‘Being a Good Woman’: suffering and distress through the voices of women in the Maldives

Abstract

This ethnographic study explored the social and cultural context of Maldivian women's emotional, social and psychological well-being and the subjective meanings they assign to their distress. The central question for the study was: How is suffering and distress in Maldivian women explained, experienced, expressed and dealt with? In this study participant observation was enhanced by lengthy encounters with women and with both biomedical and traditional healers. The findings showed that the suffering and distress of women is embedded in the social and economic circumstances in which they live, the nature of gender relations and how culture shapes these relations, the cultural notions related to being a good woman; and how culture defines and structures women's place within the family and society. Explanations for distress included mystical, magical and animistic causes as well as social, psychological and biological causes. Women’s experiences of distress were mainly expressed through body metaphors and somatization. The pathway to dealing with their distress was explained by women's tendency to normalize their distress and what they perceived to be the causes of their distress. This study provides an empirical understanding of Maldivian women's mental well-being. Based on the findings of this study, a multi dimensional model entitled the Mandala for Suffering and Distress is proposed. The data contributes a proposed foundation upon which mental health policy and mental health interventions, and curricula for training of health care providers in the Maldives may be built. The data also adds to the existing global body of evidence on social determinants of mental health and enhances current knowledge and developments in the area of cultural competency for health care. The model and the lessons learnt from this study have major implications for informing clinicians on culturally congruent ways of diagnosing and managing mental health problems and developing patient-centred mental health services.