Mental Health in the South Asian Community - An Interview with Dr. Jyothsna Bhat

Why should you need to do research if you're writing a novel? Especially if it's a fantasy novel, aren't you making everything up anyways? These are great questions (that I just made up, shhhh!). The fact is that in order to draw your reader into the world of your novel, you need to create an experience that feels real. The more fantastic elements there are in the novel, the more important it is to describe the world in the detailed way that can bring it to life. If it's a magical world, that may mean deciding how the rules of magic work, what the geography of the world is, or what the culture of the people who live there is like. You may be creating this world in your head, but you need to make sure that the rules of the world are internally consistent. If aspects of the story come from our real world, whether it takes place in an American city, or features a storyline about welding, or involves the history of the Ottoman empire, it is important to research these story elements to make sure that they feel real.

If accuracy in capturing the background of your world is important, I think it's even more important to tell the story of the people in your world with sensitivity and fidelity! The history of literature is littered with novels that present a biased, cartoonish, or dishonest interpretation of their character's inner lives either out of prejudice or ignorance. Often this is because of the character's culture, ethnicity, gender, sexual orientation, disability, socioeconomic status or other minority status, and it can result in dehumanizing or fetishizing the status of someone who is already discriminated against.

This raises the question, who has the right to write a story from which character's perspective? I don't think that's an easy question to answer. I'm currently writing a novel about an Indian-American who is gay, loves gaming, suffers from depression, and lives in Atlanta. I share some characteristics with him. I too have struggled with mental health issues, I know Atlanta relatively well, and I'm very nerdy (although I don't know as much about games as he does). But I cannot speak from my own experience about what it means to be gay or Indian-American. For this reason, I think it's incredibly important for me to learn as much as possible from people who do have this history and experience, so that I can make my story as accurate as I can and do justice to this character.

As part of my research, I reached out to Dr. Jyothsna Bhat, a clinical psychologist and an expert in the treatment of mental health issues in the South Asian American community. You can find her blog here.  I first discovered her writing after reading her article, "The Taboo of Mental Illness in the South Asian American Community". Please also check out these other excellent articles from Dr. Bhat. Dr. Bhat kindly agreed to let me interview her so I could learn more about the issues that my main character, as an Indian-American man, might face when coping with depression and anxiety.

Ben: What has your experience been like taking care of patients from the South Asian American community who are coping with mental health issues?

Dr. Bhat: It’s been an interesting journey. When I started out, I had lots of family friends coming to me, some anonymously to ask questions in order to get some informal answers. This was very telling in terms of where we are with mental health in the South Asian community in terms of stigma. Soon after, I wrote an article about this issue because I was noticing certain patterns within my own family and with the few clients that were coming to me, as well as the community reactions to mental health. People would say things like “It’s not real medicine”when discussing mental health treatment. I wrote an article about the taboo of mental health. Lots of people told me this really resonated with them. Yet, South Asians would come in for treatment, but would still show resistance to treatment and embarrassment about needing help. “Why can’t I handle my own problems? Am I defective?” was a common feeling that I heard expressed.

In the South Asian community we keep things under wraps. When a patient is dealing with depression and anxiety, their family wants to know what they are upset about, and often they look for a specific reason for these feelings. They want to find fast fixes and help them move on from things quickly. Yet these things take time to process as there are often many contributing factors behind these feelings. Issues may stem from childhood such as core beliefs evolved from early experiences that contribute to negative schemas. There may be a predisposition to mental health issues as well as generational trauma that is passed down. These may all lead to depression, anxiety, or other disorders.

There is also lots of misunderstanding and mistrust about mental health disorders and the role of psychologists and psychiatrists. Since I’m a woman, this can be a very patriarchal situation, so patients may not open up to me as much. This is especially true when treating clients who are male, father figures, or more traditional clients. Clients will say I’m coming back, and sometimes they won’t. Parents will say I want you to fix this, but they don’t want to engage with therapy themselves. I explain to the families that we need to work together.

Ben: Can you talk about mental health issues in teenagers and young adults?
Dr. Bhat: Relationships between South Asian parents and South Asian kids are really complex. You’ll find the occasional families where parents are really open, I was lucky for the most part in this regard, for example. But in talking with my patients, I’m hearing of lots of passive-aggression, sometimes even physical abuse. Lots of guilt and manipulation is used by parents, often unintentionally. When a young teen says I want to get therapy, they hear things like “don’t we do enough for you?” from parents. Parents feel this burden of guilt from coming to America as immigrants. Hard work and success is a big deal in this community. There are lots of doctors, engineers, and lawyers. They work hard to set their kids up and they want them to "succeed" so if they have issues with mental health they can't understand why. They view it as a weakness.
Love language in South Asian culture means providing, making sure they set you up for your success. They don’t understand it when a young adult or teen is upset. The teenager might have gone through physical abuse, passive aggression, any number of things. But parents ask, “how are you unhappy?” One of my clients got into Duke, and he was asked “why are you unhappy?” This type of question can get passed on as guilt to a teenager. Parents feel like, "I’m putting in so much, why is my child still feeling like this?" There is a feeling of "what have I done wrong?", but many parents don’t want to own this. When a young adult says to their parents, "I need to talk to someone," many parents feel like saying "you should talk to me" in response. But advice from the family is not the same as professional counseling from a psychologist.

I find that many young adults and teenagers feel alone in this journey. Many people don't understand the role of psychology. I try to educate them by explaining the biopsychosocial model. Getting support from medical doctors for my work is so important. Medical doctors are revered in the South Asian community. Physicians are given a lot of power by the community, so when medical doctors advocate for mental health, it has more clout. It can be more comfortable for patients to see a doctor than a psychologist. Many of my patients have dealt with loneliness and sometimes there is lots of trauma. I see lots of strained relationships between adults and their children. There is a lot of competition about academics and career in the South Asian community. Often once the young person grows up and is doing well, suddenly this cloud over the relationship passes away, everything is forgotten (i.e. negative familial dynamics) and parents are very happy.

Ben: What is it like to be a South Asian member of the LGBTQ community?
Dr. Bhat: For some folks, it is very challenging. I see that the push towards marriage can cause lots of depressive feelings. It depends how far the family is willing to walk with them. They may need to find their own community and may feel that they need to stay in the closet as long as they can. There are more psychologists focusing on this area now, leading to more open discussions. It’s becoming a more highlighted conversation. In the trenches with the families and working one on one with patients, I see that there are lots of layers of stigma and baggage.

Ben: In my novel, my main character undergoes a suicide attempt. How might a South Asian family react to this?

Dr. Bhat: There would be a sense of shock. It wouldn’t go unnoticed. When I’ve had this happen with my clients, the parents tend to rally for the most part. It’s sad, but that can be the wake up call for them. Then they are like, whatever needs to happen. They still want to get medication for their child. They will ask, "What’s the medical treatment for this?" Recently I got a contacted from a family whose daughter attempted suicide. She overdosed on something. They asked, "What does this mean for her future?" This is a question I see commonly when anything is affecting my patient's mental health, "How will it affect their future prospects with regard to marriage, relationships, work, etc...". For example, in the case of a colleague trying to find their missing sister, they didn't want to put out a missing person ad because they didn’t want to upset any future prospects for this person. It’s funny, because how can that be what you’re worried about when this is a life or death situation?
Often however, this is a moment where the family comes together and they want to do whatever they can to help their child. They also don’t want to tip the applecart. They don’t want to talk about it. You need a therapist to help explain to the family that the patient needs to be telling you things, they need to share. Often families will tiptoe around the person. Sometimes parents will react in opposite ways. One girl who was treated for her suicide attempt had a dad who was really caring and wanted her to take time off. Whereas her mom was focused on getting her back on track.

Ben: How would siblings react to a brother or sister with depression?
Dr. Bhat: It depends on the relationship between the siblings. There’s often a lot of protection and care and concern. Especially older siblings towards younger ones, or even younger towards older. There is a feeling of indebtedness. Kids are taught to respect your brother or sister especially if they’re older. It’s generally supportive, but depends on the relationship between siblings. If you have a big family with lots of cousins, these relationships can often become a main source of social connections.

Ben: In my novel, my character has a history of self-harm. How might a South Asian family react to cutting?

Dr. Bhat: You might see the mother in tears a lot. It’s scary for the family. They don’t know how to talk about it, they don’t understand it. They will ask, "How will this impact them going forward in their life?" You will often see that one of the parents may take on more of the conversation about this patient's problem, while the other may be more in “shell-shock mode”.

Ben: What do you wish healthcare providers knew about caring for patients with mental illness in the South Asian community? (Editor's note: in addition to writing a novel, I'm also a pediatrician, so I wanted to get some of Dr. Bhat's insight on how to care for these patients).

Dr. Bhat: That it's important not to underestimate some of the stigma. Also to really understand family dynamics a little more. There is often a very enmeshed experience with grandparents coming to live with family for long periods of time. There may be more people involved in the person’s life than just the parents. Patients may be thinking about all these things. Parents play a great role in the child’s mind in South Asian culture. This can impede the treatment sometimes. Its important to understand the importance and role of parents and family in working through some of these issues. Stigma is the biggest issue limiting seeking of mental health services. It is getting better, with more locations and more therapists of South Asian descent.

From a domestic violence point of view, there is lots of complexity there. There is a lot more involved from a psychological perspective. A child who has been physically abused in a South Asian family will probably not share with the school or authorities for fear of causing a problem, rocking the boat, separating the family. There’s still an underlying bond despite the abuse. Women may stay in a relationship that is abusive due to children, financial issues, immigration/visa status, etc this can also can significantly impact the mental health of their kids.

Ben: Thank you so much for your time, Dr. Bhat and for sharing your expertise!