While mental health in South Asian communities, especially among first-generation women, is pervasive, the core of these challenges is far more complex.
TW/CW: discussions of mental health, depression, and mentions of suicide
By Sara Surani
When I was in high school, I carried a very heavy backpack, a bright blue and pink JanSport filled with tens of folders, school supplies, and books—among them, a bruised calculus book and an overdue copy of The Catcher in the Rye.
I loved school. As a daughter of Pakistani immigrants who was born and raised in conservative South Texas, school was a place I could be someone else—or at least pretend to. From a young age, I loved this fantasy world: I could speak a different language, talk about boys and makeup, and run recklessly around the jungle gym. I could shed my brownness with every Lunchable I ate.
I also loved the academics. Getting all A’s made my parents happy, providing me with the validation I desperately craved as a wiry thin, glasses-wearing, non-blonde, insecure teenager. Rather than valuing my color, culture, and individuality, I built myself up with Lego bricks of accolades and academic accomplishments. My parents were pleased with my performance: I was the shiny fruit of their sacrifices. They left everything behind and immigrated to America with less than $100 so I could have the educational and career opportunities they didn’t. I was blessed with both of these, and a third they didn’t quite expect: anxiety.
My story is not unique. The backpacks of many South Asian first-generation youth and adults are not only filled with pens and books but also anxieties of constantly navigating intersecting oppressions within predominantly white spaces and the pressure to live up to immigrant parents’ sacrifices. These challenges are even deeper for many young women who may feel like they have to try harder to prove their worth in a traditionally chauvinistic society.
Priya, a 21-year-old college student living in Boston, is a daughter of parents who immigrated from India. “It feels like I am constantly carrying a backpack,” she explained, “It feels like I am constantly wearing the expectations of my ancestors on my shoulders. Sometimes I forget that it’s even there and other times the weight is so heavy that my body physically hurts.”
Although data on mental health in immigrant South Asian communities is both outdated and limited, the Asian and Pacific Islander American Health Forum (APIAHF) reported that South Asian American women, especially between the ages of 15-24, were more likely to exhibit depressive symptoms and had higher rates of suicide compared to the general US population. Ironically, although South Asian Americans exhibit higher rates of mental health issues, they have a lower rate of utilization of mental health services.
While mental health in South Asian communities, especially among first-generation women, is pervasive, the core of these challenges is far more complex. From differences in culture and perceptions of mental health to a lack of substantive representation in mental health spaces (in-person and online), the roots of these issues are tangled and multidimensional.
The American Dream. Do what you want. Follow your dreams. We hear these mantras everywhere—in the classroom, with our friends, on commercials. These constant affirmations of individualism are practically an initiation to assimilation in the United States. America revolves around a culture of pursuing your own talents and individual dreams in order to be successful. This mentality is not only encouraged and reinforced but an essential element that is sought after by prestigious companies and institutions. However, many Asian cultures, including the Pakistani culture I grew up in, place value on community over individualism. The collective progress of a family or community is considered in nearly every individual’s decision and one family member’s success signifies a community’s happiness and success.
My father became a doctor because his mother told him too, and he never questioned her decision because he believes that his happiness lies in her happiness. He learned young that he must always put his family and community first and that “doing what you want” and simply following “your” dreams is selfish. When I confessed to my parents that I did not want to be a doctor, family members were confused by my abrupt disobedience, “But that is what will make you happy and your family happy.”
I was more anxious than frustrated. Happy—what does it mean to be happy? As I continued to hopscotch between different cultures, I learned that happiness, as well as other states of mental well-being, are often culturally constructed.
While happiness in individualistic cultures is characterized by satisfaction in personal goals, professional pursuits, and relationships, happiness in many immigrant contexts is synonymous with stability—both personally and professionally. For many immigrants and communities who have experienced the harsh struggles of immigrating to America—learning a new language, relocating, financial instability, uncertainty in the future—happiness has never been the immediate priority. Financial security, food stability, and not having to constantly relocate were long-term aspirations. Stability and consistency are often prioritized over spontaneity and adventure. Following the rules and checking boxes are valued over “following your dream.”
Living with two different pedagogies for life can be confusing and disorienting. Navigating growing up in a community-centric South Asian culture within an individualistic-centric American community built my adaptability and resilience, but also triggered anxieties and cognitive dissonance—common in many children of immigrants.
Stigma and Mental Health
The intrapersonal and psychological tensions that arise from toggling between different cultural expectations can be even more challenging when conversations on mental health are stigmatized. In many Asian immigrant communities, mental health illnesses are viewed as shameful. When a South Asian friend of mine explained to her parents that she is struggling with depression, her mother responded with confusion and exasperation: “But you have everything we didn’t have! You are just complaining. What will your father think when I tell him this? No, you are just tired. Go to sleep and then you will feel better.”
This avoidant and negative perception of mental health not only stems from a lack of available education about mental health, but also from a cultural stigma of publicizing individual vulnerabilities. As reported in a Harvard Crimson article on the stigma of mental health in Asian-American communities,
“Stigma around mental illness is ingrained into the very languages spoken in immigrant households. The Chinese phrase for mental illness (shénjīngbìng) is synonymous in many minds with violent psychosis; for Korean families, preserving family honor sometimes meant sequestering mentally ill members from society—one in which the term for a mentally ill patient (jungshinbyungja) can be used insultingly. The word for suicide in Urdu/Hindi, “khud kushi,” is often mistakenly understood and pronounced as “khud khushi” or “self-happiness,” perhaps because suicide is viewed as a selfish act.”
This deeply rooted stigma of mental health challenges can create barriers in transparency when talking with family if family members prioritize the reactions of their community over the individual well-being of their child. This stigma can be overwhelming for many South Asian children of immigrants, preventing seeking not just clinical mental health care, but also the care that comes from having an authentic conversation about one’s psychological well-being.
Lack of Substantive Representation in Mental Health Spaces
When many South Asian first-generation youths do seek out clinical care, the lack of Asian and first-generation in these mental health spaces can be startling. Despite South Asian youth being more likely to exhibit mental health challenges, according to the American Psychological Association, in 2015, 86% of psychologists in the United States were white, and only 5% were Asian.
Low numbers of South Asian professionals in mental health care can be frustrating for individuals who choose to seek out care. Cultural differences and stigma around mental health can be difficult and exhausting to explain to someone who does not understand your experiences, culture, and intergenerational trauma. This barrier sometimes deters or repels many from continuing clinical mental health care, exacerbating mental health among South Asian children of immigrants.
While these are only a few root causes of mental health challenges among South Asian children of immigrants, it is critical to note that there are many other cultural, historical, social, socioeconomic, biological, and individual factors that color the overlapping oppressions and complexity of mental health among these individuals. Mental health is not easy to understand: it is intricate, it is messy, it is multidimensional. But, it is important.
Trying to understand mental health among people of color and immigrant populations is a critical step that needs to be taken in order to address systemic and systematic inequities that are perpetrated in these same communities. Other steps can include advocating for more representation in mental health care and raising awareness about mental health in first-generation American populations. More simply, we can try to cultivate empathy and try to better understand what friends close to us are experiencing. Just asking a friend if you can hold their backpack for a moment and creating a safe space to listen can go a long way.
Sara Surani (she/her/hers) is a Pakistani-American Muslim woman working on gender, health, and environmental conservation in the Peruvian Amazon. She is especially interested in using narratives and storytelling to mobilize communities, especially in the context of women’s empowerment. A Texas native, Sara enjoys wearing scarves in 70 degree weather, reading poetry, eating mango ice cream, and discovering new ways to crush the patriarchy.