Raise your hand if you’re an Asian American Pacific Islander who’s been told to “pray” your depression away, go for a walk, or get something to eat as possible mental health solutions. Conversations about mental health and therapy can be stigmatized within the AAPI community when addressed directly, leading one to avoid dealing with these feelings and thoughts altogether. My first memory of experiencing anxiety and depression can be traced back to September of 1996, when I began my first day of kindergarten at a local elementary school in Jamaica, Queens.
In the first month, I periodically ran out of the classroom in the middle of the day, as if trying to escape something. I spent hours staring idly out the window of the classroom. I had lost all interest in reading, my favorite pastime. As with all life changes, I learned to adjust to school. But these behaviors persisted throughout the years: lack of motivation in all aspects of my interpersonal and educational life, low self-esteem, and a constant, inexplicable, dull emotional ache — no matter how good life was in that moment. Many years later, I learned in therapy that these were potentially early warning signs of depression.
As is common for first- and second-generation children of immigrants, I defined success as a function of hard work and sacrifice, not fulfillment. I spent my childhood and teen years chasing an immigrant’s dream of stability, tying my self-worth and happiness to my grades and ignoring my emotional needs. When I went through what I now recognize as episodes of depression — for me, this was categorized by sleeplessness, changes in appetite, anxiety, and persistent low mood — my parents would recommend tutoring to increase my grades, or tell me to eat something, or to take up yoga. These were not full solutions so I learned to hide my emotions and tried to focus on something else, like school or a musical instrument. It’s not that my parents didn’t care about my emotional needs, they just didn’t understand what to do about them.
According to the Anxiety & Depression Association of America (ADAA), Asian Americans and Pacific Islanders are three times less likely to seek mental health services than other Americans. Barriers to AAPI individuals receiving mental health treatment, some experts say, are due to a number of factors such as stigma associated with therapy, limited access to mental health care services, a lack of therapists equipped with multicultural competency, and, perhaps the strongest barrier of all, familial or societal preconceptions on seeking help.
Eastern cultures, too, tend to see the mind and body as “one” and for centuries have treated mental health through traditional practices. In South Asia, this might look like yoga, religion and faith, diet, massage therapy, aromatherapy, or herbal treatments. In contrast, Western culture treats mind and body as separate entities, with talk therapy and/or psychotherapy being widely embraced solutions that might not suit those in the AAPI community.
“Mainstream psychotherapy in America has its roots in Western Europe,” said Dr. Geoffrey Liu, M.D., a psychiatrist at McLean’s Behavioral Health Partial Hospital Program. “Assumptions that some take for granted, like ‘talking about it will make you feel better,’ may not be shared with some Asian Americans who may prefer to deal with emotions by doing things, such as sports or academics.”
My family left India and Bangladesh in the wake of war, famine, genocide, and ethnic and religious cleansing. Political unrest taught them to survive through banding together or collectivism — to put the needs of the group over the individual. This trickled down to the younger generations, and I learned to prioritize others before myself. I felt ungrateful for having complaints about my life, as I believed my parents and grandparents had it worse.
An emerging field in epigenetic studies the likeliness of intergenerational trauma and its effects on our psychology and physiology. In several small studies of Holocaust survivors, compiled by the National Center for Biotechnology Information (NCBI), it was found that children of survivors suffer from PTSD, even though they were born after the events of the Holocaust. The studies suggest that children of parents who experienced trauma may suffer from impaired self-esteem stemming from the minimization of their own experiences in comparison to that of their parents.
My depression eventually developed into self-harm tactics: I befriended people who didn’t have my best interests at heart, prioritized others’ needs above my own, and did not practice self-care. I even developed an eating disorder along with other co-conditions like insomnia and anxiety. Therapy was never an option. I believed that it was not for people like me, who, with my middle-class privilege, had nothing to be ungrateful for. I kept my feelings hidden from family and friends until they began to affect my grades in college — I was on the verge of failing out of my major.
Finally, I realized that ignoring my issues was not working, and I sought counseling through my college’s on-campus health services. Although I made the choice to seek counseling, I was ashamed that I needed it. I went for several months, just enough to get back on track in school, before the shame caught up to me and I never went back. My depression continued to compound.
Things came to a head in my late 20s. I was living in a spacious one-bedroom apartment with my two cats in Forest Hills, Queens. I had found moderate success in my career as a mechanical engineer designing consumer products. I had just gotten my master’s degree. I had a budding social life, and spent time donating money and volunteering for various causes ranging from homeless animals to domestic violence and gender equality. Finally, I had gotten everything I’d worked for. And yet, under layers of joy I, unfathomably, felt my heart rattling as if in a cage. I muffled the noise in vain with arguments of “be grateful” and “this heartache is not that bad.”
In September of 2018, I hosted a dinner party at my apartment with a group of old friends on a Friday evening. It was a beautiful night full of joy and laughter. But by Sunday evening I started to feel hopelessness, like I could never be happy again. The following Tuesday evening, I made a choice. All the years of suppressing my emotions caught up to me and led me to map out my suicide. Before I acted out my plans, I reached out to a counselor at NAMI and was eventually admitted to the one place I had always feared: a psychiatric ward.
It was during inpatient treatment that I learned that there is a word for what I had felt my whole life: dysthymia (aka persistent depressive disorder). Dysthymia is characterized by a constant, low-level depression one experiences for two or more years. Some people, such as myself, may also experience what is referred to as major depressive “episodes,” where the symptoms are more severe — episodes can be triggered or totally random. The doctors told me dysthymia is chronic, possibly genetic, and the result of a chemical imbalance that has always existed regardless of external factors. The sudden shift I would feel from one day to the next, feeling fine one second and having thoughts of suicide in another, was a result of low levels of neurotransmitters such as serotonin, norepinephrine, or dopamine.
My hospital stay lasted almost a week, ending only when the therapists and psychiatrists were confident that my suicidal thoughts had subsided and that I was committed to taking daily medication. In addition, I was set up with a therapist in the hospital’s network. Less than 24 hours into my inpatient treatment, my mother came to see me during visiting hours. That I landed in inpatient care was shocking to my family. That I was being treated with psychiatric medicine was an outrage. India had practiced various forms of psychiatric treatment through the use of yoga or herbal remedies, but the emergence of psychiatric drugs use is fairly recent.
I turned to data to make everything make sense for her. I showed her just how ubiquitous depression can be (it’s estimated that depression affects one in four adults), and trials upon trials showing the efficacy of medication, as well as the likelihood and treat-ability of potential side effects from it. She came around, but made it a point to tell me her preferred methods for treating depression: meditation, a diet of whole foods and vegetables, positive thinking, organization, crafts, music, and love. She’s not wrong. I believe the solution is an amalgam of treatment plans — medication is just one.
The goal of any mental health journey, typically, would be the realization of your capabilities in living a fruitful, fulfilling, and productive life without the barriers of mental illness. However, beginning the journey requires de-stigmatizing your own misgivings on mental health and understanding the origins of that stigma. You have to confront yourself and find comfort in seeking help. There is no replacement for trained professionals.
Therapy is how I overcame my own internalized beliefs that therapy was for the weak, and to begin the treatment I sorely needed. It is where I learned who I am and what I require to properly heal. I found my life’s purpose in education as a math teacher because of therapy. It is also where I learned to stop resenting my culture, to stop blaming it for my mental illnesses. I now see the value in a holistic treatment of mental health that takes from Eastern and Western practices. My advice for anyone is this: Figure out what your conditions are. Name them. Destigmatization also requires self-preservation. Choose to protect yourself before you choose to protect your relationships. Lean into the support where you can find it; this can be through friends, family, or a mentor. Build a network of people who you relate to. This makes the world feel smaller, and warmer. I believe it is through community that we find healing and closure.
Three years later, and my mom still doesn’t love that I take antidepressants. I don’t know that she will ever understand all parts of it. Maybe medication works, but I know she still wonders if I really need it. Our compromises are the dawning of a recovery: she, accepting the use of pharmaceuticals, and I, agreeing to never forget to look to my history in times of suffering.
If you or someone you know is seeking help for mental health concerns, visit the National Alliance on Mental Illness (NAMI) website, or call 1-800-950-NAMI(6264). For confidential treatment referrals, visit the Substance Abuse and Mental Health Services Administration (SAMHSA) website, or call the National Helpline at 1-800-662-HELP(4357). In an emergency, contact the National Suicide Prevention Lifeline at 1-800-273-TALK(8255) or call 911.