Mental health and Asian Americans. We wish those two were uttered in the same breath a lot more, and the end of this month gives us an opportunity to do so.
May marks both Asian American and Pacific Islander Heritage Month and Mental Health Month. Thus, we want to showcase this revolutionary directory of the Asian American Federation. From the website: “AAF’s goal is to make sure every Asian New Yorker who needs mental health care is able to receive it in a language they speak, from providers who understand Asian cultures. Check the directory out here, and pass it on!”
We spoke to a Queens-based Bangladeshi-American therapist on why it’s so important to seek culturally competent care and how to reduce the stigma around mental-health issues in our communities. Abu Nasim is a licensed clinical and school psychologist in New York and practices in Jamaica, Queens. Edited excerpts from his conversation with Epicenter’s publisher S. Mitra Kalita:
S. Mitra Kalita: I want to say at the outset that it’s great to know of a South Asian therapist in Queens because I actually feel like I get asked for a referral to someone like you a lot. Does this sound familiar?
Abu Nasim: There’s very few South Asian individuals in the mental health field in general, whether in therapy, social work, and other related fields.
One reason is that mental health as a profession is still relatively new and not a traditional area of employment for South Asian communities. The individuals who are raised here in the U.S. understand the importance of mental health and see that as a valuable and viable source of employment and as a place to actually develop a career.
Growing up in South Asian families, they want you to be a doctor, a lawyer, an engineer, a pharmacist, but no one really says “Oh, you should be a mental health counselor, you should be a psychologist, you should be a social worker.”
These professions aren’t promoted within the community.
SMK: So when I ask you the question of why there aren’t more South Asians therapists, that also leads us to the question of why aren’t more South Asians in therapy?
AN: It’s very important when talking about this to talk about stigma, and there’s two directions for stigma. There’s social stigma and self-stigma. Within the South Asian community, there’s this idea that if you’re seeking mental health services, you are a “crazy person.”
And no one wants to be. No one wants to identify with being crazy or having that label attached to them. And even working with that population, there’s a stigma; “Oh, you’re going to be working with crazy people.” That was what I heard growing up and all throughout undergrad into graduate school. “Why do you wanna work with crazy people? Why do you care about crazy people?”
And in terms of seeking mental health services, if people connect with the idea “I don’t want to be crazy” or “I don’t want to acknowledge that I’m a crazy person” then they tend to avoid it. There’s a lot of stigma with seeking mental health services.
SMK: How do we get rid of that stigma in our communities?
AN: That’s a tall order. A good place to start is acknowledging that it’s okay to have difficulties.
It’s okay to talk about having problems because there tends to be a lot of avoidance. In South Asian communities, it’s okay to have issues, it’s okay to feel depressed, it’s okay to be anxious. But a lot of the response to that is like you gotta work through, you gotta power through this.
If you’re having a problem, don’t think about the problem. Just study more, do better in your exams. It’s that pick-yourself-up-by-the-bootstraps kind of mentality. That’s the undertone.
The problem with that is that it doesn’t work for everybody. It’s not sustainable and families don’t like to talk about these problems when they come up. So they tend to ignore and focus on other external things that are easier to really focus on.
SMK: This is so interesting. There’s been increasing attention, at least among Asian journalists and authors, on this idea of inherited trauma. I wonder if the act of migration itself is a form of trauma.
AN: I was born overseas. I was born in Bangladesh. I came to the U.S. when I was 2 months old.
There is definitely a pressure that’s applied to first generation immigrants, and there’s an expectation that America is a land of plenty. This is a place that is a land of opportunity, but you have to work hard.
To achieve success, the onus is on you. So if that mentality is beaten into you from a very young age, you tend to embody it. You identify with it, and you see this as the avenue out of difficulty. You watch TV, you see the big house, the big yard, you see all these things and think, “Oh, I want that for myself.”
How do you get access to that? You have to have your career. You gotta be successful. You have to be successful to earn this and not just for yourself, but for your family and for your family back home. They want to be able to enjoy the wealth that you accumulate since you are the first generation coming here. You’re the first in line to take part in the plenty.
And yet when you come here as an immigrant, none of this is provided for you. You have to earn it for yourself so that all that pressure is applied.
There’s a lot of expectations, a lot of pressure, and for a lot of first generation, they’re not expecting that pressure placed on them.
SMK: The model minority myth comes up a lot in my conversations with Asian Americans. I have a problem with the term on its own, but does it also set up expectations, from family and society, and does that have an effect on mental health?
AN: I see this in my therapy work with South Asians. For some, they dive into this myth and say okay, I have to excel. This is the expectation that I’m placing onto myself.
They identify with that expectation and it kind of pushes them forward, at least in academia when it comes to school, high school, maybe undergrad, maybe even graduate school. But once they become young adults, then they don’t have those check boxes anymore. Okay. You graduated with your undergrad. Okay, you got a job. Okay, maybe you got an apartment. Great. But then they’re looking for the next checkbox, but there’s no more checkboxes at that point.
And if this is what they’ve used as a form of identity to feel confident in themselves, when there’s no more check boxes to check off, their sense of identity starts fragmenting. They don’t really know, like, Who am I? What is happiness for me now? What does it mean to feel content in my own body?
They start having these mental health problems because they don’t have that metric anymore. That was that model minority myth.
When they aren’t able to excel in all areas, then they start beating themselves up like, “Oh, what’s wrong with me? Why can’t I be like that doctor over there? Or that lawyer over there?”
A lot of South Asian families tend to be very comparative. Of their children with other children. They’ll talk about so-and-so down the block, whose son is a doctor, lawyer, etc.
And they say that as a form of motivation for their children without even thinking it hurts their self-esteem and it hurts how they perceive themselves. I see that consistently amongst my clients.
SMK: Abu, you’re holding such a mirror up to our community. I’m very grateful for that. Are there any other myths about Asians, South Asians, Bangladeshis, and mental health?
AN: One thing I like to bring in my therapy work is the idea of mental health and spirituality and how it goes hand in hand together.
There seems to be a dichotomy, this arbitrary difference between the two where when you’re dealing with mental things, you’re dealing with a very biological, fundamental problem versus when it comes to spirituality, which is a way of understanding yourself in relation to the divine things that are greater than you, larger things like your community.
There is a lack of integration.
SMK: I love that you’re integrating that because I think for many Asian families, the reticence to talk about mental health is that it’s seen as a Western thing. I get questions from these same parents like “Is it okay for my daughter to live in the dorm?” Or “Are American teenagers really having sex?” Parents seem fearful over this somehow being more like the Americanization of their children or the alienation of their children further from values or spirituality.
AN: There’s an inherent fear that once you start working with a mental health concern, you acknowledge there’s an actual problem and to acknowledge that there’s a problem, that’s a need of healing, that’s a need of support. It’s against the mindset: “I’m gonna cover my ears and pretend it’s not a problem. The more I ignore it, the more it’ll eventually solve itself.”
That’s what the South Asian community is used to. But it doesn’t just fix itself. The research goes to show, every generation is getting more depressed, getting more anxious.
There are more and more stressors placed on teenagers and adolescents between media, technology and everything else. South Asian parents don’t have a framework in their education on mental health. So it’s very alien.
The Muslim American clients I work with, Islam is so ingrained in the cultures, in the language and the way we interact with their family and with their close friends and their mustard and other places. But then they go to school and it’s a very different environment. It’s a different language, different lingo.
Navigating that space is complicated for a lot of my clients, hence why they’re seeking therapy.
SMK: That’s amazing. We’re wrapping up AAPI Heritage Month. It’s also been Mental Health Month. Of course, for you, it’s 12 months of the year that these two things intersect. So I don’t want to act like we only care at this moment. While we have you, is there anything else you wanna add or say?
AN: I would add the importance of being explicit of our care and love for each other, especially from parents to children. I see consistently that parents want to show their love through food or through some other external forms of care, but to actually say:
I love you.
I care for you.
I’m proud of you.
You’re doing a great job.
These words of affirmation are very important for child and adult development, but in the South Asian community, it’s very rare to get that affirmation from parents. I think it’s very important for parents to be actually explicit of how much they are proud of their children.
Don’t just say it when you’re trying to boast to all the uncles and aunts. Parents should really show their care, even in the home setting and be more explicit about that.
SMK: At Epicenter, we always ask the question of what you need. So what do you need?
AN: I like the idea of building bridges between communities and having more opportunities for conversation and dialogue. I’m really grateful that you’re here, creating the space to talk about this.
There’s not a lot of communication or advertisement about these things. There should be.