May Is Mental Health Month: South Asian Mind Examined

By: Kalpana Asok, M.A., M.F.T.

Published in India Currents - May 14, 2019

The following excerpt is from Kalpana's book, Whose Baby Is It Anyway? Inside the Indian Heart

Making the decision to seek mental health services is a tough one within the South Asian immigrant community. My book lays bare cultural nuances that make this process less intimidating for patient and therapist. Here is an excerpt from the book.

Customs, beliefs, and etiquette are vastly different in India compared to the United States. Some of these differences raise questions or create emotional distance between Indians and people who are culturally American. When we know something about a person’s background, it is easier to relate to them, and our interpersonal exchanges are richer for knowing it. In looking at Indian customs and culture, it is important not to “exoticize” them or assume that they are somehow uniform across the country. There are many variations in custom and culture within the country, and it is impossible for me to include all the various customs. However, there are aspects of these that I see as common to and important in the experience of most Indians, and I will comment on some of these.

No matter which religion an Indian immigrant follows, or is raised in, the respect accorded to older people is something that defines Indian custom and tradition. It spans informal and formal areas of interaction and is reflected in respectful actions such as standing up when older persons enter the room, not showing them the soles of your feet, getting a drink of water for them, greeting them by asking if they have eaten, and addressing them as “aunty” or “uncle,” or appending that honorific to their first names. Older people expect to feel the privilege of their years, and they usually feel loving kindness towards younger Indians who give them even non-verbal indications of being aware of the age difference. Within any group, there is always an awareness of who is older and it is a matter of expected courtesy to help the older person. When an elderly couple was stranded at an airport, the “youngsters” in the group took care of the couple by taking turns getting them food and drink so they could rest instead of walking up and down endless corridors. This kind of group ownership of the elderly is very typical of the way that even Indians who are strangers behave toward other Indians. Children are expected to give up their chairs for older people, and not expected to need a whole chair for themselves. When seats are in short supply, the children are expected to share or to stand up. When young, children are coddled and made much of, but when they are a little older, they are not always given much room to voice their opinions. For example, teenagers are expected to participate in a conversation when invited to, but are sometimes not invited, and are always expected to know their place in the hierarchy by keeping a respectful silence at certain times and participating appropriately at others.

There is more physical contact with children, and almost all visitors are comfortable interacting with them in a very physical way. Babies get picked up and carried around without explicit parental permission, toddlers get faces squeezed and cheeks gently pinched, and children get their heads patted. In general, there is a degree of comfort with others’ children that would be considered unusual in the United States. Chil- dren are raised to respect their elders and seek their blessings by sometimes bowing down and touching the elders’ feet, shoes, or floor near them with their fingertips, and then ending the gesture with a Namaste. In some families, the touching of feet is a daily good-morning ritual; in others, it is reserved for special occasions such as birthdays or other celebrations when blessings are formally sought. It is traditional for young people to go see the elder members of the family on their own birthdays or special days and actively ask for blessings. The older person holds his or her right hand, or both hands, up with palms parallel to the floor, saying, “May you live long,” or, “God Bless you,” while making small patting motions that signify his or her blessings. Depending on the family and the relationships, touching the feet of elders can be either an expression of love or a substitution for it. Families with elders still living with them, or those who are more traditional, maintain this custom in the United States. In some families, the bowing takes place only in the family puja [worship] room, with children also hugging parents to finish the pranam or namaskaram. In family situations, the clinician may notice that younger people don’t challenge or confront older people directly. Sometimes this hierarchy can translate into vulnerable children being unable to protect themselves from older adults in the family. In general, the whole culture is transported to the United States along with the families. The essence of Indian culture is undiminished, even as some ceremonial aspects may be shed along the way.

In some ways, Indians are less verbally communicative in common situations than the average American. There are many levels of non- verbal interaction, including nodding slightly to show understanding or to say thank you. Many Indian people do not use the words “please” and “thank you” as often as Westerners do. These words don’t always trans- late because respect may already be built into the words used in many Indian languages. Indians also reserve these words explicitly for the really important things, and not for every small daily transaction. It is important to be aware that American culture is highly verbally oriented with a great deal of emphasis on “please” and “thank you.”

The most common Indian greeting is to say Namaste—usually translated as “the divine in me salutes the divine in you”—with palms pressed together and held up to the face or forehead. In business interactions, a western handshake is mostly used, with the understanding that a woman must first offer her hand, and then may choose to nod or select a Namaste that involves no touching. This custom is an extension of Indian attitudes that emphasize modesty in clothing—exposure of large amounts of skin is discouraged for both men and women.

There are some other non-verbal gestures to be aware of. It is very important to use your right hand or both hands to offer or receive anything of value. Gesturing at people by crooking your finger and beckoning is considered patronizing and only used in anger towards children or pets. The Indian nod can be puzzling to non-Indians. What looks like a shake of the head can actually be a circular motion of the head, like drawing a horizontal 8 that means “I understand.” Most Indians do not like to refuse outright, so people often say “maybe” or “I have to see” and express uncertainty instead. Shoes are usually taken off at the door to people’s homes, places of worship, and especially kitchens. An apology is expected if your feet touch another person’s, even if accidentally. Kicking is something that brings great disrespect, and people often touch the kicked person and then touch their chest or eyes to show that they are asking pardon and that no disrespect was intended. Some Indian people even apologize like this towards their dog or cat after accidentally tripping on them.