Affordable health care is coming to India (or is the goal)! With the closing of 2018, Prime Minister Narendra Damodardas Modi announced that the Indian government will pay for health care for half a billion of the poorest people in the country. While one of the richest nations in culture and religion, India has also become one of the poorest thanks to colonialism and the disparity created by the shambles they had left behind. As India continues to build itself, less than 100 years after the British rule, the hope is to make sure that everyone, especially the working class, is allowed the most basic of human rights with access to health and hygiene. Raising the quality of life for the poorest will allow India to function at its maximum potential.
In India, affordable health care is a wonderful idea but only if it can come to fruition in the most efficient way possible.
Currently, there are not enough doctors to support the influx of patients in private hospitals which will likely lead to the decrease in the quality of care provided to all patients since, according to the Washington Post, only one out of 1,315 Indians are doctors. Yet, 8,000 hospitals in India have signed up under this plan to take on patients as a part of India’s national health-care plan. Health care for all is a wonderful concept if and only if it is executed on the foundation of a social state, like many European countries that offer this kind of structural health care. At the moment, India has neither the infrastructure nor the stability to handle such a big change in the way health care is taken care of. Modi plans to increase the health-care budget in the Indian government from 4 percent to 11.5 percent allotting $8.3 billion to cover the anticipated costs of “Modicare.”
When asked by experts how Modi plans to help hospitals deal with the new influx of patients he did not offer any real answers, except stating that “the market will take care of that”—as though there has been no thought to how the health industry will handle or even prepare for such a radical change. As of now, this will be anticipated as one of the largest government-funded health-care plans (and considered an experiment by many), but if not executed with proper foresight or radical change, this will be written down as one of the largest failures for social health-care plans. However, if it succeeds, not only will hundreds of millions of people have access to care that they previously could’ve only dreamed of, India will set an example for the world.
February 28, 2023February 28, 2023 4min readBy Sara Qadeer
Hi! I am Sara and I am a mom to a beautiful, neurodivergent child. This piece explores some challenges of parenting an atypical child in a typical world.
It is a sunny day in the summer of 2020 and I am trying to enjoy the only entertainment that has finally been “allowed” by our province. Parks. Sunshine was always free; scarce but free. I have eyes on my daughter, running and somersaulting, with that untethered quality they say she gets from me, while socializing with two girls her age from a distance.
All of a sudden, the distance called ‘social’ gets smaller and as I run and call out in vain my child has the kid in a tight and loving but forbidden hug. I understand that pandemic or no pandemic, physical space is a basic right but for my daughter, it falls under the ‘but why?’ category.
The next 15 minutes are spent apologizing to an exasperated mother asking me why my kid was not taught the dangers of COVID-19 and personal space. She is four, I tell her, she just got excited. At some point, I zone out and just let her say her piece. Some of it is in a language I have never heard before, complete with hand gestures and melodrama as if it was not a preschooler but Bigfoot.
Maybe later I will do the thing we all do; oh, I should have said that. Maybe I won’t. This is not the first time my kid has drawn public attention and it is not the last.
Six months later, we received a diagnosis for Autism Spectrum Disorder (ASD). After the reaction time (read stress eating and ugly crying) ended, we began our journey of raising an atypical child in a world that insists on the typical.
Textbook wise, neurodivergence includes Autism, ADHD, Asperger’s Syndrome, Dyslexia, Dyscalculia, OCD, hyperlexia and Tourette Syndrome.
I could write a book on my journey as a mom raising a child who is neurodivergent (ND). I will in due time and the first chapter would be, “Fighting for inclusion in a world insisting on exclusion.” If you ask any parent with a neurodivergent kid, they will tell you that it is not finances or the fear of the future bringing them down, it is just people. But that’s been the case since the dawn of time anyway.
If you are someone who is kind and inclusive but are confused by the jargon, read on for some guidance that will make you an ever-favorite ally and, well basically, just decent. It is just basic decency after all to be inclusive and kind.
If you have a kid on the spectrum for ASD or ADHD or any other neurodivergence in your social circle, the first step is to not stop being friends with their parents. Yes, that happens. Parents can get super isolated and alienated because their kid is a certain way. Give ND families a chance to breathe. Invite them to BBQs, ask them what their kid will eat, encourage your kids to include them — the whole nine yards.
There will be meltdowns, at birthday parties, at the mall, in restaurants. Sometimes the best thing to do is to look the other way. Ask the right questions. Rather than asking “what happened?” or “why are they doing this?”simply say “how can I help?” Maybe you can help with another sibling or give the child some space.
Do not equate a sensory meltdown or otherwise to a parenting failure or a lack of discipline. ND parents face a lot of judgment on those grounds. That is one of the top reasons they scoop up their kids and leave before dinner is even served.
The biggest challenge in our community is acceptance. There is a dire need to accept that around 30 percent of our population is neurodivergent. This includes adults and undiagnosed individuals. You and I might not even know if we are atypical, the world is just getting to know this word and what it entails. As for the South Asian community, neurodivergence is practically stigmatized and seen as ‘spoilt’ child behavior or ‘mom spending too much time at work, on social media, Netflix, sewing, knitting, kayaking…’ The list goes on.
It is 2022 and we are all trying to make space for people at our tables. This includes people who might not look or act or perceive the world like us. As a parent I have fears that all parents have, but somehow those fears have been heightened to exponential limits ever since my kid’s diagnosis came through.
How is she doing? Did someone bully her? Does she have friends? Is she included in activities? What if she says something silly and they laugh at her? What happens when she is older? Will she go to college? I should not be thinking that. I want to think about how much she is learning at school, what game they played today, what she and her friends talk about and all other typical mom things.
Except I am not a typical mom. And that is okay.
My child has wonder; she has innocence. I see things from her lens and her computation of the world is unique. The biggest misconception people have is of intelligence. A child with autism finds difficulty in processing social cues (like sarcasm) but otherwise they are as smart as you and me, if not more. Probably more.
Some days are hard but not all days are hard, and not every moment of that rough day is difficult. We, parents of ND children, do not keep obsessing over the fact that our kids are atypical; we binge watch the same shows, we have hobbies and interests and date nights and ‘me-time.’ Some days are magical and the most important thing for people to know is that Autism families are not looking for pity parties, just kindness and inclusion with a healthy sprinkle of understanding— an understanding of the atypical in a world only rooting for the typical.
Valentine’s Day is here, and my calendar is fully booked on February 14th. It’s not what you think. My calendar is fully booked with therapy clients who will most definitely be reflecting on their singlehood this year. And so will I. Most of them are just like me — single South Asian Americans, between the ages of 22-40 who come from moderately conservative cultures. The adult children of immigrants, who had arranged marriages, wondering when we will ever find “the one,” and why we won’t settle.
I’m a therapist in therapy, and I’ve had a lot of family trauma and baggage to unpack with my therapist. Through my training and personal therapy journey, I learned to question a lot of the things that I’ve been told about marriage and relationships.
At the same time, it’s not easy. No one wants to be lonely. Brené Brown talks about how detrimental loneliness can be for humans in “Braving the Wilderness.” We all want to belong to someone or something bigger. And there is a difference between being lonely, without intimate companionship, and being alone in our experiences. As we get older, everyone we know in our age group is on a different life trajectory, and we start to feel both alone and lonely.
We straddle the line between two cultures — the one that we were born and raised in, and the one our parents and family tried to teach us. Many of us might live double lives. But being single is not an anomaly. In fact, according to the Pew Research Center, about 31% of adults in America are single. About 32% of American women, between ages 18-29, and 29% of women, 50-64, are single. This means that roughly about a third of American women are single, regardless of age or developmental stage.
Results vary by sexual identity and race. 56% of adults who identify as lesbian, gay, or bisexual, between the ages of 18-29, are single, compared to 29% of their straight counterparts. Black adults are more likely to be single than White or Hispanic adults. However, no statistics included Asian Americans. Some studies show we are more likely to get married due to strong values placed on marriage in Asian cultures, and less likely to get divorced. There is also a huge stigma against divorce. For Asian American women, there is a cultural pressure to not only get married, but stay married.
For many South Asian Americans who are first or second-generation, we have no blueprint for the modern world of dating. A lot of us don’t know what a healthy dating experience, let alone a marriage, is supposed to look like if it is even at all possible. In the South Asian diaspora, marriage is taken very seriously, but counter-intuitively; we are not given the opportunity to spend time on making the decision — we are expected to decide very quickly. For most of us, who are children of immigrants, our parents more than likely had an arranged marriage — that was a decision made by our grandparents, aunts and uncles. And the wedding and engagement happened fairly quickly. That is our blueprint
There are many mixed messages about how to approach marriage and dating. Many of us were told to not start dating until after we graduate from college and get a full-time job, which left a lot of us with very little dating experience, and then, Poof! We’re magically just supposed to settle down. There are many desi people who stay single because they know they have issues to work on. A lot of us are aware of how messages about marriage and dating in our communities are sometimes not realistic, if at times rooted in colorism, internalized colonialism, patriarchal and misogynistic values,and racism.
Dating is uncertain because you can’t control whether or not someone wants to date you, let alone if someone wants a relationship with you. And sometimes that has nothing to do with you and everything to do with that person’s preferences or baggage. But is it possible you have some baggage too?
Staying single because of personal baggage is not uncommon for South Asian American millennials. Because of this, many of us believe that something must be “wrong” with us, especially when people ask why we’re still single and unmarried. While we should address underlying issues for why we’re still single, that doesn’t mean anything is necessarily “wrong” with us.
As a licensed therapist, I see many single South Asians Americans who believe that something must be wrong with them because they’ve never been in a relationship before, or because they’re not in a serious relationship yet. If you’re one of these people, I want you to consider:
Who taught you how to date?
Who taught you how to socialize with other genders?
When were you allowed to date?
How often were you allowed to socialize with other genders?
What is your model of a healthy marriage or relationship?
Who taught you free will and how to exercise choice?
How were affection and romance modeled for you?
When we unpack the answers to these questions, we start to realize that there are actually very good reasons for why we’re still single.
If there are that many South Asian Americans who are afraid of dating because they don’t want to repeat toxic relationship patterns, that means that many of us are…meant for each other. So why can’t we find each other?
Our parents had an easier time finding each other because they lived in a homogenous society. My parents came from a community where everyone was of the same or similar Malayalee-Indian background and the same religion. My parents hope that I can find someone from our culture, but they forget that we live in a heterogeneous society, where finding someone who is South Asian, let alone of our specific culture, background, community, and religion, is few and far between. There is pressure on many South Asian Americans to find someone within their specific communities. Not to mention that meeting someone through a mutual connection doesn’t necessarily mean they’re a good fit for you. It makes it feel like our options are limited.
This creates a ‘scarcity mindset.’ Scarcity mindset is the belief that there aren’t enough resources or opportunities out there. When you feel there aren’t enough singles within your community that you can meet, it can cause you to become hyper-fixated on these limited ‘resources’ and even heighten anxiety. And to some extent, there is some truth to that fear — some of my clients are joining dating apps to meet South Asians out-of-state. As the people around you start to settle down, you might start to feel the pressure of settling down quickly to “catch up.” You may have tried to go on a bunch of dates or entertain the idea of certain people in your community, but they eventually fizzle out, fall flat, or end in rejection. You might start to feel discouraged. This kind of pressure can result in:
Avoiding dating in the culture or dating altogether to prevent being hurt or feeling rejected, or having to confront the social anxieties of meeting new people and being open and vulnerable.
Latching on to the idea of someone we meet, working too hard to impress them early on, and attempting to force chemistry to guarantee an outcome (marriage).
When you feel this kind of pressure, you might underestimate or overestimate how to interact with potential partners. This pressure might come from messages you’ve heard in your community that you’ve internalized. For instance, if you’ve heard someone say, “we don’t get divorced in our culture,” you might start to believe that divorce is the worst possible outcome. That might put pressure on you to find the “perfect” partner in order to prevent divorce, but the future of your marriage is not something that you can guarantee. Another example — if you hear your parents tell you to “just compromise,” you might start to believe that your expectations are not realistic; therefore, that’s why you’re not married or in a relationship yet. You might start to lower your expectations and get attached to any potential partner in the hopes that you can guarantee a relationship, but changing who you are does not necessarily mean you’ll attract what you want.
How we approach dating, especially when under this cultural pressure, can have an impact on how we bond emotionally with people. One theory based on psychological research, called Attachment Theory and Styles, describes patterns of how we create and maintain emotional bonds with others and where we fall on the attachment style spectrum or circle. Cultural pressure to settle down and marry someone from your specific culture or community can influence how we date and why, but it prevents us from being mindful and enjoying the process of dating. Your attachment style might be the result of your family dynamics, your parents’ style of emotional connection, and cultural messages you’ve been taught about what a relationship or marriage “should” be like. For example, if you’re under cultural pressure to get married quickly to appease your family, you might develop an anxious attachment style because it triggers thoughts and behaviors that fall under that category. If you question the cultural pressure, you might associate marriage with negative connotations. You might push away dating and marriage and act in the way of an avoidant attachment. Your attachment style is not genetic or something you are born with. It is a pattern of behavior that is about how you relate with others, especially in relationships. It can change over time and vary based on your anxiety or the person you’re seeing. If you want to learn more about attachment style, seeking a therapist is a good resource.
Regardless of what your attachment style is, it can prevent you from being patient, truly vulnerable, and having quality dates or quality relationships. It might keep you in unhealthy dating situations or relationships too long out of fear that you won’t find anyone else “in time.” You might be jumping to conclusions about what should happen next when you date someone. When you really like someone, you might be asking, “What if things go wrong?” But what if things go right?
Valentine’s Day has never been something special for me, and while it would be nice to be in a relationship, I’m not going to let the cultural pressure of what I’m “supposed” to do, as a South Asian American single woman, dictate my life. I have my reasons for being single, and it’s no one’s business but mine (and my therapist’s). If someone in my family or my culture doesn’t approve of my singlehood, then I sincerely hope they’re awake at night thinking about why I’m single. What they think of my life is none of my business. At the same time, I’m not going to shut myself off completely from dating and relationships. Dating will be on my terms. While rejection hurts, I have accepted that people will come and go and I wouldn’t want someone to feel forced or obligated to stay with me if they have emotionally left the relationship. Ultimately, I’m looking for someone who will fit the lifestyle I already have, but if I don’t find my life partner, I’m okay being with myself too.
You don’t have to follow your parents’ blueprint to marriage and relationships. You’re allowed to follow your own. If we adopt an abundance mindset, a mindset of knowing that there are enough resources for everyone and accepting what resources are available to us — along with practicing healthy relationship habits — we might develop better, more satisfying relationships. There are enough single South Asian Americans out there who would love to be with you. Stand firm in who you are and what you want, and be open to what comes your way.
The Covid-19 pandemic and feelings of uncertainty, which have been prevalent across the globe, had lasting effects on all of us. One of the more positive impacts has been on the mental health industry, particularly the normalization of mental health challenges and a more open dialogue about mental health. There have been discussions in the workplace, in schools, and even on Hinge profiles, but what about in South Asian communities? Though some progress has been made, mental health stigma is still widely prevalent among South Asians, impacting individuals’ desire and comfort in seeking help. As a result, the South Asian community reports lower rates of seeking mental health services. And of the individuals who do seek out mental health services, many face challenges in finding therapists who are equipped with a multiculturally competent skill set to understand the South Asian client’s concerns. This is why it’s important to recognize and become aware of the intersections of mental health and South Asian communities.
Although there is an overlap between the mental health concerns of South Asians and other communities of color, there are also unique intersections between culture and mental healththat I want to bring to the forefront of this conversation. As a South Asian psychologist, who is both a researcher and clinician, I have firsthand experience examining how our individual cultural context impacts our emotional experience. If we can understand, or at least consider, how the cultural context impacts us, we can better understand ourselves and feel seen by others too. We, South Asians, are a diverse group in terms of ethnicity, language, food, religion, traditions, and so much more. So, while learning about the “state of mental health in South Asian communities” is much more complex and nuanced than what I can cover in just one editorial, I believe starting the conversation about issues that don’t get talked about nearly enough is an important first step towards destigmatization.
What is the state of mental health in the South Asian community?
Here are some numbers to set the stage, based on research done on South Asian communities. One in 5 South Asians currently reports experiencing mood or anxiety disorders. South Asian youth and young women, in particular, are at greater risk of having suicidal thoughts and behaviors compared to other groups. Only 24 percent of South Asians diagnosed with a substance abuse problem sought treatment. And South Asian Americans express greater stigma toward mental illness than other ethnic groups. How often are facts like these discussed? Not often. Since South Asians are often mixed in with the larger Asian American population, these issues and their nuances are rarely discussed within mental health communities. This underrepresentation can make the reality of our emotional experiences easily misunderstood and make our needs feel invisible. Relatedly, concepts like “model minority” lead outsiders to often assume that South Asians are well-adjusted. And even within the South Asian community, stigma and beliefs about the causes of mental health issues (e.g., mental illness indicates problems within the family, a sign of weakness, etc.) lead all these facts to continue being ignored.
How do mental health concerns intersect with South Asian culture?
While mental health concerns are prevalent among my clients from all backgrounds, these common concerns intersect with culture to create an individualized version of the issue that requires specialized attention and care.
Substance abuse
Within the South Asian community, there are cultural differences in alcohol and drug use and the discussion of these topics. Alcohol is prohibited in Muslim and Jain faiths which makes open dialogue about substance abuse and its prevalence even more of a challenge within these communities. Admitting you have a problem can be hard and adding the cultural taboo can make it more difficult.
Career stress
There is a tendency in the South Asian community to highlight that only linear careers in financially stable or ‘reputable’ fields — such as medicine, engineering or finance — will lead to success. This expectation not only impacts career decisions but also mental health, self-esteem, and self-confidence. Even if we think we are not influenced by outside factors in our career choices, how do we know that subconscious messaging is not impacting our decisions? I personally was pre-med for as long as I can remember and was apprehensive if my parents were going to accept my desire to go into psychology and mental health instead of medicine.
Caretaker stress
Caring for loved ones, who are aging or ill, is emotionally challenging for most people. What makes this stress unique for the South Asian community? South Asian communities are collectivistic and therefore rely strongly on interdependence well into adulthood. Therefore, caretaking and providing for elders is an integrated part of our lifestyles. Pursuing personal goals can sometimes be seen as selfish and therefore South Asians feel the need to sacrifice personal desires. This can make setting boundaries in relationships or making decisions focused on one’s own needs especially difficult and not as straightforward as may be suggested by Western psychotherapy interventions.
Relationship stress
Romantic relationships can be especially stressful for South Asians because of the need to navigate between one’s own desires and family expectations. Older generations pass down messages that people should focus on their careers instead of dating, which can lead to not dating or secret dating and youth navigating romantic relationships on their own. Then, suddenly, the conversation shifts to the need to get married by a certain age, which seems especially difficult when you have not been allowed to date or when it is not something you want in your 20s. South Asians may also experience family expectations about their partner being from the same ethnic/religious background, working in a specific industry, or having a specific family background. These family or cultural expectations and issues also impact the LGBTQI+ South Asian community and South Asians often feel the need to sacrifice personal desires for the expectations that their families or deep-rooted social norms have set for them.
Emotional Awareness
Being able to communicate the complexity of our emotional experience is especially challenging when being emotional is considered a weakness. This cultural sentiment further perpetuates emotional suppression and increases the barrier to seeking support. Also, South Asian languages have limited vocabulary to describe mental health and the emotions involved. It is not only challenging to identify our emotions, but it is difficult to communicate the complexity due to the lack of words in South Asian languages to describe those emotions. Let’s take the word, “gussa,” which means “angry” in Hindi. The only way to explain the level of anger you are feeling is to describe the full situation. While in English, you can use variations of the word “anger,” such as “annoyed” or “furious” to describe the emotions with more nuance.
Body image
Culture is integrated in small and big ways into how South Asians experience their body. It can be common for family members, especially older women or “aunties,” to comment on one’s body weight in direct ways like telling someone they have gotten fat or thin. There are also unspoken rules about food that impact one’s relationship with food and potentially overeating, including “it is rude to not finish all the food on your plate,” or if you don’t go up for seconds that means you didn’t like the food. Research has also found South Asian women in particular often struggle with the pressure to conform to Western beauty norms (e.g. removing dark hair, and lightening skin color).
Identity development
We all are constantly evolving and understanding who we are and what we value. What makes this unique for South Asians? Culture intersects with other parts of our identity, including generational status (1st, 2nd, or 3+ generation), religious beliefs, gender identity, and age which impact the way we make sense of who we are. Being born in the US makes one American, but are you still American if you primarily connect with your South Asian ethnic identity or maybe your religious identity? Or what messages does culture pass down about what it means to be female? Are you supposed to do all the cooking and cleaning? Do you have to have children? Culture intersects with identity development in complex ways.
How can you get support with what you may be feeling and experiencing?
I believe the first step in breaking the barriers, is shifting your mindset about seeking mental health support from something that means you have a “character flaw” to something that you do for your overall well-being. Taking care of your emotions and processing your emotional experiences is as important as your weekly workouts, annual physicals, or that apple a day. One way to start this process on your own is to spend 10 minutes a day engaging in mental hygiene practices (meditation, gratitude journal, positive experience journaling, writing a thought log, prayer, or deliberate time in nature).
Alternatively, if you feel ready and have the means, try searching for a mental healthcare provider who actually understands and is aware of your cultural background and belief system. As we think of all the ways mental health can intersect with cultural context, it is helpful when your provider can hold cultural identity as being critical to your treatment. There is a clear and urgent need for therapists and interventions that use culturally-relevant treatments to drive clinical outcomes. One such resource is Anise Health, which is the first culturally-responsive digital mental health platform built by and for the Asian American community. Anise Health, co-founded by Nisha Desai and Alice Zhang, incorporates culture and intersectionality into clinician training and offers a wide range of evidence-based online services (therapy, coaching, self-guided resources) that are tailored to meet your unique needs.
If any of the concerns I discussed earlier resonated with you, consider signing up for Anise Health by filling out this short intake form; you’ll get matched to a culturally-responsive clinician within two business days. I’ve also listed a few additional resources below that aim to address mental health needs in South Asian communities.
I hope we can continue to bring the ways our South Asian culture impacts our well-being into the forefront of the conversation around mental health. By highlighting the South Asian community’s experiences,we can feel more seen and create a more accepting environment that allows us to get the help that we all deserve.
If you or someone you know is in an emergency, call The National Suicide Prevention Lifeline at 800-273-TALK (8255) or call 911 immediately.
