Women's Narratives of Institutionalization and Community Reintegration: A Feminist Narrative Inquiry

Background and Purpose:

In India, various underlying structural factors (e.g. gender-based discrimination and violence, poverty, inadequate family support, limited autonomy and gender bias in mental health law and practice) put women with serious mental illness (SMI) at greater risk of abandonment in psychiatric institutions as compared to men. For women who lack family support, halfway homes serve as transitional homes to facilitate their integration from psychiatric institutions to communities. Indian women’s experiences of living with SMI have received limited visibility in mental health research. Using a feminist narrative inquiry, this study explores the socio-political realities of women with SMI at a halfway home in India and examines how their narratives are shaped by gender, mental illness, and social positioning.

Methods:

The study uses a qualitative methodology grounded in a feminist epistemology and three complementary theories: institutionalization (Goffman, 1968), community reintegration (Wong, Sands, Solomon, 2010) and self in relation (Miller, 1976). Guided by a narrative approach, 35 in-depth interviews (in the native language) with 11 women were conducted to elicit narratives related to, 1) factors that contributed to their illness and admission to psychiatric institution(s) and, 2) facilitators and barriers to community reintegration. In addition, ethnographic methods (participant observation and key informant interviews) were employed to investigate how social, cultural and institutional discourses surrounding gender and mental health impacted service delivery at the halfway home. Narratives and observational data were analyzed following guidelines suggested by Fraser (2004) & Emerson (1995).

Findings:

Participants lived at the halfway home for periods ranging from two months to 10 years with limited or no contact with family. They carried a diagnosis of schizophrenia (n=9) or bipolar disorder (n=2). Some women attributed the cause of their mental illness to domestic violence and loss of relationships (e.g. death of parents) and a few others perceived the onset of psychiatric symptoms as ‘sudden’ with no specific cause. Women described being involuntarily admitted to psychiatric institutions by families who could not manage the illness at home and/or who “intended to abandon them under the pretext of mental illness”. Police hospitalized those who escaped domestic abuse and were homeless. At the institution, women reported being, 1) overmedicated, 2) physically abused by staff and, 3) kept in inhumane living conditions. At the halfway home, women shared ‘feeling stuck’. Barriers to community reintegration were: 1) families’ unwillingness to support women, 2) women’s fear of going back to abusive families, and 3) limited livelihood opportunities that deterred women from living independently.

Conclusion and Implications:

Indian women with SMI are spending prolonged periods in institutions and in dire circumstances, often over many decades. Mental health providers should pay greater attention to women’s contexts while delivering care. In the absence of family support, community based mental health services that can offer women structural supports (e.g., supported education and employment) for their social integration are imperative. In addition, socio-political and legal protections are required to ensure women with SMI are protected against exploitation by families, communities and institutions.