Cultural Nuances of South Asian Mental Health
In recognition of September as National Suicide Prevention Awareness Month, we hosted a very insightful and inspiring panel about the reality of South Asian mental health experiences, including the unique barriers and stressors and tips on how to recognize and address mental health needs when seeking care. This is the first half of our interview - Part 2 coming soon!
We had the opportunity to talk with Dr. Mala Nayak (MN) and Sangita Biswas, LMFT (SB). Dr. Nayak attended medical school in Mumbai and did her residency in Psychiatry at Stanford. Sangita is a licensed marriage and family therapist in the East Bay.
A study conducted by the American Psychiatric Association shows that Asians with schizophrenia did not reach the mental health system until three years after their initial onset of symptoms, due in large part to the stigma associated with mental illness in the community that causes them to delay seeking help.
Where do you think the stigma against mental illness comes from?
MN: The stigma comes from both lack of understanding as well as prejudice and bias. Usually, mental illness is viewed as a character flaw rather than the complex intersection of biological, psychological, social, and cultural factors it is. These perspectives often extend from the individual to families and then communities. “That’s why there is a feeling that we should be able to snap out of it.” Unfortunately, it is not as easy as it sounds and that’s when all the feelings of failure, embarrassment, and disappointment come in.
“Also, the media has portrayed people struggling with mental illness as scary, unpredictable and erratic.” Therefore, when someone has a mental health issue, the “easiest” way to deal with it is in silence. This is more prevalent in immigrant communities.
“It would be great if we evolved to a point where we separate the mental health issue from the person and take care of the problem and continue to care for the person instead of conflating the two.”
What can we do to break down the stigma and make people feel more comfortable with the idea of seeking mental healthcare?
SB: There’s a lot of not understanding what we are dealing with exactly. This means the stigma is not always intentional and can come from a place of not knowing. “We have to try to fight the silence and of course normalize the whole process and the parity between physical health and mental health.” This will come from a place of education - and not just talking about the fact that there is mental health but how to recognize it and what the appropriate language is around it.
We need more professionals talking about it to the community and share the message that this is the most natural thing to happen. There is greater understanding and empathy towards physical pain; if we feel there’s something wrong people usually say “you should get that checked.” We need to bring this dialogue into mental health. The step towards that is to “fight the silence and work to educate, talk about it, normalize it, empathize with it, and not just shut it in a corner.”
What other mental health barriers or stressors, aside from stigma, uniquely impact South Asians?
MN: It is interesting how Asian languages have a very limited vocabulary around expressing emotions and mental health. Yes, we have the basic concepts but as these issues get more complex, how do we express them? There is a limited vocabulary around anxiety, depression, and other mental health issues, which makes it very hard to think about your emotions, articulate them, and validate them. Of course, South Asians have emotional experiences, but what is not there is an external and internal consent to be able to express those emotions. We have to get to a point where we recognize there are not “good emotions” and “bad emotions” but just emotions - and that is ok to go ahead and express those emotions.
Another factor that comes into play is that our children are growing up in a culture that is different from the one we grew up in, and this results in a difference in the way a lot of things are perceived, including expression of emotion. Differences in the way they view family structure, gender roles, and sexual identity can create conflict. What comes out of that conflict really depends on the family - some are able to talk about it and move forward but others are unable to. This can cause the younger generation to resort to isolation/withdrawal or to lead a duplicitous existence where they have an inauthentic version of themselves in the home and a more authentic version of themselves outside of the home. This stress can often become unbearable and needs to be addressed.
SB: One would think that being as family-oriented as South Asians are, it would make it easier to address and deal with mental health issues. However, as a collectivist culture (goals and means of the group are placed ahead of the individual), we are very focused on what people think, and talking about mental health rarely happens. Why? The success of an individual is often celebrated by the group, and similarly, the failure of the individual is seen as the failure of the group. So, when you have something like mental health challenges, which are often viewed as failures in the community, it is taken as a failure of the whole group. “And that is why it is silenced more - because there is a lot of shame in talking about this outside. Getting help means you have to go outside and talk to a stranger about your problem.”
As immigrants, many of us also grew up in a culture where there was a set idea of what success looked like and you didn’t have too many chances to get it right. Between conforming to the label of the “model minority” and dealing with the guilt of leaving your family behind, there is an overwhelming pressure to succeed. We carry all of this with us when we are parenting; we see our children as the embodiment of our dreams.
Despite being in a totally different situation with abundant school and college options in this country, our children are still subjected to that same do-or-die mentality. As a result, we place a huge emphasis on academic success (self-worth is measured by accomplishments) and then success is measured by more traditional parameters… We know that immigration is very difficult for both parents and children; though the struggles parents face seem so big that children don’t want to burden their parents with their “struggles,” and when they do communicate, they, unfortunately, are invalidated.
What are some other benefits of belonging to a collectivist culture for our mental health?
When the power of a group can be harnessed, there is so much potential for change. There are potential protective factors, including social and familial support. It is always good when the family is actively and positively participating in the mental health treatment of a loved one. Also, the development of positive relationships with peers and with adults outside the home harness social support for mental health. “What we don’t know we can’t change, but the more we know…change can happen and as it gains momentum, we will see the impact of it in a much more pervasive manner.”
Dr. Mala Nayak:
Dr. Nayak has been working for the past 25 years at Momentum for Health, the largest non-profit provider of mental health services in Santa Clara county, providing medication management and psychotherapy services for the chronically mentally ill. During 2022, in response to the mental health crisis brought on by the global COVID-19 pandemic, Dr. Nayak has been working to set up a service for the South Asian community to navigate mental health issues through education, outreach and connection to services.
Sangita works extensively with the South Asian community, advocating how therapy works and the benefits of engaging in this work before it’s too late. One of her strongest beliefs is that the most effective way to remove the stigma around mental health is to help the community through dialogue and relevant content discussions. She conducts regular workshops for the community to raise awareness around mental health.
