Mental Health Access in the Indian Community

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

No Neglecting Mental Health - Published in India Currents
June 24, 2009

Does society expect different things from more educated people?

According to a March report from Newsday, the 1.5 million Indian Americans in the United States are the most affluent and educated of the U.S.’s 38.1 million foreign-born citizens. The median household income for Indian Americans is $91,195 compared with $46,881 for the foreign-born population overall and $51,129 for the native-born.

Maybe the two recent murder-suicides involving Indian families in California—Karthik Rajaram and Devan Kalathat, who killed themselves and members of their families in October 2008 and March 2009 respectively—have nothing to do with the above statistics. Perhaps, however, we should take a closer look at the implications of those statistics.

Does society expect different things from more educated people? Do we assume that a higher level of formal education implies an ability to think things through? To not succumb to anger, rage, violence, alcoholism, addiction, suicide, or murder? To at least know when we need to get help?

No doubt Rajaram and Kalathat were desperate and felt they had no alternatives. Their crimes were shocking, tragic, and worst of all, preventable. What do the two incidents say about the Indian community’s reputation of being close-knit, supportive, warm, and friendly? Should we look below the surface of that image? Will it be pretty?

In the news reports after the two murder-suicides, there were hints that suggested that there was more to each case than met the eye: existing signs of mental instability and domestic violence. Perhaps these are not statistically significant. Nonetheless, we owe it to ourselves to examine those signs and possibly prevent more such incidents.

There is a huge stigma among Indians attached to mental health issues.

This is borne out in my professional experience as a Marriage and Family Therapist in the community. These mental health issues include untreated addictions, depression, anxiety, and stress in relationships. These issues, in turn, often lead to misery at home, frequent squabbles, decreased productivity, and even cases of domestic violence (including verbal and physical abuse, eating disorders, and suicide attempts). More severe mental conditions such as obsessive compulsive disorder and schizophrenia are often denied completely by families—who either pretend that the right marriage or having children will fix the problem, or who hide the very fact that a family member with the diagnosis exists. Mental health issues are viewed as black or white–insanity or sanity, normal behavior or complete breakdown—and not as they really are, which is a broad spectrum of issues.

When there is no physical evidence of bodily illness, it is harder to grasp and more frightening to confront mental health issues. There is no blood test or x-ray that shows where the illness is located. There is no magic remedy to instantaneously explain and fix the problem. Who or what can be blamed? Is the disease in question heritable, communicable? Can we treat the person and family with compassion and dignity?

Why are we, as a community, unable and unwilling to reach out for timely help?

We do not distrust the medical community in general. In fact, we manifest somatic complaints more often than we express emotional concerns. In the context of a family-based culture, it might be easier for people to talk to a respected elder within the family. As we get to be a more mobile culture, traveling between cities and countries for work, how do we keep those connections alive? How can we keep our roots and heritage, and yet assimilate healthy behaviors from the western countries to which we immigrate? Is it unthinkable to get help from a professional—a doctor or psychotherapist?

I am guessing that the families involved in the murder-suicides did not get help.

Why did Rajaram and Kalathat murder their families? Was there no room for each man to fail by himself? Did he think his family was just an extension of him? Was each man trying to protect his family from the shame and sense of failure that he thought would follow his suicide? Is this the dark side and pathology of a “family-self,” in which there is no separation between a man and the rest of his family?

According to Lakshmi Srinivas, a sociologist at the University of Massachusetts, Boston, it may be as foreign for an Indian to seek help from a psychotherapist as it is for an American to go to an astrologer when confronted by a difficulty. Srinivas says that many immigrant families don’t have their own cultural support systems here (such as extended family, kinship networks, friends and religion), and that the lack of a support system makes it more likely that people are isolated in times of hardship with no avenues for help. She also points out that when people emigrate, they do so with the positives in mind, such as better career and educational opportunities and improved material prospects. They do not, however, always consider the potential emotional and social sacrifices.

While Srinivas’s view addresses absent relationships, I would like to examine the effect of negative relationships. Symptoms of depression manifest very differently in men and women. While women often express the symptoms of depression for the entire family, an angry or withdrawn male may actually be clinically depressed. Male depression is more likely to be undiagnosed for a variety of reasons including reluctance to seek help, masking symptoms, and a resistance to getting treatment. It is very possible that both Rajaram and Kalathat had clinical depression triggered or exacerbated by economic, social, or familial difficulties.

As I write this, I keep in mind that there are surviving family members who are grieving after these tragedies. If they are reading this, I offer them my condolences—unreservedly, compassionately, and without anger.

If readers were outraged by the news, and saddened by the loss of innocent lives, I am glad about the presence of feelings of community and responsibility. If seeking professional mental health help is still a foreign construct for most of us, I am comforted that going out and buying guns to eliminate one’s family is also a foreign idea to most of us.

The idea of a society where people seek professional mental health help proactively, without shame or hesitation, may be idealistic for now. But, considering the potential represented by those Newsday statistics, I remain hopeful.