The Hidden Problem: Shadows of Mental Stress Over Urban Adolescents

By Seama Mowri

Photo Credit: Allison Joyce 2015

“He had a bottle of poison in his hands and told me he would drink it if I didn’t agree to marry him.” 
– A 16-year-old girl living in a Dhaka slum explaining the circumstances that led her to consent to marriage.

Whilst this might read like teenage melodrama, the girl’s story is not unusual. During the last six months of our research (a project funded by IDRC and led by Professor Sabina F Rashid) in urban slums the research team encountered several stories of manipulative suicide threats and evidence of mental angst among both male and female adolescents and young people. Initially, a love interest may spark such incidents of dramatic behaviour but these are symptomatic of much deeper troubles. The rapid hormonal, physical and mental changes brought by puberty are difficult for any adolescent to navigate but these challenges are intensified when they are experienced simultaneously with the social, economic and structural instability of surviving in poverty in Bangladesh’s dense urban slum communities, where adult responsibilities are imposed on children before they are ready.

The multiple stressors experienced by adolescents in these settings are little discussed but include: fathers abandoning families, parents remarrying, children being forced to drop out of school, unemployment, abusive gossip and rumours about girls’ characters and “morality”, bullying, daily sexual harassment, physical abuse for dowry, taunts regarding dark skin from in-laws, and entrenched gender norms that place unachievable expectations on girls and boys. Any one of these factors – including the dynamics of the overcrowded slums they navigate, living out of cramped one-room households – can have debilitating effects on a person’s mental well-being.

Our research also highlights a complex interplay of age and identity. Amongst the slum dwellers, there is an embedded assumption that ‘married’ implies ‘adult’, and most of these married ‘adults’ are 15-16 years old. In other words, there’s almost no sense of transition about the stages of adulthood that they go through. As we’ve noted, most of the early married adolescent girls face the challenge of forming their adult identity at the same time as they are required to assume the duties of a wife and a mother which can create a great deal of mental stress. But who do they turn to?

“I have nowhere to go, no one to seek help from. I see my nonod (sister-in-law, who is only eight months younger than me) roaming around with her friends, gossiping, going to fairs… but I can’t do any of that. I am ghorer bou (bride of the house). I have to take permission from my husband and my father-in-law before stepping out of the house. The only guidance I get from relatives and programme interventions is related to family planning,” shares Ayesha about her experience after marriage.

The WHO constitution states: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” An important implication of this definition is that mental health is more than just the absence of mental disorders or disabilities. Mental health is defined as a state of well-being in which an individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.

In Bangladesh, there is a dearth of knowledge around systematically-collected data on mental disorders and so the extent of the problem remains unknown. A recent systematic review (by Hossain et al.) suggests that females are more vulnerable to mental disorders in both rural and urban settings compared to males. These findings are consistent with another rural study (Ara et al. 2001) which reported that social stigma inhibits women from seeking medical treatment for their mental problems.

The BRAC School of Public Health has undertaken a number of research projects that focus on exploring mental health issues among adolescents. One of the projects is trying to understand how early marriages change the life opportunities and well-being of girls in urban slums, and their coping strategies in coerced marriages. Qualitative cases pertaining to sexual coercion in early marriages have provided some insight into the challenges faced by adolescent females living in a society fraught with gender disparities. Another research study funded by NWO-WOTRO – “Psychodrama as Transformative Intervention in the SRH of Young Men in Urban Slums” – aims to identify the spectrum of risks and health issues affecting young men. “Sexual and reproductive health (SRH) education for young men, particularly those from vulnerable communities like urban slums, is a neglected issue,” says Dr Malabika Sarker (Professor and Director of Research at James P Grant School of Public Health) who is leading the study.

As Dhaka transitions into being the sixth largest megacity by 2030, the urban challenges of structural poverty and inequalities, steep social gradients, risky environment, deprived living conditions, entrenched and changing social and gender norms will start to have serious impacts on the well-being of the population at large. What does that mean in terms of the stress resilience of an increasingly urban population? What are the health consequences of higher social stress exposure and vulnerability of urban-dwellers, given that stress is the most likely cause of many mental disorders, particularly depression? And from a policy perspective, what actions can be taken to protect people living under dense metropolitan conditions from urban stressors and their negative mental impact? With this article I wish to stimulate a conversation in the hope of facilitating a more nuanced understanding of how urban living conditions impact our mental health. And it is imperative that we start the conversation sooner rather than later.

This article was first published in The Daily Star on World Health Day. The writer is a project manager at the Centre for Gender and Sexual and Reproductive Health Rights, James P Grant School of Public Health. 

Psychodrama as a New Form of Health Education for Young Men in Dhaka’s Urban Slums

By Rafee Muhammad Tamjid


Shujon* is a 19-year-old man living with his mother in Bhashantek, an urban slum in Mirpur, Dhaka. His father left his mother when he was a child, leaving him with too many responsibilities and unable to cope. He feels depressed because of the expectations projected on him by his family and peers. Recently he broke up with his girlfriend, because her parents wanted her to get married, but Shujon was not ready. “If I married her now, I would have to be a rickshaw puller, and that won’t make us enough money.” He admits that sometimes he feels confused and doesn’t have anyone to talk to, which takes a toll on his mental health.

To our surprise, when we explained to Shujon that the research project we were conducting would examine the physical and mental wellbeing of young men just like himself, he was immediately interested to speak to us. His eagerness was probably a reflection of the fact that in Bangladesh there is little to no attention given to mental health education, particularly related to sexual and reproductive health (SRH).

Due to shame and stigma, there is a lack of comprehensive SRH education in Bangladesh. Although several successful interventions exist around family planning for married couples, SRH education is still limited for others, particularly the target group for this research project: young vulnerable men who live in urban slums and engage in risky sexual behavior. While this study will also detect exactly which types of behavior are involved, similar studies in Africa show that risky behavior is influenced by one’s social environment.

Currently Dhaka is one of the fastest growing megacities in the world. By 2025, the UN predicts Dhaka will be home to more than 20 million people. As the population of the city grows, so will the population and size of the slums. Thus it is very important to make sure the wellbeing, including health of men in these slums are attended to just as much as women and adolescents. Generally, SRH knowledge of slum dwellers in Bangladesh is very low and they have a higher probability of being confronted with early marriage, drugs and violence.

This research project aims to identify the spectrum of risks and health issues affecting other young men like Shujon living in urban slum. Psychodrama (a group psychotherapy method) would then be used as a “transformative intervention” to help participants discover alternatives to the choices they would usually make. Psychodrama uses role-playing, dramatisation, and self-presentation to explore and gain insight into one’s life, incorporating theatre and conducted in groups under a licensed trainer, educator and practitioner.

Young men living in Bhashantek slum. Photo Credit: Rafee Tamjid

Since psychodrama is a very new concept in Bangladesh, we want to adapt this therapeutic approach and create an innovative and interactive educational tool to see if it can be used as new form of health education. It will engage young men to explore existing and alternative attitudes towards their own and their peer’s health and relationships. The hope is to use psychodrama can help these young men evaluate their decision-making process so as to decrease the risky-behaviors they engage in which may adversely affect their health.

“SRH education for young men, particularly those from vulnerable communities like urban slums, is a neglected issue,” said Dr Malabika Sarker (Professor and Director of Research at JPGSPH) who is leading the study. “An innovative approach that blends traditional methods of mental health counseling and SRH education with a more humane touch like psychodrama could help reach this population more effectively.”

*Note: Name has been changed for anonymity purposes.

Rafee Muhammad Tamjid is a research assistant at the James P Grant School of Public Health.

Stay tuned on #VitalSigns for more updates from this project!