Why is Psychosis Still a Cultural Secret among British Sikhs?

Psychosis remains a deeply misunderstood and heavily stigmatised condition within the British Sikh community, where the majority are of Punjabi heritage.

A study has illuminated the complex web of cultural beliefs, family dynamics, and religious interpretations that shape how psychosis is understood and why professional support is often a last resort.

The research, titled Exploring Lay Understandings and Help-Seeking Pathways for Psychosis in the Sikh Community, reveals a significant lack of awareness that perpetuates a cycle of silence and suffering.

This limited understanding, particularly among older generations, creates significant barriers to diagnosis and treatment, ultimately worsening outcomes for those affected.

The findings highlight an urgent need to bridge the gap between deep-seated cultural traditions and modern mental healthcare.

Awareness and Stigma

A significant barrier identified in the study is the profound lack of awareness and knowledge surrounding psychosis.

While common mental illnesses are slowly entering the communal lexicon, psychosis remains an alien concept.

The term “schizophrenia” was more recognisable, which one participant attributed to it being “mentioned even in like, programmes, and films and things”.

However, a deeper understanding of what the illness actually entails is largely absent. This knowledge gap is particularly stark between generations.

Younger participants, with access to online resources and social media, showed greater awareness, whereas older generations, who lacked such mental health education, were perceived to have a much greater lack of understanding.

One participant noted: “If I was looking at say my parents’ generation from India… if I mentioned that to like you know a Punjabi background person, schizophrenia, they wouldn’t have a clue.”

This gap is amplified through the lens of language and culture.

In Punjabi, there is no direct translation for many Western diagnostic terms. This forces people to use colloquialisms that are often dismissive and deeply damaging.

Symptoms are frequently described using words like “mad”, “crazy” or the particularly loaded term “paagal”, which one participant described as going “down to that word” as soon as mental illness is mentioned.

Without a clinical vocabulary, nuanced conditions are flattened into a single, stigmatising label.

Another individual explained:

“I think there’s a language issue where we don’t actually have words to describe it in the first place.”

“If we were to describe it in Punjabi, we would say they were either sad or paagal.”

This linguistic void feeds directly into a pervasive culture of stigma and fear. The fear is not just of social ostracism, but something more primal; a belief that psychosis could be “contagious”.

According to one participant in the research, the cultural attitude is described as “you shouldn’t really go near them, like, don’t touch them, you might catch it like that kind of thing”.

Consequently, families often resort to secrecy and denial, dismissing symptoms with phrases like “get on with it” or brushing them “under the carpet”.

One participant’s account of his wife’s family member with schizophrenia was particularly telling. He described how the family don’t talk about it and that he was told, “don’t tell anybody because my family don’t want anybody to know”.

This culture of silence means individuals often suffer without support until they reach an absolute crisis point.

A Web of Causal Beliefs

When psychosis can no longer be ignored, its causes are often attributed to a complex web of social, supernatural, and religious factors, frequently prioritised over biological explanations.

Social stressors emerged as the primary explanation, with participants citing life pressures as a direct trigger.

One stated: “Stress is known to induce things like psychosis.

“If you have too much going on, work-related, family-related, lack of support.”

Childhood trauma was also widely discussed as a latent trigger that could flare up later in life.

More culturally specific beliefs, however, also play a powerful role.

Supernatural causes, such as black magic (nazaar), the evil eye, possession, and witchcraft, were widely acknowledged as prevalent explanations within the community, even if participants didn’t personally endorse them.

These beliefs were framed as a cultural, rather than religious, phenomenon.

One participant observed: “Things like spirit, black magic all day long, you hear things like that as soon as somebody gets any form of mental health illness.”

These supernatural narratives, often encapsulated in the vague phrase “somebody has done something”, provide a framework for understanding behaviour that seems inexplicable, particularly for older generations who may struggle with medical explanations.

Religious factors like karma were also cited, with some believing the illness was a consequence of past misdeeds.

Alongside this, however, was a sophisticated attempt by some to reconcile faith with science. Biological causes, such as a genetic predisposition, were commonly mentioned.

One participant offered a fascinating synthesis, connecting God’s will directly to genetics: “God’s will for example, to me, that’s saying the same thing as you know, that this is biological.

“This is just you know, within your DNA.”

This shows a community in transition, grappling with multiple belief systems simultaneously.

Pathways Fraught with Barriers

Despite the powerful influence of cultural and religious beliefs, the study found a clear and consistent recommendation when professional help is finally considered: the GP is almost always the first port of call.

The GP is viewed as the gateway to appropriate services.

Following a diagnosis, talking therapy and counselling were widely preferred over medication. The consensus in the study was a desire to understand the root cause of the issue, with one person stating:

“This isn’t just about medication alone; this is about understanding the root cause of what has led them to this scenario.”

That said, medical intervention was still seen as crucial in the advanced stages of psychosis, especially when hallucinations or delusions posed a risk to an individual’s safety.

However, the journey to the GP’s office is rarely straightforward.

The deep-seated stigma means that professional help is often a closely guarded secret, sought only when a crisis becomes undeniable.

One participant bluntly stated that “getting professional help” is not “accepted” and if it were sought, it would be kept “very secret”.

This secrecy is driven by a powerful cultural pressure, where fear of gossip and judgment from the community is a recurring and paralysing theme.

This creates a painful paradox. The family unit, though often described as unsupportive due to a lack of education, is still seen as the primary, and often first, pathway for help.

This internal conflict leaves many feeling trapped and isolated, with crucial conversations happening, if at all, “behind closed doors”.

Religion vs Culture

A core, powerful theme emerging from the study is the clear line participants drew between their Sikh faith and Punjabi culture.

Punjabi culture was repeatedly described with words like “toxic and judgmental”, while the Sikh faith was characterised as “peaceful, brave and resilient”.

It is the culture, not the religion, that is the primary driver of negative attitudes and help-seeking avoidance.

One participant articulated this plainly: “Culturally, I think people would just be, ‘Oh, he’s gone mad, he’s completely lost it, he’s paagal’.”

They contrasted this with a religious perspective, where the response would be to “pray for you”.

Participants found immense solace and support in personal faith practices. Prayer, devotional music and meditation were all cited as powerful coping mechanisms.

However, this personal faith did not translate into institutional support.

The Gurdwara was widely deemed an ineffective and even unequipped source of help for serious mental illness.

One participant noted that religious leaders “have no knowledge of these things, and very ignorant to these”.

While Sikh scriptures were said to contain references to mood and anxiety, participants felt they did not “lean towards psychosis or severe mental health”.

The peaceful environment of the Gurdwara was seen as beneficial for general well-being, but it was not a substitute for professional, informed guidance and care.

The study’s findings are a stark reminder of the urgent need for culturally sensitive mental health provisions for the British Sikh community.

The pervasive stigma, linguistic barriers rooted in the Punjabi language, and a lack of awareness create a perfect storm that leaves vulnerable individuals isolated.

A critical step forward will be to empower the community to distinguish between progressive Sikh teachings and the more restrictive cultural norms that fuel stigma.

To break this cycle, healthcare organisations and community leaders must collaborate to create bilingual resources, deliver mental health workshops in trusted community spaces, and normalise conversations around mental health.

Only by addressing these complex, interlocking issues of faith, culture, and health head-on can the community begin to dismantle the wall of silence that surrounds psychosis.