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It has been seen that women in developing countries face many challenges that can stop them from fulfilling their potential, but also increase the risk of mental illness. Therefore it is very important to put in place effective strategies that can help these women improve their mental wellbeing as well as increase their inner strength and resilience. Considering the financial constrains these strategies need to be also cost-efficient. Here we would like to discuss the potential of writing as a tool for womens’ mental health in developing countries, where writing is not well known as a therapeutic method. The method has been however already used for psycho-emotional development with positive results in the western world. Here we show how by implementing writing as a selfempowering tool for womens' mental health in developing countries a significant contribution to womens’ empowerment can be made.
Women in developing countries face several disadvantages including limited access to education, fewer chances for professional development, domestic violence and societal abuse. Each and all of them can have serious consequences for the quality of womens’ lives and increase the risk of depression. Since women are more vulnerable to experiencing mental problems related to psychological and physical challenges, a high prevalence of depression among females can significantly hinder women empowerment. On the contrary promoting mental well-being and psychological self-counselling can be seen as an effective way for empowerment. Indeed, psychological empowerment on top of having mental health benefits has been proven promising approach to sustainably promote subjective wellbeing and objective change in communities and society (Christens, 2012). There are several methods that have received attention for its potential to empower women, especially in the communities where hardship and inequality is gender embedded. These methods include cognitive-behavioral interventions, coping strategies, problem solving approaches, hope therapy and psychosocial interventions. Here we would like to explore empowering potential of writing.
While discussing writing as a therapy method we will use two terms “therapeutic” and “expressive” writing, which describe the “simultaneous participation in and observation of life and its journeys, traumas, lessons, quests, disappointments, joys and foibles” in a way that leads to understanding, insight, acceptance, and growth (Adams, 1999). According to Sandy Grason, writer and journal facilitator, writing is a window to whatever is important to someone. It can bring clarity in a very confusing world (Grason, 2010). It can be used as a therapy method or as a complementary tool to psychotherapy. For instance journal therapy describes the purposeful and intentional use of a cathartic, reflective, process or integrative writing to further therapeutic goals (Adams, 1999). Depending on the goal in each case, certain techniques are given. But sometimes it is not enough just to open our diaries and write, it can even become overwhelming. Therefore the technique is more successful when it has structure and is being facilitated by the expert, as opposed by free writing which is “unboundaried, unstructured, open–ended, non-directed” (Adams, 1998).
One of the basic goals of psychotherapy is to help people better understand their problems and their reactions to them (Rogers, 1992). Expressive writing can be very useful for this aim, because when someone writes about their experiences, they see them from a distance and change their point of view. Another expert in the field, Dr. Ira Progoff believes that people who get through a difficult period in their life and experience physical or emotional pain, find more power, tenderness, sensitivity, capacity for insight and harmony within them than expected, when they use writing. When someone is working intensively on their life, they activate energies that they did not know existed within their soul and body (Progoff, 1992). Research from Dr. James Pennebaker, has shown that expressive writing helps people organize their thoughts and find a meaning in their traumatic experiences. One of his main conclusions is that the more one is finding meaning in life’s difficulties, the smoother the adaptation will be. Writing was proven to be valuable tool for this process while working with AIDS and cancer patients, sexual abuse victims and veterans of the Vietnam War (Pennebaker, 2004). There are many potential benefits of therapeutic writing which according to studies can help: heal from physical or emotional pain, reduce stress, enhance the immune system, change mood, understand past, recover from trauma, process our life experiences, understand and integrate personal story, organize life, deal with social life, have better performance at work, school or studies, increase the possibilities of finding a job and many others. Additionally, it can be used for increasing self-esteem, raising self- awareness, listening to inner voice, finding authentic self, making an integrated personal story, increasing intuition, gaining wisdom and insight.
Expressive writing is also valuable method because it can be used by anyone in any period of their lives. It can be used equally in quiet or more stressful days. It can be used by children, adolescents, adults or elderly people. It can also be used for addictions, aging, HIV/AIDS, anger, anxiety disorders, bipolar illness, depression, mania, chronic or life – threatening illness, co-dependency, dis-associative disorders, eating disorders, dream interpretation, dysfunctional families, family relationships, grief or loss, guilt or shame, incest or sexual abuse, psychosis, schizophrenia and thought disorders ( Adams, 1998) also during life transitions and trauma recovery.
Altogether expressive writing is thought to be beneficial for longer term health effects and as such is now frequently referred to in general psychology textbooks as a potentially beneficial intervention, which has been reinforced with the findings of meta-analyses of expressive writing randomized clinical trials. However there has been also some criticism suggesting that possible reasons for the apparent beneficial findings. More recently the renewed need to evaluate the effectiveness of this intervention has been recognized based on the considerable number of new randomized control trials which will be used to answer the question whether therapeutic writing help people with long-term conditions and how this finding can be used for economic modeling (Meads et al., 2014).
Globally women may sometimes be the weaker gender from a physical and emotional perspective and are therefore still very often subjected to mental and physical abuse in their families and communities. Firstly, limited access to education and fewer chances for professional development and secondly, traumatization due to abuse, can have serious consequences on the quality of womens’ lives in developing countries. This includes a serious medical burden including depression, which has been linked to risk factors such as conflict, intimate partner violence and child and sexual abuse, the levels of which vary and are the highest in developing countries (Ferrari et al., 2013). A high prevalence of depression can hinder the development in these countries, creating social and economic burdens from disability and decreased productivity. The direct and indirect costs of mental ill-health worsen the economic condition, setting up a vicious cycle of poverty and mental disorder (Patel & Kleinman, 2003).
Since women are considered more vulnerable to experiencing mental problems related to psychological and physical challenges, a high prevalence of depression amongst females can significantly obstruct the current efforts to empower women and encourage the use of their feminine power in order to serve their families and communities with dignity. Writing can be used in order to help women in developing countries express their feelings in a safe environment and narrate their stories. They learn how through writing they can have a lifelong friend and a low cost counselor. Women who practice writing skills, can also build trust, increase inner strength and self-esteem. These qualities are the basis of empowered actions taken in order to live life to the full as far as courage and happiness potential are concerned. This is very important, because it will not only improve the lives of empowered women, but it will also have an impact on their families and communities.
The socio-economic and political situation in developing countries is perpetuating the problem because of the lack of resources in effective mental care, including inaccurate assessment, lack of awareness and social stigma associated with mental problems. These all increase unnecessary suffering. Although scarcity of resources can limit some approaches for improving mental health, existing resources can be used to provide better care for people with mental illness, using affordable yet efficient and cost-effective methods such us expressive writing. Therapeutic writing is a low cost treatment. Its use requires one (or more) qualified facilitator(s), a paper and pen or computer. The physical presence of the facilitator isn’t always necessary. It can be applied successfully through the internet using specific web tools as email prompts, e-diaries, web platforms, videos, teleconferences etc.
Moreover, there are no prerequisites as far as good writing skills or language use are concerned, because this method encourages free writing without the anxiety of good spelling or grammar rules. One of the main goals for the participants is to learn how to write without the stress of criticism. In special cases participants use narration and a mediator writes. The problem of different languages being spoken by facilitator and participant can be solved with the mediation of translators.
In line with that, we are convinced that bringing expressive writing methods to women in selected developing countries can benefit them at a personal and professional level, but also offer benefits to their communities and societies. However the scope conditions of this approach should be defined at the local level together with community leaders who are able to answer the questions regarding the position and willingness to change educational and social disadvantage within specific community. It is also important to ask if writing is indeed acceptable medium to allow expression of emotions in a culturally acceptable way or other creative therapeutic approaches e.g. art, music could be more efficient and effective in some cases.
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