Somatization as a Major Mode of Expression of Psychological Distress in Familial and Interpersonal Relationships Among Iranian Women

Abstract

Introduction: In some cultures, women must adhere to defined social and religious hierarchical roles. Any deviation from these conventions is discouraged and sometimes prohibited. A girl who attempts to express her emotions, for example, is regarded as less virtuous. Sharing one’s inner thoughts openly is interpreted as a sign of weakness, and psychiatric disorders tend to be highly stigmatized. Somatization disorder, which is characterized by frequent and recurring physical pain and other complaints that require medical attention, has become a significant route of emotional discharge for women of rural or low socioeconomic status in various sociocultural groups and among ethnic groups that discourage open dialogue about emotional distress.

Main Body: Our study examines somatization patterns in 380 Iranian women, ages 15–81, who were diagnosed as depressed and represented diverse social circumstances: 166 were rural and 214 were urban; 276 were married, 9 were divorced, 57 were single, and 38 were widowed. Within the total number of study participants, 110 were university graduates, 12 were university students, 202 completed elementary school, and 56 were illiterate. We found that somatic symptoms were a frequent manifestation in depressed Iranian women. The condition was more common among women with less education and among those who were married or residing in rural areas. Among the participants, 256 women (67.4 %) complained of physical symptoms as the presenting problem. Headache (16.6 %) and pain in other areas of the body (12.4 %) represented the leading and second most common complaints. Married women more frequently reported physical complaints compared to single women (72 % vs. 54 %). Physical symptoms, with pain and without pain, were also more commonly reported by rural (78 %) women compared to urban women (59 %).

Discussion: A high rate of somatization may be a marker of societal prohibitions for emotional discharge, particularly where traditions reinforce hierarchical gender roles. Several barriers, including financial dependence on men and inadequate knowledge of social and legal rights, may limit emotional expression among Iranian women.

Implications: For these women, somatization may be an inevitable and viable solution for expressing their profound personal dissatisfaction.

Response

• Abrisham Tanhatan Nasseri 

1. Center for Traditional Medicine and History of Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

   Abrisham Tanhatan Nasseri

The Challenges of Being an Educated Woman in a Developing Country

In some developing countries, a woman encounters many challenges in life, including maintaining her identity and self-cohesion along with her sense of autonomy and independence. In comparison to a male citizen, a woman encounters many more obstacles in achieving her goals.

For example, a preadolescent girl who is thinking about her future possibilities will find few opportunities compared to her same-aged brother. Should she wish to continue her studies after high school, there would be very few choices available. A girl who is lucky enough to enter university and complete her studies still faces the challenge of finding a suitable job in a world of limited options. Furthermore, restricted access to some specialties considerably reduces a girl’s chances for success compared to her male counterpart.

Marriage compounds these difficulties. Many men demonstrate negative attitudes about women. They see a woman’s life circumscribed by two key functions: bearing children and raising children. There is no distinction between the concepts of motherhood and womanhood. In some subcultures of Iran, a woman is not permitted to go out of the house without her husband’s approval. For most women, their assimilation with these defined cultural expectations eventually lowers their personal expectations for life and locks them into masochistic, codependent relationships.

A woman usually has to choose between bad and worse in the event of marital dissatisfaction. The decision to divorce remains the right of men, and there is no coherent social system to support a woman following a failed marriage. Often, a woman may become estranged from her children as custody is commonly awarded to the father and his family.

Each gender is presumed to have its own attributes in patriarchal societies: power and ability belong to men; weakness and vulnerability belong to women. An educated woman who wishes to be her husband’s equal runs the risk of igniting his vulnerable, narcissistic traits. A husband who is challenged in this way may feel inferior and try to prove his masculinity by creating a competitive and aggressive climate in the home. A similar dynamic dominates the work environment with male coworkers.

Given the cultural assumption of masculine power and ability, men do not see these conflicts as problems of their making. Most men are unable to take responsibility for their contributions to familial problems. They are, therefore, also unwilling to seek counseling to address marital discord.

In summary, a woman living in a developing country, especially if she is educated, faces challenges in balancing different roles. She carries the burden of several, and occasionally mutually exclusive, duties. It often means that she must devote a great deal of her psychological and physical energy to managing her relationships and managing how she is perceived by society. When she cannot express her emotions directly, a woman has little choice but to discharge those emotions by indirect means—namely through somatization.