by Alisha H.
Image source: https://assembly.malala.org/stories/why-we-dont-talk-about-mental-health-in-pakistan
As a first-generation immigrant, I considered vulnerability a weakness. “Log kia kahen kay?” my parents would caution me in Urdu, our native language. “What will people say?”
At the risk of disappointing my family — who immigrated to Canada to give us better opportunities in life — my siblings and I tried to stay quiet and be resilient. In doing so, we could not be emotionally vulnerable. I considered this silence a good sign until my sister confided in me about her difficulties in adjusting to a new country. She did not understand how to cope, and truth be told, neither did I.
Approaching my parents for support was difficult. Their discomfort in addressing my sister’s struggles made clear that, growing up in Pakistan, conversations about mental health were limited. Avoiding this topic altogether had created stigma, the effects of which emerged in our household. My mother, sister, and I struggled for validation, feeling unable to express ourselves until finally, for the first time, we opened up to one another. In sharing our feelings, I gained a newfound sense of admiration for the strength with which they carried themselves, despite the pressures of fitting in. While my voice is now acknowledged in our household, I understand that many people of colour still lack the support they need, and that my story and my struggle is one of thousands.
A study by Tahira Jibeen, PhD. from the University of the Punjab, Pakistan investigated predictors of psychological well-being of Pakistani immigrants in Toronto, Canada (1). Through a general health questionnaire, results demonstrated that Asian immigrant groups experience higher levels of acculturative stress, leading to diminished psychological well being and an increased prevalence of depression, anxiety, insomnia, and somatic symptoms (1). The stress arises from stark cultural differences; Western individualistic ideals emphasize independence, self-reliance, and personal achievement, while our South Asian values prioritize family cohesion, conformity, solidarity, and interdependence.
Despite these concerns, Asian Americans underutilize mental health services to a greater extent than the general population, largely due to culturally-linked stigma within immigrant South Asian communities which may hinder help-seeking behaviour (2). Tehreem Rehman, MD MPH, in her article investigating Pakistani Muslim Female populations and unequal access to services, cited the lack of understanding of mental health professionals towards Pakistani cultural values as another reason for resistance towards health treatment (3). Expressing mental health symptoms can feel challenging, almost foreign. At times, it feels easier and more acceptable to attribute struggles to a migraine or stomach ache– something physical that others may better understand.
I have been reflecting on how my experiences as an immigrant, Pakistani women have shaped how I conceptualize mental health. What I once saw as a weakness has evolved into a sign of strength. I have come to realize that, while self-care may take a different form for me than it does for others, its value remains unchanged; it still applies to me. Compassion applies to me. Mental health applies to me.
I believe it is crucial to foster a culture that promotes open discussions, validation, and support for mental well being. By creating safe spaces where individuals can share their experiences and seek help without fear of judgment, we can work towards breaking down the barriers that prevent people of colour from accessing the support that they need.
Everyone deserves the opportunity to navigate their mental health journey with compassion, understanding, and cultural sensitivity.
References:
- Jibeen T, Khalid R. Predictors of Psychological well-being of Pakistani Immigrants in Toronto, Canada. Int J Intercult Relat. 2010 Sep 1;34(5):452–64.
- Karasz A, Gany F, Escobar J, Flores C, Prasad L, Inman A, et al. Mental Health and Stress among South Asians. J Immigr Minor Health. 2019 Aug;21(Suppl 1):7–14.
- Rehman T. Social Stigma, Cultural Constraints, or Poor Policies: Examining the Pakistani Muslim Female Population in the U.S. and Unequal Access to Professional Mental Health Services. Columbia Undergrad J South Asians stud. 2010;2(1):1–21.
