By:  Francis Jacobs, Ph.D., LCSW-R; and Mathew Mukalel, MSW, M.Phil., LMSW, Harlem Hospital Center (May 2006)

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 priests 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.)