Content Disclaimer: This column includes mentions of mental health and suicide.

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I grew up in an environment where the subject of mental health was practically non-existent.

Not because it didn’t exist – my community’s shared history of forced migration and refugee status meant we were much more susceptible to mental health issues – but because it was rarely recognized.

It existed only in the case of people who were called paagal or madman, who had to be avoided as one would avoid a contagion. It shaped my previous understanding of mental illness; it was a disease.

It was pretty much the same when I moved to the United States. Even as suicides occurred at an alarming rate in my Bhutanese community, the conversations surrounding it were in low tones, never directly confronted.

There had been no open talk about mental health in my family, let alone in my community. When such issues have been raised, they have rarely been treated as legitimate. I grew up seeing emotions as a weakness and mental health issues as a lack of willpower and self-discipline.

This attitude towards mental health reflects wider South Asian society, where the subject is taboo. Unlike individualistic Western society, South Asian communities are largely collectivist. Personal identity is deeply rooted in the collective identity of a group.

In a society centered on honor and shame, “What will people say? is a toxic mantra that governs people’s lives, guiding their behavior and interactions. Emotional restraint is considered a sign of strength and mental courage; emotions are rarely expressed verbally. These factors further perpetuate stigma and prevent people from seeking treatment.

Maybe you’ve heard young South Asian adults say they never heard the words “I love you” growing up. It’s not uncommon. This is how some of my friends and I first bonded. Love was rarely expressed in verbal or physical affection, and for some this led to difficulties in forming and maintaining relationships – both romantic and platonic.

A cultural aversion to emotions hinders awareness of mental health. There are nearly 5.4 million South Asians in the United States, but little mental health literature exists for this demographic.

One of the few nationally representative datasets available comes from a 2002-2003 study that reported that one in five South Asians suffers from a mood or anxiety disorder during of his life. Young South Asians in particular face increased stress due to high expectations from their parents.

With few precedents to model, it can be difficult for South Asian students to open up about mental health. The mental health care system is expensive, bureaucratic, and complicated, making it difficult for anyone, but especially South Asian students, to navigate.

In my own experience, it was an arduous process of learning about my diagnoses, articulating my feelings in therapy, and unlearning deeply ingrained harmful beliefs. With minimal social support, the road to recovery often seemed long and lonely.

For many, the emotional labor of educating family members is exhausting, especially when the unconditional support you seek isn’t reciprocated. The generation gap makes it difficult for older family members to understand our issues, and we continually encounter pushbacks.

Hierarchical honor systems make it difficult to communicate personal boundaries, as it is seen as disrespectful to our elders. Challenging traditional norms is absolute sacrilege.

Language barriers are another issue. It took me over a year to be comfortable opening up to my parents. In preparation for our dreaded conversation, I tried searching for the Nepali equivalent of ADHD and anxiety, to no avail.

Throughout the conversation, I struggled to explain basic concepts in Nepali because, until then, all the conversations I had about mental health were in English. In the lexicons of many South Asian languages, mental health terminology is virtually absent.

Finally, South Asian patients bear the added burden of contextualizing these topics for mental health providers. In my previous therapy sessions, I felt a disconnect because my therapist was operating from a different worldview.

This is evident in health professions – while Asian Americans make up 17.1% of physicians, only 5% are mental health professionals. The majority of mental health care providers are white and lack the personal understanding to help these patients enough.

This requires more intersectional and culturally sensitive mental health care, especially in UNC’s own counseling and psychology departments, which are often the first point of contact for students beginning their mental health journey.

@dthopinion

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