This document summarizes Abhi Dalal's presentation on South Asian American mental health. Some key points include:
- Cultural factors like collectivism and family dynamics can create barriers for South Asian Americans seeking mental health care.
- Mindfulness, gratitude, and compassion were presented as strategies for managing emotions and navigating cultural differences.
- Experiences like dating risks, controlling relationships, and balancing family responsibilities with individual needs were discussed in the context of mental health. The presentation aimed to start a dialogue around making mental health care more culturally relevant for South Asian Americans.
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South Asian American Mental Health Challenges and Solutions
1. South Asian
American
Mental Health
Abhi Dalal (ad4839@berkeley.edu)
Faculty Sponsor: Ann Cheney
(ann.cheney@medsch.ucr.edu)
Department of Social Medicine & Population Health
UC Riverside, SOM
Center for Healthy Communities
Presented at SAF x PSA Chai Talk: Mental Health on
1/24/19
Please cite the authors if utilizing this
presentation in the preparation of any future
work including, but not limited to, PowerPoint
presentations, IRBs, and articles.
2. Backstory
Why was I motivated to address
Desi mental health?
What do my experiences show?
3. Culture and
Mental Health
The role of culture
Medical anthropology
South Asians Americans: Some
Desi-ness, some American-ness.
6. ACHEE:American
CollegeHealth
Emotional
Empowerment
forSouthAsian
Americans
Global Mental Health
My research questions
What are SAA students’
understandings and experiences of
mental health?
What are the contextual factors (e.g.,
culture, family, gender) that create
barriers to seeking mental health
care?
What would culturally relevant care
look like for this population?
7. ACHEE
Contributions to literature
Emerging adulthood
US based South Asian mental
health
South Asian American
experiences in general
Verifying culturally relevant
mental health
10. Emotional
Differences
As I noted in the beginning, more
traditional minded SAA, namely
your parents and elder community
members, will not understand
emotions in the same way we do.
“I would always be like, ‘Oh, I'm so
nervous.’ And [Maa] said, ‘Oh,
nervousness is not a thing. Like
there's no such thing as being
nervous.’”
“I feel I could never just go to my mom
and talk about how I'm truly feeling.
Because that's not what she's
interested in. She's interested in my
accomplishments and my academics.”
11. Dating Risks and
Violence
Despite the fact that there is little discussion on
romance and relationships and dating is often
taboo, SAA still pursue romantic relationships
and often, unhealthily due to the lack of
knowledge/support and often, having to keep it
secretive.
“you don't date. You don't have sex until you get
married. You stay with one person your entire life.
So me calling her and saying, ‘Hey mom, I'm
meeting a new guy tonight, how should I approach
him?’ That would be totally like, no. She'd be
yelling at me. So, I wouldn’t.”
“recently, like I've cut off this bad habit because I
entered like a new healthy relationship. But the
person I was dating freshman year, like after a
while, once we broke up he got into a new
relationship but we still anytime like I had like a
problem or anything, like I would still go to him
kind of like as a safety mechanism”
“I broke up with him for the final time, and my
family had gotten really, really close to him ... I did
have a restraining order against him.”
12. We, Me?
SAA students experience tension
between their heritage culture’s
collectivism and American culture’s
individualism.
“Because I do have an apartment here in
Riverside, but I go back and forth from
Fullerton to here, because my grandma is
sick right now. I have to take care of her
… and I've got to pick up my brothers
from practice, go walk the dog and come
back here, go to class and find time to
study.”
“I know there's been times where like
we'll have … parties like at our house
and like I'll have the CBNS midterm the
next day and it's super frustrating
because it's like, it's like, mom, do you
want me to get straight A’s?”
17. Resolution:
Dating Risks and
Violence
What is it?
Signs to watch for
If s/he checks your cell phone or
email without your permission
Monitors you throughout the day
and/or exhibits extreme controlling
behaviors
Extreme jealousy
Physically hurts you in any way …
(The National Domestic Violence Hotline)
24. Discussion
Questions
1. Do you have any general reflections that you’d
like to share with the group?
a. Reflecting on my research, do you think that there’s
something that I haven’t touched upon?
2. What brought you to this Chai talk today?
3. What would you like to be different when you
walk out of here today?
4. College is a transformative but also challenging
time. Would anybody like to share any
experiences? Or what has helped you to grow or
survive through this transitory period?
5. Does anybody want to share powerful quotes or
books or the likes?
6. Any other things people would want to share?
25. References
Ackerman, C. (2018, February 05). 22 Emotion Regulation Worksheets &
Strategies: Improve Your DBT Skills [Blog Post]. Retrieved from
https://positivepsychologyprogram.com/emotion-regulation-worksheets-strategies-
dbt-skills/
APA Presidential Task Force on Evidence-Based Practice. (2006). Evidence-based
practice in psychology. The American Psychologist, 61, 271-285.
Bedi, R. P. (2018). Racial, ethnic, cultural, and national disparities in counseling
and psychotherapy outcome are inevitable but eliminating global mental health
disparities with indigenous healing is not. Archives of Scientific Psychology, 6(1),
96.
Benedict, R. (1934). “Anthropology and the Abnormal.” Journal of General
Psychology 10(1), 59–80.
Bernal, G., Jimnez-Chafey, M. I., & Domenech Rodrı́guez, M. M. (2009). Cultural
adaptation of treatments: A resource for considering culture in evidence-based
practice. Professional Psychology: Research and Practice, 40, 361–368.
Bhui, K., Bhugra, D., & Goldberg, D. (2002). Causal explanations of distress and
general practitioners' assessments of common mental disorder among Punjabi and
English attendees. Social psychiatry and psychiatric epidemiology, 37(1), 38-45.
Brach, T. (2014, July). Article: Awakening from the Trance of Unworthiness [Blog
Post]. Retrieved from https://www.tarabrach.com/articles-interviews/awakening-
from-the-trance/
Castillo, R.J. (1997). Culture & Mental Illness. Pacific Grove, CA: Brooks/Cole.
Chew‐Graham, C., Bashir, C., Chantler, K., Burman, E., & Batsleer, J. (2002).
South Asian women, psychological distress and self‐harm: lessons for primary care
trusts. Health & Social Care in the Community, 10(5), 339-347.
Dobalian, A., & Rivers, P. A. (2008). Racial and ethnic disparities in the use of
mental health services. The journal of behavioral health services & research, 35(2),
128-141.
26. References
Ekanayake, S., Ahmad, F., & McKenzie, K. (2012). Qualitative cross-sectional
study of the perceived causes of depression in South Asian origin women in
Toronto. BMJ open, 2(1), e000641.
Foucault, M. (1965). Madness and Civilization: A History of Insanity in the Age of
Reason. New York: Pantheon.
Frank, J. D., & Frank, J. B. (1993). Persuasion and healing: A comparative study
of psychotherapy (3rd ed.). Baltimore, Maryland: John Hopkins University Press.
Griner, D., & Smith, T. B. (2006). Culturally adapted mental health intervention: A
meta-analytic review. Psychotherapy: Theory, research, practice, training, 43(4),
531.
Hall, G. C. N., Ibaraki, A. Y., Huang, E. R., Marti, C. N., & Stice, E. (2016). A meta-
analysis of cultural adaptations of psychological interventions. Behavior
therapy, 47(6), 993-1014.
Imel, Z. E., Baldwin, S., Atkins, D. C., Owen, J., Baardseth, T., & Wampold, B. E.
(2011). Racial/ethnic disparities in therapist effectiveness: A conceptualization and
initial study of cultural competence. Journal of Counseling Psychology, 58(3), 290.
Kabat-Zinn, J. (2013). Full catastrophe living: Using the wisdom of your body and
mind to face stress, pain, and illness. New York: Bantam Books.
Karasz, A. (2005). Cultural differences in conceptual models of depression. Social
science & medicine, 60(7), 1625-1635.
Karasz, A. (2017). Mental Health. In M. Hasnain, P. Parikh, & N.C. Nagaraj (Eds.),
Health of South Asians in the United States: An Evidence-Based Guide for Policy
and Program Development (pp. 219-240). Boca Raton, FL: Taylor & Francis Group.
Kearney, M.H, Murphy S., Irwin, K., & Rosenbaum, M. (1995). Salvaging Self: A
Grounded Theory of Pregnancy on Crack Cocaine. Nursing Research, 44(4), 208-
213.
Kleinman, A. (1980). Patients and healers in the context of culture: An exploration
of the borderland between anthropology, medicine, and psychiatry (Vol. 3). Univ of
California Press.
27. References
Mindful Staff. Getting Started with Mindfulness [Blog Post]. Retrieved from
https://www.mindful.org/meditation/mindfulness-getting-started/
Owen, J., Imel, Z., Adelson, J., & Rodolfa, E. (2012). 'No-show': Therapist
racial/ethnic disparities in client unilateral termination. Journal of Counseling
Psychology, 59(2), 314.
Rangaswamy, P. (2017). South Asian Americans: A Demographic and Socioeconomic
Profile. In M. Hasnain, P. Parikh, & N.C. Nagaraj (Eds.), Health of South Asians in
the United States: An Evidence-Based Guide for Policy and Program Development
(pp. 3-24). Boca Raton, FL: Taylor & Francis Group.
Rastogi, M. (2007). Coping with transitions in Asian Indian families: Systemic
clinical interventions with immigrants. Journal of Systemic Therapies, 26(2), 55–
67.
Scheff, T.J. (1966). Being Mentally Ill: A Sociological Theory. Chicago: Aldine.
Shankar, B. R., Saravanan, B., & Jacob, K. S. (2006). Explanatory models of
common mental disorders among traditional healers and their patients in rural
south India. International Journal of Social Psychiatry, 52(3), 221–233.
Summerfield, D. (2004). Cross-cultural Perspectives on the Medicalization of
Human Suffering. In G.M. Rosen (Ed.), Posttraumatic Stress Disorder: Issues and
Controversies (pp. 233-245). West Sussex, England: John Wiley & Sons, Ltd.
Summerfield, D. (2012). Afterword: Against “global mental health”. Transcultural
Psychiatry, 49(3), 1-12.
The National Domestic Violence Hotline. What is Domestic Violence? [Blog Post].
Retrieved from https://www.thehotline.org/is-this-abuse/abuse-defined/
Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The
evidence for what makes psychotherapy work (2nd ed.). New York: Routledge.
Wrenn, G. L. (1962). The culturally encapsulated counselor. Harvard Educational
Review, 32, 444–449.
Editor's Notes
Opening remarks from organizers:
I want to deliver some opening remarks and give background on Abhi Dalal, who will be presenting his work on Desi mental health and whose talk will foreground our discussion. Abhi is the principle investigator of “ACHEE: American College Health Emotional Empowerment for South Asian Americans”. He also teaches mindfulness and yoga, on the side. Abhi’s undergraduate training was in South and Southeast Asian Studies and over the course of his scholarship, he has published 2 non-health and 7 health-related articles on topics ranging from South Asian kingship to clinical interpersonal dynamics to healthcare delivery science and to wellness. With that being said, I would like to invite Abhi to head our chai talk, today.
Introductory remarks
Thank SAF for inviting me over.
Self Deprecating: When I was invited by Ayesha to speak about Desi mental health, my experiences gave me a pause. I thought to myself that oh, I’m desi and I’ve had trouble managing my mental health and not spazzing out over the slightest remarks or daily encounters.
The backstory on why I wanted to work on Desi mental health is because of my experiences with my family.
2. To make long story short, when I moved from Desi capital Cerritos to IE, I was confronted with racism and this included being placed into Special Education unjustly. I think most of us in this room can fathom how this would make one feel and its high stressfulness but my parents never wanted to talk about it nor were they able to have a discussion around my emotions. Later in life, my psychotherapist struggled with working around my cultural background.
3. My experiences reflected both (1) the cultural disconnect between my parents and myself at the level of cognizance and (2) the intervening nature of culture to addressing one’s mental health.
1. My experience underscores the importance of culture. Culture influences the nature and expression of innerworkings of the mind and an individual’s understanding of psychological health and illness (APA Presidential Task Force on Evidence-Based Practice, 2006).
2. Medical anthropologists would say that South Asian Americans have different explanatory models of mental illness than their white mainstream counterparts.
3. Explanatory models of illness refer to the set of ideas about the nature of illness, its cause, its severity and treatment preferences (Kleinman, 1980).
For South Asians, not South Asian Americans, (1) emotional experiences are seen as a normal reaction to life’s problems and situations and (2) they are more likely to present with physical symptoms when feeling distressed (Karasz, 2017).
There is little known about South Asian immigrants in the US, who would be exposed to both their cultural heritage model of mental illness and western models of mental illness (Bhui, Bhugra, & Goldberg, 2002; Chew-Graham et al., 2002; Ekanayake, Ahmad, & McKenzie, 2012; Karasz, 2005; Rastogi, 2007; Shankar et al., 2006).
My experiences also exemplified how the idea of mental health itself is a cultural construct or in other words, is socially defined (Benedict, 1934; Castillo 1997; Foucault, 1965; Scheff, 1966; Summerfield, 2004; Summerfield, 2012). I’m sure that you all know that “mental health” is not discussed within Desi families.
2. Just as mental health is a cultural construct, counseling and psychotherapy are culturally encapsulated professional practices (Frank & Frank, 1993; Wampold & Imel, 2015; Wrenn, 1962).
According to Bedi (2018), these “professional practices were developed in the Western world to address problems common in Western countries in a manner consistent with Western understandings” (p. 96).
The incongruence of supposedly universal Euro-American psychology with Racial and Ethnic minorities in this country have contributed to disparities among these populations (Bedi, 2018).
for example, Racial and ethnic minority individuals are not attending psychotherapy as much (Dobalian & Rivers, 2008), show fewer positive results (Imel et al., 2011), and drop out at higher rates (Owen et al., 2012).
2. For Western racial and ethnic minorities, culturally adapting counseling and psychotherapy would theoretically address the source of and has remedied disparities in therapeutic outcomes (Bernal, Jimnez-Chafey & Domenech Rodriguez, 2009; Griner & Smith, 2006; Hall et al., 2016).
My research on SAA student mental health fits within the global mental health narrative by informing culturally adapted counseling and psychotherapy and enhancing cross-cultural psychology.
1. The combination of my findings will make unique contributions to the research literature and enable mental health practitioners and public health efforts to enhance their services.
a. To date, there is no research on SAAs’ emerging adulthood.
b. There is little understood about SA mental health in the US. Based on a review of South Asian immigrants across Western countries, my research would address the knowledge gaps on SAA’s explanations for mental health and on such contextual dynamics as the role of racism and discrimination, risks, and effective interventions (Karasz, 2017).
c. Based on a review of SAA experiences in general, my research would also bear upon the knowledge gaps on acculturation, social support, and gender roles (Rangaswamy, 2017).
d. There are a few theoretical counseling literature pieces, but there is a need to empirically verify culturally relevant mental health care for this population. There is no qualitative research on SAA mental health.
Given my own experiences with mental health, I am hopeful that these findings will assist the provision of mental health services and help those (including myself) that suffer from poor mental health understand their own mental health.
My research is qualitative, unlike the majority of studies on student mental health which are quantitative. There are national statistics on various factors of psychological distress from a Western standpoint, for example. However, these quantitative findings are limited and are not as helpful to practitioners nor mental health services.
Quantitative research was not feasible given the lack of background info on which to work off of and the surface level meaning generated from quantitative analyses.
Qualitative research involves a creative, interpretative approach to managing +500 pages of interview transcripts to build integrative theories that would answer my research questions in the form of figure(s).
Here is an example of a figure that would result from qualitative research.
Time permitting, review some key methodology:
The first step involved developing a tool to be able to organize and encapsulate +500 pages of transcripts. This step is called open coding and lead to the tool called an initial codebook that consists of codes that define and organize a distinct thematic pattern in the data (e.g., the code Multicultural/Cosmopolitanism involves difficulties with cultural incompetence). This step was inductive.
The second step involved applying the 20 codes to the transcripts and collecting the narrative text onto a table. This step is called in-vivo coding and was deductive.
The third step, where I’m at currently, involves examining the nature of and relationships within the codes and between them. I would eventually formulate integrative hypotheses that would answer the research questions in the form of a figures that would like this.
I’m currently in the last phase of qualitative data analysis.
Segway: Nevertheless, I wanted to share some valid, prominent trends.
1. Practitioners will benefit from understanding that your parents have different emotional and mental conceptualizations and that they would need to see things not solely from American culture’s individualism but collectivism. Practitioners and service organizations would benefit from understanding the risks and vulnerability of dating violence for this population.
2. With the knowledge that my research would contribute, the next research steps would be a large-scale quantitative research program to examine the extent to which my integrative theories on South Asian American mental health and culturally relevant care are applicable to other 1.5th-2.5th generation South Asian Americans and to develop psychometrically rigorous tools for this population.
1. In the coming weeks, I will be working on fine tuning my analyses and plan to hold a workshop for students and young adults.
SD: This is something that I ached for when I needed help to bounce back from tough times and this is a chance possibly to meet other people who value mental health.
2. If you are interested, please give me your name, number and email on this sheet. Please pass it around.
3. I will also disseminate my findings and encourage efforts beneficial for this population via academic journals and professional workshops among mental health researchers and practitioners.
I didn’t want to leave this discussion with a cliffhanger on my research findings, which I hope its preview has benefited you.
And in order to make this more applicable to you, I wanted to review some practical tips based on my research findings.
1. Because South Asian American parents will not understand you in the same way that friends will get emotions and mental health, the best thing to do is to avoid becoming frustrated by trying to seek this from your parents and instead, seek it from friends if possible.
2. This was a hard lesson for me.
1. Dating violence is a risk and happens more than we think.
2. Dating/Domestic violence can be physical, sexual, emotional, economic or psychological actions or threats of actions that influence another person (The National Domestic Violence Hotline).
3. Ask yourself if your partner engages in …
I understand that telling your parents may be difficult and so I encourage you to keep your relationship in check by keeping another person informed, such as a close friend, a counselor, a mentor, or a trusted family member.
If you find yourself in an abusive relationship, the road to ending the relationship and the healing afterwards can be tough but rewarding – you can reach out to your social network, counselors, or domestic violence hotlines for help.
There is an inherent tension between South Asian culture’s collectivism and American’s individualism.
I think that it is helpful to have this insight in mind so that you can be more adept at navigating family dynamics and hence, experience less distress.
I’ll give you one example that I heard from an Indian therapist: he had a female Punjabi client that wanted to pursue her PhD but was expected to get married. Her parents were not happy with her plans but she intended to be dependent on them and have close relations. Rather than becoming more independent, she still wanted to live at home and so to alleviate her parent’s and community disappointment, she started working with a prominent religious leader and raised her reputation whilst pursuing her PhD (R. Bedi, personal communication, November 10, 2018)
Those are my three resolutions
lastly, I want to introduce mental health management techniques that anybody can benefit from, namely mindfulness which is my other hat so that you walk away from this Chai talk better able to care for your self.
No matter how balanced one is, everyone will experience negative emotions and disruptive times (Ackerman, 2018)
Emotional regulation affects how one is functioning intrapersonally and in his/her relationships (Ackerman, 2018)
We often develop emotional regulation techniques through trial and error. Some can be unhealthy, such as self-isolation that lead to burnout and anxiety (Ackerman, 2018).
Mindfulness helps put space between ourselves and our reactions, breaking down our conditioned responses (Mindful Staff).
You don’t need much time to begin cultivating mindful qualities throughout the day – maybe start small by spending 5 minutes in the morning to meditate (Mindful Staff).
Mindfulness can be described as living in the present non-judgmentally (Mindful Staff).
You can strengthen this quality by practicing formally with meditation or body scans like yoga (Mindful Staff).
You can practice this informally throughout the day by taking a moment to pause and breath such as before picking up the phone or by noticing your ruminating thoughts come and go without identifying with your thoughts – you are not your thoughts and you don’t have to believe them (Mindful Staff).
For example, I typically meditate after a morning yoga session and throughout the day, I bring awareness to some of the daily fear based thoughts about a catastrophe happening in my home – I make a conscious decision to observe these fearful thoughts, return to the moment, and let the fear based thoughts slide into the present moment of experience.
To tune into mindfulness throughout the day,
Observe the present moment as it is
Let your judgments roll by
Imagine balancing a ball on top of a point. Sometimes they will stay and most of the times, the ball will roll off. The task of mindfulness is to continue coming back to the point (i.e., your breath or some other object of awareness) nonjudgmentally and perhaps, with some kindness.
All this of this is abstract and will mean a lot more once we practice so I am going to lead you through a short meditation.
Gratitude and compassion are 2 attitudes that can help ease bringing mindfulness throughout your daily life (Kabat-Zinn, 2013).
I want to express my gratitude to everybody for coming today and I hope that this information is helpful.
Please write your contact information on the sheet of paper that is going around if you wish to be in touch about my project.
Also, I’m happy to give you whatever advice I can and possibly teach community yoga classes if your affiliated organizations are interested – I’ve brought my business cards if you wish to stay in touch directly with me.
Now that I’ve given you a background on Desi mental health through my research project, I’ll let Ayesha take over. Also, on the next (and final) slide, I have some questions that can spur additional discussions.