On the outside, Sarika Agarwal’s life looked perfect. She scored top grades, excelled in Indian classical dance, and was respected by her family and community. But in her drive to please everyone around her, she became dependent on others and their approval for her self-worth and self-confidence, and a lingering sadness and constant stress crept in.
When she turned to her community to talk about the emotions she was having, people reacted in stark contrast to the positive ways they reacted toward her achievements. “When I told a family member about my mental illness, I was labeled as ‘crazy,’” she said. “The resulting embarrassment led me to stay silent for years.” Isolated in her own thoughts, she eventually turned to self-harm and a suicide attempt, until she finally found help to treat her diagnosed major depression and anxiety.
Agarwal is far from alone. According to the South Asian Public Health Association (SAPHA), one in five US South Asians report experiencing a mood or anxiety disorder in their lifetime, but often express greater stigma toward mental health than other groups. This stigma can sometimes lead to deadly consequences. Studies show that suicide continues to be the leading cause of death among South Asian Americans at ages 15 to 24, and Asian American girls in grades 9 through 12 are 20 percent more likely to attempt suicide as compared to white female students.
The stigma against mental illness can make it harder to reach out for help when needed. “South Asian communities are often collectivist and family-centered with a hierarchy that promotes the collective family interests over individual interest,” said Anjali Gowda Ferguson, Ph.D., LCP, a culturally responsive psychologist. “This messaging suggests that focusing on the self may be inconsiderate of larger community demands. Women may receive messaging that this focus is selfish or unnecessary.”
However, a new wave of celebrity openness, generational attitude shifts, and the expanding resources that emerged during Covid-19 are changing the conversation around mental health, creating safer spaces to share our emotions, and allowing all of us the opportunity to build a more balanced body and mind.
Taking the First Step
Acknowledging your own feelings can be a good first step to taking your own mental health seriously, along with recognizing that struggling does not make you less-than. “As a South Asian woman, I felt so much pressure to be perfect, and I was incapable of seeing a way in which I could admit to suffering mental illness and ask for help while still maintaining that ‘perfect’ image,” said Agarwal. “I only saw two choices: I either became a disappointment to my community by disclosing my hardships, or a disappointment to myself by continuing to suffer in silence.” But she eventually realized that being someone who struggled with mental illness and being someone the community could be proud of did not have to be mutually exclusive.
In fact, taking care of ourselves can allow us to be in greater service to the people around us. Dr. Ferguson likens taking care of our mental health to putting your oxygen mask on first in an airplane emergency, emphasizing that it’s important we put on our own oxygen masks first before helping others. By seeking support for our mental health, we can create a more solid foundation for our family and friends.
“It does not make you selfish for doing so, it actually makes you stronger, more able to face the demands of your role as a South Asian woman, and ultimately more able and capable of supporting your family and community,” says Dr. Ferguson. “So, start by acknowledging your needs and seek support [systems] that are culturally-informed and a mental health provider who understands the nuanced demands of the culture and how it impacts your mental health.”
A mental health journey isn’t often a linear one, with ups and downs that can shift as our lives continue to change. For Agarwal, that meant reminding herself that low days weren’t an indication of her getting sick again or as a failure, but as an opportunity to use the tools she’s learned to to manage through and emerge on the other side more quickly than before.
The value of rest for our mental health can be another area that can feel at odds with cultural conditioning. “Whenever I used to take rest, I felt lazy. Why be resting when I could be working on achieving something more?” said Agarwal. “Yet as I’ve started prioritizing my mental health, I’ve realized that taking rest is not lazy, but rather one of the most responsible things I can do for myself.” Instead of running ragged to the point of burnout and failure, she began to recognize that rest is what enables both her mind and body the ability to achieve.
To Speak or Not to Speak
Even when we embrace our own mental health struggles, talking with friends and family members about it can still feel fraught, and positive feedback is never a guarantee. When and if you decide to share this journey with others, it can be helpful to set your own expectations of what you want out of the process. Before disclosing to others, Dr. Ferguson recommends preparing answers to the following questions:
- What would you like to achieve out of sharing the process?
- Do you need to share every detail?
- What would you like that individual to do with the information?
If they fall short of your expectations and do not respond in the way you’d like, it’s important to also have a self-care and coping plan. Boundaries can also be important during this journey, and it’s okay to distance yourself from someone until you are in a better, more internally resourced place. “Remember that you do not need other people’s acceptance to focus on your health needs. Taking care of yourself does not need to be approved,” said Dr. Ferguson. “If you broke your arm and needed surgery to fix it, would you ask for approval from your family members before seeking surgery?”
Agarwal also recommends taking a compassionate response when possible. “Consider that people’s reactions to this topic are not personal but are rather coming from an extremely powerful cultural misinterpretation that has been around for centuries,” she said. Pushback isn’t always an attack, but often a lack of knowledge on a topic; and patience, especially with friends and family members, can start to pave the way for bigger change.
For Agarwal, now a public speaker for mental health education organization Minding Your Mind and a third-year therapist in a doctoral program, speaking up became a powerful way to continue to heal herself and help others. “As I started opening up about my mental health and not letting other people’s reactions discourage me from speaking my truth, I realized that communicating honestly about my illness in spite of the stigma is what allowed me to combat it.”
Her honesty also continues to help others. She recalls the time she spoke to a group of parents at a nearby school. “An Indian woman in her 50s came up to me afterwards in tears and said ‘I now realize I’ve understood my daughter all wrong. There’s nothing wrong with her; she’s just suffering.’”
As Agarwal continues on her journey, she emphasizes that mental health issues aren’t indicative of who you are, but rather what you’re going through. “Asking for help does not change your identity,” she says. “Quite the opposite. Accepting help and being able to heal will allow you to become the greatest version of yourself that you can possibly be.”
3 Women Forging New Frontiers in Mental Health
Through their research, advocacy, and education, these women are changing the face of mental health support.
Founder, Live Love Laugh Foundation
Actor Deepika Paukone still remembers the day vividly when she woke up directionless and empty. While she often thought about giving up, her mother recognized something was amiss and insisted she get professional help. After being diagnosed with anxiety and depression, she started a long road to recovery. “The love and support of my family, counselor, and psychiatrist encouraged me through those dark days,” she says. But in her journey, she recognized the stigma and lack of awareness around mental illness. She wanted to be able to save at least one life and decided to go public about her illness and set up the Live Love Laugh Foundation. Today, the foundation works toward providing mental health education, building mental health capacity for doctors, and enabling mental healthcare access in rural areas. thelivelovelaughfoundation.org
Principal, Business Development at the Noetic Fund
The daughter of business icon Indra Nooyi, Preetha Nooyi is making her own strides as a leader at Noetic, which invests globally in companies at the forefront of mental health therapeutics in biotech, digital health, and medical devices. “In my role, I love educating people about what’s happening in mental health and psychedelics,” she says. “It’s not just about investing. This is really about providing help and support to those who need it.”
Sahaj Kaur Kohli, MA, NCC
Creator of Brown Girl Therapy
When she embarked on her own therapy journey, Sahaj Kaur Kohli was living with her immigrant parents who didn’t understand her need for professional support. But the experience inspired her to provide support and encouragement to others, and create the community Brown Girl Therapy while starting her own practice. “I know that I wouldn’t be who I am today if I hadn’t had years of therapy,” she said. “I really wanted to be able to provide that to someone else.” She now runs the Culturally Enough community and newsletter for those who want to learn to live more authentically in their bicultural/multicultural identity, and is the author of the forthcoming book But What Will People Say? On Navigating Mental Health as the Child of Immigrants. sahajkohli.com
Mental Health Resources
- Designed to be used just like 911, the 988 number connects those in crisis to the National Suicide Prevention Lifeline. Brand new in 2020, the number can be used for calls, texts, or chats for anyone experiencing mental health-related distress. samhsa.gov/find-help/988
SAMHIN. Originally started in New Jersey, the South Asian Mental Health Initiative & Network now provides nationwide access to research, resources, and a searchable database of mental health professionals. samhin.org
Center for Mindfulness and Compassion. This partnership between Cambridge Health Alliance and Harvard Medical School provides free daily meditation and mindfulness practices to help ease anxiety, grief, and fear. You can register for live sessions in advance on the website. chacmc.org/connect
SAPHA. The South Asian Public Health Association focuses on promoting the health and well-being of South Asian communities in the United States, and provides culturally specific resources and health providers. joinsapha.org/community-guide/mental-health-resources