September 25, 2020March 22, 2021 7min readBy Maria Kari
Trigger warning: This article contains material related to suicide and mental illness. Discretion is advised. If these topics cause emotional, mental, or physical distress, please call your National Suicide Prevention Hotline.
A Real Illness
At the end of July, after months of battling postpartum depression (PPD), 31-year-old Nima Bhakta died by suicide. She left behind a devastated family and her seven-month-old baby, Keshav.
Nima’s struggle with PPD was real and it was serious. But Nima should not have died because of it.
Perinatal depression (which includes both prenatal and postpartum depression) is a condition that can happen to anyone regardless of age, race, culture or income level. The causes can range from changes in hormones during or right after pregnancy, life stress or because of a woman’s existing predisposition to depression.
And even though symptoms can be easy to miss and often go unnoticed (which mom-to-be or new mom isn’t overwhelmed with emotions or constantly tired?), perinatal depression is very much treatable.
Regardless of how or when it happens, perinatal depression is never because of something a woman did or did not do.
The Story of Nima Bhakta
When Nima Bhakta found out she was expecting, she was thrilled. After all, she was already known as a star maasi (aunt) to her sister Priya Bhakta’s children. So, happily, she shopped for baby clothes and scheduled a maternity photoshoot.
But, at the end of December 2019, when Nima gave birth to baby Keshav, everything changed.
“The change was immediate,” recalls sister Priya Bhakta. “The second her son was born she was different. Every mom struggles at first. The lack of sleep, the work a newborn requires – it’s a complete life change. But Nima, she was different after the baby.”
Priya watched helplessly as, day by day, her younger sister’s light dimmed.
According to Priya, Nima would go from moments of high anxiety and uncontrolled worrying to moments of complete calm verging on an almost reckless apathy.
“I would be changing [Keshav’s] diaper and [Nima] would just be hovering over me. She would be adamant about which Aquaphor to use — the tube not the tub. She would panic because the baby was sleeping 8+ hours at night even though everyone told her it was okay. When [Keshav] would take naps, she would sit a few feet away just watching the baby monitor,” recalls Priya.
“She was just very obsessive over her son. We would try and reassure her and she would tell us ‘you don’t understand him, he doesn’t eat, he’s not gaining weight’ even though he was perfect.”
Other times, Nima would be completely unphased by her baby’s discomfort. Once, Priya recalls Nima telling her, “oh, he’s crying. And, I don’t care to pick him up.”
For months, it went like this. And, to be clear, Nima’s family did their best to get her help.
During one of Nima’s routine visits with her obstetrician, her husband made sure he was on speakerphone (because of COVID-19 restrictions, he couldn’t attend appointments with her). To her husband’s surprise, when the doctor asked Nima how she was feeling, Nima said she was fine. He had to stop the conversation and tell the doctor some of the things he’d found concerning.
“Nima would hide it,” says Priya. “She had this thought in her head that she had to be a perfect mom.”
This need to be perfect is something every generation of South Asian women is familiar with and can attest to. Even when we are marinating in hormones and cortisol, during or after our pregnancy, we are taught to soldier on.
“In desi culture, motherhood is [not only] an expectation, it’s a rite of passage,” explains Maliha Khan, a licensed therapist at The Menninger Clinic. “Women are expected to be able to handle motherhood. And if she finds the journey challenging, people ask what is wrong with her.”
This is something I experienced when last year, in my first trimester, I was diagnosed with perinatal depression.
Before my diagnosis, I hadn’t given much thought to perinatal depression. It was only when my mind, along with my body, felt stretched to the point of no return and when, one day, I found myself calling a national suicide hotline, that I realized how many women around me were suffering or had known this suffering.
Prenatal depression (what I had) affects around 14-23 percent of women during pregnancy. Postpartum depression (what Nima had) affects around 1 in 7 women in the year after giving birth.
That means, in a group of friends — should they all choose to become mothers — at least one will go on to struggle with the same condition that robbed Nima Bhakta of her life.
But, if perinatal depression is so common and so treatable, the question then becomes: why are women still dying because of it?
The experts I spoke to for this article point to the stigma that still exists in South Asian communities when it comes to discussing mental health.
“Perinatal depression, like other mental health conditions, is a touchy subject for South Asian families. Especially ones with a high degree of perfectionism,” says Khan.
“Desi families, for generations and generations, have idealized appearing perfect. That’s why conversations at desi family gatherings revolve around our social successes: how our child got into an ivy league school, or how we bought our dream home or the latest model Mercedes or found the perfect match for marriage,” Khan said.
Because of these unspoken social rules and societal expectations, it can take every ounce of a depressed person’s energy to finally ask for help, which is exactly what happened the day Nima completely broke down and called Priya for help.
“I told her ‘okay, you’ve got to get help. It’s okay to get help. You have our support, we love you, and everyone is going to help you,’” Priya recalls.
Nima agreed and together the sisters found a therapist who confirmed that Nima was suffering from PPD and had a lot of anxiety. Because of COVID-19 restrictions, the therapist recommended weekly phone sessions. But, because of the lack of an in-person connection, Priya thinks her sister did only one or two sessions.
Screening for Suicide
In our post-pandemic world, therapy has moved online, prenatal appointments are solo affairs and all of us are living more isolated lives. This is why, according to Dr. Sue Varma, a New York-based board-certified psychiatrist, the need to screen for perinatal depression is greater than ever.
“The whole process [of how coronavirus is shaping the world] will shape a woman’s experience. Giving birth, for many women, can be a very vulnerable time in their lives. They are under a lot of pain [and now] they may not always be able to best advocate for themselves in the midst of a lot of quick change,” explains Dr. Varma.
Dr. Varma stresses that doctors do not hesitate to screen for suicide. She recommends that obstetricians have mental telehealth referrals lined up for patients, adding that for perinatal depression, “cognitive behavioral therapy can be very effective [as well as] medications, which, of course, are a very personal decision.”
Priya does not know if her sister Nima was ever screened for suicide. But, she can recall clearly how, in the months leading up to her death, Nima’s spark and her excitement for motherhood all but disappeared.
There were times when Priya caught a glimpse of the sister she had always known. The Nima who loved to dress up and take pictures. The Nima who loved boiled peanuts. But, after giving birth, Priya recalls how mostly Nima was no longer Nima. Instead, the new mom spent most of her days in sweatpants, sometimes even refusing to show Keshav to her family on FaceTime.
“She was perfect from the start,” Priya tells me. “She was organized, studious, a shy girl who got straight As.”
In the end, it was this societal demand for perfection that would escalate Nima’s undoing.
Despite having the support of her loved ones, in late July, Nima would decide she was done playing by Desi society’s rules. In a half-finished note on her phone, which her family found after her death, Nima leaves behind a haunting paragraph directed to her community.
“Society,” she writes. “Don’t blame my husband, my in-laws or my family. They are not responsible for anything. I felt the way I felt because of myself only. If you want to criticize the kind of person I was for abandoning Keshav, I am the only one to blame. Things happen that are out of people’s control. My mind needed to be at ease and this was the only way I felt it could. I wasn’t able to communicate to my friends, family, or anyone anymore and lost the ‘Nima’ everyone knew through social media, texts, and in-person. My appearance changed, my mind was troubled, I was wearing sweats every day, and never even went outside. Please let me go in peace.”
Even in death, Nima knew she’d have to answer to her community. Even in death, Nima knew her parenting would come into question. Even in death, Nima knew her family would be judged and talked about. Even in death, Nima knew she would not find peace unless she justified herself.
The Cult of Perfection Killing Us
Suicide is the leading cause of death for new moms.
Yet, in the desi community, we are so far from acknowledging maternal mental health, let alone tackling the topic of perinatal depression and how to stop young moms from dying because of it.
“Conversations surrounding the mental health of pregnant women should be the norm. Just like we value a healthy baby, a healthy mom should be a priority,” says Khan. “It’s crucial for the desi community to realize this so we don’t lose more amazing mothers to perinatal depression. When we are aware, we can do better.”
Perinatal psychiatrist Dr. Pooja Lakshmin, who runs Gemma (an online platform for women’s mental health education) and perinatal psychiatrist Dr. Sue Varma both echo similar sentiments.
“South Asian culture is strongly collectivist and interdependent. There is this sense of not ‘airing your dirty laundry’ to strangers. Given the [large size] and the interdependence of our families, there is a fear of judgment or persecution from the community,” explains Dr. Lakshmin. “The unfortunate consequence is that women end up suffering in silence because getting help is viewed with suspicion and stigma.”
According to Dr. Varma, “there’s so much stigma, shame and a lack of proper language and acceptance around depression and anxiety in the South Asian community. There’s a pressure and an emphasis on getting married, having a family — sometimes at any cost.”
In a culture like this, suffering from perinatal depression feels a lot like standing on the deck of the Titanic yelling “Iceberg! Iceberg!” You’re shouting into the void, while, behind you, the band keeps playing and the party carries on.
So what is a woman to do if society or her loved ones are unable or simply unwilling to understand and help her?
“Don’t be afraid to go outside of your circle,” advises Dr. Lakshmin. “If your family isn’t able to understand you or is dismissing you, you need to find a tribe outside of them.”
Resources
Dr. Pooja Lakshmin encourages women to turn outside of their immediate circle, if necessary.
Reach out to school friends, colleagues or join mom groups — most of which, since the pandemic, have moved online — she advises. She also encourages women to visit www.womensmentalhealth.org to learn more about perinatal depression and, if they need a safe place to sound off, she invites women to join her non-judgmental online community on Facebook.
Dr. Lakshmin has also recently written an article for the New York Times on how to support a loved one suffering from perinatal depression.
Dr. Sue Varma appears monthly on Sirius Satellite’s Doctor Radio where she interacts with live callers and provides expert advice on a variety of psychiatric questions. Meanwhile, Maliha Khan, a licensed therapist based in Houston, Texas, runs an Instagram and YouTube platform (@MentalHealthWithMaliha) where she raises awareness of mental health illness in a way that is specifically geared to the South Asian community.
January 16, 2023January 16, 2023 6min readBy Sejal Sehmi
I was a mere 14-year old on the fateful night of 22 April 1993. The night that witnessed black teenager Stephen Lawrence brutally murdered in a racially motivated attack as he waited for a bus. The night that cemented my fear, that the colour of my skin does matter. The same night that confirmed my indifference as a British Asian in the United Kingdom — were we really united? Fast forward to May 25 2020, the murder of African-American George Floyd by a white policeman was the turning point for British Asian author and my lovely friend, Shweta Aggarwal to finally break her silence and narrate her story of colourism, in her new book, “The Black Rose.”
Aggarwal’s gripping memoir emits so many emotions; that of an awakening, a voice that has been suppressed for years, filled with anger, mistrust and guilt. But most importantly, “The Black Rose” successfully disrupts the narrative that consistently allows society to box someone as indifferent based on a visibility factor. For Shweta, this factor was the colour of her skin. The injustices she consistently endured via some family members and fellow South Asian peers throughout her life, was as a result of her skin tone failing to qualify as ‘acceptable’, or as she often quotes in her book, not ranking high enough on the ‘fairometer.’ Whether she was in India, Japan or London, the scale was never too far behind.
Within the first chapter, she recalls as a child in India, the distinct lack of subtlety displayed by certain family members through direct taunts of her duskier appearance in comparison to her parents. She realised that she wasn’t in complete isolation from this prejudice, as her maternal aunt and uncle were also harshly nicknamed on the basis of their skin colour — Kaali (black) and Savla (wheatish). Aggarwal was left mortified by what many South Asians sadly still continue to casually exercise. Echoing similar incidents within my social proximity, it’s infuriating witnessing the recipients of such remarks surrender to laughing at themselves too.
Except it isn’t funny. Born into a culture where conversations on religion, caste and hierarchy in India are still so prominent, the comparison of Aggarwal’s skin colour being as dark as that of the domestic help (often from poorer families), prematurely planted seeds in her mind that she simply didn’t belong with her family, especially when she was sent to boarding school. Her lack of self-worth coupled with these taunts, gave her a whole new vocabulary for the letter B, that grew in parallel with the ongoing prejudice and anxiety. B for blackie, beggar’s child, bedwetter! Not funny, but derogatory. Post her book launch that Brown Girl Magazine attended, she tells me,
I personally feel we are way behind when it comes to understanding the importance of mental health. Name-calling was normalised and if you objected, you were ridiculed further with remarks such as ‘So sensitive! Can’t you take a joke?’ Body and colour shaming can lead to a feeling of inadequacy in the victim, which can further lead to depression and much worse mental illnesses.
During the 1984 Hindu Sikh riots in India, where over 3000 Sikhs lost their lives, Aggarwal recollects the frightening moment when she and her classmates fled into hiding to escape the violence during a school trip. As a means to save all the students from harm, the Sikh boys were forced to remove their turbans and long hair — their visible identities stripped to keep them alive. Yet, ironically, even in this horrifying situation, Aggarwal felt least at risk, attributing this self-assurance to her darker appearance.
The crux of her self-loathe was the love-hate relationship she formed with skin whitening creams. The birth of Fair and Lovely, India’s most renown brand (now known as Glow and Lovely following a backlash) was notorious for selling the damaging message that fairer skin equated to a happier and fulfilling life. For it was fairer skin women that would qualify for marriage — clearly their only sole purpose!
Tactfully using famous fair-skinned Bollywood actresses in television ads and posters, their so-called perfection would scream out to vulnerable young girls. (Men were targeted much later on, but the importance seemed less). Akin to the wretched beach body posters plastered on every corner in January — because apparently bikinis only look good on a certain body type — the damaging message remains the same. Social acceptance comes at a cost, and that cost is to look a certain way.
It’s an extension of the dated methods imposed on women from the womb, where mothers are lectured on drinking milk with saffron to ensure the baby is fair, traditional matrimonial sites asking women to specify skin colour, and women being told to stay out of the sun. These socially ingrained views are eventually developed into modern day methods in the form of cleverly marketed consumables. Aggarwal admits,
Most people only use the cream on their face just as I did. At that time, I didn’t even think about the rest of the body. I felt that if the face becomes fairer, that will be enough for acceptance. My mum noticed the difference for sure and I was lighter by the time I met my husband, Amit. I must admit the addiction is a combination of three factors: the justification in your own head, the strong marketing message that ONLY fair is beautiful, and the ‘compliments’ from those around you.
I admired Shweta’s honesty on admitting what essentially was a dangerous obsession that she remained faithful to throughout her teenage and adult life. A ritual that, whilst prompted gradual results in her appearance, was never going to eliminate the insecurities she felt within herself. Moments of joy with her husband and children on holidays abroad, would be broken up by the need to ‘fix’ any damage the sun may have inflicted i.e. reverse her tan. The booming tanning industry in U.K., her now home, and admiration of her ‘sun-kissed’ look by Brits initially surprised Aggarwal — as if her colour had now gained acceptance.
But who are we seeking acceptance from? A society that is still deep rooted in patriarchy forcing women even now to adhere to dated rites of passage that holds no relevance? Or a society that seeks to point out one’s indifference because of how they look — their skin, their religious attire, their weight? Or a society that passes judgement on a woman’s self-worth, and continues to abuse that same woman behind closed doors under the eyes of Goddess Kali? Aggarwarl goes on to explain,
The more damaging perceptions of colourism, are that ‘fair is rich’, ‘fair is successful’ and ‘fair is better educated’. Essentially, ‘fair is supreme’ in every sense. And if that’s the case, where does that leave dark-skinned people? In Ukraine, for example black and brown people were discriminated against and not given a fair chance to save their lives. Is it fair to be denied a basic human right — survival — based on your colour?
I personally was curious to know from my family what the definition of prejudice in the Hindi vocabulary is and how it is/was applied to in India. “Pakshappat” (taking sides) or “poorva dhaarna”, were the closest pure Hindi definitions known to my cousin, yet rarely used. However, my dad stated that “hum bedh bhau nahin hai” was the common term used to state amongst family and friends when someone was not biased and believed in equality. Somehow, colourism never really came under that category. A sentiment echoed by some of my Chinese and black friends . Even in parts of China and Africa, the belief that darker skin is perceived as inferior, is accredited to stereotyping certain groups of people as manual labourers working under the sun, and therefore of a lower class or caste. Does Shweta believe we can change this attitude?
A couple of my aunts are still reluctant to help me with my mission. One even said ‘it’s pointless fighting it’, while one said, ‘everyone has the right to define beauty for themselves and being fairer is what beauty is for some.’ The problem with this is that people then start to look down on people who aren’t. Colourism, casteism and classism divide people, creating more unrest in society. If we continue to aspire to be fairer, we’re still encouraging white skin privilege, and encouraging colonial values. The more we allow ourselves to succumb to these social constructs, the more enslaved we feel internally. Melanin is crucial for protecting our skin against the harmful radiation of the sun. Feel blessed that you have it and wear it with pride!
I wonder how we can dare to walk shoulder to shoulder with our black friends in the Black Lives Matter movement, if we refuse to face up to our own biases against colour? We seek equality in the U.K., but deny our deep-rooted prejudice, whilst a white privileged man lectures the world on the difference between racism and unconscious bias (yes Prince Harry, I’m looking at you!). “The Black Rose” has paved a way for many more voices to speak out against the damaging impact of colourism, and in my view, rightly belongs under the definition of prejudice in the collective South Asian vocabulary.
“The Black Rose” is available to purchase on Amazon.
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.
September 13, 2023September 13, 2023 8min readBy Manali Deolalkar
Photo by: Yeexin Richelle
Traditionally, psychotherapy has let women down. This is not to say that women and other minority group members have never received help, but rather that the therapy they received made little attempt to address the root causes of their problems. In focusing narrowly on the personal and individual, which a lot of mainstream approaches focus on, they ignore the big picture and miss the point. An alternative approach — feminist therapy — can help challenge the norms and support South Asian women in a more comprehensive way.
A therapy which fails to address power issues in people’s lives automatically reinforces oppression. Feminist therapy is a way to look at people as part of society and not merely as individuals. As more people of marginalized identities realize that the cause of their mental and emotional difficulties are not individual factors but structural, they are seeking more thoughtful therapists and counselors. Feminist therapists are aware of the cultural dynamics that uniquely affect women and keep these at the center of their practice.
Feminist therapy has a lot to offer to women of color, particularly South Asian women. It is formed on the assumption that social forces impact, and these forces include the many identities that a South Asian woman holds — including race, ethnicity, caste, etc. Feminist therapy can help support our clients and us as therapists to conceptualize the client’s difficulties, as not just stemming from internal sources, but as an outcome of the deep-rooted patriarchal system.
Feminist therapy is the key to a progressive approach towards mental health care. There is a lot of awareness about feminism nowadays and women encourage feminist approaches to therapy. Feminist approaches look at how social and political forces interact with our own identities. Feminist therapy especially puts in a lot of emphasis on how our intersectional identities such as religion, family dynamics and social class plays a role in our own gender identity. Feminist therapy can help support our clients and ourselves as therapists to conceptualize the client’s difficulties as not just stemming from internal sources, but rather face the impact of the deep rooted patriarchal system.
Here are some important aspects of a feminist approach to therapy, whether you are a therapist or someone who wants to start therapy themselves:
Therapists’ own biases
Therapists, while working with South Asian women, as with any other client, need to put in their own personal work in understanding the assumptions and biases that they may hold towards these identities. If a counselor holds bias that a South Asian woman is timid, or doesn’t know what she wants, it may cause the counselor to take in a more direct approach rather than a collaborative one.
South Asian women are often being told what to do. Hence, therapists who may choose to be more directive rather than collaborative, may often reinforce the position of power and authority onto a South Asian woman reflecting what she faces in the world. South Asian women, especially who may have not been exposed to therapy, may look at counselors from a view of receiving advice or guidance. It is through our own ability to explore and process our biases that we can help challenge this narrative for the client, and help take a more collaborative approach.
Exploring identity work
It is important for a therapist to be aware about gender, sexuality and the intersectional aspects of feminism; about how sexual minorities, caste, religion impact gender in influencing the kind of experiences that women face. The counseling relationship is a space for clients to process the identities that are the most salient to them. We can start off with providing some context and psycho-education around the purpose of understanding these identities. Helping the client process different identities that are important to her can help take a more holistic approach to understand her difficulties. We can help provide information around how every identity that we hold impacts us in some way or the other, because of its interaction within the social context. This can also be a time when a client may self-disclose about their own identities, if comfortable and appropriate, to model this understanding.
Ask instead of assume
It is considered best practice with every client to ask their preferred pronouns; as well as identities they would like to highlight at the beginning of the counseling relationship.
Asking, instead of presuming, can help clients hold their voice from the beginning of the counseling relationship and create a safe environment. Processing identities that are salient to them and opening up space to share other identities can help clients share openly about how they choose to identify with their gender/sexual identity. It creates space for clients in the process of exploring their identities, to get curious about their identified gender/sexual identities for the first time.
One of the initial and ongoing processes of feminist therapy is educating women from a collaborative aspect. Providing psycho-education about their rights, consent, impact of patriarchy and other systemic factors promotes empowerment. While providing psycho-education, it is important to process the power dynamics in the relationship and model consent within the relationship by exploring the question: “What is it like for you to hear this information from me?”
We as therapists can be considered as guiding forces, but we should also be mindful that we are providing this guidance and information from a collaborative aspect rather than enforcing authority or being direct. South Asian women are often asked to respect people in authority and not defy them. We, too, as therapists may end up reinforcing these patterns, and instead need to do our own exploration by engaging in psycho-education with collaboration and continuing to check in with the client’s internal process.
Hold context around starting therapy
A South Asian woman puts a lot of thought into seeking therapy. The cultural stigma towards mental health can have an imperative impact on her recognising that therapy could be a potential need to take care of herself. Along with the courage that it takes to reach out to a therapist, either openly or whilst keeping it hidden from her family, there may also be a potential element of what kind of therapist do I want to see. Especially for South Asian women living in the US/UK or other Western countries, there may be a significant deliberation that goes into seeing a white therapist v/s a person of color therapist v/s a south asian therapist.
Can we think of potential factors that may prevent a South Asian woman from reaching out to a therapist who may hold similar cultural identities ?
Can we think of potential factors why a client may want to work with a South Asian therapist?
Explore reasons that led them to choose you
When a client comes in for therapy, she has probably considered the therapist’s background. She may choose to see a non-South Asian woman because of past and internalized fear of being judged by other South Asian women in her life. Or a client may deliberately choose to work with a South Asian woman therapist for perceived similarities in identity. For therapists, it’s important to create space at the beginning of the relationship to ask the client what led them to choose you as their therapist. For clients, it’s important to ask questions about your therapist that are important to you.
Fostering environment for all their identities
Clients are fully seen and valued for all aspects of their identity, background and experiences. It also means that we ground our interventions from a systemic and anti-oppressive approach.
We constantly learn and evolve to provide responsiveness, humility and respect to our clients and really redefine the standard of care based on the identities and background of South Asian women.
Background of the client
Particularly while working with South Asian immigrants, it is important to know the background of the client we work with in order to design culturally-appropriate interventions. As a lot of research has asserted, not all Asians are alike and group differences within Asian groups is often overlooked.
There’s a lot of information and knowledge around Indian groups that tend to be generalized across other communities from South Asia such as those from Pakistan, Sri Lanka, Bangladesh, etc. It is important for counselors to be aware about similarities and differences across these cultures, and create interventions that are more specific to the client’s cultural background.
It is important to check in about how the interventions land with the client. We may use certain strategies from a Western perspective that go into exploring a client’s relationship with her parents or caregivers. This can particularly bring guilt or shame for the client as it may be in conflict with her cultural value of holding respect for her parents.
A lot of the deep respect and regard towards family comes in the form of loyalty and not speaking “ill” about the family with strangers. Reflecting on family, based on Western interventions, can sometimes make it challenging for clients based on their values. Checking in with clients on how these interventions feel, and making space for the guilt and shame to surface can once again help clients to hold value in her own voice.
Examining values and beliefs
Therapy can support South Asian women in differentiating between their own values and society’s expectations. Even though collectivism is a value within South Asian culture, it may not necessarily be an individual value to our clients.
South Asian women very often bear the burden of the value of collectivism where they have to meet family’s expectations, be in touch with other family members and engage in other collective activities. It is an expectation that has been imposed upon them. A therapy space can be a space for clients to explore what their own individual values look like. It can be a space for counselors to collaboratively work with clients in choosing what matters to them, even if what matters to them is to take care of the family.
In this essence, she now has had a voice in choosing how she wants to move forward as v/s feeling stuck in expectations set by others. When the client recognizes that she has a choice in exploring her own values and beliefs, there can be support around how to engage in behaviors that are based in these values. Sue and Sue (2008) has recommended discussion about values, beliefs and behaviors of their family and culture, so that clients can discover those that are for them, those with which they identify and those with which they are ambivalent.
The reason why a South Asian woman may choose to work with a South Asian therapist is to feel understood and not hold the burden of having to explain different cultural norms and expectations. When working with a therapist from a different racial background, clients may feel the need to explain and defend their own culture. It may feel difficult to hear about certain norms being toxic or problematic from someone who doesn’t share the same background as you.
When we as South Asian therapists work with South Asian women clients, we have the unique opportunity to validate the importance/meaning of these cultural norms, as well as challenge its problematic impact on our mental health. We have the context and ability to hold the community and cultural system accountable. It is important to hold the value of one’s desire to have a community and fellowship, as well as hold the impact of this collectivism on the mental health of South Asian women.
It is important to pause and explore: What about the culture feels impactful? How does this impact self-esteem and the way they view the world?
South Asian women are bound by the cultural value of adjustment and acceptance. Accepting our culture the way it is and moving on is what they have been taught to do across generations. The therapy room can be a good space for us to pause and help them choose what aspects of the community are helpful and what feels unacceptable.
This, in turn, can help with increasing their voice and control on their own value system. When they come to you looking for that cultural connection, you can hold space to both empathize with their cultural upbringing and to be able to challenge it. There’s more likelihood that they need it to be challenged and from someone who understands what they are going through.
Manali is a licensed psychotherapist based in California. Manali has completed her Masters in Mental Health Counseling from Columbia University, … Read more ›
