Mental Health Aspects of the ‘#MeToo Movement’: Challenges and Opportunities

Abstract

The whole world including India is experiencing the ‘#MeToo movement’ to address the issues of patriarchy, gender violence and related issues. To a large extent, the current course is one of confrontation and not cooperation to address the issues of long—standing disparities in gender roles and relationships. There is a mental health aspect to the expected changes to gender relationships—both pluses and minuses. The paper discusses how the gender-equation has been an issue in every age, which every culture and society has addressed in their own unique ways. While the changes have been gradual and incremental, it will be difficult to define what is ‘ideal’. Reporting of a few cases of ‘MeToo’ is neither the best way to address the needed changes though individual instances can trigger changes. As seen in the case of Nirbhaya episode in 2012, nothing much seems to have changed in the last one decade. We probably are not asking the right questions nor acting at the right level or on right targets. The chapter will address various aspects of the mental health dimension including the recognition of the gender inequalities as vital to bring about changes, integration of mental health knowledge in recognition of the importance of equality, social connectedness, the lifelong impact of adversities like child trauma, living in conflict situations, value of family life and impact of urbanization. It covers how the changes in whatever form, desirable or undesirable, will have mental health implications. It will also present the importance of understanding the mental health impact of changes at the level of individuals, families, community, state, international levels as part of the change process and the need for systematic engagement of the society at many levels, to prevent or protect women against similar situations.

Appendices

Appendices

Appendix 1: Voices of the Community to Sexual Violence

• President of India, Mr. Pranab Mukharjee, ‘let us resolve this death will not go in vain’.

• Prime Minister Mr. Manmohan Singh, ‘we should channelize emotions to concrete action’ further he assured that ‘we will make all possible efforts to ensure security and safety of women in this country. The Home Minister has already spoken about the steps being taken. We will examine without delay not only the responses to this terrible crime but also all aspects concerning the safety of women and children and punishment to those who commit these monstrous crimes’.

• Ms. Sheila Dikshit, then CM of Delhi, ‘what is in our society that has resulted in this tragedy. We all have to think about this and find solutions. It is a time for deep reflection’.

• Home Minister Mr. S. K. Shinde, ‘Government to make changes in the law to prevent such incidents’.

• Mr. K. P. S. Singh, Minister of State for Home, ‘Government will take steps so that no other citizen will have to go through the same suffering… we should prevent such incidents do not occur and called for change at the level of people-the fault is not with laws but with people’.

• Ms. KrishnaTorath, Minister noted, ‘we have to do many things. We have to bring about changes in our educational system’

• Mr. Soli Sorabjee, ‘concentration on the removing of causes’.

• Mr. Arun Jaitley, ‘it is time for Indian Society to introspect..we need to create an environment in India so that no woman is treated in this manner’.

• Ms. Brinda Karat, ‘support to the survivors’.

• Mr. RamJethmalini, ‘the fault is not with the laws but with the people’.

• Ms. Brinda Grover, social activist, ‘many things need to be done’.

• Ms. Ranjana Kumari, ‘our systems have failed’.

• Ms. Sunita Krishnan, ‘a whole mental health system to support the survivors’.

• Ms.UrvashiButalia, ‘let us ask how we contribute to rape’

• Ms. KiranBedi, ‘prevention comes first’.

• Mr. Parveen Swami ‘the problem is us’

• Some of citizen comments on the mass media were to: ‘rebuild the tone of the society’; ‘need for total societal change’; ‘attitudes are ingrained in our society’; ‘no band-aid solutions’; ‘we must look at it from a societal point’; ‘mindset problem need to be addressed’.

Appendix 2: Salient Points of the Indian Psychiatric Society ‘Sexual Boundaries in the Doctor Patient Relationship: Guidelines for Doctors’ (Box 2) (25)

• (1) It is the ethical duty of all doctors to ensure effective care for their patients. This would mean that their own conduct should in no way harm their patient.

• (2) Doctors should ensure that they do not exploit the doctor–patient relationship for personal, social, business or sexual gain.

• (3) In view of the power gradient in the doctor–patient relationship and possible transference issues, doctors are reminded that even “consensual‟ sexual activity between patients and doctors irretrievably changes the therapeutic nature of the doctor–patient dynamic.

• (4) Any non-consensual sexual activity would amount to sexual abuse/molestation/rape and doctors would be answerable to the law of the land.

• (5) It is obviously important for doctors to take a relevant sexual history and perform appropriate physical examination. This should be done sensitively and documented properly in the notes.

• (6) If treatment that requires the patient to be sedated is used (like electroconvulsive therapy, or any procedure that requires anaesthesia), a nurse should be present during the induction and recovery of anaesthesia.

• (7) Doctors are reminded that even a relationship with a former patient is discouraged and could be construed as unethical, as the previous professional relationship can influence the current relationship.

• (8) Though these guidelines pertain primarily to patients, doctors are reminded that similar care should be extended to interactions with students, colleagues and other professionals in the multidisciplinary team- indeed anyone who is in a „power imbalanced relationship‟ with the doctor.

• (9) Any failure to follow these guidelines, if reported to the Indian Psychiatric Society (IPS) will be referred to the Ethics Committee. It is suggested that all allegations of SBV be taken up for initial enquiry by the Ethics Committee of the IPS. If considered appropriate, they will refer the case to the local ‘Internal Complaints Committee’ (as required by the Supreme Court mandated law on Prevention of Sexual Harassment of Women in the Workplace (Prevention, Prohibition and Redressal Act 2013.) Though this law pertains to women at the workplace, many hospitals/nursing homes have gender neutral policies which extend to patients too.

• (10) If any criminal act is reported, then the appropriate process of enquiry by the police should be initiated. Doctors are reminded of their own ethical obligation to report unethical conduct by colleagues. (As listed in Sect. 1.7 of The Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002). Where children are involved, reporting is mandatory or risks imprisonment (Protection of Children from Sexual Offences Act, POCSO 2012).