Join me on this journey of re-constructing my Pakistani upbringing, where shame and guilt are used as gatekeepers to prevent family issues from seeping through the walls and into the public sphere and what it’s like to lose a parent to mental illness.
I am rebelling and I’m glad you’re here, rebelling with me.
Post-natal depression and psychosis were foreign terms in 1997, especially in Lahore, Pakistan. However, there is much conversation around the ‘baby blues’ in today’s world and is a fast-growing issue among South Asian Women compared to White British females due to relationship difficulties, financial difficulties, lack of social support and language barriers (Sihre HK, Gill P, Lindenmeyer A; et al, 2019).
Early Loss
I don’t remember much of my early years living in Pakistan. My brother and I were passed around from relative to relative after my mum could no longer look after us. During this time, my dad was working in England to make money to send back for our care. We soon joined him, when I was 6 after he remarried. I was always curious about my mum and what had happened to her. But it took me until I was 10 to be able to ask my dad, “why was mum unable to look after us?”
My mum was someone I spoke to on the phone once a year. Dad would buy a calling card to make international calls to Pakistan and we were told to speak to our mum. My brother distanced himself and avoided these calls. I followed in his footsteps, not because I didn’t want to speak to her, but because I felt guilty for wanting to know my birth mum when we now had a new (step) mum. The calls lasted five minutes asking how the other was, what was eaten in the day, and then complete silence until my dad took the phone realizing there was nothing else to say.
I was 11 when I found out that my mum had Postnatal Schizophrenia. I did what any other child would do. I dove into the internet. I read the words, ‘dangerous,’ ‘psychotic,’ and ‘violent.’ I was confused. I was frustrated because I couldn’t recall anything about her. But when you’re young, you also feel anything is possible. So I detached myself from those labels and refused to define my mum as any of those things. I would spend hours on the internet searching for treatments for her, aspiring to one day maybe treat her myself. Any ounce of hope that came my way, I took it. At the time, I never shared these thoughts with anyone. I cleared the browser history so my parents wouldn’t know. While my thoughts would fester from “will I be safe around my own mum?” to “what if one day I wake up and she is no longer in this world?” Despite being the quiet girl on the outside, my inner- world always felt so loud.
I look back and imagine how difficult it must have been for my dad, who is a quiet man too, to navigate how to talk about something like mental health with his children. Especially since issues like this are taboo and often ignored in the society in which he grew up. If I could go back, I would ask him more about the diagnosis. The only thing that stopped me was the discomfort of having him recall something he had never spoken about. I would shy away and rarely challenge these unspoken themes because it simply felt wrong. Nevertheless, finding out about my mum’s diagnosis at that moment secured my passion to help others with mental health difficulties.
Before I knew it, I was already internalizing the emotions I felt towards my mum and the mother’s wound was exposed for everyone to see. Bowlby’s Attachment Theory states that children with inconsistent parenting are vulnerable to experiencing anxious attachments. This is when parents are inconsistent in meeting their child’s emotional and physical needs, and the child becomes more likely to be afraid of abandonment. I read this at the age of sixteen and it provided the most insight I’d ever had in my life towards an explanation of why I also felt that way. I learned from rumors and gossip that my mum was unable to look after me, didn’t attend to my basic needs, and at one point had felt afraid she would harm both me and my brother. Attachment styles also show up in adulthood. My past relationships would have me feeling like I was on an emotional rollercoaster, constantly worried about being abandoned and looking for that reassurance.
From the beginning, my dad and my mum (step-mum) would often look at me as if I were different like I was living in the shadow of my mum’s mental health. I spent hours isolated in my room and lost in my thoughts. From a young age, it had been implied that I would end up like my mum. Relatives would belittle me for staying within the four walls of my room and say, “your mother was also like this when she was becoming unwell. You don’t want to end up like her. We don’t want to see a repeat of what happened to your mother.” This allowed my unhealthy behaviors to manifest and start to define me.
When I was twelve I met my mum after 9 years. She lived with her older sister in Pakistan, who looked after her. Tears streamed down her face — I wondered whether a hug would be appropriate for my own mum, there was so much distance between us, even though she was right in front of me. During my time with her, I grew to learn about her silence, her depressed composure, and the hours she spent in bed becoming thin to the bone. I didn’t understand much of what was going on with her at that time and was experiencing mental health difficulties myself. I was told how she would support my auntie in looking after my younger cousins and I wondered “why not me, then?”
I didn’t see her again until I was 18. As a young adult, my understanding of mental health developed more. This time, seeing her was different. I was proactive in my interaction with her and supported her in simple day-to-day things such as having a shower or eating. I remember spending two hours trying to get her out of bed to freshen up — slowly comprehending the role switch between us, she was now the infant and I the mother. At first, I felt empowered, but when the lights went out, I escaped to the rooftop, feeling more alone as I came to know who my mother was. I can sense the heaviness I felt in those moments as I recall this. Little to my awareness, my fight and flight mode was activated, and I was disconnected from myself and the world around me.
Now I’m 24 and we talk weekly. Our conversations last up to 20 minutes on days she is willing to speak. To this day, I sometimes feel haunted that I am unable to remember any memories of my mum from my early years.
I write this contemplating the expectation that I might need to take care of my mum one day. Some days, this can be a difficult thought, because I think of how little I know this person despite my many attempts. I’ve been told how my mum was lively, sporty, and wrote poetry like me. It has taken me time to accept that this person was someone before she became unwell. While I did not know her, I grieved at the idea of her. I wonder if this makes me a bad person. I went through emotions of denial when I tried to develop a relationship with my mum and became angry when she would not open up. I thought encouraging her to speak about her emotions would allow her to be seen and heard, but I was a stranger. How could she open up to me? Eventually, I buried my hopes of one day having that mother-daughter relationship I had always wished for
A part of me felt guilty but through therapy, I’ve been coming to peace with the idea. I received school counseling at school when I was 12 which I found helpful. Another secret I hid from my parents. Though in those sessions, I was selective about what I shared because being the only Brown girl in an all-White school – there were things they would never understand. Following those years, I was in and out of therapy, meeting the next therapist with open arms, but still finding myself holding back. Until I finished university and realised how much of my childhood trauma was leaking into my adult life. I knew I needed help. It just took making that one decision that felt right. This time I didn’t just find any therapist, I found a South Asian therapist. Someone who would understand intergenerational patterns and Pakistani family traditions.
https://browngirlmagazine.com/mental-health-balance-south-asian-millennial/Before this, I had become quite disconnected from my ethnic and cultural identity. But I was willing to accept this and make a change. I refused to allow my upbringing to be my only perception of mental health difficulties in a Pakistani household. Therapy has truly taught me a lot and continues to do so even now. I shared my entire story in my first session and over time we revisited each segment of it when I was ready and spoke about it. I knew about attachment difficulties as mentioned earlier, but I didn’t know the severity at which they manifested in my everyday life. I increased my awareness of my emotional responses and how to nurse my mother’s wound. Though the most important thing I learned was about how trauma lives in the body. All those early years I had forgotten with my mum and those feelings of unsafety were no longer memories, but bodily responses. My feelings of anxiety were just one part of the story. On finding this out, I began to allow myself to feel what I feel (including the discomfort I avoided), speak my truth and think what I want — in hopes that I will, one day, shorten the distance between us.
I have learned so many things through this journey, but most importantly, I’ve learned the value of having difficult conversations. In South Asian culture we are so used to keeping our feelings and thoughts quiet. But, talking can make all the difference. It was revolutionary when I began to ask my dad questions about my mum. He had experienced his own trauma being an immigrant to a new country, trying to create a home for his children whilst his wife was unwell. He had made his own sacrifices as he knew my mum could no longer look after us and left my brother and me in the care of his sister. Only to then work long hours in a new country alone so that he would have enough money to bring his children back home to him. It was revolutionary, because as introverted as he was, he began to articulate his feelings about these difficulties. It was revolutionary when I showed that I was not going to be defined by the anxiety I experienced, but instead, I would be defined by my resilience. Most importantly, it was revolutionary when my story became my strength and not a vulnerability. I hope that in sharing this very story, I have shone the light on others who are unable to find hope in their own journeys.
If you or somebody you know needs someone to talk to, below are some helplines to contact:
In the UK:
Samaritans: To speak to someone, call116 123. This is open 24 hours a day, 365 days. You can also email jo@samaritans.org.
Shout: Text SHOUT to 85258 or YM if you are under 19.
Childline: If you are under 19, you can also call 0800 1111.
Papyrus: 0800 068 41 41 Monday to Friday 10 a.m. to 10 p.m. Weekends 2 p.m. to 10 p.m.. Bank Holidays 2 p.m. to 5 p.m. Text 07786209697. Email pat@papyrus-uk.org.
If you are unable to contact the helpline, contact your local GP for an urgent appointment or call 111.
If you or somebody you know is experiencing a mental health emergency, call 999.
July 7, 2023September 10, 2023 11min readBy Ushma Shah
BGM literary editor Nimarta Narang is honored to work with author Ushma Shah in this utterly creative and novel, pun not intended, story about a young woman who has just moved to the United States with her husband, and her trusted diary. Ushma is a short story writer and an aspiring novelist. She has her short stories published in a few anthologies and online literary magazines like Kitaab and The Chakkar. She was born in Mumbai and raised in Mumbai and Cochin. She has an MBA and works in the corporate world. Work and life have given her the opportunity to live in multiple cities in India. She currently resides in Seattle and goes by the handle @penthythoughts on Instagram.
She is the kind of person who doesn’t like to go into stores without a purpose. But she sometimes does. And that’s how she becomes a hoarder. She also prefers only tried and tested places. The kind where she doesn’t have to go out empty-handed. The urge to not disappoint people is strong. So she ends up buying useless things. Like a snow globe with a turnkey. Or 12. She loves the tiny magical people and animals in it. Rotating. Glowing. Musical. But I am deviating from the point. Who am I, you ask? I am her. A piece of her. She takes me everywhere. Writes down her thoughts in me. Writes how her day was. That’s why I know her so well. Why am I telling you all this? Because she hasn’t written for a week now. Longest she has gone in half a decade. I don’t understand it. She won’t tell me anything anymore and I am just so curious. No, curious is the wrong word. The intensity is just not right. I am impatient. Restless. Maybe even hurt, too? I see what she does. How she looks. But that’s just not enough. Not for me. Her confidante for five years and suddenly it’s all poof.
Human addiction is a true addiction. I was superior for those glorious thoughts that nobody knew about her. She doesn’t look happy. She opens and shuts me, picks me up and then back down. In her new Michael Kors bag she bought recently at a premium outlet mall. She always wanted to see a new country. 32-years-old and she had never visited any country other than the one she was born in — India. She should be happy she is finally here. She couldn’t stop chirping about it when they got their visas approved. She and her husband. She has been here for three months now. Initially, she was happy. But then the euphoria died down and anxiety kicked in. The last thing she wrote was: “I haven’t had a bath for a week now.” Her husband is too busy with work to notice. The new project takes up most of his time. Plus navigating life in a new country is a project in itself. I hear him not understanding why an appointment is required for a self-guided tour of the apartments. And that they have appointments only till 5 p.m. which means they have to go house hunting during his office hours. Downtown Bellevue mostly has apartments for rent that are managed by corporations rather than individuals. But at least he is okay with the cold, having survived Delhi weather all throughout his life. It also doesn’t help that she is not used to the cold, having lived in Mumbai all her life. It only needed to turn 22 degrees Celsius in Mumbai when she used to set off; removing her sweaters and jackets from the untouched-for-a-year cupboard. So house hunting is a major bummer, painstaking process even for her. In a place where it always drizzles but doesn’t bring the smell of wet mud. Everything around her is concrete. Asphalt. Sterile.
One day on their way back, they visited the Meydenbauer Beach Park along Lake Washington. I saw a hint of a smile. The first one in a week. The pine trees are a solace. They stand strong, holding their ground at maybe a 100 feet. She cranes her neck back and tries to catch a look at the tip. Making her feel dizzy. She feels like she is falling back. Tilting her five feet frame. She removes her feet from the shoes. She looks at the rounded stones. Big stones. The size of an ottoman big enough to comfortably sit on but hard enough to not sit for long.
But by the end of the visit, she looked worse. That night she wrote and I was thankful for the visit. The first sentence read: I feel claustrophobic. She has lived in Mumbai all her life and never knew that subconsciously the sea made such a big impact on her psyche. The sea, unending in its view. Its waves crashing and rebelling against the rocks gave her a sense of space even though she lived in a one-room kitchen apartment. The warmth. She missed the warmth, although sometimes too stifling. The sweat, and the saltwater smell. There was much to be thankful for here in Bellevue, even though there were no crashing waves and it was 45 degrees Fahrenheit today. The sand, too cold. But there was peace, there was calm. But what about the sounds that she craved, the feeling that stimulated her senses? That accompanied her every morning: the ‘tring tring’ of the cycles, the ‘tip tip’ of the water overflowing from the tank after it was filled. The daily TV news her Ma watched. The smell of her morning chai with grated ginger. The ting ting of her small bell during pooja. These are the things that she does not write but I know her. I know how to read between the lines.
But somewhere I have failed her. I must have. If she did not find comfort in writing. For how could she have gone on without it for a week? How could she? She is as used to me as I am to her. Or at least I thought that.
But now is not the time to feel irritated. She has started writing again. I was overjoyed; I thought everything would be back to normal now. How naive was I? A few lines in, and I am worried. I am also worried that my annoyance will seep through the pages and into her hands. She writes: I miss my place where the duration of the days and nights are almost the same throughout the year. A place where I don’t have to see a 4:30 pm sunset. Or a sunrise after 7:30 am. Nobody prepared me for less than 10 hours of daytime. I feel like I took the sun for granted. When I first came here in October, the sun set at around 7 p.m. Every day, the sun set a little early from then on. 6:50, 6:43, 6:22, 6 p.m., 5:54 p.m. And then on November 6 came the thing I was least prepared for. The Daylight Savings. I would gain an hour, they said! What I gained was a sense of doom. Because the clocks were set back by an hour, the sun set before 5 p.m. every day from then on.
The seasons are what make me. Why then, am I afraid of the seasons? No matter what the weather, the weather is constant. It is constantly too hot, or too cold or just not warm enough or just not cool enough. Every day in itself brings a new season.
“Oh, there is a heavy rain forecast for the whole day today.”
“Do you know it’s going to snow today?”
“Amazing weather! Isn’t it a perfect day to travel?”
Seasons are a universal language, everyone understands it. It transcends manmade boundaries. Just as I am feeling the cold under the layers of clothes I wear. A breeze rippling through the surface of the lake water makes me shiver. If the seasons are what make me, why do I feel cold and sad. Maybe because I long for a different weather. Having grown up in a tropical city, my body is not used to the cold. But is that all? The great reason for the hollow? It can’t be. And I am restless because I can’t figure it out. If not this, then what else? What else could it possibly be?
When she writes this I figure it out. I am always able to figure her out. Her mind does not want to go there. Because after all, this is the life she chose. Of course, how could I have been so blind?
*
Around two weeks ago I observed her. Observed and observed for a few hours. A few days. Even then I knew something was amiss. She was writing but her heart wasn’t in it. It was dwindling. She doodled and dawdled. A sentence here. A sentence there. Then I was discarded on the coffee table in front of her. My observations, you ask? She scrolls through LinkedIn, going through a series of posts about the looming recession. She searches and applies obsessively to 50 job openings every day. And day after day, her laptop or phone chimes in with a rejection email. She refreshes. Refreshes. Refreshes. Every 10 minutes. Whatever she is doing. No matter if she is in the kitchen or the washroom or the living room. She is glued to her phone checking for a new email. A new job opening. She set her filters to relevant job openings… And then goes on to the painstaking process of filling her details out on different company portals. When she reached the USA, she was hopeful. Of finding a new job. Was very optimistic. She had worked with global companies in India after all. Surely that had to account for something. But with each passing day, the light within her dimmed just a little. Bit by bit. I hate to admit it but I didn’t come to this conclusion when I observed her. It struck me when I stopped and she wrote again. Sometimes I need a macro perspective after micro is too much. She is so inside her head and not on paper that she cannot understand. But I also don’t think it is as easy to pinpoint. It’s a combination of things in her life, culminating in a single point of paralysis. Even now, who knows? It’s just my opinion of a subject I don’t understand completely. She is talented enough to fool everyone around her. Her friends and family also do not know this about her. They think she is enjoying her break from work. They think she is immensely enjoying the exploration of a new country without a worry in the world. She hates admitting that she is miserable. She wants them to feel that she has got it all together. That her life is perfect. When they go through her social media profile, they find her happy pictures. Ecstatic even.
*
A couple of months ago when she was leaving for the USA, her office colleagues had warned her: “One of my sisters lives in the States. She is miserable there. Wants to come back but her husband doesn’t.”
“Why?”
“He has a high-paying tech job and all so he is okay. But he is on an H1-B visa without an I-140.”
“So? What does that mean?”
“Which means the spouse can’t work. So she can’t work.”
“Oh.”
“I am surprised you didn’t know this.”
“I haven’t started my research yet on the visa types and job search. But I intend to.”
“It is very important to understand your options. It is not always as picture-perfect as it seems. My sister is busy doing all the household chores. And she is not happy. Her social life was here. She has no friends there. Only his work friends they mingle with.”
“I know about my visa type though. I can still work there.”
“Oh, honey,” she gives a sympathetic smile, “but everyone wants to convert into an H1-B once they go there. So there could be a brief period where you might have to be unemployed.”
“But that doesn’t matter. Because we intend to come back in a few years. We just want to experience a different work environment and culture and to have that thrill of living in a new country. But only for a few years.”
“Honey, they all say that. As I said, consider your options once you are there before you decide anything. Okay?”
“I will, thanks. I am sure my husband would also check about these things. It is a major decision after all.”
“Oh, I am sure he would.”
*
She was very emotional on the last day of her job. She had worked there straight out of B-school. She had met some people who would become close friends and some who were toxic. But on the last day, she knew she would miss them all. She didn’t think that saying goodbye would be this difficult. Her name on the desk and chair in bright white letters with a black background came alive with memories. Memories of birthdays celebrated, lunches ordered, huddles and meetings, apprehension of deadlines, the adrenaline rush of getting it done just in time, the accolades. It felt empty by itself if not for the people she surrounded herself with. Her friends.
Her colleagues. They motivated her and pushed her to give her best. Her manager was always an inspiration. Solving problems and giving solutions in a way she herself didn’t think was possible. She learned a lot from each of them. But she was excited to begin a new chapter. But the isolation in a new country was what she hadn’t counted on.
Her husband noticed when she hadn’t had a bath for a couple of days. He thought it could be laziness. When he asked her about it, she said she would. Her reply was curt, and tone grumpy, so he left it at that. After a week of the whole no-bath scenario, her husband thought it was time to have a talk. This wasn’t one of those phases she would overcome on her own. A little push. A little nudge would maybe do her some good. When he saw her refreshing her Gmail inbox for the umpteenth time that day, he said,
“You know, we came to this country to experience a new place, a new city.”
“Hmm.” Eyes glued to the screen.
“Don’t you think it’s time to do that?”
“Hmm.”
He places his hand in front of her phone.
“What are you so worried about?”
She looked at him for a moment before answering. “That I won’t find another job. Every day on LinkedIn, there is a new company that’s laying off or announcing a hiring freeze and I am worried that my career break will just go on longer.”
“But weren’t you always saying that you needed some time off to pursue your passion of writing?”
“All that’s good to talk about. But I need to focus on my career too.”
“I understand that, but the recession is not your fault. You are doing everything you can.”
“I need to do more.”
“You need to get the bigger picture. Zoom out. You have a glorious opportunity to work on your writings. You have notebooks filled with stories. Don’t you think it is time you polished the pieces and submitted them somewhere?”
“What I need to do is get a job.”
“You will get it but the time that you have right now, in between jobs, is hard to come by. Think about it. You can try to do what you always talked about doing. Or was all that just big talk?” I could see, she took the bait.
She considered. “Hmm,” was all she said.
“I also found something for you.”
He had searched for a public library nearby. A magnificent three-storied red brick building standing beside a park. Just a mile away from their home. She could get herself a membership there. I thought this was an amazing idea. She had always wanted a house near a library. I could tell that this piqued her interest even if she feigned indifference to her husband. She wanted to see it first. I could see it in her eyes. And here I thought that the husband was too busy to notice her worries. I guess he was letting her be. Well, I couldn’t have guessed it. I can’t read his thoughts.
*
The next morning, she woke up to her alarm at 7:30 a.m. and had a shower. She was ready by 8:30 a.m., in time for the library to be open by 9 a.m. She was armed with her warmest winter jacket and a beanie. Wandered around the streets on her way to the Bellevue library. Taking in the strollers with their prams and pets. Warm coffees in their hands. In 10 minutes, she was standing in front of the library and was not disappointed. Covered with floor-to-ceiling glass panes, she could peer inside as she walked to the front door. She was also pleasantly surprised at a life-sized bronze statue of Mahatma Gandhi just outside the library; in the midst of now barren trees. There was ample seating space inside. Aisles and aisles of books: classics, romance, historical fiction, new interesting fiction and non-fiction sections, choice reads, monthly picks, and a dedicated holds section for reserved books.
Her husband was right. Isn’t this what she always wanted to explore? Read and write. Write and read. Surround herself with books and pages. She had found her place. She touched her fingers in reverence to the cracked paperbacks, reminding her of the piles of books she left behind at her place in India. She borrowed a few novels and set off with them and me in her backpack. Couldn’t resist a warm cup of coffee from a cafe she spotted. Picked a window-facing table overlooking a park. She read as she finished her coffee. A good girl’s guide to murder was a page-turner. It was the first time in months that she had ventured out on her own. She felt at ease. At peace. Her breath, a little lighter. A little deeper. She saw two dogs playing outside. Free and wild. She picked up her phone and googled bookstores and art galleries around. She found that a couple of independent bookstores nearby also host monthly book clubs and writing clubs. She signed up for them and started off in the direction of the art gallery.
I was happy. She was bouncing back. One step at a time.
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.
Paritosh Joshi is a graduate student in Clinical Psychology at Teachers College, Columbia University. His background includes a Master of … Read more ›
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.
