“Complete desolation.” “Sheer humiliation.” “Life is bleak and meaningless.” These were the revelations of three depressed women I Interviewed under the clutches of societal flaws and stigmas in Bangladesh.
In order to understand the manifestation of mental illnesses in any type of setting, it is essential to understand the circumstances that shape an individual, with culture being a monumental precursor for poor mental health. Structural oppression, poverty, and homelessness are the leading causes of depression in Bangladesh (Selim, 2010). However, these are merely a catalyst for the mental disease; cultural processes encourage the development of psychopathology. The stigmatization of mental illnesses in the Bangladeshi community is an aspect of culture that constantly works hard to keep depression preserved. In fact, as a result of this constant stigma, many Bangladeshis are demonstrating somatization – an outward manifestation of mental illness, such as headaches and muscle pain, that have no identifiable physical cause. This phenomenon hints that there are much more serious and subconscious occurrences that are impeccable for the deterioration of one’s mental health, especially that of a woman’s.
To support my thesis, I have interviewed three Bangladeshi women, two of whom live in Bangladesh and one who is an immigrant living in America, who all showed signs of somatization. Farhana, 49, is a housewife and mother of three who immigrated to the U.S. when she was 18 years old, married with one child. She has trouble sleeping at night, claims her heart beats out of her chest, and complains of frequent pains in her stomach and in the muscles of her arms and legs. While she is on medication for anxiety and gastrointestinal problems, her symptoms are at a low at certain times and flare up during times she becomes stressed. When asked about her thoughts on mental health services, she said, “I have gone to a psychologist before, but I don’t like it there, they ask me strange questions like whether I have thought of suicide or whether I possess guns.” When asked about the sources of her stress, she mentioned her children, two of which are married, but would offer no more details.
Rabia, 40, a resident of Bangladesh and also a housewife says she has frequent headaches that prevent her from doing her day to day tasks and that cause her to be bedridden for most of the day. “The only reason I get up and do my chores is because if I don’t cook or clean the home, no one else in the family will.” Her doctor gave her painkillers and instructed her to stay hydrated but her headaches persist. She worries a lot about finances and says her husband barely makes enough to feed the entire household, which consists of 10 people. She did not believe visiting a psychologist would help her because she firmly believed she was not “crazy”. “What would help me is if someone gave me money. Money would take all my problems away”, says Rabia.
Jeba, 45, a housewife, a mother of four, and a resident of Bangladesh complains about pains in her joints, headaches, fast heartbeat, sleeplessness, and an overall sense of unwellness. She too is bedridden for most of the day and has servants to do the daily chores. Her doctors have prescribed her different medications over the years but while one symptom goes away, another seems to dominate. When asked about her mental state, she expresses she feels unhappy. “There is always something to worry about; finances, family issues, my children’s future, my parents’ health…” The thought of visiting a mental health professional had not crossed her mind and although she does not deny that she is depressed, Jeba is skeptical about the benefits of psychologists and psychiatrists.
All of the women I interviewed had somatic symptoms, sources that they were frequently stressed or worried about, and hesitation or resentment towards mental health services. This alone showed that there were common processes at play that caused these women to develop similar attitudes. One of the most pressing similarities to explore was their gendered identity and how Bangladeshi culture shapes a woman’s individuality.
The degrading dowry system of Bangladesh, a cultural tradition whereby the bride’s family compensates the groom’s family for the marriage, shames women and often exacerbates financial problems (Selim, 2010). In families with numerous daughters, dowry becomes the main reason for poverty and a harbinger of depression not only for the parents but the daughters as well (Selim, 2010). This payment can be flexible in its form but often exceeds the family’s means (Begum, 2014). Social norms demonize daughters for their inability to bring home an income, even though the same cultural conventions look down upon working women. To make up for the “loss” that the groom’s family will incur, i.e., an extra mouth to feed without an extra source of income, the dowry system heroically saves the day. Moreover, dowry also compensates for the investment parents make in their sons’ educations and careers (Begum, 2014). Although this notion is outdated and many women in Bangladesh are able to make a living, the dowry system continues as a cultural tradition, especially in rural areas.
Bangladeshi women’s subordinate position in society may be the reason why women are more susceptible to depression than men (Hossain, Ahmed, Chowdhury, Niessen, & Alam, 2014). Women of all classes are considered to be less than men in almost every aspect. In many households, women depend completely on their fathers or husbands for decisions and financial support. They are expected to be obedient and adhere to gender normative roles or else face punishment. In addition, women endure humiliation and physical abuse from their family and community if they are unable to bear male children (Tarafder and Parves, 2014). As a result, women suffer from an immense amount of psychological pressure, leading to feelings of restraint, fear, anxiety, and low self esteem, which can affect core aspects of one’s self-identity (Tarafder and Parves, 2014).
In comparison, men are socialized into a patriarchy where domination is normalized (Yount, James-Hawkins, Cheong & Naved, 2016). They are uninhibited by societal norms and have complete autonomy over themselves, their wives, and their children. Therefore, the factors that prevent self growth in women are practically nonexistent for men, making men less susceptible to depression.
The impact of depression on an individual can extend to work, education, and relationships (Selim, 2010). The person loses motivation to complete goals, whether they are long term or day-to-day tasks. For instance, they might miss work or school frequently, be unable to study for important exams, and start growing distant from friends and family, even significant others. Many participants in Selim’s (2010) study expressed that they saw a bleak future for people with this ailment. They felt that if left unsolved, depression could lead to other illnesses, such as stroke, and even make a person more susceptible to attempting suicide (Selim, 2010).
Although it appears that the Bangladeshi community has a generally accurate grasp of what depression entails, labeling depression as a mental disease and seeking treatment for it would be considered social suicide. Depressed individuals are heavily stigmatized throughout many parts of society. They are the misfits, the rejects, the underlings of the community that a “normal” person (someone who is not labeled with mental health concerns) will not associate with. This negative attitude towards mental illnesses leads to discrimination and a lower quality of life for patients (Davey and Keya, 2009). Studies have shown that individuals are blamed for having a mental disorder when in fact there are several genetic and environmental causes that are out of the individual’s control (Davey and Keya, 2009). Households with mentally ill patients are completely avoided as if they were contagious, and this in turn ruins the family prestige (Davey and Keya, 2009).
In addition to society, family members reject their own. A depressed patient will become mistrusted and is excluded from decision-making, which demonstrates a complete loss of independence (Davey and Keya, 2009). Even after their conditions have improved, the stigma stays like a permanent scar and it becomes strenuous to salvage relationships (Davey and Keya, 2009). Many marriages are denied or broken off down the line, making relationships difficult to obtain and preserve (Davey and Keya, 2009). Non-disabled members also have a difficult time settling down or maintaining relationships because “an entire family takes up the shame and burden of having a mentally ill member” (Lauber & Rössler, 2007).
This discrimination against mentally ill patients also extends to the workplace. Patients are paid a lower salary and not taken seriously (Davey and Keya, 2009). They have little to no chances for promotions or bonuses regardless of the quality of work they produce. Employers refuse to give patients positions that hold a lot of responsibility due to skepticism of their abilities (Davey and Keya, 2009). Thus, we can see how a mentally ill patient could also become financially burdensome to their family. As a result of this crippling stigma, some families decide to abandon their mentally ill members, all of which can have adverse effects on an individual’s mental well being (Lauber & Rössler, 2007).
At the end of the social stigma spectrum lies the equally detrimental phenomenon of self stigma. The misconstrued beliefs people have regarding psychosis starts to affect victims on a more internal level. It is one thing if society suppresses an individual, it is a completely different ball game if that individual starts to suppress herself as well. Self-suppressing behaviors are the consequence and demonstration of an individual who starts to believe the stigma. This represents the complete forfeit of that individual’s self esteem and sense of self worth (Darraj, Mahfouz, Sanosi, Badedi, & Sabai, 2017). When a person feels they have nothing left to fight for, hope and motivation are lost. The person harbors a negative self image and has little faith in their own abilities. They start to demonstrate withdrawal from others and discourage themselves from achieving their potentials. In the circumstance of depression, self stigma is often the reason treatment is avoided or delayed extensively (Darraj et al., 2017). The phenomenon of self stigma goes hand in hand with a theory described and demonstrated by numerous psychologists called the self-fulfilling prophecy.
The self-fulfilling prophecy is essentially the embodiment of self stigma. It is described as the tendency for individuals to accept and act out what is expected of them (Madon, Guyll, & Spoth, 2004). The expectations could be set by friends, family, and society at large. The expectations pressed onto these individuals create intimidation and the compulsion to belong (Madon, Guyll, & Spoth, 2004). We see this happen on a daily basis in the context of family. Parents who make it apparent that one child is favored over the over are setting up the children to encounter the self-fulfilling prophecy. The favored child has more confidence and support and so continues to achieve in school and extracurriculars. The unfavored or “bad” child has less confidence and may consistently partake in risky and self destructive behaviors. In this way, something that was originally false becomes reality through the need to fit anticipations (Darraj et al., 2017).
Expectancy behaviors in the form of stigmatization is constructed by the collectivistic attitude of traditional societies, such as Bangladesh. A traditional society is “characterized by familial orientation and group-centeredness, low education and poor economic development.” (Lauber & Rössler, 2007). A prominent focus on the group as opposed to the individual causes person-to-person value to be measured by their contribution to community and not by their self worth. Moreover, contribution is specified by gender, which further marginalizes individuals with mental illnesses because of their limited roles. For instance, men who cannot earn a living, reach their career potentials, nor make decisions for the family are devalued. Women who cannot give birth to children, please their husbands, or carry out domestic activities such as cooking and cleaning are also devalued. Although mentally ill women may still be fertile, the community looks down upon these mothers for tainting their lineage with mental illness .
It is essential to note that a lack of understanding of mental illnesses is widespread among many traditional societies, which is how stigmas are fostered. In these societies, mental illnesses such as depression are thought of in a more abstract way as compared to Western societies. In the case of Bangladesh, even the word “depression” is not clearly translatable (Selim, 2010). Most recognize it as a persistent state of worry that stems from stress, and do not consider it a mental illness at all (Selim, 2010). Terms such as chinta rog (meaning worry illness), tension (anxiety), brain stop (brain stops functioning), orthonoitik (financial), durbolota (weakness), and bhuk dhorfor (palpitation) are used to describe depression and depressive symptoms (Selim, 2010). Studies show that if labeled a mental illness, depression is equated to schizophrenia, which is a more visibly intensive disease, with the label ‘mental illness’ being the only binding factor (Lauber & Rössler, 2007). Moreover, due to a large emphasis on paranormality and religion and not enough knowledge on psychiatrics, chronic mental health problems are attributed to black magic, possession by spirits, divine punishment, and social and moral deception of ancestors (Lauber & Rössler, 2007). Pinpointing mental illnesses, something that Bangladeshi people cannot explain, onto other abstract concepts – the supernatural – gives society a sense of consistency. As per human nature, we tend to be afraid of the unknown. Therefore, any perceived knowledge on a matter, whether accurate or not, alleviates feelings of concern when faced with ambiguity. This inability to acknowledge mental illness as a health problem aggravates stigmatization because it does not offer a permanent solution.
The fact that stigmatization of mental illnesses has such deep roots within society brings forth a larger problem. From fear of being labeled insane and all of the humiliation that trails along with it, people with potential mental health problems are either ignoring their issues, or bottling them up. Normalizing depression and anxiety into concepts such as chinta rog makes it easier to disregard these illnesses as serious mental health complications that need to be treated. For those who may realize what they are suffering from, seeking any type of treatment is not an option, as it would risk putting their entire lives and reputation on the line. Families often encourage this as they keep their mentally ill members a secret from the public for the sake of their own prestige (Lauber & Rössler, 2007). However, because it is human nature to find a way to endure even the most difficult situations, we see the development of factitious coping mechanisms among the women in the Bangladeshi community.
Many families who become desperate for a solution may revert to traditional (TH) and spiritual healing (SH) methods while avoiding the biomedical approach completely. Traditional methods have been a part of the Bangladeshi culture for a long time, while psychiatrics is still a very underdeveloped field in the country. It is very difficult to have faith in a system about which little is known. Moreover, traditional healing is an attractive method because it encourages the idea that hardships are due to bad luck and paranormal sources and do not originate from the patient (Ayshi et al., 2015). It also convinces a person that the only solution is to “change fate” through supernatural means (by citing incantations, prayers, performing rituals, etc.) (Ayshi et al., 2015). Jeba herself mentions in her interview that her calamities might be a punishment from God, caused by her lack of faith and worship. Because traditional methods have been a part of Bangladeshi culture for a long time, it remains a vital part of the solution. However, this becomes problematic when the issue is a part of mental health and patients are relying on supernatural and spiritual means to try and alleviate stress permanently.
When society is structured in a way where people are shamed for having a mental illness, but not shamed for having a physical illness, this subliminally teaches patients that all ailments must be physical. Therefore, another coping mechanism created by depressed patients is to embody their illness into a physical symptom. Somatization and depression have been found to occur together more frequently in non-western countries than western countries (Selim, 2010). The process is a largely subconscious development that nonetheless creates a safe haven for patients. Somatization protects from the stigma that can destroy a person’s career and interpersonal relationships. For those patients and families in denial of depression, somatization also gives a socially acceptable name to a problem, such as a chronic headache, and options for socially acceptable treatments, such as a visit to the doctor. Patients who are depressed have complained about several somatic symptoms such as dizziness, sleeplessness, aches and pains, burning sensations, shaking limbs, and heart problems (Selim, 2010). For somatization, many health professionals will try to alleviate these symptoms but will find it to be a temporary fix, suggesting that the issue is not in the body.
Somatization of mental illnesses has been found to occur in other countries and cultures as well. A study done in 2008 has found that many North Asian countries such as China have dramatically lower occurrences of depression (2.3%) compared to western countries like the United States (10.3%) (Ryder et al., 2008). However, this was attributed to Chinese patients demonstrating depressive symptoms in a different way than western psychopathology expects (Ryder et al., 2008). Psychiatric patients in China were diagnosed with neurasthenia, which is an array of somatic symptoms (headaches, fatigue, sleeplessness) that are often associated with emotional disturbances (Ryder et al., 2008). Upon exploration of the causes of somatization among the Chinese, a few theories have been discussed. One theory is that the Chinese language lacks the vocabulary for describing psychological conflicts or emotions (Ryder et al., 2008). However, this has been criticized by other scholars who question how a language can be classified as elementary or advanced (Ryder et al., 2008). Other scholars counter that emotional expression is given visceral terms and somatic metaphors, and are still observed among Chinese Americans, who have a wider range of vocabulary (Ryder et al., 2008). The more compelling theory is that stigma regarding psychiatric symptoms pushes an individual to avoid psychiatric labeling (Ryder et al., 2008). Similar to Bangladeshi societies, Chinese communities also suffer from humiliation and the degradation of familial prestige in the face of mental illnesses, giving them a reason to conceal their psychological distresses (Ryder et al., 2008).
Similarly, Nicaraguan grandmothers and children have been known to express physical symptoms in the face of distress (Kohrt & Mendenhall, n.d.). The term pensado mucho, which means “thinking too much,” has been found to be culturally important and is an embodied idiom for chronic worry (Kohrt & Mendenhall, n.d.). A common occurrence in Nicaragua is the outmigration of parents for financial opportunities, which is “the most significant, disruptive force impacting the lives of women of the grandmother generation…” (Kohrt & Mendenhall, n.d.). Under these circumstances, grandmothers assume full care for their grandchildren, which brings about stress regarding bills and expenses. One grandmother named Marbeya explains that there is a distinct difference between worrying and thinking too much. Worrying, she explains, is a more trivial process that can be attributed to materialistic and external things and can be solved (Kohrt & Mendenhall, n.d.). Thinking too much, on the other hand, is a more intrinsic issue that is not easily resolved (Kohrt & Mendenhall, n.d.). It is the constant repetition of thoughts that Marbeya claims makes the noise “riqui, riqui, riqui” in her head (Kohrt & Mendenhall, n.d.).
This study supports the theory that mental distress can be a socially learned phenomenon and is labeled in culturally shared manifestations. In Nicaragua, when a grandmother talks about pensado mucho, her peers understand that this an expression of her current strife (Kohrt & Mendenhall, n.d.). In contrast, grandmothers feel a disconnect with doctors because their situations are deemed “all in their head”, which makes them unwilling to share their struggles with professionals (Kohrt & Mendenhall, n.d.).
It is important to note that a diagnosis that labels somatic symptoms “all in your head” actually exists in the medical world. It is called Somatic Symptom Disorder (SSD) and is for people who have excessive and recurring thoughts about certain visceral symptoms, which then leads to exorbitant behaviors regarding the symptoms (Klaus et al., 2015). For instance, a person suffering from SSD may constantly worry about having a serious underlying illness, frequently check the body for impairments, have persisting but useless health care visits, and paradoxically express the inefficiency of medical treatments or complain about side effects (Klaus et al., 2015). Patients with these symptoms are extremely distressed and can become disabled due to pain. This disorder emphasizes mentally-induced somatic symptoms and attributes the cause to various factors such as genetic, personality, hidden emotional issues, etc (Klaus et al., 2015).
Although SSD sounds very similar to what Bangladeshi women are going through, it is still vastly different from the process of somatization due to stigmas. For one, SSD has a tendency to propose that patients who develop this disorder are emotionally weak. Although they are referred to mental health professionals, the focus of treatment is still targeted at the intrinsic qualities of the patients rather than systemic injustices and their experiences as a whole. Labeling patients with SSD in this way makes them feel that their feelings are insignificant and being overlooked. That because they are being told “it is all in their head,” that they are not going through pain and suffering. For this reason, my study does not acknowledge somatization as a disorder but as a humanistic reaction to psychiatric stigma. It is acknowledged as a manifestation, which suggests that the focus of treatment and mediation need to be placed elsewhere before it is placed on the patient alone.
A majority of this labeling, whether accurate or not, occurs within the four walls of a doctor’s office. There are two main issues of the medical profession that must be addressed; patient-centered mistrust toward the medical field and stigma from the medical field toward their patients. Misconceived beliefs and lack of awareness from the patients splinter the patient-doctor relationship, leading to reservations about the field and depreciation of the vital role a doctor plays in psychiatric health. In a study conducted on postnatal depression in Bangladeshi mothers, participants expressed “an unclear perception of the role of the health visitor” (Hanley, 2007). They emphasized the importance of family relations and community support and thought that sharing emotional issues with strangers was considered weak (Hanley, 2007). When visiting doctors, they masked the disturbances they had. What would be considered psychiatric issues by the medical world were interpreted by the patients as unquestionable challenges created by a higher being (Hanley, 2007). The reason that postnatal mothers with depression were visiting doctors was because they believed the follow-ups were mandated by law and focused on childcare. Therefore, the visits were not being utilized to their full capacity in terms of mental health as the mothers were not aware that these services even existed or how they related to the way they currently felt (Hanley, 2007).
Another reason that women ignored the potential relief provided by medical professionals is that they turned instead to religious and cultural beliefs to offer solace. Given the profound importance of familial advice, those suffering from depression would often consult and adhere to the guidance provided by family members. For instance, the concept of the Jinn is a recurrent topic among family that is attributed to poor emotional and mental health (Hanley, 2007). In the Holy Q’uran, Jinns are beings made of fire that can materialize as both humans and animals and have the capability to possess bodies (Hanley, 2007). While there are good jinns, there are ones that torment people, which is the reason given for certain mental states. In terms of prenatal and postnatal care, new mothers and mothers-to-be are told not to wear bright colors, refrain from tight clothing, not let their hair down, stay inside after dark, read the Q’uran, and pray (Hanley, 2007). If these precautions are disregarded, a mother can supposedly endanger the lives of both her and her child by enticing the jinn. In some cases, mothers that are deemed to be affected by Jinn are ones who show symptoms of postnatal depression. In Hanley’s study (2007), a Bangladeshi mother named Chunna was told by a doctor she was experiencing postnatal depression and was prescribed Valium, a drug that treats anxiety and seizures. However, she attributes her improved health a few days later to an amulet her mother got her from a spiritual healer to wear around her neck for protection (Hanley, 2007). Considering that anxiolytics such as Valium can take a few days to work, the cause of ameliorated mood in Chunna could have been the Valium, although it was overlooked.This illustrates the misunderstanding Bangladeshis have regarding the sources of their problems and where resolutions originate.
Conflictingly, stigma and the effect of cultural beliefs do not escape doctors in the medical field. Many medical professionals also harbor prejudices towards depressed individuals, which originates from the society they grew up in and their familial, religious, and cultural beliefs. These prejudices exist as early as medical school, which impact the specialty that medical students decide to pursue, deterring them away from the field of psychiatry. Farhana expressed in her interview: “Psychiatrists are doctors for crazy people and that is not considered reputable in our culture”. Parents’ emphasis on reputation through the career of their child puts pressure on the child to live up to their family’s expectations. As a result, anti-psychiatric opinions start forming from a young age and follow individuals through to medical school. Consequently, Bangladesh has one of the lowest numbers of mental health professionals (Giasuddin, Levav, & Gal, 2014), and this only exacerbates the gap between patients and medicine.
As the face of the health care system, medical professionals have the ability to shape the mental health experience for their patients (Fernando, Deane, & McLeod, 2010). Doctors who harbor a stigma toward mental illnesses can often mold a very negative experience for patients as a result of subconscious discrimination (Fernando, Dean & McLeod, 2010). This in effect leads to the internalization and bottling of depression, which then leads to somatization, as discussed earlier. A study done on developing countries stated that, “(three quarters of) medical educators…were unwilling to work with a person who had made a complete recovery following a psychotic illness” (Fernando, Dean & McLeod, 2010). Damaging psychiatric stigma also increased chances of doctors discontinuing treatment, which can harm a patient’s mental health (Fernando, Dean & McLeod, 2010). Most professionals have expressed that they believe mentally ill patients to be unpredictable, and a smaller portion believe they are a danger to others (Fernando, Dean & McLeod, 2010). Despite the higher education in this field, professionals still felt that mental illness was to blame on the individual and that they should “pull themselves together” (Fernando, Dean & McLeod, 2010). Depressed individuals who interact with these professionals feel undermined and misunderstood (Fernando, Dean & McLeod, 2010). Together, these aspects of the medical field completely disengages psychiatric patients from seeking help. Rather than feel like the clinic is a safety net that they can fall back on, depressed individuals, perhaps particularly women, do not feel a sense of comfort with doctors, both primary care and psychiatric, because they feel they are being judged and devalued. Thus, suppression is fostered in these circumstances and somatization steps into existence.
In order to alleviate the occurrence of somatization in Bangladeshi women, scholars need to tackle the profound research gap that exists regarding the role of culture in depression and stigmas in Bangladesh (Newman, 2013). Without more knowledge about the interplay of factors, it becomes nearly impossible to understand the full breadth of the issue. More importantly, it becomes difficult to intervene with effective solutions to end issues like depression and somatization due to depression.
The primary focus of mediation needs to be placed on the root of the issue: a lack of education. Illiteracy can have a harmful snowball effect on an individual and their family. Even though poverty is the lead cause of depression, impoverished families are in a financial bind because they lack the training and knowledge to further their businesses or apply for well-paying higher-status jobs. The lack of exposure to academia forces an individual to develop perspectives based on the society around them, which are often short-sighted in traditional societies such as Bangladesh. This forces them to rely on cultural traditions such as the dowry system, which in turn emphasizes women’s inferiority. A lack of education also prevents individuals from understanding the true role of the medical field; how illnesses more generally are not biased towards personality or supernatural forces, but can happen to anyone who is exposed to a virus or contains a predisposed gene for a disease. Illiteracy inhibits the comprehension and empathy toward mental illnesses, including the belief that psychological abnormalities are an individual’s fault. It deemphasizes the seriousness of depression and the availability of professionals who could potentially mitigate the causes of mental health related issues.
Although there is still room for more research, the existence of studies on Bangladeshi society have facilitated intervention programs focused on educating the residents of Bangladesh. For instance, a study was conducted that focused on the most efficient way of health communication in the face of a life-threatening outbreak called Nipah virus (Parveen et al., 2016). The study exposed the fact that the Bangladeshi people harbored a strong mistrust toward the medical field, which prevented them from seeking treatment (Parveen et al., 2016). Despite the warnings elicited by the outbreak response team, the residents of the affected areas continued to drink raw sap, which was thought by professionals to have caused the outbreak of the virus (Parveen et al., 2016). Researchers recognized that there was a vast miscommunication exacerbated by using eurocentric biomedical models to explain a concept that was interpreted through a different lens (Parveen et al., 2016).
After taking initiative to explore the community perceptions of the virus, the researchers were able to design a more interactive, culture-centered approach (Parveen et al., 2016). They communicated the same messages about the Nipah virus through more meaningful ways by arranging community group meetings, making house-to-house visits, and giving residents an opportunity to ask questions (Parveen et al., 2016). In the meetings, the epidemiology of the disease was explained in simple, causal terms with the aid of illuminating photographs (Parveen et al., 2016). As a result, the study was successful in educating about prevention and treatment and persuading residents that the virus was transmitted from bats to humans as opposed to the supernatural forces that residents previously believed caused the disease (Parveen et al., 2016).
The implementation of more educational programs that take approaches similar to the Nipah virus study can effectively bring needed changes to the Bangladeshi community. Programs can be designed with different focuses such as eradicating mistrust toward doctors and other professionals, abolishing gender inequality, explaining the causes and treatment of depression, and educating about the transition from depression to somatization.
In addition to educational programs toward eliminating mistrust in systems, interventions need to be placed that focus on increasing the amount of professionals in the mental health industry and mentally ill patients that utilize their services. Incorporating psychology classes and other social sciences into school and university curriculums would expose the field of psychology, minimize stigma, and spark interest from a younger age, potentially increasing the number of individuals who decide to make it a career. As for those who are reluctant to see a mental health provider, it would be valuable to create programs where several volunteer psychologists give free therapy sessions to new clients. This would expedite exposing the benefits of psychotherapy to the Bangladeshi community, some of which may otherwise never utilize the service for monetary purposes. This would also further aid in phasing out the crippling stigma on depression and other mental illnesses.
Taking a grassroots approach to an issue that itself is rooted inside the convoluted concept of culture is not an easy solution. Approaches like these require a lot of time, dedication, and hard work due to the fact that they attempt to change a lot of fundamental ideologies. However, with enough persistence, not only can success be achieved, but the solutions are long lasting as opposed to quick, external fixes that fail to reach the foundation of the issue. Somatization is a manifestation; the cherry on top to a big scoop of depression. Just as the cherry would have nothing to sit on if there was no ice cream, somatization would not exist in Bangladeshi women if it were not for financial hardships, the double standards of gender, and the hindering stigma of mental illnesses, all precursors to depression. With the right approaches and a receptive attitude, the standard of life for depressed women in Bangladesh can potentially become significantly less agonizing and painful than it is now.
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