Mental Health, Stigma, & Survival In The South Asian Community

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“You’re depressed? Get married and have a kid!” 

This advice is routinely offered by family and friends to people suffering from mental illness in the South Asian community, Dr. Apurva Bhatt, a clinical assistant professor at the Stanford University School of Medicine, tells me. Dr. Sripriya Chari, professor of psychiatry and behavioral science at Stanford’s Centerspace clinic, who works with Dr Bhatt in treating patients, confirms the observation.

I am speaking with Dr. Bhatt and Dr. Chari about their initiative to establish a South Asian mental health clinic at Stanford in collaboration with a team of professionals. The program caters to members of the general population who have Medicare or other health insurance. 

I ask Dr. Chari why a specialty clinic is needed.

The clinic might be able to address specific cultural issues, she says, such as someone having a problem with the mother-in-law or an arranged marriage. Such issues are handled more easily by South Asian therapists. Many patients also prefer a South Asian therapist who may share a language with them. When she gives lectures in the community, she tells me, people approach her afterwards, seeking help. 

On the flip side, patients are sometimes hesitant to see South Asian therapists because they might be a part of the community and therefore too close for comfort. Even after it is explained that their information is private, patients are afraid of being judged by fellow South Asians.

More South Asian youth seek treatment for mental health

In my conversations with Dr. Bhatt and Dr. Chari, conducted separately, I am struck by the magnitude of mental health problems in the South Asian community. Sixty percent of the youth she treats are South Asian, Dr. Bhatt tells me. In addition to her teaching position, she is a psychiatrist who treats children, adolescents, and adults at Stanford’s Inspire early psychosis clinic and Inspire 360 clinic and also serves as a consultant to a couple of school districts in the peninsula. 

The Early Psychosis clinic has seen a lot of South Asians coming through, she says, more than in other programs and more than you would expect based on demographics alone. 

The shocking news is that a huge proportion of these kids also have a parent suffering from mental illness. 

Aren’t the kids discouraged by their parents from taking treatment, I ask. 

Yes, they are, she replies, but they overcome that obstacle. Thankfully, kids and parents make different choices. Kids choose to get treated, but parents often don’t. 

“I hadn’t seen so many South Asian families in a clinical setting before,” Dr. Bhatt says. “Many kids come into the clinic only after a crisis, after they’ve been hospitalized. Sometimes the families think that children can choose or not choose to have mental illness.”

I ask her about the alleged epidemic of suicide among South Asian youth. She tells me of a study she has published, reporting increasing rates of suicide in AAPI –Asian American and Pacific Islander – as well as South Asian youth (Breaking the Silence: An Epidemiological Report on Asian American and Pacific Islander Youth Mental Health and Suicide (1999–2021, Miles P. Reyes, Ivy Song, and Apurva Bhatt, March 25, 2024,

Methods of suicide vary from other populations, she says. More Asian-American males die by suicide than females, but more females report depression. Perhaps women talk their feelings out, whereas males act out their emotions. There is also a huge concern regarding not reporting depression and other mental problems.

The curse of the model minority

Does the focus on achievement contribute to mental health problems in the South Asian community, I ask? 

Yes, she says. There is more pressure in the Bay Area than in other parts of the country, such as Chicago, where she grew up. Parents are putting pressure on kids here, and the kids are putting pressure on themselves. Ivy League is not necessary for success, but kids are barely sleeping. They’re trying to keep up with classes. They are burned out by the time they go to college. 

Dr. Chari confirms her observation. “Yes, parents are extremely worried about their kids,” she says. “But there is a lack of awareness about it. Parents don’t acknowledge it.”

She addresses the model minority myth, the idea that South Asians are inherently successful, hardworking, and academic achievers and therefore superior to other minorities. 

Immigrants bring these attitudes here from their native countries, Dr. Chari says. They bring with them their sense of scarcity.

The burden of cultural expectation

How do South Asian cultural aspects like patriarchy, misogyny, and sexism play into the dynamic, I wonder.

“A tough question,” Dr. Bhatt says, taking a moment to mull over “a politically correct” response. These cultural pressures do exacerbate mental health conditions, she admits. For example, as a South Asian female, she is expected to do well in her studies, in her career, and to be independent. Her mom is a trailblazer who started her own real estate business.

Still, Dr. Bhatt has to balance between being too powerful and being respectful. Women continually navigate this duality, she says. In her profession, she is in a leadership position; she is making the decisions, but in other spaces, she is not seen as calling the shots. She has to honor the cultural norms of her family.  

“What norms are you talking about?”  

“Expectation to have children, expectation to run the household, to prepare the food, bring the cultural and religious elements into the family, hold the unit together. Being the one who is not out there but at home.

“These demands can exert a lot of psychological pressure on women. I have to work in this capitalistic society,” she adds. “And then I have to act as an Indian female. Sometimes these gender norms are weaponized in toxic ways. There is sometimes intimate partner or domestic violence happening. It’s important to know when to shift the balance in the interest of safety.”

“Is there resistance if someone wants to get a divorce?” 

“There’s a lot of shame. Some families have never had a divorce. Marriage is often seen as a solution. There is pressure to ignore the mental health crises caused by such cultural issues.”

A typical patient

At my request, Dr. Bhatt draws a portrait of a typical patient. A thirteen-year-old girl lives with her mother, who has a mental health condition. The mom moved to California, but has no family around. She suffers from schizoaffective disorder, a combination of schizophrenia and bipolar. She has mood changes and is not sleeping. She is agitated and suffers from unusual thoughts. She does not trust people because of her psychosis and does not share her problems. 

The kids in the family are growing up with a mother whose mental state is fluctuating. At times, the mother is affectionate; other times, she is harsh. As the children get older, they suffer from a loss of self-esteem.

The oldest daughter takes on the parental role but is alone and at high risk for mental health. Over time, she begins to experience symptoms – hearing voices and seeing things. Her thoughts speed up; she has trouble sleeping. She contemplates suicide. She is besotted by fear of violence her parents might perpetrate. She has behavioral problems in school. She is reported and sent to the ER. 

At last, she gets help. 

The moral of the story, Dr. Bhatt says, is that early intervention leads to better outcomes.

A personal reflection

As I listen to the tale, goosebumps rise all over my body. The topic of mental health in the South Asian community is not just of academic interest to me, but a very personal one. If I were to pinpoint a singular event that marked my life while growing up in India, it was the “nervous breakdown” my mother suffered when I was thirteen years old. Nothing would ever be the same for me.

Now, after years of pondering the mystery of my mother’s ailment, which was never definitively diagnosed, after years of suffering from silent trauma, after poring over books and essays, I am gratified to learn that the young daughter’s story has a happy ending. Stanford’s South Asian mental health clinic will help others like her. 

A taboo topic

Our conversation naturally segues to the topic of taboos surrounding mental illness. The stigma is huge, Dr. Bhatt says. “South Asian families are not open about the diagnosis. They don’t want to utter the word psychosis.” 

Dr, Chari agrees, noting that after the patients go through treatment, the social circle of the parents as well as the children shrinks.

Which perhaps explains the fact that many kids come into the clinic only after they have been hospitalized, after a crisis. 

I am all too familiar with such attitudes. Throughout my mother’s life, my relatives avoided any acknowledgement of her condition. In our immediate as well as extended family, her illness was governed by a code of silence.

Stigma is not restricted to the South Asian community alone, Dr. Bhatt points out. It’s societal. The DSM (Diagnostic and Statistical Manual of Mental Disorders), a handbook issued by the American Psychiatric Association and used by clinicians and researchers to classify, diagnose, and study mental health conditions, traditionally contained stigmatizing language like disorganized behavior, delusional, addict, alcoholic, etc. 

School counselors and educators exacerbate the stigma by telling kids that they won’t be able to excel. In contrast, Dr. Bhatt tells her young patients that they can go to college and do well. In fact, last year, all of her patients went to college. 

Lack of data on South Asians

But obstacles remain. A major problem is that there is not much research on South Asians, Dr. Chari points out. Next to Mexicans, Indians form the largest group of people born outside the United States, but there is inadequate research on Asians in general and South Asians in particular. This is because South Asians are left out of the census categories. 

“You’re not Asian,” I recall many Americans telling me, and recount the innumerable occasions on which I have had to put myself in the “other” category on job applications and other forms. 

Another obstacle to helping South Asians suffering from mental disorders, Dr. Chari says, is that there aren’t words in Indian languages like Tamil – her mother tongue – to talk about gradations of emotions. Nuances are absent. I pause a moment to think of my own mother tongue, Marathi, and suspect that this might be true for my language as well.

I ponder the South Asian inclination to value human beings based on their academic and professional achievements, their preoccupation with “what will people say,” and wonder if a spiritual overhaul is needed. 

Such a revolution is already underway, I learn. 

Solutions that may help

In the “Sitar for Mental Health program,” a movement and immersive performance series, music maestro Rishab Rikhiram Sharma uses traditional Indian classical music, mindfulness, and sound therapy to promote well-being, reduce stress, and foster inner calm. Blending ancient Raga therapy (https://darbar.org/ragatherapy-indian-musics-healing-powers/) with modern techniques like meditation and sound bowls, he guides audiences toward introspection and deep healing. 

Founded in 2019, Brown Girl Therapy, the first and largest mental health and wellness organization for children of immigrants, uses Instagram to destigmatize mental health and promote the exploration of bicultural identity through narrative storytelling, workshops, and discussion meetups. 

Dr. Chari also teaches a class on de-stigmatizing psychosis using art by people who are living with mental illness. In fact, the illustrations accompanying this article come from that program. 

I can’t help thinking that with our ‘go-getter’ attitudes, we South Asians will soon be virtuoso professionals in teaching and practice of mental health. But then I recall the fallacy of such achievement-oriented thinking and stop myself from gloating.