“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.
Sohrabji, Sunita, India West (2013), July.
