“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 psychotherapy practice. Although born and raised in the United States, many South Asian Americans (Americans of Indian, Pakistani, Sri Lankan, Bangladeshi, etc. descent) are heavily influenced or affected by their parents’ views on mental illness.

Many first generation youth even co-opt their parents’ traditional views of mental health, despite the fact that these issues have begun to be more accepted and better understood by average 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 mental health awareness and treatment to the South Asian American community.

A recent article in India West reported on interesting findings of the Asian and Pacific Islander American Health Forum (APIAHF) 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 further suggested that factors such as family conflict and stress/anxiety may contribute to the greater rates of depression and/or suicide seen 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 immigrating 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 seen as merely 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 that arise in their families. After all, how can a cultural group celebrated for high intelligence, adaptability and resilience be seen as mentally weak?  This incongruity between the reality of mental health issues and the self-projection of resilience creates even greater stress and makes it even more difficult for those afflicted to reach out for help.

Acculturation or cultural assimilation to American society may be one of the biggest factors involved in whether South Asian Americans seek psychological services.  Leong and Lau (2001) argue that the more acculturated Asians are into mainstream society, the more favorably they view psychological services.

As South Asians take on more “western” views, psychotherapy, a traditionally “western” concept, becomes more acceptable.  Conversely, those South Asians struggling through the assimilation process, trying to find their place in American society without giving up their own cultural roots, may see therapy as being “too American” or “too liberal”, a bridge too far. The level of acculturation, therefore, appears to play a significant role. As such, the expectation is that over time, each successive generation removed from the immigrant generation will be more accepting of mental illness and more inclined to see therapy as an option.

Until then, the question remains, 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 three things:

In my own practice, I have noticed that South Asian clients struggle with accepting their mental health problems as valid. This unfortunately leads to significant inner tension and conflict, as mentioned above. The case of “feeling abnormal” is universal, among clients of every culture and race. That is why I maintain a dialogue with my client’s parents or loved ones, reassuring them that their child’s or significant other’s issues are normal and common.

I also use medical or physical analogies, to which they may relate more easily, in order to help foster a better understanding of an issue.  I focus on removing blame and using acceptance rather than avoidance. South Asians often deal with considerable guilt, whether it is self-inflicted or from another person, usually a close family member.  A parent’s guilt over their child’s issues may be so strong that they cover it up with defensiveness and avoidance.  If a parent or loved one is too resistant, I help the patient identify another family member or friend as an ally to support their therapy process.

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 a few of the issue South Asian Americans grapple with.  Given all this, it is important for South Asian Americans (especially those in the medical and mental health field, as well as those who have struggled with mental illness personally or in their families) to advocate more openly and help normalize mental illness. Regardless of cultural background, when it comes to treating mental illness, knowledge is power and early detection and support are critical to helping a loved one cope and eventually thrive.