In the UK, being a woman means you’re three times more likely than a man to have a mental health problem. Rates of self-harm among young women have more than tripled since the 1990s. For those facing interlocking systems of oppression, it gets worse. Black British women are more likely to be diagnosed with a mental health problem than white women. South Asian women are 2.5 times more likely to attempt suicide than white women. Trans women and gender non-conforming folks face a “crisis of trans mental health”. But are women really becoming more “mentally ill”, or are we simply having understandable responses to a traumatising and unjust world?
I’ve previously written about the lies of “mental health” – how we are failing people by locating their problems within them as some kind of mental disorder or psychological problem, and thereby depoliticising their distress. And as a psychologist, I’ve seen how mental health services are diagnosing women and girls who have experienced injustice, patriarchal violence and abuse with “mental disorders”.
One example is the highly stigmatised diagnosis of “borderline personality disorder” (also known as “emotionally unstable personality disorder”), which is disproportionately given to women and young girls. In my experience, those receiving this diagnosis are often survivors of extreme sexual abuse, oppression and violence, which could surely explain the “emptiness, inappropriate and intense anger, mood swings and distrust” that are so-called “symptoms” of the disorder.
The psychiatric label can deny the legitimacy of emotions, sending a disempowering message that there is something inherently flawed or disordered in a survivor’s personality. It risks obscuring the violent causes of suffering. The adaptive strategies women use in the face of multiple injustices are not symptoms of “mental illness’” – they are courageous survival responses to unbearable conditions.
Women are more likely to experience poverty, sexual and domestic violence, along with the challenges of childcare and burnout. In a climate of social media hyper-visibility and body image obsession, where police are murdering women they’re supposed to protect, and two women a week are killed by their partners, doesn’t it make sense that women are suffering? At what point does a woman’s fear, rage and sadness at living on the threatening edges of a patriarchal world get labelled as madness or “mental illness”?
“Difficult” women have been labelled “psychiatrically impaired” throughout history, often for refusing to conform to social roles imposed upon them. “Angry woman syndrome” was a disorder classified by “marital maladjustment”. Women were locked in asylums for having sex outside marriage and chatting with other women. So-called symptoms of diagnoses such as hysteria (derived from the Greek hystera meaning “uterus”) or erotomania, were “treated” with freezing cold baths, shackles, and electric shocks through the brain. Surely we’ve come a long way since then?
Well, not quite. History’s shadow looms over women in psychiatric systems today. Young girls are dying from violent restraint, coercion and neglect in psychiatric hospitals. Black women are more likely to be restrained or sectioned, and have their distress criminalised. Electroconvulsive therapy (ECT) is still used across the UK (despite calls for it to be banned on human rights grounds), with women and older people disproportionately likely to experience its damaging effects. Muslim women’s cultural or religious experiences risk being labelled “symptoms” of mental illness by white, eurocentric services. Psychiatric diagnoses such as “premenstrual dysphoric disorder” pathologise women’s hormonal changes, and “postnatal depression” risks medicalising what is, for some women, an understandable response to life-altering, sometimes traumatic changes, in a woman’s life and body.
Shockingly, diagnoses are even being invented. Last week, a Panorama investigation revealed that at least seven pregnancy advice centres in the UK state that termination can cause “post-abortion syndrome”, a so-called “mental disorder” unrecognised by the NHS and an obvious attempt to frighten pregnant people.
Psychiatric diagnoses have been helpful for some women: they can validate pain, or help us access necessary support in the form of therapy, benefits or sometimes psychiatric drugs. Not getting a diagnosis prevents some women from receiving what they need. The emotions women are experiencing are very real and debilitating, requiring support.
But what if we had a bigger toolbox? One that also helps us dismantle systems of oppression that are hurting us? What if we could access all the things we deserve – validation that our pain is real, an explanation, a sense of belonging, compassion, justice, resources, relief and respite, therapy and community – without believing there is something wrong with us, or that we have a broken brain?
With these in our toolbox, a radical transformation in our approach to women’s emotional pain would be possible. We need a cultural shift – one that gives us compassionate room to feel how despair shows up in our bodies and express our rightfully messy emotions, without always rushing to “fix,” medicalise or label them. Our disquieting and tangled emotional landscapes are far more complicated than a TikTok video or psychiatric label might suggest.
One thing is clear: healing cannot happen in isolation – we desperately need each other’s support. The dehumanising lies of gendered hierarchy weigh heavily upon us all. Social action can help us tend to the sometimes hidden roots of our pain – the oppressive systems that hurt us. We must prioritise secure housing and universal basic income for women and families and redirect resources to underfunded domestic violence shelters and rape crisis centres. We also need more community organisations like Imkaan and Sistah Space, working to prevent gender-based violence against black women, or Beyond Equality, which works with boys and men, dismantling the ways patriarchal violence is upheld in their behaviour.
We are not living through a crisis of chemical imbalances, but of power imbalances. Women deserve shelter, safety, community, therapy, resources, spaces to breathe and be fully human; wildly woman and deliciously rageful. When we dare to reveal ourselves, neither we nor our unruly emotions can be boxed or labelled. Our seemingly unsightly pain is longing to be witnessed, and met with love. It is only through collectively caring for our hurt, that we can move beyond survival – to cultivate the joy, pleasure and freedom we deserve.
This article was amended on 8 March 2023 to remove a reference to “abortion providers” when pregnancy advice centres was meant.
Dr Sanah Ahsan is a clinical psychologist, poet, writer, presenter and educator. She is speaking at the Women of the World festival on 10 March
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