A comprehensive search of several databases from the date of inception to the date of the search was conducted. The databases include PubMed, PsychINFO, Cochrane Library, and Google Scholar. I also searched the date base of ongoing clinical trials through clinicaltrials.gov. The search was designed using controlled vocabulary and keywords “Patriarchy*”, “Mental Health”,” Feminism”, “Trauma*”, “Adverse Childhood Experiences”, “Anthropology”, “Developmental Psychopathology”, Gender Discrimination therapy”, “Social Determinant*”. It was performed in all languages and was limited to human subjects. We also performed a manual search. The inclusion criteria were any published material on patriarchy across all ages with links to mental health. Studies focused on social determinants associated with gender-based discrimination, patriarchy, and developmental psychopathology were selected for the review. We identified 305 published materials after the removal of duplicates. After reviewing the abstract, only 35 studies met our inclusion criteria. 24 other studies were added manually after reverse citations were reviewed to update the material. Figure 1 provides the details.
Is Patriarchy A Coherent Concept?
Patriarchy is often used loosely to indicate women’s oppression through male domination. There is a growing body of literature studying the impact of patriarchy (as a social determinant) on psychological functioning, and there are numerous theoretical explanations of patriarchy stemming from various fields including not only the social and political sciences but also the humanities (Acker, 1989). A contextual understanding of Patriarchy’s deeply entrenched roots would be incomplete without diving into historical literature. Feminist movements paved the way in the systematic studies of patriarchy; both Anglo-American and French feminist criticism and theory, for example, offer unique insights into the term “patriarchy.” The former meditated on the concept of gender in a patriarchal society and the latter did so in the specific context of literature and art (Radford, 1986). In his sociological definition of patriarchy as a system of government in which men rule societies through their positions at the head of their families, Max Weber refers to “Herrschaft:” a relationship based on the domination of men over women and subordinate men in households (Weber, 1947). Critics have found this definition to be focused too exclusively on domination and submission, and consequently grossly lacking in intersectionality.
Given the complexity of the topic, it is imperative to examine the evolution, perpetuation, and factors associated with the persistence of patriarchy. A panoramic patriarchy overview of its mention in the various forms of literature provides insight from various vantage points in those times.
Apologists
Among Western cultures, there are accounts from early Celtic settlements (6th-11th centuries) in which women were legally equal to men (Luley, 2016). They could hold and sell property, marry or divorce, and hold high educational degrees (physician, lawyer, religious). Subsequently, Gaelic Christianity was brought into alignment with Roman Catholic orthodoxy(Maier, 2015). ‘Traditional’ patriarchal concepts of marriage, equality, authority, and ordination became dominant in biblical interpretation and canonical literature (How Gaelic Irish Women Exercised Agency in Early Modern Ireland, 1400–1700 | the Ascendant Historian, 2022). That priestly ordination can only be conferred upon men is controversial to this day.
Although scripture states God created men and women as equals in his image, giving them both dominion over the earth and all living things, the writings of noted theologians declare otherwise. St. Thomas Aquinas (Summa Theologica, q. 92 a.) writes (Bell, 1983):
“Woman is defective and misbegotten, for the active force in the male seed tends to the production of a perfect likeness in the masculine sex; while the production of a woman comes from defect in the active force or some material indisposition….”
St. Augustine (Genesi Ad litteram, 9, 5–9 ) writes:
“I don’t see what sort of help woman was created to provide man with if one excludes the purpose of procreation. If a woman was not given to a man for help in bearing children, for what help could she be…?” clearly writings influenced the development of Western philosophy and Western Christianity.”
Likewise, in Eastern Theology, the ancient Sanskrit scripture “Manusmṛiti” dating back from the 2nd century BCE to the 3rd century CE was a systematic legal text of written codes establishing Brahminic (caste-based social order) Patriarchy. The text discusses denying women the right to bodily integrity, marriage rights, right to contraception, right to divorce, etc(Doniger, 1991). Women are objectified and considered sexually promiscuous in a deeply disturbing misogynist set of rules (dharma) in which subordination is celebrated to propagate the patriarchy as natural.
In the rules of the medieval common law in England, widows were usually automatically entitled to a third share of their late husband's wealth. However, it changed with the Statute of Westminster II (1285) c. 34; when property holders may claim exceptions citing elopement and adultery to oppose widows’ attempts to claim their share (Brand, 2001).
Advocates and apologists for patriarchy have used the sexual division of labor to explain the gender roles propagated by patriarchy. According to Lerner, the progression of civilization from tribal existence into larger communities required different individuals to attend to varying necessary life activities (Lerner, 1987). The female was seen as the birth-giver and child-rearer while the male was seen as the hunter, provider, and protector. The latter set of roles was perceived as the more highly valued one in society and led to a sort of excuse for the legitimization in society of female inferiority. Apologists' views of gender continue to reference this idea of higher male value perpetuating male supremacy in society as an attempt to explain gender relations.
Marxism and Feminist Marxism
In the 19th-century movement of ideas of an egalitarian state with classless societies, Marxism completely rejects theological hegemony with its theories about gender and equality. Nonetheless, Friedrich Engels perpetuates an argument rooted in the hunter-gatherer society. Engels states that in such a society, women were demoted to the subordinate position of child-bearer, caretaker, and provider of erotic pleasure to men. Paralleling Marxism, he maintains that the development of private property led to the “enslavement” of women (Dunayevskaya, 2018). This perspective draws from an evolutionary theory of socio-biology, however a theory that has been largely debunked (Brenner, 1984). Feminist Marxism understands patriarchy as the capitalist mode of production. According to Sylvia Walby, patriarchy is “a system of social structures, and practices in which men dominate, oppress and exploit women” (1989)(Theorising Patriarchy - Sylvia Walby, 1989, n.d.). Juliet Mitchell refers to patriarchy as a system of kinship among men based on the commodification and exchange of women (1974)(Gardiner, 1992). Eisenstein connects patriarchy to a sexual hierarchy, with the woman’s role relegated to domestic labor and procreator (1979)(Beechey, 1979). Patriarchy is thus often seen through a wider lens including not only capitalism but also colonialism and racism. It should consequently be noted that in early Anglo-American feminist movements, women were carrying banners for not only women’s suffrage but also the abolition of slavery and ending the exploitation of children in the labor force. Furthermore, in the 1960s, women were championing not only feminism but also civil rights, an end to the Vietnam War, children’s welfare, and social and educational reform for individuals with disabilities (Breines, 1996). The history of these opportunities for women is not a linear one, but rather a snakes and ladders type of projection in which the trajectory forward has often been plagued by societal failures and political pitfalls.
Anthropological And Developmental Points Of View
There are critiques of Charles Darwin's “The Descent of Man, and Selection in Relation to Sex” in which he argues mate choice is explicitly aesthetic. Darwin repeatedly writes of mating preferences as an ‘aesthetic faculty’ and describes them as a “taste for the beautiful”. These theories remain deeply problematic for millennials whose reproductive options, sexual orientations, and gender identities have become more fluid. Contraception has revolutionized the reproduction (Fritzsche et al., 2021). It has afforded innumerable individuals autonomy over their bodies. According to the natural selection argument of fitness and worth being intertwined with reproductive capability, contraception diminishes the worth of the person using it. Currently, with mounting political opposition to abortion and contraceptive rights, patriarchal factions seem bent on imposing laws on the bodies of women: another plummet down the game board of snakes and ladders. These theories have lent themselves to arguments invalidating those who identify as part of the LGBTQ community and/or undergo gender affirmation surgery.
Among mammals, sex differences in behaviors stem from differences in how females and males reproduce. According to Trivers, reproduction is an intensely time and energy-consuming process for the female, beginning with gestation and continuing after birth to lactation and child-rearing (1972). For the male, however, there is less commitment according to Trivers in terms of time and effort, as the male commitment ends with fertilization (1972) (Trivers, 1972). Thus, Trivers refers to the interest of the male as simply maximizing the number of fertilized eggs to increase the chances of having children (1972). This divergence of interest, translated into human world-building based on ownership of private property and disproportionate valuation of male-male community bonds, and the resulting aggression can be seen as the beginning of the patriarchal domination of the female. In this view, females have been forced to surrender power and property to males to ensure heightened safety for their offspring, usually to the detriment of female advantages (Smuts, 1995) (Smuts, 1995). However, the anthropological account does not suggest that counterstrategies are entirely unavailable to females. Smuts found that after studying great apes, aggressive male sexual conquest of females be mitigated by social support from same-sex communalism among females (1995).
Perpetuation Of Systemic Patriarchy
According to Walby (1989), six structures—broadly termed the patriarchal mode of production, patriarchal relations in paid work, patriarchal relations in the state, male violence, patriarchal relations in sexuality, and patriarchal relations in cultural institutions such as religion, media, and education—perpetuate systemic patriarchy(Theorising Patriarchy - Sylvia Walby, 1989, n.d.). While these structures can be seen in the larger society, they are also seen in the familial unit, in which patriarchal tradition, practices, and ideals are vertically transmitted from generation to generation (A. A. Singh, 2009).
Parental guidance is shaped by patriarchal beliefs such as gender norms, which are usually a large part of patriarchy in practice and perpetuated through households both consciously and unconsciously. The be-all and end-all goals of patriarchal practices remain control over female reproduction, and the ultimate sanction to achieve this goal is a violation of the basic human rights of others. Evolutionary analysis suggests that whenever we consider any aspect of gender inequality, we need to ask how it affects female sexuality and reproduction in ways that benefit men at the expense of women (and other men).
Anecdotal narratives of such indoctrination and subsequent commodification are rampant among women from the Indian subcontinent. It is not uncommon for families to be unwilling to send women to school, preferring to save up for their wedding expenses instead (R. Singh & Vennam, 2018). The culture of the extravagant wedding with the expectation of the bride’s family bearing the expenses underscores the pervasiveness of these practices. The oppression is often at a subversive level, enmeshed within the culture. Innocuous comments underlie the instinctive disdain for anything feminine, indicating that an achievement worth celebrating can only be achieved via a man. This has a deeply traumatic effect on the psyche of women, who learn to view themselves as inherently “less.”
Parenting plays a formative role in the indoctrination of gender roles from infancy(Paul Halpern & Perry-Jenkins, 2016). Parents make lasting decisions regarding a person’s gender identity from the time of birth, dictating the person’s name, pronouns, semantics, and activities. Any male child showing an instinctive preference for so-called feminine toys or colors may be chastised and ridiculed. Young girls may be encouraged to act in “womanly” ways, indicating a submissive and yielding attitude. This indoctrination of societal norms creates an oppressive environment, damaging the self-confidence of men and women.
Closely related to this is the issue of body image. Increasingly, cases of extreme anorexia and bulimia, often significantly heightened through exposure to a highly patriarchal social media feed, are becoming common among teenage girls and young women. The patriarchal convention of the “perfect woman,” accompanied by a punishingly harsh physical model, bears negative upon impressionable psyches. Women are driven to desperate measures in their attempts to conform to unrealistic physical expectations. These psychological issues lead to intense physical harm and can even prove to be fatal in extreme cases. In a patriarchal society, gender identity is viewed through a fundamentally rigid heteronormative lens. The heteronormative standards are maintained as “normal,” and as a result, any deviation from heteronormative behavior is presumed to be a form of deviance that needs treatment (McGough, 1973). This has led to the labeling of homosexual and transgender individuals as diseased people who then are shunned and mistreated. Members of the LGBTQIA + community face harassment and violence in society as their authentic gender identities lead to ostracism. Thus, oppressive social norms are linked to mental health disorders.
The patriarchal system perpetuates a narrow, heteronormative, and archaic worldview. In fact, in the context of South Asian societies, certain patriarchal beliefs and practices can be traced back to history.
Patriarchy And Its Historical Relationship With Psychopathology
Malleus Maleficarum, (Latin: “Hammer of Witches”) is a detailed legal and theological document written in 1486 by Heinrich Kramer, an Inquisitor of the Catholic Church, and regarded as the standard handbook on witchcraft, including its detection and its extirpation, until well into the 18th century. Published 30 times between 1486 and 1669, a best seller in Germany and France, it was a deeply disturbing misogynistic treatise approach to female religious transgression (Herzig, 2010). The Hammer of Witches is an especially egregious example but in other historical periods, we can discern societal developments that were particularly influenced by a patriarchal understanding of gender rules and behaviors.
Elaine Showalter explores this theme in The Female Malady, in which she discusses the development of psychiatry in England. The Victorian period, spanning almost the entire nineteenth century, was known for its rigid rules of conduct based on the division of the sexes (Busfield, 1994). It was also, however, a time of enormous scientific discovery; the study of the human mind became particularly exciting, and there was significant interest in understanding and treating mental ailments. Despite this rising interest in mental illness, the study was steeped in socially prevalent patriarchal beliefs, resulting in deep-rooted biases against women. Unsurprisingly, such institutionalized patriarchy with its inherent misogyny had a profound impact on the female psyche.
Numerous ailments were viewed as “feminine problems” and allotted a place of derision. This very naming of certain maladies brings this inbuilt bias to light. A psychiatric diagnosis of “hysteria” was often imposed on women suffering from epileptic fits, and the term is derived from the Latin term for “uterus.” Similarly, “madness” was viewed as a feminine affliction in Victorian England, and treatments often included surgically removing internal female reproductive organs (The Hysterical Female). Psychiatrists often diagnosed perfectly sane women with insanity if they did not conform to social norms and conventions. Such diagnoses were often followed by incarceration in mental asylums with heinous practices including electric shock and lobotomy. Women, children, and the severely mentally ill were particularly likely to be lobotomized without their consent, or sometimes, even knowledge (Schlich, 2015).
Generations of the scientific community theorized and perpetuated oppressive norms for women. In the last three decades of the 19th century, lobotomy gained widespread popularity for not only dysmenorrhea and ovarian neuralgia but also epilepsy, nymphomania, and insanity. Thousands of primarily young women had their healthy ovaries removed to cure them of a range of mental disorders that were believed to be caused by menstrual disorders. Thus, female sexuality, viewed as a dangerous aspect of femininity that needs to be kept under tight control, was increasingly viewed through a pathological lens (McGough, 1973). Ironically, “madness,” unnatural behavior, and trauma were often actually the results of women’s desperate efforts to live up to stifling social norms of conduct.
Sociologist Thomas J Scheff referred to the relationship between power hierarchies in society and the labeling of individuals as mentally ill in Being Mentally Ill: A Sociological Study (2017). Socially negotiated power dynamics under the patriarchal system put men at the highest level of authority and social-behavioral norms parallel patriarchal rules. Actions or behavior that might threaten such social norms and conventions are summarily termed “deviant.” Any behavior that could be related to mental illness was seen as deviant behavior and thus, women who were relatively powerless in society became more susceptible to being labeled mentally ill (Thomas J. Scheff |, n.d.).
Phyllis Chesler, in her book Women and Madness (1972), argues that one of the largest causes of a numerically higher prevalence of women in mental patient populations is that “women, by definition, are viewed as psychiatrically impaired—whether they accept or reject the female role—simply because they are women.” Women’s behavior is then devalued and even pathologized. Given that the world of psychiatry has also been traditionally overwhelmingly male, it is hardly surprising that patriarchal stereotypes of acceptable sex roles and the presumed inferiority of feminine traits underlie the attempts to address mental ailments. Notably, it is because of the overwhelming presence of male thinking and the establishment of the study of the mind as a masculine enterprise that psychoanalysis continues to be more successful in understanding men than it is in women.
Sigmund Freud (1856–1939) claimed that anatomy is destiny and that one’s gender determines one’s main personality traits (1973). This belief has continued to play a dangerously significant role in shaping how women are treated by men and even fellow women. Women have been taught that the fluctuations of their natural biology, such as menstruation, menopause, and pregnancy, are pathological conditions that incapacitate their ability to function (Olfman, 1994). While considering herself a disciple of Freud, Karen Horney (1995 − 1952) disagreed. She argued that the overwhelming impact of culture over biology was the primary determinant of personality. She refuted Freud’s claims that a woman’s sense of inferiority to the male sex stemmed from some universal process such as what Freud referred to as “penis envy.” She wrote “[t]he wishes to be a man…may be the expression of a wish for all those qualities or privileges which in our culture are regarded as masculine, such as strength, courage, independence, success, sexual freedom, right to choose a partner” (Horney, 1939).
Developmental Psychopathology and Patriarchy
The societal impact of patriarchal attitudes toward women’s anatomy is nearly universal. Women are taught about the role and behaviors expected of them from infancy. The impact of patriarchal oppression on women can be found in presumably healing scenarios. In analytical psychology, the term “Father complex” was developed both by Freud and Jung, and it's applied to a group of unconscious associations specifically about the image or archetype of the father (Blos, 1987). While What Freud described as fear, defiance, and disbelief of the father, Freud considered being resistant to treatment”? In Jung’s view, when a woman experiences what he termed a negative father complex’, she was disposed to see all men as likely to be, etc (Jung, 1919).
In Western culture, the 1960s sexual revolution and subsequent feminist movements have had a huge impact on somewhat diminishing the gender gap (Sigusch, 1998). However, in the non-Western world, including populous Southeast Asia, women continue to be subjected to violence in many forms including domestic violence, rape, harmful traditional and customary practices, “honor killing,” and trafficking (Heyzer,N, n.d.). In India, for example, it is common for young women to be treated as secondary to their male siblings. The needs of the male children in the patriarchal family are given precedence in aspects from clothing and nourishment to education and medical attention. The idea that the woman is someone else’s property gets reemphasized at every step of her life. These beliefs go on to feed the unwillingness of parents to spend on their daughter’s education. They attempt to justify this by stating that since the girl will have to be married off at a fairly early age, any benefits from her education will not be accruing to the birth family and is thus seen as a waste of limited resources (Malhotra et al., 1995).
Scholars have observed the underlying phenomenon of commodification and “exchange of women,” a socially accepted form of conduct that dehumanizes women and makes them a commodity to serve male requirements. Interestingly, this phenomenon also indicates a degree of male-male cooperation in humans that remains highly unusual in other mammals (Rubin, 1975) (L??vi-Strauss et al., 1969). Negotiated marriages, bride stealing, and ritual defloration are common representations of this commodification. Women are indoctrinated from childhood to accept their subordinate roles and their obligation to kin to accept such exchanges.
Impact Of Patriarchy On Mental Health
Patriarchal division of gender norms has set certain behavioral expectations for individuals based on biological sex. The patriarchy perpetuates a psyche of equating biological sex with the socially constructed element of gender—pressurizing individuals in society to adhere to a strict set of narrow “acceptable behaviors” for each biological sex. This could be traumatic for individuals who may not necessarily want to adhere to such behaviors or extremely limiting boundaries of gender. These individuals face alienation and ostracization and are more susceptible to sexual violence for example individuals from the LGBTQIA + communities are frequently subjected to harassment and sexual abuse.
Thus, the patriarchal society makes for a fundamentally unsafe and detrimental space for non-conforming women and those who do not fit within narrow societal limits of gender and sexuality. Though this power imbalance may often be seen to exclusively benefit men, it has insidious dangers for the psychological well-being of men as well.
The rigid patriarchal outlook became particularly prominent in the social norms of the nineteenth century. William Alcott’s The Young Woman’s book of Health (1850) and Edward H. Clarke’s Sex in Education or A Fair Chance for the Girls (1873) are both examples of instructive texts that were created based on the premise of female physical inferiority(Wm. A. Alcott, n.d.) (ALICE K. SMITH, n.d.). Needless to say, such a social outlook had a massive impact on the psychological well-being of women, who imbibed a predisposition towards submission based on presumed lower status, and thus accepted male aggression and violence towards them as normal and even necessary.
With the increasingly ubiquitous presence of social media, people are more vulnerable to patriarchy-induced deterioration of mental health. Social media and the internet have made it easier to perpetuate gender bigotry, support patriarchy, and spread negative portrayals of women (Popa & Gavriliu, 2015). Studies have specifically indicated that “social media use may be tied to negative mental health outcomes, including suicidality, loneliness, and decreased empathy” (L. Hur & Gupta, 2013). For example, social media platforms exhibit curated visual content promoting unrealistic lifestyles and body images that can trigger comparison, jealousy, and anxiety in individuals. Social media has also become a fertile ground for sexual predators(L. Hur & Gupta, 2013). Prepubescents and teenagers are particularly susceptible to falling victim to grooming: a practice in which an adult “builds a relationship, trust and emotional connection with a child or young person so they can manipulate, exploit and abuse them”. Sexual violence is a major element of Adverse Childhood Experiences (ACE) and leaves lifelong scars on the psyche of the child. Feminist thinkers and intellectuals, beginning with Simone de Beauvoir, have postulated that a patriarchal society is built around and caters to, male sexual instincts from early childhood (Beauvoir, 1989). Mary O’Brien has argued that male sexual violence is essentially a form of dominance display used to compensate for the male inability to bear children (Widerber, 1983). According to Elizabeth Fisher, the mating practices and forced mating of animals became the source of inspiration for the human male to practice sexual violence (Fisher, 1979). Aided by the conducive social atmosphere, man’s sexual dominance and institutionalized aggression found roots.
In the 1970s Susan Brownmiller who was a part of the New York Radical Feminists started a movement against the prevailing narratives around sexual violence. In a blistering rebuttal, she famously said “rape is nothing more or less than a conscious process of intimidation by which all men keep all women in a state of fear”. In 1975 her ground-breaking book “ Against Our Will” was published, years after the foundational works of Kate Millett’s Sexual Politics and Shulamith Firestone’s The Dialectic of Sex (West, 1979).
Needless to say, sexual violence is experienced by both sexes, though the number of women significantly outnumbers male victims. The perpetrators too are overwhelmingly male, once again validating the fundamental definition of patriarchy as an institution of dominance aided by aggression and violence (Borumandnia et al., 2020).
ACEs and subsequent trauma have life-altering impacts, often diminishing a person’s long-term well-being. A particularly brutal example of ACE is Female Genital Mutilation/Cutting (FGM). This refers to the “surgical modification of the female genitalia, comprising all procedures involving partial or total removal of the external female genitalia or another injury to the female genital organs for cultural or nontherapeutic reasons” (Yirga et al., 2012). This practice continues to be prevalent in many parts of Africa and Asia, and sporadically around the globe. According to the World Health Organization, available data from 30 countries where FGM is practiced in the Western, Eastern, and North-Eastern regions of Africa, and some countries in the Middle East and Asia reveal that more than 200 million girls and women alive today have been subjected to the practice with more than 3 million girls estimated to be at risk of FGM annually. Victims of FGM often suffer prolonged health complications and even death, and survivors of the practice report extreme levels of trauma (Melese et al., 2020).
An oft-overlooked ill effect of patriarchy on mental health vis-à-vis gender is the negative impact it has on the well-being of men (Horowitz & Fetterolf, 2020). A large section of the male population faces incessant pressure to go against their natural inclinations and behave according to acceptable stereotypes. Men are expected to exude ‘masculinity’ in their everyday lives by negating emotions and adopting an aggressive attitude. Boys face ruthless bullying and cruelty from peers if they display any form of sensitivity or other ‘feminine’ traits. As a result, they learn to suppress emotions and adopt a lifestyle that normalizes violence to live up to patriarchal gender constructs (Mayer, 2018). It has been long recorded that men on average have a shorter lifespan than women. While some of this can be attributed to genetic and biological factors, it is also largely exacerbated by increased risk-taking behaviors and consequent heightening of stress levels in men (Liz Plank, n.d.). A large proportion of men exhibit signs of stunted emotional development, which eventually leads to difficulties in forming and maintaining relationships as adults. Stereotypes about male resilience and ‘toughness’ prevent men from seeking mental health help, which worsens an already difficult situation.
Addressing Patriarchy In Clinical Encounters
It bears repeating that patriarchy is a fundamentally oppressive, all-pervasive system that permeates all aspects of life. The impact of this disruptive system is exemplified in physical, emotional, financial, and socio-political realms and, as argued here, no more than in the realm of mental health and disorder. As clinicians, we encounter persons with very different concerns. What can clinicians do?
We, clinicians, are accustomed to making personal inquiries into all aspects of persons’ lives, most particularly, into:
• their competencies founded upon their attachments
• their adverse life events and how these have shaped their embodied experience of current stressors
• their stress responses in the body and mind
• their coping strategies
• their experience of demoralization is distinct from but interactive with any psychopathological interferences there may be in their pursuit of personal flourishing
• their life-affirming values provide motive force for countering demoralization and trajectories towards harm and restoring them to their trajectory toward personal flourishing
• their support systems provide scaffolding and guidance when individual efforts to retrieve life-affirming values falter.
Instead of an image of climbing ladders, scala instrumental to attain the heights of human flourishing—we have examples from antiquity onwards—Clinicians might conjure up from childhood memories: the game of Snakes and Ladders (aka Chutes and Ladders), depicting road-blocks, set-backs, and effortful turnarounds. With this image in mind, IF clinicians construe patriarchal oppression to be among the factors potentially affecting competencies, factors potentially contributing to ongoing stressors but also potentially constraining adaptive stress responses, factors contributing to demoralization, factors affecting the formation, or deformation of values supporting or undermining revaluations that take patriarchy into account, factors lodged firmly among the encrypted structural biases that lead to social system failure, THEN clinicians can make a start in shaping clinical inquiries into the ‘snakes and ladders board game in which persons have been given their roles to play(Galvin & Project, 2021) (IU Conscience Project, 2011).
Some persons will come with concerns about the role they perceive they have been assigned and seek to challenge; some persons will seem content to privilege the rules as received while others will discern the injustices inherent in them and call for new ones. Some people will deeply wonder about the construction of the game board itself. In each case, the clinician is privileged to make personal inquiries. See Fig. 2 for details.