Wellness: Breaking Down Barriers: South Asians and Mental Health

By Devika Koppikar

Thirty-year-old Neetha, a New Jersey dentist, refused to consider an arranged marriage her parents had set up. The resulting turmoil caused her to seek help in the form of psychotherapy. But after just one session, her 55-year-old male Caucasian psychiatrist bluntly announced, “I can’t help you. Your emotions are situational and I don’t understand your situation.”

She then turned to a counselor of Bangladeshi descent, who better understood her family’s expectations and helped her heal, said Neetha. “The South Asian therapist was significantly better, since she understood the culture and I didn’t have to spend precious therapy time explaining things to her,” she said. “I didn’t have to explain the pressures I face against living an independent, single life.”

Neetha’s story is not unusual. For many South Asians who have grown up in the United States, finding a therapist who understands South Asian culture—especially South Asian family dynamics—is rare. And when professional therapists analyze a situation experienced by a South Asian client, the result may not always apply in a South Asian context, according to Razia Kosi, a licensed clinical social worker (LCSW) in Ellicot City, Maryland.

“For example, if a 30-year-old South Asian woman lives with her parents, the therapist might say the woman is ‘enmeshed with her family.’ However, living with one’s parents until marriage is the norm in many families,” said Kosi, a Tamil speaker who was born in India.

To help address this intercultural gap between therapists and South Asian clients, Kosi helped establish Counselors Helping South Asian Indians (CHAI) in 2001, and serves as executive director. A nonprofit organization based in Columbia, Maryland, CHAI is composed of volunteers concerned about mental health in the South Asian community. Its specific mission involves mental health outreach, referral and educational services.

One of CHAI’s major endeavors is the Culturally Proficient Professional Workshops. The workshops provide cultural training to mainstream therapists to better serve South Asian clients. The workshops cover basic information such as where South Asians come from, cultural differences, stereotypes, taboos and norms.

“Pathological definitions of mental health do not smoothly translate from country to country,” said Kosi. “South Asians often view or handle family situations differently. So we train therapists to break down the psychoanalytical language into a South Asian context.”

Suzanne Gee, a Woodbridge, Virginia resident who was married to an Indian man for 14 years, said it’s important for a person seeking therapy to work with someone who understands their values. “The (client) must sort out how to make choices based on living in a society that in many ways is different than the one they grew up in. Relationship norms are very different in each culture. For instance, Indian people don’t date for the most part, and role expectations are different.”

Clinical psychologist Mehvash Ali, PhD., who practiced in the Midwest and West Coast before moving to the United Arab Emirates said, “An individual may feel that a counselor from the same background may have a more thorough understanding of the issues, especially if they are culturally bound and therefore have more trust in the treatment being provided.”

In addition to cultural sensitivity workshops for non-South Asian therapists, CHAI also aims make the South Asian community more aware of the benefits of mental health therapy.

“People are not open about mental health in the South Asian community,” Kosi said, explaining that the immigrant generation prefers to consult extended family or religious leaders for family matters.

“However, as social status and pressure to be a ‘model minority’ is important in the South Asian community, many hesitate to seek help from other community members at risk ‘losing face,’” Kosi added.

Ali added, “Since family members and religious leaders are part of the individual’s social circle and will continue to be a part of the individual’s life even after the issue is resolved, the person may not feel comfortable disclosing all the issues, negative or shameful thoughts, and feelings that they might be experiencing.”

Therefore, through the women’s wellness group and book club, CHAI aims to create a safe space for people to discuss challenges that the South Asian community sees as taboo, including marriages falling apart, sexual abuse, pre-marital sex and incest.

Also leading some South Asians to hesitate before addressing mental health, Kosi said, are problems including anxiety, depression, suicide, alcoholism and substance abuse. “Traditionally, these challenges have been downplayed or taken less seriously,” he said.

According to Ali, “South Asians tend to wait longer before seeking help for mental health issues than their Caucasian counterparts. If they do seek help for mental health issues, South Asians are more likely to first go to a medical doctor than a psychologist or mental health counselor. South Asians do have a tendency to minimize the impact that mental health issues can have on your overall health.”

Both Ali and Kosi said the attention given to mental health and the type of action South Asians take depends on specific demographics.

“Attitudes towards seeking assistance for mental health issues are dependent on several factors including gender, educational level, age, and acculturation,” said Ali. “Family members and religious leaders in the community can be a great source of support for South Asians and seeking their help can be a very important component of recovery. However, I would be cautious in relying solely on such individuals for serious mental health problems. Mental health professionals have years of training in identifying underlying issues, and providing a variety of interventions to address the problems. Mental health professionals are training to identify and intervene in case there are severe underlying mental health issues that may not be apparent to others.”

For CHAI, the crux of their mission, according to Kosi, is to make South Asians less resistant to therapy, to be aware of its benefits, and to train those providing such services to be more proficient in meeting their clients’ needs.

“Ultimately, we teach people to take ownership of their mental health and develop healthy communication patterns that contribute to a person’s holistic wellness,” he said.

For information about CHAI, visit www.chaicounselors.org.