The Taboo of Mental Illness in the South Asian American Community: Why so much Stigma?

“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.

References:

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. 

Psychotherapy for the Soul

In today's rat race of economic difficulties, competitive global markets, sky-rocketing social media communication, etc, it is not surprising that we are all feeling more emotionally and psychologically rattled. There is alot to deal with in today's world! But how are you dealing with it? Do you have someone to talk to when you are out of sorts? What if you have the consistent feeling of impending doom or hopelessness?

 I have recently been thinking a lot about how important it is to be heard. Everyone needs a space to be able to voice their fears, hopes, dreams, desires, secrets without judgement. Sometimes people have the good fortune of having family members or friends who can provide this basic need. However, often the issues are more challenging and take a toll on one's spirit, such as what I mentioned above. Depression, for example, can range from mild dysphoria to severe psychosis. So, an individual who is beginning to feel these more difficult emotions would need something beyond what a family member or a friend can provide. This is when professional help from a trained psychotherapist is key.

 Psychotherapy provides that safe space where a person can express extreme emotions and feel validated and comfortable "obsessing" or "feeling stuck" or "struggling through life and death issues." Besides providing non-judgemental and empathic support, Psychologists are trained to assess a client's issues and coordinate treatment with the collaboration from the client themselves  and via the lens of empirically-established, theoretically-rooted techniques. The person coming to see a psychologist is not only gaining a non-biased advocate, they are also gaining insights into new perspectives and making behavioral changes.

The only who you can change is YOU. You may know that in theory, but what steps have you taken to implement change in your life? One change, can make a shift in your perspective that is so profound that you can see things in a whole new and empowering light. While research is still establishing the data regarding brain changes due to psychotherapy, there have been some differences found with people with certain types of depression and OCD. Thus, therapy is definitely targeting, not only your mind, emotions, and behavior, but at a molecular level. Psychologists work with you to raise your own levels of serotonin, for example, through natural means of adaptive thinking and helping you replace old and mal-adaptive thoughts, reactions, and responses.

Per the research, psychotherapy used in conjunction with medications (if necessary) has made a more significant impact, than medications alone, especially for depression and anxiety. Why simply put a Bandaid on your pain? Learn to empower yourself with the tools to change yourself from the inside out!

When you have physical ailments, you seek medical attention, similarly psychotherapy is a non-pharmacological approach to emotional/behavioral ailments. Nowadays, an integrative approach is the way to go. Talk to your doctor and have them refer you to a psychologist, it may just be the difference you were looking for.

Talking to Your Child About Sandy Hook

It has truly been a horrifying last few days for those parents who have lost their children in the shooting at Sandy Hook Elementary School in Newtown, CT. As a parent, it is natural to be struggling with how to process this issue for yourself and especially for your child. First of all, it is absolutely normal to feel at a loss as to what to say to your child. It is important however to talk to them especially if they have access to news, school chatter, social media, etc. and in this day and age, that is most kids!

Depending on their developmental level, children may react in a variety of ways, including feeling anxious, scared, sad, curious, or confused. Naturally, they may be questioning their own safety, particularly their safety in school. Older children especially will be forming their own ideas based on things they may have heard about and talked about with their friends. Younger children may regress in their behavior – for instance by clinging more to you or wanting to sleep in your room. So it is vital to touch base with your child to make sure they are able to express their concerns and see you as someone they are safe to share difficult feelings with. For some children, this may be their first exposure to death and processing an event like this can be difficult.

Here a few things to think about when talking to your child:

• Choose a time that is conducive for this discussion. Avoid talking to your child about this early in the morning before school or before they go to bed.
• Take time to really listen to their concerns and validate the very real feelings they are experiencing without interrupting them. Gently assure them that they are not alone in what they are feeling. Give them praise for their communication with you.
• Help them understand that some things are difficult to explain even for adults, however, reassure them that this is a rare event and not something that happens every day.
• If they have questions about why this person would hurt others, be honest and tell them that those answers are still being figured out and that as soon as you know more, you will talk with them about this.
• Your child may ask about mental illness after hearing something from school or in the media. Explain to them that some people struggle with mental health difficulties and in some cases, with doing the right thing. But rarely do they kill other people.
• You want to ensure your child that you are always looking out for their safety and that they can talk to you anytime when they have questions or fears.
• Help them find another person at school who can be there for them when they need to talk, such as a teacher, guidance counselor, or any other educator/mentor.
• It will be beneficial to limit your child’s access to news and media images so that they are not constantly bombarded by this event. As mentioned earlier, they are likely to have been exposed to all kinds of stories. Watching a news program along with them may be helpful. However, having the news shows on for several hours on a daily basis rather than watching just one program, may be overwhelming or exacerbate their anxieties and fears.
• Channel your child’s concerns on this issue in a positive direction. Help them think of ways that they would like to turn their fear into something positive. Obviously, if you have shared your religious beliefs with them, then something along those lines would be an excellent way to focus their energies. Other ideas include making a card for those affected, spending quality time together as a family, or sharing with them stories of real people doing good things for children and the community at large.
• Keep the lines of communication open! If they are afraid to go to school, validate them and be there for them as a support until they are comfortable again. Be sure to talk with guidance counselors/school psychologists, keeping them informed of what’s going on.
• If your child continues to struggle, do seek professional services. We all can use a little extra help after undergoing a traumatic event. This will help empower your child and help him/her feel that they are supported now and in the future.

Dr. Jyothsna Bhat is a licensed clinical psychologist with a private practice in Newtown, PA.  Learn more at www.bhatpsych.com.

Is Your Child Overstimulated?

ATTENTION SPANS in AGE OF TECHNOLOGY

 Have you noticed that your child has a hard time sitting still or focusing on an activity, whether at home or in school? And maybe he or she is quick to jump on the computer or play on the iPhone, and is also switching between television programs. Have you observed with your older children that their grades may have dropped or that they struggle with completing homework? It seems like our kids are not as good at concentration as we remember being at their age. And unfortunately, as adults, we are experiencing the same thing. Yet, however, today’s world is vastly different from the one we grew up in.

If your child seems to have trouble focusing, or finishing simple tasks without getting distracted, you may be wondering if your child has a learning disability such as ADHD. It is natural to be concerned when you see your child struggling with focus and attention. Before jumping to conclusions, take some time to survey your child's environment. I am constantly telling my child/teen client’s parents to limit and/or restrict the amount of time they allow their kids to be on the phone and/or looking at gadgets. Sure, an DS or an Ipad Mini can take the place of a good babysitter for a moderate amount of time, but nothing can replace a child’s ability to create, engage in make-believe, invent, focus on a single task mindfully, or simply just run around outside and get the body’s natural endorphins moving. Finally, the time a child spends on his/her gadget may be a time you are missing out on bonding and helping your child’s ability to plan, organize, and execute a new project or idea.

In the age of fast-paced modern technology and social media, it is no wonder, adults, let alone, children are not able to focus their attentions on areas that require concentration and processing. Think about how much stimulation we ourselves are exposed to daily, and how much this impacts your world. Between smartphones, iPods, email, TV, DVR, the Internet, social media, and so on, our brain's neurons are literally firing on all cylinders, full speed ahead! Basically, your brain is on constant overdrive.

Our children are experiencing the same stimulation, even though, developmentally, they are still learning how to organize information and pay attention. While being bombarded daily with excessive stimulation and distraction, they are expected to focus on subjects that may not hold their interest in the way these other stimulating, instantly gratifying information-providing systems do. Therefore, many children are unable to handle focusing on a task and grow overwhelmed or simply bored.

 Dr. Richard Restak's book, The New Brain, How the Modern Age is Rewiring Your Mind covers this topic in depth. In it, Dr. Restak discusses how we all reach our breaking points and then shut down. This is what could be happening with many of our children. A child who is seen as "having difficulty focusing" or "bright, but not working to his full potential," may just be unable to keep up with the demands of his stimulus environment. According to several researchers and writers, a new form of ADD is arising, which is caused primarily by a technology overload or over-indulgence. The brain is trained at a young age to multi-task to such a high degree, that they are unable to focus on one task or thought at a time. The state of mind created is coined “Tech ADD (Tech Attention Deficity Disorder)” and is actually found in the Urban Dictionary (Mackenzie, 2010). A few studies done in the UK and in the US found teachers expressing concerns that technology was shortening and/or interfering with attention span (Parker, 2014). Additionally, children’s brains are reinforced for their ability to bounce from one thing to another, according to Michael Rich, Harvard Medical School associate professor and executive director of the Center on Media and Child Health in Boston.

In 2010, in looking at homework and gadget use, Kaiser Family Foundation found that of students ages 8 to 18, half of them are watching TV, surfing the Internet, or utilizing some other form of media most or some of the time while doing their homework. A study of boys who played video games and TV after they finished their homework was conducted in 2007 at the German Sport University in Cologne. The results showed that overall, the video games interfered with the boys’ sleep quality and led to significant lowered abilities to remember vocabulary words. Additionally, it was noted by one of the lead researchers, Mark Dworak, that it was not clear if it was the disrupted sleep or if the intensity of the game “overrode” the boys’ processing of the recording and the information.

Teachers, in their own way, are also learning to adapt to this new world and are using technology in the classroom just to capture and maintain the attention of their students. In essence, they are using their language, to keep them focused. While these techniques have both positive and negative aspects, one thing is certain the global usage of gadgets is your child’s reality. With growing academic technological demands, it is all the more imperative that parents help kids moderate their use at home.

Here are a few tips to help your child develop attentional capacity and power of concentration:

1. Monitor “Screen Time”

How much time does your child spends on a smart phone, or watching TV, or playing on the computer or Playstation? Those screens are overloaded with information, movement, color and hyper-stimulation. Set strict daily time limits, such as 30-45 minutes a day, after homework and chores are done. Once they reach their limit, and you are available, spend time with your child. Try reading a book together, painting, taking a walk, baking/cooking, playing a board game/sports, or help them find out a hobby they may be interested in developing.

2. Train the Brain

 Break your child’s tasks into smaller, more manageable chunks, and reward them for successfully completing those tasks. In time, completing the task becomes its own reward, and they learn the beauty of becoming absorbed in doing something they find enjoyable.

3. Relax the Mind

Teach them relaxation and deep breathing to increase focus and mind control. When they are doing homework, try playing some soft music in the background at a low volume to help their brain learn to focus. You could also both engage in mindfulness while engaging in mundane activities, purposefully focusing your attention together on your tasks.

4. Make the Bedroom A Stimulus Safe Zone

A lot of teens sleep while texting on their phones which is causing sleep deprivation and fatigue. Sound sleep is one of the best for improving attention and focus. Take the TV, computer and smart phone out of the bedroom. Set a strict time for your child to wind down and help them by lowering noise levels, dimming lights, and doing relaxing activities.

 5. Teach Delayed Gratification

 Nowadays, kids want immediate pleasures and when they don’t get them, they lose focus, attention, and grow impatient. This is a life skill that will help your child persevere and remained focus on goals in which the returns are not immediately experienced. It is an essential ability that will help your child/teen gain success in his/her life. Identify both short and long-term goals with your child and encourage him/her to work towards them. Give them choices to have smaller rewards earlier or larger ones later.

Dr. Jyothsna Bhat is a licensed clinical psychologist with a private practice in Newtown, PA. Learn more at www.bhatpsych.com.

 References: 

The Henry J. Kaiser Family Foundation (2010) Generation M2: Media in the Lives of 8-18 year olds

McKenzie, J. (2010) “Addressing Tech A.D.D.: Technology Attention Deficit Disorder. From Now On: the educational Technology Journal, November, V.20 (2)

Parker, S. (2014) “Do Schools Need to Teach Kids How to Grow Their Attention Spans?” TEACH series Feb This article was created as part of the social action campaign for the documentary TEACH, produced by TakePart's parent company, Participant Media, in partnership with Bill and Melinda Gates.

Ritchell, Matt (2010) Growing Up Digital, Wired for Distraction. New York Times: Business Technology