Seeking Therapy in the South Asian Community

“Why therapy? Aren't we enough?”

These were the words one of my young clients, Simran (note: all names have been changed to protect individuals’ identities), heard from her family when she told them she was seeking therapy. Albeit with good intentions, South Asian families often view the decision to seek therapy as a reflection of their failure to address their loved one’s problems at home.

“You are, Ma,” Simran responded, “but I've been feeling down and I need an outlet for my feelings.” Her mother’s reaction was telling. “Don’t we provide enough for you? You went to an excellent school and have a great job. Why are you so upset?”

The complex issues swirling around these common interactions between immigrant parents and their first-generation South Asian children when it comes to seeking mental health treatment are worth considering. Family members sometimes have trouble supporting or fully understanding how debilitating mental health challenges can be. Their immediate reactions may range from defensiveness about their parenting and financial status, to concern about social stigma. “Log kya kahenge?” as Hasan Minhaj brilliantly explored in "Homecoming King." What will people say?

Even beyond financial success and social status, the wellbeing and achievements of their children are the silent scorecards that many immigrant families keep all their lives in weighing the wisdom of their monumental decision to come to the United States—against all odds, leaving their families behind, and investing decades of hard work and sacrifice for which they may never personally see a return. Those deeply held emotions leave very little space for empathy for the invisible mental health struggles of children who are meant to be the visible totems of their success.

Thus, an individual’s lack of motivation may be viewed as mere laziness, and sad feelings as self-indulgent, ephemeral, or even nonsensical. Anxiety, depression, and more serious mental illnesses are deemed issues to be kept under wraps and handled in secret within the family.

Unfortunately, such reactions inevitably worsen an individual’s mental health symptoms. Several of my South Asian clients over the years have shared that they have felt much worse after hearing these types of reactions from their parents and have therefore kept their challenges secret from them.

“You should feel lucky you have a good family who is not broken.” —mother of Neha, age 16.

Culturally, South Asians tend to place a huge emphasis on gratitude for one’s blessings and respect for the wisdom of one’s elders. Gratitude is a powerfully healing emotion and can be a tremendous construct for individuals as they rebuild their inner resources to tackle mental health struggles. However, this call for gratitude in the context above is not always entirely pure; it often comes laced with a guilt trip. The emphasis on leaning on one’s “good family who is not broken” and the advice of one’s elders can be a double-edged sword if inherent family dysfunctions are overlooked or excused in the service of blind obedience.

“Don’t waste your time and money on such things; you just need to be stronger.” —father of Jay, age 23.

Another common cultural factor is the high value placed on inner strength and forbearance. These are undoubtedly positive and critical assets if deployed in a healthy way. However, these same strengths become liabilities when there is a push for reticence. Keeping a lid on one’s pain and suffering alone, while traditionally seen as a cultural virtue, can be very harmful.

“Why can’t you just be happy?” —mother of Amolya, age 16.

With this kind of gut-punch question, South Asian parents can unintentionally transfer their own guilt to their children. Guilt is often a major emotional factor in the South Asian immigrant story and a predominant thread that underlies many of the above statements and themes.

Guilt refers to “the feeling of responsibility for an offense, a crime, or a wrong act that is real or imagined.” It can be either a positive or a toxic force and is frequently used as the latter. While guilt can propel us towards making amends and guide us back to a feeling of inner alignment with our values, it can lay heavily in our bodies, literally acting as a burden that weighs us down. Guilt is one of the less obvious clinical symptoms of depression that clinicians are taught to look for. It goes along with feelings of worthlessness and irrational expectations, indicated in the DSM as "delusional guilt."

In the South Asian community, guilt culture helps to maintain a collectivist framework. As discussed in the case of Neha above, guilt can be subconsciously weaponized by family members to secure obedience and loyalty. This can range from benign statements such as, “No one understands my pain” to more harmful statements like, “You are a disgrace to this family.”

Guilt Essential Reads

Parental Engagement When an Adult Child Has a Mental Illness

Why Mothers Feel So Guilty, and What to Do About It

When individuals seeking help are guilted out of doing so, made to feel they are jeopardizing their family status and causing their parents pain, the consequences can be disastrous and irreversible. They either seek help in secret, with the fear of being discovered, or reject support altogether. Guilt can wreak long-term havoc on self-esteem, familial relationships, and physical health.

As I continue to work with clients who face these familial challenges, I also feel a great deal of empathy for the trepidation parents feel when confronted with mental health challenges in their children’s lives. Below are some tips I have shared with South Asian parents learning how to support their children (whether minor or adult) in seeking treatment.

1. Mental health is just as valid as physical health. Both mental and physical health impact each other. Just as you would not hesitate to go to a doctor for a broken arm, seeking therapy is vital to those who are struggling with mood, adjustment, anxiety, and depression issues.
2. Mental health challenges are not simply negative feelings; they may be actual symptoms that need attention. The experience of depression or anxiety goes beyond sadness or nervousness. It requires the skill of trained professionals to help diagnose and alleviate symptoms.
3. There is a difference between family advice and professional dialogue. It is important to recognize when familial advice is no longer sufficient and professional help is called for. Family will always play a critical role, though—they can help or hinder a person in this process.
4. Playing the "guilt card" can exacerbate the problem. It’s important, particularly as South Asian immigrants, to become aware of the generational trauma and subconscious guilt we often carry and pass on. Guilt-inducing reactions can worsen symptoms, create feelings of hopelessness and despair, and prevent children from seeking help.
5. Seeking help is a sign of strength, not weakness. Our mythology and cultural ethos are filled with heroes and heroines whose fortitude and silent suffering marked them as icons of admiration and worship. But the world we inhabit has changed. It is infinitely more nuanced, complex, and multi-cultural. As South Asians, we need to redefine what it means to be strong.