I write this from a medical conference in Greece where I am posing as a world-famous rheumatologist. I think my ploy might work if no one asks me to spell it without my computer handy, not that I know what rheumatologists do. Highly esteemed medical professionals (including my parents) from across the globe have come together to give all sorts of technical medical sessions. Not being medically inclined, I have shunned most of these in favour of playing Pokemon with my younger brother. However, I braved two of the sessions today on mental illness. The first one was fascinating (in the second session I only understood 10% of the words), looking at the challenges and scale of mental illnesses and substance abuse in 2018. Whilst the talk used a lot of data from the USA, when possible it used data from all over the world. It is looking fairly grim everywhere.
My Nigerian friend once told me that in West Africa there is a perception that “depression is a white man’s disease.” He was bemoaning the fact that attitudes toward mental illnesses in Nigeria are still lagging behind the medical understanding of these issues. All countries have serious issues with both mental illnesses and substance abuse. Mental illnesses transcend culture/race/creed/favourite football team (although anecdotally Manchester United fans seem more likely to cause stress to those around them).
Here, one of my dear friends has written an honest and vulnerable account of her experience with mental illness with particular focus to her South Asian background. Her international upbringing allows to her to bring fantastic insights to the discussion. So without further ado…
A South Asian perspective on depression
I was born in Bangladesh to two budding young doctors who wanted to change the world. So, when I was three months old, my parents set off to do just that – by moving to Africa as Muslim missionaries to build and run a hospital in a little town. We spent seven years there before moving to Scotland. It wasn’t a very traumatic move – although I had friends back in Africa, I forgot them quickly (call me heartless, but I was only seven) and settled in to new friendships in Scotland.
As I mentioned, my parents were Muslim missionaries, and as such, I was raised a Muslim too. From a young age I was keen to fast and pray 5 times a day, as well as read the Quran. During high school however, I became interested in other religions, and what made them different from Islam. To cut a long story short, I converted to Christianity when I was sixteen, after asking a billion questions of my close Christian friends, and investigating the historical proof for Jesus (I’d love to go into this more but since that isn’t the topic of this blog post, I would highly recommend this book to get more of an idea of my journey to Christianity – or just in general because it’s an amazing book and I wish I’d known about it in high school). I didn’t tell my parents about my conversion until my second year of university. When I finally did, things were extremely difficult, and I ended up becoming depressed as a result.
If you’ve ever been to any event where I gave a talk, you’ve heard all the above already. That’s the standard formula of my testimony – family background, conversion process, a brief description of the effects of telling my family, and then summing up with something like ‘that stuff was and is difficult, but Jesus carried me through it all – and he can do the same for you too’. Not to sound insincere – I mean it’s definitely true. But it’s not the whole truth. The whole truth can’t really be packaged up in a nice ten-minute structured talk (nor, for that matter, in a blog post). Nevertheless, here are some things that you might not have heard before about that time:
- I was ALWAYS TIRED. I didn’t want to get out of bed in the mornings, and I’d have spent all day sleeping if I could (although that was also compounded by low motivation). My bed was my safe place – if I was asleep, I could pretend none of the awful things were happening.
- Having never really loved Medicine, I started to really hate it. I used to be a clever kid in high school, but now, understanding new concepts was like wading through a marsh with lead boots on. I ended up having to take a leave of absence in my third year, and I spent the rest of my degree barely scraping through.
- Food became a chore. Cooking became a chore and eating became a chore – and if you know me, you’ll know what a big deal that is for me. I became underweight.
- Depression isn’t just about being sad or down, but I was sad and down a lot. One time I spent a whole day crying. (I’m sure there was more than one time, but another fun side-effect of being depressed for that year is I can’t remember very much of it.) I was almost impressed with my body for churning out so many tears.
- I remember wanting nothing else than to die, and this thought occupying my mind constantly. I’d go through my day like a zombie, and sometimes even be able to have half-decent interactions with people, but the whole time be thinking about how best to end my life. On one of my worst nights, I walked out to the river in my home town and stared at it for an hour trying to work up the courage to jump.
- I felt guilty all the time. Guilty for wanting to die. Guilty for not having the energy to pray anything more than ‘help’. Guilty for what my boyfriend had to put up with. Guilty for ever telling my parents about being Christian and putting them through so much distress. Guilty for what my sister had to go through because of me. Guilty for not being able to regret telling the truth. I constantly thought everyone in my life would be better off without me (see previous point).
- Social interactions became very difficult. I came to university having had a huge friendship group at high school and expecting more of the same for three more years. And although I had made some wonderful friends, suddenly, being around them was difficult. I withdrew to a core group of about four or five friends, and put on a mask around everyone else. But I didn’t want to bring everyone down by being the sad person in the corner, so I started saying no to more and more events.
- My Christian life became very difficult. First year was an amazing time of making new friends and growing as a Christian both in the CU and in church. But once depression hit, CU became my personal nightmare, and church became a chore. I gave up CU and had to be dragged out of bed most Sundays, which then made me feel guiltier and added to feelings of inadequacy.
I was on medication for around a year but I don’t know if it was the medication or a change in circumstances that finally lifted the cloud. Interestingly, when I took my leave of absence and returned home, things started to change a little. I think my family started to realise I wasn’t just making things up for attention, which helped a lot. However, for many reasons, things were still very messy – and in fact, things are still messy today. I’m sure these reasons aren’t unique to my experience, but I do believe they’re nuanced in a particular way for South Asians. Many aspects of South Asian culture make discussions about mental health very difficult indeed. I want to focus on just two of these today.
For most people suffering with mental illness, there are huge self-perpetuated and societal stigmas surrounding the topic. We may feel weak and ashamed of ourselves, or worry that people will treat or perceive us differently. It’s a huge step to get over being ashamed of yourself for having depression – to then be faced with the judgement of others can seem like just too much. But, at the risk of sounding dismissive, you don’t know judgement till you’ve been in a South Asian community! As humans, we tend to hold our reputation in high regard – but this is taken to some devastating extremes in the South Asian paradigm. A family’s reputation and status must be protected at all costs because of the fear of what others in the community will think and say. This isn’t necessarily a nefarious motivation – the value of family is at the heart of it, and out of that comes a desire to protect those in the family. So, for example, when I was told not to tell anyone in the community the truth about why I was at home instead of in university, it wasn’t necessarily because my parents were ashamed of me – they were trying to protect me from gossip. And although I can see that now, it didn’t exactly help when I was in the depths of depression to think that my parents saw me as an embarrassment.
Causes of depression
Both my parents are trained medical doctors. They built a hospital from the ground up in three years and ran it for seven years, treating people from all over as people would come to the hospital from neighbouring countries. But when I was diagnosed with depression and started taking medication for it, I was seriously discouraged from doing so by them. I was told I’d become addicted, that I wouldn’t know how to be happy without them, that they didn’t really do anything, that the true problem lay in our broken family relations. And in fairness, like I said earlier, I don’t know whether it was the medication or a change in my family circumstances that ultimately ‘fixed’ me. But what about the depressed South Asian who has a perfectly functioning family?
The causes of mental health problems are misunderstood in society, but this is compounded by additional factors in South Asian communities. Some believed causes of mental health problems include:
- Black magic
- Bad parenting
- The will of God
In my case, I was told that my depression was a punishment from Allah for the emotional turmoil I had visited upon my family. And again, while in the depths of depression, that was a welcome lie for me to believe and put myself further down about.
One of the main issues South Asians face regarding mental health is not giving it a place within the realm of medicine. Of course, this isn’t a problem unique to the South Asian community – and indeed, neither is the desire to preserve one’s reputation. However, in my experience, there’s something ingrained in my culture which enables these problems to grow in silence. We are taught to be resilient, to endure everything without complaining. It’s hard enough to convince my parents to go to the doctor when they’ve been coughing for weeks. So, when you’re dealing with an ‘invisible condition’, it’s almost impossible to be taken seriously. And when everyone in a community shares this mindset, when your family’s reputation is the most important thing, silencing or hiding another family member is permissible – commendable, even.
I’ve often wondered what it would take for these mindsets to change. I think the solution, as cliché as it sounds, lies in education (and this applies to all cultures when it comes to mental health). That’s not to say we’re uneducated – but I think there’s a ridiculous self-denial going on in such communities. Depression is seen as a white person’s problem. It’s the kind of issue you invent when you don’t have serious difficulties in your life. Brown people have bigger problems to overcome, like racism, earning enough to send to relatives back home, figuring out how to live as British Asians without betraying our cultures, and generally living up to the expectations of our communities and families. We can’t possibly have depression.
Even as a South Asian, I don’t really know how to overcome these cultural barriers, because they are so ingrained in our communities. Maybe the responsibility lies with second and third generation immigrants, to educate their elders in the hopes of changing cultural norms. Or maybe every South Asian who has ever suffered from mental health problems needs to speak up so we can end this self-denial once and for all.
If you’d like to talk to me about any of the topics raised in this post, please contact Aneurin and he will pass you on to me! Also, I highly recommend the following resources if you’re interested in learning more about attitudes to mental health in South Asian communities:
Noggy again. Feel free to get in touch with the author via the blog (email or comments) or on the Facebook page if you have any comments or suggestions. Or if you want it to be personal, email noggybloggy.@gmail.com and they can respond. Mental illnesses are things that affect us all and we need to talk about them more! One of the best ways we can help is by normalizing them by keeping the conversation going. Please keep talking about this, makes life so much better for us.
In other news we are hosting a TCK Art Gallery on the blog. The purpose is to help people explore challenging yet necessary concepts through art. Other people can often articulate what we are going through and give us a voice. The theme is ‘Home and Rootlessness.’ For more info check out the Gallery tab and please invite your friends to the Facebook event to help spread the word. The more people that hear about it the better.