Journey of Struggles and Survivors

By Meriam Omar Din

Understanding women with depression, anxiety, HIV, domestic violence, sexual abuse, and marital crisis. 

 

A book on women in crisis written by Consultant Psychologist Dr Meriam Omar Din, compiling selected experiences over her twenty years of practice. It provides valuable knowledge and data for graduate students in Psychology and Counselling, and as an initial self-therapy for women in crisis while looking for professional help. This book consists of 8 chapters including numerous quantitative and qualitative studies on Malaysian women and with more than 50 client cases. 

• Language: English
• Publisher: Meriam Omar Din
• Release date: Jan 15, 2021
• ISBN: 9781393897804

Meriam Omar Din

Dr Meriam Omar Din is a private Consultant Psychologist in ACCESS Counselling since 1998. She obtained an MA (Counselling Psychology) from National University Malaysia, and a PhD (Psychology) from International Islamic University with a thesis on Women with Depression. Her areas of interests are mostly related to women in crisis and mental health issues, including depression, anxiety, domestic violence, HIV, and marital crisis. 

Book preview

Dedication

Foreword

This book is written to provide a psychological-based knowledge in understanding women’s behaviour in relation to psycho-social problems and crises in life. It covers a comprehensive and in-depth knowledge of women’s behaviour with emphasis on women’s experiences during a crisis in life. It is mainly intended for educators, counsellors, and therapist with the hope to provide a more in-depth and accurate understanding of women’s behavioural issues and effective approaches in attending to their concerns and needs. It also provides an overall exposure for women in crisis and may be helpful as an initial self-therapy while looking for professional help.

As a single author of this book, the author has also included a few journals of her significant experiences as a therapist, to provide some insight into the therapist-clients experiences and the interaction effects of the therapy provided to the clients. Readers are expected to gain some insight into the complexity of women’s issues and skills needed to provide a more effective help. This will enable readers a better understanding of women’s issues and to avoid an over-simplistic perceptions and distorted interpretations of women’s behavioural problems.

Selected psychotherapy theories most applicable to women’s issues are also presented and discussed in relation to the cases reported. The writer’s selected cases of counselling and psychotherapies for women during her private practices for over fifteen years are presented based on the categories of issues reported by the clients and the quantitative and qualitative studies by the author. Issues and progress of the clients with long-term relationship with the therapist will be summarised and discussed as to the universality and uniqueness of each case. Cases that achieved the solution stage will be further discussed as to the significant psychological and behaviour changes made by the clients. It is hoped that this book will provide a better understanding of women’s issues and needs during a crisis to enable a better support from significant others and related community service providers.

Discussions of clients’ cases are presented at the end of each chapter and classified into four main categories of clients: (1) depression and anxiety, (2) women with HIV, (3) domestic violence, and (4) marital relationship issues. Experiences from multi-racial and cross-cultural groups of clients have enabled the writer to observe some similarities in their issues reported, indicating certain universality in women’s behaviours in crisis. Differences in interpretation of the problems, magnitude of the problems, and coping mechanisms were reported too. These differences are discussed in relation to the underlying sociocultural factors, adverse childhood experience, and family history of mental-health symptoms reported by the clients.

The content of this book is mainly based on three main sources of data: (1) the findings from quantitative and qualitative data from the writer’s Ph. D thesis on depression in women, completed in 2008; (2) the qualitative data obtained from the records of clients from 1998 to 2015; and (3) past literature reviews related to women issues in Malaysia. Selected cases of clients who attended counselling sessions with the author are presented at the end of each related chapter. These cases are presented using anonymous names and are reported in a summary form in order to protect the confidentiality of individual clients. The selected cases are also reported in further detail with the most recent follow-up interviews conducted in 2019. Significant therapist personal experiences during the sessions were added to provide a more accurate description of the therapist-client interactions experiences.

29th Jan 2020

Acknowledgements

Firstly, I would like to extend my gratitude to Dato Dr Abdul Halim Othman and Dr Wan Abdul Kader Wan Ahmad for their invaluable contributions as mentors during my student years in the National University Malaysia, and in my consultancy services at ACCESS COUNSELLING SERVICES. Dr Wan also assisted me in the editing and content verification of this book. To Dr Mardiana Mohamad, thank you indeed for your valuable help in completing the final stage of writing and helping me to go through the process of publishing the book.

My most invaluable appreciation goes to my Ph. D supervisor, Prof. Dr Noraini Mohd Noor, from the International Islamic University Malaysia, who has developed my writing skills and give me the confidence to start writing this book. Thank you to associate Prof. Dr Wan Sharazad Wan Sulaiman for her valuable contribution in the final editing of the book. Thank you to my closest friend Matron Fadzilah Abd Hamid for her dedication and passion in helping children and mothers in HIV shelter at Rumah Soleha, Kuala Lumpur. She has inspired me to work through the challenging cases of HIV and has enabled me to achieve a great sense of fulfilment as a therapist. Thank you to Fathiiah Hamzah for her hospitality and cooperation throughout my visits to the HIV home.

Last but not least, my greatest compassion goes to my beloved husband, Adnan Murus, who has tolerated my negligence in domestic roles during the busy years. To my four children Shahifulazam, Ezlina, Ezwati and Shahifulazmi; thank you for being my lovely kids, and as adults who have worked through your achievements without compromising humanity and humility values. Ezwati, who shared common professional interest with me, has also contributed to the content of this book.

May Allah bless all of you in this life and hereafter.

Chapter 1: Women and Mental Health

Women’s roles in relation to men, families, and community have been widely documented. Since the ancient times, their roles are believed to be mostly in domestic and child-bearing functions around the vicinity of the home, within the context of the patriarchy relationship. These roles have been culturally accepted in most societies. However, there are a few exceptional evidences of women participating in society roles during the Greek civilisation; these women were allowed legal rights to own property and worked outside the home. A few women during the ancient times had reached legendary roles as rulers (Barbara Watterson, 2011).

As the society progresses overtime, the functions of women have extended to economic and societal roles outside their home, resulting in an increase of the magnitude of stress and conflict among women in trying to meet family’s and society’s expectations. Since the eighteenth century, theories in psychology have addressed the mental and psychological illnesses of women and men, but less attention has been given to the differences in the aetiology between gender.

The need to look into women’s issues as different from men became more crucial with the persistent presence of a patriarchal family relationship, in spite of the increasing and changing roles of women. In the 1990s, the women’s liberalism groups developed the feminist theory as a basis to protect women’s interest and rights in society. Feminism focuses on the promotion of women’s rights and interests with the goal of providing insight into the reality of the issues faced by women and of advocating changes for the equality of rights.

In collaboration with the Global Institute for Women’s Leadership at King’s College London and International Women’s Day, Ipsos (2019) conducted a global study from 2018 to 2019 on a diversified cultural sample of 18,800 adults across 27 countries. The study found that 52% of the respondents believed that it is more advantageous to be a man than a woman, whereas only 12% believed that being a woman is more advantageous than being a man. Three common issues were reported by the respondents: (1) sexual harassment of women and girls, (2) sexual/physical violence, and (3) sexualisation of female figures in the media. Sexual harassment was found to be the biggest equality issue facing women around the world. Balancing work and caring responsibilities and gender stereotyping are the pressing issues reported by the Malaysian sample.

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Women’s Health Issues

Women still face many health issues that need to be addressed in spite of the declaration of women’s rights in 1995. Among the common health issues that predominate women worldwide are cancer, reproductive health, maternal health, HIV, domestic violence, and other sexually transmitted diseases. Sexual and reproductive health problems constitute one third of the health issues for women between the age of fifteen and forty-four years. Young women are also vulnerable to HIV infections and other sexually transmitted diseases. Physical and sexual violence by a partner or non-partner are reported by one in three women under the age of fifty, affecting their physical and mental health.

According to the World Health Organization (WHO), the overall rates of psychiatric disorder are almost identical for both men and women. However, gender differences occur particularly in the rate of common mental problems, including depression, anxiety, and somatic complaints. Depression is more prevalent in women than in men. Unipolar depression is twice as common in women than in men, and is predicted to be the second global disability burden. Depression in women seems to be associated with other mental-health symptoms, including anxiety, somatic symptoms, panic attack, and psychosis symptoms. Family history and adverse childhood experiences tend to increase the severity of the symptoms. Suicidal thoughts and ideation, particularly in the cases of depression, require further sensitivity and understanding in handling the victims (WHO updates: https://www.who.int/health-topics/gender).

Based on the American Psychological Association (2010) findings from a total sample of over 3,000 men and women from 2007 to 2010 data, men and women reported different reactions to stress, both physically and mentally. Women are more likely to report physical and emotional symptoms associated with stress, and connecting with others are the important elements in coping with their stress. Among the common somatic symptoms of stress reported are headache, sadness, upset stomach, and indigestion. Thirty-three percent of married women reported stress symptoms as compared to 22% of single women, indicating stress related to the domestic, child-bearing roles as possible contributing factors. In regard to coping with relationship conflicts, psychological researches have generally shown that women have higher empathetic and interpersonal skills to minimise hostility and conflict. Men perceive a threat from intimacy problems, while women sense threat from separation. Marital relationship issues are able to explain higher stress in married women as compared to single women.

Past studies have generally reported differences in psychosocial issues between men and women. Men reported more work and achievement issues, while women reported more relationship issues. Women rely more on social support and connectivity with others in coping with their issues at home or work setting. The main issues reported by women are mostly about dominating relationship with men, unshared domestic and child-bearing responsibilities, and meeting the challenges in working with men.

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Women’s Mental Health Issues in Malaysia

The National Health and Morbidity Survey (NHMS, 2015) reported an increasing trend in the prevalence of mental health problems among adults (from 10.7% in 1996 compared to 29% in 2015), thus indicating that females, younger adults, and adults from low-income families are at higher risks of having mental-health problems (NHMS 2015, Vol II). The WHO (2020) reported that gender differences have occurred in the rates of common mental disorders, which include depression, anxiety, and somatic complaints. These disorders, which women predominate, affect approximately one in three people in the community and constitute a serious public health problem.

Unipolar depression, predicted to be the second leading cause of global disability burden by 2020, is twice as common in women than in men. The increasing incidences of teenagers’ vulnerability to mental-health illness may be an indication of the need for further attention on parenting styles and expectations. A signal of the younger generation’s cry for help is the increasing incidences of teenagers’ suicides and suicidal attempts associated the inability to meet parents’ or society’s expectation on academic performance.

NM Noor (2006) examined the relationship between women’s role (work and family) and well-being by measuring the level of happiness and symptoms of distress in a sample of employed Malaysian women consisting of 288 Malays and 92 Chinese. After controlling for socio-demographic variables, job autonomy was found to predict both measures of well-being, and spouse support was found to predict happiness. The author concluded that the lack of sharing of family responsibilities by the spouses of working women affected the latter’s well-being, particularly due to the presence of a patriarchal relationship in the society.

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Summary and Conclusion

The studies mentioned generally reported similar findings that indicate different reactions to a stressful situation between men and women. Women reported a higher prevalence of depression, anxiety, and somatic illness compared to men. The underlying factors to the increasing rates of mental-health problems in Malaysia, with higher prevalence in women than men, and increasing incidences of suicides among teenagers, are most probably due to cultural changes in the society. Family values, which emphasise more on the tangible and material achievement as compared to the humanistic values, may result in an overly-stressed society which manifested in the increasing of mental health issues in the nation. There is a need to inculcate a more positive social and humanistic values, particularly in the younger generation. Humanistic values include dignity, honesty, determination, good social ethics, respecting, and caring for others. These values could also be inculcated through the religiosity and spirituality activities in the society which emphasises the internalisation of relationship values among mankind.

Moments with Clients: My First Encounter with Women in Crisis

My first exposure to psychotherapy and counselling was during my post-graduate diploma study in psychology counselling at