“Things are not changing fast enough"
Over the years, mental health perception has changed and improved in many ways.
Discussing mental health in a British Pakistani household is challenging and one of the most difficult conversations to have.
However, despite the stigma that surrounds mental health, there is no shame to be had.
It is common in British Pakistani households to repress emotions and feelings.
The campaign Time to Change has found that within the Pakistani community mental health is heavily stigmatised.
This is primarily due to the fear and shame of being found out by others.
According to his 2015 article, Inamullah Ansari explained:
“Mental health is the most neglected field in Pakistan.”
Staggeringly, over 14 million sufferers of psychiatric illnesses are mostly women.
Research has shown that within the South Asian community in England and Wales, older South Asian women are an at-risk group for suicide.
Furthermore, high rates of suicide in young women have been reported in the South Asian diaspora worldwide.
To better understand mental health perception on a personal level, interviews with four women of different generations living in the same household were arranged to gather their viewpoints on the subject.
What is Mental Health?
Mental health encompasses our psychological, social, and emotional welfare.
It impacts the way we think, make decisions, our behaviour, and the way we feel.
The predisposition of mental health services being constructed around a Western paradigm of mental illness may be a barrier to the correct identification, treatment, and medication of depressive symptoms.
Higher rates of depressive symptoms among South Asians have been shown in multiple studies.
For this article, the interviewees were all individually asked, “What is mental health?”. Parveen, aged 72, said:
“I have thoughts in my mind that do not let me sleep, such as why my legs hurt, how I am losing weight and that my hands hurt.”
48 year old Mehreen revealed:
“I’m not entirely sure. Is it dealing with health issues of the mind?”
Arooj, aged 24, stated:
“Mental health is an illness that is associated with your mind and emotional behaviour.
“It’s similar to how our body would need a doctor for any physical pain, whereas our mind would need a psychiatrist or a psychologist to treat it.”
Moreover, Zoya, aged 15, told us:
“Mental health has to do with the way you think and behave.”
These answers demonstrate that the older generation of this household does not have much awareness of the topic and associates mental health with physical illness.
Mehreen has some awareness, but she asked a question that implies uncertainty on the accurate definition of mental health.
It was found in a 2012 study by Ineichen and subsequent research by Karasz et al in 2019 that South Asians were more likely to report physical/body issues as opposed to psychological symptoms.
This is crucial since expressing mental problems in a somatic form can impact the support professionals can provide.
Those who work in mental healthcare and multinational surroundings benefit from having an awareness of people’s beliefs about depression.
This could include what they think depression is, and what causes it, whilst also learning from those who have personally been impacted by the condition.
Arooj has demonstrated an in-depth understanding and can differentiate between physical and mental health.
Zoya has provided a more simplified response and understands the basics of mental health at the age of 15.
Family & Mental Health
The next posed question(s) was: “What if your loved one had a mental disorder? How would you view them or perceive them?”.
Parveen answered:
“I would share my pain with others if they share their pain with me.
“But sometimes I worry that I’ve revealed something I shouldn’t have and regret my decision to say anything at all.”
Mehreen portrayed:
“I would probably give them the time around the clock and provide them with family support.
“If that person is ill, I will get support from the doctors if I’m not able to help.”
Arooj said:
“I would perceive them as normal human beings and would try to cater to their needs.”
“I would introduce any mental health facilities that can help my loved one achieve better health and well-being.”
Zoya chimed in saying:
“As a normal person, help them by being there for them to express themselves and creating a safe space to talk.”
Interestingly, Parveen had difficulties understanding the question.
She revealed she would not express her feelings unless someone spoke about their vulnerabilities first.
She feared that she would be exposed as public image and perception are of great importance in the South Asian community.
Mehreen is a caring individual and she would take the right steps to help her loved ones.
Both Arooj and Zoya stated that they would perceive their loved ones as ‘normal’ and would be there for them.
However, Arooj goes a step further and introduces mental health facilities for support and well-being.
Desi culture takes a very holistic and collectivist approach which is unlike Western culture which is focused on individualism and self-expression.
However, ironically when it does come down to mental health, the majority of the community thinks it should be a matter that is kept confidential and private.
In a focus group study with service users of South Asian descent, it was concluded that cultural exclusion was seen throughout psychiatric facilities and services.
This rendered many patients unable to voice their concerns.
People often maintain culture-specific beliefs about the causation of conditions such as depression, which influences others to not disclose their symptoms and experiences.
Mental Health & You
Individuals were then questioned: “Would you seek help if you suffered from mental health such as depression, anxiety, or other disorders?”
Parveen said:
“No, only if it is physical. When my husband died, I got a lot of support from the village women, and without them, I don’t think I would have been able to heal.”
Mehreen stated:
“It depends on what type of mind frame I’m in.
“I wouldn’t say no, but only if I needed it, then I would. I usually would go for walks and keep myself occupied in my daily duties.”
Arooj referenced:
“I have already sought help for my anxiety, which was successful.
“I learnt a lot from CBT and the coping strategies they provided and would recommend this for anyone struggling with stress in their lives.”
Zoya claimed:
“I would, as I would like to go seek professional help rather than speak to a family member.”
Parveen demonstrated that she would not seek mental health support and associates mental health with physical illness.
She uses her husband’s death and states that the support she received helped her heal.
Therefore, she understands that a conversation is essential but would remain reluctant to discuss such subject matters.
South Asians with mental health issues frequently interpret their symptoms to be physical illnesses, therefore disregarding the need to seek psychological help and support.
One study found that when South Asians bring psychological struggles to their doctors, they are quite often untreated.
They are undiagnosed as they are introduced as somatic rather than having symptoms of depression.
Somatisation of stress has also been recognised as a disadvantaged health effect of abuse, including gastrointestinal problems, sleep abnormalities and bodily pains.
Mehreen shows that mental health is not as important as physical well-being.
She wouldn’t voice her issues and would instead get on with her daily duties rather than receive help.
On the other hand, Arooj is an open-minded individual who is not reluctant to seek aid from mental health services.
She understands the process, has named a therapy, and advocates for others to receive support.
Zoya states that she would instead seek professional advice and support than go to a family member and directly talk to them.
Support & Help
The penultimate question was: “Do you know what mental health services are available to you?”
Parveen revealed:
“I wouldn’t know exactly where to go, but I guess it would be with the regular doctors, but I wouldn’t go in except if I was in physical pain.”
Mehreen said:
“I would just go to my GP first, and they will help you from there.”
Arooj revealed:
“I do, just because I work in an environment with children where mental health is appreciated and needed in every aspect of a child’s learning.
“Therefore, having contact with any of these facilities is always available to me.”
Whereas Zoya stated:
“There’s a helpline at school, and we can go to a counsellor to speak to for help, and they can provide more information.”
Parveen has a vague idea of where to receive help.
She assumes it is with regular doctors. But again, confirms that she would not go to get help unless it had to do with her physical pain.
Mehreen states that she knows that she would go to a doctor first, and then if she needed support, the GP would help her from there.
Arooj and Zoya, on the other hand, are aware of mental health and know what facilities they can access to receive help.
This is primarily due to them being in an educational environment.
Somatisation amongst South Asians can be identified within the idea of collectivism.
In the West, individualism and independence are heavily emphasised, and self-autonomy and personal accomplishments are appreciated.
In contrast, South Asian communities are collectivist, highlighting family cohesion, solidarity, conformity, cooperation with interdependency, and valuing group importance over the individual.
Despite traditional, collectivist families appearing to be strong and close-knit.
Conventional gender norms, patriarchy and the importance placed on ‘obedience to the elderly’ are used to repress women and younger family members.
Furthermore, individuals in collectivist societies are far more likely to keep their problems to themselves.
Only seeking professional mental health services as a final resort. Seeking external support may be perceived as a failure of the family to resolve the issues.
The limiting understanding of mental health services has been prevalent among South Asian women.
One UK study contrasted the perceptions of illnesses and those who were seeking treatment between North Indian immigrant women and Caucasian women.
North Indian women were far more prone to report that the treatment for depression would be disadvantageous.
One of the predictors of mental health distress amongst South Asian women is a history and record of domestic violence.
Studies have discovered that depression, PTSD, anxiety, low self-esteem and suicidal thoughts are a direct result of verbal and physical abuse.
Financial coercion and forced isolation in marital disputes further propel the gender discrepancy in depression.
It is often a result of women being perceived as inferior to men in status.
Acceptance & Change
The final question asked was: “Do you think mental health is accepted?”
Parveen revealed:
“No, it’s not accepted, we don’t talk about these issues because it’s not good to discuss personal things with others as people will talk and say negative things.
“’This is how they sit; this is how they talk, their daughter-in-law is like this, etc.’ It’s best to keep family matters in the family.”
Mehreen said:
“No, I don’t think most people are open about it. People don’t want to talk about it; some people would, and others wouldn’t.
“I know I wouldn’t. I think it’s something confidential and not something to say out loud.”
Arooj commented:
“I don’t believe it’s as accepted as it would be, especially in the South Asian community.
“You cannot openly talk about mental illnesses as you would with physical illnesses.
“It’s still tough for me to say that I am having a depressing day, or I’m feeling very anxious, and I need to be by myself to my in-laws.
“They come from a traditional and conservative upbringing.
“I think even though mental health is accepted by some in the Desi community, when it’s their own, it’s harder for them to come to terms with it.”
Zoya illustrated:
“No, mental health is seen as a taboo topic.
“People in our community don’t think it’s necessary and see it as overreacting.”
“However, I do think we should be open about it and it shouldn’t be anything to be ashamed of.
“Things are not changing fast enough and it will take a while before it is acceptable in our society.”
Parveen shows that she is unaware of mental health.
She believes it discusses her thoughts to others and worries about how her family will be perceived while fearing societal reproving.
She believes her thoughts should not be projected because others would judge her.
However, she agrees that mental health is taboo but does not think somebody should voice it either.
Mehreen states that she does not think it is acceptable in our society.
But she wouldn’t want to talk about it either as it’s not something to be voiced, similar to Parveen.
Arooj and Zoya, on the other hand, both mutually agree that it’s not something that is accepted.
Both have found themselves struggling with specific mental health issues.
Considering the evidence there is a generational difference in thinking and perception.
The younger generation is more open to seeking help and wanting to normalise mental health in the South Asian community.
A substantial difference exists in depression rates between South Asian men and women, primarily older women and younger married women.
However, despite the suicide rates differing in the West, they are higher for men.
The suicide rate in addition to self-harm is much higher and greater amongst South Asian immigrant women than their counterparts.
Depression is the most common of all mental health conditions amongst South Asians in the UK.
Studies have showcased that in the UK, India and the US, they have investigated predictors of depression and concluded the following:
Literacy, education, language, financial struggles, older age, gender roles, perception of illnesses, poor physical health and social isolation were factors that contributed to the condition.
Overall, these interviews have shown a generational difference in mental health awareness; stigmas still exist in the older generation (40 and above).
However, the younger generation (39 and below) are open to seeking help.
They know exactly where to go to receive support and what facilities to access.
By interviewing different generations in the same household, we can gather further knowledge held upon mental health.
It demonstrates that it may take a while before our elders will normalise mental health acceptance or even choose to educate themselves on this topic.
From these interviews, it was concluded that the older generation in this household lacked knowledge of mental health and perceived it as unnecessary.
While the younger generation was adamant about seeking change and reformation.
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