Libre Magazine

Mental illness is not a topic of everyday conversation amongst most families and friends. In this respect Desis are no different. What is different is we do not tend to seek help as much as Caucasians or African-Americans do even when we are afflicted with psychiatric disorders.

The research article titled, “Manifestation, Attribution and Coping with Depression among Asian Indians from the Perspective of Health Care Practitioners” published in the Journal of Transcultural Nursing in 2005 discusses in some detail how the Indian social and religious beliefs impacts us in the US and how those affected with a mental disorder cope with the illness in the US.

The primary reason for Asian Indians not seeking help in the US could be the lack of awareness of resources or the existence of a mental disorder.

Not too long ago Perveen Babi a popular actress in the 70’s and ‘80’s, featured on Time magazine’s cover in 1975, known for her unconventional behavior and roles suffering from paranoid schizophrenia was reported dead on January 20, 2005 in her Mumbai apartment. The oddity of her behavior had been reportedly witnessed by several on numerous occasions. It is said that many tried to help her as best as they could. But alas it was too late. In her later years she lived her last years as a recluse with diabetes. Mahesh Bhatt’s semi-autobiographical movie Who Lamhe is his tribute to their relationship.

Recently there have been a handful of other movies like Hiding Diva, 15 Park Avenue, and Maine Gandhi Ko Nahin Mara that deal with mental disorders, but by an large mental illness remains hush-hush because of the social stigma attached to such illnesses.

Diseases such as diabetes, heart conditions, cancer can easily be blamed on stress, eating habits, and the environment. Some of us even proudly go out in public with our several inches bigger than healthy waist-line because of our age-old belief that the size of our bellies or being overweight reflects our prosperity. But most people suffering from mental illness go unnoticed in society. If they do get attention, it is not the correct type of attention. This is not necessarily because medical help or support might not be available, but because of the barriers associated with seeking and receiving help.

How does one explain to society at large that their autistic child is not their fault? Or the fact that their child has attention deficit hyperactivity disorder (ADHD) is not their fault? And neither is depression or anxiety in their spouse or child?

How do make sure we do not commit suicide or are not responsible for helping our loved ones try to take their lives?

Our first instinct is to immediately deny that no such thing could happen to us. Because we are after all one of the most educated, affluent, upward mobile and politically savvy ethnic immigrant community. We are Indian-Americans.

But let us not forget that we have left our homes to make a new home in a foreign county, some of us voluntarily and others not so voluntarily. Even to the most adaptable of us, this can prove to be stressful. Once we arrive, we have to adjust, accommodate, keep compromise, and keep proving to our selves and others 24/7 that we are just as good, if not better than others at what we do. At some time or another we face depression, anxiety, stress, isolation, feelings of guilt, pressure trying to assimilate into mainstream American culture outside our homes. In the case of some of us, these symptoms are heightened by socio-economic status, family structure, work conditions, cultural expectations, violence, generation gaps, and the universal gender discrimination.

Whereas elderly women report feeling isolated due to lack of established family and social networks, which served as support systems back home.

What and where does this get us? We get to keep our jobs, climb professional ladders, put our kids in good schools, and do our best to make sure their lives are secure at the expense of our health and families. We even try to get dual citizenships.

At the end of it all, if things don’t always work out as we expected or would have liked to, what then? Whom do we turn to? With the change in our family and social structures talking to a friend or two is not always a viable option.

In general, feelings are kept bottled in going day in and day out about our business. And it works for most of us, because perhaps we expect a certain level of disappointments, misery, stress, and aliments because we are originally from another country, belong to more than one place, in more than one sense. We speak differently to the native’s; our English is not quite of the Queens. Ours has color, whereas there is bland. We know this and even make light of our accents and differences during stressful moments in our lives as foreigner. But how do we face problems that persist and do not going away in spite our trying to make light of them?

It not surprising that November 2006 results from the Asian American paper drawn from the first larger National Latino and Asian American Study (NLAAS) showed that overall Asian immigrants have a lower prevalence of a mental illness compared to all Americans (almost half, about 25 percent).

For this paper, the researchers interviewed from May 2002 to November 2003 nearly 2,100 native-born or immigrant Asian Americans who were 18 or older. Participants included 600 Chinese, 520 Vietnamese, 508 Filipinos and 467 other Asians including Japanese, Koreans and Asian Indians.

However, according to the National Institutes of Health (NIH), based on NLAAS, US born children of Asian immigrants are not so fortunate where mental health is concerned. They have more lifetime cases of mental disorders. What is disconcerting is not only that Asian American immigrants seek less help, but also their children show similar patterns in terms of seeking mental health care compared to the general population.

The burden of mental illness is high among Asian Americans. This is reflected in the high statistic for suicides rates, more so in the immigrants from India.

A study done by Patel SP showed that suicide rates of young women immigrants from the Indian subcontinent are consistently higher than those of their male counterparts and of young women in the indigenous populations of the countries to which they immigrate. In most cases, family conflicts appear to be the precipitating factor. More research is needed on the epidemiology of psychiatric illnesses and their contribution to suicide in Indian immigrants.

It is not surprising that Asian Americans show lower rates in terms of seeking help for mental disorders. The associated stigma and importance to social status does not make things easier. In the study presented at American Psychological Association 2005 Annual Convention in Washington, D.C., the investigators found that 74 percent of Asian-American NLAAS participants said they had experienced some kind of unfair treatment and 63 percent attributed such instances to racial factors.

It has been speculated the disparities in treatment could be due to the unfamiliar culture or their proficiency of the English language, making seeking treatment less important.

Unfortunately, when Asian Americans with mental illnesses do present to primary care providers, providers often find it difficult to identify their patients’ mental disorders, because typically these patients present to their primary care physician with somatic (physical) symptoms such as dizziness, aches, and pains. Doctors don’t tend to ask about mood and feelings, making mental illness under diagnosed in such patients.

Lack of understanding different cultural sensitivities further hinders accurate diagnoses, since unlike other illnesses mental disorders can be diagnosed only from verbal and nonverbal communications with a doctor.

According to the US Surgeon General’s Report, finally when Asian Americans do use mental health services, severity of disturbance tends to be high, because of the delay in seeking appropriate treatment.

When Asian Americans do get prescriptions for their mental health, successful treatment with drugs is often times less, because compliance is low due to more side effects compared with Caucasians or other the races. In short, a lot more needs to be done towards helping Asians have better mental health in terms of medical practices. After all they are an influential race in America in terms of education and financial progress of the country.

It is not surprising that the supplement released by The US Surgeon General in 2001 to a report on mental health entitled “Culture, Race, and Ethnicity,” states that “culture counts” in the diagnosis and treatment of the identified ethnic groups.

The clearly increasing cultural diversity of the country requires that physicians without ambiguity understand how cultural differences impact diagnosis and treatment.

According to the February 2007 survey report released by American Community Asians released there are at least 12 million Asians, a 4.2 percent of the total population, and the number is increasing rapidly. According to a May 2006 CNN report there was a 3 percent increase in Asians in the US from 2004 to 2005, yet the US Surgeon General’s Report shows that there are only about 70 Asian Americans providers available for every 100,000 Asian Americans in the U.S., compared to 173 per 100,000 Caucasians.

The dilemma with mental health is that most consider “Asian Americans” as a single entity, wherein the term includes more at least 43 different ethnic subgroups originating from different countries and speaking over 100 languages and dialects, making effective communication on both patient and physician side challenging and reporting of accurate analyses. Pacific Islanders are also lumped in under the term.

No reliable information is available regarding the Asian language capabilities of mental health providers in the U.S. To add to the problem, overall about 21 percent of Asian Americans lack health insurance compared to 16 percent of all Americans.

The Centers for Disease Control Fact Sheet indicates that disparities in mental health between races in the US exist. Only 25 percent of Asian Americans are likely as whites and 50 percent likely as African Americans and Hispanics to seek outpatient care and are less likely than whites to receive inpatient care, which largely accounts for their under-representation in most mental health services.

If these trends continue, rates for Asian Americans with mental health problems will rise dramatically, especially since we know that patients with chronic illness such as diabetes tend to have a higher prevalence of depression, impacting costs from every angle and at each level.

It is obvious that more needs to be done for this group in terms of research, prevention and treatment, in particular for the Indian-Americans as it has been reported that the suicide statistics for immigrants in general from the Indian subcontinent are at least 2 to 3 fold higher (particularly in the UK) compared to other countries in Southeast Asia.

More needs to be done so that the Asian American community seeks more help before mental health crises.