Sumita Dutta Shoam, 47, a single mother of two, was trapped in a nerve-wracking 19-year-long marriage. Today, a published author and a graphic designer, Shoam remembers when her husband left her brutally battered, her injuries including a punctured eardrum.
When she visited her doctor for treatment later, Shoam says she made up a story to explain the wounds.
“The doctor listened to me, but categorically stated in the report that the punctured eardrum was due to a blow to the head. That report became my support when I applied for a divorce,” she says. “My ex-husband’s temper had gone haywire after his angioplasty. Some of the things he said and did made me suspect that he needed mental health care, but he just wouldn’t consider going to a mental health professional.”
Perhaps if Shoam’s husband had sought professional therapy, her domestic abuse and trauma could have been avoided.
South Asia has a complicated relationship with mental health. There is severe stigma associated with mental illness, where those afflicted often carry feelings of shame, guilt, fear and denial. Although serious conversations around mental health have finally begun inching their way into mainstream media, they rarely make headlines unless they involve a celebrity. The untimely death of actor Sushant Singh Rajput, for instance, left countless Indians gobsmacked.
However, the widespread stigma concerning mental illness is deeply entrenched in our collective consciousness. It is so profoundly paralyzing that it often deters people from seeking medical care or professional counseling.
In 2018, The Live Love Laugh Foundation (a non-profit organization for mental health founded by Bollywood actress Deepika Padukone), conducted a survey of over 3,000 participants, aged between 18-45 years, from varied socioeconomic backgrounds.
The survey’s findings were mortifying but not surprising:
About 62 percent of the participants “used derogatory terms like retard (47%) or crazy/mad/stupid (40%) or careless/irresponsible (38%) to describe people with mental illness,” while 40 percent admitted to feeling threatened by the presence of a mentally ill person in their neighborhood.
This crippling fear of being judged, misunderstood or bullied, functions as a psychological bulwark, dissuading people from openly discussing their mental health situation, even with their close ones. Denial of the illness, however, only hinders early diagnosis, when it can be most efficiently treated or healed.
Dr. Nidhi Khosla: “In South Asian communities, mental illness could be considered a result of one’s sins …Possibly, the shame surrounding those sins prevents people from addressing mental illness.”
The Power of Myth
The presence of countless superstitions further strengthens biased perceptions about mental illness. “Culturally, many South Asians believe that our relationships, health and wealth are affected by the actions and sins we (and others close to us), did in a past life incarnation,” says Dr. Nidhi Khosla, an associate professor at California State University, whose research focuses on immigrant health in South Asian communities. “Thus, mental illness could be considered a result of one’s sins…Possibly, the shame surrounding those sins prevents people from addressing mental illness.”
There is also oft-narrated myth that those with emotional malaise are cerebrally weak, and therefore, ‘defective.’ Another belief is that they are possessed or haunted by malignant spirits. Such misconceptions lead to feelings of confusion, loneliness and hopelessness among those afflicted.
One of the most common, but serious, global mental health illnesses is depression, impacting approximately 264 million people.
An article published in The Lancet narrows the lens further: Women are twice as more likely to experience depression than men. The National Mental Health Survey of India (2015- 16) found that while mental morbidity was observed to be higher among males, “specific mental disorders like mood disorders (depression, neurotic disorders, phobic anxiety disorders were higher in females… Neurosis and stress related disorders affected 3.5% of the population and was reported to be higher among females (nearly twice as much as males).”
Sometimes, due to lack of awareness, families find it difficult to understand what the afflicted person is going through. If the individual is of a marriageable age, it is reasoned that he or she would feel better once married.
“If it’s a man, parents believe that once the bahu (daughter-in-law) comes in his life, he will feel better. They truly believe that once married, he will learn to become responsible,” explains Dr. Vasudev N. Makhija (above), the founder of SAMHIN , a non-profit organization dedicated to addressing mental health needs of South Asians in the United States. A practicing psychiatrist, he is also a Distinguished Life Fellow of the American Psychiatric Association.
For women, the situation is far murkier. There have been reported incidents in which parents have tried to get their daughter married while hiding her history of mental illness. When the spouse eventually finds out, he may abandon the woman. Often due to the stigma, lack of awareness, paucity of resources, or sheer apathy, women also face homelessness after being abandoned by immediate family members.
This leaves them helpless, hopeless and struggling low self-esteem. In 2018, The Lancet Public Health reported that the highest percentage of global female suicide deaths, one-third of the total, were reported in India.
The Cultural Factor
Stigma surrounding mental illness, however, is not geographically bound to the country of origin. It deeply impacts the diaspora as well.
“South Asians are the fastest-growing immigrant group in the U.S.,” says Dr. Khosla.
However, while many South Asians willingly embrace and adopt Western culture – from its high-tech smartphones to its fast-paced lifestyle – they consciously steer away from Western psychotherapy and its approach to treating depression and anxiety.
According to WHO , about 800,000 people take their lives every year, one person every 40 seconds. Depression is said to be one of the major contributors to suicides.
South Asian culture continues to be patriarchal, which places huge expectations on women. While men have their own sociocultural pressures to deal with, depression in South Asian women may be triggered or intensified by traumatic experiences and stress-inducing environments. This includes being forced to marry against one’s will, domestic abuse, caretaking of the elderly, the pressure of providing a male heir, and miscarriages, to name a few.
“South Asian women are particularly vulnerable to childhood sexual abuse, intimate partner violence, and/or familial violence. A history of physical and sexual abuse is unfortunately, an important risk factor in suicidal behavior,” said Dr. Husseini Manji, the head of neuroscience of Johnson and Johnson’s Global Therapeutic Area. He is also the former director of The Mood and Anxiety Disorders Program at the National Institute of Mental Health.
“SOUTH ASIAN WOMEN ARE PARTICULARLY VULNERABLE TO CHILDHOOD SEXUAL ABUSE, INTIMATE PARTNER VIOLENCE”
“Given the various factors articulated above with respect to gender and depression, it seems like many women, unfortunately, see suicide as the only way to end the mental anguish,” he said.
Research also shows that the immigration experience can contribute to depression.
For one, the experience of packing one’s entire life, leaving home and moving to an unfamiliar country can be disorienting. Then, there is the long-drawn process of adjusting to a new sociocultural landscape, finding employment, applying for health care, language fluency and experiencing racial discrimination/lower community position. In addition, for them, as well as for second-generation South Asian Americans, there is tremendous pressure to live up to the model minority stereotype. Among South Asian youth, the pressure to achieve unimaginable academic heights also affects them gravely.
In a study conducted by Dr. Khosla with her colleague Dr. Karla Washington, further showed that South Asians living in the United States “were more reluctant than other ethnicities to report pain.”
Dr. Manji tries to explain it: “In South Asian culture, it is common for patients not to report their pain to avoid burdening others or being seen as weak. Also, South Asian Americans are hesitant to seek mental health care because of a perceived inability of Western health care professionals to understand their cultural views.”
The Promise of Tomorrow
There is, however, a glimmer of hope. Although South Asians continue to be skeptical, there has been a gradual elbowroom for healthy conversations. Over the years, SAMHIN has been holding mental health screenings at health fairs across New Jersey.