Relational Sense of Self and Recovery Among Women Living with Serious Mental Illness in Institutions: Implications for Mental Health Practice

Background: Feminist conceptualizations of women’s psychological development acknowledge the centrality of relationships in women’s lives. The relational sense of self theory of women’s psychological development (i.e., an identity that is formed by being in relation with others and community) has important implications for women living with Serious Mental Illness (SMI) in institutions. The loss of social roles and institutional confinement may lead women to experience a sense of personal isolation and ‘disconnection’. However, there is limited research on how loss of social roles due to illness and institutional confinement may impact women’s well-being, particularly in India and other LMICs where mental health care is predominantly institutional.

Methods:  This present study explores experiences of women living with SMI in institutions through the relational theory lens. Through 35 in-depth interviews with 11 women living with SMI at a halfway home in an urban city in India, the study explored how loss of relationships and social supports due to illness and institutionalization impacted women’s sense of self. Interviews were conducted in the native language (Bengali and Hindi), transcribed verbatim, and thematically analysed using NVivo 12.

 Findings: Women participants lived at the halfway home for periods ranging from 2 months to 10 years. Each of the 11 women had limited or no contact with their families; women who were mothers had no contact with their children. Women shared that they experienced disconnection and the absence of reciprocal empathy in their marital relationships. Despite conforming to gender norms and meeting cultural expectations i.e., taking care of families, women continued to experience severe forms of violence and neglect in natal and marital homes. For years, women silenced their voices and needs to stay connected in their relationships but experienced a deep sense of betrayal and regret over failed relationships. In the absence of familial and structural supports, women did not have many alternatives to reintegration. Nevertheless, women contested dominant gender norms/roles and relational ideals of caring for their families. They refused to return to abusive domestic relationships and recognized the urgent need for individual autonomy and economic independence as the only pathway to community reintegration.

Conclusion and Implications:

The study calls for gender-responsive services that can account for the centrality of relationships in women’s lives. Institutional care should acknowledge that separation from families and social relationships impact women’s well-being and take careful measures to not recreate abusive and non-empathic relationships in clinical practice. Mental health practices that are relational in nature will promote healthy connections for women and be better equipped to address their trauma and mental health issues. It is also important to acknowledge that while relationships and connections are central to human growth and development (including women), there is a need to distinguish between relationships that are positive to one’s development and relationships that invalidate, humiliate and violate women’s rights. Incorporating feminist psychology in mental health practice in India implies empowering women with resources that can enable them to separate from relationships that impede their self-development, cause distress and create barriers to their recovery.