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.
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.
February 7, 2023February 7, 2023 4min readBy Sneha Challa
Photo credit: @golibtolibov
In July 2022, Sania Khan’s life was ruthlessly taken from her by her ex-husband. Sania was a young, vibrant South Asian woman – a creator and photographer who had the courage to step out of an abusive marriage, even in the face of community norms that discourage women from speaking out. While this tragedy seemed to stir a consciousness in the South Asian diaspora that we can no longer justify the status quo, it is far from the only such incident. Just months later in December of 2022, Harpreet Kaur Gill was stabbed to death by her husband in Vancouver. While the most extreme cases like those of Sania Khan and Harpreet Kaur Gill are highlighted by mainstream media, a small body of research provides evidence that intimate partner violence experiences are equally, if not more, prevalent in South Asian communities than the general population in the US or Canada. That’s why we need to do more as a community and throw light South Asians and intimate partner violence.
Despite the identification and investigation of these norms in South Asia, there’s so much we still don’t know about diaspora communities, especially in relation to South Asians and intimate partner violence. In the US, South Asians have become one of the fastest-growing populations, but we remain unaware of how the stresses of raising a family in a different culture, and the weight of growing up between two worlds, affect these norms, expectations, and experiences among South Asian immigrants, the second generation and beyond.
In this article, we’ll take a deeper look at how these norms are enacted to influence intimate relationship dynamics, discuss the recent rise in intimate partner violence, and explore the work that researchers, policymakers, and program implementers can do to address violence in South Asian diaspora communities.
Social Norms and Violence in South Asian Diaspora Communities
Why does it take catastrophic events to serve as a call to action? For one, the “model minority myth” continues to portray South Asians in America (who originate from Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka) as a healthy and wealthy group. As a child of Indian immigrants, I always thought this was just a frustrating trope that lived rent-free in my head next to the eternal question, “Log kya kahenge?” (What will people say?) However, I have realized that this constant worry is not just an innocent preoccupation. It’s the result of a dangerous spiral beginning with the portrayal of South Asians as a model minority and the need to maintain that well-to-do image. This only reinforces the traditional gender norms that overlook men’s perpetration of violence and encourage women’s silence, crippling any efforts to understand the scope of the problem and draw attention and resources to address it.
The Impacts of COVID-19 on Intimate Partner Violence
Prior to the start of the COVID-19 pandemic, the frequently-uttered phrase among researchers, practitioners, and advocates alike was “one in three” — one in three women ages 15-49 experiences physical and/or sexual violence inflicted by an intimate partner in their lifetime. Under the cover of the COVID-19 pandemic however, rates of violence against women rose dramatically, prompting UN Women to call for recognition of this “Shadow Pandemic.” During the height of the pandemic, the social isolation that came with lockdowns and quarantine procedures to curb the spread of disease made home a more dangerous place for an increasing number of women. As communities seek to rebuild, the inequities in access to and use of potentially lifesaving services have deepened. Now more than ever, it is critical that we shine a light on the many intersections of our society to prevent South Asian women’s experiences of intimate partner violence from being pushed even further into the shadows.
First and foremost, to better understand South Asians and intimate partner violence, we need better data disaggregated by racial/ethnic group. Since the 1980 Census, only those of Indian origin have had a fill-in bubble.All other South Asian groups have to write something in, decreasing their participation. South Asian communities in the US are not a monolith and they are certainly not all of Indian origin. This perception, fed by our lack of data, likely privileges the Indian community in America and limits the visibility of other South Asian communities.
More accurate information will help us better understand where the need is greatest. We can make a stronger case for more equitable resource allocation, improve South Asian language materials for survivors, and enhance provider training programs, accounting for the specific cultural implications of disclosing and seeking treatment for violence in South Asian communities. Public health researchers should increase efforts to understand the prevalence of experiences of violence, the environmental factors that make South Asian women in America vulnerable to experiences of intimate partner violence, and how it impacts their health.
While outstanding organizations such as Narika in California and Sakhi in New York are leading the charge in raising awareness, running active helplines, and providing support, they cannot be the sole safe space for survivors. While the system’s failure to protect Sania is not an isolated incident, it has served as a wake-up call.
All South Asian women in America should be able to be healthy and safe and lead lives free from violence, coercion, or abandonment. To achieve this, we need better data, more research, culturally-tailored resources, and appropriate legislative action that will allow for prevention, screening, and treatment efforts to finally take root.
May is an important month for mothers around the world as we get to celebrate motherhood for Mother’s Day and support mental health for Mental Health Awareness Month. It is also a month in which a week is dedicated to honour maternal mental health before, after and during pregnancy. To honour this beautiful month, I would like to explore motherhood as I have experienced it as an South Asian, immigrant mom — the magic, the struggles, the mental health challenges, the community expectations — and share how I have reached the most comfortable, confident version of myself as a mother.
12 years ago, on a very hot, humid August morning, after going through a few years of unexplained infertility and then finally getting pregnant, I was rushed for an emergency C-section and my tiny, but very feisty, daughter was handed to me. As I held her in a severely drugged-up state, very much disappointed in my body’s failure to deliver naturally, I felt a rush of the most beautiful, gut-wrenching, fierce, protective love I had ever experienced. In the hours following her birth, I also experienced major confusion and anxiety every time she cried endlessly; I didn’t know how to soothe her.
I grew up listening to my mom, grandmothers and aunts talk about the beauty and miracle of motherhood, but no one ever talked about the extreme sleep deprivation, the mental and emotional breakdowns and the sheer physical exhaustion. I had seen most moms in my very traditional, Pakistani family, sacrificing their own needs for the comfort of their children. In fact often, I would be confused at how proud my grandmothers were for sacrificing their health and mental peace to raise their families.
After moving to Canada I repeatedly witnessed the same thought and behavior patterns in other South Asian maternal figures. I’ve come to the conclusion that this is a cultural thing, especially among the older generation! They love to talk about the beauty and magic of motherhood and glorify the rough parts of this journey with a kind of toxic positivity. South Asian women, I find, generally don’t like to discuss the struggles, the vulnerability and the mental load of motherhood. Yes, motherhood is magical, beautiful and one of the biggest blessings but also it might probably be the most difficult thing you will ever do! In retrospect I do feel, had I heard healthy discussions about the mental and emotional challenges of motherhood, along with its privilege and beauty, I would have been much more prepared for this magical, roller coaster journey!
The mental health challenges, the invisible load of motherhood, the continuous mom guilt, the overwhelm, the self doubts, I experienced all of these during the happiest time of my life. And I felt extremely guilty for having these feelings! Was I not supposed to have that ethereal new mama glow and calmly enjoy this new phase with ease and joy? My overwhelm and anxiety as I protectively held my five-pound, feisty baby girl just felt wrong! It made me doubt myself as a mother.
As an immigrant mother, one of the hardest things I have had to do is to break away from, and unlearn, so many culturally-acquired behavior patterns and expectations. It is so important to acknowledge the fact that mamas need to be vigilant about and take care of their emotional and mental health in order to be fully intentional and engaged in raising their children and taking care of their families. Thankfully, the thought patterns are evolving and finally the South Asian community has started having discussions about mothers’ mental health issues and acknowledge that motherhood, though absolutely precious, is exhausting, rough and can sometimes leave one questioning their sanity.
After the initial years of motherhood, I started researching and reading on mental health and South Asian behaviour patterns. My observation and research has led me to a point in time where I can proudly say that I am the most comfortable I have ever been in raising my children. I have come to the realization that this will be the most fulfilling, but also the most daunting and exhausting thing that I will ever do. I have also come to a very solid conclusion, the better my headspace and mental health is, the better I will be at being the best version of myself for my children. I really want my children to see me making my mental health a priority so that they learn that their mental health is also as sacred as their physical health.
Once I realized how pivotal my own mental health was for my family’s wellbeing, I became more mindful about prioritizing my mental health. These 10 mantras have really helped make a difference in my mental health:
It is not normal to feel excessively overwhelmed and anxious all the time just because you are a mom. Reaching out for help is not a sign of weakness. Talking to your doctor about your sense of overwhelm is a great place to start. Accepting medical intervention (meds) and therapy are an important part of my parenting journey; they do not make you a weak or bad mother in any way. Rather it makes you a braver, better parent!
Motherhood is not always glorious and rosy as most of us have been made to believe. Like any other relationship, it will also have its ebb and flow. It will sometimes be chaotic, messy and hard and that is ok!
They say, it takes a village to raise a child and that is so true! In case of immigrant families, a lot of times their village is far across the oceans so what do you do. You mindfully try seeking out a village of like-minded families/people that share similar values and beliefs as your own. And then you help each other out. In other words, when offered, graciously accept help from that elderly neighbour, a family friend or a distant relative. They probably have gone through this busy season themselves and realize how exhausting and isolating it sometimes can be.
In today’s world, many of our decisions are driven by our favourite influencers, mom bloggers and social media personalities. Majority of them curate content that just spells perfection and beauty! From a beautifully arranged, tidy house, to an impeccably put together, happy mama serving fresh, organic meals in her tastefully-decorated, minimalistic kitchen; we know very well that social media can be unrealistic and shows only the beautiful parts of the journey. Yet most of us feel this immense pressure to be perfect and be the providers of the absolute best for our children. Honestly, in my experience, motherhood became so much easier, smoother and calmer once I let go of my exhausting efforts to be the perfect mother! Once I accepted that there is no such thing as a perfect mother — only a mama who loves her children like crazy — I felt at peace and became way less anxious.
Most South Asian cultures measure the worth of a woman by her marital status and later by the success of her children. In the first few years of being a mom, I enrolled my tiny humans in as many different activities as I could in dreams of future success in education and careers. I was always running around planning things for them to do. The result was an extremely burnt-out mama with overwhelmed kids in tow. It has been quite a journey to learn that children will be at their happiest with simple routines and happy experiences. You DO NOT need to lug your family to fancy, expensive activities in order to prove your worth as a good parent! Children will remember simple, happy experiences where they can connect and spend time with their loved ones. A simple picnic in the park on a beautiful day, feeding the ducks at the local pond, visiting the farmers’ market, going to the beach on a hot day, camping trips with other families, these are some things my kids consistently recall happily from their tiny human days.
Connecting with other moms going through a similar situation will make your journey less isolating, less intimidating and so much calmer. Culture tells mothers to be resilient and unwavering, and not share their vulnerability with others. That can be very isolating! After a rough night with a teething baby and a clingy toddler, nothing feels better than having a quick cup of chai over a phone call with another sleep-deprived, tired mama!
Mamas, you are being so generous and giving to everyone around you. Be kind to yourself too! Indulge in self care and take out time to do little things that bring you peace and joy. It could be a lunch date with a friend, getting nails done, doing a yoga class, taking a walk by yourself, listening to a podcast or going out for a movie. Remember your children are observing you all the time and will learn emotional regulation and self care by watching you do it.
Mom guilt is real and can be devastating for one’s mental health. Know that you are only human and the only way to learn about motherhood is by actually going through it. You will make mistakes and it is okay! Give yourself extra love and grace on those hard days. As long as our children see us apologizing, being respectful and loving and trying to be a better parent, it’s all good.
Taking care of one’s physical health will always help in achieving better mental health. Eating well, staying hydrated, learning some breathing techniques, moving one’s body, all these help so much when the days seem long and never-ending.
Motherhood, specially in the initial years will be physically exhausting. If you are like me, maybe you have also thrown your babies at your spouse as soon as he walks into the house and escaped to the washroom for a mommy time out! It is probably the busiest season of life for both you and your spouse and might leave both of you angry with and snapping at each other. Try to find little pockets of time when you and your partner can reconnect, away from the beautiful chaos of the tiny people you have created together. Something as simple as having a takeout meal together after kids’ bedtime can feel heavenly and therapeutic and recharge both of you for the day ahead.
So moms, I urge you to let go of overthinking, enjoy the present moment, go with the flow and savour the messy as well as the beautiful, uplifting parts of your journey. Cherish and protect your own mental health, reach out for help and support if the journey gets too isolating and overwhelming. For your children, will grow up seeing the beauty and wonder around them through the eyes of the most important person in their lives — their mom.
