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By Amisha Parekh

But what will the neighbors think?
Overcoming mental illnesses in the South Asian American family

On the surface Ronak Patel's family seems perfect; her life story mirrors so many other first-generation Indian-American women. Ronak's parents immigrated to America, carrying dreams of opportunities along with their luggage. They found a home in a New Jersey suburb, and had two children, Ronak and her older sister. They settled into a tight-knit Indian community where families formed the entire neighborhood and secrets did not exist. People saw them as the perfect family. Yet Ronak and her family were silently managing a devastating, too often invisible disease.

When Ronak was a teenager, she began to observe sudden changes in her

Photo by Suraj Shetty

mother's moods and actions. "It started when I was in the ninth grade," says Ronak. "Her mood swings came out of nowhere without any warning signs or indications." One minute, Ronak and her sister were laughing about something with their mother and the next minute her mother would be angry with them. As these mood changes became more erratic, Ronak's family realized there was something seriously wrong.

Seeking help proved more difficult than making a doctor's appointment, Ronak explains. The most difficult task was to convince her mother to see a psychiatrist in the first place. "Like most people with a mental illness, mom was ashamed to try to find help," says Ronak. Her mother wanted to maintain her family's flawless image. Eventually, though, she saw that she had lost control and decided to seek help. She was diagnosed with a bipolar disorder, a depressive disorder that affects 1.1 million women in the United States.

According to the National Institutes of Mental Health (NIH), bipolar disorder is a manic-depressive illness that causes changes in a person's mood, energy, and functional ability. The symptoms of the disorder are severe and are not the typical mood changes most people experience. Depression is the most rapidly growing illness among women worldwide. In the United States alone, depressive illnesses, including bipolar disorder, affect twice as many women as men and these numbers are on the rise.

According to the NIH, women outnumber men in almost all types of mental illnesses such as anxiety disorders, eating disorders and Alzheimer's disease. Schizophrenia, one of the most chronic and disabling of these diseases, affects approximately 1.1 million women of all races and ethnicities.

So the Patel family story is not unique; many South Asian women struggle with mental illnesses. In fact, according to a 1990 study at the University of Toronto, women of South Asian ethnocultural backgrounds are particularly at risk for developing depression.

But why is this particular demographic at such a great risk? Dr. Chhaya Maisuria, a psychotherapist at Hollinswood Hospital in Queens, New York, says that women of South Asian descent are particularly vulnerable to developing mental disorders due to cultural pressures and constrained lifestyles. In Dr. Maisuria’s doctoral dissertation at the University of Hartford, she determined that cultural identification plays an important role in the psychological well-being of first generation and immigrant Indians in America.

“We are walking on the border of both Indian and American cultures with the constant pressure to choose sides,” says Dr. Maisuria. “There is a perpetual sense of ‘not feeling

understood’ which can lead to depression and other mental disorders.” Dr. Maisuria says that South Asian parents believe their daughters should be “Americanized” in regards to education, but should be more “Indian” when it comes to family obligations and feminine duties, thus many South Asian American women have conflicted cultural identities.

A significant amount of research has been done in England about the status of first generation South Asians raised in Western society. In a study published in the British Journal of Psychiatry, hospital statistics show cultural conflict as the primary reason that South Asian women attempt suicide. According to a factsheet published by the Health Education Authority of England, South Asian women have, “conflicting values, beliefs and differences in expectations between generations and genders. Beliefs around divorce, widowhood, marriage outside culture or religion, and the preservation of family honor can negatively affect individuals and cause mental health problems.” Along with cultural conflicts, religious beliefs sometimes forbid certain activities that are accepted in Western society, such as dating and alcohol use. Within their families, many of women have thus found communication difficult and support lacking.

One therapeutic outlet Ronak recalls was SAMHAJ, a program from The National Alliance for the Mentally Ill based in New Jersey. SAMAJ focuses on educating their local South Asian population about the causes and treatments of mental illness. The organization provides support group meetings, creates numerous publications, and has also created a comic book that tells the story of a young Indian-American woman's struggle with bipolar disorder.

Dr. Maisuria believes that, regardless of race and gender, there is a stigma that surrounds mental disorders. This type of illness is not as easily accepted and understood as a physical illness--often mental illnesses are not seen as treatable, let alone curable. A mental illness should not be thought of as an absolute state, however, says Dr. Maisuria, because there are treatment options and cures available to reverse the course of the disease. In addition, Dr. Maisuria believes that educating people about the prevalence of mental illness is essential in convincing those who suffer from the disease to seek treatment.

Ronak Patel and her family know the effort that is needed daily to help Ronak’s mother. Even now, as her mother is coping with psycotherapy sessions and medications, Ronak stresses the most important lesson she learned from this experience: “There were times that I wanted to give up, but my father wouldn’t let me. He said the four most important words to me--Never give up hope. And I never did.”

Places to Find Help:

-The American Psychological Association (APA) recommends going to a primary care physician, contacting a local psychological association, or the department of mental health or the American Psychological Association ( directly. These resources are not just for patients, but for family members as well.

-Another viable option is confiding in friends. A recent WebMD survey of women found that depressed women are more likely to communicate their problems to friends rather than to their primary care physicians. Most women (62%) who have experienced symptoms of depression such as sadness, anxiousness or stress, talk with their girlfriends, while three-fourths do not talk to their physicians.

- SAMHAJ, an organization in Sommerset, NJ, offers free self-help group for South Asian families. The meetings are once a month and are open to anyone.

Amisha Parekh, 25, is currently finishing her Masters in Public Health at George Washington University in Washington, DC. She will be traveling to India for 9 months to work on building public health programs in rural communities.

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