When I mentioned it to my friend, her eyes bulged a bit. She said:
Oh my god, why? Is everything okay?
And then, quickly:
That’s good, though. I mean, we all probably need it.
Her response was the clumsiest I had received to my admission about not being available to go out:
Sorry, I can’t. I have therapy.
There was a time when I would have debated telling her, a family friend whom I have known since I was three. Our mothers, despite being friends for decades, are as likely to volunteer that kind of information to each other as they are to seek out therapy in the first place. Which is to say, not at all likely.
In my experience—and, I assume, that of so many South Asians—going to therapy is a shameful thing. It is indicative not of temporal difficulties, chemical imbalances of serotonin outside of our control or, you know, just wanting someone to talk to, but instead of an inherently damaged person. And it’s a question of image, as most things are.
People will think I’m abnormal. People will question my parent’s parenting. They will be wary. Uncomfortable. They will speak in hushed tones when I leave the table at a dinner party and with loud, disdainful authority on phone calls afterward. That my frustration with the stigma around seeking therapy took up a few sessions with my therapist is some cruel irony.
I never had to tell my mother about this; one of the greatest privileges I’ve acquired as an adult is my own health insurance plan. When I did casually mention my weekly sessions, she was upset. She asked how and why, despite her best efforts at raising me, I was “still unhappy.” She said:
When we were upset, we talked to our family.
I figured it wouldn’t help to point out that our family members go to painstaking lengths to hide unpleasant details from each other.
I have always known that I can talk to close friends about it. Most of them either go to therapy, used to go, or have considered it. When I worry out loud to my best friend—about the existential dread of Sunday nights, the looming threat of complacency, the latest boy to wrong me, etc.—she’ll say:
I can’t recommend SSRIs enough.
And I laugh because it’s funny, but it’s also reassuring. We won’t waste any time pretending everything is fine.
Openness from my friends is what encouraged me to seek out therapy when I needed it in the first place. Eventually, I stopped going out of my way to make up some other excuse for why I am busy on Tuesday nights or wondering whether it’s a good idea to talk about it.
(Spoiler alert: It definitely is a good idea to talk about it.)
Now, in conversation I’ll say without ceremony or taking a deep breath:
Well, my therapist says…
Yes, it is personal, but it has nothing to do with wanting to air personal information. It has everything to do with giving visibility to something that feels as ordinary and necessary for me as shopping for groceries. The process of normalizing a topic by just talking about it is the simplest concept, and yet so frustratingly rare for mental health.
So when I told this Pakistani friend that therapy helps me make sense of my feelings towards people and situations, helps me avoid burdening friends with emotional baggage, and in general, teaches me about myself, she said:
You know, I always wondered whether I should talk to someone, and I have no idea where to even start looking.
I gave her some tips. I don’t know if she will follow through on it, but I do know that there is lightness in discovering that you aren’t alone.
May is Mental Health Awareness Month. If you would like to contribute to our #TherapyTalk series, please email us at Staff@0mq.349.myftpupload.com with your submission.
Komal Kazim lives in Brooklyn, NY and works in advertising. She likes anemones and Kanye West and is a diehard poptimist.
The Covid-19 pandemic and feelings of uncertainty, which have been prevalent across the globe, had lasting effects on all of us. One of the more positive impacts has been on the mental health industry, particularly the normalization of mental health challenges and a more open dialogue about mental health. There have been discussions in the workplace, in schools, and even on Hinge profiles, but what about in South Asian communities? Though some progress has been made, mental health stigma is still widely prevalent among South Asians, impacting individuals’ desire and comfort in seeking help. As a result, the South Asian community reports lower rates of seeking mental health services. And of the individuals who do seek out mental health services, many face challenges in finding therapists who are equipped with a multiculturally competent skill set to understand the South Asian client’s concerns. This is why it’s important to recognize and become aware of the intersections of mental health and South Asian communities.
Although there is an overlap between the mental health concerns of South Asians and other communities of color, there are also unique intersections between culture and mental healththat I want to bring to the forefront of this conversation. As a South Asian psychologist, who is both a researcher and clinician, I have firsthand experience examining how our individual cultural context impacts our emotional experience. If we can understand, or at least consider, how the cultural context impacts us, we can better understand ourselves and feel seen by others too. We, South Asians, are a diverse group in terms of ethnicity, language, food, religion, traditions, and so much more. So, while learning about the “state of mental health in South Asian communities” is much more complex and nuanced than what I can cover in just one editorial, I believe starting the conversation about issues that don’t get talked about nearly enough is an important first step towards destigmatization.
What is the state of mental health in the South Asian community?
Here are some numbers to set the stage, based on research done on South Asian communities. One in 5 South Asians currently reports experiencing mood or anxiety disorders. South Asian youth and young women, in particular, are at greater risk of having suicidal thoughts and behaviors compared to other groups. Only 24 percent of South Asians diagnosed with a substance abuse problem sought treatment. And South Asian Americans express greater stigma toward mental illness than other ethnic groups. How often are facts like these discussed? Not often. Since South Asians are often mixed in with the larger Asian American population, these issues and their nuances are rarely discussed within mental health communities. This underrepresentation can make the reality of our emotional experiences easily misunderstood and make our needs feel invisible. Relatedly, concepts like “model minority” lead outsiders to often assume that South Asians are well-adjusted. And even within the South Asian community, stigma and beliefs about the causes of mental health issues (e.g., mental illness indicates problems within the family, a sign of weakness, etc.) lead all these facts to continue being ignored.
How do mental health concerns intersect with South Asian culture?
While mental health concerns are prevalent among my clients from all backgrounds, these common concerns intersect with culture to create an individualized version of the issue that requires specialized attention and care.
Substance abuse
Within the South Asian community, there are cultural differences in alcohol and drug use and the discussion of these topics. Alcohol is prohibited in Muslim and Jain faiths which makes open dialogue about substance abuse and its prevalence even more of a challenge within these communities. Admitting you have a problem can be hard and adding the cultural taboo can make it more difficult.
Career stress
There is a tendency in the South Asian community to highlight that only linear careers in financially stable or ‘reputable’ fields — such as medicine, engineering or finance — will lead to success. This expectation not only impacts career decisions but also mental health, self-esteem, and self-confidence. Even if we think we are not influenced by outside factors in our career choices, how do we know that subconscious messaging is not impacting our decisions? I personally was pre-med for as long as I can remember and was apprehensive if my parents were going to accept my desire to go into psychology and mental health instead of medicine.
Caretaker stress
Caring for loved ones, who are aging or ill, is emotionally challenging for most people. What makes this stress unique for the South Asian community? South Asian communities are collectivistic and therefore rely strongly on interdependence well into adulthood. Therefore, caretaking and providing for elders is an integrated part of our lifestyles. Pursuing personal goals can sometimes be seen as selfish and therefore South Asians feel the need to sacrifice personal desires. This can make setting boundaries in relationships or making decisions focused on one’s own needs especially difficult and not as straightforward as may be suggested by Western psychotherapy interventions.
Relationship stress
Romantic relationships can be especially stressful for South Asians because of the need to navigate between one’s own desires and family expectations. Older generations pass down messages that people should focus on their careers instead of dating, which can lead to not dating or secret dating and youth navigating romantic relationships on their own. Then, suddenly, the conversation shifts to the need to get married by a certain age, which seems especially difficult when you have not been allowed to date or when it is not something you want in your 20s. South Asians may also experience family expectations about their partner being from the same ethnic/religious background, working in a specific industry, or having a specific family background. These family or cultural expectations and issues also impact the LGBTQI+ South Asian community and South Asians often feel the need to sacrifice personal desires for the expectations that their families or deep-rooted social norms have set for them.
Emotional Awareness
Being able to communicate the complexity of our emotional experience is especially challenging when being emotional is considered a weakness. This cultural sentiment further perpetuates emotional suppression and increases the barrier to seeking support. Also, South Asian languages have limited vocabulary to describe mental health and the emotions involved. It is not only challenging to identify our emotions, but it is difficult to communicate the complexity due to the lack of words in South Asian languages to describe those emotions. Let’s take the word, “gussa,” which means “angry” in Hindi. The only way to explain the level of anger you are feeling is to describe the full situation. While in English, you can use variations of the word “anger,” such as “annoyed” or “furious” to describe the emotions with more nuance.
Body image
Culture is integrated in small and big ways into how South Asians experience their body. It can be common for family members, especially older women or “aunties,” to comment on one’s body weight in direct ways like telling someone they have gotten fat or thin. There are also unspoken rules about food that impact one’s relationship with food and potentially overeating, including “it is rude to not finish all the food on your plate,” or if you don’t go up for seconds that means you didn’t like the food. Research has also found South Asian women in particular often struggle with the pressure to conform to Western beauty norms (e.g. removing dark hair, and lightening skin color).
Identity development
We all are constantly evolving and understanding who we are and what we value. What makes this unique for South Asians? Culture intersects with other parts of our identity, including generational status (1st, 2nd, or 3+ generation), religious beliefs, gender identity, and age which impact the way we make sense of who we are. Being born in the US makes one American, but are you still American if you primarily connect with your South Asian ethnic identity or maybe your religious identity? Or what messages does culture pass down about what it means to be female? Are you supposed to do all the cooking and cleaning? Do you have to have children? Culture intersects with identity development in complex ways.
How can you get support with what you may be feeling and experiencing?
I believe the first step in breaking the barriers, is shifting your mindset about seeking mental health support from something that means you have a “character flaw” to something that you do for your overall well-being. Taking care of your emotions and processing your emotional experiences is as important as your weekly workouts, annual physicals, or that apple a day. One way to start this process on your own is to spend 10 minutes a day engaging in mental hygiene practices (meditation, gratitude journal, positive experience journaling, writing a thought log, prayer, or deliberate time in nature).
Alternatively, if you feel ready and have the means, try searching for a mental healthcare provider who actually understands and is aware of your cultural background and belief system. As we think of all the ways mental health can intersect with cultural context, it is helpful when your provider can hold cultural identity as being critical to your treatment. There is a clear and urgent need for therapists and interventions that use culturally-relevant treatments to drive clinical outcomes. One such resource is Anise Health, which is the first culturally-responsive digital mental health platform built by and for the Asian American community. Anise Health, co-founded by Nisha Desai and Alice Zhang, incorporates culture and intersectionality into clinician training and offers a wide range of evidence-based online services (therapy, coaching, self-guided resources) that are tailored to meet your unique needs.
If any of the concerns I discussed earlier resonated with you, consider signing up for Anise Health by filling out this short intake form; you’ll get matched to a culturally-responsive clinician within two business days. I’ve also listed a few additional resources below that aim to address mental health needs in South Asian communities.
I hope we can continue to bring the ways our South Asian culture impacts our well-being into the forefront of the conversation around mental health. By highlighting the South Asian community’s experiences,we can feel more seen and create a more accepting environment that allows us to get the help that we all deserve.
If you or someone you know is in an emergency, call The National Suicide Prevention Lifeline at 800-273-TALK (8255) or call 911 immediately.
February 28, 2023February 28, 2023 4min readBy Sara Qadeer
Hi! I am Sara and I am a mom to a beautiful, neurodivergent child. This piece explores some challenges of parenting an atypical child in a typical world.
It is a sunny day in the summer of 2020 and I am trying to enjoy the only entertainment that has finally been “allowed” by our province. Parks. Sunshine was always free; scarce but free. I have eyes on my daughter, running and somersaulting, with that untethered quality they say she gets from me, while socializing with two girls her age from a distance.
All of a sudden, the distance called ‘social’ gets smaller and as I run and call out in vain my child has the kid in a tight and loving but forbidden hug. I understand that pandemic or no pandemic, physical space is a basic right but for my daughter, it falls under the ‘but why?’ category.
The next 15 minutes are spent apologizing to an exasperated mother asking me why my kid was not taught the dangers of COVID-19 and personal space. She is four, I tell her, she just got excited. At some point, I zone out and just let her say her piece. Some of it is in a language I have never heard before, complete with hand gestures and melodrama as if it was not a preschooler but Bigfoot.
Maybe later I will do the thing we all do; oh, I should have said that. Maybe I won’t. This is not the first time my kid has drawn public attention and it is not the last.
Six months later, we received a diagnosis for Autism Spectrum Disorder (ASD). After the reaction time (read stress eating and ugly crying) ended, we began our journey of raising an atypical child in a world that insists on the typical.
Textbook wise, neurodivergence includes Autism, ADHD, Asperger’s Syndrome, Dyslexia, Dyscalculia, OCD, hyperlexia and Tourette Syndrome.
I could write a book on my journey as a mom raising a child who is neurodivergent (ND). I will in due time and the first chapter would be, “Fighting for inclusion in a world insisting on exclusion.” If you ask any parent with a neurodivergent kid, they will tell you that it is not finances or the fear of the future bringing them down, it is just people. But that’s been the case since the dawn of time anyway.
If you are someone who is kind and inclusive but are confused by the jargon, read on for some guidance that will make you an ever-favorite ally and, well basically, just decent. It is just basic decency after all to be inclusive and kind.
If you have a kid on the spectrum for ASD or ADHD or any other neurodivergence in your social circle, the first step is to not stop being friends with their parents. Yes, that happens. Parents can get super isolated and alienated because their kid is a certain way. Give ND families a chance to breathe. Invite them to BBQs, ask them what their kid will eat, encourage your kids to include them — the whole nine yards.
There will be meltdowns, at birthday parties, at the mall, in restaurants. Sometimes the best thing to do is to look the other way. Ask the right questions. Rather than asking “what happened?” or “why are they doing this?”simply say “how can I help?” Maybe you can help with another sibling or give the child some space.
Do not equate a sensory meltdown or otherwise to a parenting failure or a lack of discipline. ND parents face a lot of judgment on those grounds. That is one of the top reasons they scoop up their kids and leave before dinner is even served.
The biggest challenge in our community is acceptance. There is a dire need to accept that around 30 percent of our population is neurodivergent. This includes adults and undiagnosed individuals. You and I might not even know if we are atypical, the world is just getting to know this word and what it entails. As for the South Asian community, neurodivergence is practically stigmatized and seen as ‘spoilt’ child behavior or ‘mom spending too much time at work, on social media, Netflix, sewing, knitting, kayaking…’ The list goes on.
It is 2022 and we are all trying to make space for people at our tables. This includes people who might not look or act or perceive the world like us. As a parent I have fears that all parents have, but somehow those fears have been heightened to exponential limits ever since my kid’s diagnosis came through.
How is she doing? Did someone bully her? Does she have friends? Is she included in activities? What if she says something silly and they laugh at her? What happens when she is older? Will she go to college? I should not be thinking that. I want to think about how much she is learning at school, what game they played today, what she and her friends talk about and all other typical mom things.
Except I am not a typical mom. And that is okay.
My child has wonder; she has innocence. I see things from her lens and her computation of the world is unique. The biggest misconception people have is of intelligence. A child with autism finds difficulty in processing social cues (like sarcasm) but otherwise they are as smart as you and me, if not more. Probably more.
Some days are hard but not all days are hard, and not every moment of that rough day is difficult. We, parents of ND children, do not keep obsessing over the fact that our kids are atypical; we binge watch the same shows, we have hobbies and interests and date nights and ‘me-time.’ Some days are magical and the most important thing for people to know is that Autism families are not looking for pity parties, just kindness and inclusion with a healthy sprinkle of understanding— an understanding of the atypical in a world only rooting for the typical.
I’m at the gym. I’m on my grind. I keep telling myself that if I keep doing ‘X, Y, and Z,’ I’ll get results. Which is true — all the fitness gurus say so. The personal trainer I once had said as much. Yet, I forget to take a breather. I’m hoping for instant gratification, when I know the results I want — better energy, endurance, and metabolism — take time. I have to be patient with myself. So why do I feel pressured?
When I sit down to take a breath, I notice this idea of instant gratification weaves a common thread. I put pressure on myself to complete projects, quicker and faster. As a licensed therapist, my clients also talk about how they feel the pressure to do more work in a shorter amount of time, leading to longer work days and burnout. Some new clients ask, “How long does therapy take? Will I feel better after three sessions?” It’s like those junk tabloids with headlines like, “how to lose 10 lbs in 10 days!” In an ever-changing, fast-paced world, there are expectations to do things faster and better. On top of that, a relationship with our body, our career, our mind, and yes, our therapist, takes time too. To wait for results can create an uneasy feeling. We can’t trust the process if we don’t see results right away. We’re focused on the destination rather than the journey.
I believe the same idea is being applied to dating and relationships too. I cringe and roll my eyes when I hear, “Dating is a numbers game.” While it’s true that you might have to meet many people before finding your person, this has caused some of my clients to ‘gamify’ dating: swiping right on every dating profile and trying too hard on the first date in the hopes of landing “the one.” This prevents them from slowing down, truly seeing the person in front of them for who they are, and being vulnerable. My South Asian American clients feel the cultural pressure to settle down quickly and think they need to “catch up” with their friends who are getting married. They’re working very hard in the South Asian dating market, hitting up all the singles they meet, and finding instant chemistry with “the one.”
But just like a fad diet, once you get the results, you’re back at square one. You gain all the weight back, and the person you fell in love with falls out of love with you. You start to feel demotivated and hopeless all over again. Relationships that build quickly tend to fizzle out quickly too.
Here’s how South Asian American singles should stop shaming themselves for being single, this Valentine’s Day season, and try dating with intention. At the same time, this therapist has some thoughts on how we South Asian singles could be dating better. If you’re single this Valentine’s season and wondering, “when am I going to find my person?” you’re going to have to challenge some long-held, societal beliefs about dating, marriage, and relationships, both within and outside of our culture. It means:
Being okay with not going on a ton of dates
Dating is not a game to win! Forget about the “numbers” game. You are also not trying to “trick” anyone into being with you. That shit is not cute. Show up authentically and don’t be afraid to be “caught off guard.” After changing their perspective, some of my clients tell me, “I haven’t found a decent quality person!” Yeah, that’s kind of the whole point. You could go on a ton of mindless dates and have your time wasted, or you can have one or two quality dates and feel fulfilled. Pick one.
Stop love-bombing
Because some South Asian cultures have a much faster timeline with marriage, you might find yourself trying way too hard to impress your first date in the hopes that it will rush the chemistry high. Dating scenarios that start this way burn out once things get serious. Looking for chemistry too soon is like chasing a temporary high. Be patient and take your time getting to know someone because chemistry takes a long time to build.
Paying attention to what your date says and how they say it
We’re all putting our best foot forward on a first date. What do they talk about? How do they talk about other people? Does the conversation feel superficial? Does it feel like a performance? Do they take an interest in you? Are they sharing anything about themselves?
Remembering what you want from a long-term partner
Superficial qualities aren’t an indicator of how good of a partner they’ll be in the future. Having a high income doesn’t mean they’ll contribute to your relationship or the family you both build. However, their financial decision-making can indicate what they prioritize and what they value. And while physical attraction is important, there is no fountain of youth. Will you still want to share your life with this person when they are 60? Or will they annoy the shit out of you?
Taking your parents’ opinion with a grain of salt
Marriage is not just a blending of two families; it’s a ‘business contract’ between you and your spouse. Would you go into business with this person? Would you want to share physical space with them? Share a bed with them? Your parents are not the ones who are going to bump uglies with them, and at some point, your parents will no longer be around. Whose decision do you want to be stuck with?
Remembering no one is perfect
There is no such thing as “Mr/Mrs. Right.” Let go of the idea that there is someone better out there. Dealbreakers are important because they indicate what you have tolerance and patience for, and this can affect intimacy, but don’t write someone off for something workable. Think about the things that give you the “ick” versus things that don’t give you the “ick.” If someone’s qualities are only mildly imperfect but overall don’t give you the “ick,” then it shouldn’t be a dealbreaker. If it’s something that can be changed, then maybe it’s worth being flexible. If it’s something that can’t be changed and you can’t get over it, then you’re wasting your time and their time too.
As a South Asian American who is also single, I am pressured by my family to get married quickly too. I know that many people in my situation would either give in to their demands or take matters into their own hands. They might date to appease their parents that they’re “working on it.” But I refuse to give in to the pressure. When I date, I date to enjoy the person in front of me. I see the person for who they are, not some idea I cooked up in my head for the outcome I’m trying to achieve. I put my most authentic self forward. If this doesn’t result in a relationship quickly, I’m okay with that.
If this therapist can be patient with her process, then why can’t you? Like exercise, relationships take time, and you could be doing everything right and still not getting exactly what you want. You won’t be a good fit for everyone, and likewise, not everyone will be a good fit for you. But don’t close yourself off from the world. This Valentine’s season, learn to trust the process. Tune out the noise; the idea of “instant gratification,” Be patient, be honest, and be yourself. And don’t forget to take that breather.
