“I can’t tell my parents about this.”
“There’s no such thing as depression, it’s just all in your head.”
“I should be able to be okay. This is a sign of weakness.”
These are just some of the statements I hear from South Asian Americans in my psychology practice. Even though they are born and raised in the United States, many South Asian Americans (Americans of Indian, Pakistani, Sri Lankan, Bangladeshi, etc. descent) are still heavily influenced by their parents’ views on mental illness. I have observed that many youth of this first generation carry on their parents’ traditional views of mental health, even in America, where these issues have begun to be more accepted and understood by mainstream Americans. As an Indian American myself, I feel compelled to explore this issue, to help remove the stigma of mental illness in this community, and to advocate for the value of psychological counseling to a South Asian audience.
A recent article by India West reported on the recent findings of the Asian and Pacific Islander American Health Forum (APIAHF). Per the article, the Forum found that a higher percentage of South Asian Americans, particularly those between the ages of 15 and 24, had been found to exhibit depressive symptoms. The article also pointed out a higher rate of suicide among young South Asian American women than the general US population. The article suggested that factors such as family conflict and stress/anxiety as a possible cause of the greater rates of depression and/or suicide in this population. Unfortunately, according to the same APIAHF report, South Asian Americans have the lowest rate of utilization of mental health services. Naturally, this also contributes to a worsening of underlying illnesses.
What are the reasons for this? The South Asian American community has struggled for many years to overcome the stigma and societal discomfort around mental illness. In India, the country of my parents’ birth, mental illness was, and still continues to be, a taboo subject. Even though Indians have experienced depression, schizophrenia, and other issues, those suffering from mental illness are still not completely accepted in mainstream Indian society. South Asians emigrating to the United States have naturally brought these biases and fears with them. Many believe mental illness is not a real illness, but rather the product of hysteria or an overactive imagination. A person with depression is often dismissed as just playing the victim. Someone dealing with anxiety or stress is just weak-minded.
Ironically, the same qualities that have marked South Asians’ successful immigration experience – an outward projection of emotional resilience, a relentless work ethic, a strong drive to assimilate – further complicate how they deal with mental health issues when they arise in their families. After all, how can a cultural group celebrated for its high intelligence and resilience be seen as “mentally weak”? This incongruity between the reality of mental health issues and the self-projection of psychological resilience creates greater stress and makes it even more difficult to those afflicted to reach out for help.
Acculturation or cultural assimilation to American society, may be one of the biggest factors involved in whether SouthAsians seek psychological services. Leong and Lau (2001) discuss the finding that the more acculturated into mainstream society Asians become, the more favorably they begin to view psychological services. One reason for this may be that as South Asians take on more “western” views, psychotherapy, a traditionally “western concept” becomes a more acceptable option. Conversely, many South Asians are trying to find their place in American society without giving up their own cultural roots, and may see therapy as being “too American” or even “too liberal.” The level of acculturation appears to play a significant role in this issue.
So the question is, what can South Asian American psychologists, and any psychologist who treats this population, do to reverse this trend? I believe that it comes down to awareness building, education and support. In my own practice, I have noticed that South Asian clients struggle with accepting their mental health problems as valid issues. This unfortunately leads to significant inner tension and conflict, as mentioned above. The case of “feeling abnormal” is universal even among Americans. That is why I always talk with all my client’s parents about how normal and how common their child’s issues may be. I also reassure them that their child is “not crazy” and use medical analogies, which they relate to more easily, to help them have a better understanding of the issues. I also focus on the removal of blame and the insertion of acceptance, rather than avoidance. Southeast Asians often deal with considerable guilt, whether it is self-inflicted or from another person, usually a close family member. The parent’s guilt over their child’s issues is so strong that they cover up with defensiveness and avoidance of the issue in the first place. Another step in the process would be helping the child/teen identify an ally, if their parents are not supportive.
Overall, there are a lot of issues here that need to be highlighted. Depression, anxiety, eating disorders, self-mutilation, issues around sexual identity/orientation,etc are just some of the problems that plague South Asian Americans. Given all of this, it is important for Indian Americans (especially medical and mental health professionals as well as those who have dealt with such issues) to share their views on mental health illness in order to help normalize this for their peers as well as the older and newer generations. I hope to continue this dialogue on my own blog. Knowledge is power and early detection and support is the key to help a loved one cope and eventually thrive. This is especially for the SouthAsian communities in the US, who still struggle to accept that mental illness is a real problem that deserves attention.
Leong and Lau (2001) Barriers to Providing Effective Mental Health Services to Asian Americans, Mental Health Services Research, Dec, Vol. III, issue 4, pp 201-214
“Suicide Amongst Indian Americans: We’re Stressed, Depressed, But Who’s Listening?”
Sohrabji, Sunita, India West (2013), July.