Ever since Dev’s mother told their family friends that was diagnosed with ADHD, they noticed a change in their behavior. Mothers no longer wished to schedule play dates with the sweet 8 year old boy. They would make transparent excuses that sent a clear message to his mother that they wanted to distance themselves from Dev. When she asked one of her neighbors why this was happening, her neighbor said very matter-of-factly, “I’m sorry Shubha but I just don’t want Dev to be an influence on my little Raj.”
Aarohi called her mother and father one evening and divulged to them that her doctor had diagnosed her with depression. He father reacted with anger. “You wouldn’t be depressed if you just focused harder on your studies and had gotten into a better college like your brother!” Her mother followed up with, “Just stop being so negative. Be happy in life and this whole depression nonsense will go away. It’s in your hands Aarohi!”
Mariam knew she had an anxiety problem and a visit to South Asian counselor confirmed her suspicions. As soon as she left the office, she felt this overwhelming sadness. She felt it was necessary to step down as a board member of her favorite charity. She also contemplated cancelling her social engagements for the next few weeks. With this diagnosis, she suddenly lost her confidence and began to feel that she couldn’t manage anything that she was able to do before.
Neal had just moved to college three states away. His recurrent illnesses were addressed by the college health center. After seeing numerous doctors, he was diagnosed with bipolar disorder. As soon as he let his parents know, they demanded that he move back home. “You’re not going to be able to keep up with the difficult curriculum of college,” his mother said, “and we don’t want you to get into any trouble.” He didn’t understand. “Well we know that people like that can get angry and do things to hurt people. We just think we can protect you better at home.”
Stigma is highly prevalent in South Asian culture against mental health issues. The above four examples highlight just a few of the ways stigma presents itself in the community and in families. There are two types of stigma – public stigma and self-stigma – and on both sides there are three specific exhibitions of negative attitudes toward mental health.
Public stigma is how people view anyone with an emotional health issue whereas self-stigma is how people with mental health issues view themselves because they are part of a stigmatized group. Regardless of the source of the stigma, both groups express it in three ways: through stereotypes, prejudice and discrimination.
Stereotypes are negative beliefs and attitudes towards a person because of their membership in a particular group. Common stereotypes that result in public stigma include believing that people with emotional health issues are dangerous (like what Neal’s father was insinuating), that they are incompetent (as evidenced by Neal’s mother who believed he could not keep up with college anymore) or that they are weak.
Similarly, self-stigma is perpetuated by stereotypes that people living with mental illness believe about themselves. They may believe the message they are getting from friends and family that they are a character flaw or that they are not competent enough to live a full life with responsibilities.
Both public and self-stigma are also strengthened by prejudice, which are thoughts or feelings that support the stereotype. Aarohi’s parents reacted to her diagnosis with anger and yelled at her because they thought she had created her negative situation herself. Other common examples of prejudice associated with mental health stigma include liking the person less, being afraid of them or not feeling as comfortable around them. People living with mental illness or any emotional health issue tend to be prejudiced to themselves often experiencing low self-esteem and believing they can’t do anything on their own, as Mariam felt.
Finally, both types of stigma are also fueled by discrimination. This is specific behaviors that are in response to stereotypes and prejudice. Friends and family may distance themselves from people with emotional health issues, as mentioned in Dev’s case who lost lots of play dates. They may not reach out to offer help, especially if they believe the person created their own situation, as is the case in Aarohi’s example.
Living with emotional health issues, South Asians may stop pursuing activities, interests or work, believing that they cannot handle it. They limit their exposure to people worried about how others will react to them, stop going out and even reaching out to friends and family.
The worst part about stigma is that often the effects of it, including social isolation, lack of support and low self-esteem, are often worse than the actual emotional health issue itself. Experiencing stigma while also living with emotional health issues can also significantly impact the response rate to treatment and prognosis. In fact, many South Asians living with emotional health issues, because they feel they can’t talk about it, often resort to substance abuse or suicide as a way to deal with the seemingly impossible task of being accepted by their community.
South Asians are a very community oriented group and just as we reach out to someone who has lost a loved one or who just had surgery, South Asians need to break the wall of stigma and reach out to those who are living with emotional health issues as well. The support and community feeling that comes from that can act as a strong protective and resilience factor, helping the person to recover and live healthier much sooner.