How do you describe psychotherapy to fellow South Asians?

The article below has been written by Brown Therapist Member Kavita Sekhsaria. She is a clinical psychologist based in Maryland.

Let’s be honest – our South Asian tongues are limited in their vocabulary when talking about mental health. I only speak Hindi, but I don’t think it is unique in this phenomenon. There is no real word for depression. Anxiety seems to be replaced by tension when we’re talking to our auntys, and despite the seamless way they use it, it’s not Hindi either! Pagal (crazy) certainly isn’t the word you’re trying to use to start a conversation about concerns. Even when we’re having a conversation in fluent english, I think the limitations of our mother tongues can form some of the challenges we face. 

There is a great deal of research that shows that Asian American attitudes about mental health stop many of us from seeking help. Asian Americans seek help less. This is at least partially because they tend to devalue the benefits of treatment and diminish their own experience of distress. All of this contributes to stigma, and makes psychotherapy less accessible to those in need. The research is fairly clear about the harmful impact of these attitudes on help seeking. 

But the question this research hasn’t been able to answer effectively is “what are we supposed to do about it?!” The answer is likely pretty complicated and layered, just like mental health itself. For a while, the thought was that the “medical model” would be helpful. There isn’t a lot of stigma against taking medication for high blood pressure or diabetes. So if we can convince people that depression is the same as these diseases, we’ll show them it’s okay to seek help – right?

Not quite. Researchers set out to explore the idea that stigma would be reduced if the public could better understand the biological roots to mental illness in the same way that they understand the biological roots of medical illness. First, they found that beliefs about the causes of severe mental disorders did shift towards recognizing biological causes for mental illness rather than blaming families or personal characteristics over 1996-2006 – probably because of a push to get people to think of depression like diabetes. However, as they probed the impact of the shift, they found that it did NOT result in less prejudice and discrimination. Instead, they found that highlighting biological roots actually led to increased attitudes that those who are mentally ill were dangerous and unpredictable. While the research on the medical model of mental illness is still developing, it seems clear enough that simply thinking about mental illness biologically isn’t enough to fight stigma, and that it creates new problems in understanding.

Given the complexity, I obviously can’t now say that I have the perfect solution about how to talk about mental health and psychotherapy with fellow South Asians. However, I would like to offer an analogy that I think helps start conversations and addresses some of the biggest misconceptions I encounter about mental health and how psychotherapy works. This is particularly geared at understanding the benefits of therapy, and encouraging people not to diminish their own distress. 

Psychotherapy, for many, is like physical therapy. When we injure a body part, often the remedy is physical therapy, where we see a professional who has spent a lot of time studying bodies and understands how they work and what they need to heal. They assess and evaluate our injury, how it is limiting us, and what range of motion and activity level we want back in our lives. Then, they guide us through the therapy itself, where we build our strength back.

We use their expertise and guidance, but we’re the ones working our muscles and gaining back our strength. They give us safety and reassurance that any pain is geared towards healing and not further damaging our body. We’ve generally accepted that physical therapy is hard work but makes us stronger, and that working with a knowledgeable and competent physical therapist is crucial to our healing. We know that having an injury, and seeking help to heal it, doesn’t make us weak. Instead, it’s proof of our desire to be fit and whole. 

We can start to think of psychotherapy in a similarly empowering way. While many are concerned that it is a “cop out from doing the work” or that relying on someone other than our friends or family is “weak and indulgent” – this is far from the truth. Telling ourselves we don’t need something because others have it worse is also problematic, and stops us from using care preventatively, and from being fair to ourselves.

There are times in all of our lives when we recognize that the emotional and psychological pain we hold is stopping us from meeting our dreams and goals for ourselves. In these times, it can be invaluable to be able to access help from someone who is trained to help us tap into our resilience. Safety in a therapeutic space, so that we can heal, is crucial. That requires talking to someone we can trust, but also someone who doesn’t have their own attachment to our lives – while our friends and family love us dearly, their ability to see our potential for healing is limited by that precise attachment.

Psychotherapy does not stop us from “toughening up” and does not make us dependent on a therapist. Instead, we find the opposite – assured that we’re in a space where we can look at our vulnerabilities without fear, we can heal and grow. We don’t go to therapy because we are weak, but rather because we know we have the capacity to be stronger. 

Of course, this analogy won’t work for everyone. Perhaps it is limiting for those who do find reassurance and validation in the idea of their distress being rooted in biology. However, for all of us working to make help more accessible to those who could benefit from it, understanding different ways to frame the message is important. I hope it is useful to understand that healing and growth aren’t diminished if we seek professional help. 

Citations:

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Atkinson, D. R., Whiteley, S., & Gim, R.H. (1990). Asian-American acculturation and preference for help providers. Journal of College Student Development, 31, 155-161.

Hwang, W. C., & Ting, J. Y. (2008). Disaggregating the effects of acculturation and acculturative stress on the mental health of Asian Americans. Cultural Diversity and Ethnic Minority Psychology, 14(2), 147.

Kim, J. E., & Zane, N. (2016). Help-seeking intentions among Asian American and White American students in psychological distress: Application of the health belief model. Cultural Diversity and Ethnic Minority Psychology, 22(3), 311.

Kvaale, E. P., Haslam, N., & Gottdiener, W. H. (2013). The ‘side effects’ of medicalization: A meta-analytic review of how biogenetic explanations affect stigma. Clinical psychology review, 33(6), 782-794.

Lee, S., Juon, H. S., Martinez, G., Hsu, C. E., Robinson, E. S., Bawa, J., & Ma, G. X. (2009). Model minority at risk: Expressed needs of mental health by Asian American young adults. Journal of community health, 34(2), 144-152. 

Lee, S. Y., Martins, S. S., & Lee, H. B. (2014). Mental disorders and mental health service use across Asian American subethnic groups in the United States. Community mental health journal, 51(2), 153-160.

Pescosolido, B. A., Martin, J. K., Long, J. S., Medina, T. R., Phelan, J. C., & Link, B. G. (2010). “A disease like any other?” A decade of change in public reactions to schizophrenia, depression, and alcohol dependence. American Journal of Psychiatry, 167(11), 1321- 1330.

Shea, M., & Yeh, C. (2008). Asian American students’ cultural values, stigma, and relational self-construal: Correlates and attitudes toward professional help seeking. Journal of Mental Health Counseling, 30, 157-172