Overcoming Mental Health Stigma in South Asian Communities

In the world of mental health, we often discuss stigma. Stigma is defined in the Oxford dictionary as a mark of disgrace associated with a particular circumstance. Mental Health Stigma then indicates negative attitudes, beliefs and stereotypes associated with mental illness. This means that for stigma to exist, one must be aware of mental health.

In cultures where emotions are seldom talked about and mental illnesses carry cultural significance, could it be that the challenge is not so much mental health stigma, but instead a lack of awareness and a fear of the unfamiliar?

Different cultures have varying beliefs about the nature of mental illness, its causes, and acceptable ways to cope. In some cultures, for example, mental health problems may not even be recognized as “mental illnesses” in the way they are understood in the West. Symptoms such as sadness, excessive worry, or physical complaints might be interpreted as spiritual disturbances, issues of faith, or even physical illness, rather than psychological ones. In Hindu and Buddhist traditions, for example, mental suffering might be viewed through the lens of karma or spiritual imbalance, and healing is often sought through meditation, prayer, or spiritual guidance rather than clinical treatment.

Reflect on this: Are you able to label the six primary emotions: Happiness, Sadness, Anger, Disgust, Surprise and Fear in your traditional language? How often were these discussed and labelled in your childhood or now? When experiencing these emotions, were they acknowledged by those around you? How were negative emotions handled; were they at all?

This is not to say that mental health stigma in South Asia does not exist -- Stigma is a universal experience. Rather, my intent here is to indicate that the stigma experienced in South Asian culture often comes not from disdain but from a lack of understanding. Stigma in western cultures manifests in the fear of being judged, discriminated against, or marginalized by society due to one’s mental health struggles. In South Asian cultures, stigma results in issues of mental health not being recognized and therefore becoming manifest as symptoms of physical ailment.

Take, for instance, a South Asian family’s reluctance to openly discuss mental health struggles with a therapist. To an outsider, this may seem like an example of stigma in the western sense: fear of judgement and discrimination. However, within the South Asian culture, the reluctance to seek professional help may stem from cultural values such as Izzat, honoring community privacy, or respecting traditional modes of healing.

Similarly, the concept of emotional restraint is highly valued in many East Asian cultures. For example, in Japanese culture, the expression of emotions like sadness or anxiety might be seen as a loss of self-control or an inability to cope with life’s challenges. This can sometimes be misinterpreted as stigma or shame when, in fact, it reflects a cultural preference for inner strength and emotional regulation. A person who is quiet about their distress might be seen as stoic, rather than stigmatized.

This raises an important point: what is perceived as mental health stigma in one culture may simply be a different way of coping with or responding to mental health struggles in another culture. 

The key to addressing the contrast between mental health stigma and cultural differences in mental health care is education and empathy. It is important to recognize that cultural frameworks influence how people understand and respond to mental health issues. And, it is equally important to address when these frameworks unintentionally hinder access to the mental health support people need. Approaches to overcoming mental health stigma in South Asian communities include:

Seek culturally attuned mental health care.

• Seek a professional who is understanding of your culture and can understand how mental health is perceived and treated.

Discuss mental health in a way that respects traditions and values.

• Involve community leaders in discussions to reduce the perceived “stigma” surrounding mental health challenges. An example of this in the Sikh community is holding mental health conversations at the Gurdwara, and to label them as conversations around “Mann-shanti (Inner-peace).” This method uses terms the community is familiar with.

  
  

• Engage parents in conversations. Due to acculturation gaps, 1.5 and 2nd generation immigrants tend to learn about American norms faster than their parents do, this includes mental health. When conversing with parents about mental health, remember they may not be familiar with terms like "depression" and "anxiety." Speak in terms that are familiar to them. It may help to describe what that experience feels like for you.

  
  

• Minimize defensiveness: It is likely that you will be met with defensiveness when talking to your family about your mental health struggles. Family members may feel blamed for your emotional experiences. They may in turn say things that make you feel defensive too. To avoid this defensiveness trap, try using "I" statements, and limit the conversation to describing your internal experiences without placing blame on external factors. If you still feel yourself becoming defensive, take a break from the conversation and come back to it after engaging in your self-soothing strategies.

  
  

• Lastly, to avoid accepting projected feelings of shame, remember that your family may prioritize the cultural value of Izzat more highly than you do. That's okay. It is entirely your decision who and when you choose to share your mental health struggles with. Talking is encouraged and never a requirement.

Promote universal mental health awareness.

• While the language is different, the conditions are universal. Connect what is considered a mental illness in the West to what it may look like in your culture. For example, in the West, Schizophrenia is a clinical diagnosis; in Punjabi, psychosis of any kind is something that happens to a person and labelled a “daura.”

  
  

• While cultural differences will always exist, it’s essential to promote universal principles of mental health care, such as compassion, understanding, and support. This creates a foundation for bridging cultural divides without diminishing the value of individual cultural beliefs.

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