At first, when talking about health, I quickly think of my dearest icon of health and medicine which is Ibnu Sina. He is one of the reasons why I have an interest to dig into health and medicine world especially when related to women. From this course, I learnt how to analyze the intersection of gender with cultural models of medicine, sickness, health, and the human body across the world. Looking back on the activity post, I chose Malaysia as the country to research for this course. Based on the World Health Organization (WHO) website, the percentage of women in Malaysia is higher than the percentage of men. Therefore, women would have the greatest focus on health in Malaysia. Furthermore, as mental illness is quite disturbing in Malaysia healthcare, I prefer to talk about the depression in Malaysia through feminist anthropology perspective among all theoretical perspectives learnt in this course. WHO describes mental illness as “a status of well-being in which the person realizes his or her aptitudes to handle customary strain of life and work efficiently in order to make a contribution to his or her community. Also, based on the definition learnt through the lecture video in week one, the feminist theory is reviewed as “seek to understand on how gender gives impact to a situation or inequalities”.
There are many determinants that can determine and give impacts to this health issues throughout the time. WHO have listed some of the determinants such as early childhood, poverty, social support, heathy food, and transportations (Wilkinson & Marmot 2003) as some of the determinants in a population. In term of social determinants, the writer of a book entitled “Social Determinants of Health: The Solid Facts” mentioned that (Wilkinson & Marmot 2003):
“It is not simply that poor material circumstances are harmful to health; the social meaning of being poor, unemployed, socially excluded, or otherwise stigmatized also matters. As social beings, we need to feel valued and appreciated”
“Without these we become more prone to depression…”
This statement explains that social determinant is an important aspect that could gives big impact to depression. Most of the depression cases happened in Malaysia showed that the victims are socially disturbed. A survey has been made by three Malaysians in order to study the perception of Malaysians regarding the causes of depression in Malaysia. The most common answer came out was feelings of Sad and Guilt which is 73.67%, approximately 621 Malaysians (Tahir et. al 2017). Therefore, social and relationship problems were found to be the main causes of depression. To support the above statement, Professor Mohamed Azmi also stated in his writings that (Ahmad Hassali 2015):
“The importance of looking at social determinants of health in any health policy planning agenda had been long advocated by international organization such as WHO”
“The more recent Rio Political Declaration on Social Determinants of Health in 2011, which also organized by WHO has underlined the crucial importance of policies and actions on social determinants of health in the promotion of health equity”
“They were equity in access to health services – those who need the services should get them, not only those who can pay for them; that the quality of health services is good enough to improve the health of those receiving the services; and financial-risk protection – ensuring that the cost of using care does not put people at risk of financial hardship”
Even though above statement said that they want to ensure the cost of medical healthcare would not put people in financial risk, however, economic determinants still could give impact to depression among Malaysians. Malaysia, a rapidly fast-growing developing economy in the Southeast Asian countries, spent 2.94%, and 4.49% of GDP on its total health expenditure in 1997, and 2012, respectively. The World Bank has estimated that Malaysia’s gross national income (GNI) per capita will pass the high-income threshold of 12, 236 USD in between 2020 and 2025. Nevertheless, there are still more than half of Malaysian will be earning less than 12, 236 USD since the distribution if income is skewed towards the rich (Samantha Ho 2017). The World Bank director for Malaysia, Thailand and their regional partnership, Dr Ulrich Zanchau shared that “the poorest 10 percent of Malaysians spend almost 70 percent of their income on food and housing alone” (Samantha Ho 2017). This statement means that they only have less money left from the rest of their income to spend for healthcare especially when mental healthcare is very expensive. The increases in the cost of living and expenditure in Malaysia not only made them to skip the mental healthcare but also the main cause of depression since managing money would never end. In addition, individuals with better socioeconomic position enjoy better quality of lifestyles, healthcare services, as well as have better health status. In contrast, one’s with lower socioeconomic position have lower quality of life, less access to healthcare, and thus have lower levels of overall health (Vivien & Noor Azlan 2014).
Other than that, political issue that happens in Malaysia also can cause depression among Malaysians. Recently, in May 2018, Malaysia has changed their parliament for the first time with the opposition as the winner of Malaysia general election. The changes of parliament depressed some of Malaysians since most of the rules and regulations change depends on the new ruler. Some articles and news describe that racism is rising and makes people live in fear. Some are saying that the financial issues of this country sometimes are swaying and that could increase the depression among Malaysians. Moving on to the cultural determinants, since Malaysia is a multiracial and multicultural country, different culture plays different role on their people. As an example, some people believe that all the housework are the women responsibilities and they have to stay at home. In Malaysia, the society have put a high standard of becoming a woman such as having a white and fair skin, slim and fit body shape, and mastering in housework. These standards made a lot of women trap into a world of consuming diet pills, whitening pills and so on which will definitely give bad consequences to their body in the future. Not only the body health, the mental health which is depression also become the consequences from culture’s standard in defining a woman. Living in nowadays world, education is one of the most important aspects to have a better healthcare. People with less educational level tends to have poorer healthcare. For instance, people with less educational level will see the depression matter as a small health problem meanwhile the person with higher education tends to buy a better medicine or get a better treatment (Vivien & Noor Azlan 2014). Not to denied, higher educational level gives opportunities to someone to secure a better job and have a good socioeconomic level. Education makes someone to wisely differentiate what is better for oneself.
The important matter above all points is gender inequality in Malaysia. In social aspect, the social cases always involve women as victims such as what happen in social medias nowadays. The moment when a woman posts about herself or update a random status about what she feels that day, there must be a lot of people bashing and attacking her with bad words or jealousy which makes her to depressed. Women have high tendency to get bash if they are not achieving the social’s standard rather than men. Just like what happen to most of the actresses or singers in other countries as well, where they tend to take drugs and other medications because of depression. This matter also attacks a mere girl and woman out there, even though they are not a famous person. To recall, depression is an illness caused by a chemical imbalance in the brain which can definitely ruin someone’s life if it is not being treated since most of the cases recorded suicide event because of untreated depression (Malaysian Mental Health Association n.d.). The data analyze from Malaysia recorded that four out of ten Malaysian are most likely to be the victim of mental illness and the numbers will keep rising in days and years (The Star Online 2017). Same goes to economic determinants. Once a woman married to someone she loves, she has to obey her husband words. Almost high number of women in Malaysia are not allowed to go work and has to be housewives at home all the time. With the increasing cost of living, women usually have hard time discovering how to manage their money for families and all bills. A study about depression made by Sherina Mohd Sidik shares that the number of women undergo depression in marriage is more than unmarried women (Mohd Sidik et. al. 2012). From the survey table provided in her study, childhood abuse physically and sexually, serious marital problems, serious housing problems, unhappy relationship with husband or partner and others are on the list as the causes of depression among women in Malaysia. In addition, there are a lot of cases regarding maids or housewives killed babies because of depression. The most surprising news is when there was a maid who was willing to keep a baby in a freezer because of her internal or mental illness problem. Not to forget, there are also cases where women being left out or divorced without specific or strong reasons which is also one of the causes of depression. As for cultural determinants, a woman has lower social status than a man. Men would inherit most of the wealth from the family than women.
Explaining through anthropology perspectives, I believe that feminist theory is definitely the most suitable theory perspectives to describe the depression of women in Malaysia. According to feminist anthropology explanation from University of Alabama, there are three waves of feminist anthropology, with one ending triggers the beginning of another, but not so strictly chronological (Dominguez et. al. n.d.). The second wave of feminist theory touch on gender; both male and female, the cultural construction, and the relationship between them (Dominguez et. al. 2018). The third wave of feminist theory focused more on class, race, ethnicity, and many more. The main point in third wave of feminist theory is the differences among existing women but not the differences between men and women (Dominguez et. al. 2018). Both waves can be used in explaining the feminist theory for depression of women in Malaysia even though the third wave is the recent one.
In a nutshell, depression among women in Malaysia can be determined by social, economic, political and cultural determinants through feminist theory perspectives. Datuk Seri Dr Hilmi Yahaya, a health deputy minister in Malaysia shared that a study has been conducted last year and the result showed 18, 336 Malaysians are suffering from various stage of depression. The study is obtained through mental health screening programs on approximately 273, 203 individuals at health and community clinics in 2017. Of all those individuals, the statistics showed 4.03 percent (11, 811 people) were found to suffer from mild depression, 1.26 percent (3, 680 people) suffer moderate depression and 0.62 percent (1, 682 people) experience severe depression (Wani Azahar 2018). According to one of Malaysia’s prominent newspapers, New Straits Times, the writer mentioned that the shocking fact is mental illness is expected to be the second highest health problem after heart disease by the year 2020 in Malaysia (Wan Mustapha 2018). Depression is also one of the most worrying disease that everyone should concern aside from other prominent diseases such as heart disease, cardiovascular disease and much more. Government should pay more attention on solving the depression problem not only in Malaysia, but also in any other countries because some people tend to not share their internal or mental disease with other people. I pray and hope that the percentage of people with depression will decrease and solve from time to time in Malaysia soon.
Ahmad Hassali. (2015). Focus more on social determinants of health. The Star Online. Retrieved from https://www.thestar.com.my/opinion/letters/2015/04/14/focus-more-on-social-determinants-of-health/
Dominguez et. al. (n.d.). Feminist Anthroplogy. The University of Alabama.Retrieved from https://anthropology.ua.edu/cultures/cultures.php?culture=Feminist%20Anthropology
Malaysian Mental Health Association. (n.d.). Depression. Malaysian Mental Health Association. Retrieved from http://mmha.org.my/understanding-mental-health/understanding-mental-illness/depression/
Mohd Sidik, Sherina et. al. (2012). Prevalence of Depression Among Women Attending A Primary Urban Care Clinic in Malaysia. Singapore Medical Journal. 53. 468-73.
Samantha Ho. (2017). Most Malaysians Still Earn Below Average Incomes. The Edge Markets. Retrieved from http://www.theedgemarkets.com/article/most-malaysians-still-earn-below-average-incomes
Tahir et. al. (2017). The causes of depression? A survey among Malaysians about perception for causes of depression. Asian Journal of Pharmaceutical and Clinical Research. Retrieved from https://www.researchgate.net/publication/236154957_The_causes_of_depression_A_survey_among_Malaysians_about_perception_for_causes_of_depression
The Star Online. (2017). Depression: 40% of Malaysians Will Suffer from Mental Health Issues in Their Lifetime. The Star Online. Retrieved from https://www.thestar.com.my/news/nation/2017/04/02/malaysians-will-suffer-from-mental-health-issues-in-their-lifetime/
Vivien Yew Wong Chin & Noor Azlan Mohd Noor. (2014). Social Determinants of Health and Illness. A Theoretical Inquiry. Malaysian Journal of Society and Space. Retrieved from http://www.ukm.my/geografia/images/upload/5ok.geografia-jan-2014-vivien-edam.pdf
Wan Mustapha, Wan Norliza. (2018). Depression on the rise. New Straits Times. Retrieved from https://www.nst.com.my/opinion/columnists/2018/04/361026/depression-rise
Wani Azahar. (2018). Study Found 18, 336 Malaysians Suffering from Depression. Human Resources. Retrieved from http://www.humanresourcesonline.net/study-found-18336-malaysians-suffering-from-depression/
Wilkinson R. G. & Marmot M. (2003). Social Determinants of Health: The Solid Facts. World Health Organization. Retrieved from http://anthropology.msu.edu/anp270-us18/files/2015/05/Soc-Determs-of-Hlth-the-solid-facts-WHO-2003.pdf