Today women in Colombia are more likely to seek psychiatric help for depression than in the past, said Rocio Barrios, M.D., a psychiatrist from Bogota, Colombia, at the annual meeting of the American Academy of Psychoanalysis (AAP) in Chicago in May.

"Women are recognizing symptoms of depression because of increased self-awareness and educational campaigns. There is also less stigma associated with seeing a psychiatrist, and general practitioners are referring more depressed patients to us," said Barrios at a session on Latin American women. The session was sponsored by the AAP’s Committee on Psychoanalysis and Women.

Colombian women exposed to the arts and humanities and science are finding new ways of looking at themselves rather than simply accepting the traditional views of women promoted by the Roman Catholic religion, said Barrios. Colombia, like most Latin American countries, is predominantly Catholic.

"Today women are more likely to reflect upon their inner selves and behavior and think about how to accomplish their goals than had women of previous generations," said Barrios.

However, traditional views about gender roles and male domination or "machismo" still persist.

"When women accept the cultural view that their fulfillment comes only through giving to others and deny their own needs, they can become depressed," explained Barrios.

Women who work outside the home may not get any support from their husbands and may face pressure from their families to stay at home to raise the children.

"There is still a stigma in our society that a working woman cannot properly raise her children," said Barrios. "However, men earning high incomes tend to be accepting of their wives’ careers and help at home and with child care. In contrast, men with low incomes do not support their wives at home or in their jobs, which women take to help the family economically."

In addition, it is still culturally acceptable for men to have extramarital affairs.

"Women will often come to me who are successful in their work complaining that their husbands are having extramarital affairs and are not supporting them at home or helping with childrearing," said Barrios. "These women are very bright and intelligent but are poor and self-abandoned emotionally. The culture has led her to assume myths, taboos, and feelings of guilt and helplessness in terms of her place in society."

Women also have had difficulty freeing themselves from traditional patterns of male domination regardless of their economic productivity, said Barrios. This includes tolerating verbal, physical, and sexual abuse, which produces "insecurity, fragility, and susceptibility to future abuse," said Barrios.

"Women in triangular, abusive, and conflictual relationships often end up with major depressive symptoms and psychosomatic disturbances including headaches, colitis, and vertigo," said Barrios.

In spite of her depression, a woman often stays in the marital relationship because her economic interests prevail. However, the couple’s relationship grows more dysfunctional over time, which only increases the dissatisfaction of the woman. "This vicious cycle makes it harder for her to seek different possibilities for herself," said Barrios.

Many Colombian women also are afraid of change, facing new challenges, and breaking traditional patterns, said Barrios.

"Although this generation of women question their mothers’ and grandmothers’ ideas and beliefs, they are insecure about defining their own roles and ambivalent about their decisions," said Barrios.

Women often feel guilt about their roles as mothers. This is perpetuated by the feeling that, compared with their mothers and grandmothers, they are not giving enough to their children or protecting them sufficiently. "Not being sure of what her role as a mother should be adds to a woman’s pressures and guilt," said Barrios.

Her goal in therapy is to help depressed women become more assertive and articulate their needs and desires in all areas of life so they can accomplish their goals.

"I help them understand that their first priority is taking care of themselves and to say no to situations that they are not responsible for. I also help them become more independent regardless of whether they work or not and encourage them to enjoy life with less guilt," said Barrios.—C.L.