Hesperian Health Guides

Common mental health problems

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HealthWiki > A Health Handbook for Women with Disabilities > Chapter 3: Mental health > Common mental health problems


Although there are many kinds of mental health problems, the most common ones are anxiety, depression, reactions to trauma, and misuse of alcohol or drugs.

Depression (extreme sadness or feeling nothing at all)

a woman walking alone, looking sad.

Depression affects almost 5 in 10 women with disabilities, compared with around 2 in 10 people without disabilities. This is not surprising, because many girls with disabilities do not get the chance to get an education, develop confidence, or learn how to do things for themselves. As you grow older, the social barriers and changes in your health that make it more difficult to do as much as you used to, make you more likely to feel unhappy and depressed.

Signs:

  • feeling sad most of the time
  • difficulty sleeping or sleeping too much
  • difficulty thinking clearly
  • loss of interest in pleasurable activities, eating, or sex
  • physical problems, such as headaches or intestinal
    problems, that are not caused by illness
  • lack of energy for daily activities
  • thinking about death or suicide


Although it is hard to believe when you are suffering from it, depression does not last forever. See information on ways to overcome depression.

As you grow older

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Your body will continue to change as you grow and age. Your daily tasks will take longer, some disabilities will get worse, and you may get ‘secondary’ disabilities from overuse of certain parts of your body. As you grow older, more things may go ‘wrong’ with your body and you will have to adapt the way you do things frequently. These constant changes can make you feel as though you will never be really independent and that you must constantly rely on others to help you. Feelings that your dependence is increasing can affect your self-esteem. See Chapter 13: Growing older with a disability.

If you are feeling sad a lot of the time, or you are unable to sleep, or if you see changes in your mood, talk to someone in your family you trust, or talk with a health worker.

Anxiety (feeling nervous or worried)

If feelings of nervousness or worry (other common names for anxiety are ‘nerves,’ ‘nervous attacks,’ and ‘heart distress’) continue for a long time or become more severe, then you may have a mental health problem.

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Signs:
  • feeling tense and nervous without reason
  • sweating
  • feeling the heart pound (when there is no heart disease)
  • frequent physical complaints that are not caused by physical illness and that increase when you are upset


Panic attacks are a severe kind of anxiety. They happen suddenly and can last from several minutes to several hours. In addition to the signs above, you may feel terror or dread, and fear you may lose consciousness (faint) or die. You may also have chest pain, difficulty breathing, and feel that something terrible is about to happen.

Trauma

When something horrible has happened to a woman, she has suffered a trauma. Some of the most common kinds of trauma are violence in the home, rape, war, torture, and natural disasters. Trauma threatens a woman’s physical and mental well-being. As a result, she feels unsafe, insecure, helpless, and unable to trust the world or the people around her. It can take a long time for a woman to recover from trauma, especially if it was caused by another person.

Disability caused by trauma

When a woman becomes disabled later in life, because of war, an accident, or an illness, the sudden change can be very difficult for her. Some women who are newly disabled may feel they have lost all worth to themselves, their families, and communities. They may also be afraid or disturbed because of trauma.

Often, a woman who becomes disabled later in life has grown up with confidence, good education, and many skills. She may have always had strong relationships with others and expects to be treated with respect. When she becomes disabled, it can take time to adjust to the changes in her body. It can be even harder to adapt to the changes in how other people see her, or how she sees herself.

Many women who become disabled later in life say they had to make a decision not to give up. Even though they felt sad and shocked, they realized they had choices about how to live their lives. (See “Annie's story.”)

Abuse is one kind of trauma

a woman kneeling on the floor near two crutches; she holds her face while a child touches her hand.

Girls with disabilities are especially at risk for abuse or violence from someone in their family. Abuse happens if anyone touches a girl in a sexual way, or if a father, brother, cousin, or caretaker forces a girl to have sex. Abuse can also involve hitting or hurting a girl, humiliating her, caring for her cruelly, or refusing to care for her. Abuse is a kind of trauma that causes great harm to a girl’s mental health. If a woman was abused or hurt as a child, it can affect her for many years.

Many women with disabilities who continue being abused as adults don’t complain because they believe they do not deserve to be treated well. See Chapter 14 for more information about abuse.

Reactions to trauma

If you have experienced trauma, you may have many different reactions, such as:

a woman in bed dreaming that soldiers are attacking her.
  • going over the trauma again and again in your mind. While you are awake, you may keep remembering the terrible things that happened. At night, you may dream about them or be unable to fall asleep because you are thinking about them.
  • feeling numb or feeling emotions less strongly than before. You may avoid people or places that remind you of the trauma.
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    People suffering from reactions to trauma may also feel anxious or depressed, or misuse alcohol or drugs.
  • becoming very watchful. If you are constantly looking out for danger, you may have difficulty relaxing and sleeping. You may overreact when startled.
  • feeling very angry or full of shame about what happened. If you have survived a trauma where others died or were seriously injured, you may feel guilty that others suffered more than you did.
  • feeling separate and distant from other people.
  • having outbursts of strange or violent behavior, in which you are confused about where you are.

Many of these signs are normal responses to a difficult situation. For example, it is normal to feel angry that a trauma has happened, or to be watchful if the situation is still dangerous. But you need help if the signs are so severe that you cannot carry out daily activities, or if the signs start months after the trauma has happened.

Helping overcome reactions to trauma

If you have suffered a trauma, you may need help to:

  • learn to trust others again.
  • talk about your life before the trauma as well as your current experiences. This way you can realize that although life has changed a lot, in many ways you are the same person as before.
    a woman with a white cane looking sad while another woman comforts her.
  • express painful things that are too difficult to talk about or that are ‘buried’ where they cannot be remembered. Drawing or painting, or a healing activity like massage, can help you express or relieve these painful feelings.
  • understand your reactions. Once you understand your reactions, the feelings usually have less control over you.
  • make a plan for those reminders that you cannot avoid. If reminders of the trauma make you react in fearful ways, it will help to make a plan for those reminders that cannot be avoided. For example, you might tell yourself: “His face is like the face of the man who attacked me, but he is a different person and does not wish to hurt me.”
  • remember that you are not responsible for what you said or did if you were raped or hurt in any way. All responsibility lies with those who hurt you. People who hurt you can make you feel as if you can never feel whole again. While bad experiences can change you, with support from those who care about you, even the most terrible experiences can be overcome.


Try to keep an object from your new life nearby as you sleep. This way if you dream of the trauma, when you wake the object will help you remember that you are safe now.

If someone you know has experienced trauma

At first it may be best for friends, families, or caregivers of a woman who has experienced a trauma to do everyday activities together with her or to do some of them for her if that is what she wants. You can let her know you are willing to listen and wait till she feels ready to talk. Later, encourage her to take up some of the same activities she enjoyed before or that were part of her daily routine.