Growing up in Texas, Priya Tahim felt like she didn’t have a voice. A second-generation immigrant and the middle daughter of South Asian and African parents, Tahim said sharing feelings was an alien concept in her household, causing her to struggle with her emotions.

Her grandfather’s death, while Tahim was a freshman in college, was the breaking point. “That hit me hard,” she said. “I was really close to him. If I was shown that it’s okay to talk about emotions and feel this way, then I probably wouldn’t have held in my anxiety for so long.”

It led her to seek counselling, but her American therapist found it difficult to understand why Tahim would have to take her parents’ permission to go out or obey their orders even when she didn’t want to. “Well, why don’t you just stand up for yourself?” her therapist demanded, unaware that submission is often equated with respect in South Asian families.

These cultural nuances, deeply ingrained in South Asians, could be hard for those from outside the community to grasp. “Being a South Asian, there are things that are expected of me that maybe my peers didn’t have to go through,” Tahim said. “There are all these different rules that our families put on us. And I didn’t find the ‘if you don’t like it, you should leave’ advice to be helpful. That’s not how it works in our culture.”

Culturally-sound therapy

South Asian immigrants face numerous challenges, including anxiety about a different cultural environment, challenges with communication, immigration issues, intergenerational stress as well as discrimination. According to a 2018 study titled Mental health conditions among South Asians in the United States, “Stress related to acculturation, trauma, and discrimination has been linked with depression, anxiety and substance abuse among South Asians.”

Getting help is not easy as it seems. Most traditional psychotherapy has been modelled on Western – white middle-class – families. “Taking something that is built on Western theory and then applying it to a South Asian family without making any modifications can be really problematic,” said Naveen Jonathan, a licensed therapist and an associate professor at Chapman University in California.

Jonathan has consulted with numerous South Asians in the US, mainly on intergenerational and family-related issues. “First-generation immigrants come to me with issues saying, ‘I feel like my child is misbehaving, but from Western standards, their behaviour may be considered appropriate.’”

What can bridge this gap is culturally sensitive therapy – an approach in which mental health practitioners emphasise understanding their client’s background, ethnicity and belief system – or a therapist with a similar cultural background.

“It’s important to have a therapist who just knows what they mean when they use certain phrases or explain certain common South Asian family dynamics,” explained London-based Raj Khaira, the founder of South Asian Therapists, an online directory for those seeking a mental health expert from their own community. “It can help the therapy move faster, but also allow for the patient to feel ‘seen’ by their therapist.”

Online communities

The stigma around mental health, especially among South Asians, often deters members of the community to seek help. Dil to Dil, a non-profit organisation in the US, aims to address just that. Tahim, a licensed professional counsellor based in Washington, D.C., is a member of the online community working towards deconstructing stigma surrounding mental health illnesses in South Asian communities through open and honest conversations.

“We have someone share their journey and their own mental health story, which allows people to know there are others that may be experiencing the same thing that they are going through,” the 31-year-old explained, adding that they are mostly active on Instagram. “It also gives people the opportunity to speak openly in a safe environment.”

Brown Girl Therapy, a mental health community for children of immigrants, is another such initiative. Founded by Sahaj Kohli, a second-generation South Asian immigrant and therapist in training in New York City, the online community aims to help immigrants – especially South Asians and women of colour – learn more about therapy and identity exploration.

Such online communities and a rise in conversations on social media around the common mental health struggles of South Asian immigrants have helped take away some of the stigmas around therapy, which Dr Tina Mistry, a Birmingham-based clinical psychologist, said has brought several members of the community to her clinic.

“People are now realising that there are issues that a white therapist may not be able to truly understand because of the Eurocentric nature of their training,” the clinical psychologist, who is a second-generation South Asian immigrant, said. “Often we see internalised or even systemic racism play out in therapeutic approaches as well through stereotypes and microaggressions, so it’s a very tricky space to navigate and get right.”

Hyphenated existence

For children of immigrants, there is a duality in their hyphenated existence. “We have the freedom to pick and choose from both cultures, identities and communities,” Kohli wrote on Twitter. “But with that also comes the isolating reminder that we don’t totally belong in either.”

This cultural conflict, especially among teenagers and young adults, can often lead to an identity crisis. “You could get to a point where you suddenly realise I haven’t got a clue who I am,” explained Mistry. “It’s not a binary process. It’s a very gradual transition that you may face.”

It often plays out as a cultural conflict: I’m being told to be obedient and talk softly at home, but my teachers are encouraging me to ask questions. “So you get this kind of conflict of sorts, and begin to wonder, ‘Who am I supposed to be? What am I supposed to be?’” Mistry added. “That often continues up until early adulthood and then flatten out and settle to some degree.”

Other common struggles

In her practice, Tahim has encountered a number of cases of depression and anxiety among her South Asian clients, which she believes are often a result of suppressed emotions. To get to the root of the issue, Tahim says she asks her clients: “What did you perceive as love and being cared for when you were growing up?”

Often, the response is linked to academic or professional achievements. “Coming from a South Asian culture, we’re told that success only means making a certain amount of money, being in a certain career field or achieving more than a relative’s child,” said Tahim.

While it’s not unusual for accomplishments, identity and worth to be intertwined, according to Kohli, this can create unique struggles for children of immigrants in the workplace and in their careers.

“Parentification,” explained 35-year-old Khaira, can be another common struggle for children of immigrants, “where they act like grown-ups for their parents – helping them negotiate the challenges of life in a new country, especially where there is a language barrier”.

A common narrative that plays out among the global South Asian diaspora is of a resilient community that moved away from their native lands with little money in their pockets, often facing racism and violence in their adopted country.

“We’ve all grown up knowing about this, and sometimes, as children of immigrants, you might feel like your struggles pale in comparison to that of your forefathers and so you shouldn’t complain,” said Kahira. “This can lead to children of immigrants invalidating their own experiences and telling themselves they have no right to be unhappy because ‘at least they have it easier than the generations before them’, or worse, having their feelings and experiences be minimised by their families because they themselves had it worse.”

This dynamic can often breed shame and guilt, which Mistry classified as “toxic emotions that can immobilize us,” and can lead to low mood and depression. Through therapy, Mistry said, she aims to help South Asian immigrants pass down their gifts to the next generation, rather than their burdens.

Being an immigrant also means having to “adapt to live in a white person’s world,” she said. “We have to assimilate and mould according to the dominant culture because of the fear of racism.”

Outright discrimination or even microaggressions and systemic racism, such as being denied a job offer because of your name, are an attack on one’s identity, safety and sense of belonging. “Years and years of this happening can cause trauma to your body,” said Mistry. This can lead to both physical and psychological ailments.

Amid all this, Tahim said, it’s crucial for South Asian immigrants to know that it’s acceptable to talk about and seek help for their struggles. “Too often we hold on to things out of fear of ‘what will people say?’” she said. “But we have to start thinking about it as ‘What can people share’ or ‘what can people teach?’ Because unless somebody starts to talk, there’s little to no change that can happen.”