In the middle of March, Dr. Lindsey Zubritsky, a dermatologist in Pittsburgh, Pennsylvania and a member of the American Academy of Dermatology’s social media team, began to see a concerning flurry of COVID-related photos splashed across the news and lining her social media pages.
Each image was similar. A healthcare worker’s face was framed in a close-up snapshot. Somber eyes stared into the camera. The removal of face and eye protection revealed deep mask imprints, red bruises, skin tears, smudged makeup, and sweat. According to the U.S. Census Bureau, women hold 76 percent of all healthcare jobs, and indeed many of the photographs featured women. Zubritsky called these images “the faces of the coronavirus pandemic.”
Zubritsky’s dermatology training allowed her to immediately recognize a skincare problem. Face masks cause friction, moisture buildup, and skin degradation. For the hundreds of thousands of essential workers across the country wearing masks daily (including her husband, who is a cardiologist) this damage could lead to open skin vulnerable to infections.
“All day long, people were messaging me asking what to do,” she said. “It seems like an insignificant issue, but it’s not. None of this is vanity. It’s painful, decreases morale, and leads to infection.”
Since then, Zubritsky has posted helpful tips and advice on social media, saying a post on Instagram about skincare for essential workers was her most popular one by tenfold. Her inbox has been flooded with additional questions and messages of gratitude.
Below are a few of her takeaways and recommendations:
What’s the Problem?
In most instances, there are no alternatives to the use of masks and eye protection, Zubritsky says. And in the hospital, healthcare workers may wear protective equipment for 12+ hours a day and re-wear old masks. This leads to a few key concerns:
Constant pressure and friction of the face can lead to microtears and skin breakdown, usually seen on the nose, cheeks, and forehead.
Skin irritation from daily mask use can lead to old conditions, like acne, eczema, or rosacea surfacing.
Non-stop mask use leads to humid and moist environments in which infections can thrive.
All of the above lead to open, vulnerable skin, which is a poor barrier against fungal, bacterial, and viral infection.
Advice for Before a Shift
Zubritsky recommends the following pre-shift protocols to create a clean and strong skin barrier.
If you usually wear makeup, skip it for now. Sweating with makeup on can lead to increased acne.
Wash your face with a gentle cleanser.
Moisturize with a fragrance-free and dye-free moisturizer.
Apply thin adhesive strips called dressing strips to areas that come into contact with masks or goggles. This can act as a barrier to decrease friction.
Advice for After a Shift
After a shift, Zubritsky recommends the following to allow for skin healing.
Wash your face with a gentle cleanser.
If you have open skin, apply a wound dressing gel or healing ointment only to the open wounds, red sores, erosions, and tears. This can be repeated a few times a day.
Moisturize again. For dry skin, look for moisturizing products with glycerin and Vitamin B5 or niacinamide to help redness.
Avoid aggressive skin treatments like exfoliants, retinoids, or scrubs.
If you’re developing acne, try a simple benzoyl peroxide face wash.
For worsening acne or skin conditions, contact a physician for further medication.
What About Hands?
With increased handwashing comes dryness and irritation.
“I don’t recommend stopping hand washing because your hands are dry or chapped,” Zubritsky says. Here are tips she recommends at home to keep hands healthy.
Wash your hands with lukewarm water. When your hands are still slightly wet, it is the best time to moisturize.
Look for a moisturizer that comes in a tube or jar. The greasiest moisturizers, called ointments, are the best for dry skin. Lotions, which are water-based, are the worst.
If greasy hands are too inconvenient during the day, try it at night! At bedtime, slather on the thickest moisturizers. Occlude hands with white cotton gloves so the moisture sits on the skin all night long.
Superglue — yes, superglue — works perfectly when applied carefully to close skin fissures.
Zubritsky hopes that by sharing information, she can help alleviate some of the stress that is seen among our healthcare’s frontline.
January 16, 2023January 16, 2023 6min readBy Sejal Sehmi
I was a mere 14-year old on the fateful night of 22 April 1993. The night that witnessed black teenager Stephen Lawrence brutally murdered in a racially motivated attack as he waited for a bus. The night that cemented my fear, that the colour of my skin does matter. The same night that confirmed my indifference as a British Asian in the United Kingdom — were we really united? Fast forward to May 25 2020, the murder of African-American George Floyd by a white policeman was the turning point for British Asian author and my lovely friend, Shweta Aggarwal to finally break her silence and narrate her story of colourism, in her new book, “The Black Rose.”
Aggarwal’s gripping memoir emits so many emotions; that of an awakening, a voice that has been suppressed for years, filled with anger, mistrust and guilt. But most importantly, “The Black Rose” successfully disrupts the narrative that consistently allows society to box someone as indifferent based on a visibility factor. For Shweta, this factor was the colour of her skin. The injustices she consistently endured via some family members and fellow South Asian peers throughout her life, was as a result of her skin tone failing to qualify as ‘acceptable’, or as she often quotes in her book, not ranking high enough on the ‘fairometer.’ Whether she was in India, Japan or London, the scale was never too far behind.
Within the first chapter, she recalls as a child in India, the distinct lack of subtlety displayed by certain family members through direct taunts of her duskier appearance in comparison to her parents. She realised that she wasn’t in complete isolation from this prejudice, as her maternal aunt and uncle were also harshly nicknamed on the basis of their skin colour — Kaali (black) and Savla (wheatish). Aggarwal was left mortified by what many South Asians sadly still continue to casually exercise. Echoing similar incidents within my social proximity, it’s infuriating witnessing the recipients of such remarks surrender to laughing at themselves too.
Except it isn’t funny. Born into a culture where conversations on religion, caste and hierarchy in India are still so prominent, the comparison of Aggarwal’s skin colour being as dark as that of the domestic help (often from poorer families), prematurely planted seeds in her mind that she simply didn’t belong with her family, especially when she was sent to boarding school. Her lack of self-worth coupled with these taunts, gave her a whole new vocabulary for the letter B, that grew in parallel with the ongoing prejudice and anxiety. B for blackie, beggar’s child, bedwetter! Not funny, but derogatory. Post her book launch that Brown Girl Magazine attended, she tells me,
I personally feel we are way behind when it comes to understanding the importance of mental health. Name-calling was normalised and if you objected, you were ridiculed further with remarks such as ‘So sensitive! Can’t you take a joke?’ Body and colour shaming can lead to a feeling of inadequacy in the victim, which can further lead to depression and much worse mental illnesses.
During the 1984 Hindu Sikh riots in India, where over 3000 Sikhs lost their lives, Aggarwal recollects the frightening moment when she and her classmates fled into hiding to escape the violence during a school trip. As a means to save all the students from harm, the Sikh boys were forced to remove their turbans and long hair — their visible identities stripped to keep them alive. Yet, ironically, even in this horrifying situation, Aggarwal felt least at risk, attributing this self-assurance to her darker appearance.
The crux of her self-loathe was the love-hate relationship she formed with skin whitening creams. The birth of Fair and Lovely, India’s most renown brand (now known as Glow and Lovely following a backlash) was notorious for selling the damaging message that fairer skin equated to a happier and fulfilling life. For it was fairer skin women that would qualify for marriage — clearly their only sole purpose!
Tactfully using famous fair-skinned Bollywood actresses in television ads and posters, their so-called perfection would scream out to vulnerable young girls. (Men were targeted much later on, but the importance seemed less). Akin to the wretched beach body posters plastered on every corner in January — because apparently bikinis only look good on a certain body type — the damaging message remains the same. Social acceptance comes at a cost, and that cost is to look a certain way.
It’s an extension of the dated methods imposed on women from the womb, where mothers are lectured on drinking milk with saffron to ensure the baby is fair, traditional matrimonial sites asking women to specify skin colour, and women being told to stay out of the sun. These socially ingrained views are eventually developed into modern day methods in the form of cleverly marketed consumables. Aggarwal admits,
Most people only use the cream on their face just as I did. At that time, I didn’t even think about the rest of the body. I felt that if the face becomes fairer, that will be enough for acceptance. My mum noticed the difference for sure and I was lighter by the time I met my husband, Amit. I must admit the addiction is a combination of three factors: the justification in your own head, the strong marketing message that ONLY fair is beautiful, and the ‘compliments’ from those around you.
I admired Shweta’s honesty on admitting what essentially was a dangerous obsession that she remained faithful to throughout her teenage and adult life. A ritual that, whilst prompted gradual results in her appearance, was never going to eliminate the insecurities she felt within herself. Moments of joy with her husband and children on holidays abroad, would be broken up by the need to ‘fix’ any damage the sun may have inflicted i.e. reverse her tan. The booming tanning industry in U.K., her now home, and admiration of her ‘sun-kissed’ look by Brits initially surprised Aggarwal — as if her colour had now gained acceptance.
But who are we seeking acceptance from? A society that is still deep rooted in patriarchy forcing women even now to adhere to dated rites of passage that holds no relevance? Or a society that seeks to point out one’s indifference because of how they look — their skin, their religious attire, their weight? Or a society that passes judgement on a woman’s self-worth, and continues to abuse that same woman behind closed doors under the eyes of Goddess Kali? Aggarwarl goes on to explain,
The more damaging perceptions of colourism, are that ‘fair is rich’, ‘fair is successful’ and ‘fair is better educated’. Essentially, ‘fair is supreme’ in every sense. And if that’s the case, where does that leave dark-skinned people? In Ukraine, for example black and brown people were discriminated against and not given a fair chance to save their lives. Is it fair to be denied a basic human right — survival — based on your colour?
I personally was curious to know from my family what the definition of prejudice in the Hindi vocabulary is and how it is/was applied to in India. “Pakshappat” (taking sides) or “poorva dhaarna”, were the closest pure Hindi definitions known to my cousin, yet rarely used. However, my dad stated that “hum bedh bhau nahin hai” was the common term used to state amongst family and friends when someone was not biased and believed in equality. Somehow, colourism never really came under that category. A sentiment echoed by some of my Chinese and black friends . Even in parts of China and Africa, the belief that darker skin is perceived as inferior, is accredited to stereotyping certain groups of people as manual labourers working under the sun, and therefore of a lower class or caste. Does Shweta believe we can change this attitude?
A couple of my aunts are still reluctant to help me with my mission. One even said ‘it’s pointless fighting it’, while one said, ‘everyone has the right to define beauty for themselves and being fairer is what beauty is for some.’ The problem with this is that people then start to look down on people who aren’t. Colourism, casteism and classism divide people, creating more unrest in society. If we continue to aspire to be fairer, we’re still encouraging white skin privilege, and encouraging colonial values. The more we allow ourselves to succumb to these social constructs, the more enslaved we feel internally. Melanin is crucial for protecting our skin against the harmful radiation of the sun. Feel blessed that you have it and wear it with pride!
I wonder how we can dare to walk shoulder to shoulder with our black friends in the Black Lives Matter movement, if we refuse to face up to our own biases against colour? We seek equality in the U.K., but deny our deep-rooted prejudice, whilst a white privileged man lectures the world on the difference between racism and unconscious bias (yes Prince Harry, I’m looking at you!). “The Black Rose” has paved a way for many more voices to speak out against the damaging impact of colourism, and in my view, rightly belongs under the definition of prejudice in the collective South Asian vocabulary.
“The Black Rose” is available to purchase on Amazon.
Traditionally, psychotherapy has let women down. This is not to say that women and other minority group members have never received help, but rather that the therapy they received made little attempt to address the root causes of their problems. In focusing narrowly on the personal and individual, which a lot of mainstream approaches focus on, they ignore the big picture and miss the point. An alternative approach — feminist therapy — can help challenge the norms and support South Asian women in a more comprehensive way.
A therapy which fails to address power issues in people’s lives automatically reinforces oppression. Feminist therapy is a way to look at people as part of society and not merely as individuals. As more people of marginalized identities realize that the cause of their mental and emotional difficulties are not individual factors but structural, they are seeking more thoughtful therapists and counselors. Feminist therapists are aware of the cultural dynamics that uniquely affect women and keep these at the center of their practice.
Feminist therapy has a lot to offer to women of color, particularly South Asian women. It is formed on the assumption that social forces impact, and these forces include the many identities that a South Asian woman holds — including race, ethnicity, caste, etc. Feminist therapy can help support our clients and us as therapists to conceptualize the client’s difficulties, as not just stemming from internal sources, but as an outcome of the deep-rooted patriarchal system.
Feminist therapy is the key to a progressive approach towards mental health care. There is a lot of awareness about feminism nowadays and women encourage feminist approaches to therapy. Feminist approaches look at how social and political forces interact with our own identities. Feminist therapy especially puts in a lot of emphasis on how our intersectional identities such as religion, family dynamics and social class plays a role in our own gender identity. Feminist therapy can help support our clients and ourselves as therapists to conceptualize the client’s difficulties as not just stemming from internal sources, but rather face the impact of the deep rooted patriarchal system.
Here are some important aspects of a feminist approach to therapy, whether you are a therapist or someone who wants to start therapy themselves:
Therapists’ own biases
Therapists, while working with South Asian women, as with any other client, need to put in their own personal work in understanding the assumptions and biases that they may hold towards these identities. If a counselor holds bias that a South Asian woman is timid, or doesn’t know what she wants, it may cause the counselor to take in a more direct approach rather than a collaborative one.
South Asian women are often being told what to do. Hence, therapists who may choose to be more directive rather than collaborative, may often reinforce the position of power and authority onto a South Asian woman reflecting what she faces in the world. South Asian women, especially who may have not been exposed to therapy, may look at counselors from a view of receiving advice or guidance. It is through our own ability to explore and process our biases that we can help challenge this narrative for the client, and help take a more collaborative approach.
Exploring identity work
It is important for a therapist to be aware about gender, sexuality and the intersectional aspects of feminism; about how sexual minorities, caste, religion impact gender in influencing the kind of experiences that women face. The counseling relationship is a space for clients to process the identities that are the most salient to them. We can start off with providing some context and psycho-education around the purpose of understanding these identities. Helping the client process different identities that are important to her can help take a more holistic approach to understand her difficulties. We can help provide information around how every identity that we hold impacts us in some way or the other, because of its interaction within the social context. This can also be a time when a client may self-disclose about their own identities, if comfortable and appropriate, to model this understanding.
Ask instead of assume
It is considered best practice with every client to ask their preferred pronouns; as well as identities they would like to highlight at the beginning of the counseling relationship.
Asking, instead of presuming, can help clients hold their voice from the beginning of the counseling relationship and create a safe environment. Processing identities that are salient to them and opening up space to share other identities can help clients share openly about how they choose to identify with their gender/sexual identity. It creates space for clients in the process of exploring their identities, to get curious about their identified gender/sexual identities for the first time.
One of the initial and ongoing processes of feminist therapy is educating women from a collaborative aspect. Providing psycho-education about their rights, consent, impact of patriarchy and other systemic factors promotes empowerment. While providing psycho-education, it is important to process the power dynamics in the relationship and model consent within the relationship by exploring the question: “What is it like for you to hear this information from me?”
We as therapists can be considered as guiding forces, but we should also be mindful that we are providing this guidance and information from a collaborative aspect rather than enforcing authority or being direct. South Asian women are often asked to respect people in authority and not defy them. We, too, as therapists may end up reinforcing these patterns, and instead need to do our own exploration by engaging in psycho-education with collaboration and continuing to check in with the client’s internal process.
Hold context around starting therapy
A South Asian woman puts a lot of thought into seeking therapy. The cultural stigma towards mental health can have an imperative impact on her recognising that therapy could be a potential need to take care of herself. Along with the courage that it takes to reach out to a therapist, either openly or whilst keeping it hidden from her family, there may also be a potential element of what kind of therapist do I want to see. Especially for South Asian women living in the US/UK or other Western countries, there may be a significant deliberation that goes into seeing a white therapist v/s a person of color therapist v/s a south asian therapist.
Can we think of potential factors that may prevent a South Asian woman from reaching out to a therapist who may hold similar cultural identities ?
Can we think of potential factors why a client may want to work with a South Asian therapist?
Explore reasons that led them to choose you
When a client comes in for therapy, she has probably considered the therapist’s background. She may choose to see a non-South Asian woman because of past and internalized fear of being judged by other South Asian women in her life. Or a client may deliberately choose to work with a South Asian woman therapist for perceived similarities in identity. For therapists, it’s important to create space at the beginning of the relationship to ask the client what led them to choose you as their therapist. For clients, it’s important to ask questions about your therapist that are important to you.
Fostering environment for all their identities
Clients are fully seen and valued for all aspects of their identity, background and experiences. It also means that we ground our interventions from a systemic and anti-oppressive approach.
We constantly learn and evolve to provide responsiveness, humility and respect to our clients and really redefine the standard of care based on the identities and background of South Asian women.
Background of the client
Particularly while working with South Asian immigrants, it is important to know the background of the client we work with in order to design culturally-appropriate interventions. As a lot of research has asserted, not all Asians are alike and group differences within Asian groups is often overlooked.
There’s a lot of information and knowledge around Indian groups that tend to be generalized across other communities from South Asia such as those from Pakistan, Sri Lanka, Bangladesh, etc. It is important for counselors to be aware about similarities and differences across these cultures, and create interventions that are more specific to the client’s cultural background.
It is important to check in about how the interventions land with the client. We may use certain strategies from a Western perspective that go into exploring a client’s relationship with her parents or caregivers. This can particularly bring guilt or shame for the client as it may be in conflict with her cultural value of holding respect for her parents.
A lot of the deep respect and regard towards family comes in the form of loyalty and not speaking “ill” about the family with strangers. Reflecting on family, based on Western interventions, can sometimes make it challenging for clients based on their values. Checking in with clients on how these interventions feel, and making space for the guilt and shame to surface can once again help clients to hold value in her own voice.
Examining values and beliefs
Therapy can support South Asian women in differentiating between their own values and society’s expectations. Even though collectivism is a value within South Asian culture, it may not necessarily be an individual value to our clients.
South Asian women very often bear the burden of the value of collectivism where they have to meet family’s expectations, be in touch with other family members and engage in other collective activities. It is an expectation that has been imposed upon them. A therapy space can be a space for clients to explore what their own individual values look like. It can be a space for counselors to collaboratively work with clients in choosing what matters to them, even if what matters to them is to take care of the family.
In this essence, she now has had a voice in choosing how she wants to move forward as v/s feeling stuck in expectations set by others. When the client recognizes that she has a choice in exploring her own values and beliefs, there can be support around how to engage in behaviors that are based in these values. Sue and Sue (2008) has recommended discussion about values, beliefs and behaviors of their family and culture, so that clients can discover those that are for them, those with which they identify and those with which they are ambivalent.
The reason why a South Asian woman may choose to work with a South Asian therapist is to feel understood and not hold the burden of having to explain different cultural norms and expectations. When working with a therapist from a different racial background, clients may feel the need to explain and defend their own culture. It may feel difficult to hear about certain norms being toxic or problematic from someone who doesn’t share the same background as you.
When we as South Asian therapists work with South Asian women clients, we have the unique opportunity to validate the importance/meaning of these cultural norms, as well as challenge its problematic impact on our mental health. We have the context and ability to hold the community and cultural system accountable. It is important to hold the value of one’s desire to have a community and fellowship, as well as hold the impact of this collectivism on the mental health of South Asian women.
It is important to pause and explore: What about the culture feels impactful? How does this impact self-esteem and the way they view the world?
South Asian women are bound by the cultural value of adjustment and acceptance. Accepting our culture the way it is and moving on is what they have been taught to do across generations. The therapy room can be a good space for us to pause and help them choose what aspects of the community are helpful and what feels unacceptable.
This, in turn, can help with increasing their voice and control on their own value system. When they come to you looking for that cultural connection, you can hold space to both empathize with their cultural upbringing and to be able to challenge it. There’s more likelihood that they need it to be challenged and from someone who understands what they are going through.
Mental health in the South Asian community has long been stigmatized, and South Asian individuals who experience psychological issues might feel hesitant to express their concerns due to the shame they may encounter. Nevertheless, while there has been progress made in studying and openly discussing South Asian mental health, several topics remain in need of further examination; these include studying the relationship between mental health and gender, specifically the role of masculinity on mental health outcomes.
What is South Asian masculinity?
Masculinity and mental health have come under greater scrutiny by researchers, particularly as traditional masculinity is often cited as the reason why men are less willing to reach out for support regarding psychological issues. However, the influence of masculine norms on well-being has been insufficiently viewed through an intersectional lens and is understudied within South Asian mental health. From a South Asian context, traditional masculinity can include focusing on material success while displaying suppressed emotionality, which can be manifested through anger or practicing other harmful behaviors.
In order to understand its influence, it is critical to examine the impact of traditional paradigms of masculinity across the diaspora. For instance, some traits associated with traditional masculinity among South Asian men include displaying control over others. A Sri-Lanka-based study found that most male participants “associated manhood with dominance…” A Forbes India article asserted how boys in India are “taught to … apply themselves to the task of growing up to be a strong, unwavering support system for their families,” which in turn forces them to be silent about topics that may make them seem weak. This pattern of behavior becomes manifested in a particularly harmful way because boys grow up with the inability to handle their emotions or formulate healthy coping strategies during challenging circumstances.
These norms can have drastic implications and harm other community members. For instance, a focus group conducted among Nepali men found that failure to deliver for their household economically as breadwinners eventually resulted in heated disputes, which escalated and led them to engage in domestic violence. The presence of domestic violence can also be observed through media stories on the pervasiveness of gender-based harm within South Asian communities, as seen in the murder of Sania Khan.
Traditional masculinity also hides the wounds that South Asian men may be battling within themselves. One paper asserts that for a sizable number of Indian men, “…sadness and despair find a distorted manifestation in destructive behaviors that deny their emotional pain to themselves and to others.” Thus, performing conventionally masculine behaviors can mask deeper mental health issues.
Repercussions of South Asian masculinity on mental health
Because of the pressure to adhere to such strict standards of conduct, traditional masculinity has significant, greater repercussions for mental health and well-being. For instance, because of the narrow ability of men to compartmentalize their feelings, this restrictive emotionality can result in an inability for others to recognize their mental health issues, thus failing to target the deeper causes of men’s behavior. Furthermore, men themselves might engage in fewer help-seeking behaviors. This is also further complicated due to gaps in culturally competent services that can serve South Asian men when they do utilize support systems.
Additional social forces experienced by South Asian men might explain mental health outcomes, particularly when considering the role of immigration. Among South Asian American men in the United States, one study noted that “a lower social position” within their community was linked to higher distress, indicating how critical it was for first-generation men to be leaders and actively participate in their ethnic community’s organizations. Thus, social expectations of men within South Asian communities influenced their well-being, as did their social status and relative power.
What we can do to change the status quo on South Asian masculinity and mental health
In order to ensure that men in South Asian cultures can embrace their mental health, it is important to formulate a prudent, welcoming paradigm that encourages greater help-seeking behaviors. Greater attention to this topic can also contribute to theories on feminist and sociocultural therapeutic frameworks, which both offer the following includes suggested remedies:
Challenging gender stereotypes and encouraging mental health care as a means to discuss issues about well-being
It is imperative to encourage South Asian men to show more emotion, thus changing the existing narrative and social pressure they face to limit the expression of their feelings. Fortunately, there is a platform, known as @BrownManTherapy, that posts content about the struggles South Asian men experience. Furthermore, therapy ought to be recommended as a means to deal with mental health concerns, which should be combined with support from the community.
More South Asian male clinicians
In addition to instituting changes in community norms, there needs to be more diverse representation in the mental health field. In doing so, there will be greater platforms to have conversations about the negative repercussions of traditional masculinity that are unique to South Asian men. Furthermore, it is critical to challenge the social stigma that mental health is a female-dominated profession or that seeking therapy is emasculating.
More research studies examining cross-cultural differences in masculinity across South Asian cultures
The connection between masculinity and mental health ought to be investigated much further. Studies should particularly assess masculinity within non-white contexts in order to examine the standards of manhood across several communities and truly understand the unique stressors men face across different cultural backgrounds.
While the connection between South Asian masculinity and mental health is not discussed among psychology professionals, it is critical to study the association since it plays a role in South Asian gender inequities and in mental health behaviors among South Asian men. More broadly, given the prevalence of intimate partner violence within the Asian American and Pacific Islander communities and the role of patriarchal norms in inflicting this harm, it is now more important than ever to reimagine expectations surrounding men’s behavior.
By further examining the problems caused by adherence to traditionally masculine norms and implementing certain solutions, these ideas can be challenged and dismantled to create a progressive and more inclusive model of manhood. Above all, identifying and eradicating toxic ideas rooted in traditional South Asian masculinity will lead to liberation for all people.