Why Is There Virtually No Research on South Asian American Mental Health?

An interview with Dr. Sripriya Chari, a pyschologist with Stanford Medicine's South Asian Mental Health Program

Dr. Sripriya Chari (credit: Dr. Sripriya Chari)

When I began writing They Called Us Exceptional, I searched for research studies that would help illustrate how common and complex suicidality was within our communities—it’s something nearly every South Asian family I know has some experience with, yet I’d never heard it discussed as a phenomenon worthy of deeper examination. It was seen as a tragic, one-off, freak incident; never as part of a societal issue that demanded a reckoning.

I had hoped that contextualizing my family’s experiences with research could help illustrate the scope of the problem and portray it as a systemic issue that we must address—rather than as a strictly private matter to be hidden by shame. Of course, South Asian diasporic experiences are so varied and our backgrounds are incredibly diverse along lines of religion, caste, immigration status, gender, sexuality, class, and more. But as caste-privileged Indian Americans, in particular, have gained prominence in the public spheres of politics, entertainment, and business, I wanted to show how the one-dimensional, celebratory story of success built around these figures hid a darker and more complicated reality that holds everyone back from accessing the help our communities need.

I was stunned, however, when I found virtually no data to support my family’s experiences. It was maddening; another way in which the world was telling me that what I saw around me was not real. Since the book’s publication, I have heard from countless readers about families suffering alone and in silence, thinking they, too, were the only ones.

Why doesn’t the data reflect these realities? I began to wonder how a lack of research on South Asian American mental health both contributes to our isolation and compounds our struggles, and how the image of the “model minority,” in particular, may block critical research for all South Asian communities in America.

To answer some of these questions, I reached out to Stanford University Clinical Associate Professor and Clinical Psychologist Dr. Sripriya Chari, who is part of Stanford Medical Center’s recently launched South Asian Mental Health Program. “There’s not much awareness that this is a community that is struggling,” she confirmed in our interview. “It’s really hard to gather the data, the questions have to be asked in a very different way. And I suspect that that’s why many of these national, broad-based interview studies are not really picking up this.”

We spoke about why South Asians present so differently from white Americans, how strong cultural beliefs can prevent us from advocating for our needs, and how conventional notions of success compel us to hide anything seen as less-than-perfect. Read our full interview below.

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Tell me about the new South Asian Mental Health Program at Stanford Medicine. How did that come about?

The program is housed within the Centerspace Clinic. Centerspace provides culturally-contextualized, trauma-informed care for people for whom the experience of carrying marginalized, multiple or intersecting identities is an important part of their mental health and well-being. We work with individuals to achieve meaningful recovery in complex contexts including cross-cultural dynamics, integrating spirituality and faith, spiritual and/or racial trauma, immigration and displacement.

My reason for asking for this new South Asian focus within the larger umbrella of Centerspace was because we are seeing a large number of South Asians at our psychosis clinic, but not as much in the general anxiety and depression clinic or the PTSD clinic. From speaking with people in the local South Asian community, it is obvious that many people are struggling with their general mental health, but are hesitant to seek out professional care. They may not even be able to acknowledge that these could be “real” problems. The hope is that having a South Asian program within the Centerspace clinic will encourage more people to seek out care.

What do mental health resources for South Asian Americans look like right now?

In some ways, it looks pretty bleak. I don’t think there are enough providers that are culturally attuned to the needs of South Asians seeking help.

South Asian people present very differently from the average white person presenting to a mental health clinic. They might present to primary care with more body aches, or other physical symptoms, rather than mental health symptoms.

The idioms of distress that we use are different. There are no subtle-emotion words in many Indian languages, for example. I personally am a fluent speaker of Tamil, and I can say that I’m angry or sad, but I couldn’t differentiate between being depressed and just being sad that, you know, I didn’t get the right flavor of ice cream. It’s just one single word. Maybe the scholars will be able to point out words, but in common parlance, there’s no way to express our emotions. And so I think we come with not much awareness of emotions. This is something that we’re seeing actually in our clinical work as well. When we do have South Asian adults—people who are first generation immigrants—they often struggle to identify or name their feelings. There’s a stark difference between the younger South Asian Americans who’ve gone to school here and are sort of taught the language of emotions, versus the older generation, the immigrant generation like me, for example.

There’s also a sense of fatalism. It comes, I think, from the scriptures and the karma theory and so on. Like: you get what you deserve. If I’m struggling, I should grin and bear it, because maybe I did something wrong in this life, or past lives. Which can be helpful, because not everything that produces distress needs to be addressed and changed—but there are large things that can be changed and cause distress that are not addressed at all.

There are not enough mental health resources where people understand how South Asians present, and understand the cultural context and being able to translate or even parse what somebody is presenting with. There are maybe slightly increasing numbers of South Asian providers, but not nearly enough.

Therapy wasn’t helpful for me at all until I found that. And it was rare to find, even in New York City, at the time.

Yeah, in the San Francisco Bay area, I can think of maybe 5, 10 psychologists of South Asian descent. And then there are a lot more people at the masters level. But even then, not quite enough for such a large metro with such a huge population.

There’s an association between success and wellness, and success and goodness. We tend to imbue all of these other values and traits upon success. As a mental health professional, what have you seen or read about success as a way to mask stress or mask mental health issues—is success always a sign of wellness?

Those two are conflated often. If you ask people, they will tell you that their idea of success is living a fulfilled life and being happy. But in reality, maybe that’s not how they define success. If success is defined by how much money you make, what your job title is, how big your wedding was, then that’s what you’re going to push for. And if that’s how we define success, then we’re going to neglect the other facets of our well being and our mental health and our physical health.

My sample is skewed, because I work with people who are struggling with mental health issues—so I’m not seeing the general population. I’ve had young people actually across the immigrant spectrum, across different immigrant backgrounds. We had a very touching conversation once; a number of them talked about how, as long as they were doing well in school and they were keeping up their grades—even if they were telling their parents that they were struggling, they were not taken seriously. It was the minute that their grades started slipping that the parents sat up and took notice. And even then, the emphasis was on getting the grades—checking off those boxes rather than saying, What is really going on? How can I help you? What do you think would make your life better?

This comes up a lot when I talk to parents: [I] ask them, What do you really hope for for your children? They’ll tell you something like, I want them to be happy. I want them to be successful. And then the question is: What do you think defines their happiness? Every parent wants their child to be happy. But often what happens is that they say, Well, this is how I got to where I am, and so my child needs to follow that same path, without stopping to think that your child might want to take a completely different path. And in fact, your path might not lead to happiness at all for them.

To what extent has the model minority myth potentially held back research or access to mental health?

One thing that’s happened for South Asians, in general, is exclusion in research. When you get lumped into one group in the census, all of us check the box as Asian. But the average American doesn’t think of us as Asian, right? Look at the research for Asian mental health, many [studies] start off with the standard paragraph of saying there are 22 ethnicities. Then the focus will always be on an East Asian group. We sort of get lost in the shuffle somewhere. We don’t get counted. I think that’s hopefully changing.

There was a study from DuPage County in Illinois, just outside Chicago, where they looked at people who had died by suicide. They found that 55 percent of the South Asians had been mischaracterized as some other race, so they weren’t even counted. So they actually went and looked by name, and tried to identify who was South Asian. And then went back, and dug up some back stories on these people. Thirty-four percent of those people who died by suicide had never sought out mental health care.

People were struggling to the point where they had died—but they had not sought out mental health care. And these were people who were living at home or living with families, or working—successful, so to speak, from the outside. There’s this intense aversion towards seeking out help and asking for help—or maybe it’s not even an awareness.

Maybe that distress is so deep, but if you hear about other people who’ve struggled similarly, you say, Oh, you know what I’m experiencing, sounds like what that person did. And maybe there’s a model to follow. But we have no sort of “model citizens” in our community, right?

I’ve had so many people tell me, Oh, you’re a mental health professional, but, you know, why? That’s an American thing, right? I mean, that’s not something that happens to us. Like American kids—they get depressed. And it’s like, well, so do South Asian kids. It’s just that we don’t talk about it, and we’re not aware of that. And because we don’t talk about it, we’re just sitting in our own bubbles and really struggling, but then we’re not advocating for better resources, or more research, and that has to change. At the same time, after almost every social event I attend, someone I met there will call me privately to ask about help for themselves or a family member.

Maybe that’s where the model minority myth comes in, right? Keep in mind that the South Asian population is a bimodal distribution. Not everybody is a doctor or a lawyer. We have lots of restaurant workers and taxi drivers, and people on the lower end of the socioeconomic spectrum. But if you’re talking about the people who are seen as conventionally successful, whatever that means, there is this sense that you have to succeed. There’s a huge pressure to try and be perfect. With that comes this idea that you can’t admit to difficulties, right? You can’t admit that something’s wrong. You can’t admit that you’re struggling. You have to pull yourself up by your bootstraps. We’re not advocating for more services that are tuned towards South Asians, because we’re not actually saying that we’re in trouble. We’re saying, I’m doing just fine. There’s not much awareness that this is a community that is struggling.

And then there’s also the stigmas, right? The “log kya kahenge” kind of thing. How are people going to see us? Growing up, this was something that was just taken for granted. You wouldn’t admit to any difficulties, because then nobody in your family would get married, nobody would want to have any connection with your family, and so on, right? Those are attitudes that are left over from a different time and place. But I think people are sort of stuck in that old-fashioned idea.

Are there any salient statistics about South Asian mental health, specifically?

This was just a really, really small sample. Out of 20 people who filled out the survey at a talk that I gave within a South Asian community, 11 people said that they had never met anybody who struggled with mental health problems—which, to me, is not possible. They said they’ve only heard about it in the popular media, or not at all. Which means that they’re not even aware that these people are struggling with mental health problems.

Maybe it’s not 50%, but my guess is it’s a pretty large percentage where people [in South Asian communities] think that mental health is something weird that happens to other people.

One of the statistics that was has been jarring to me is seeing that Asian Americans between the ages of 18 and 24 are the only ethnic group whose leading cause of death is suicide. Or that an estimated nearly one third of South Asian American youth are depressed.

I think we need to advocate for more funding and more light shining into these little crevices where people are hiding their distress. There are a few studies that suggest that the rates of suicide attempts, or maybe even completion, are high in South Asian populations. But the results are so muddled that I really don’t know what to make of them, other than people are probably distressed in ways we don’t understand. A lot of sample sizes are really small because we don’t have these wide ranging research studies, which I think we really, really need to have.

It sounds like we don’t have any conclusive studies or any sort of national trends that we can speak of for the South Asian community and mental health, but there are small individual studies over the years that suggest that this community is struggling profoundly in a way that we can’t really even assess or fully understand.

Right. We don’t have the data to understand at this point.

But we can, for certain, say that there is a significant amount that is struggling silently?

Yes. I see this a lot: When you talk about stress, often people are not even able to say that they are stressed. It’s easy to say: my child is stressed. But it’s not easy to say that they, themselves, are stressed.

It’s really hard to gather the data, because I think the questions have to be asked in a very different way. And I suspect that that’s why many of these national, broad-based interview studies are not really picking up this. I don’t think we’re asking the questions in a way that people are able to understand what’s being asked, and respond accordingly.

I also think South Asians in the US, especially first generation immigrants, sometimes feel very isolated without those large family networks that are present in the home country. Those networks come with both positives and negatives. There can be a lot of conflict within these large family networks as well. But I’ve heard a few times now that people really miss that connection. Everybody’s in everybody’s business, and so there’s somebody who can help out, rather than these isolated, nuclear families. What if there’s problems? You know, there isn’t anybody that sort of within the four that you can just talk to, right? If you lived in a big joint family with five uncles and aunts, somebody somewhere might step in to help out. People are feeling that sense of isolation as well.

Note: This interview has been lightly edited and condensed for clarity.