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“Women as Troublemakers”: The Hard Sociopolitical Context of Soft Bipolar Disorder in Iran

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Abstract

Gender differences in the prevalence of psychiatric disorders, with higher prevalence of mood and anxiety disorders among women, have been the focus of much debate. In Iran, the adoption of the construct of Bipolar Spectrum Disorder (BSD) and of the concept of “soft bipolarity” has been associated with a large gender difference in rates of diagnosis. This paper discusses the gendered meanings of the diagnosis of BSD in Iran. In this qualitative study, we conducted 25 in-depth semi-structured interviews with prominent psychiatrists and university professors (7 female and 18 male) at six different universities in Iran and 37 in-depth semi-structured interviews with patients (23 female and 14 male, 18–55 years of age) who had received bipolar spectrum disorder diagnosis and treatment, excluding Bipolar I. Findings suggest that the high rate of diagnosis of bipolar spectrum disorder (i.e., subthreshold or soft bipolar disorder) among women in Iran is influenced by gender, sociocultural, political, and economic factors, as well as the diagnostic practices of biomedical psychiatry. The dominant biological psychiatry system in Iran has led many psychiatrists to frame sociopolitically and culturally rooted forms of distress in terms of biomedical categories like soft bipolarity and to limit their interventions to medication. This bioreductionist approach silences the voices of vulnerable groups, including those of women, and marginalizes discussions of problematic institutional and social power. To understand the preference for biomedical explanations, we need to consider not only the economic interests at play in the remaking of human identity in terms of biological being and the globalization of biological psychiatry, but also the resistance to addressing the sociocultural, political, and economic determinants of women’s mental suffering in particular contexts.

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Notes

  1. Details of this phase of sampling are explained in an earlier article that focuses on psychiatrists’ views of the increase in bipolar spectrum diagnosis in Iran (Mianji and Kirmayer 2020).

  2. We thank Dr. Abbas Afshari and Dr. Azarakhsh Mokri (psychiatrists) and our research assistant, Daria Khadir (BSc in Cognitive Science), for their help with the MINI translation.

  3. Dr. Joel Paris (Professor) and Dr. Danielle Groleau (Associate Professor), Department of Psychiatry, McGill University).

  4. This included the 31st Annual Meeting of the Iranian Psychiatric Association, Tehran, Iran (October 14–17, 2014), the First Iranian Psychoanalytic and Psychodynamic Psychotherapy on Culture and Psychotherapy, Tehran, Iran (October 11–13, 2014), the 4th Social and Cultural Psychiatry Conference, Tehran, Iran (May 13–15, 2015),

  5. Some anticonvulsant medications such as valproate sodium, lamotrigine, carbamazepine, are used as mood stabilizers to treat or prevent mood episodes in bipolar disorders.

  6. Iran’s mental health system does not suffer from a shortage in human resources such as social workers and psychologists but their expertise in mental health care systems has been undermined. For example, some of our participants viewed the use social workers as administrators instead of considering them as an essential part of mental health teams as a management problem in Iran’s mental health care systems.

  7. The mission of the Gasht-e-Eershad, Guidance Patrol or “morality police” (Police-e-Amniat-e- Akhlaghi) is to impose Islamic codes and norms of conduct and dress in public, particularly regarding women wearing hijab or appearing in public with unrelated men without a make guardian. These dress codes and norms have been viewed resisted by some urban women, who try to push the boundaries of dress code and related norms. These women may be subject to arrest, penalty, and harassment by the Gasht-e-Eershad.

  8. Since the 1979 revolution, there have been different forms of "morality police" (Police-e-Amniat-e- Akhlaghi, the term is used by Iran’s regime), but the Gasht-e Ershad is currently the main agency that enforces Iran's Islamic code of conduct in public (https://www.bbc.com/news/world-middle-east-36101150).

  9. http://legada.techlab360.org/survivors/stories

  10. http://www.bbc.com/persian/specials/162_violence

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Funding

The research was supported by grants to the first author (FM) from the Global Health Research Capacity Strengthening Program (GHR-CAPS), funded by the Canadian Institutes of Health Research (CIHR), and by the Quebec Population Health Research Network (QPHRN), funded by the Fonds de recherche du Québec - Santé (FRQS).

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  1. Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University, Montreal, Canada

    Fahimeh Mianji & Laurence J. Kirmayer

  2. Culture and Mental Health Research Unit, Institute of Community and Family Psychiatry, 4333 Chemin de la Côte Ste-Catherine, Montreal, QC, H3T 1E4, Canada

    Fahimeh Mianji & Laurence J. Kirmayer

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Mianji, F., Kirmayer, L.J. “Women as Troublemakers”: The Hard Sociopolitical Context of Soft Bipolar Disorder in Iran. Cult Med Psychiatry 46, 864–888 (2022). https://doi.org/10.1007/s11013-021-09743-4

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