed as a case of depression. She improved with medicines and counselling over time. With the permission of the woman, I also invited the sons to discuss their support to the mother.
4. An elderly married woman came on her own to OPD to seek support for psychological distress. A colleague referred her to the hospital based crisis centre. She narrated that her husband worked most of his life abroad & few years back had returned to live at home. Since then he hasn’t been at good terms with her, insults her, makes her feel inferior, and dominates her. She accepted these bad experiences as part of her life & that there was no escape from the abuse. Besides counselling, the team explained to her that she can seek police support for the violence she is subjected to, and an intervention can be also carried out to enable the husband to learn nonviolent ways of conflict resolution. This process provided her with care, support and options should she want to take them up. The woman continues to visit me for ongoing psychiatric care.
5. Yet another referral came to me from an ophthalmic department. She was referred for counseling. She was remarried and middle aged. She narrated psychological abuse and bullying by brother in law & sister in law. She was mocked for marrying again and face stigma because she had divorced her first husband. The family members verbally abused her often and the husband though supportive of his wife, was a mute spectator to this. During a couples counselling session, the husband disclosed that there was an underlying property dispute and if he questions his brother, he and his wife may be thrown out of the house. I explained to the husband that living in constant abuse has had a deep impact on his wife and it is important to prevent such conduct. A referral was made to the crisis intervention department so that the woman could learn ways of asserting herself and putting forth that such behaviour was unacceptable.
6. A young unmarried woman came to my OPD to seek treatment for her brother. She herself was also diagnosed with generalized anxiety disorder (GAD) She disclosed that she felt burdened with taking care of her brothers both of whom were unemployed, unmarried and alcoholic. She found it difficult to cope with managing the house as well as taking care of them. I worked closely with the crisis centre and provided her with counselling and skills to negotiate her conditions at home. She is unable to leave the house as she has no other place to reside and does not have any other family members. Through a series of counselling sessions, psychiatric medication and support from crisis intervention department she is negotiating her space in the house and has been able to confront her brothers.

These examples show that when a health worker is aware of the impact of violence on women and their psychiatric health and how it manifests in practice, they can identify signs and symptoms of violence and can provide women and girls support immediately. Having a crisis centre is an advantage as the counsellors are skilled in referrals to services outside of the hospital if the survivors of violence require them. While bearing witness to the stories of violence against women do cause distress to me as a doctor and a human being, the women’s resilience far outweighs the distress and I am hopeful that as health workers, who listen to women, believe them and support them, we can bring about a positive change in lives of women and girls facing violence.

Written by Shaheen Saiyed

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Dr Shaheen Saiyed,
Senior Psychiatrist &
Nodal officer, CIC North Goa,
North Goa District Hospital,
Mapusa, Goa.