“What happens at home should stay in the home” or “Don’t air out dirty laundry” might be familiar phrases if there’s a familial or cultural stigma around discussing emotional distress in your family. If you’re Asian, like me, you might relate to these sentiments deeply.

Before we dive in, it’s important to note that Asian cultures are not a monolith. Indians, Koreans, Sri Lankans, and Indonesians each have unique cultural identities and practices. Generalizations about Asian cultures can oversimplify and overlook the rich diversity within them. Understanding these cultures requires nuanced thinking and a deep appreciation of their complexities.

Historically, Asians have faced significant barriers in seeking mental healthcare. While practical issues like cost, time, or lack of insurance are real, there’s often a more profound systemic barrier rooted in cultural beliefs about mental health. In many Asian communities, mental illness is surrounded by a considerable taboo, often dismissed as a sign of weakness or failure.

As a South Asian therapist, I often see the profound impact of cultural stigma on mental health. Many of my clients struggle with the conflict between their mental health needs and the deeply ingrained cultural beliefs about mental illness.The silence around these issues can be deafening, and it’s a barrier I’m committed to helping my clients overcome.

Our cultural identities are an important and ever-present part of ourselves as we show up in life or in the therapy room and the following are some themes I often touch on while working with Asian clients.

Cultural Stigma and Shame:

Growing up, I witnessed firsthand how mental illness was often seen as a personal failing rather than a legitimate health issue. In many Asian cultures, there’s a pervasive belief that mental struggles reflect poorly on one's character or family. This stigma creates a wall of silence, where individuals suffer in isolation, fearing judgment or disgrace. This stigma can show up differently in families.While some families may outwardly say things like “what happens in the home should stay in the home” or “therapy is for crazy people”, other families may be more covert in their stigma by not telling other members about their diagnosis or medications they may be taking for anxiety or by stressing the importance of learning resilience through suffering and mental fortitude. I understand this pressure intimately and strive to create a safe, non-judgmental space where my clients can openly discuss their struggles.

Family Honor and Reputation:

Family honor is a significant concern in our cultures, and mental illness can be seen as a threat to that honor. I’ve heard from clients who, despite their suffering, hesitate to seek help due to fears about how their families might react. They worry about the shame they might bring upon their loved ones. In therapy, I work with clients to navigate these fears while considering family dynamics.

Traditional Beliefs and Practices:

Traditional beliefs often influence how mental illness is perceived. Spiritual and moral explanations can sometimes overshadow the need for conventional mental health care. However, spiritual and/or religious identities are an important strength for my clients. I acknowledge and respect these beliefs, and I often incorporate a culturally sensitive approach into therapy. My goal is to bridge the gap between traditional practices and modern psychological methods, ensuring that clients receive holistic care.

Communication Styles:

Communication norms in many Asian cultures tend to be indirect, which can make it challenging for individuals to express their emotions and seek help. I’ve learned to navigate these subtle forms of communication, paying close attention to non-verbal cues and creating a space where clients feel comfortable sharing their feelings. Moreover, I have learnt that “Western” approaches to creating/communicating boundaries and conflict resolution are different to what Asian clients may seek in their lives. My approach is to gently encourage open dialogue, helping clients find their voice and articulate their needs in a manner consistent with their core values.

Generational Differences:

The generational gap within immigrant families can further complicate discussions about mental health. Older generations might adhere to traditional views, while younger individuals are more open to seeking help. Occasionally despite our best efforts, it is impossible to bridge this gap and clients experience grief around having to mask their behavior in front of relatives/not share their struggles openly for their own wellbeing. I help address this divide by working with clients to understand and address these differences, fostering mutual understanding within families and encouraging support for mental health.

Seeking Help and Access to Services:

Finding culturally competent care can be a challenge. Many of my clients face language barriers and cultural misunderstandings when seeking help. As a therapist familiar with these challenges, I offer services in multiple Indian languages (Hindi, Odia and Kannada). I have recently started to learn American Sign Language in an effort to make therapy more accessible and effective for clients from diverse backgrounds!

If you’re struggling with mental health issues and find that cultural barriers are making it difficult to seek help, I am here to support you. Therapy can be a powerful tool for addressing your concerns, especially if your therapeutic relationship is built on similar/shared experiences. If not for shared experiences, then trust that your therapist is culturally-informed and someone who exercises curiosity and openness towards your complex sociocultural identity is imperative!

Conclusion

Breaking the silence around mental illness in Asian cultures is not easy, but it’s a journey worth taking. By acknowledging and addressing cultural barriers, we can pave the way for more open conversations and better access to mental health care. Together, we can work through the stigma and challenges you face, helping you find a path to healing and well-being. If you’re ready to take the first step, I’m here to help guide you through this process with empathy and expertise.

Breaking the Silence: Addressing Mental Health Stigma in Asian Cultures