Dr. Kani’s Take: A guide to Desi mental health

When I started my psychiatry practice in 2008, Desi patients only came to me when they were in dire emergencies, such as on the verge of suicide or when the police were involved. My first Desi patient was a house call, and the police were at his home when I arrived. 

Now, Desi patients are reaching out to me because they are sad, anxious, or having delusions, hallucinations, mood swings, or insomnia, but not solely because they are on the verge of hospitalization or imprisonment.

I am grateful that we can intervene earlier in the course of their illness. In today’s column, I want to discuss the ins and outs of mental health, as well as share a valuable resource:

Advocates for Desi mental health

South Asian Mental Health Awareness in Jersey, or SAMHAJ, is one of the leaders in advocating for mental health in our community. As a psychiatrist, I see the impact of SAMHAJ’s work.

Subha Bolisetty, the organization’s program manager, told me she pursued this work because of her son’s physical disabilities and mental health challenges. 

Bolisetty observed that when her son was getting heart surgery, many members of the South Asian community provided support. But once they came to know that her son was autistic and had mental health challenges, the number of people who supported her family reduced drastically. Some people even thought her son’s anxiety would be contagious, so they stopped inviting him to playdates.

The experience filtered their social circle. Bolisetty says now they “have a core group of friends who accept us as a family and who are there for us every moment. They have become our chosen family.”

Bolisetty expressed that there is a lack of awareness, understanding and support in the South Asian American community.

If someone breaks a leg, you get a lot of support from the family, but when it comes to mental health, people don’t know how to react and what to say. SAMHAJ helps provide this vital education.

Cultural shame and emotions

SAMHAJ hosts a Recovery Connection Group facilitated by young adults who share the need for open communication with loved ones and changing the way we talk with each other.

It’s common in Desi culture to feel shame around expressing emotions, according to therapist Sangeetha Thomas. She says the masking of emotions exists across all ethnic subgroups of Asian communities, and we have immigrated with that mask.

We need to share how we feel so we can model to our children how to express and share feelings. If we don’t share our feelings, how can we expect our children to share their feelings?

Bolisetty mentioned there are cultural misconceptions that mental illness is “just a phase” or a person “acting out.” She gets comments from some family members that she is spoiling her son because she is too attentive.

“I am giving him what he deserves,” she said. “He needs a little more protection because of his heart condition and his issues with comprehension. We want him to advocate for himself and be independent.”

There are multiple reasons why Desis don’t feel comfortable with emotional expression.

In South Asian cinema, characters who show psychological symptoms aren’t treated with compassion, understanding or therapy. Rather, they are shipped off to a psychiatric hospital, Bolisetty said, adding that the common refrain is to “put them on the Erragadda bus,” in reference to a local psychiatric hospital. 

Desis may also be reluctant to disclose mental illnesses in the family because they fear that it would adversely impact the marital prospects of not only the affected individual but all their family members, due to community stigma around mental health.

Grace Jung, a media studies Ph.D. and stand-up comedian, shared some additional cultural reasons for mental health stigmatization in her book K-Drama School: “The fear of being labeled an invalid is linked to its associations with weakness and lacking use value. It’s a fear tied to the need to survive — you must have a purpose or you will be killed. In Asian countries, where war and despots had zero tolerance for the invalid, admitting to any illness or making any mention of a need was suicidal.”

The case for therapy

Due to historical and cultural stigma, some Desis may think it is a weakness to go to a therapist. I strongly disagree and tell my patients that even Olympic athletes need coaches. We live in a time when therapy and medication are readily available. Why not get the help you need?

Devoting time to healing helps restore our strength, resilience, compassion, energy, patience and perspective. It is a huge gift to yourself and others, especially your family, during the political and economic conditions of our current chaotic world situation. 

I am in therapy, and I find it helps me recover myself, my memories, my relationships and my humanity. Therapy helps me not feel like just a cog in the production machine. 

“I want everyone to look at mental health as any other form of physical health,” Bolisetty shared. “I want to normalize [talking about] mental illness so that people will reach out whenever they need help with their mental health. With more awareness, more people will get help, so they can be more productive and happier.” 

Who should go to therapy

Anyone who could benefit should go to therapy. You don’t have to be totally distraught and depressed. You don’t have to be at a certain point on the scale of suffering to qualify.

You could go if you feel you would like to discuss some of the issues you are facing in your life with someone objective outside of your friends, family and coworker orbit.

You could go if you are feeling tired and would benefit from some support. You could unburden your heart from secrets you are carrying or the trauma you have experienced, with ensured confidentiality — as long as your therapist is not concerned that you are an imminent risk to yourself or others.

If doing it for yourself is not sufficient motivation, please consider doing it to help heal your children and future generations. 

As psychotherapist Terrence Real put it in one of his books, “Family dysfunction rolls down from generation to generation, like a fire in the woods, taking down everything in its path until one generation has the courage to turn and face the flames. That person brings peace to their ancestors and spares the children that follow.” 

If you feel your loved one needs professional mental help but doesn't seek therapy, I encourage you to go so you can learn how to cope with them more easily and provide them with a good example of self care. There are also some resources from the National Alliance on Mental Illness (NAMI) for how to approach loved ones who may not recognize or understand their mental health challenges. 

If you have a loved one with mental illness, be as kind and compassionate to them as possible, advises Saroja Ilangovan, M.D., a longtime NAMI volunteer and my mother. Your loved one did not ask to be born with a mental illness, and they are doing what they can to cope with their situation.

If we are kind and accepting, our loved ones are more likely to feel valued and engaged in their treatment. If we are critical, our loved ones are more likely to be withdrawn and disengaged in their treatment. 

May you seek the support that is readily available and enter a space where you feel seen, valued and heard. I like the saying, “Hurt people hurt people. Healed people heal people.” We need all the healers we can get in our heartbreaking and beautiful world.

Dr. Kani Ilangovan is a child, adolescent and adult psychiatrist, mother, writer and activist. She is a board member of The E Pluribus Unum Project and works for pluralistic curriculum advocacy.

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