The stigma against therapy revictimizes Indian American dealing with it, making depression an incredibly lonely battle.
Meena sat mortified as the EMT wheeled her through the hospital into the emergency room. The knot in the pit in her stomach continued to grow, even when the nurse drew the curtains around her to block her from view. She waited silently in the cold, sterile space for someone to explain what was going on.
“How did this happen?” Meena kept asking herself. In the moment, she did not realize that no single incident had landed her in the hospital but rather years of ignoring her mental illnesses.
Meena had always thrown herself into whatever was happening around her. When she started at Wellesley College, Mass. in 2001, she quickly became an active part of campus life. At the same time, she was struggling with extreme bouts of depression and anxiety, coupled with an inability to come to terms with her sexuality.
“I was doing all of these very public things, and then behind the scenes, I just hated myself,” she said.
She despised herself for falling victim to a mental illness. Needing to punish herself for her lack of willpower, she felt there was only one thing she could control: her eating habits.
Meena began starving herself, and soon, her 5’6” frame weighed a mere 105 pounds. Finally, during her junior year at Wellesley College, Meena’s girlfriend insisted that she visit the campus mental health center to seek help for her anxiety attacks and eating disorder.
That’s how Meena ended up in the hospital room, surrounded by doctors, scared into silence, and finally staring her depression in the face.
Only Meena can remember the shame and fear she felt at having to acknowledge her depression, but Indian Americans across the country will relate. Depression, anxiety, and other mental illnesses remain taboo among many in the population. Members of the community who cannot practice self-control to deal with their mental illnesses in private are seen as weak. This attitude can fill people like Meena with guilt about humiliating their family, which in turn prevents them from seeking help. While there are limited studies about mental illnesses in the Indian diaspora, a study published in the Journal of Immigrant and Minority Health found that only 40% of U.S.-born and 23% of foreign-born Asian Americans diagnosed with a psychiatric disorder used mental health services. Yet even the few who do decide to seek help confront many obstacles.
That is why, when Meena eventually called her parents from the hospital and they immediately decided to drive over to see her, she was petrified.
As soon as she saw her mother, Meena knew her fears were valid. It was obvious that her mother had been fretting about the implications of her daughter’s hospital visit during the five-hour drive from their suburb of Cedar Knolls, N.J., to Wellesley College. She demanded answers from Meena: What did Meena’s illness mean for her marriage prospects? How would it affect the rest of the family? The only question she never asked was how she and Meena’s father could help their daughter through her depression.
This reaction was exactly what Meena had expected and dreaded. She knew her mother loved her immensely, but she also knew that her mother cared deeply about her family’s reputation. A depressed child would tarnish the image her mother was trying to uphold.
Jyothsna Bhat, a South Asian clinical psychologist in Newtown, Pa., studies the desire to maintain the family name and reputation among Indian Americans. She explained that upholding a favorable reputation is of utmost importance to Indian American families because it dictates the future success of its members in marriage, careers, social status, and societal recognition. As a previous SEEMA article explained, members of the community bury and ignore illnesses like depression, often until they reach a breaking point, to preserve the name.
Chowdhary argues that the value put on family reputation is also a result of India’s collectivist culture.
Families solve their troubles themselves and view seeking external help, no matter how necessary, as betraying and humiliating the family unit.
Although Meena was worried about the effect her depression would have on her whole family, she was most concerned about what it would do to her younger brother. Having grown up in an immigrant household with parents who had to work long hours, Meena, who is five years older than her brother, often felt like his third parent. She knew that if the news about her depression spread in their community, she was putting his future at risk. She could not stand to ruin her brother’s future, so Meena chose to stay silent.
This dynamic is not unique to her family. The eldest child in Indian American households adopts many responsibilities from a young age, said Sudha Wadhwani, a staff psychologist at Montclair State University who works with immigrant populations. Chowdhary refers to this demographic as “parentified children.” They typically have trouble putting themselves over others. If they choose to work on their mental illnesses, the decision comes with a lot of internal conflict and guilt about abandoning the needs of their younger siblings.
Like Meena, Anjali*, a 26-year-old Indian American whose parents immigrated to the United States when she was a child, felt this weight of being an older sibling and its resulting mental health effects. Anjali, too, stepped into the role of caretaker while her parents worked long days, as well as when she and her brother were sent back to see relatives in India over their summer holidays.
“I felt like I was like a babysitter and a protector for my brother from a very young age,” Anjali said. “For a long time, I was a very angry child,” she added, saying she blamed her parents for forcing her to grow up too quickly. The role of protector also included shielding her younger brother from their parents’ volatile relationship. Despite being on the brink of divorce several times, they never seriously considered ending their marriage or seeking professional help. Instead, Anjali stepped in when their fights became too overheated. “I have been a relationship counselor for my parents since I was 14 years old,” Anjali said.
At the onset of COVID, and after a heated discussion with her boyfriend, Anjali decided to enter therapy to help her manage her low-grade depression. Like many people her age, she had moved home during the pandemic, and she knew she would be sucked back into the pattern of putting her family’s needs above her own if she did not seek help.
However, she first had to face her own biases, which were more ingrained than she had imagined. Unexplored biases are common among Indians who have grown up in the United States with traditional parents, said Sruthi Swami, Assistant Professor of Psychology at California State University, Fresno. While they want to be progressive, they often hold preconceived notions about therapy and those who seek it out because of their parent’s views.
Anjali had been a vocal advocate for therapy since her early days in college. However, when her boyfriend suggested that she could benefit from it, she realized her faith in the practice only extended so far. “My entire self- identity and self-worth were defined by my academic ability,” Anjali said. For her, the idea of needing support meant she was no longer a success but a failure.
For Meena, therapy was an exclusively American concept. “It was always like, “these Americans don’t know how to handle things,” and so they all go to psychologists, and they get drugs,” she said.
When Meena was admitted to the psychiatric ward by her college health department, her image of those who needed therapy terrified her. Had she become one of those people? Meena could not accept that possibility and, therefore, could not accept therapy.
Meena pushed through her college years without therapy but was eventually drawn back to it at twenty- three. During her time at Wellesley College, she had started dating a transgender man whom she knew her Indian American family would have difficulty accepting. She needed help deciding whether she should stay with him or honor her family’s values. While Meena was guarded at first because of her college experience, she eventually realized she held a misconstrued image of those with mental illnesses. However, she did not tell her family about this realization or that she was in therapy for years.
Meena is now talking with her mother about intergenerational trauma, mental illnesses, and how therapy can break unhealthy patterns. Anjali also initiated similar conversations with her mother.
Anjali and Meena are now trying to break the taboos against depression and therapy in their families and communities. They are determined to prevent future generations from feeling the same level of fear, uncertainty, and loneliness they did. As Meena said, “when we stigmatize mental health, we ultimately stigmatize ourselves.”
*Meena and Anjali requested we use pseudonyms to protect their families’ privacy.