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Beyond Cultural and Religious Biases
Asian
Indians and Mental Health Issues
M.Phil., LMSW, Harlem Hospital Center
Mathew Mukalel, MSW Dr. Francis Jacobs, Ph.D., LCSW-R
It’s legitimate to ask questions such as: “How do Asian Indians handle mental health issues? Do Asian Indians view mental illness the same way they view physical illness?” While their perceptions of physical illness or somatic symptoms are almost the same as those of Westerners, their perception of mental illness is different. Being afflicted by physical illness and seeking help from physicians and other health professionals is normal, as it draws no attention from the community. However, this is not the case with mental illness, and, therefore, seeking professional help is a matter of extreme privacy. It’s okay to be physically ill, but it is not okay to be mentally ill.
Appeasing the Wrath of God
Psychiatric illnesses are considered a “curse from God” or
a punishment for “sins of the past life” or “manifestations
of evil spirits.” To be an object of a curse from God is a tragedy
far beyond the imagination of an ordinary Asian Indian - similar to that
of Job when his friends accused him of being a sinner, an object of a
“curse from God”. Job began doubting the concept of a loving
God. To appease the wrath of God, ordinary people turn to priest and priestesses,
seeking solace in their misery, which, in this case, is the psychiatric
illness of their loved one. As help is sought, every precaution is taken
to ensure anonymity for the persons seeking help in order to protect families
from unwanted attention and stigma.
Stigma and Rejection
Studies of psychiatric patients in India show that the tendency to perceive
and report distress in psychological or somatic terms is influenced by
various social and cultural factors. Symptoms of mental illness are often
interpreted along religious lines. Further, females, younger-age patients,
as well as caregivers are the most stigmatized. There is a need to hide
facts from others because of a fear of rejection by neighbors and, thus,
the community, as well as concerns about marriage.
Stigma about mental illness is significant and could lead to negative
consequences for patient and family, which can include rejection, denial
of equal opportunity and participation in society, humiliation and even
violation of human rights. Thus, people want to protect their loved ones
from “public stare” and, at times, even remove them from their
own community. Taking them to faith healers and treating them with rituals
rather than appropriate medications is the first and readily available
option of choice.
Achieving “Wellness”
The “Vedas” interpret wellness in the context of “wholeness”.
Wellness is more than not being sick, it is an approach to health that
aims to reduce the risk of serious illnesses. The way people live has
a lot to do with their health. Coming to America, while a “dream
come true”, can have a profound impact on “total wellness,”
particularly in the area of mental health, an essential ingredient in
the quest for “wellness.”
The stress of adaptation and acculturation is an important factor impacting
wellness. Learning a new language (though not unfamiliar with English);
adapting to new customs; confusion about roles, values, feelings; and
rejection by the host and dominant group are just some of the realities
faced by immigrants. Experiences in a host country during the first years
of resettlement may have more effect on mental health than past experiences
before migration. All these factors can negatively impact the mental health
of Asian Indians resulting in anxiety disorders and depression, two major
complaints among them. This in no way implies that Asian Indians aren’t
susceptible to schizophrenia, manic depression and other such mental illnesses.
Help Seeking Patterns and Changing Attitudes
The help seeking patterns of patients or the treatment of the mental illness
in India vary significantly from those of Europeans and Americans. Traditional
medicine and magico-religious beliefs play an important role in the treatment
seeking patterns and the care patients receive. Studies show that many
schizophrenic patients undergo magico-religious treatment; and also, many
who seek magico-religious treatment believe in a supernatural causation
of mental illness. Local and community belief in supernatural phenomena
is an influencing factor in the decision to seek magico- religious treatment.
It is difficult for first-generation Asian Indians to totally ignore the
cultural traditions and belief systems of their dominant culture in their
decisions to report psychiatric symptoms and seek and use mental health
systems. While they feel less affected by the stigma about mental illness
they, nonetheless, continue to exhibit a tendency to be uncommunicative
about their private lives. There is greater acceptance of mental illness
among second-and-third generations of Asian Indians and, thus, also, of
treatment. They readily acknowledge the importance of communicating about
their “private lives” and are open to medication and psychotherapeutic
interventions.
Changing Patterns
The “conquests of time and space” have drastically changed
the attitude of Asian Indians about mental illnesses and mental health
treatments. Education and awareness generated by mental health professionals
and by the media have led to gradual change in attitudes toward mental
illness especially among the educated Indians. Availability in India of
psychotropics and neuroleptics, used in North America and Europe, has
drastically changed the common perception that mental illness is “incurable”.
Conclusion
An understanding of the Asian Indian’s way of life, i.e., cultural
practices, belief systems and attitudes toward mental illness and related
aspects, is essential for mental health professionals working with Asian
Indians immigrants. Being informed about their customs, traditions and
values would help professionals to be more sensitive to the needs of their
Asian Indian clientele.
(Dr. Jacobs and Mr. Mukalel are board members of the American Association
of Asian Indian Social Workers.)