Ever since I came out to my family about my depression and anxiety a year ago, I never fail to forget the struggle it took to get them to accept my illness. I grew up in an average Muslim household in a community that was fairly conservative in terms of culture and religion. No one talked about mental illness. If you did, you were ‘one of the crazies’ and pretty much everyone around you would shun you. Gossip would spread that you were either incredibly non-religious or that you were doing it for attention or that you just weren’t trying hard enough to be happy.
What I personally know from experience: those aunties were completely wrong. I wasn’t ‘sad.’ Sadness is a very different feeling from being depressed. Everyone gets sad from time to time, like when a relative dies or when you don’t get your dream job. But depression is a whole other beast. Depression is kind of like a fog over you. It’s this cloud that doesn’t let you see or think properly. You’re always kind of there but not really, and it stays like that for a long time. Sometimes, it gets even worse.
So how can we tell the difference between being sad and being depressed? Here are some signs to look for within yourself and/or a loved one.
You have lost interest in the things you liked to do before. Let’s say you loved to bake all the time. But now, anytime you think about baking, you end up thinking, “Nah, I don’t think I want to. What’s the point? ” But losing interest is different than moving on from a hobby or trying something different. When you lose interest as a result of depression, it has feelings of hopelessness attached to it and apathy. You’re indifferent to whether you do something or not.
You have a decrease in energy. You would much rather stay in bed, not go out, not socialize, and not exert any kind of physical or mental energy. Regular tasks you used to complete effortlessly before seem almost impossible now. Things like, taking a shower or getting out of bed or brushing your teeth seem like difficult tasks.
This goes back to depression becoming like a fog. You can sort of piece things together, but you’re not functioning at your best. You forget things more easily, you find it harder to focus and it becomes difficult to start — let alone finish — any kind of task. You may see the effects of this at work or in school.
You end up feeling guilty about how you are feeling. You begin to have thoughts that you are worthless, you have thoughts of hopelessness, and you truly believe that no one cares about you. And having all these thoughts can cause you to feel guilty. You may feel guilty about having thoughts like this or you may feel like a burden if you share your feelings with someone. You may think that no one cares or wants to hear about your problems, and this creates isolation and feelings of loneliness.
You may either sleep less or sleep more. Sometimes, because of your decreased energy, you may end up sleeping more and lying in bed. You may feel exhausted and tired and sore. Other tim,es you may sleep less because anxiety may keep you awake. If there is a significant difference in your sleeping pattern, this may be a sign of depression.
Usually, when in depression, appetite is decreased. I know personally, for me, I didn’t have the energy to cook or go outside and grab something or even reach in the drawer next to me for a breakfast bar. Plus, my appetite was suppressed. Sometimes, though, for some individuals, appetite may increase.
Feelings or thoughts of suicide are never okay. These are never ‘normal’ thoughts to have. In depression, one may think that everyone has thoughts like these, but that is untrue. Apathy, sadness, and isolation all play into this. If you or anyone you know is thinking about suicide or has a plan to carry out suicide, please call the National Suicide Prevention Lifeline at 1-800-273-8255.
Depression doesn’t know any race, religion, sex, culture or creed. It is a chemical imbalance, like most illnesses, but tends to be ignored in the desi community because the symptoms are invisible until it’s too late. It’s a disease with various bio-psycho-social factors and it shouldn’t be ignored because of reputation or status. Withholding treatment for mental illness because of dialogue like, ‘Someone may find out’ or ‘No one will want to marry you’ or ‘What will they think of us,’ are not good enough reasons. There’s NEVER a good enough reason to NOT get treatment for mental illnesses. These are real symptoms with real side effects and they can get worse if therapy or medication is not used.
Our culture creates a huge amount of stigma around discussing mental illnesses. It’s because those suffering are usually seen as crazy, non-religious, or lazy, and they simply need to pray more or try harder to be happy or not talk about it altogether. But the truth is, the more we talk about it, the more we can normalize that depression and anxiety DO exist in our community. Let’s rid our culture of the taboo our communities hold. Let’s normalize the treatments of these diseases. Let’s continue to talk about mental illness.
Dr. Rabia Toor is a recent graduate of Saba University School of Medicine. Her passion for social work and providing care motivated her to pursue an MD. After suffering in silence for many years, she believed it was time to speak out and be an advocate for the education and treatment of mental illnesses. Her first foray into the arts is a documentary called “Veil of Silence,” a film on the stigma of mental illness in the Muslim community. She hopes to continue her work in the future as a family physician specializing in psychiatric care. Between studying mindlessly for hours on end and being a social advocate, she loves eating Mexican food, crocheting, playing with her kitten and shamelessly discussing her Pinterest fails.
Valentine’s Day is here, and my calendar is fully booked on February 14th. It’s not what you think. My calendar is fully booked with therapy clients who will most definitely be reflecting on their singlehood this year. And so will I. Most of them are just like me — single South Asian Americans, between the ages of 22-40 who come from moderately conservative cultures. The adult children of immigrants, who had arranged marriages, wondering when we will ever find “the one,” and why we won’t settle.
I’m a therapist in therapy, and I’ve had a lot of family trauma and baggage to unpack with my therapist. Through my training and personal therapy journey, I learned to question a lot of the things that I’ve been told about marriage and relationships.
At the same time, it’s not easy. No one wants to be lonely. Brené Brown talks about how detrimental loneliness can be for humans in “Braving the Wilderness.” We all want to belong to someone or something bigger. And there is a difference between being lonely, without intimate companionship, and being alone in our experiences. As we get older, everyone we know in our age group is on a different life trajectory, and we start to feel both alone and lonely.
We straddle the line between two cultures — the one that we were born and raised in, and the one our parents and family tried to teach us. Many of us might live double lives. But being single is not an anomaly. In fact, according to the Pew Research Center, about 31% of adults in America are single. About 32% of American women, between ages 18-29, and 29% of women, 50-64, are single. This means that roughly about a third of American women are single, regardless of age or developmental stage.
Results vary by sexual identity and race. 56% of adults who identify as lesbian, gay, or bisexual, between the ages of 18-29, are single, compared to 29% of their straight counterparts. Black adults are more likely to be single than White or Hispanic adults. However, no statistics included Asian Americans. Some studies show we are more likely to get married due to strong values placed on marriage in Asian cultures, and less likely to get divorced. There is also a huge stigma against divorce. For Asian American women, there is a cultural pressure to not only get married, but stay married.
For many South Asian Americans who are first or second-generation, we have no blueprint for the modern world of dating. A lot of us don’t know what a healthy dating experience, let alone a marriage, is supposed to look like if it is even at all possible. In the South Asian diaspora, marriage is taken very seriously, but counter-intuitively; we are not given the opportunity to spend time on making the decision — we are expected to decide very quickly. For most of us, who are children of immigrants, our parents more than likely had an arranged marriage — that was a decision made by our grandparents, aunts and uncles. And the wedding and engagement happened fairly quickly. That is our blueprint
There are many mixed messages about how to approach marriage and dating. Many of us were told to not start dating until after we graduate from college and get a full-time job, which left a lot of us with very little dating experience, and then, Poof! We’re magically just supposed to settle down. There are many desi people who stay single because they know they have issues to work on. A lot of us are aware of how messages about marriage and dating in our communities are sometimes not realistic, if at times rooted in colorism, internalized colonialism, patriarchal and misogynistic values,and racism.
Dating is uncertain because you can’t control whether or not someone wants to date you, let alone if someone wants a relationship with you. And sometimes that has nothing to do with you and everything to do with that person’s preferences or baggage. But is it possible you have some baggage too?
Staying single because of personal baggage is not uncommon for South Asian American millennials. Because of this, many of us believe that something must be “wrong” with us, especially when people ask why we’re still single and unmarried. While we should address underlying issues for why we’re still single, that doesn’t mean anything is necessarily “wrong” with us.
As a licensed therapist, I see many single South Asians Americans who believe that something must be wrong with them because they’ve never been in a relationship before, or because they’re not in a serious relationship yet. If you’re one of these people, I want you to consider:
Who taught you how to date?
Who taught you how to socialize with other genders?
When were you allowed to date?
How often were you allowed to socialize with other genders?
What is your model of a healthy marriage or relationship?
Who taught you free will and how to exercise choice?
How were affection and romance modeled for you?
When we unpack the answers to these questions, we start to realize that there are actually very good reasons for why we’re still single.
If there are that many South Asian Americans who are afraid of dating because they don’t want to repeat toxic relationship patterns, that means that many of us are…meant for each other. So why can’t we find each other?
Our parents had an easier time finding each other because they lived in a homogenous society. My parents came from a community where everyone was of the same or similar Malayalee-Indian background and the same religion. My parents hope that I can find someone from our culture, but they forget that we live in a heterogeneous society, where finding someone who is South Asian, let alone of our specific culture, background, community, and religion, is few and far between. There is pressure on many South Asian Americans to find someone within their specific communities. Not to mention that meeting someone through a mutual connection doesn’t necessarily mean they’re a good fit for you. It makes it feel like our options are limited.
This creates a ‘scarcity mindset.’ Scarcity mindset is the belief that there aren’t enough resources or opportunities out there. When you feel there aren’t enough singles within your community that you can meet, it can cause you to become hyper-fixated on these limited ‘resources’ and even heighten anxiety. And to some extent, there is some truth to that fear — some of my clients are joining dating apps to meet South Asians out-of-state. As the people around you start to settle down, you might start to feel the pressure of settling down quickly to “catch up.” You may have tried to go on a bunch of dates or entertain the idea of certain people in your community, but they eventually fizzle out, fall flat, or end in rejection. You might start to feel discouraged. This kind of pressure can result in:
Avoiding dating in the culture or dating altogether to prevent being hurt or feeling rejected, or having to confront the social anxieties of meeting new people and being open and vulnerable.
Latching on to the idea of someone we meet, working too hard to impress them early on, and attempting to force chemistry to guarantee an outcome (marriage).
When you feel this kind of pressure, you might underestimate or overestimate how to interact with potential partners. This pressure might come from messages you’ve heard in your community that you’ve internalized. For instance, if you’ve heard someone say, “we don’t get divorced in our culture,” you might start to believe that divorce is the worst possible outcome. That might put pressure on you to find the “perfect” partner in order to prevent divorce, but the future of your marriage is not something that you can guarantee. Another example — if you hear your parents tell you to “just compromise,” you might start to believe that your expectations are not realistic; therefore, that’s why you’re not married or in a relationship yet. You might start to lower your expectations and get attached to any potential partner in the hopes that you can guarantee a relationship, but changing who you are does not necessarily mean you’ll attract what you want.
How we approach dating, especially when under this cultural pressure, can have an impact on how we bond emotionally with people. One theory based on psychological research, called Attachment Theory and Styles, describes patterns of how we create and maintain emotional bonds with others and where we fall on the attachment style spectrum or circle. Cultural pressure to settle down and marry someone from your specific culture or community can influence how we date and why, but it prevents us from being mindful and enjoying the process of dating. Your attachment style might be the result of your family dynamics, your parents’ style of emotional connection, and cultural messages you’ve been taught about what a relationship or marriage “should” be like. For example, if you’re under cultural pressure to get married quickly to appease your family, you might develop an anxious attachment style because it triggers thoughts and behaviors that fall under that category. If you question the cultural pressure, you might associate marriage with negative connotations. You might push away dating and marriage and act in the way of an avoidant attachment. Your attachment style is not genetic or something you are born with. It is a pattern of behavior that is about how you relate with others, especially in relationships. It can change over time and vary based on your anxiety or the person you’re seeing. If you want to learn more about attachment style, seeking a therapist is a good resource.
Regardless of what your attachment style is, it can prevent you from being patient, truly vulnerable, and having quality dates or quality relationships. It might keep you in unhealthy dating situations or relationships too long out of fear that you won’t find anyone else “in time.” You might be jumping to conclusions about what should happen next when you date someone. When you really like someone, you might be asking, “What if things go wrong?” But what if things go right?
Valentine’s Day has never been something special for me, and while it would be nice to be in a relationship, I’m not going to let the cultural pressure of what I’m “supposed” to do, as a South Asian American single woman, dictate my life. I have my reasons for being single, and it’s no one’s business but mine (and my therapist’s). If someone in my family or my culture doesn’t approve of my singlehood, then I sincerely hope they’re awake at night thinking about why I’m single. What they think of my life is none of my business. At the same time, I’m not going to shut myself off completely from dating and relationships. Dating will be on my terms. While rejection hurts, I have accepted that people will come and go and I wouldn’t want someone to feel forced or obligated to stay with me if they have emotionally left the relationship. Ultimately, I’m looking for someone who will fit the lifestyle I already have, but if I don’t find my life partner, I’m okay being with myself too.
You don’t have to follow your parents’ blueprint to marriage and relationships. You’re allowed to follow your own. If we adopt an abundance mindset, a mindset of knowing that there are enough resources for everyone and accepting what resources are available to us — along with practicing healthy relationship habits — we might develop better, more satisfying relationships. There are enough single South Asian Americans out there who would love to be with you. Stand firm in who you are and what you want, and be open to what comes your way.
The Covid-19 pandemic and feelings of uncertainty, which have been prevalent across the globe, had lasting effects on all of us. One of the more positive impacts has been on the mental health industry, particularly the normalization of mental health challenges and a more open dialogue about mental health. There have been discussions in the workplace, in schools, and even on Hinge profiles, but what about in South Asian communities? Though some progress has been made, mental health stigma is still widely prevalent among South Asians, impacting individuals’ desire and comfort in seeking help. As a result, the South Asian community reports lower rates of seeking mental health services. And of the individuals who do seek out mental health services, many face challenges in finding therapists who are equipped with a multiculturally competent skill set to understand the South Asian client’s concerns. This is why it’s important to recognize and become aware of the intersections of mental health and South Asian communities.
Although there is an overlap between the mental health concerns of South Asians and other communities of color, there are also unique intersections between culture and mental healththat I want to bring to the forefront of this conversation. As a South Asian psychologist, who is both a researcher and clinician, I have firsthand experience examining how our individual cultural context impacts our emotional experience. If we can understand, or at least consider, how the cultural context impacts us, we can better understand ourselves and feel seen by others too. We, South Asians, are a diverse group in terms of ethnicity, language, food, religion, traditions, and so much more. So, while learning about the “state of mental health in South Asian communities” is much more complex and nuanced than what I can cover in just one editorial, I believe starting the conversation about issues that don’t get talked about nearly enough is an important first step towards destigmatization.
What is the state of mental health in the South Asian community?
Here are some numbers to set the stage, based on research done on South Asian communities. One in 5 South Asians currently reports experiencing mood or anxiety disorders. South Asian youth and young women, in particular, are at greater risk of having suicidal thoughts and behaviors compared to other groups. Only 24 percent of South Asians diagnosed with a substance abuse problem sought treatment. And South Asian Americans express greater stigma toward mental illness than other ethnic groups. How often are facts like these discussed? Not often. Since South Asians are often mixed in with the larger Asian American population, these issues and their nuances are rarely discussed within mental health communities. This underrepresentation can make the reality of our emotional experiences easily misunderstood and make our needs feel invisible. Relatedly, concepts like “model minority” lead outsiders to often assume that South Asians are well-adjusted. And even within the South Asian community, stigma and beliefs about the causes of mental health issues (e.g., mental illness indicates problems within the family, a sign of weakness, etc.) lead all these facts to continue being ignored.
How do mental health concerns intersect with South Asian culture?
While mental health concerns are prevalent among my clients from all backgrounds, these common concerns intersect with culture to create an individualized version of the issue that requires specialized attention and care.
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.
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.
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.
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.
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.
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).
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).
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.
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.