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he had initially accompanied her child to a psychiatrist for treatment, but the visit ended with her opening up about her own struggles.
“Doctor, I don’t know what else I can do,” she said in desperation to Hospital Sultan Abdul Aziz Shah consultant psychiatrist, Associate Prof Dr Ruziana Masiran.
The mother, a working woman in her 30s, told the doctor she had been helping her child cope with severe anxiety and refusal to go to school, while at the same time dealing with her marital problems.
In a recent interview with Bernama, Dr Ruziana said the woman concerned had read extensively about mental health to better support her child. She also adjusted her work schedule to manage her household responsibilities and tried to meet her husband’s expectations in the hope of easing his frustrations, but none of her efforts produced the desired outcome.
“In family therapy practice, I encounter many women like her,” the doctor said, adding, “They are capable, intelligent and deeply dedicated, whether as full-time homemakers or professionals. They juggle raising their children while caring for their ageing parents, all amid financial pressures and marital strain.”
EMOTIONAL EXHAUSTION
Elaborating, Dr Ruziana said across cultures, women are expected to be nurturing and prioritise the feelings of others, and refrain from complaining or exposing family “secrets”, leading many women to suppress their emotions.
“Over time, this can result in hidden depression and anxiety, as well as physical symptoms such as fatigue and body aches. This phenomenon is known as ‘smiling depression’… it occurs when outward expressions mask the true feelings within,” she explained, adding that women are more prone to depression and stress compared to men.
She noted that despite carrying a heavy emotional burden, women tend to continue fulfilling the social roles expected of them, giving the impression that they are “doing fine” in the eyes of others.
“However, smiling on the outside while crying within is not a sign of weakness. Rather, it reflects strong emotional resilience and signals a need for a safe space for them to be heard and understood,” she said.
CHALLENGES
Dr Ruziana added that the mental strain experienced by women in Malaysia today stems from multiple factors, with the conflict between traditional and modern roles being a key contributor.
“Although more women are now part of the workforce, they are still expected to shoulder the primary responsibilities at home. Work-family conflict has been identified as one of the main sources of mental stress among working women.
“In the digital age, the boundaries between work and personal life have also become increasingly blurred. Work-related communication through messaging apps, emails and online meetings makes it difficult for women to truly disconnect from job demands, even when they are at home,” she said.
Dr Ruziana Masiran.
She added that changes in workplace culture and the rise of the digital economy have further intensified the pressure on women as they are required to continuously acquire new technological skills, compete in an unstable job market and constantly prove their capabilities at work.
Despite the pressures they face, she said many working women are reluctant to open up, fearing they may be perceived as weak and that it could affect their career advancement.
In addition, the pervasive influence of social media today has further intensified the pressure on women as they are constantly exposed to other women’s “perfect” and “happy” lives.
“They tend to compare themselves with those women and may feel judged on their appearance, parenting style and career achievements. The pressure to appear successful on social media can add to their emotional burden,” she said.
Women’s lives, said Dr Ruziana, are complex and filled with challenges. For working women, the day often begins early in the morning, managing their children and household duties before enduring long traffic commutes to earn a living. At work, they are expected to meet performance targets and professional responsibilities.
“When they return home, their roles as mothers, wives and family managers await. As a result, many women experience prolonged physical and emotional fatigue, with very little time left to rest or care for themselves,” she said.
For single mothers, the challenges are even greater as they must raise their children alone while dealing with other issues, including former spouses who may neglect child support obligations.
“This reflects the extraordinary resilience of women, but at the same time highlights their need for strong support from family, society and social systems to safeguard their mental well-being,” she said.
IMPACT ON PHYSICAL BODY
Dr Ruziana also said that emotional and mental stress can have a direct impact on the cardiovascular system in women. Stress hormones such as cortisol and adrenaline, when continuously released, can raise blood pressure, cause irregular heart rhythms and increase the risk of heart attacks and strokes.
She added that women’s hormonal systems are highly sensitive to stress. Prolonged stress can disrupt menstrual cycles, making them irregular or causing them to stop altogether.
“Gynaecological conditions such as polycystic ovarian syndrome (PCOS) may worsen, and fertility can also be affected. In terms of immunity, elevated cortisol levels can weaken the body’s defence system, making women more susceptible to illness.
“This is concerning because autoimmune diseases such as lupus and thyroid disorders are more common among women, and stress can further aggravate these conditions,” she said.
Dr Ruziana also noted that mental stress can affect the digestive system and sleep patterns, leading to stomach discomfort or changes in appetite.
“In the long term, high cortisol levels can reduce bone density and increase the risk of osteoporosis. It may also lead to headaches, migraines and persistent muscle tension,” she said.
In this regard, she advised women to seek professional help if emotional difficulties begin to interfere with their daily lives, particularly if symptoms such as prolonged sadness, anxiety or irritability persist for several weeks.
“Other serious warning signs that shouldn’t be ignored include difficulty controlling emotions, withdrawing from loved ones or feeling hopeless and thinking that life is meaningless.
“Immediate help should be sought if there are thoughts of self-harm or harming others, or if one begins to rely on alcohol, drugs or other substances to cope with stress,” she said.
Dr Ruziana stressed that families and society must play a role by offering full support to affected women.
“This support includes listening without judgement, giving them space to express their feelings and not dismissing what they are going through. Family members can also help by sharing household responsibilities and childcare duties as this dual burden is often a major source of stress for women.
“Support at home plays a crucial role in their recovery and mental strength,” she said, adding that promoting women’s emotional well-being is not only a personal or family matter, but also a responsibility of society and the nation.
She noted that stigma surrounding mental health remains strong, causing many women to suffer in silence and avoid seeking help.
“Society also has a role in creating a safe and nonjudgmental environment. Neighbours, colleagues, women’s organisations and community leaders can help by encouraging open conversations about mental health, sharing accurate information and offering support without waiting to be asked,” she said.
This article is in conjunction with International Women’s Day, celebrated on March 8 every year.
