(Editor’s note: India-West reporter Sunita Sohrabji received a fellowship from the University of Southern California’s Annenberg School of Journalism to report on mental health disorders in the South Asian American community).

A year before he died earlier this year on April 23, Sunil Tripathi had dropped out of college at Brown University, allegedly suffering from bouts of depression.

Tripathi, 22, went missing Mar. 15 from his Providence, Rhode Island, home, leaving behind his cell phone and his wallet. The former philosophy major, who played saxophone in a jazz band, was described as thoughtful and gentle by his friends according to several media sources. 

Tripathi’s family, father Akhil, mother Judy, sister Sangeeta and brother Ravi, immediately set up a massive social media effort – “Lend Your Hand” – to find the young man.

Tripathi’s body was pulled Apr. 23 from the Providence River. In a brief interview with India-West shortly after her brother’s body was found, Sangeeta Tripathi said she and her family were struggling to understand what had happened.

"In Sunil's case, we really feel a powerful part of the story is how much pressure there is in society broadly to innovate, find internships, find jobs, network like crazy, etc in order to thrive. There are not enough resources for young people who feel like they are getting left behind," said Tripathi.

"We think so much about that both for Sunil as well as for other young men and women in such a pivotal and pressure-filled time in their lives," she said.

Ravi Tripathi, Sunil’s brother, told CNN, “He was never clinically diagnosed with depression. But we in the family knew he had problems with his mood.”

In 2008, Congress proclaimed July as National Minority Mental Health Awareness Month. One out of four adults living in the U.S. and one out of every ten children struggles with mental health issues, reports the National Alliance on Mental Health, one of the country’s largest non-profit organizations addressing the issue.

Minority communities are less likely to access health care for mental health issues because of the stigma surrounded around depression and other mental health illnesses, according to NAMI.

While there is a lack of data related to depression in the South Asian American community, a study released by the Asian and Pacific Islander American Health Forum reported that a higher percentage of South Asian Americans, especially between the ages of 15 to 24, tested positive for symptoms of depression.

Young South Asian American women have a higher rate of suicide than the general U.S. population, noted the study, adding that family conflict, anxiety and stress were precursors to depression and suicide in this community. 

Conversely, South Asian Americans are the lowest users of mental health services because of the perceived cultural stigma attached to mental health issues, noted the APIAHF report.

Asian American teenage girls have the highest rates of suicide of any U.S. population, concluded NAMI in a 2011 report.

 

HIGH RATES OF SUICIDE

Suicide levels are very high among Asian Americans, agreed Aruna Rao, associate director of the New Jersey chapter of the National Alliance on Mental Illness. “Young people don’t have any outlets to talk about their problems and they try suicide and complete suicide,” she told India-West. 

“They can’t talk to their families, because we are the model minority, so there’s no one to talk to,” said Rao, adding that the bulk of young people who successfully commit suicide have not been diagnosed with depression.

Parijat Deshpande, a clinical psychologist and founder of MySahana, an organization which aims to increase awareness about mental health issues, said very few Indian Americans seek counseling.

“There’s a lot of misinformation about what mental health is. Those few that do come for counseling often don’t know why they are there,” Deshpande told India-West.

“There’s definitely a stigma in the community about discussing mental health issues. People don’t understand why it’s important to share, and they feel, ‘I don’t know whether they will be able to understand me,’” she said, noting that the greater mental health community for the most part does not have enough knowledge of the South Asian culture.

 

DEPRESSION HIGH IN MED STUDENTS

More than 14 years after her only son Neil’s death, Neena Grover said she still cannot understand why he committed suicide. 

“Neil was a perfect child; he had good grades, he was laughing all the time. I never thought he had any depression,” she told India-West by telephone from her home Brighton, Mass. 

Neil Grover was a medical student at the University of Massachusetts Medical School in Worcester, Mass., and presumably doing well in school, according to his mother, who noted he received 98 points out of a possible 100 on a critical exam the day before his death.

Grover committed suicide on campus Nov. 14, 1998, by cutting his wrists. 

In the months before the young Indian American’s death, Neil began acting out of character, his mother said. He laughed less, attended classes irregularly, stopped eating properly and started to give away his possessions. 

When he came home the Sunday before his death, his mother said she could see that something was wrong, but attributed it to Neil’s attempts to break up with his girlfriend.

Neil left a suicide note, but it unfortunately provided no clue about the reason for his suicide. Instead, it only added to the mystery. 

“I had everything, but life is a double-edged sword. If I tell everything, I will lose everything,” he wrote in the note. 

A post-mortem autopsy also failed to provide any answers.

In 2001, Neena Grover founded the “End of Secrecy” walk to pay homage to her son. The community walk, now known as “Out of Darkness,” is sponsored by the American Foundation for Suicide Prevention.

Several studies have found that medical students and residents suffer a high rate of depression, with as many as 30 percent exhibiting depressive symptoms. Long hours, an inability to deal with death and dying, and harassment by professors and trainers are major contributors to depression.

Like Neil Grover, medical student Srinivas Akkaladevi — who was completing a residency in internal medicine with the Scranton-Temple Residency Program in Scranton, Pa. — was an affable person who got on well with fellow residents.

Akkaladevi, who had come from Hyderabad to attend the training program, committed suicide Mar. 1, 2009, with multiple lacerations to his neck.

“We were shocked,” Pardeep Bansal, then a second-year resident at STRP and close friend of Akkaladevi’s, told India-West recently. “There was nothing to suggest any sort of depression. Srinivas was a very outgoing, very jolly sort of fellow,” he said, adding that his friend was also an excellent doctor.

 

GREAT EXPECTATIONS

Rap artist Sullee J of Baltimore, Md., struggled with depression for almost five years beginning when he was 17.

“I was never (diagnosed as) clinically depressed, but I was struggling. I didn’t want to make friends, go out; most days I would just sit myself in a corner,” Sullee – whose real name is Babar Khan – told India-West during a wide-ranging and candid interview. 

Growing up within the confines of a rigid Pakistani American home, Sullee said he struggled from relationship issues, racism, parental neglect and, conversely, enormous pressure from his parents to do well.

“In our culture, parents have very high expectations of their kids. If you’re doing well, they say ‘do better’,” asserted the rapper, who will release a new CD, “Free World,” later this July.

Sullee’s best friend, also a Pakistani American, was struggling with his own mental health issues. “His whole life was a constant battle. His dad wasn’t around, he was on the streets a lot, but you’d never imagine it in him.”

“He held himself up strong, and presented as a happy, positive person, but it was building up,” said the rapper.

The friend, whom Sullee requested to remain anonymous, got into a street fight and was taken to jail. At his court hearing, he was ordered to spend four weeks in a psychiatric hospital, where he hung himself.

“It was a real shocker,” said Sullee, adding that he still has not got over the loss of his friend.

“A lot of us are really pressured so much by our parents and it creates so much stress in our lives. We really have to learn to stand up to them, but it’s very difficult,” said Sullee.

“There are so many kids out there depressed, all they need is an ear, but there’s no one to talk to, no one to listen, and they’re struggling with it alone,” he said.

Deshpande said she has seen children as young as nine years old with suicidal thoughts.

She related the story of one nine-year-old who felt very pressured to get straight As. When she got an A- in math, her parents started to go to her school almost weekly to talk to the teacher about how their daughter could improve.

“She felt her parents didn’t like her. She gave me a plan for her suicide,” Deshpande told India-West. “I began a series of many, many meetings with her parents,” she said.

 

SEXUAL IDENTITY

Sexual identity is also a factor in depression, said Kanwar Anit Singh Saini, a gay underground musician, in an interview with Urban Desi Radio. “I think suicide plays a role in a lot of young gay people’s lives, especially through the coming-out process,” said Saini, who admitted he had contemplated suicide when he was 18, but had the foresight to seek professional help. 

“I know a lot of gay people who have contemplated it, when they were coming out, especially at younger ages. The first generation as well, who are from North America, but whose families are immigrants. It’s difficult because it’s a compromise, everything you have, which is essentially your family,” he told India-West.

Saini instead practiced self-mutilation by using a lighter to periodically burn his hand. “The pain on the outside of my body would help unify the pain within and it felt great.”

Though girls are more likely to think about killing themselves, and attempt it – often several times — boys are more likely to complete suicide, said Aruna Rao of NAMI.

She suggests that one way to identify depression in teens early on is by observing changes in their behavior, such as eating and sleeping, including pacing in their bedrooms, a lack of sleep, or, conversely, an inability to wake up regularly. Excessive hostility towards parents, abandoning long-time friends and withdrawal from social activities are also symptoms of impending depression.

 

SELF-MUTILATION

While suicide is an extreme, other self-harm behaviors prevalent within the community include eating disorders – anorexia, bulimia and binge eating — cutting, hair pulling, and substance abuse.

Lovleen (not her real name), a high school junior in the San Francisco East Bay, told India-West that every so often she needs an escape from her life, which is rife with academic pressure from parents and herself, friend-related drama, and physical bullying by her older brother.

The lively young woman revealed that about twice a month she uses a kitchen knife to make long gashes in her upper thighs. 

“I like watching the blood coming down,” she confessed.

While cutting wrists are more common, Lovleen cuts in an area that goes unnoticed by her family. She said she doesn’t feel pain as she is cutting, but later experiences throbbing in her legs. As scars form afterwards, Lovleen said she picks at them to watch the blood.

The teenager said she began her habit after listening to acquaintances at school. 

“At school, it’s cool to be a cutter,” she said, noting that she learned how to do it when friends pointed her to cutting videos on the Internet.

“Some teens feel so numb that cutting is the only way to get relief. The pain of it reminds them that they are alive,” Deshpande of MySahana told India-West, adding that cut marks are pretty easy to hide.

Deshpande has also worked with a girl who burns herself by taking a lighter to her skin.

 

MALE EATING DISORDERS

Rao of NAMI said eating disorders are very common among young Indian American men. “This is the only thing they can control in very pressured lives,” she explained, adding that disorders such as anorexia, bulimia, and over-exercising are manifestations of anxiety and self-image issues.

“Boys are barraged with comments like ‘you’re too wimpy, you’re too girly,’ just at the point when they’re trying to fit in as men,” said Deshpande, noting that both boys and girls tend to be judgmental of their bodies and internalize comments made by critical parents and relatives.

Rao and Deshpande both acknowledged the emotional distance parents feel as their child becomes a teen, adding that breaking down that distance is key to the mental health of a young adult. 

Deshpande suggests talking with children while doing a joint activity and sharing your own experiences. “Your child can’t talk about her emotions unless you do,” she said.

Rao of NAMI asserted that Indian American parents must reduce their expectations of perfection in their children. “A B – also known as the Asian fail – is not a bad grade,” she asserted.

Sullee and Saini both advised teens contemplating suicide to find professional help or just someone who will listen.

“Life is not at an end, no matter how bad,” Sullee told India-West. “You still have to grow.”

 

HELPFUL RESOURCES

SIGNS OF DEPRESSION, EATING DISORDERS

DEPRESSION

•    Sad or “empty” mood

•    Irritability

•    Difficulty concentrating, remembering, or making decisions

•    Feeling worthless or helpless

•    Thoughts of death or suicide

•    Sleeping more or less than usual

•    Eating more or less than usual

ANXIETY

•    Constant worry

•    Inability to concentrate

•    Constant irritability and fatigue

•    Irregular heartbeats

•    Sweating

•    Heavy breathing

•    Muscle tension or pain

•    Dizziness or fainting

ANEXORIA

•    Inappropriately low body weight

•    Significant attention to thinness and body weight

•    Absence of at least three consecutive menstrual cycles

BULIMIA

•    Overeating or binge eating followed by an immediate visit to the restroom

•    Mood swings and odd behaviors

•    Too much value placed on looks and a distorted image of one’s own looks

•    Isolation or, conversely, being too outgoing or social

*Information provided by the South Asian Public Health Association

RISK FACTORS FOR TEEN SUICIDE

•    Depression, including feelings of loneliness or helplessness

•    Alcohol or drug addiction

•    A family history of abuse, suicide or violence

•    Previous suicide attempts

•    A recent loss such as a death, breakup, parents divorce or illness

•    Fear of ridicule for getting help for problems

•    Being bullied or being a bully

•    Exposure to other teens committing suicide, such as school friends or media personalities

•    Access to firearms (half of teen suicide deaths are committed by guns)

*Information provided by the National Institute for Mental Health.

RESOURCES FOR INFORMATION ABOUT MENTAL ILLNESS

•    MySahana - 408-657-9569

•    National Alliance for Mental Illness – 1-800-950-6264

•    South Asian Mental Health Awareness in Jersey (affiliated to NAMI, New Jersey) – 732-940-0991

•    Counselors Helping Asian Indians – 410-461-1634

•    South Asian Public Health Association – www.sapha.org

 

 

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