Alt text: Close up image of a smiling woman with brown skin and short, curly black hair, beside a white man with blue eyes and blond hair. Their heads are touching.

Hi, I’m Meera.

This is a story about how I went from existing as a jumble of disjointed pieces to becoming someone who is whole, healing and unapologetically myself. It’s just one version of my story.

I grew up Indian American in a predominantly white and conservative New Jersey town. From a young age, I learned what it meant to feel in-between: too American for my Indian culture, and too Indian for American culture.

I experienced racism from a very young age and remember flinching when classmates spit my last name out in anger, called me slurs, mocked my parents or my skin tone and commented on my food and culture. While the racism became more nuanced and less overt as I got older, what remained was that shame of otherness. By the time I graduated high school, I managed to hide that shame, and was seen as resilient—a well-rounded, high-achieving kid with good grades, musical talent and a cheerful presence, although my closest friends also sensed my walls. I jokingly referred to myself as a “coconut”: white on the inside, brown on the outside. I was proud of my culture inside of my home, yet afraid to be viewed as different beyond those four walls. 

And then I entered college. Something shifted when I stepped onto the Wellesley College campus. People who come to this New England women’s college are taught early on that there are no limitations to what we can do. We’re urged to examine ourselves and experience our lives fully.

All at once, removed from my childhood context, I found myself facing three different aspects of myself: my sexuality, my identity as a woman of color, and my experiences within my own family. I had always identified as straight, as someone that stood up for the gay community—an ally, back in the late nineties, when allyship felt less common than it is today. I had crushes on boys throughout my teen years, and “girl crushes” that I always dismissed. For the first time, surrounded by womxn on the Wellesley campus, I realized these attractions weren’t actually different from one another; I was attracted to specific people irrespective of their gender identity. I didn’t know what to do with that information, but it shook my sense of self to realize that I wasn’t straight.

During my first year of college, I also grew closer to other socio-politically minded classmates and found myself gravitating toward the Wellesley South Asian community. I forged rich friendships with fellow South Asians. Together, we thought about ourselves in the context of being people of color in the United States—and we cultivated a sense of solidarity with other communities of color on campus. For the first time, I really reflected on the microaggressions I grew up hearing, the way racism had hurt me, and began to take deep pride in my cultural background. And in doing so, I began to experience a sense of true belonging. 

In the midst of all this, I was also grappling with something personally painful; the relics of childhood trauma.

I come from a  family lineage of deeply embedded intergenerational trauma. Over generations, my family inflicted harm on one another in various ways, from parents to children to siblings. Each person did their best to survive their own experience, but without meaningful healing, generation by generation, trauma and shame was passed on from one to the next in different ways. We never talked about any of it. I doubt any of us genuinely understood it, and the stigma around mental health and fear of “what people would think” meant we couldn’t name it. I found myself confused about my own struggles, and felt deep guilt around naming “trauma” as a part of my family experience. My family loved me. Wasn’t it a betrayal?

My superpower—and probably one of the most terrifying abilities I had growing up and well into early adulthood—was the ability to compartmentalize everything to a debilitating degree. I could be in a horrible state without having eaten for 30 hours, without sleep, obsessively saying painful things to myself—and then I could show up to a meeting with a smile like nothing was wrong. I carried a lot of shame, and as my sense of sexuality and identity began to develop, that shame grew heavier.

I remember thinking: I don't get to be South Asian and also get to be queer. 

When I was 19, a classmate and I started dating. We’ll call her Alyson. My parents knew—and while they never, ever threatened me with disownment or punishment—they were very unhappy that I was dating a woman. They expressed disappointment in my judgment and my choices, and questioned me. Why? Why was I doing this? I persisted, because I outwardly and politically believed there was nothing wrong with being in a same-sex relationship, and I believed in my right to be in one. But outward beliefs are not the same as inward ones.

I was deeply at odds with myself. For the first time, I had found belonging within my community as a South Asian woman and a woman of color, and I was terrified of losing it. I couldn’t shake the internalized homophobia. I didn’t know how to reconcile my identities, and I kept returning to the persistent shame in my bloodline. I told my then-girlfriend Alyson we had to stay closeted, that we couldn’t be seen together in public. I placed an ultimatum on the relationship; we couldn’t remain together once she graduated. My own best friends didn’t even know. 

Increasingly, my life and sense of self began to feel disjointed. To make matters more complicated, I was a very public facing person on campus. I was in leadership positions where I had to deal with race tensions at school, where I led diversity initiatives and pushed the administration for increased funding for advisors, access to housing for international students. I sang and performed in a popular group on campus. I was dedicated to service leadership. Yet, internally, I was struggling with myself. I began isolating from everyone else who loved me and turned to food as a form of control. My 5"6' frame soon weighed in at 105 pounds. I was just skin and bones.

Things came to a head after I went two days without food, and was acting deliriously. My girlfriend, who was experiencing her own pain from my shame and anger, was scared enough to drag me to the student help center. I ended up hospitalized for three days. When the doctor asked if I was suicidal, I wasn’t able to say no. I felt like a stone.

Worst of all, my family had no idea what had been going on. Their understanding of my college experience was simply that I went from being a seemingly joyful, happy kid to an unfathomable person. I had become very angry, especially with them, yet I couldn't articulate why. Looking back, I realize I was frustrated about the poor boundaries we had and all that unnamed trauma from my childhood; issues that would take me years to undo in a healthy way.

Still, it broke my heart to see fear in my parents’ eyes, after they drove the five hours to Massachusetts to check on me. I hated feeling like I had become inexplicable to everyone, including myself. I remember making a very distinctive choice while sitting in the hospital room. I would not cause anyone additional worry. I would leave that hospital as soon as I could. I would prove that I wasn’t “broken.”

When I told my parents and the doctors that it was all just academic stress, that I’d just let myself go during finals and wasn’t really taking care of myself, they believed me. After all, I had a gift for compartmentalization. I was discharged within days, and no one found out about my disordered eating. But I became even more cautious and guarded about my pain.

And that’s how I carried on. The Meera that everyone knew—a dynamic leader, caring friend, bold young woman of color, advocate and performer. And the Meera that no one saw—wounded, confused, struggling with shame, self-loathing, isolation and the relics of trauma. Occasional glimpses led people to describe me as “intense.”

Shortly after, Alyson and I had a messy breakup, as college breakups often are. There was an evening when I was alone in my office space,  terribly upset and angry. Because she was still worried and afraid for my health, she sent someone else over to console me, a mutual friend. And this is how an incredible human being named Eliot soon became my best friend.

Eliot and I met when I was 19 and first dating Alyson. He was also a classmate, just one year older than me. Despite my guardedness around most people at that time, we easily became friends, feeling as though we had known one another our entire lives. Over time, we would say that this is because we are soul mates; the instant we met, we felt like we had found home. At the time, we had no romantic notions. Eliot was in a relationship, and so was I.

But it was on his 22nd birthday, that our connection would begin to deepen into abiding trust. You see, as I was going through my struggles, Eliot was beginning his own transformation: he had just come out as transgender, identifying by the pronouns and identity by which he is seen today. And so it was over the next year—as I entered my senior year of college and Eliot navigated his first year in the workplace while physically transitioning—that we became one another’s foundations and sounding boards. We were able to be there for one another at a time that each of us was going through an evolution or a shedding of pain, to listen deeply and to recognize one another’s deepest essence instead of getting stuck at the surface. By the time I graduated from college, we knew we were in love. But I continued to insist that we couldn’t be together. I couldn’t let go of the idea that if I made “this choice”—and at the time, I did view it as a choice —I would be causing irrevocable harm to myself and others. I told myself it was to protect my younger brother; what if my decisions had ramifications for his life? I convinced myself that as a brown person in this country, anything but the norm meant losing my community—losing any semblance of belonging. 

After graduation, I made a conscious choice to go back to New Jersey, and found a place just an hour away from my childhood home. In a way, by moving back, I believed I was choosing my family and my culture and my heritage over what I wanted—to be with the love of my life, who happened to be a transgender man. I genuinely believed that love fell into different categories and that I could have one or the other, but could never have both.

Eliot and I still talked. Every single day. We sent gifts, made surprise visits. He knew the ins and outs of my life and I knew the ins and outs of his. When we did see each other, it was like nothing had changed. Every goodbye felt heavier than the last. The looming losses in between just hung over us for so many years. 

My family always knew about Eliot; they knew who he was, and they eventually knew that I loved him and wanted to be with him. They also knew his identity as a transgender man as they’d met him before and during his physical transition. My younger brother adored him and didn’t fully understand what I was agonizing over. He rolled his eyes at me, as younger brothers tend to do.

But my parents would say, “We see how happy he makes you. We see that. He makes you laugh like you used to, and we know you really care about him. But you don't know what you don't know. The things that you will face. As you get older, you don't know the things that are supposed to exist in a marriage. You won't be able to have children. You think those things are okay now, but they won't be okay. You’ll lose your community. You’ll be alone.”

Jumbled together in these comments was a mix of fear that they would lose their community, the belief that my life would be happiest if I followed a “known” path, and their own misguided views about the queer community and what this kind of love “looks” like.

My parents reiterated that they would always love me, that they wouldn’t leave me, that if I made this choice and if the family was ostracised, they would never disown me. But they always did remind me that my choice could make them lose everything.

This was such a weight to bear that I sometimes wished they would simply cast me out. 

I began self-harming around this time, shortly after college. I was in a management role at work and began losing the ability to be completely functional, putting any energy I had into work. I’d stay in the office until 10 p.m. and start again at 7 a.m. the next morning. Even on my weekends, I’d work. In this society, people reward that particular addiction, but the truth is, being a workaholic is its own kind of compulsion. For me, like self-harm and controlling my eating, it was yet another painful coping mechanism. I earned promotions, was respected by my employees and management alike, and did well. I also started performing in community theatre; once again, mimicking the disjointedness of my college years. 

This went on for years. Success at work and onstage, misery in private, and a sense of complete indecision around one central question: Eliot, or my family? Eliot, or my family? My heart, or social expectation? Throughout those years, I went to talk therapy, but found little relief. It would still be years before I discovered trauma-focused therapies and experienced significant change. But once again, what appears on the outside doesn’t always reflect what’s going on inside of us.

When I was 27, I hit a tipping point. A moment of clarity, in reality synthesized from years of reflecting and agonizing. And in this moment, three strings of wisdom collided to help me make a decision.

The first: a fellow South Indian friend’s words echoed in my head: “Our parents sometimes say they’re giving us advice because we’re making the wrong decision,” she had said, “but the reality is that they’re afraid. They’re afraid that THEY can’t handle our choices. But they can, Meera. They just don’t know it.” My parents were afraid. For the first time, I realized that they hadn’t been sharing wisdom for all these years; they had only been sharing fear and calling it wisdom.

The second: I realized that my actions and my choices are separate from other people’s reactions. It sounds so logical, but for a really long time, I believed that if people I loved became upset with me or felt that I destroyed their life by making a certain decision, if their blood pressure went up, if they became anxious—it was somehow my responsibility. For the first time, I realized what a false burden it is to bear responsibility for other people’s emotions.

And the third: I recognized that the only way to make a truthful decision would be to align it with my own values. And I wrote down those values: truth, honesty, kindness, courage, love. I decided that as long as my choices and actions enacted those values, I could be at peace, no matter the way others reacted. And that included my parents.

Armed with these three threads of wisdom, I decided to take a step back to examine my spirit and the higher values that drive my life. Anytime I do this, the answers become clear. And that’s exactly what happened.

Within hours, I called my parents, and I told them that I’m only responsible for living within my values. They were acting from fear and calling it advice. They really believed what they were saying was for my own good. But the truth is, they were afraid because there were so many unknowns. They believed that if I followed a certain known path, then maybe I wouldn't ever get hurt, maybe we wouldn't ever suffer loss. But that's just not true.

I said, “I love you. I will be patient. I will be understanding if this takes time. But I am asking Eliot to move here and be with me.”

There was no arguing, no pushback. For the first time, my parents and I heard confidence and clarity in my voice.

Eliot moved to New Jersey, and the two of us were engaged within one year. Now, in a romantic comedy version of our story, this is where the tale would end. But that’s not how life works. Life remains a complex and beautiful thing to the end of our days.

You see, choosing Eliot—choosing love and deciding that I didn’t have to choose between aspects of myself—was the beginning of an important journey. The journey to integration, to each of us becoming a whole person, without shame and without secrets. Over time, I’ve grown to believe that the most important journey we take in this lifetime is the one in which we choose to face and live out our whole truths. And to do this, we can’t live based on the limitations of others around us, whether those limitations come from society, parents or our own self-judgment.

At our beautiful Vedic wedding, only a handful of people knew about Eliot’s identity. A piece of us remained secret. And it was clear, early on, that marriage wouldn’t magically heal old pain; when two people, even soul mates, enter into a partnership, we each bring our own wounds to the table. 

I decided to begin dialectical behavioral therapy with a trauma-specific therapist, who gave me an entire binder full of information and taught me all about how a traumatized brain functions—and how we can dialectically shift it. All of a sudden, everything made complete sense. I changed rapidly; so rapidly, in fact, that it took Eliot and I a few years to even come to terms with the fact that my years of stagnant pain are part of the past. Over time, I’ve been able to gently speak with my mom about trauma, and together, we have healed some generational wounds.

We are breaking the cycle.

Eliot, too, began this kind of therapy and exploration. Today, he’s even studying to become a therapist himself. We now know how to name what we feel and need. When new grief and pain has come our way over the past eight years of marriage, we’ve been capable of recognizing it, of getting through it together without compartmentalizing or hiding from ourselves. 

The more aligned and integrated I’ve become with myself, the less burdensome life has felt, even when it’s terribly hard. There is a simplicity and a liberation that comes with being open and honest about who you are, in allowing all the parts of you to co-exist—and others are drawn to it, too. Today, as an artist, writer, photographer and coach, I find that my wholeness invites others to be fully themselves when we work together. I am all of myself all the time, and authenticity begets authenticity.

It was only two years ago that Eliot and I felt ready to express our full identities publicly. As someone that physically transitioned 15 years ago, Eliot’s identity is “invisible” and the choice to share publicly was primarily his, but also a collective one. We were strongly driven by our sense of responsibility to those younger than us; our honesty could pave a path of safety for others that identified as queer desis or transgender, especially within our shared community. But most importantly, we felt it was time to remove the veil of shame created by secrecy.

A few days before hitting publish on an online post that would make it to my South Asian community here and abroad, I called to let my parents know my plans.

My mom was fearful; she didn’t understand why we felt the need to be public. She was still afraid of the backlash, the potential for ostracization. 

“It's just something we have to do,” I told her. “We won’t  live in shame around this.” A moment of silence later, she said, “Yes. I know you and Eliot always do things for a reason. I hope it ends up ok.”

In that response, I realized how much my parents had changed. And I realized that if I hadn’t followed my truth, they would never have had the chance to evolve, too. 

Soon after we told our story, closeted teens within my community began flooding my inbox with messages. Some adult friends of my parents felt freer to talk about their childrens’ identities. And we feel more connected than ever to the communities that we call our own.

There’s a quote I often return to, especially when I feel my existence or Eliot’s existence are being scrutinized, debated or at risk. It’s from queer novelist Armistead Maupin:

“The world changes in direct proportion to the number of people who are willing to be honest about their lives.”

To this day, Eliot and I personally and professionally work with young folks that have experienced marginalization to show them that their power lies in being wholly themselves. When we tell our stories, it should be our whole story. The story we were born to live. 

Alt text: A work of art by Meera that reads “My life is not an apology. I no longer permit this broken world to dictate what it means to be Whole.” The black text is on a white background with purple, red, pink, yellow and orange paint strokes at the top and bottom of the canvas.

Thank you to Meera Mohan-Graham for sharing your truth with us. Meera is an artist, personal and wedding coach, photographer, a mentor for young queer folx and a champion for vulnerability and self-liberation. Learn more about her and her work at www.lovemeera.com or www.meeraphotography.com  and be sure to give her a follow on Instagram or Facebook.

In essence, intergenerational trauma is trauma that began years before the current generation. Researchers and clinicians are growing increasingly aware of how this kind of trauma, which disproportionately affects the most vulnerable groups (people of color, LGBTQIA+ folks, people with disabilities etc.) manifests through time—and how unaddressed trauma is passed on to subsequent generations.

Even family members who may not have directly experienced certain traumatic events can still be significantly impacted by them because their descendants, while carrying that trauma, often react to their world in ways that someone who experienced trauma firsthand would. I really loved this example from Támara Hill of The Association for Child and Adolescent Mental Health:

For example, the patriarch of a family may suffer from an untreated severe mental health disorder which causes him to engage in harmful behaviors toward his daughter. This daughter, having endured years of emotional and psychological abuse, now has her own family but has not been able to release herself (psychologically and emotionally) from the torture she endured. As a result, she begins to exhibit many of the same behaviors of the patriarch which leads to her own children exhibiting similar behaviors. These behaviors, including dysfunctional ways of coping, continue for generations. These unhealthy behaviors then become a “normal” way of raising children within the family.

In this excellent primer on intergenerational trauma, Hill offers clinicians some advice:

• Understand that intergenerational trauma almost always includes a loss of safety (emotional/psychological, physical, financial, etc).

• Be aware of the emotions your clients are expressing to you and be open to psychoanalyzing their reactions and the ways they discuss their emotions.

• Encourage your client to openly discuss (when ready) the loss they feel and why. You can eventually help them define and add meaning to their story.

• Once the heavy processing involved in trauma work is over, lead your client to focus on designing a future far removed from their thoughts and feelings of the intergenerational trauma. They must understand that generational chaos can end with them.

Alt text: A graphic that reads “A Q&A with trauma-focused psychologist Anushka Patel” featuring a photo of an Indian psychologist wearing a scarf and smiling at the camera.

Anushka Patel is a clinical psychologist and post-doctoral fellow specializing in trauma-focused care at the Trauma Recovery Center at the University of California, San Francisco. She’s worked with many trauma survivors, from combat veterans to survivors of child abuse, and specializes in the psychological effects of gender-based violence.

What can you tell us about common behaviors often associated with trauma survivors? 

Following a traumatic event, many people develop distressing reminders and nightmares, which can co-occur with changes in arousal and produce sleep and concentration difficulties. It’s also common to see changes in mood, distorted sense of blame, extreme shame and altered worldviews in trauma survivors.

And because these symptoms (and trauma memories in general) are difficult to deal with, survivors often try to avoid anything related to that trauma. Avoidance might include staying away from external reminders like people or places as well as internal reminders, like thoughts and feelings about a particularly traumatic event or situation from the past.

Meera mentioned seeing a trauma-informed therapist. What exactly is trauma-focused therapy? 

Trauma-focused therapy involves actively approaching—rather than avoiding—the trauma-related material so that survivors can address the effects head-on. Examples of evidence-based trauma-focused therapies include cognitive processing therapy (CPT), prolonged exposure (PE) and narrative exposure therapy (NET). Many techniques allow gentle exposure to memories of the trauma, coping skills to handle inevitable distress, and ways of integrating the trauma memory so it becomes a coherent story rather than disparate shards of memory that pop up, unbidden, like intruders.

While many trauma-focused therapies exist, a trauma-informed lens unites these paradigms. And when we adopt that trauma-informed lens, we are deeply curious about answering “What’s happened to you?” rather than “What’s wrong with you?”

How is trauma-focused therapy different from general talk therapy or cognitive behavioral therapy (CBT)?

CBT refers to a wide umbrella of evidence-based cognitive and behavioral tools, and it’s been modified for many psychological disorders. For youth who have been exposed to trauma, trauma-focused CBT is a frontline treatment. For adults, trauma-focused therapy draws from CBT techniques and philosophies and also involves actively processing the actual traumatic event.

For example, CBT is geared at helping clients alter their thinking patterns or behaviors to produce more balanced thinking patterns or adaptive behaviors. In this vein, trauma-focused therapy specifically targets how the traumatic event has shaped a client’s belief system and day-to-day thinking patterns, how it has altered their behaviors (e.g., avoiding a lot of activities associated with the trauma) and the impact it has on emotion regulation. Using this frame, trauma-focused therapy is laser-focused on identifying exactly how that trauma connects with a client’s cognitive, behavioral, and emotional patterns out in the world.

A trauma-informed therapist—whether they use CBT or another approach—understands that all symptoms can be conceptualized as adaptations to the traumatic experience. Using this gentle and non-stigmatizing approach, a therapist can draw a client in to weigh the relative risks and benefits of these adaptations and help a client make changes when they’re ready. The end goal of trauma-focused therapy is to have a balanced understanding of the trauma by cultivating acceptance, growing coping skills to dial down the distress associated with the trauma, and, ultimately improving quality of life.

What kinds of treatment or therapy options are there for coping with intergenerational trauma in particular?

The intergenerational trauma treatment model (ITTM) linked here is one example of a commonly used treatment. This one focuses on reframing a caregiver's role by addressing their unresolved trauma and empowering them to become healthier versions of themselves as parents. The treatment is a phase-based approach that integrates attachment theories with trauma theories to start disrupting the negative impacts of trauma on survivors' belief systems.  

Can you tell us a little more about dialectic behavioral therapy, which Meera has had great success with? 

DBT is a very effective treatment for several difficulties ranging from borderline personality disorder to non-suicidal self-injury. It is underpinned by navigating dialectics (i.e. opposites) inherent in our lives to help clients tolerate and overcome the distress associated with making big life choices and meandering dilemmas. DBT is a skill-focused treatment that teaches people to become aware and mindful of their emotions, how to regulate their emotions, and how to improve interpersonal effectiveness with improved communication skills. 

How do you approach trauma-focused therapy in a culturally sensitive way?

Nearly all aspects of how trauma-related symptoms present and are responded to are subject to broader cultural forces. From how much blame we assign to ourselves/others to how much social support we receive following a traumatic event, these aspects are culturally shaped. And social support, as we all know, hugely helps mitigate negative outcomes of trauma exposure.

This is why trauma-focused therapy must deeply engage with a client's personal and cultural worldview in order to be considered culturally sensitive therapy. When a therapist is culturally sensitive in delivering trauma-focused therapy, they might draw on the client's subjective explanation of their symptoms, causes, and coping to develop a a personalized explanatory model of trauma. This model can serve as an entry point into the client's worldview, which includes personal and cultural aspects of how they have made meaning from their trauma.

A therapist might also use mirroring language to reflect the client's experiences by using local idioms of distress that are non-stigmatizing ways to communicate universal suffering. It’s also essential to draw on a client's personal and cultural strengths when establishing “homework” in treatment and modifying treatment to be culturally attuned. For instance, a Muslim client who is religious may find deep peace in cleansing rituals and meditative prayer, which can be woven into their treatment as gentle ways of exposing a client to anxiety-provoking sensations and thoughts that they may have previously avoided.

What advice do you have for anyone who might be interested in seeking trauma-focused therapy?

1. "Shop" for the right therapist! Don't be afraid to try a few therapists until you find the right match, skillset, and orientation that suits your needs and recovery goals. A good way to educate yourself on the treatments out there is to rely on trusted sources and professional organizations. You can use those links to read more about evidence-based therapies for trauma work. These resources serve as a starting point for discussions with therapists about what they offer for treatment.

2. Don’t believe everything you think! Traumatic events are watershed events in most people’s lives: there is a “before the accident” and “after the accident” so to speak. Because of the nature of how big these events are and their impact on life, it’s normal for your thinking patterns to feel very much unlike yourself. It’s important to recognize: “Hey, this isn’t really me. I need some help to feel and process like myself again.” This can help improve quality of life a lot sooner than delaying the help-seeking process; it can reduce the intensity of the pain following trauma; and it can literally be life-saving. When we consider the link between trauma, depression, and suicide that affects too many people, it’s so important to remember, “This is not me; this won’t go on forever,” because suicide is preventable, especially today with the incredible trauma-focused therapies out there. 

Have you ever heard of the Emotional Freedom Technique—a.k.a. EFT tapping? According to Healthline, it’s a temporary acupressure treatment that’s been used to help folks with anxiety, depression, PTSD, as well as insomnia and general physical or emotional pain.

How it works

Similar to acupuncture, EFT targets energy hot spots to help you restore energy balance, which many believe can relieve symptoms a negative experience may have caused. Instead of using needles (like in acupuncture), EFT requires using your fingertips to apply pressure. The technique’s effectiveness against other treatments is still being researched, but proponents say EFT tapping helps send signals to the part of the brain that controls stress, ultimately reducing or eliminating intense reactions to negativity. 

This 2019 study found that EFT was effective in easing anger and anxiety symptoms related to Hwabyung (or “fire syndrome” in Korean), a psychosomatic syndrome arising after periods of suppressed feelings of injustice and fairness. A 2016 review of 20 studies reported the technique was highly effective in reducing symptoms of depression, and those findings suggested that EFT was as effective if not more effective than standard treatments for depression.

Note that EFT as it commonly exists was conceived in English, but here’s an explanation in Spanish—and another in Hindi. It’s highly recommended that you continue to seek traditional treatment options and consult with your clinician before beginning EFT tapping.

How I've Learned That Being a Bisexual Chinese American Woman Doesn't Make Me ‘Leftover’ (Traci Lee, Teen Vogue): “At the end of the day, it all comes down to how I choose to identify and how I choose to embrace who I am – and this year, I’m determined to do it with pride.” In this op-ed, Lee explores how cultural expectations shaped her identity as a bisexual, Asian American woman. Read here.

She tried everything to treat her complex PTSD. Now she’s writing a book to help others—and herself. (Stephanie Foo, Carter Fellows): In February 2018, Foo was diagnosed with Complex Post Traumatic Stress Disorder. But as she researched the condition with symptoms mirroring her reality, she couldn’t find a conclusive answer for treatment. “I belonged to a community of immigrants and refugees traumatized by war and poverty, who then passed that trauma onto their children. Abuse was normalized in my community. I want to use my story to witness how traumas are encoded in an adult and to ask whether it is possible to heal those traumas. How? What does that feel like?” Read here.

What Isn’t Mine Is Mine: Accepting Intergenerational Trauma (Ilana Masad, Catapult): “We laugh like our family, gesture like them, even chew like them! Is it not possible we could hurt like them, feel guilt for horrors we've survived?” A beautiful essay on intergenerational holocaust trauma. Read here.

An Arab Trans Woman, Struggling To Find Myself In Language (D.T., The Establishment): “Hot child in the city, I met Montreal’s community of queer and trans people of color, a community that taught me the first of the words I needed. Precious words to name my feelings, my desires, my distress, my orgasms, my transgender body, my transgender body of color, and all the fast-paced beats of my heart that has now become open to the possibility of being. Being me, being trans, a girl seeking birth, a stranger seeking home.” A beautiful essay from Tunisian Canadian D.T. Read here. 

From Haunting to Healing: On the Gwangju Uprising and ‘Human Acts’ (Hannah Bae, Catapult): Bookmark this: Bae’s “Gwangju Daughter,” a Catapult column that uses art about the 1980 Gwangju uprising to unpack political and personal traumas. In this debut piece, Bae writes about learning to read Hangeul as an adult and finding out she’d always mispronounced her father’s Korean name, yet another reminder just how little she really knew about him and his past in South Korea. She then reads into Han Kang’s historical masterpiece, Human Acts, and slowly unwraps the toll of the 1980 Gwangju uprising’s emotional burdens on her parents’ generation. “Perhaps, in never speaking of this history to his American-born children, my father believed, falsely, that he was shielding our generation, too.” Read here.

Kissed a Girl (Vickie Vértiz, Longreads): “I pretend she’s done nothing wrong. Amá can think I’m a victim because her baby can’t be anything but perfectly straight. But her Catholic Chicana baby is definitely gay, okay.” In this excerpted piece from Graffiti, Vértiz maneuvers her way around teenage love, friend envy, and being outed by her Mexican mother. Read here. 

5 books featuring marginalized voices, intergenerational trauma or queerness

• On Earth We’re Briefly Gorgeous by Ocean Vuong: A shattering portrait of a family, a first love, and the redemptive power of storytelling formatted as a letter from a Vietnamese son to his mother

• My Grandmother's Hands: Racialized Trauma and the Pathway to Mending Our Hearts and Bodies by Resmaa Menakem: Menakem, a therapist, looks at the way racism affects the psyches and bodies of Black Americans, White Americans and police

• The Best We Could Do: An Illustrated Memoir by Thi Bui: An evocative memoir exploring the lasting effects of displacement on a child and her family after the fall of South Vietnam in the 1970s

• We Have Always Been Here by Samra Habib: A work of eloquent prose from Habib, who recounts her childhood in Pakistan, early years as a Canadian immigrant, and how she embraced her queerness after an unwanted arranged marriage

• Cantoras by Carolina de Robertis: In 1970s Uruguay under a repressive dictatorship, a group of gay women find and build their own queer family

That’s all, folks. I hope you enjoyed this issue. And if you did, please share it with loved ones.

A big thank you to editing champs Farah and Hanaa’ for contributing your talents—and to Meera Mohan-Graham, Támara Hill and Anushka Patel for sharing your stories and expertise. Forever grateful to Sustaining Members Hannah B., Safurah B., Alex C., Alma C., Rebecca C., Rodrigo C., Katie H., Liz S., Puja S., Roz T., Hossein T. and my mama, Safia P. Without you all, this work would not be possible.

—Fiza

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Foreign Bodies is an email newsletter centering immigrant and refugee experiences with a mission to de-stigmatize mental illness through storytelling. It’s written and curated by Atlanta-based writer Fiza Pirani with copyediting and fact-checking help from Boston-based journalist Hanaa’ Tameez and traveling journalist Farahnaz Mohammed. Want to contribute your time or share your own #ForeignBodies story? Fill out this form and be sure to say hi on Twitter,Instagram or Facebook. 

If you're thinking about suicide or worried about someone who might be, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 741741 to connect to a crisis counselor in the USA. You can also find a wealth of culture- or language-specific recommended resources on our landing site, foreignbodies.net.

Foreign Bodies is a mental well-being newsletter for immigrants and refugees with a mission to de-stigmatize vulnerability through storytelling. Our issues are free for the public and fully funded by paying subscribers. We need your support to do this.

Issue 19: I'm not always attached to living, but hear me out.

On suicidal ideation, thoughts of suicide

Issue 18: We can all break the cycle of shame and trauma

On intergenerational trauma, embracing queerness

Issue 17: What can I say that hasn't been said?

On passing the mic to Black immigrants, being an effective, anti-racist ally

Issue 16: Why am I so afraid of medication?

On pill shaming and my personal experience with antidepressants

Issue 15: Undocumented, disabled and hung out to dry. Still, we rise.

On being a blind, undocumented Latina—and how the public charge rule hurts disabled immigrants

Issue 14: My parents don't believe I'm depressed. Now what?

On how to refocus on your own healing when you feel dismissed

Issue 13: Are you possessed by demons or are you actually sick?

When we mistake mental illness for jinn, espíritu and other nonhuman beings

Issue 12: Upper lip, too?

On hairless beauty standards, PCOS in Indian womxn and the mental health connection

Issue 11: I can't just pray my disorder away.

When you're living with a mental illness, what role does faith play?

Issue 10: Climate change is coming for our homelands.

On climate anxiety and the aching desire to protect the lands we remember

Issue 09: My job was killing me, so I quit. Should I feel guilty?

On immigrant survivor's guilt and the privilege of risk-taking

Issue 08: What if no place feels like home?

The influence of one's sense of belonging on mental well-being

Issue 07: Please stop asking about my weight.

On body shaming, internalized dysmorphia and cultural stigmas associated with weight

Issue 06: Dad, what does it mean to be a good man?

On masculinity in some immigrant communities

Issue 05: Her sister has autism. Here's what she wants you to know

The stigma of autism in one South Asian community

Issue 04: Salaam, brother.

On internalizing global tragedy

Issue 03: Excuse my French, but...

On escaping accent prejudice

Issue 02: The f*$%-ing model minority myth

How the myth and its racist roots affect immigrant mental health

Issue 01: It's not just the winter blues

One immigrant's struggle with seasonal depression

“I’m not welcoming these calls,” Neal Lester, a Black professor at Arizona State University known for his extensive knowledge on race and society, told his third caller that morning, a white columnist at The Arizona Republic searching for some insight on how to best address racism within her community.

“I have no wisdom. I have pain, hurt and anger,” Lester told her. Karina Bland could tell he was tired, “tired of talking about race, of saying the same thing every time this happens. He’s tired of answering the questions.”

No one should have to ask him or other Black people how to act or respond, he added. If someone was drowning, would she wait for someone else to tell her what to do?

We all know what to do and how to get those answers. Donate, vote, petition, protest, challenge each other and speak up. And yet, I somehow find myself wondering what it really means to be an ally—and whether I should even subscribe to the word at all. What does it mean to do the kind of good that results in concrete change in both thought and action?

And what exactly is my role as a privileged non-Black immigrant with a mini platform such as this? What can I say or do that hasn’t already been said and done?

For weeks, I’ve been going back and forth on how to present this 17th issue of Foreign Bodies, compiling resources and doing hours of research and then berating myself for positioning myself as some sort of expert on anti-racism. I am not.

A fairly new acquaintance of mine, Meera Mohan-Graham, recently shared a gentle but firm reminder for “newly-awakening non-Black peers” who might be feeling frenetic, helpless and guilty about their inaction and silence.

In addition to donating and amplifying Black voices, “you may find yourself tempted to do something new, on your own, with limited guidance,” she writes, referring to the many like myself who feel an urgency to compile a list of recommendations, reading lists, study groups, even solidarity art. She asks us to hold, pause, breathe and then pause again. Consider what’s already out there. Think about the experts behind every resource you’ve read or heard or seen and consider the years of research, advocacy and action that led to that work.

“Anti-racism is about humility,” she writes. “You begin where you are.”

In my messy quest to bring you this issue, I’ve questioned my every move.

When I first decided to reschedule our June issue on LGBTQ+ immigrant experiences and acceptance and instead address anti-Black racism, a topic I had planned for later in the year, I knew that from the outside looking in, the decision itself could undoubtedly be viewed as performative allyship—that is, when someone from a currently non-marginalized group “professes support and solidarity with a marginalized group in a way that either isn’t helpful or that actively harms that group.” This kind of pseudo-activism “usually involves the ‘ally’ receiving some kind of reward,” sociologist Holiday Phillips wrote for Forge last month. “On social media, it’s that virtual pat on the back for being a ‘good person’ or ‘on the right side.’”

Am I comfortable defending myself against such criticism? Absolutely not. I’m not supposed to be comfortable with any of this.

As someone with a unique platform like Foreign Bodies, with an audience of primarily people of color, an audience of immigrants, of Black immigrants, indigenous peoples, advocates, activists and mental health professionals, I felt it would do more harm to do nothing at all. I know in my gut that dedicating this moment to the social issue we all have on our minds is the right thing to do. After all, racism is absolutely intertwined with mental health and well-being. And anti-Black racism is especially rampant within immigrant communities, both Black and non-Black.

But as a non-Black person of color, how could I proceed with caution and, again, with humility?

I immediately felt I needed to find a Black voice who could speak on mental health, on racism and on the immigrant experience, someone who might be itching to tell their own story. If you’ve read the previous issues of Foreign Bodies, you already know that each begins with a personal essay from a marginalized voice with a story to share. The questions I send my storytellers are always intimate. They often require sitting in one’s pain, addressing personal traumas and working to find lightness in vulnerability. How could I ask a Black individual to muster up the energy to do that kind of emotional work right now?

Yet I did. I reached out to a kind, stellar Black first-generation immigrant working in global health, someone I’ve been following closely for months now, and we were both eager to begin the collaboration process. A few days later, as he was answering the questions I sent, he realized he just wasn’t ready. He didn’t expect this process to be so hard for him, he wrote me via text. I deeply appreciated our brief discussion and I hate that he felt the need to apologize. That’s on me, 100%.

Covering any kind of tragedy—from police brutality to neighborhood fires to domestic terrorism—is part of the job and often, journalists instinctually feel called to report as soon as such tragedy strikes. When reporting on tragedy, we’re also taught to look for the victims, the relatives of the victims, the most vulnerable in the moment, the people who can best relay or expose the truth for our readers or viewers.

In traditional journalism, half the reporting work involves finding that “right” source. I’ve had editors tell me that writing a story is a lot like directing a movie. You have to find the right cast, the right leading man to tell the story that needs to be told.

And so, in traditional journalism, losing my lead source would be considered a major setback. It would put some added pressure on my shoulders to immediately find another before deadline.

As problematic as it might seem—and we in the industry have much to unlearn and much to learn about our approaches—there is some undeniable power in this method of raw storytelling.

But I’m free of those reins right now. I didn’t rush to find that second leading man or tell my first (whose name will undoubtedly pop up here in the future, because he rocks) that his reluctance is normal, that his story could ultimately help others—as is the standard and ethical one-final-push procedure in journalism when a source backs out.

Instead, I decided to hold, pause, breathe and then pause again.

I’m taking this moment to re-examine the role of personal storytelling in the midst of pain. How can I, as editor of a small digital publication that encourages vulnerable storytelling, better center the appropriate storytellers without potentially traumatizing them? Without doing so just to do so? And most importantly, have I sincerely asked myself whether centering a Black voice is really the right thing to do in this moment, when they’re the ones drowning, exhausted and just waiting for the rest of us to step up?

If I take your race away, and there you are, all strung out. And all you got is your little self, and what is that? What are you without racism? Are you any good? Are you still strong? Are you still smart? Do you still like yourself? I mean, these are the questions. Part of it is, "yes, the victim. How terrible it's been for black people." I'm not a victim. I refuse to be one... if you can only be tall because somebody is on their knees, then you have a serious problem. And my feeling is that white people have a very, very serious problem and they should start thinking about what they can do about it. Take me out of it.

— Toni Morrison, 1993 interview with PBS’s Charlie Rose

So, dear Foreign Bodies reader, this issue will read a bit differently (and perhaps a bit messier) than the others.

Nothing feels quite ready to tie with a silk ribbon. Every time my fingertips hit the keys, the latest headline zaps me back into my seat, and once again, I question the validity and effectiveness of my role here. I’m starting off with complete transparency and letting you take a good look at how I’ve messed up and how I need to do and be better.

For this issue, I’ve tried to put together whatever I noticed might be lacking or in short supply—and whatever I felt I could adequately do with my specific expertise and experience as a storyteller, a journalist, an immigrant and an advocate for better mental health among marginalized communities.

In the following sections, you’ll hear from Black voices, yes, and each Black individual included in this issue is an expert on either immigration or mental health work. I ask that you not look to them solely for anti-racism guidance, but instead consider amplifying the great work they do.

To accompany their profiles, I’ll start with a brief overview of the complex experiences facing Black immigrants in the United States, including how Black immigrants perceive mental illness and treatment.

You’ll also find some tips on how to be an effective advocate or ally while battling mental illness and experiencing heightened burnout.

Next, you’ll hear from an old friend of mine—a South Asian woman in an interracial relationship—and the complexities of being so close to someone whose experiences she’ll never truly understand.

And lastly, alllll the way at the end, you’ll find a downloadable compilation of responses to the common pushback non-Black immigrants often hear about racism and police brutality in the U.S., including what’s worked and what hasn’t for many in generating thoughtful discourse. Data for the resource was compiled through a form I sent out a few weeks ago, which led to more than a hundred entries, the bulk of which came from Asian American and Latinx individuals. A good friend of mine, Nabila Jamal, was invaluable in her research.

I’m happy to share a few of my go-to anti-racist resources at the bottom of this letter, but just to reiterate: this should not be anyone’s one-stop-shop.

I wholeheartedly welcome your criticism and feedback. And now, before I pass the mic…

Depending on who you ask or which academic journal you flip open, the exact definition of a Black immigrant may vary. In this particular Issue, we are defining a Black immigrant as any person who was born outside the U.S. to non-U.S. citizen parents and who identifies as Black or African American.

According to the latest Census data, there were at least 4.2 million Black immigrants living in the U.S. in 2016—a fivefold increase in the Black immigrant population in recent decades. Roughly one-in-ten Black individuals in the country are foreign-born. The largest individual home countries of Black immigrants in the U.S. include the Caribbean, Jamaica and Haiti.

Compared with other immigrant groups (and with the overall U.S. population), Black immigrants are generally more likely to be proficient English speakers, though educational attainment varies greatly by country of origin.

Foreign-born Black people are also “often perceived by whites and even black Americans as different and 'special' — as harder-working and more productive citizens than their black American counterparts,” Fordham University professor Christina M. Greer wrote in her book, Black Ethnics: Race, Immigration, and the Pursuit of the American Dream.

“It's a phenomenon that academics started noticing decades ago — that immigrants generally are ‘strivers’ who work hard to better their lives,” Valerie Russ reported for The Philadelphia Inquirer in 2018.

It’s important to keep in mind, says Catherine Labiran of the Black Alliance for Just Immigration, that the process of colonialism on the African content historically pressured Africans into believing that European practices, policies and beliefs were superior.

“People who had a closer proximity to whiteness, through gaining Western education, converting to Christianity, and adopting a European language, were afforded privileges that others were not,” she says. “Not only were they made to look down on people who resisted this forceful transition within their countries, they were also made to look down upon Black people who were descendants of enslaved Africans.”

Oftentimes, Labiran says, Africans on the continent are fed “harmful stereotypes” depicting Black Americans as “lazy and criminal.” In the U.S., on the other hand, both Black and non-Black people have long been fed stereotypes of Africans as “primitive and uncivilized.”

So when Black immigrants—the vast majority of whom have not experienced the magnitude of racial trauma Black children in the U.S. grapple with every day—end up overpowering native Black Americans in education and socioeconomic status, it might feel natural to build some resentment.

“For many Africans, it takes migrating to the U.S. and experiencing racism for them to begin to identify with Blackness and the plight of Black people in America,” says Labiran, whose family hails from Nigeria. “But I do not think it has to be this way. We have to be committed to doing the work of unlearning the stereotypes that we have been taught about one another, which oftentimes means unlearning what we have been taught to think about ourselves.”

Similar to the model minority myth that’s historically pinned Asian Americans against Black Americans, this rift between native and foreign-born Black communities only serves the interests of white supremacy, echoes Dr. Barbara Thelamour, a professor of psychology specializing in Black immigrant identity at Pennsylvania’s Swarthmore College.

Thelamour’s recent research suggests, however, that Black Africans are actually rapidly growing more aware of the hardships still plaguing Black Americans today. And they want to see more of an alliance, especially as police brutality continues to dominate the national conversation.

“We must remember that when it comes to police brutality, Black immigrants are not immune,” she says.

Think of Botham Jean, a Black immigrant from the Bahamas, who was shot and killed by an off-duty officer in Dallas, Texas, in 2018. Jean was inside his own apartment when the officer fired. The officer said she mistook his residence for her own, and believed his “large silhouette” belonged to an intruder. Years before, 23-year-old Guinean immigrant Amadou Diallo was shot and killed by four plain-clothed NYPD officers, one of whom previously claimed to have mistaken Diallo, who was unarmed, for a rape suspect. The officers fired a total of 41 times outside his apartment in the Bronx. Around the same time and in the same region, a Haitian man named Abner Louima was sexually abused and assaulted by NYPD after being arrested outside a Brooklyn nightclub. The injuries required multiple surgeries.

“It doesn't often get discussed within the mainstream media, but Black immigrants also make up a pretty significant percentage of undocumented immigrants in the country,” Thelamour says. “And the likelihood of Black immigrants being targeted by law enforcement on account of being Black is pretty high. Once it's discovered that perhaps they don't have papers, the likelihood of being deported is fairly high, too.”

It’s true. Black immigrants may be more likely to be U.S. citizens compared to other immigrant groups, but as The Atlantic’s Jeremy Raff previously pointed out, although only 7% of non-citizens in the U.S. are Black, they make up 20% of those facing deportation on criminal grounds.

“There are so many entry points” to deportation, New York University law professor Alina Das told Raff. And “when you are a person of color who is also an immigrant, you face a double punishment.”

You may have heard of 25-year-old Ousman Darboe, an undocumented Gambian man who grew up in a heavily policed Bronx neighborhood known for its prison-to-deportation pipeline. Since he was a teenager, Darboe faced a series of police stops, misidentifications and arrests that resulted in incarceration—and ultimately, in ICE detention. As of June 2020, he remains in ICE custody.

While Black immigrants in the U.S. initially have health outcomes similar to white Americans, research suggests the advantage decreases with more time in the country and over generations.

A recent study out of Princeton University on birthweight rates among the nation’s foreign-born Black population found that any Black immigrant “birthweight advantage” seems to disappear within a single generation. In contrast, researchers wrote, a modest advantage tends to persist across generations of foreign-born Hispanics.

These findings led the authors to suspect that anti-Black discrimination and inequality in the U.S. could be a contributing factor to deteriorating health outcomes over time. After all, “interpersonal discrimination, both before and during pregnancy, are likely to trigger physiological stress responses that negatively affect birth outcomes.”

“One of the major barriers to health care access is lack of health insurance,” says Labiran, who specializes in Black immigrant mental health through her work with BAJI. “Without quality, holistic, and affordable health insurance, many Black immigrants are forced into debt trying to pay medical bills.” Not only is cost a barrier, but Black women, both immigrant and native, “have grown accustomed to being ignored, silenced and abused in medical settings.”

Another barrier is the relationship that sometimes exists between healthcare practitioners and law enforcement, she says. Immigrants are often afraid to disclose particular details to their doctors or therapists because they are justifiably worried about being criminalized, incarcerated, or even deported.

And when it comes to mental health care in particular, Black immigrants are generally slow to embrace the more clinical approach to psychology that’s popular in the West.

“In my experience speaking with children of immigrants about their parents’ perception of mental health, they often report that their parents do not know what mental health is,” says Labiran. “In many cases, however, it’s not that their parents are completely unaware of what mental health is, it is just that they have a different phrase or way to describe it.”

In one example, an interviewee shared that her mother would say she’s “bored” when she was actually struggling with depression.

“Given the stigma attached to words like depression and the pressure that is placed on Black immigrants to overperform, it is understandable why she would refrain from using the clinical term. Her choice of language by no means undermines her experience and I think that those of us who have received training in mental health need to do a better job of meeting people where they are,” says Labiran.

Many Black immigrants also believe in an indivisibility between mental health, spirituality and culture, she adds. “We are aware that what affects our minds also affects our spirits and bodies, so we are more likely to seek holistic solutions. Some people, for example, find that they benefit from a combination of reiki, spiritual baths and therapy rather than just cognitive behavioral therapy on its own.”

Hi! I’m Kari. I’m a writer, journalist, mom of two brilliant, young humans, and a mental health and diversity advocate. I’m based in Atlanta, but Trinidad & Tobago—and my kitchen!—will always be home. I’m Black and Indo-Trinidadian (a mix called “dougla” in Trinidad) and my kids are also mixed. I live with depression, a chronic illness and other complications. I love my sister friends, Carnival, soca music (this groovy jam is on repeat now), reading (!!!), running, the sea, exploring new cultures, and solitude. I’m a firm believer in solo vacations. I speak fluent Spanglish, Trinidadian dialect, and English. My mom is the cutest, most selfless human being I know.

Walk us through the trajectory of your professional experience so far and how you wound up at The Carter Center.

I started my journalism career freelancing for newspapers and magazines before becoming a staff writer at a mid-sized daily newspaper in Florida. (This was before Twitter launched and you needed a dot-edu email address to register for Facebook.) After a stint in media relations, I became executive producer of social media for a TV newsroom, then moved into platform analytics and leading digital content strategy for multiple local newsrooms.

All these roles impacted my mental health, whether interviewing a grieving single mother, covering fatal car accidents, the steady buzz of the police scanner, dealing with online vitriol, supporting teams covering elections, natural disasters, and mass shooting after mass shooting — or wondering if I’d get laid off. It got to the point where my body had a visceral reaction when breaking news notifications popped on my phone.

The Carter Center’s Mental Health Program wasn’t just a chance for me to step back from being always on. I wanted to support journalists telling the mental health stories that needed to be told and help them look out for their own mental health.

What do you do as senior associate director of the Rosalynn Carter Fellowships for Mental Health Journalism?

I support fellows and other journalists through coaching, training and mental health reporting resources. I oversee the fellowships’ operations and sustainability in the United States, Latin America, Qatar and the United Arab Emirates. I’ve also been working behind the scenes with our small, mighty team for the past year to ensure that future fellows are more diverse, that more mental health projects address underserved communities and news deserts, and that we’re actively recruiting and supporting journalists of colour. Next up is adding more representative talent to our Fellowship Advisory Board.

You recently completed mental health first aid training. Tell us more about the training and why you feel it’s an especially useful workshop for journalists.

I took mental health first aid training in August 2019 and it was transformative, not just for approaching people dealing with trauma or helping others in the middle of a mental health crisis, but how to keep myself physically and mentally safe in the moment and after. It’s a short, skills-based training course that teaches you about mental health and substance use risk factors and warning signs, understanding their impact, how to offer initial help during a mental health crisis and connect people to appropriate care.

As a journalist, it was invaluable for understanding mental health as it surfaces more and more in coverage, interacting with people who’ve been through trauma, and understanding how to cope with trauma or mental health challenges. I wish I’d taken it sooner! You can find a course near you through Mental Health First Aid USA.

If you’re comfortable, tell us how mental illness has manifested in your life.

Having grown up in Trinidad, I had to overcome intense cultural stigma around mental health just to seek help and get on medication. Then came sharing my struggles with loved ones. I talked about how difficult that was in my TedxPortofSpain Talk last year.

I moved to the U.S. in my late teens, and have been navigating the immigration system and being Black in America for half my life. When I tell most U.S. citizens it took almost two decades and $20,000 in attorneys and filing fees to become a citizen too, they’re shocked. It’s been a trial by fire and I’m truly grateful to have attended a Historically Black College & University.

But for the past two decades, I’ve lived with a sense of uncertainty as a Black immigrant trying to become legal in my adopted country and watched more recently as immigrant rights have been eroded. I’ve been discriminated against because of my ethnicity, nationality, gender and age. I’ve been called a n****. I’ve been a token person of colour in a newsroom dealing with microaggressions, disparate pay and unpaid diversity labour. I stay on the phone with someone when I’m pulled over by police. I’ve paid taxes, but couldn’t seek social services. I’ve been hurt irreparably by people I loved for sharing my truth. I talk to my kids about race and allyship. I’ve inherited a different kind of generational trauma. And my experiences and efforts are constantly interrogated. It is layered trauma and it takes its toll.

You’ve previously shared some stellar self-care advice for journalists covering trauma. What else would you want fellow journalists—especially Black journalists—to keep in mind right now?

When you’re one of the only Black journalists in your newsroom elevating the voices of Black, Indigenous and communities of colour, especially now, it’s hard to step back for your mental health. But if you don’t take a break, your body will. If you get physically sick, you don’t have a choice. Before your body shuts down or you have a breakdown, take care of yourself. We need you. (And I have to plug here that The Carter Center’s Mental Health Program is supporting Wellness Check-in calls with Black journalists and allies in collaboration with Sarah Glover, former president of the National Association of Black Journalists. Follow @Sarah4NABJ or @CarterFellows or join the Diverse Social Media Editors and Digital Journalists Facebook group for info on upcoming calls.)

For more information about Kari’s work with The Carter Center, visit mentalhealthjournalism.org and follow @KariWrites and @CarterFellows on Twitter.

I’m Barbara Thelamour, a Black woman and assistant professor of psychology at Pennsylvania’s Swarthmore College—and a second-generation Haitian American.

What can you share about your academic work and research?

A lot of the work that I do focuses on young people and how they're contending with the intersection of being both Black and immigrant in the U.S., where xenophobia has grown more explicit in recent years, and what it means to embrace American culture, what it means to be Black—but not Black American or African American.

What do you wish all immigrant communities would better understand about their role in the Black Lives Matter movement?

I think what some groups can kind of forget is that our rights and are intertwined. Despite the kind of relative privilege that some immigrant groups might have over others, every marginalized group has historically benefited from black liberation work, from voting rights to civil rights. We're all much, much, much more connected than the silos in which we often find ourselves allow us to see.

From time to time, I might come across Asian and Latinx immigrants who say, you know, where was the Black Lives Matter movement when we are being locked up in cages? Where was the Black Lives Matter movement during heightened COVID-related discrimination against Asians? But what's been fascinating to see is how other individuals of the same races respond to those narratives.

For example, when someone criticized the lack of similar outrage for undocumented immigrants separated from their families or locked up in cages, another Latinx individual educated the original poster on the harms of derailing the conversation.

Similarly, with Asian people, many have been making the connection between immigration rights and the civil rights movement. Hasan Minhaj, too, put out a video urging South Asian immigrants not to be silent and to address colorism among their own communities. That’s been heartening to see.

You can follow Barbara on Twitter at @B_theLove.

My name is Catherine Bisola Labiran and I am Nigerian — Yoruba, specifically. I was born in New York and raised in London, and currently live in New York, so life has come full circle. I work at Black Alliance for Just Immigration as the Gender Justice Program Coordinator, where my main focus involves research on the mental health and wellness of Black immigrant women and femmes. I also represent BAJI as an Advisory Committee member of National Bail Out, am a member of the HEAL ACT Coalition and a Planning Committee Member of United We Rise. 

You’ve mentioned online that you have a deep love of writing. What is it about the medium that you appreciate so much?

I am fascinated by words because, like actions, they live longer than we do. It’s remarkable to consider how a single word has the capacity to radically transform our moods, conversations and relationships. It is this understanding that motivates me to treat all words as sacred. The care I have for words is intrinsically linked to the appreciation that I have for silence. I believe that silence, like isolation, provides us with the opportunity to hear our own thoughts before we share them with someone else. I believe that we would be better communicators, and ultimately better people, if we were more observant of what exists when words don’t. 

What led to your current work with the Black Alliance for Just Immigration?

I actually studied psychology at Emory University in Atlanta, and initially, people were confused as to why I would want to study psychology given my very clear passion for social justice and writing. I, however, felt that an understanding of psychology was necessary given that I didn’t only want to know how a person, or group did something, I also wanted to understand why they did it.

Furthermore, I was interested in learning about intergenerational trauma as a way to begin thinking about intergenerational healing. After graduating from Emory, I worked at the U.S. Human Rights Network, where I began as an executive assistant and then later as the Human Rights Advocacy Coordinator. While at USHRN, I was responsible for connecting grassroots human rights movements to relevant mechanisms at the United Nations. For example, I set up civil society consultations for the UN Special Rapporteur on Racism and the UN Working Group of Experts on People of African Descent. During my final year of working with USHRN, I began pursuing my master’s degree in African Studies at Yale University, where my concentration was art and literature.

I was especially invested in researching how Nigerian literature has been used to advance human rights within the country. While at Yale, I was also awarded a fellowship to study Yoruba — my family’s indigenous language. After graduating from Yale, I knew that I wanted to combine my training in human rights, psychology and African studies. As the Gender Justice Program Coordinator at BAJI, I have been able to bring all of my experience, knowledge and creativity to the forefront. 

For those of us who might not know much about BAJI, can you tell us what the organization does?

Sure! BAJI educates and engages Black communities, including those who are immigrants and those who are not, to organize and advocate for racial, social and economic justice. We have organizing committees in New York, Georgia, California and Arizona that build coalitions and initiate campaigns to push for racial justice. Our staff is comprised of people who have expertise in areas such as organizing, law, research and policy. We provide training and technical assistance to partner organizations and to the communities that we serve. We also initiate vibrant in-house dialogues between Black communities so that we can learn more about race, our diverse identities, racism, migration and globalization. 

As a Black immigrant yourself—and a professional in this field of research and advocacy—what can you tell me about the Black immigrant experience that you feel the public and world of academia know little about?

A lot of people see the immigrant experience as either purely traumatic, or as an exceptional success story. Many people fail to pay attention to the nuances in people’s stories that would allow them to see that highs and lows oftentimes coexist. They like to sensationalize our stories, so if we are not in despair, or if we are not running for office then our stories are not seen as valuable. By adopting this reductionist view, they miss out on the richness of our experience as we navigate hardship, but also joy, love and happiness simultaneously.  

You work in a sector that focuses on expanding access to healthcare for immigrant women and families. Why were you especially drawn to these subjects?

Immigrant women and femmes are oftentimes made to assume caregiving roles for their families. The amount of responsibilities that are placed on their shoulders takes a physical, spiritual and mental toll. Despite having to look after people, many are unable to look after themselves as they are unable to access our failing healthcare system. Once their health declines, their ability to care for their families declines, too. It is a never-ending cycle. I am drawn to doing this work because I believe that healthcare is a right and not a luxury. I believe that everyone should have access to free, quality, holistic healthcare. 

How are you/BAJI working to address issues of healthcare access and mental health stigma for immigrants?

I currently serve on the Health Equity and Access under the Law (HEAL) Act Coalition, which aims to expand access to healthcare access for immigrant women and families. Last month, we worked alongside Senator Cory Booker’s office to get the HEAL Act introduced in the Senate. The HEAL Act, if passed, has a number of benefits including the removal of the five-year waiting period that immigrants have to endure before they are able to access Medicaid or the Children’s Health Insurance Program. 

At BAJI, we also recently interviewed 84 Black immigrant women and femmes to learn about their mental health and wellness. During these interviews, several respondents shared that they had not spoken about mental health or the possibility of therapy before speaking with us. Through these kinds of conversations, we actively combat mental health stigma. We are excited to publish our report, so that more people will be able to see themselves in the stories and visions of our interviewees. We are also excited about the discussions that the report will generate between partners, families, and communities. 

For more information about Catherine, her writing and her work with BAJI, visit catherinelabiran.com. You can also follow her on Twitter and on Instagram as @cathslabiran.

I’m Lebura Nwenu and I’m from Nigeria, but I call Atlanta home. While I don’t identify with a particular faith group, I am a believer of a higher power. Currently, I work at the International Rescue Committee as an immigration caseworker.

You also used to work in resettlement before you joined immigration, right? What do both roles entail?

Yes, I was originally very interested in the resettlement aspect of the IRC. I wanted to get my hands dirty and be part of that initial rehabilitation process with new arrivals, which involves all the basics, such as finding housing, teaching new immigrants about American customs, helping them secure jobs and education. And it was fantastic! Working with the resettlement department gave me the reassurance I didn’t know I needed.

But I have always been interested in law and now, as a caseworker within the immigration department, I have a chance to empower new immigrants by helping them with access to social services, citizenship tests, evaluation assessments and more.

The majority of your clients, you said, are also Black. Speaking from both professional and personal experience, what have you noticed is the most significant issue facing new Black immigrants?

Hmm, there are a lot! Being Black and an immigrant in America feels doubly negative. You're not only facing the issue of acceptance in a new culture, but you’re also facing discrimination because of the color of your skin. Immigrants have to work ten times as hard to prove themselves and get closer to the same level as non-immigrants. On top of language barriers (English is usually not their first language), most immigrants also don't understand the law of their new home, which usually results in them falling prey to the hunter and unable to rescue themselves.

All in all, the Black immigrant experience is not a beautiful sleep. It's a lot of turning, fighting, bad dreams, and a hot room with water deprivation to quench your taste or cool you down. Nothing is given out for free. They—we—work very, very hard to get to where we are at any given moment.

Do you have any advice for both immigrants and non-immigrants who might be thinking about protesting or getting involved in the Black Lives Matter movement?

To be a responsible ally, be patient. Be a student again. It's time to relearn, get involved in BLM organizations, and implement the mission in your work.

I have also been advising my own clients to know their rights if they do choose to go out and protest. It’s important to know the impact of an arrest on your immigration status, as well as the proper procedures and measures to take.

For more information about the IRC’s work, visit rescue.org.

A couple months ago when I was (still) struggling at home with two kids, managing my health, desperately worried about family, and fluctuating between some semblance of work and total despair, I kept falling down the rabbit hole that I shouldn’t feel that way because [insert privilege of choice here], that I should be doing more. My friend Masuma Ahuja responded with, “There are no shoulds.” Intellectually, you understand the importance of slowing down, but when you’re in a depressive episode, it’s hard to talk yourself out of that spiral. None of this is normal; none of this is easy. And “there are no shoulds.” It’s something I keep coming back to. And of course, Twitter is not the best place for nuanced discourse. Don’t let random people who don’t know a thing about your experience or struggles define you.
—Kari Cobham

Between COVID-19 (which we're still not over, even though many seem to think so) and everything that's happening with the Black Lives Matter movement, this is an incredibly stressful time. The one piece of advice that I would give anyone—a tip I'm trying to stick to myself—is to unplug and take a break from the news cycle. As important as it is to stay engaged, we all need a break from the never-ending onslaught of terrible images, of death and of anger. But the beautiful thing about social media is that whenever you are ready to engage, you’ll find so many ways to participate without having to be out in the streets. I, for example, would love to be marching right now. However, I know that doing so means potentially putting my family at risk. What I’m doing instead: I'm writing letters, sending emails, posting on social media, donating and reading as much as I can. Then, at a certain point during the day, I shut everything off, and give myself space to be with loved ones.

I’m also clinging to the hope, too. Yes, I'm angry and sad about all of it, but at the same time, to see the number of people protesting, even if many (particularly white) people are very late to the game, is something to behold. I don't know how that will translate into policy because at the end of the day, that's what we desperately need, but seeing how different cities are kind of moving in the right direction is encouraging and I hope that even though I'm not on the streets with them, the little bit that I am doing from home is helpful. And I hope that we keep it up. The last thing we need is for this to fizzle out, but it’s been amazing to witness the growing momentum over the last couple of weeks.
—Barbara Thelamour

Remember that you are human and not a machine. Capitalism tricks us into thinking that our goal is productivity when really, for many of us, it’s peace. Allow yourself rest and reset. If we, as a society, took more time to slow down we would cause much less harm to each other. Similarly, if we, as individuals, allow ourselves to slow down then we cause less harm to ourselves. Not only do we prevent harm, we welcome healing. 
—Catherine Labiran

I can't advocate self-care enough. Be selfish when it comes to your well-being. I know it's easier said than done, but try. Do the little you can do—a little goes a long way. Personally, I am taking it one day and one step at a time. I indulge in new challenges to help shift my focus. I limit my news consumption. And I also make myself available for those who need me.
—Lebura Nwenu

A handful of helpful resources:

• How To Handle Emotional Burnout As You Keep Pushing For Anti-Racist Change, a guide from Bustle with tips from psychiatrists, mindfulness experts and social scientists

• The Nap Ministry, a platform championing Black rest as a form of resistance against burnout culture and capitalism with free pop-up nap pods and workshops around Atlanta (when there isn’t, like, a global pandemic)

• The Black Dream Escape, an intergenerational therapeutic practice promoting Black and Indigenous rest affirmations (also, lullaby sessions!)

• A No-Panic Guide To Mental Health Help During The Pandemic from LAist with specific information for Californians but helpful for all

• Therapy for Black Girls, an organization dedicated to combating the stigma around therapy that might prevent Black women from seeking care. Every Thursday, TFBG holds free group support sessions on Facebook.

• Dive in Well, an organization offering digital classes on various wellness practices, such as donation-based digital events on breath-work

• National Queer and Trans Therapists of Color Network, a healing justice organization committed to transforming mental health for queer and trans people of color with a database of featured practitioners

• Open Path Collective: a nonprofit providing inclusive, affordable, in-office and virtual psychotherapy for clients who lack health insurance or whose health insurance lacks adequate mental health benefits

• The UndocuBlack Guide for Mental Wellness Specialists, a downloadable resource patients can use while accessing care and service providers can use to educate themselves about caring for undocumented Black individuals

Akil and I first met while working at a virtual reality start-up, and he always joked that I was a “blur” that first week I started. Just “some new marketing person.” We both became really close friends and eventually, our friendship turned into more. I feel so lucky to now be married to my best friend.

Throughout our relationship, we’ve received both positive and negative comments, but the ones we choose to hold onto make us smile. I remember once, we were walking down the street, hand-in-hand when, out of nowhere, a stranger stopped us in our tracks just to tell us how beautiful we are together. Another time, at a check-out counter, someone told us they could just see the love we have for one another.

Like me, Akil is also somewhat of a first-generation American. He was born in Trinidad and moved to Brooklyn when he was two. So, in a sense, both of our families came from a land where there were more people who looked just like them than not.

I am a Pakistani-American and a child of two immigrants, one of whom survived war zones and forced migration from sub-state to sub-state. And still, I am a child of privilege.

Growing up on the outskirts of Atlanta’s North Fulton county, I was surrounded by the Black community. But we certainly lived in a predominantly middle-class/upper-middle-class area. Just next door, in South Fulton, schools were more likely to be run-down, and the teacher-student ratios were vastly different. It wasn’t until I learned about gerrymandering that I really began understanding how large of an issue the socioeconomic divide is—and how it disproportionately affects Black individuals.

I remember having a serious conversation with Akil once, about where we were in life and our expectations. In retrospect, my approach was both naive and embarrassing. It was the first time I saw him look at me with disappointment.

Raised by a single mom, Akil is the only one in his nuclear family to have gone to college. And unlike me, he had to figure a lot of it out on his own. You read about systemic racism and the trickle-down effects of various socioeconomic circumstances, but it feels different when it’s your family.

I worry a lot, especially when Akil is around my South Asian community. After all, it’s no secret that South Asians are notoriously prejudiced against Black Americans. I often catch myself worrying Akil will get looks in our prayer hall—or that he’ll be stopped from entering the hall altogether. It’s a gut-wrenching feeling to think that at any given point, your loved one could be discriminated against, could be pulled over or worse—just for the color of their skin.

I’ll never understand what Akil is feeling right now. But I also know I have to keep trying to understand, because the truth is, our children may have to endure the very same realities. And nothing hits us harder than that. He keeps telling me that yes, it’s important to be a part of the change and to speak up. But it’s also good to remember that sometimes revolutions are slow.

They may be slow, but I have to admit, I’ve been so pleasantly shocked with how my family has been reacting to everything that’s happening right now. I have cousins who have literally been on the streets protesting every day, others who’ve been donating to various causes and sharing resources and even more family members who have been emailing and writing letters to state legislators. It’s really so beautiful. We have felt supported, and in good company. 

Disclaimer on the above resource for non-Black POC: The responses included in this file are by no means a guide on how to hold the most appropriate conversations, nor do they all align with our own preferred and vetted approaches. We highly recommend that you first read through the links on the document’s essential resources page before browsing what's worked and what hasn't for our respondents. The resources on the essential resources page have been compiled by experts with extensive knowledge. What we're doing is providing anonymous feedback in hopes that those who may have tried everything with no luck will find something useful as a barrier-breaker. You’re welcome to submit your own experiences here. Additionally, we request that you be mindful and not circulate this resource in a way that could harm the Black community i.e. posting screenshots on public pages or sending this directly to Black individuals. The pushback included is unkind and painful to hear. Our purpose as non-Black POC is to challenge and dismantle any such discourse, not to amplify it.
- Fiza Pirani, Nabila Jamal

My personal anti-racist go-to resources.

This is absolutely not an exhaustive list.

• For the latest on petitions, protests, information on elections and where to donate your money, click here.

• A guide to starting anti-racist conversations with friends and family (DoSomething.org)

• For South Asian power-building and movement work (Equality Labs)

• Allyship 101: How to act with intention (@SouthAsians4BlackLives)

• Letters for Black Lives (multiple translations via Medium)

• Implicit bias test (Harvard University)

• Infographic: Overt vs. covert white supremacy (@theconsciouskid)

• Anti-racist reading list from Ibram X. Kendi (Chicago Public Library)

What are some of your go-to resources?

That’s all, folks. Take care of yourselves.

—Fiza

Thank you to editing champ Farah for contributing your talents—and to Kari Cobham, Nureen Gulamali, Catherine Labiran, Lebura Nwenu and Barbara Thelamour, for sharing your stories and expertise. And a very special thanks to Foreign Bodies Sustaining Members Hannah B., Safurah B., Alex C., Rebecca C., Rodrigo C., Katie H., Liz S., Puja S., Roz T. Hossein T. and my mama, Safia P. Without you, this work would not be possible.

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• Past issues

• Foreign Bodies FAQs

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Foreign Bodies is an email newsletter centering immigrant and refugee experiences with a mission to de-stigmatize mental illness through storytelling. It’s written and curated by Atlanta-based writer Fiza Pirani with copyediting and fact-checking help from Boston-based journalist Hanaa’ Tameez and traveling journalist Farahnaz Mohammed. Want to contribute your time or share your own #ForeignBodies story? Fill out this form and be sure to say hi on Twitter, Instagram or Facebook.

If you're thinking about suicide or worried about someone who might be, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 741741 to connect to a crisis counselor in the USA. You can also find a wealth of culture- or language-specific recommended resources on our landing site, foreignbodies.net.

These days, it seems more and more authors and celebrities are opening up to tell their stories in an effort to eradicate mental health stigma. But for many of us—including first-generation immigrants and individuals within Asian communities—mental illness is still often considered an “American disease,” one that’s rarely acknowledged at home.

That was certainly the case for me.

I grew up in Utica, New York, and knew my grand uncle only peripherally, from family gatherings here and there. But I did remember being intrigued by the fact that Uncle Roger, who was born in Mauritius but was of Chinese descent, had a Caucasian wife and that he was a board-certified psychiatrist.

Later, when I was a teenager, I began flipping through some old family albums and came across a young, mixed raced girl at a family gathering. When I asked about her, my aunt told me she was a cousin who had died of suicide.

Being raised by my grandparents—both of whom were very stereotypical Chinese immigrant parental figures—I don’t remember ever talking about feeling sad. The closest I came to confiding my anxieties was balking about doing certain tasks like making phone calls or speaking in public. My complaints typically wound up inviting lectures about needing to work harder and to stop being lazy. 

My Grandpa would say things like, “Remember, there’s always room at the top,” and “You can shoot for the stars. Even if you don’t make it, you’ll get to the moon.”

There’s a reason why the immigrant workaholic parent is such a trope. I suppose that, when you think about American psychologist Abraham Maslow's proposed "hierarchy of needs," things like feeding your children and paying rent naturally take priority.

So-called “luxuries” like focusing on one’s feelings are often submerged under layers of stress and the overarching need to simply survive. 

I had my first bout with depression in college, prompted by a thwarted romance, academic setbacks and a fear of the future. I don't remember telling anyone about it. In fact, most of my memories of that period are unclear. I do remember how impossible it felt to get out of bed.

Somehow, I convinced myself to try therapy, then immediately stopped attending sessions once I felt better. I was determined to prove that I was strong enough to persevere on my own. If I could just work a little harder...

During medical school, a professor once told me that you could diagnose a person with depression if talking to them made you feel sad, too. I guess it makes some sense. Having experienced depression, I remember being afraid that I would “drag down” my friends with my pain. That fear often led me to pull away from those I needed most.

But my professor's words are also incredibly misleading. There are a lot of people (myself included) who can front very well and hide their symptoms behind smiles and accolades. And the truth is, it's not just mental. Your brain chemistry affects your physiology, your heart rate, your sweat glands, your muscle contractions. This is something medical schools just don’t emphasize enough.

By the time I was in my fourth year of residency, I had been on antidepressants twice. Both times, when I emerged from the darkness, I convinced myself that I didn’t need medications anymore. I now know it was all an act of machismo.

As someone whose parental figures constantly pushed her to be “better” or more “accomplished” than those around her, I felt like a failure for not being able to overcome this mental illness. 

Despite my being an MD with the education to understand the role of neurotransmitters, my "Eureka!" moment didn’t arrive until my psychiatrist matter-of-factly told me, "You know, you might just be one of those patients whose brain needs more serotonin."

What felt like a character flaw was simply translated to a natural chemical imbalance, though it’s important to note that depression itself is much more complex. Scientists say it’s not just mood regulation in the brain affecting any chemical imbalances. Stressful life events, genetics, and medical problems all play a role, too.

But the fact was, my psychiatrist believed this could potentially be managed. So why was I pushing back? I mean, I would never tell a diabetic patient that she was weak for needing insulin, right?

I’ve been taking medication ever since.

When I became a parent and witnessed my own tween’s stomach pains and moodiness transition into frequent avoidance, loss of interest in activities she once used to enjoy and overall withdrawal, I began having flashbacks of my own youth.

As I wrote in this essay, my focus as a mother quickly turned from Girl Scouts and science fair projects to wondering what I could do to give my daughter the vocabulary she needed to identify her feelings, the permission to be sad and anxious, and the grace to understand that it’s not shameful to seek help if you need it.

But it wasn’t easy. After all, I hadn’t grown up with the tools to navigate this with my daughter.

I slowly learned that trying to be my child’s therapist wouldn’t work. It was so hard to just listen! I kept falling into “this is what I would do” advice-giving, which invariably had her bristle. I also had to figure out how to keep my own panic at bay. I tried instead to encourage my daughter to gently follow her interests.

Reading, music and theater helped turn things around for my child and bring back the happy-go-lucky spark that had begun to fade. These activities stimulated all aspects of herself, including her body while dancing. Being in a theater production also allowed her to be part of creating a work of art that was something greater than the sum of its parts.

But it also took therapy.

When I first hinted at the idea of counseling, my spouse would say things like, “I don’t know if it’s really to the point where she needs therapy.”

His extended family and I were able to convince him it’s never too early for therapy—that there’s more of a chance it’ll help her than cause any harm. And truly, it has worked wonders for our daughter.

For now, she’s not on medication, though I continue to be on high alert for physical signs like poor appetite and sleep disturbances. It’ll be a joint decision if we do choose to go for it, of course, but it’s especially nice that I’ll be able to share my own positive experiences with antidepressants if and when the time comes.

It’s important to me to be able to pass on stories that leave hope.

As I’ve been researching mental illness for my work and as a parent, I’ve noticed far too much of the narrative surrounding depression is focused on death by suicide.

This is harmful in two ways:

First, it ignores the earlier stages of identification, hampering prevention and a sense of hope. And second, when everything surrounding depression is about suicide, it plays into an all-or-nothing game where people who haven’t considered suicide may not seek help because they tell themselves that their mental illness isn’t “bad enough.”

Even when I sense that kind of ambivalence or reluctance about medication and therapy—or when I notice any significant distress among my own patients, I try to give them the chance to speak with a patient who’s tried the intervention—whether it’s a surgical intervention or medication. This is where stories can be especially powerful, because when people read about others and see themselves in those pages, sometimes it’s the first time they can envision the path forward. 

If I had had the representation to give words and language to how I was feeling when I was younger, as well as examples of people who survived and thrived with mental illness, maybe I wouldn’t have struggled so much to get to where I am now. 

A massive thank you to Ilene Wong Gregorio for sharing her story. Gregorio is out with a new book titled This Is My Brain In Love. It’s a YA contemporary romance novel exploring mental illness—with a happy ending. 

Years of clinical research have proven that a comprehensive approach combining a prescribed regimen of psychiatric medication with psychotherapy results in the best outcomes for those suffering with a mental illness.

But even today, taking medication to help with depression, anxiety and other behavioral disorders remains highly stigmatized; medication is often viewed as a crutch for folks who don’t have the strength to manage their own problems.

The stigma associated with medications is sometimes referred to as “pill shaming” in mainstream media. It typically involves perspectives downplaying the need for medical intervention while suggesting the cure for most distress can be found in willpower, improved diet, exercise or faith. This isn’t to be confused with the stories of well-informed individuals who share their true, unsuccessful experiences with medication that may stray from the literature.

Pill shaming—whether the stigma is rooted externally or internally—is considered “one of the strongest deterrents for people wishing to continue medical treatment for mental health disorders,” Healthline’s Kimberly Holland reported in 2018.

Kim Meehan, a psychiatric nurse practitioner, told Teen Vogue that many of her clients feel starting medication is a “last resort.” When they opt in, they feel like they’ve failed. Many said they were told constantly to just “suck it up” or felt invalidated. Others were under the impression that “taking a medication is just a Band-Aid, but does not treat the cause.”

Add pill shaming to generations of immigrants with untreated illnesses, to various cultural stigmas, a legitimate mistrust of Western medicine and unrealistic pressures to be the model minority and you’ve only touched on the many factors that often keep immigrant communities from considering medication.

Despite being a doctor herself, Ilene, too, has had to overcome internalized barriers before she could embrace ongoing medication to help treat her chronic depression.

Just a few research highlights on medication stigma and use among immigrants with mental illnesses:

• In this study population of 965 patients in the Netherlands, of which half consulted their doctor for issues unrelated to mental illness but were ultimately diagnosed with depression, anxiety, panic, or obsessive-compulsive disorder, non-Western immigrants were almost five times as likely to decline a doctor’s prescription for treatment compared to the general population.

• It’s been established that once Asian Americans have a diagnosed mental disorder, “it tends to be very persistent, and they are less likely to seek treatment for psychological problems than European Americans.” In addition, one 2008 study found that Asian Americans with a “past-year depressive disorder” were significantly less likely to access any depression treatment compared to non-Latino Whites.

• In Vietnam, which has one of the highest rates of drug nonadherence in the world, researchers found that many communities tend to emphasize physical symptoms over psychic distress. “They recognize their emotional distress, even if they do not readily present it as a symptom to doctors,” authors wrote. “Thus, patients medicalize their suffering but tend not to psychologize it (Tran, 2016). For them, the emotional distress is certainly related to symptoms such as insomnia or headaches but is not to be treated medically.”

• According to this 2008 research, poor adherence to major depression treatment tends to be more frequent among Latinx patients compared to the general U.S. population. In the study, participants reported that they believed antidepressant medication was only meant for “severe” cases. It was also commonly feared as a potential gateway for drug addiction—a common misconception with separate connotations related to negative perceptions about Latinx culture.

  What one participant said:

“Muchas de las personas piensan por el hecho de estar tomando medicamentos antidepresivos es como las personas que toman cocaína y todas esas cosas, que van a estar así.”(Many people think that because they are taking antidepressant medications, it's like people who are using cocaine and all those other things, that they're going to be like that.)

• Some Latinx individuals also believe that taking medications categorizes people as floja (weak), inutil (useless) or chiquitita (small) — characteristics that “violate this fundamental lived value of being a hard-working person who struggles to overcome problems.”

• Among Iraqi immigrants living in Michigan, about 37% in this 2016 study did not adhere to their antidepressant treatment. Researchers noted that those who did not stick to the medication were more likely to be in poorer health compared to the previous year.

• A study based in Sweden found that immigrants born in the Middle East and other countries outside Europe had lower primary medical adherence to antidepressants. Authors suggested a few possible explanations: cultural stigma, language barriers or low trust in Swedish health care.

• African Americans (both immigrant and native) are also likely to mistrust a health care system with a history of longstanding inequalities—especially when it comes to potentially being “experimented with” via medication.

Have some research to share?

Before I tell you about my own experience with antidepressants, I want to offer a disclaimer: There is absolutely no “one size fits all” treatment plan when it comes to depression. Research shows depression is caused by a combination of multiple factors (genetic, environmental, psychological etc.) If you keep in mind that no two brains, bodies or life experiences are exactly alike, it shouldn’t come as much of a surprise that our experiences with medication vary, too. But if antidepressants are part of your recommended treatment plan, please don’t let stigma or fear keep you from potentially life-altering care.

I’ve been on fluoxetine (or Prozac) for a few years now. The first time my parents suggested I get on the medication, I was recovering from ongoing suicidal ideation. In a way, my family and I were desperate for a cure-all to the boulder-like weights glued to my shoulders. At that point, I didn’t have room for pill shaming or fear. I just needed to be able to fall asleep without secretly hoping I wouldn’t wake up.

I need to make a point here to say that I should have been on antidepressants for much of my life. For as long as I can remember, I’ve been uncomfortably emotional and uneasy about, well, everything. And even when I was a kid, I had trouble imagining myself growing older. I might put up a front if we don’t know each other too well—and, honestly, even if we’re best friends. I’ve never been good at seeking help, despite being head over heels in love with and trusting of the people I choose to let into my life. There’s a lot behind the why, but for now, all I really want to say is I should’ve opted for medication long ago. It should not have been any kind of “last resort.”

Anyway…

Unlike Ilene, my folks (also physicians) seemed much more comfortable scribbling down the name of an antidepressant than they were when my brother and I mentioned psychotherapy. It’s as if they either inherently believed or wanted to believe my pain could be “solved” using a mathematical equation; find the perfect little dosage and all is well. A quick fix. Or at the very least, a guaranteed fix.

I was on fluoxetine without counseling for a few weeks before I started noticing a difference. It’s not that I was magically happy all of a sudden. It was just a little easier to make it through the day. I didn’t constantly run to the bathroom to break down with every news alert of a school shooting, a suicide, a travel ban. I felt it. I did the work my newsroom needed me to do. I moved on.

The medication turned the intensity down a notch, helped regulate my mood a bit and offered just enough clarity to be able to see into tomorrow. The high highs and low lows straightened out, and I started going through life with this dull white noise machine playing in the background.

But I knew that couldn’t become my normal. What I was lacking was enthusiasm, joy, desire. And that’s when I decided to seriously consider counseling.

In a way, the fluoxetine planted the seed or the thought of regaining some kind of control, or at least a fleeting desire to want to be in the driver’s seat again, headed somewhere. But honestly, it took coupling the medication with weekly therapy for me to really flourish again.

I still have bad days, of course. Really, really bad days. But it’s different. I don’t see a bad day and immediately think of an end. I see a bad day and am able to push myself to think of it as a momentary increment of time, a minuscule segment of something much bigger. And when I say I want to just sleep things off, my head falls to my pillow with the intention of rising up again.

Want to talk about your own experience?

I Need Medication to Treat My Mental Illness. Why Can't People Accept That? (Maria Yagoda, VICE): Maria Yagoda is used to strangers recommending she try yoga or meditation instead of taking medication for depression and anxiety. A decade into treatment, she’s learning to tune them out. “Having a mental illness is already hard enough. But then to face this routine resistance to its medical treatment makes me, and others, want to be quiet about this stuff.” Read here.

9 Women on Their Experiences With Antidepressants (Tessa Miller, The Cut): The Cut asked nine women about their experiences with antidepressants, why they choose to take them, the pros and cons of medication, and the biggest misconceptions about mental health treatment. “The meds allow me to get out of bed — to have the same hope others wake up with naturally — while suffering from severe depression.” Read here.

All I Want for Christmas Is Zoloft (Jessica Valenti, GEN): This ode to Zoloft—er, personal essay—takes a feminist look at how women are made to feel “as if we need to suck it up” when we’re struggling. “For me, funnily enough, starting medication ended up feeling like a feminist win.” Read here.

My Mental Illness Did Not Prevent Me From Succeeding, But The Stigma Nearly Did (Michelle Yang, Huffington Post): Michelle Yang begged her parents for treatment for months, but as Asian American immigrants, they “misguidedly feared a mental illness diagnosis would tarnish my permanent record, ruining my chances at college,” or worse, any potential marriage prospects. Even years after being hospitalized and diagnosed with a mental illness, Yang’s family tried to stop her from taking medication. Read here.

Thank you again to Ilene for sharing your story—and to Marissa (that art!) + editing champ, Farah, for contributing your talents.

What did you think of this issue? Did anything in particular stand out? Tell me in the comments or send an email my way.

—Fiza

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• Past issues

• Foreign Bodies FAQs

• Official website

Foreign Bodies is an email newsletter centering immigrant and refugee experiences with a mission to de-stigmatize mental illness through storytelling. It’s written and curated by Atlanta-based writer Fiza Pirani with copyediting and fact-checking help from Boston-based journalist Hanaa’ Tameez and traveling journalist Farahnaz Mohammed. Want to contribute your time or share your own #ForeignBodies story? Fill out this form and be sure to say hi on Twitter @4nbodies or Facebook. Special shout-out to Marissa Evans for Issue 15’s art and Carter Fellow and friend Rory Linnane for our adorable animated logo!

If you're thinking about suicide or worried about someone who might be, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 741741 to connect to a crisis counselor in the USA. You can also find a wealth of culture- or language-specific recommended resources on our site, foreignbodies.net.

Foreign Bodies is a mental health and well-being newsletter centering immigrants and refugees with a mission to de-stigmatize vulnerability through storytelling. Our work is directly funded by paying subscribers.

I’m Conchita—short for Maria de la Concepcion in Spanish. I was born in a small town about an hour away from Mexico City, and came to the United States when I was five years old with my mother and four siblings. My brother and I are both legally blind.

When we first arrived in the U.S., we came as tourists, with no plans to stay. But during our visit, my mom learned about services here that actually helped people with disabilities—people like my brother and I.

In Mexico, we did not have such protections. There were no professionals to help guide us. At the time, a child with a disability in my country did not have the right to a public education. No educator in our area knew how to teach us, and there were no accommodations or attempts to include us in school. Many students actually end up dropping out. Today, about 60% of people with disabilities in Mexico remain illiterate.

Unlike in the US, Mexico as we knew it didn’t view these roadblocks as the overarching problem. Instead, it was those of us with disabilities who were considered problematic.

My mom knew that back home, our opportunities for education, for employment, and for happiness would be very limited. So we did not return to Mexico when our visas expired.

These decisions are often vilified in the media, but I will be forever grateful for the difficult choice my mother made for our family. 

Undocumented in the United States of America

Like many undocumented immigrants, we did not know the language or have any family here to rely on. When we settled in the small farm town of Woodland, California—which was not and still isn’t a sanctuary city—we also quickly realized that due to our status, no one could be trusted.

The fear of deportation was always present. We could have fun, sure, but we could not divulge too much information, get too close to friends or attend faraway school trips. We knew police often worked closely with immigration officials, and that someone could be deported if they were pulled over for a broken tail light or for speeding. There were many raids on and off around town, so we often stayed home.                               

Though things were definitely difficult, I cannot overemphasize how joyful we tried to make it. Growing up, my family was very involved in our church, where we built connections with others in the same situation as ours—connections that are still strong to this day. We still celebrated, enjoyed life and built a strong community that was always there for each other. 

What it means to be undocumented and disabled

The first thing I did when I became a permanent resident was travel to Mexico and meet family I had not seen in 15 years. The second was receive the support I needed to plan for a future.

Though no one told me at the time, I later learned that having this legal document meant I was finally eligible for government disability rehabilitation services. Up until then, our limited language proficiency and immigration status kept us from getting adequate disability support. Schools and doctors’ offices did not bother to fully explain things to my parents because of the language barrier. And while we were in California—the birthplace of the modern disability rights movement—we never had access to information about disability rights nor did we know where to turn for help.

Undocumented immigrants are barred from participating in Medicare, Medicaid, or accessing the Affordable Care Act network. However, while in public school, my brother and I qualified for special education with Individualized Education Program (IEP) documents. The IEP program was never fully explained to my parents, and what we did get was minimal, but in all honesty, they were just glad we had any type of service in school as this did not exist in Mexico.

My brother and I also received a mediocre health plan that left us with just one clinic near town willing to see us. But the wait was always hours long; you never knew when you would actually be seen. If we had to go to the doctor, this meant we would have to take an entire day off from school. That’s why my mom often used home remedies. We didn’t go to the clinic unless there was an emergency.

At a loss, my mom would take me to church services she believed could help heal my blindness. To say it was awkward is an understatement. It was traumatic.

I somehow figured it out and graduated high school. Through the National Federation of the Blind and with the help of Carlos Servan, a blind man from Peru, I learned how to travel independently, cook for myself and even read fluently. Soon, I was able to apply for college. Now, at 34, I’m pursuing my doctorate in special education and currently work in administration on issues of blindness in public schools. I am able to travel freely and can provide for my family. But life could have been so much easier for me had I been given adequate services.

Being disabled and undocumented also severely limits the type of work you can do. It makes you feel like an outsider in every community you are a part of, and no one fully understands your experience.

I have met recipients of DACA—or the Deferred Action for Childhood Arrivals (DACA) program, who lost their work permits because they weren't able to efficiently do their jobs. Some who gained their disability at work couldn’t take advantage of disability-related benefits and wages. When an undocumented friend of mine fell on the job as a construction worker, for example, his company offered him a meager amount of money for disability compensation because they knew people like him had few options.

My new Green Card finally afforded me those transformative disability services and rights.

We need to do better.

Everything I’ve learned in college and beyond, I’ve shared with my parents and my community. My parents have come a long way and now have a much more positive view on disability, which goes to show this wasn’t just an issue within Latino culture, and that stigma wasn’t the sole barrier. There was also a significant lack of access to information.

It is absurd that I had to go to college to learn about basic disability rights and systemic roadblocks for disabled immigrants, especially for those of us who are or were undocumented. The disability community needs to make more of an effort to reach out to families like mine—people who may never make it to a college lecture series.

I’m trying to do my part, too.

Four years ago, I founded a nonprofit called METAS with some of my best friends and fellow professionals. It stands for Mentoring Engaging and Teaching All Students.

We help train educators in Latin America and the U.S. who work with blind or disabled students, offer free workshops and support to blind individuals and their families—no matter their immigration status—and we incorporate mental health aid throughout.

Last year, I switched roles from being a teacher to focusing on efforts to ensure blind students are being educated in the state of Maryland. I love working to change systemic issues that were once barriers for me.

When we’re able to fund a workshop and get a cane into the hand of a blind individual who has never left the house before, or we finally get a young blind person connected to information—I can’t describe how fulfilling it feels.

The elephant in the room: public charge

It’s obvious that getting a Green Card changed everything for me. But had the current public charge rule been in effect, I would not have been eligible.

The Inadmissibility on Public Charge Grounds final rule was officially implemented on Feb. 24, 2020. Imposed by the Trump administration, it aims to deny permanent legal status (Green Cards) to immigrants who appear likely to need public benefits such as Medicaid, housing vouchers or food stamps.

The U.S. has had different versions of public charge in the books, and Fiza will go into detail later on in this Issue. But the main difference between this new ruling and previous policies is that this specifically relates to services. Medicaid, according to the American Civil Liberties Union, is the only way to access critical disability services. And disability rights advocates like myself are concerned that this policy will discourage immigrants with disabilities from accessing the benefits they need to fully participate in society whether or not the service is listed as a public charge. Families will quit using any and all benefits just to be safe.

Disabled immigrants depend on many of these services to live. People are going to die because of this, and that’s not an exaggeration. 

According to the National Law Review, Congress first established the public charge rule in 1882 to allow the government to deny a U.S. visa “to anyone who is likely, at any time, to become a public charge”—someone whose lack of resources is judged likely to make them a burden on taxpayers.

In the 1880s, the target of the rule was “any convict, lunatic, idiot or any person unable to take care of himself or herself,” University of Miami School of Law historian and professor Kunal Parker told NPR’s Mary Louise Kelly last August.

At that point in post-Civil War America, immigrant demographics were beginning to shift. The country had grown accustomed to a large number of migrants from northern and western Europe, but “there was a lot more negative sentiment towards immigrants from the east and south of Europe and from Asia,” said Parker. Officials often excluded people from entering the country if they were likely to be public charges—that is, if they looked ill or had little cash in their pockets.

According to The Book of Instructions for the Medical Inspection of Immigrants, pregnancy (regardless of marital status) and the sexually transmitted diseases syphilis and gonorrhea were also listed as grounds for exclusion in the 1900s.

Unlike today, there were no general welfare programs like food stamps or Medicaid set up at the time, so it wasn’t really feasible to target people who would make use of ‘em. The particulars of immigration restriction didn’t really fall under the scope of the federal government either; this was largely an issue handled at the local level. Officials around the country interpreted the provision in their own ways, applying various and inconsistent standards.

It wasn’t until 1999 that the feds issued more formal guidance on public charge through the Field Guidance on Deportability and Inadmissibility on Public Charge Ground. The provision defined a public charge as someone “primarily dependent on the government for subsistence, as demonstrated by either the receipt of public cash assistance for income maintenance, or institutionalization for long-term care at government expense.” These guidelines explicitly excluded Medicaid, food stamps, WIC, unemployment insurance, housing benefits, child care subsidies, or other non-cash benefits from qualifying immigrants as public charges.

The new 2019 ruling, on the other hand, says that immigrants who have received public benefits such as Supplemental Security Income, Temporary Assistance for Needy Families, the Supplemental Nutrition Assistance Program, Medicaid, and public housing assistance for more than a total of 12 months within any 36-month period may be classified as a “public charge” ineligible for permanent residency. It specifically targets immigrants who use (or would probably use) safety net programs to stay permanently in this country. Certain types of immigrants are exempt from the current ruling, including: refugees, asylees, petitioners under the federal Violence Against Women Act, certain T and U visa applicants, and Afghans and Iraqis with special immigrant visas.

The Trump administration first published a version of this proposed rule in October 2018.

In January 2020, the U.S. Supreme Court voted to begin enforcing the new rules as relevant lawsuits continued through the federal court system. On February 24, 2020, the Inadmissibility on Public Charge Grounds Final Rule went into effect for most of the country.

Kenneth T. Cuccinelli II, the acting director of the United States Citizenship and Immigration Services (USCIS) stated the policy will "have the long-term benefit of protecting taxpayers by ensuring people who are immigrating to this country don’t become public burdens, that they can stand on their own two feet, as immigrants in years past have done."

But Marielena Hincapié, the executive director of the National Immigration Law Center, along with most disability rights advocates, argues the rule "will have a dire humanitarian impact, forcing some families to forgo critical lifesaving health care and nutrition. The damage will be felt for decades to come."  

For more FAQs and really, really, really specific details about the recent ruling, read this really, really, really long USCIS page on public charge.

1. The public charge rule, advocates and experts say, will dramatically increase the likelihood that legal immigrants and their families will forego mental health benefits out of fear.

According to the Urban Institute’s 2018 Well-Being and Basic Needs Survey, one in seven adults in immigrant families (13.7%) reported avoiding public benefit programs, including those related to health, in 2018 for fear of risking future green card approval. The figure was even higher (20.7 %) among adults in low-income immigrant families. Adults who had heard “a lot” about the proposed rule were the most likely to report “chilling effects.” This was after the public charge rule was first proposed and before it ever went into effect.

2. We already know deportation and family separation can lead to significant psychological consequences. This rule is likely to only increase deportation numbers and instill more fear within immigrant communities.

According to the American Psychological Association, research shows “immigrants who fear deportation are much more vulnerable to heart disease, asthma, diabetes, depression, anxiety and post-traumatic stress disorder” and their kids “are more likely to experience psychological distress, academic difficulties and disruptions in their development.” In October, the United States Commission on Civil Rights found that the effects of family separation and detention policies were “widespread, long-term, and perhaps irreversible physical, mental, and emotional childhood trauma.”

3. Vulnerability increases even more when the people experiencing mental illness also belong to other scrutinized groups, such as disabled immigrants or undocumented immigrants—or disabled, undocumented immigrants like Conchita.

For many, physical disability and mental health go hand-in-hand. If a physical disability affects your ability to work, if you rely on benefits to do said work well, you’re likely to experience added stress, anxiety and depression, especially over financial stress, sense of identity and sense of fulfillment. Undocumented immigrants who may not have a reliable community they can trust are also likely to isolate themselves. And research shows social relationships play a critical role in the mental health and wellbeing among those with disabilities.

4. This is all on top of the fact that immigrants are already at an increased risk of psychological harm compared to the native U.S. population.

Immigrants living through migration and acculturation are likely to face their share of prejudice or discrimination, both of which are factors that increase risk of mental health issues. Studies show that the longer immigrants live in the U.S., the higher their risk of psychiatric disorders largely due to issues like cultural stigma; the pressure to succeed/validate the struggles of the previous generation; the confusing sense of identity or pressure to acculturate but hold onto tradition; negative immigration policies and attitudes; lack of insurance etc. 

5. Mental health stigma is likely to worsen, both here and abroad.

As the American Association of Physicians of Indian Origin (AAPI) tweeted last year, APA research shows “among females from all racial backgrounds between the ages of 65 and 84, Asians had the highest suicide rate. #PublicCharge rule can exacerbate this issue making it more difficult to access mental health care and address cultural stigmas.” This, I fear, will harm so many families and generations.

Those are only five ways this rule intertwines with mental health. I’d go on, but I keep getting a “post too long for email” warning.

Find your community within the disability rights movement.

From Conchita:

Many mental health services are often out of reach for immigrant communities who don’t have health insurance or legal status. But I believe in the resiliency of community and how regardless of the law, we will continue to thrive and educate each other. Communities will serve as the delivery model that the state fails to provide.

Find your community and let it wrap you and guide you forward, because talking about what we are struggling with and sharing it with others who understand makes the load a little lighter. One way to do this is to find inspiring activists who are leading the conversation.

Here are just a handful of Conchita’s personal role models:

• Carlos Servan was in military training in his homeland of Peru when a grenade exploded in his right hand. According to an essay he wrote in 2001, Carlos lost that hand and was blinded immediately. He and Conchita met through the National Federation of the Blind, where he helped her access disability services that completely changed her life. Currently, Carlos is executive director at the Nebraska Commission for the Blind and Visually Impaired.

• Dior Vargas is a queer Latina feminist mental health activist and creator of the online photo series, People of Color & Mental Illness Photo Project. Her book, The Color of My Mind: Mental Health Narratives from People of Color, is based on the project. You can follow Dior on Twitter or check out her website for more.

• Sara Acevedo is an “autistic mestiza, educator, and disability justice advocate born and raised in Colombia,” and part of the National Coalition for Latinx With Disabilities’ Society for Disabilities Studies. Listen to Sara speak on disability, culture and identity through the California Institute of Integral Studies podcast here.

• Rosy Carranza is a blind Latina who advocates for educational equity among individuals with disabilities. In 2009, she penned this braille letter to former President Barack Obama on the systemic deficiencies she experienced in the United States as a blind immigrant. “I graduated from high school unable to see well enough to read my own diploma,” she wrote.

• Yosimar Reyes is a queer undocumented poet who coined the hashtag #UndocuJoy to show the world that our experiences aren’t always about performing trauma. We live, love and we can enjoy life, too. But we may need a community of support to remind us every now and then. You can follow Yosimar on Twitter or check out his website for more.

Do some reading.

There is already so much out there on disability and how to think about it in a progressive way that it is really transformative.

Conchita recommends the following:

• Autistic Hoya: Radical writing about disability, neurodiversity and autism

• Disability Visibility: An online community on amplifying disability culture

• Disability Justice is a term coined by Black and Brown disabled individuals. Learn what it’s about and how you can be a part of it.

• Sins Invalid: a disability justice based performance project that incubates and celebrates artists with disabilities, centralizing artists of color and LGBTQ / gender-variant artists

• This Disability Justice Primer: a primer from Sins Invalid on disability justice

Tell your story.

You don’t have to be a professional writer to publish your truth. In addition to journaling or starting a blog or newsletter, consider submitting pitches or stories to editorial sections of your favorite outlets. There’s HuffPost Personal, Teen Vogue Identity, ZORA and many more publications that value new voices. And of course, don’t forget about Foreign Bodies!

Such a Pretty Girl by Nadina LaSpina is one of the few disability memoirs to focus on activism, and one of the first by an immigrant. It tells LaSpina’s story as a girl growing up with polio in Sicily, Italy and then follows her to America, where she spends much of her youth feeling hopeless in hospitals. But a new kind of power blooms once she joins the disability rights movement. “It is the journey to find one's place in an ableist world—a world not made for disabled people, where disability is only seen in negative terms.” (NYU Press)

How U.S. Immigration Treats Disabled Kids (Michael Waters, The Outline): Vandelice de Bastos noted in her asylum claim that her grandson Matheus da Silva, who has autism and severe epilepsy, was a target at home in Brazil. Despite clearing the preliminary interview, officials still sent her grandson far away from her, to a holding center in Connecticut. Read here.

Life With a Disability in the Migrant Caravan (Carlos Ríos Espinosa, Human Rights Watch): “Living in Latin America with a disability has never been a simple task,” writes Espinosa, a researcher, advocate and wheelchair user living in Mexico City. But for the nine people with disabilities he met on migrant caravans in Central America and Mexico, things were far worse. Read here.

A massive thank you to Conchita, Marissa (that art!) and my editing champs, Hanaa’ and Farah.

What did you think of this issue? Anything in particular stand out? Tell me in the comments or send an email my way.

—Fiza

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Foreign Bodies is an email newsletter centering immigrant and refugee experiences with a mission to de-stigmatize mental illness through storytelling. It’s written and curated by Atlanta-based writer Fiza Pirani with copyediting and fact-checking help from Boston-based journalist Hanaa’ Tameez and traveling journalist Farahnaz Mohammed. Want to contribute your time or share your own #ForeignBodies story? Fill out this form and be sure to say hi on Twitter @4nbodies or Facebook. Special shout-out to Marissa Evans for Issue 15’s art and Carter Fellow and friend Rory Linnane for our adorable animated logo!

If you're thinking about suicide or worried about someone who might be, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 741741 to connect to a crisis counselor in the USA. You can also find a wealth of culture- or language-specific recommended resources on our site, foreignbodies.net.

Foreign Bodies is a mental health newsletter centering immigrants and refugees with a mission to de-stigmatize vulnerability through storytelling. Our work is directly funded by paying subscribers. 

My parents don't believe I'm depressed. Now what? A guest post:

My name is M. I’m 29 years old. I grew up in Queens, hopping around Manhattan and Long Island for school. After graduation, I moved to India, where I worked as a journalist. I’m living in New York again, for the first time on my own as an adult.

My childhood was a process of shifting personalities to fit the environment I was in. My parents were strict, and behaving according to their plans meant that I was rewarded with love and kindness; misbehaving led to ostracization and abuse.

I learned to lie adeptly at a young age. I’d edit report cards to fix failed grades, cut school to indulge in the debauchery of adolescence, and come home to talk about the club meetings I’d been to and the tests I’d aced.

By my senior year, I’d started cutting school just to spend long hours in bed. Sometimes, I’d pretend to take the subway in the morning just to hop on the line back as soon as I knew my home would be empty.

This facade wasn’t fool-proof, but I would lie valiantly whenever I was caught with something. I was trying, desperately, to hide the fact that I wasn’t the person my parents wanted me to be. I wanted so badly to not have to feel their wrath, and I feared being abandoned. My life felt like it had no depth, and I’d have long stretches of time that feel like a blur.

I couldn’t keep up the secrets for long — eventually, I hit college.

My parents wanted me to be a doctor, and I never knew how to say no to them. So I agreed, enrolling in an eight-year medical program. I thought I could do what I’d always done: continue living a double life.

I’d skip entire months of class and had an extremely active social life filled with parties and tons of new friends. But I was hiding sadness and fear. I had this crippling inability to do anything for myself. I remember going on dates just to get away from having to see the piles of unwashed clothes in my bedroom. I continued to dedicate my time and energy on the people around me—the people I partied with, the men I dated—to avoid thinking about the mask I slid on every morning.

But I knew that I had to do something about my classes. They were, after all, what defined my future.

When I decided to drop out of my medical school program to study English, I first spoke to my mother. I told her I suffered from depression. I’d never put those words to it before, but they tumbled out as I opened up to her. I felt surprised that I’d used those words, and questioned whether it felt like the right diagnosis.

My mother is a healthcare professional and scoffed at my confession, telling me about the far worse cases she’d seen in her hospital.

They had reasons to suffer from depression, she insinuated. But me? I had a stable family and food on the table.

My father was in the room and asserted that there had to be another reason. Was it living in the dorms? Had I been eating right? They were furious.

I returned to school and continued living the next few years like a ghost. Bad grades, hyperactive social life, no one I really spoke to. I didn’t think I had depression—I allowed the doubt my parents expressed to color my own judgment. I told myself there’d be one day where I’d just pick myself up and get my act together. That day never came.

Instead, I rotted away, pushing people away as they got closer, cocooning further into my shell. Boyfriends would pass through me, never leaving their mark because there had been nothing of me to get to know.

If the thought of getting professional help ever did cross my mind, I was quick to dismiss it. Therapy seemed expensive. I grew up in a working class family, and had been trained from a young age to not ask my parents for money. I worked to earn what I had, and therapy felt like it would be a waste of money if I didn’t somehow get better by the end. After all, based on what I’d seen around me, spending money on mental health was only for white people.

The a-ha moment

My mental health moment happened—and this is a tough thing to admit—when I began dating my then-boyfriend my senior year.

He was an adjunct professor at my school, about 15 years older than me. I’d taken his class, failed my way through it, and tried to reason with him at the end. Unlike the other older professors I’d managed to charm, he gave me a bad grade anyway. Still, he reached out to me that summer and tried keeping in touch with me.

He’d email me things I should read and he’d ask smart, attentive questions. This older, interesting man was so different from the younger, more emotionally inexperienced boys my age. For the first time in my life, I felt heard. We ended up dating for a year once I was back on campus in the fall.

There were many issues with our relationship that I won’t list here, but he had suffered from depression for years in his 20s, and he knew how to name what I felt. He knew how to slow down and pinpoint my issues, and knew how to listen to my cares. 

After we broke up, I moved to India for a journalism job. Therapy was significantly cheaper there (around $10 USD per session) and I decided to give it a go.

There, my therapist finally named my issues as depression; it made me feel so much lighter.

India itself felt like a departure from my previous life in New York. For four years, I lived alone and no one hovered over me. I could afford to live sustainably and well. I was in a new environment, without the overarching menace of expectations, and I could truly be myself.

I’m back in New York now, and my relationship with my parents has improved significantly, largely because I have no expectations of them. That’s not to be condescending — they’ve made sacrifices that I’ll never understand. But my parents, perhaps like many other South Asian immigrants of their generation, are stunted when it comes to understanding their mental health.

My parents were raised in a cruel world, where slowing down and caring for their own emotions felt like it would gobble them up.

They had an arranged marriage (my mother at 18), lived in meager circumstances in New York for most of their lives, and worked hard to even be recognized in this country. They’re not doctors or lawyers or traditionally wealthy or “respectable” South Asians. Who they are today has required fighting tooth and nail against an American system, stacked against them, and an Indian system, also stacked against them.

Reframing my relationship was a privilege, one that not everyone has. I was lucky to have the distance from them to process what had happened. I was lucky that they, too, were processing.

When I approached my mother about my depression years later, she apologized to me. Sure, her apology wasn’t ideal. Parts of it still sting. Still, I saw something in her that I hadn’t before — she saw me as a whole person.

Today, my relationship with mental health is far from perfect. I still let money get in the way of seeking therapy in New York. I went when I had better health insurance at my last job, but now that I’m at a small company, I tell myself I can’t afford to go. 

And I still fall into bouts of depression. I’ve ruined relationships because of it; I’ve lost friends because of it; I sometimes feel sad that I’ve lost years of my life to it.

I’ve never taken medication and I’m afraid of starting. But I’ve found little tricks that help me cope. Cooking has changed my life. Picking a complicated dish, treating vegetables with love and care, and coming out with a beautiful thing to eat feels like an act of love that I’d want someone else to do for me. Other times, I reach out to friends, and ask them about their days. I have a tendency to feel that sharing my emotions is a burden, so that routine of listening to them first, and then proceeding to share, really helps.

I know these aren’t perfect routines, but they’ve done a lot for me during my spells.

I tell myself that depression is a lifelong battle, one that I’ve met once, twice, a million times. I’ve learned to be kinder to myself during the fall, and to treat those ups and downs as friends.

Most importantly, I’ve learned that those who don’t believe my depression live a warped existence — not me.

A huge thank you to M for opening her heart and sharing her truth with us.

Parents with stigmatizing attitudes toward mental illness can serve as some of the most immediate barriers to treatment, because adolescents usually require “adult gatekeepers” to take part in formal health care.¹

If, for example, children express common symptoms of depression (i.e. lethargy, loss of appetite, mood swings) but parents don’t necessarily consider such symptoms to be “problematic,” then it’s unlikely they’ll be running to a doctor for help.

And even if they do consider their kid’s behavior to be a warning sign, immigrant parents may be reluctant to seek outside help because of mistrust in Western medicine or the cultural expectations to appear resilient and invincible in the eyes of their non-immigrant counterparts. For mixed status or undocumented families, there might be an added perceived risk of deportation or legal trouble.²

And, like, how would a diagnosis even help?

In the eyes of immigrants who grew up with a stigmatized view of mental illness, such labels only lead to stereotypes and discrimination. A diagnosis might keep their kid from getting a job, finding a spouse, becoming what they perceive as successful—and that’s a direct reflection of their own parenting, right?

And hey, the stigma is still very much alive in the present, at least in India. According to a 2018 survey of India’s mental health landscape commissioned by the Live Love Laugh Foundation—a charity dedicated to reducing mental illness stigma—71% of the 3,556 study respondents used language associated with stigma when asked, “How would you describe a person with mental illness?” Another 60% said they believe one of the main causes of mental illness is one’s lack of self-discipline and willpower.

It may not come as much of a shock, then, that so many Indian parents are reluctant to label themselves or their children with a diagnosis.

But the thing is, research consistently shows¹ that, left untreated, poor mental health is likely to worsen, to negatively impact adult outcomes and result in unemployment or limited social mobility.

And the accurate labeling of psychiatric disorders, at least in some young populations³, has actually been linked to decreased self-stigma, ultimately “negating certain stereotypes,” including the belief that your conditions are a sign of weakness, not illness.

“Some people dislike diagnoses, disagreeably calling them, boxes and labels, but I've always found comfort in preexisting conditions; I like to know that I'm not pioneering an inexplicable experience.”
—Esmé Weijun Wang, The Collected Schizophrenias

We heard from M how having a name to explain her problems made her feel lighter. Maybe her official diagnosis still holds some stigma in her parents’ eyes, but for her, it helped validate a lifelong struggle to be a meaningful, active participant in her own life. Instead of going through the motions and waiting for something to change, she gained the strength to both want better for herself and understand that healing demanded she squelch the doubt her parents once projected onto her.

But she’ll be the first to say that’s far easier said than done.

In a perfect world, our parents wouldn’t just dismiss us if we’re opening up about feeling depressed, suicidal or if we admit to seeking counseling. But that just isn’t the reality for many of us from cultures that still view vulnerability as weakness. I turned to Sharon Lo—a first-generation Taiwanese American and clinical psychologist—for some expert tips.

Q: What advice would you give to immigrants, refugees or first-gen youth and young adults who want to talk to their parents about having a mental illness?

First, simply thinking of talking to your parents about having a mental illness is a courageous step, so it’s critical you take the time to commend yourself.

You’ll want to keep in mind that this is a relationship-building endeavor, which means that it is, by definition, quite expected for something to "go badly."

Before diving in, ask yourself what it actually looks and feels like for a conversation to "go badly”—and what that might tell you about your own fears. These insights won't necessarily give you a step-by-step, clear-cut answer, but any advice that seems to offer a win-win approach probably isn't taking into account the nuances and complexities of this process.

In setting the stage and creating a growth-focused environment where you can be heard, it’s important to be mindful about the foundation. Consider building from a place of love and respect for yourself.

Love is also the place from which unexpected or perhaps not-so-desirable behaviors from family members usually stems, which can be difficult to keep in mind when acts of love feel misguided.

Misguided reactions may come from a place of sheer fear—and fear-based reactions can be displayed in a variety of ways (i.e., crying, yelling, shutting down).

One way to mitigate such reactions is by focusing on describing your symptoms and daily experiences rather than using a diagnostic label, if applicable. And try to go into the conversation with a list of your specific needs.

From a more practical standpoint, before the conversation, consider reading about the mental health stigmas your parents or family members grew up with. Acculturation status and mental health stigma go hand-in-hand.

Q: How can we recover and refocus if the conversation does end up going badly?

If a conversation "goes badly," it's only an indication that you're growing and creating a cultural shift. Remember, you can't be emotionally vulnerable and lead with courage without expecting difficult emotions and occasional "bad" conversations.

Tune-in to yourself to stay grounded. For one person, this may entail journalling and quieting; for another it may be talking it out with a friend. But check in with yourself to know what it is that you need in that moment to acknowledge the hurt you may feel without pushing it away completely.

The best pieces of advice are also simple, but not easy. One that has resonated with me during these types of heated conversations is to slow down. Once you've slowed down, slow it down even more. Take a step back. There's no rush or pressure to revisit the conversation in 10 minutes, 10 days, or even 10 weeks. During this process, it is common for some to feel an increased risk of harm or danger. If this is the case, seek professional help immediately, and know that you aren't alone in this.

If you don’t feel you’re in immediate danger, remember that this journey for you will unfold in a timeline that feels right to you. Taking time to sit back from a place of observation affords you the control to make choices in what you say or do.

And I cannot emphasize the importance of language; you cannot take back your words.

Q: What advice would you give immigrant parents who didn't grow up around mental health discourse? How can they be supportive without the appropriate education or language?

Ask questions and be curious about your child's experience while withholding judgement. It’s easier said than done, and finding support within your community may be helpful. As with any new experience, learning how best to support your child will require novel ways of thinking and accessing information. Consider seeking out reputable internet support groups and supportive online communities or reaching out to religious faith leaders who have not shied from talking about mental and emotional health. 

It may also help to reflect on a time when you needed to change your perspective. For example, if you made the leap to immigrate to a new country, that must have required a great deal of courage. To adapt, you also probably had to take on the perspectives of those around you. Through this new lens, you learned to adopt different ways of thinking and/or behaving. Consider how you approached those situations and apply the same thoughtful lens as you learn about how mental health is perceived where your children are growing up.

And again, the language you use matters. Certain words and labels can further ostracize your children. In the resources below, Fiza will share some of the most commonly stigmatizing phrases or actions to avoid.

The following tips were compiled with help from the Stanford Mental Health Innovation Network, the little brown diary and experts in the field.

For parents during and after the talk

• Listen.

• Don’t get defensive or angry.

• Remember, this isn’t about you or your reputation. It’s not even about your child’s reputation.

• Don’t project guilt or let them feel they’re being ungrateful or weak by expressing their truth.

• Write down what confuses you so you can do your research after the talk.

• Avoid joking about their experiences; this can feel like an immediate dismissal.

• Sometimes, parents might think changing the subject helps take the pressure or focus off, but don’t do this. Leave room for discomfort.

• Don’t place blame on: a lack of exercise, a lack of faith, a bad academic record, friends, the supernatural, your decision to migrate, yourself.

• Don’t tell them they just want attention.

• Don’t tell them they can’t trust medicine or other treatment options or project your own beliefs about the system onto them.

• Don’t discount their feelings just because you believe you had it worse.

• Remind them that you are rooting for them and will do whatever you can to help.

• Remind them that coming forward is a sign of strength.

• After the conversation: Continue to check in, ask how you can help and consider letting your guard down to establish a stronger emotional connection.

For youth and young adults before, during and after the talk

• Do your research. If you need to, keep notes on hand.

• If you communicate best through writing (like I do) write a letter or email before meeting in person.

• Before your talk, think about how your loved ones might respond negatively and prepare your own reaction to that to avoid an emotional fallout.

• Keep in mind that they, too, may be living with trauma or a mental illness, but there’s no need to point that out in the initial conversation if your parents are likely to grow defensive. Let them address their experiences, if they want to.

• Make the conversation about you and your symptoms, not about them and their parenting.

• Don’t sugarcoat your symptoms.

• Focus on the positives of therapy and treatment. This can show them that you want them to be included in the process, but that you’re trying to take control of the situation, too.

• Involve mental health professionals in the discussion or invite your parents to a therapy appointment, if you’re comfortable.

• If things get heated, suggest a break. Come back when you and your parents are more calm, even if that means you chat at a later date.

• If you just don’t think you’re ready for another confession or confrontation, lean on outside support, such as friends, safe and supportive online forums and, if you can afford it, counseling.

For clinicians

Develop cultural competency for the populations you treat most often and consider learning how these cultures express distress. This is essential because primary care clinicians who see Asian American children for “routine” or school physical examinations, for example, play a crucial role in recognizing and treating depression. Oftentimes, these check-ups are the only opportunity to identify debilitating depressive symptoms.⁴

Do you have any tips to share?

How I Learned To Talk To My Filipino Mom About My Mental Health (Malaka Gharib, NPR): When Filipino American Malaka Gharib, author of our first-ever giveaway pick, I Was Their American Dream, first began going to therapy for her anxiety, she hoped her mom would understand. Instead, she told her daughter, “You don't need therapy. You're fine. Imagine what it was like for me.” Gharib left that conversation “feeling like whatever I was going through was all in my head, and maybe I was — as my mom mentioned on our phone call — ‘thinking too much.’” As painful as it was to hear this dismissal, Malaka has come to realize she can’t blame her mom for the way she reacted. Read or listen here.

I Almost Didn't Tell My Chinese Parents I Was Going To Therapy — Here's Why I Did Anyway (Wendy Lu, Bustle): Four months after beginning psychotherapy for her anxiety and depression, Wendy Lu was still surprised her parents had been so supportive about her seeking treatment. But she also knows that’s not the norm among Asian Americans and Pacific Islanders. Read here.

How Telling My Immigrant Parents I Contemplated Suicide May Have Saved My Life (me, Teen Vogue): How do you tell the two people who left everything they knew behind to give you a better life that you don’t want to be alive? Here’s one idea: Get snowed in atop a mountain with no way to escape the four walls of your Airbnb rental, right in the middle of a breakdown. At least that’s how I did it. I’ve shared my personal story with readers before, but it’s obviously relevant to this issue. Read here.

What Depression Means When You’re An Immigrant’s Kid (Betsy Aimee, Folks): “As a family of first-generation Latino immigrants, my parents believed that even the strong only had a slight chance of making it. As for the weak? They didn’t survive.” This essay really hit home for me; I, too, have heard the “survival of the fittest” argument from loved ones. But Aimee’s and her parents’ growth is especially encouraging. Read here.

My Brother Wants Me to Keep His Depression a Secret (Cheryl Strayed and Steve Almond, The New York Times): In this cult-favorite advice column from Cheryl Strayed and Steve Almond, an anonymous reader reveals her 19-year-old brother, who had been suffering silently with depression, begged her not to tell their Asian immigrant parents, fearing they would never understand what he was going through. She reluctantly promised to stay mum, but his condition only worsened. Then he began emotionally hurting the people around him. What should she do? Read here.

What did you think of this issue? Anything in particular stand out? Tell me in the comments or send an email my way.

—Fiza

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• Past issues

• Foreign Bodies FAQs

• Official website

A massive thank you to M, Dr. Sharon Lo, Marissa Evans (that art!) and my editing champs, Hanaa’ and Farah.

Sources

1. Villatoro, A. P., Dupont-Reyes, M. J., Phelan, J. C., Painter, K., & Link, B. G. (2018). Parental recognition of preadolescent mental health problems: Does stigma matter? Social Science & Medicine, 216, 88–96. doi: 10.1016/j.socscimed.2018.09.040

2. Mental and Emotional Health. (n.d.). Retrieved from https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Immigrant-Child-Health-Toolkit/Pages/Mental-and-Emotional-Health.aspx

3. Yap, M. B. H., Reavley, N., Mackinnon, A. J., & Jorm, A. F. (2013, June). Psychiatric labels and other influences on young people's stigmatizing attitudes: Findings from an Australian national survey. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23333077/

4. Abright, A. R., & Chung, H. (2002, September). Depression in Asian American children. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12208830

Foreign Bodies is an email newsletter centering immigrant and refugee experiences with a mission to de-stigmatize mental illness through storytelling. It’s written and curated by Atlanta-based writer Fiza Pirani with copyediting and fact-checking help from Boston-based journalist Hanaa’ Tameez and traveling journalist Farahnaz Mohammed. Want to contribute your time or share your own #ForeignBodies story? Fill out this form and be sure to say hi on Twitter @4nbodies or Facebook. Special shout-out to Marissa Evans for Issue 14’s art and Carter Fellow and friend Rory Linnane for our adorable animated logo!

If you're thinking about suicide or worried about someone who might be, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 741741 to connect to a crisis counselor. You can also find a wealth of culture- or language-specific recommended resources on our site, foreignbodies.net.

Foreign Bodies is a mental well-being newsletter for immigrants and refugees with a mission to de-stigmatize vulnerability through storytelling. This is our final issue available to the public for free. In 2020, our work will be fully funded by readers like you. We need your support to do this.

Once upon a time in medieval Arabia, shape-shifting creatures made of smokeless fire were born.

These invisible beings—called jinn, djinn or genies—are believed to possess nonhuman powers. In many Muslim cultures, they’re blamed for all kinds of misfortune.

Though jinn were around long before the creation of Islam, the creatures, which may appear in animal or human form, are actually mentioned in verses of the Quran as one of three types of beings: humans (made of earth), angels (made of light), and jinn (made of smokeless fire).

Like humans, jinn are neither inherently good nor bad. But more often than not, the ever-changing folklore that’s passed down from generation to generation casts the creatures as cunning and malevolent—interpretations that definitely make for some solid horror-tainment.

In fact, a couple of years ago, See Something Say Something podcast host Ahmed Ali Akbar rounded up some user-submitted spooky jinn stories for a Halloween special. In one, a listener recalled a crying jinni dressed as an old woman who would regularly appear in her childhood bedroom at 3 a.m.

Another said his Indian family always reserved a corner of the courtyard for the jinn to rest through the night. If someone disturbed the space, “strange things happened.”

There are several other stories describing pointy-fingered beings and humanlike creatures with hooves for feet, but much of modern lore suggests jinn usually have an invisible, ghost-like presence; they are entities with the ability to overpower the human brain.

In Islamic writings, jinn often tempt and seduce humans to stray from Allah (God)—and the devil (or shaytan) is thought to be from their world. True jinn possession, some believe, can cause a person to have seizures and to speak in an incomprehensible language.

It’s easy to see how these beliefs can lead to various manifestations related to mental illness—manifestations that aren’t exactly amenable to medical treatment, researchers Amin A. Muhammad Gadit and T.S. Callanan wrote in a 2006 opinion piece for the Journal of the Pakistan Medical Association.

Gadit mentioned a Pakistani patient he met who was booked on charges of blasphemy and under trial. Though this woman had been diagnosed with schizophrenia years before, her relatives dismissed the diagnosis and insisted on the phenomenon of jinni possession.

Symptoms commonly associated with demonic or spiritual or jinni possession—convulsions, hysteria, or erased memories—can mimic symptoms of conditions like epilepsy and schizophrenia.

The case resembled U.K.-based social worker Aisha’s experience, too. When her brother began having schizophrenic episodes and her sister was diagnosed with bipolar disorder, Aisha was instructed by family to keep her distance, lest the evil reach her. She told Metro reporter Faima Bakar that her mother was convinced that jinn—not biology—were behind it all.

A 25-year-old married woman in Pakistan, when asked by psychiatrists with the Aga Khan University’s Department of Psychiatry and Behavioral Sciences to describe the visual and auditory hallucinations she’d been experiencing, completely denied having them. “I am possessed by jinn, I don’t need any medication,” she said. The psychiatrists suspected bipolar disorder and prescribed appropriate medication. They also recommended admission to a psychiatric unit or further workups. The patient never followed up.

In northern Lebanon, one mother said her son, Hussein, was struggling to sleep, could barely recognize his surroundings or his loved ones and would often run away from home. Thinking he must be cursed, she took Hussein to various sheikhs to try and remove the jinn from his body.

“This is usually done in one of three ways—remembrance of God and recitation of the Qur'an (dhikr); blowing into the person's mouth, cursing and commanding the jinn to leave; and seeking refuge with Allah by calling upon Allah, remembering him, and addressing his creatures (ruqyah),” according to a 2005 study published in the Journal of the Royal Society of Medicine.

The understanding is that a person is made more vulnerable to possession if they fail to secure protection through prayer and other forms of worship.

But in some cases, faith leaders might also strike the possessed individual, claiming the harm they inflict is hurting the jinni and not the person.

This practice, researchers noted, is considered deplorable by Muslim scholars and “far from the principles of Islam and the instructions of the Prophet.”

Nonetheless, Hussein’s mother told Médecins Sans Frontières that during these rituals, the sheikhs they met with did just that. They’d try and beat the jinn out of Hussein’s body. It didn’t work.

That’s when she decided to make the 40-hour trek from their small town of Wadi Khaled to Tripoli to see a psychiatrist, where Hussein was officially diagnosed with schizophrenia.

Unlike Gadit’s patient, Hussein has been seeing a mental health counselor and receiving treatment since the diagnosis. And that’s primarily because MSF clinicians opened up a free mental health clinic in their town. Otherwise, there was no way Hussein’s family could afford the transport and treatment costs in Tripoli.

In almost all of the stories I’ve read on the subject, individuals viewed as being possessed by jinn—many of whom experience common psychotic symptoms—are made to feel there’s no help or medical treatment out there.

Instead, they and their loved ones wind up feeling helpless under the control of a more powerful being. This helplessness and submission to jinni power, research shows, actually contributes to additional suffering.

I grew up in a Shia Muslim household that rarely, if ever, mentioned jinn. I didn’t even know what these creatures were until I went to college and met people who were much more in touch with their religions or cultures.

When I started working on this issue, I asked my mom if Nani had ever used the word around her when she was growing up in Pakistan. Was this something she believed, too?

“I remember Nani asking things like, ‘Bhoot bhar gaya kya?’ or ‘Is the ghost in you?’” my mom told me. Colloquially, at least in her upbringing, “jinn” was used sparingly and jokingly. She recalls one specific situation when her mom used the phrase; she and her sisters were teenagers, giggling about boys.

But jinni possession was definitely an accepted belief around town, particularly if there was a mention of any kind of mental imbalance, my mom said. And exorcisms were quite common, too. Sometimes the rituals would involve locking up afflicted individuals in a room, an attempt to starve the jinn and force it to leave the body. My mom had also heard of beatings, of tying individuals down, of holy water prescriptions.

“What would people say if the exorcisms didn’t…work?” I asked.

“Simple,” my mom said. “They’d say this jinni is just too strong to overcome.” But a lot of the times, the ritual itself would scare the individual into having some control over his actions in fear of having to suffer through another exorcism—reinforcing the belief that there was a jinni that needed removing in the first place, she said.

So what exactly does it mean to say that someone is behaving a certain way because they’re possessed by a spirit?

Scientists have, in the past, approached an understanding of spirit intrusion by viewing it as a form of pathogenic possession, similar to a virus or carcinogen. 

In fact, according to some researchers, even some religious healers might “employ a representation of human biology of various degrees of sophistication to argue that spirits achieve their effects by directly targeting the bodily organ or centre responsible for that effect.”

Typically, pathogenic possession involves the spirit “making” its host behave bizarrely, with some kind of goal in mind, similar to an act of sorcery.

Executive possession, on the other hand, involves displacement—the belief that an individual’s identity and agency can be totally eclipsed by a spirit or demon. This is where the science seems to get…complicated.

“To be driven against one's rational judgement is a few steps removed from being driven against one's conscious will,” writes London philosopher and researcher Mohammed Abouelleil Rashed.¹

The ubiquity of spirit possession

For centuries, before the birth of modern disciplines like psychoanalysis and psychopathology, “the social institution of spirit possession had been preserving the intentionality of socially inappropriate and un-understandable behaviour” all over the world and across numerous cultures, according to Rashed.

• The Hindu Vedas refer to supernatural beings known as asuras that “challenge the gods and sabotage human affairs.”

• Woo-Woo ghosts haunt some Chinese communities “to the point where if someone fell down or cut their finger, it was blamed on a nasty spirit—“Aiya! Get the Polysporin! But make sure there are no ghosts in the fucking medicine cabinet!” Lindsay Wong, author of the memoir The Woo-Woo, wrote for Vice. According to Wong, Woo-Woo ghosts are ancestors who have the ability to occupy any individual at any time.

• For the ancient Greeks, too, “demon-like creatures lurked on the shadowy fringes of the human world,” The Atlantic’s Mike Mariani reported last year.

• In some Jewish folklore, demonic spirits are called dybbuks. According to the Jewish Chronicle, these spirits “came from the domain of evil. The person could not be cured until they were exorcised, sent back to where they had come from… the domain of evil is called in kabbalistic terminology the Sitra Ahra, the ‘Other Side.’” 

• Most modern research cites this major cross-cultural study from anthropologist Erika Bourguignon, who found the presence of institutionalized possession in nearly all regions of the world, but especially so in Sub-Saharan Africa and the Circum-Mediterranean.

• You may have heard of the zār or sar, a type of spirit associated with dissociative episodes such as sudden changes in consciousness or identity that often lead individuals to being apathetic, withdrawn and unable to accomplish daily tasks. Zār is most common among Islamic and minority Christian communities throughout the Middle East and Africa.²

• Various Latino communities are likely to attribute unidentified voices to their hallucinations “to the realm of unidentified spirits, or forces which at times serve as protections or provide ominous warnings.”

• In Britain, Asian immigrants—particularly Pakistani immigrants—also commonly ascribe their psychological ailments to a religious cause (like jinn).

• According to recent Gallup polls, roughly half of Americans today believe in spirit possession, too.

In these societies, the spirits don’t just explain illness; they inform one’s understanding of themselves and others—their “agency, responsibility, identity, normality, and morality.”

As our world becomes more globalized, as more and more people move (willingly or not) from rural areas and small cities to larger cities, from low- and middle-income countries to high-income countries, it’s essential for mental health clinicians and leaders alike to understand their changing communities and familiarize themselves with culture-bound syndromes and histories.

A look at the zār across multiple cultures:

According to a well-known Ethiopian story, Adam and Eve had thirty children and to protect the most beautiful ones from the Divine envy, Eve tried to hide fifteen of them in the Garden of Eden, out of God’s sight. God, who was all-seeing, got angry with Eve and declared that those children would remain invisible for eternity. The fifteen invisible children became the ancestors of resentful and unpredictable spirits like zārs, and the other fifteen became the ancestors of humanity. In Ethiopia, if a zār chooses a person, then that person would be a member of the zār cult.²

In Sudan, the Hofriyati community believe that the zayran (types of zār) never abandon their hosts’ body. A person who is possessed will always be possessed and can be affected by her spirit(s) at any time, according to ethnographers. These spirits also tend to afflict a specific demographic: married women.

But in Iran, “the poor and deprived people (such as fishermen) seem to be the most common victims.” According to the Encyclopædia Iranica, most (but not all!) sheikhs or cult leaders in Iran—called Bābā or Māmā zārs—believe patients should only join the zār rituals when their doctors cannot treat them.

Here’s a very detailed (and very long) description of one Iranian zār ritual:

Photo: Zār ceremony in Hormuz Island/CC BY-SA 4.0

When Bābā or Māmā zār chooses someone to heal, the patient will stay in the Bābā or Māmā zār’s home for up to seven days.

During this separation phase, only Bābā zār or Māmā zār can visit the patient; moreover, the patient’s body is washed with seawater and every night Bābā zār or Māmā zār rubs a combination of aromatic herbs and spices on the patient’s body.

In the last day of the separation phase, when the patient’s body is cleaned and washed to be prepared for the incorporation phase, one of the cult members, who is usually the one who has formerly been possessed by zār, informs everyone about the upcoming zār ceremony.

Ahl-e-Hava (Eve’s family), who are people who have already been possessed by the zār and have been treated at least once, have to attend every zār ritual. In addition, other people of the cult, who may or may not be possessed, also participate as it is considered a sin not to attend a zār ritual.

Depending on how big the Bābā or Māmā zār’s home is, the ritual can be inside or outside the house. Participants gather in a U-shaped open area—Maidān—with a patient sitting in the center. A piece of tablecloth including eggs, confetti, dates, and aromatic herbs is placed on the floor in the center of Maidān.

After Bābā or Māmā zār covers the patient’s head with a piece of white cloth, a big tray holding aromatic herbs on burning charcoal is passed around and the patient and all participants are frequently incensed with the smoke from the mixture.

The zār leader—Bābā or Māmā zār—leads the music, which involves local drums played by musicians and which is followed by others who are present at the ceremony. The leader is someone who knows the name of the zārs and its related music (the specific beat of drums). The leaders also sing and the participants respond to them. Songs of the incantations can be in a different language or just melodic sounds without lyrics. During the singing, when the zār hears its related music, it makes itself known through the body of the patient, who feels a strong inner urge to move.

Every spirit has its own piece of music and some members of the cult, mainly Ahl-e-Hava, may start moving and shaking with every piece of the music, as they are supposed to be the eternal hosts of the zār. The leader cannot identify the zār until the patient reacts to the music, so musicians change the tune until the zār takes over the afflicted; the signs of this occurrence appear when the upper body and the head swing and the shoulders shake.

When the zār is identified, Bābā or Māmā zār starts to communicate with the zār in a language that is ordinarily unfamiliar to themselves and the patient. This language is a combination of Persian, Arabic, Swahili, and Indian. Through this communication with the zār, the healer tries to find out the reasons behind the affliction and what the spirit wants in exchange for leaving the patient alone.

Through the afflicted, the zār names its demands, which vary from simple things, such as a few prayers or a piece of bamboo (ḵeyzārān), to something more considerable, such as a sacrifice. Bābā/Māmā zār assures the zār that its demands will be met by tying a piece of cloth around the patient’s arm. It is believed that if the zār’s wishes are not granted, the zār will return and make more trouble for the patient.²

If you’re experiencing mild panic attacks or depression, most clinicians would probably initially recommend talk therapy over medication, Swaran Singh, head of the Mental Health and Wellbeing division at Warwick Medical School told BBC. “In some cultures this means talking to a healer, so it may work.”

Problems tend to arise when it becomes an alternative to medical care—when “instead of taking medication, they rely exclusively on religious ceremony or religious procedure. That's not going to treat the condition, so faith may offer comfort but it doesn't offer a cure for illness.”

In addition to patients completely opting out of medical care, related factors that commonly compromise psychiatric treatment include: Lack of clinical knowledge about jinn or other spirits as a cultural explanation for serious psychiatric illnesses; limited awareness among the public about psychiatric illnesses in general; poor access to health care; low socioeconomic status and education levels; stigma attached to mental health conditions; wide availability of and belief in spiritual healers; lack of insight by the afflicted person.⁵

In several cases, patients who attributed their symptoms to spirits actually showcased additional signs of distress. Some examples I came across:

• According to this study of patients with a Muslim background in the Netherlands, patients often showed “signs of fear and depression while talking about jinn and suffered considerably from the prospect of the consequences that might have.”³

• Another report noted ample support for a strong relationship between traumatic experiences and pathological possession states.

• Singh told BBC of a Sikh patient who went undiagnosed and untreated for his psychiatric ailments for 13 years. By then, too much damage had been done, he said. Without treatment, individuals with mental illness are known to face recurring symptoms, hospitalization, substance abuse, damaged relationships, and much more.

I’d also be remiss not to mention the potential for exploitation.

CW: Some disturbing examples

• Using beliefs to explain away crimes: In 2012, four members of the same family were found guilty of murdering 21-year-old British Muslim Naila Mumtaz, who was pregnant at the time of her death. Her in-laws, her husband and her brother-in-law were convicted of her killing. During the trial, the family members claimed she was possessed by jinn.

• Using beliefs to silence victims of abuse: “If somebody was saying I was being abused, or I'm living in horrific conditions, they would automatically silence them by saying ‘she’s possessed,’” U.K. teacher Yasmin Ishaq told BBC. “I'm talking from personal experiences - family members, neighbours, community members - where women were beaten on the premise that they were possessed when really it was just violence against women.” Fed up with beliefs’ being exploited, Ishaq became a healer herself.

• Inspirited Minds: Faith-based U.K. charity educating imams and community leaders “to dispel the idea of a dichotomy between Islam and mental health” and combat stigma

• Foreign Bodies! Explore our loooong list of faith-based resources from Issue 11.

• And remember, if you’re looking for a faith-based therapist in America, Psychology Today’s Find A Therapist search tool offers options to filter for therapists versed in the following religions: Buddhism, Christianity, Hinduism, Islam, Judaism, Mormonism and “Other Spiritual or Religious Affiliations.”

For current or aspiring clinicians and researchers

When seeking help, an individual who believes they’ve been possessed may limit their explanation to the mysterious work of an otherworldly power. Some resources and tips to approach spirit possession in clinical settings with understanding:

• See what research is already out there. Here’s one: This paper on Zār spirit possession in Iran and African countries may help clinicians adopt a “sociocultural and historical understanding of zār spirit possession that will help them identify this condition in clinical settings in order to avoid misinterpreting it as a psychosis and/or dissociative identity disorder and to increase intervention efficiency.”²

• In general, consider consulting a faith counselor. “When medicine invites conflict with culture and religion, the therapeutic alliance suffers. Most people are content to utilize biomedical treatments without giving up traditional explanations of illness; therefore there may be a strong case for involving an Imam or religious leader in the management of these cases.”⁴

• Refresh your memory on the cultural variants researchers have already identified, including the (admittedly limited) list of culture-bound syndromes included in the DSM-5.

• Take note of Mentalhealth4muslims.com’s Dr. Nafisa Sekandari, whose center offers a “multimodal approach” where patients can get the psychological support they need and still incorporate faith as part of their treatment.

For community leaders

Community leaders and clinicians alike may want to consider collaborating with spiritual healers and incorporating them into the treatment plan “by inviting them for talks and educational sessions in mosques, community centers, schools, and madrassas (religious schools).”⁵

Recommend a resource

I Grew Up with Parents Who Didn’t Understand Mental Illness (Lindsay Wong, VICE): Lindsay Wong, author of The Woo-Woo, penned a fascinating essay about growing up in her deeply superstitious Chinese American household. Read here.

Will My Mom’s History of Mental Illness Repeat Itself in My Kids? (Kristina Wright, Healthline): Kristina Wright’s mother claimed to hear voices and see demons, Wright wrote for Healthline. “A minor infraction, like walking on a freshly mopped floor, would result in screaming and crying… She would take to her bed, or the couch, for two or three days at a time, sleeping or staring listlessly at the television.” Their relationship grew dysfunctional, worsened by her mother’s refusal to seek treatment. Eventually, Kristina cut her out of her life. Read here.

When Mental Illness Is Mistaken for Demonic Possession (Emily Korstanje, VICE): Around her 18th birthday, Nadia (name changed for story), would often feel worthless; she suffered from anxiety and depression and at times could barely get out of bed. She turned to her parents for support, and they took her to a faith healer who determined evil spirits entered her because of a lack of faith. “He made me drink something strange, recited the Quran and then choked me with two of his fingers until I passed out,” Nadia said. Read here.

As a psychiatrist, I diagnose mental illness. Also, I help spot demonic possession. (Richard Gallagher, Washington Post): “Is it possible to be a sophisticated psychiatrist and believe that evil spirits are, however seldom, assailing humans?” Meet Richard Gallagher, who says he may have seen more cases of possession than any other physician in the world. Read here.

American Exorcism (Mike Mariani, The Atlantic): More and more Americans are seeking priests for help with demonic possession. “Why, in our modern age, are so many people turning to the Church for help in banishing incorporeal fiends from their body? And what does this resurgent interest tell us about the figurative demons tormenting contemporary society?” Read here.

That’s all, folks. Wishing you all a very, very Happy New Year. Here’s to more highs than lows, more reflection, more books, more therapy, more dogs, more travel, more of whatever else makes you smile. Thank you from the bottom of my heart for supporting Foreign Bodies. I don’t know what the future holds for this newsletter, but it’s been a lovely ride so far.

—Fiza

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Sources

1. Rashed, Mohammed. (2018). More Things in Heaven and Earth: Spirit Possession, Mental Disorder, and Intentionality. DOI: 10.1007/s10912-018-9519-z

2. Mianji F, et al. (2015). Zār Spirit Possession in Iran and African Countries: Group Distress, Culture-Bound Syndrome or Cultural Concept of Distress? PMID: 27006667; PMCID: PMC4801492

3. Lim A, et al. (2018). The Attribution of Mental Health Problems to Jinn: An Explorative Study in a Transcultural Psychiatric Outpatient Clinic. DOI: 10.3389/fpsyt.2018.00089

4. Khalifa N, et al. (2005). Possession and Jinn. DOI: 10.1258/jrsm.98.8.351

5. Khan Q, et al. (2016). “Jinn Possession” and Delirious Mania in
   a Pakistani Woman. DOI: 10.1176/appi.ajp.2015.15030281

Foreign Bodies is an email newsletter centering immigrant and refugee experiences with a mission to de-stigmatize mental illness through storytelling. It’s written and curated by Atlanta-based writer Fiza Pirani with copyediting and fact-checking help from Boston-based journalist Hanaa’ Tameez and traveling journalist Farahnaz Mohammed. Want to contribute your time or share your own #ForeignBodies story? Fill out this form and be sure to say hi on Twitter @4nbodies or Facebook. Special shout-out to Carter Fellow and friend Rory Linnane for the adorable animated logo and Marissa Evans for Issue 13’s art!

If you're thinking about suicide or worried about someone who might be, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 741741 to connect to a crisis counselor. You can also find a wealth of culture- or language-specific recommended resources on our site, foreignbodies.net.

Foreign Bodies is a mental well-being newsletter for immigrants and refugees with a mission to de-stigmatize vulnerability through storytelling. Our issues are free for the public until 2020, when our grant money runs out and we will become fully funded by readers like you. We need your support to do this.

It all started in third grade.

During recess on one warm April day, some boy I was crushing on pointed out dark, thick hairs sprouting from the follicles polka-dotting my pale legs as I swung from the swings. His eyes moved from limb to limb, accompanied by comments about my arms, my eyebrow (singular) and, finally, the damn upper lip.

Others in our group joined in with a cackle or two, and the white girls in class kindly pointed out how light and nearly invisible their own body hairs were, how unlucky I must feel to not be blonde.

You have no idea, I remember thinking.

I went home crying to mama that day, and thus began my foray into the tortuous world of hair removal.

I wish it was just the razor bumps and cuts from shaving I had to endure. The simplicity of a blade gliding and slicing was not an option for me, I was often reminded. Use a razor, and the hair will grow back ten times thicker. Use a razor, and your skin will be as prickly as a man’s beard. Who will want to touch you?

That year, I began the weekly threading appointments, quietly nodding “Yes” to every beautician’s “Upper lip, too?” For the longer limbs and more private areas, I turned to dripping hot wax. The physical pain of ripping away my hairs was only secondary to how it felt being overexposed and vulnerable, nearly naked on a table in the back room of a corner salon at an age I was only beginning to find a relationship with my own body.

The smelly Nair and Sally Hansen creams that promised painless ease never did work on my stubborn threads. The burning hair lightening bleach from Jolen made me feel less-than, and I could feel my skin getting more irritable. The painful, never-ending zap-zap-zap of evil lasers seemed to hyper-discriminate against my dark hair and fair skin (and emptying bank account) no matter how many buckets of numbing cream I purchased.

The practice of removing female body hair can be traced all the way back to cave-people, who used flint blades, shells and other sharp objects to get rid of hair to prevent frostbite or parasite infestation.

Ancient Egyptians used copper razors and homemade pastes. Unlike the Egyptians, who promoted hairlessness in all people, Romans reserved the trait as a uniquely feminine ideal, and men were free to wear their natural body and facial hair however they liked.

Across Europe, a womxn’s hairlessness eventually became a symbol of status. (We’ve all seen the eyebrow-less Elizabethan portraits, right?)

But according to the Women’s Museum of California, “the modern era of hair removal may have been encouraged by Charles Darwin’s 1871 book, Descent of Man, through the popularization of his theories of natural selection.”

Darwinist interpretation might suggest “homo sapiens have less body hair than his/her antecedents because less hairy mates were more sexually attractive.” Thus, “body hair became a question of competitive selection.”

Within 30 years of the book’s publishing, upper- and middle class white American womxn began associating smooth skin with a desirable femininity. In 1915, Gillette advertisements encouraged womxn to remove any “unsightly” and “objectionable hair,” especially if that hair grew in places like—gasp—the underarms! By 1964, as hemlines rose, 98% of white American womxn were regularly shaving.

“In a remarkably short time, body hair became disgusting to middle-class American women, its removal a way to separate oneself from cruder people, lower class and immigrant,” Rebecca M. Herzig wrote in her book, Plucked: A History of Hair Removal.

In the ‘60s, doctors even began prescribing hormonal drugs with dangerous side effects to combat stubborn excess facial and body hair (or hirsutism) in womxn, drugs now primarily reserved for individuals transitioning from male to female.

“It’s not a coincidence that the pressure for women to modify their body hair has risen in tandem with their liberties,” Nadine Ajaka wrote for The Atlantic in 2017. According to Herzig, Ajaka wrote, “the effect of this hairlessness norm is to ‘produce feelings of inadequacy and vulnerability, the sense that women’s bodies are problematic the way they naturally are.’”

Hair removal might just be one of the biggest self-care lies we’ve adopted as womxn, she argued. “It keeps us in an impossible loop, one in which we are constantly in pursuit of velvety limbs and the moral virtue of cleanliness.”

For those of us with darker skin, with thicker hair or wider hips, the feminine western beauty ideal is already pretty much unattainable. Add stubborn excess facial or body hair and, well, you get the point.

While western conventions of beauty have undoubtedly influenced the global standard (hi, colonization), let’s consider the ways certain cultures make living with excess hair all the more complicated or shameful for womxn—cultures where her objective worth is still deeply rooted in feminine prowess and fertility.

I’m going to introduce you to a dear friend of mine now. Puja Shah and I have known each other for about a decade (maybe longer?) and have been close since college. She’s one of those people you meet once and want to meet again, always oozing genuine love for the people in her life and for the work she does.

At 16, Puja received a diagnosis to explain the excess hair and irregular periods she was experiencing: polycystic ovary syndrome. PCOS is one of the most common hormonal disorders among womxn, affecting 1 in 10 of those within childbearing age.

According to the Mayo Clinic, the exact cause of the condition is unknown, but several factors play a role: too much insulin, genetics, high levels of androgen.

If you have PCOS, you may experience severe acne, male-pattern baldness and enlarged ovaries that fail to function regularly. It can put you at higher risk of infertility, Type 2 diabetes, miscarriage, metabolic syndrome, sleep apnea and a slew of mental illnesses, including depression, anxiety and eating disorders.

Anyone with ovaries and uteruses, no matter their ethnic background, is at risk during reproductive age. But the way PCOS manifests physically (its phenotypic expression) can indeed vary across ethnicities and geographies.

For example, research shows a strikingly high prevalence of PCOS-related hirsutism among womxn of South Asian, Middle Eastern or Mediterranean origin.¹

Puja is a born-and-bred Georgian and her family comes from Gujarat, India. While she’s learned to master the balancing act of her Indian roots and western upbringing, she admits it wasn’t easy to appease the harsh beauty standards of both cultures, especially with PCOS.

When her endocrinologist suggested birth control at 16—a customary treatment option for PCOS management—Puja’s mom was adamantly against the idea. Stigma against contraceptive use is fairly common in Asian American communities, even if the patient isn’t sexually active. It’s the mere possibility of sex, the mere taboo of discussing sexual health at all.

So her doctor recommended the next best course of action: a change in diet and exercise coupled with Metformin, a medication used to lower blood sugar and improve insulin sensitivity. I’ve used it myself when I was pre-diabetic and dealing with my own metabolic syndrome.

As the years went by, Puja’s periods became so irregular that she often had to learn to induce them. She’d skip out on trips and pool parties and anything that required her to leave the house because she never knew when the induced period would arrive, or just how intense it might be.

“I was honestly just really, really devastated,” Puja says. “I didn’t really know why this was happening or what exactly was going on. There wasn’t much research or support out there at the time.”

It didn’t help that the subject was rarely addressed in family settings. To this day, Puja’s dad has no idea.

The irregular periods are certainly still cumbersome. But 12 years later, it’s the hirsutism that gets to Puja most.

“It’s definitely influenced my confidence and self-esteem,” she says. “Hair is always on my mind.”

When she takes photos with friends, she asks to see the final shot before anyone uploads it. Then she scans the image to see if there are any visible hairs sprouting from her chin or upper lip.

Sometimes Puja will skip out on big events or hangouts with friends because she just doesn’t want to go through the pain of waxing her upper lip for a couple of hours of fun.

Recently, she met up with a male friend after getting her eyebrows threaded, leaving her brows and forehead lit up in a reddish hue. When her friend commented on the redness, Puja let him know that, you know, threading hurts!

“Couldn’t be that bad,” he replied. So she drove him to get his own eyebrows threaded for the first time.

He left the beautician’s chair in tears.

But it’s not just the pain of hair removal (and lack of understanding) that bothers Puja. For her and for many with metabolic syndromes (myself included) any type of hair removal tends to give way to even thicker, more stubborn replacements. And the more you shave or wax or laser, the more the skin gets exacerbated and discolored.

That’s influenced the type of clothes Puja feels comfortable wearing, too. Sleeveless tops and dresses expose the discoloration under her shaved underarms. A bikini feels out of the question.

If you know Puja, you know she’s the biggest, warmest cuddlebug around and she loves to hug, kiss, hold her friends’ hands. It’s hardly surprising that her primary love language is touch.

Still, she says, she hates being touched.

“It’s weird, I know. And I definitely think that’s stemmed from insecurity,” she says. “I don’t want people to touch me and feel the hair on my body.”

It makes her self-conscious about being intimate with someone, too. “What if they wonder why I’m discolored? Or think I’m not clean?”

The hair and discoloration have also affected her relationship with her mom, who constantly reminds her to get rid of the fuzz before a trip to the temple, to a wedding, to any family gathering. The repetitive reminders have added a lot of anger and resentment toward a culture that rarely speaks aloud about womxn’s health but unquestionably promotes hairless, fair and velvety skin as the sole face of beauty.

Even when Puja’s mom says she’s “just joking around,” it gets to her.

“Because of the comments, I don’t lay on her or let her touch my face,” she says.

But Puja recognizes how different her mom’s upbringing had been, how the culture shock of leaving a country for an alien world may have complicated the way she shows her love. She may not always have the right words, but Puja’s mom is constantly on the lookout for new herbal supplements and vitamins that might ease her daughter’s symptoms, and that means a helluva lot to Puja.

Fostering a close friend group has also been critical through all this, she says. At least half of her friends have PCOS or some kind of metabolic syndrome, and they’re actually willing to talk about it.

“We’ll help each other out, you know,” she says. “We’ll share what works and what doesn’t.” Sure, PCOS symptoms and treatment effectiveness vary by individual, but it’s just good to openly talk about a subject that’s still so hush-hush at home, she says.

Puja’s also found support in Facebook and Instagram groups for others diagnosed with PCOS. She attended a conference for PCOS awareness and met people who were dealing with the same sh*t. Being part of these cohorts helped her feel a little more understood. And it’s been key to her gaining confidence over the years.

“If you had asked me to talk about this five years ago, I would have said no,” Puja says. But now, “I've kind of grown and accepted that, you know, it is what it is. All I can do is maintain what I can. I'm not gonna let it stop me from doing whatever I want.”

Looking ahead, Puja (a total science nerd) is optimistic about the research emerging around PCOS symptom management, considering the condition has had a long history of limited funding.

But if you’re reading this and dealing with metabolic syndrome or hirsutism and all the psychological distress associated with the conditions, some advice from Puja:

• Connect with others who can relate, whether that’s through a support group, online, or friends willing to chat.

• While Puja wasn’t diagnosed with a mental illness, she recommends everyone get screened for common mental disorders. If your social anxiety, self-esteem or body dysmorphia is affecting your daily life or keeping you from enjoying yourself, please consider counseling.

• Know you’re not alone. Just in the U.S., between 5% to 10% of women of childbearing age (~5 million) have PCOS. And yet, less than 50% are properly diagnosed, leaving millions of womxn living with PCOS undiagnosed.

• Don’t take your anger out on loved ones (or your endocrinologist!) Frustrated with her new normal, Puja ended up avoiding her endocrinologist for a while and resenting her when she was just trying to help.

Want to get in touch with Puja?

The mental health and well-being connection

To what degree PCOS influences your individual mental health and well-being depends on so. many. factors. Do you already have a history of mental illness in your own life or in your family? Which PCOS symptoms are most personally troublesome for you? Is it the excessive facial hair, the weight gain, the irregular periods, the infertility? Some interesting research:

• In general: Infertility = higher scores of depression. Obesity = higher anxiety scores. But PCOS patients with oligomenorrhea-hirsutism (infrequent menstrual periods + excess hair) are “overall more affected in terms of physical functioning, physical role function, pain, social functioning, emotional role function, and emotional well-being.”²

• For Iranian and Sri Lankan womxn, hirsutism tends to be the most psychologically distressing PCOS symptom. “Not only is hirsutism itself a major concern for womxn diagnosed with PCOS, but the time and energy spent at concealing it aggravates the distress further.”³

• A study on American, German and Australian womxn with PCOS found that obesity was the most distressing PCOS symptom, whereas body hair was the least of their concerns.⁴

Because this issue is dedicated to #hairhairhair let’s focus on why hirsutism—whether it’s a symptom of PCOS, another medical condition or simply due to genetics—might be especially burdensome to psychological well-being.

“Despite the fact that the syndrome, from my perspective as a physician, may give rise to other serious conditions such as high blood pressure, cardio-vascular diseases, high lipid levels in the bloodstream, diabetes, difficulties conceiving and overweight, women with polycystic ovary syndrome rate the excess hair as the second most difficult thing to live with. Second to difficulties conceiving.”

— Dr. Maria Palmetun Ekbäck, a physician and researcher with Sweden’s Örebro University

Those with unwanted hair due to hirsutism often feel self-conscious, and plan their lives according to how well they can hide their bodies, Ekbäck says. Because of this, they might avoid close physical contact, or make themselves seem unapproachable.

The more unwanted excess hair growth a patient experiences, she adds, the more potential for social anxiety and depression. And statistically, womxn living with PCOS who tend to experience anxiety or depression seldom seek psychiatric help for their hirsutism symptoms because they’re embarrassed.

"As doctors, looking at the whole picture, we most likely often view the hair growth as trivial,” she said. “But if these women are to find the strength to cope, follow dietary and exercise advice, and go under medication, there must be a sense of empowerment in the way that they are approached and treated by healthcare staff. We need to provide adequate information and lift the stigma brought about by this condition.”

Research shows South Asian womxn with PCOS disproportionately experience more severe hirsutism and infertility⁵. Research also shows multiple countries in South Asia, including Pakistan and India, are among the worst for women⁶ based on violence and lack of health services. Research also shows South Asians, who are more likely to exhibit depressive symptoms and are at higher risk of suicide⁷ compared to the general U.S. population, are among the least likely demographic to seek psychiatric help, and that includes migrants.⁸

Find a doctor or specialist

• Introductory guide to finding the right doctor (Endorcineweb.org)

• Amino search engine: Free and personalized! Search function based on how much experience clinicians have treating patients like you—with the same condition or procedure you need, your age, and your sex.

• NeedyMeds: Low-cost, sliding sale nonprofit clinics. The PCOS Awareness Association offers U.S. patients a free prescription drug card.

• Ongoing clinical trials (global)

• PCOS and Depression: Understanding the Connection and Finding Relief (Therapy options via Healthline)

• UCSF PCOS Clinic: Patients see a team of specialists in reproductive endocrinology, dermatology, nutrition, psychology and genetics. (Only Oakland and San Francisco, but reach out and ask for recommendations near you?)

Get support: Online groups

• Cysters.org (website dedicated to reproductive justice for marginalized womxn)

• myPCOSteam (free social network)

• The Cysterhood (paid web program)

• Instagram: @pcosaa | @twobrokegirlswithpcos

• Facebook: PCOS Support Group | Soul Cysters

• Apps: PCOS Diva | everyPCOSbody | PCOS Tracker

Get educated and stay informed

• Q&A with Cedars-Sinai’s Dr. Jessica Chan (PCOS specialist)

• PCOS and the associated mental health conditions (Care For Your Mind)

• Expertscape (Uses the National Institute of Health’s PubMed database to identify individuals and institutions currently conducting research, publishing papers, and conducting clinical trials around PCOS and thousands of other medical conditions).

• PCOS Challenge Magazine (e-zine)

Get involved: Events and advocacy

• PCOS Awareness Month and Challenge (September awareness/fundraising fun)

• PSOS Con (Annual PCOS conference)

For clinicians

• Clinical manifestations of polycystic ovary syndrome in adults (UpToDate)

• A comprehensive mental health care program for women with polycystic ovary syndrome: protocol for a mixed methods study (Reproductive Health)

From PCOSAA: The Crisis Text Line serves anyone, in any type of crisis, providing access to free, 24/7 support and information. Text PCOS to 741741 from anywhere in the United States or UK, 24/7. We will text about whatever is a crisis to you - addiction, anxiety, assault, bullying, depression, eating disorders, self-harm, and suicide.

Recommend a resource

The Casualties of Women's War on Body Hair (Nadine Ajaka, The Atlantic). “I’m sure there was a time when I was not hairy, but I can’t remember it,” writes Ajaka. “I recall inspecting the black hairs on my legs with serious fascination; my mother would use sticky sugar to rip them out from their stubborn roots. ‘Beauty requires strength,’ she would say.” Read here.

The Syndrome That Made Me Question My Femininity (Mariana Viera, ZORA). “She just needs to scrub harder when she showers,” Mariana’s aunt lovingly said when she was just 10. As she reached teen-dom, Mariana’s mom let her replace meals with Slim Fast shakes to combat the weight gain. In the bathroom mirror, she began noticing the discoloration along her neck, “the most stubborn dirt I had ever encountered.” Read here.

6 Women On Living With Polycystic Ovary Syndrome (Jacqueline Kilikita, Refinery29). Priya, 33, admits she’s slathered herself in skin lightening cream and even slept with the harmful hydroquinone on her face overnight. Twenty-six-year-old Rachel is primarily concerned about infertility. But what’s frustrating is the pity from others. “I shouldn’t be made to feel that I’m broken.” Read here.

Brown Girls and Hair by Neamah Hussein. “Body hair and the ordeal of dealing with it is a big part of my life... and I find that hilarious.” This “cathartic tragicomedy on body hair” will leave you laugh-crying for days. Watch here.

Issue 13, out on New Year’s Eve, will mark one year since we launched! We want to hear from you. What have you loved or disliked about Foreign Bodies? Do you have a favorite issue? Is there something you want us to do differently in 2020?

Tell us!

And remember, our grant money runs out at the end of December. That means in 2020, we will be fully funded by readers like you. We really need your support to continue this work.

If you haven’t yet, please consider upgrading your account from free to paid:

Subscribe for $3/mo or $33/yr

Give more for $4.95/mo or $54.45/yr

You can also send in one-time donations. If your gift exceeds any of the above annual rates, we’ll automatically add you to our paying subscribers list for 365 days so you never miss a beat. Just shoot us an email and let us know you’ve sent us a gift.

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If you're a student, or if you find the cost in any way prohibitive, email me and we’ll figure something out.

Another birthday gift we’d love? Tell a friend about us.

Share this post. Share any of our posts. Spread the word so we can reach more readers. Help us in our mission to de-stigmatize vulnerability through storytelling, however you can.

Share

- Fiza

P.S. A very special thanks to Puja for being a stellar friend and for sharing her story. And don’t forget: The giveaway for Bassey Ikpi’s powerful memoir, I’m Telling the Truth But I’m Lying, ends TONIGHT!

Sources

1. Lo JC, et al. (2006). Epidemiology and adverse cardiovascular risk profile of diagnosed polycystic ovary syndrome. DOI: 10.1210/jc.2005-2430.

2. Acmaz G, et al. (2013). Level of anxiety, depression, self-esteem, social anxiety, and quality of life among the women with polycystic ovary syndrome. DOI: 10.1155/2013/851815.

3. Khomami M, et al. (2015). Of PCOS Symptoms, Hirsutism Has the Most Significant Impact on the Quality of Life of Iranian Women. DOI: 10.1371/journal.pone.0123608.

4. Thomson RL, et al. (2010). Lifestyle management improves quality of life and depression in overweight and obese women with polycystic ovary syndrome. DOI: 10.1016/j.fertnstert.2009.11.001.

5. Mehta J, et al. (2013). Phenotypic expression of polycystic ovary syndrome in South Asian women. DOI: 10.1097/OGX.0b013e318280a30f

6. The World’s Worst Places to be a Woman. (n.d.)

7. Sohrabji, Sunita. (2013). Suicide Amongst Indian Americans: We’re Stressed, Depressed, But Who’s Listening?

8. Elias, Priya-Alika. (2015). The Silence About Mental Health in South Asian Culture Is Dangerous.

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Foreign Bodies is an email newsletter dedicated to the unique experiences of immigrants and refugees as they relate to coping with mental illness and wellness. It’s written and curated by Atlanta-based writer Fiza Pirani with copyediting and fact-checking help from Boston-based journalist Hanaa’ Tameez. Want to contribute your time or share your own #ForeignBodies story? Fill out this form and be sure to say hi on Twitter @4nbodies or Facebook. Special shout-out to Carter Fellow and friend Rory Linnane for the adorable animated logo!

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If you're thinking about suicide or worried about someone who might be, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 741741 to connect to a crisis counselor. You can also find a wealth of culture- or language-specific recommended resources on our site, foreignbodies.net.

Growing up in a practicing Muslim family in the United Kingdom, Noha Magd wasn’t entirely surprised when her parents encouraged her to turn to prayer after she revealed she was experiencing suicidal thoughts. A devout Muslim herself, Noha hoped faith could keep the fog at bay, too.

And religion did keep her going for a while, that is, until Noha noticed her health wasn’t actually improving. Thoughts of suicide continued to linger with no signs of dimming. And her devotion left her replete with a new kind of self-reproach.

“Islam regards suicide as a major sin, and I didn’t want to be sinful,” she wrote in a HuffPost essay earlier this month before we connected online. In an audio file sent via email, Noha spoke of the all-consuming guilt and the contradictions of being a suicidal person and a person of faith.

“I felt very…ungrateful,” she said. “But it’s not that I wanted to just die. I wanted the pain, the anxiety and the mental illness to stop.”

Putri Surya’s parents, like Noha’s, also suggested that she lean on her faith to get through the not-yet-diagnosed anxiety and depression.

“I would read the Quran and pray as they suggested, but it just made me more angry at God because I felt like I wasn’t making any progress,” she wrote in a blog post for ADAA.org. Putri felt pressured “to get better in order for my parents to be fulfilled in their faith. It was like I was a prisoner in my own thoughts and I wasn’t allowed to feel how I needed to feel.”

Psychiatrist and Michigan State University professor Farha Abbasi understands this sentiment all too well. In Muslim and other faith communities, it’s common for members to view mental illness as a sign of weakness “in their faith in God, in their character, or in their mind,” she told Psychology Today. “People will say, ‘You’re not praying enough. Be thankful.’”

But Noha’s prayers and self-help techniques eventually reached their limit, she said. A friend urged her to see a psychiatrist.

Her named illness—first diagnosed as anxiety and depression, but later as bipolar disorder—initially created a “toxic and invalidating” divide between her and her Egyptian parents, both of whom couldn’t understand how their PhD-holding daughter was supposedly depressed or living with a chronic illness despite being so “functional.”

But in recent years, as Noha continued to open up about her illness and encourage understanding, she’s noticed a shift. Her family has grown to become much more supportive.

I asked Noha what she wishes she could say to her parents and others instinctually compelled to suggest a renewed or amplified devotion to faith when their kids come to them for help.

“Believe the children,” she said, urging parents and guardians to take their sentiments seriously, make the effort to get educated and immediately seek professional help. Remember, she added, that your children are in a fragile state, and whatever you say can have a tremendous effect on them.

If you’re struggling with your own mental health but don’t feel like your family’s responding very well to your disclosure, Noha suggests bringing in a third party to speak with them.

How faith communities can play a role

Research shows that religion or spirituality can offer a sense of structure, a sense of belonging, a connection to something larger than ourselves—and all of these factors may have a significantly positive impact on our mental health.

For those with an emotional, centric connection to faith, know that your devotion can be useful in “coping, resilience, and finding the strength to move forward. But it’s not necessarily preventive,” psychiatrist Rania Awaad, who founded the Stanford Muslims and Mental Health Lab, said in an interview with Psychology Today.

Awaad helps train imams and other faith leaders in the Bay Area to become mental health advocates themselves. One totally disengaged imam turned advocate once said to her, “I now realize how much I didn’t know. There were all kinds of cases that probably came to me, and I didn’t realize they were about mental health, and I should’ve referred them to mental health professionals.”

She hopes her sessions with Muslim congregations can be replicated across religious groups. After all, “the scripture may be different, but the essence of the struggle is the same,” she said.

Immigrants and Religion

According to the Pew Research Center, 56% of immigrants report a belief in God (87% of Historically Black Protestant immigrants and 86% of Muslim immigrants!) and 58% say religion is very important in their lives.

Physical religious spaces are also especially powerful safe spaces for immigrant communities. Houses of worship not only foster one’s spiritual and prosaic needs, but they can also serve as a resource when immigrants need help adjusting to life in a new country or culture.

“The church—through both pastors and laypeople—teaches worshippers everything from how to apply for a social security card to how insurance works in America,” CUNY and Queens College professor Pyong Gap Min, who has studied how Korean churches and Hindu temples aid congregants with assimilation, told CityLab in 2017. “Through casual conversations, new immigrants can easily become part of a larger network that disseminates information about employment and housing opportunities.” These houses of worship may also act as “unofficial work referral systems, where worshippers can hear about jobs or scope out who they might hire themselves.”

When immigrants are internally struggling, it’s hardly surprising that they tend to consult family members and religious leaders for help and are less likely than the native population to seek medical assistance for things like anxiety, depression, chronic illness etc. This rings especially true for Latino, South Asian and African immigrants, the latter of which often lean heavily on spiritual leaders.

But the thing is, if you’re living with a mental illness and your faith community doesn’t accept your disorder as a real medical condition, you may feel further isolated. Your symptoms are likely to worsen over time, especially if you’re not receiving professional help.

For ChristianityToday.com, Amy Simpson, whose father was a pastor for 10 years, wrote about the family secret that went unacknowledged in her church growing up: her mother’s diagnosed schizophrenia.

“Many people didn't know what was happening, and the church leaders who probably wanted to help us didn't know how,” she wrote. “No one ever talked about mental illness at church,” and the church’s lack of engagement, she later learned, was hurting countless families struggling in silence.

Much of that has to do with the fact that faith communities (and, frankly, the world) tend to respond differently to mental illness compared to other afflictions, Simpson wrote.

We don’t tell people in anaphylactic shock to let go of their Epipens and to let God take over. We don’t encourage our aging grandparents with heart problems to replace the potentially life-saving pills with a few extra hours of du’a or an additional evening of Bible study. Living with a mental disorder or a chronic illness is just as valid, just as deserving of medical care.

Special thanks to Dr. Noha (@Get2Noha on Twitter) for opening her heart and sharing her story. And psst… If you would like to see the latest updates from Foreign Bodies in your primary inbox, please drag this email from the “Updates” or “Promotions” tab, to the “Primary” tab.

Looking for a faith-based therapist in America? Psychology Today’s Find A Therapist search tool offers options to filter for therapists versed in the following religions: Buddhism, Christianity, Hinduism, Islam, Judaism, Mormonism and “Other Spiritual or Religious Affiliations.” I did a search for “Islam” in Atlanta and got six professionals. Not a lot, but…

Other culture- or faith-specific resources

• The Altruist: This India-based organization from mental health advocate Milesh Hamlai pioneered the country’s Dava and Dua (Medicine and Prayer) model, one that brings mental hospitals, faith healers and families of mentally ill patients together. Read about its success here.

• Asian American Christian Counseling Service: A California-serving nonprofit that believes “faith experiences are diverse and the expression of faith is complex. For this reason, Scripture and prayer are offered only with informed consent.”

• Christian support groups across the country, courtesy of NAMI.

• Institute for Muslim Mental Health: Committed to optimizing the Muslim community’s emotional health and well being. Offers a network of mental health professionals working to ensure all American Muslims have access to high quality resources.

• Khalil Center: Ninety percent of the Khalil Center’s 2,000+ annual patients come to the organization for spiritually integrated psychotherapy. While clinicians predominantly focus on contemporary issues facing American Muslims, services are not exclusive to any specific community. (Bay Area, Chicago, Los Angeles, New York and Toronto)

• Relief: A non-profit organization geared specifically toward members of the Jewish community who are dealing with mental health issues.

• SEEMA: This group, co-founded by three Pakistani-American sisters and named in honor of their mother, offers “support groups, educational workshops, social activities, and access to professionals, to eradicate mental health stigma within the Muslim community.”

• Sikh Your Mind: A UK-based organization made up of clinical psychologists, social workers, therapists and other experts working to address mental health issues affecting the Punjabi Sikh community.

Erasing stigma in your congregation and community

• General tips from MentalHealth.gov to get you thinking.

• Read about how churches are addressing mental health needs in the black community. (NYU Steinhardt)

• NAMI FaithNet: An interfaith resource network of National Alliance on Mental Illness members, friends, clergy and congregations of all faith traditions who are welcoming and supportive of persons and families living with mental illness.

• Also from NAMI: A list of activities, prayers and invocations created in collaboration with faith communities and secular organizations to dispel myths and stigma about mental illness.

• Faith leaders, this American Psychiatric Association guide can help you learn about being more inclusive; understanding how and when to make a referral to a professional; dealing with resistance to treatment; distinguishing spiritual/religious problems from mental illness and understanding how best to approach someone with an urgent mental health concern.

• Learn how to deliver effective behavioral health and community-based social services with these training and technical assistance programs from the Substance Abuse and Mental Health Services Administration.

• For faith leaders interested in mental health ministry: Learn about Pathways to Promise, an interfaith co-op providing training, consultation and other resources for faith groups.

For clinicians

• Developing Cultural Competence in Clinical Practice (sorry, paywall!) by Julie Benbenishty, Hadassah Medical Center

• Faith, Spirituality, and Medicine: Toward the Making of a Healing Practitioner by Dana E. King, MD (New York, Haworth Press)

• General tips on addressing spirituality and religion through patient care, including the HOPE questionnaire used in some medical institutions today (Hopkins Medicine)

• Health care providers’ handbook on Hindu patients (Australia-based government resource; useful for all)

• Practical tips for working with Muslim mental health clients (Institute for Muslim Mental Health)

• Working with Latino/as in counseling: This article very generally addresses the role of faith in Latinx communities. (Counseling Today)

And in general, for all: Consider getting trained in mental health first aid.

Do you know of a specific faith- or group-based organization/program I can recommend? Please, please share.

Let’s talk about sex (and other things)

Here are some topics we’re excited to cover in the coming months. Reply to this email or send a message to 4nbodies@gmail.com if you want to share your relevant experiences for a future issue!

• BODY HAIR x MENTAL HEALTH: If you, like me, have been body-hair-shamed on the playground, the bedroom or in your own home, LET’S COMMISERATE. This one will take a look at relationships with body hair/image/Western beauty ideals and self-esteem.

• CHASING A CREATIVE CAREER/NOT BECOMING A DOCTOR lol: Are you an immigrant/child of immigrants with a penchant for the arts as a career? Has the revelation torn your family apart, affected your mental health? Whether or not you’re established in the creative field or still dreaming of getting your foot in, would love to chat. This goes for careers in writing, film, music, painting or whatever else you consider art. 

• SEXUAL HEALTH (MASTURBATION FOCUS) x STIGMA: Are you someone who grew up ashamed of masturbating? How did you first learn about it/try it? Let’s talk about the historical/religious/patriarchal/cultural taboos of loving on ourselves.

In “Are You Looking to Buddhism When You Should Be Looking to Therapy?” C.W. Huntington, Jr. writes about the conflation between Buddhist practice and psychotherapy. “It’s essential that we appreciate the critical difference between how mindfulness is used in the context of modern psychotherapy and how this same meditative technique has traditionally functioned as an indispensable element of the Buddhist path to enlightenment (nibbana).” Read here.

This painfully gorgeous essay from Shaheen Pasha for Narratively is a must-read. God “wouldn’t have brought me into the world just as Daddy’s mental illness began to spiral out of control, when he was still a young man, not even 40 yet. God wouldn’t have done all of that if he didn’t plan on making it better. We just had to wait. And hope. And pray.” Read here.

“Psychiatry and communities of faith don’t have to be mutually exclusive.” In this Psychology Today editorial brainstorm, Laura Lee Huttenbach speaks to Muslim Americans fighting mental health stigma. Read here.

For Patheos, Ambaa Choate, a Hindu living with clinical depression, wrote about attending her Sri Shiva Vishnu Temple’s mental health panel. Read here.

“While Jews were instrumental in establishing the field of psychology, the Jewish community is not always comfortable dealing with those who suffer from psychiatric conditions.” A wonderful My Jewish Learning newsletter post on Judaism and mental illness. Read here.

Ahem, hello. It’s Fiza. Enjoying your read? Tolerating it, at least?

I have a few updates to share, which I detailed here, too.

First of all, welcome to Substack! I’m slooowly transitioning out of the old CMS, primarily because I prefer the interface and public- and free- subscriber options.

On that note:

I wanted to let everyone know that Foreign Bodies will remain free for subscribers through December 31, 2019, thanks in large part to a yearlong fellowship grant from The Carter Center. But to realistically sustain a thoughtful, quality product for readers from then on, I’ll need some help covering research, writing and domain costs.

So in 2020, I’ll be switching things up a bit to ensure the newsletter can live on within my humble freelance writer’s budget, which means I’ll be asking for a small monthly fee ($1 to $3) from subscribers for access to our monthly letters—plus some fun giveaways! Keep an eye out for the first subscriber giveaway on Friday, Nov. 1.

All that being said, this newsletter was created to help fellow immigrants navigate their mental illness and feel a little less alone in this big bad world. So if you're a student, or if you find the cost in any way prohibitive, email 4nbodies@gmail.com and we’ll figure something out.

Questions/comments/concerns/dog pics? Please share. In the meantime, tell your friends and family about us. Let ‘em know why we’re worth keeping around.

Love,
Fiza, Lady (+ Scamper, not pictured)

p.s. Happy Halloween! /^(o.o)^\

That’s supposed to be a bat.

Foreign Bodies is a monthly e-mail newsletter dedicated to the unique experiences of immigrants and refugees as they relate to coping with mental illness and wellness. It’s written and curated by Atlanta-based writer Fiza Pirani with copyediting and fact-checking help from New Jersey-based independent journalist Hanaa’ Tameez. Want to contribute your time or share your own #ForeignBodies story? Send an email to 4nbodies@gmail.com or say hi on Twitter @4nbodies. Special shout-out to Carter Fellow and friend Rory Linnane for the adorable animated logo!

If you're thinking about suicide or worried about someone who might be, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 741741 to connect to a crisis counselor. You can also find a wealth of culture- or language-specific recommended resources on our site, foreignbodies.net.

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Last winter, my mom returned to Karachi, Pakistan, for the first time since her father passed away 25 years ago. She and her former medical school classmates were hosting a reunion party for students from three graduating classes, all of whom were robbed of their commencement ceremony, largely due to street riots back in the day. My mom led the effort to reserve navy blue gowns and mortarboards for all attendees.

We FaceTimed every day, multiple times a day. I wanted to know everything. Was she having fun? How was the food? What were her friends like? But there was only one thing on her mind.

"It's just not the Pakistan I remember."

The entrance to her school was unrecognizable, she says. When she arrived on site, she thought she'd given the driver the wrong address. The trees were gone. There was barely any pavement. The dense air had always been troublesome, but the pollution felt thicker on her skin, in her eyes.

I tried to change the subject, get her out of a funk I wasn't used to seeing her in.

"But you're with friends! How are they? Do you have plans tonight?"

I realize now how little time I gave her to grieve the loss of a memory, and I wonder how often she thinks about the land she once knew, how her kids may never get the chance to really grasp the magic of it.

The conversation with my mom kept playing in my head as I read about 16-year-old Swedish climate activist Greta Thunberg, who was making her way by boat from the United Kingdom to New York just in time for the United Nations Climate Summit.

A year ago, Thunberg began striking from school each Friday to protest global climate inaction. This month, she addressed world leaders at the UN.

"How dare you? You have stolen my dreams and my childhood," she reprimanded the so-called grownups.

Thunberg's gusto and unrelenting frustrations inspired massive protests around the world, including in Pakistan, which has been listed as the seventh most vulnerable country to be affected by climate change.

Last fall, the UN's Intergovernmental Panel on Climate Change said the world must act quickly to adjust energy, transportation and other systems and hold warming below an increase of 2.7 degrees Fahrenheit.

Why? Well, for anyone who's been out of the loop, NASA has a breakdown of several potential implications of warming, many of which are already impossible to overlook: more heat waves, stronger hurricanes, rising sea levels, compromised ecosystems, lack of drinkable water, massive human displacement and so on.

"The axis along which almost all climate change anxiety orients is, by necessity, pointed toward the future," Omar El Akkad, who grew up in Qatar and returned to find its landscape transformed, wrote for LitHub. "We have framed climate change as a crisis of the future because its worst ramifications are still to come, and because the future is something we feel we can still control."

But have we thought about how climate change will upend our pasts?

"In the great undoing that is climate change, there is born an entirely new means by which one dispossessed generation can say to the next: your home used to be here and it was taken from you unjustly," El Akkad writes. "It was the sea or the storm or the drought that buried it but it was something else that killed it—its killer was a system, an institutionalized greed, an infinitesimally small bump upwards in the wealth of the already wealthy.

"We must create new ways to think about what comes next, but also about what came before," he adds. But how?

El Akkad admits some of this work to become conservationists of memory will fall on historians and researchers, but, more than ever, the burden is on artists, on the world's storytellers.

"We have an obligation to document and preserve this compendium of fiction, these stories we tell ourselves. And we have an obligation to do it now, meticulously, because the stories and the empathy they engender might save us still, might move people to act."

As someone who didn't grow up in a home of sustainability ethics, as someone who never thought twice about buying plastics and taking unspeakably long showers, a good story is exactly what it took for me to reassess my own daily habits and drive me to outrage. For me, climate anxiety was debilitating before it became constructive.

But what's been propelling me has, admittedly, been the upending of the future. Not once have I considered the potential loss of culture, of history, of documented truth.

I don't know what it's like to return to the past and find it unrecognizable, largely because I'm not sure I'll ever have the kind of connection to a land or town the way my mom and other immigrants who fled their homelands at a later age have. I'm also highly aware that the grounds I've called home for most of my life now are causing the bulk of the globe's problems, yet we will be among the last to reap the worst.

What could this potential loss of our past mean for my generation and for future immigrants? How might the transforming landscape, the growing physical disconnect from our original roots influence our sense of identity, our sense of appreciation for heritage?

Is it on us—the immigrants and children of immigrants of today—to keep a closer eye on our descendants' lands and histories, to appreciate and document it all before the world inevitably metamorphoses?

Deep breaths.

Climate change and mental health: What's the connection?

So.

In general, disasters related to extreme weather can cause significant stress and distress. Extreme heat has been linked to increased alcoholism, domestic violence and suicide deaths. And those with mental health disorders are disproportionately impacted by the consequences of climate change. (APA)

In this study, researchers at the University of Newcastle in Australia found that more and more people who haven't yet directly experienced the impacts climate change are also suffering; they're getting anxious about the effects of global warming and governmental inaction.

While there’s no clinical definition for this phenomenon, it’s often referred to as climate/eco-anxiety or solastalgia, “the distress that is produced by environmental change impacting on people while they are directly connected to their home environment.”

Those with solastalgia or eco-anxiety often experience psychological responses similar to patients with general anxiety disorder, such as conflict avoidance, fatalism, fear, helplessness and resignation. Eco-anxiety can also be coupled with survivor’s guilt, which we addressed in .

Eco-anxiety x immigrants: From “climate apartheid” to potential ethnocide

One of the gravest effects of climate change is on human mobility and migration. Regions at highest risk of displacement—sub-Saharan Africa, South Asia and Latin America—face concerns over their survival and security. Experts warn this unequal distribution of climate change impacts puts the world at risk of a “climate apartheid,” in which “the wealthy pay to escape overheating, hunger, and conflict while the rest of the world is left to suffer.”

Regional cultural identities are also under threat.

What happens if we lose our tongues and cultures?

There are the tangible cultural losses of extreme weather: buildings, monuments or burial sites, for example. And there’s the intangible, like oral traditions and languages. According to the Linguistic Society of America, while approximately 7,000 languages are spoken in the world today, only about half are expected to survive this century, primarily due to globalization, persecution of minority groups, and, yes, even climate change.

The loss of a language can impact the “health and vitality of a community for generations to come,” according to Canadian linguist Anastasia Riehl. “It is a loss of knowledge about the world as well, as when descriptive names for plants or practices — still unknown outside a local area — are forgotten.”

A progressive or sudden loss of cultural norms (like languages), religious customs, or social support systems all heavily influence rates of mental illness.

This kind of cultural bereavement, which involves reactions similar to grief, has been associated with psychotic, anxiety and mood disorders. If migration is a result of forced displacement or trauma, you’re also dealing with increased risk of post-traumatic stress disorder.

Maintaining or building a sense of new identity, scientists say, is another compounding factor among migrants reeling the potential loss of their culture or home. The pressure to acculturate (or adapt) in a new region may lead to low self-esteem. Deculturation, or the complete loss of cultural identity, can amplify feelings of isolation and depression. It can also ultimately result in ethnocide, or the systematic destruction of an entire group.

Have you read a study that debunks or perpetuates some of the experiences you've read in this issue? Send to 4nbodies@gmail.com!

How can we preserve culture as climate change uproots our communities?

Ultimately, the vanishing or transfiguration of our homelands, whether due to globalization, war or climate disaster, feels inevitable. And for many of us, the landscapes of our pasts have already dramatically distorted. How do we keep our cultures from fading away?

I can’t say I have an overarching answer to this massive question, but the more I think about potentially disconnecting from my geographic origin or culture, the more I want to make sure I document my family’s history in excruciating detail. I want to book my trips to India and Pakistan and inhale what’s left of my parents’ memories. I want to learn how to read and write in Urdu and Gujarati and even Arabic and eventually learn how to cook the perfect roti from scratch.

In general, if you’re dealing with mental distress or paralysis over climate change, consider speaking with a professional + find ways to take action, big or small.

Any kind of proactive move can help ease anxiety, according to Susan Clayton of the American Psychological Association. That might mean getting involved with environmental groups, protesting, adopting a predominantly plant-based diet, advocating for more green space in your neighborhood, writing your representatives or running for office yourself.

For the politically inclined, Victoria Herrmann of the Arctic Institute suggests pushing for the inclusion of cultural heritage into your city’s climate change policies:

"City climate change policies can allocate resources to document with dignity the historic sites, traditions, and cultural assets damaged or left behind by newly arrived climate migrants,” she wrote in June. “This can take the form of small to medium grants for documentation of cultural assets to local museums, nonprofit groups, universities, and art centers in cities. Such a low-cost migrant heritage grant program embedded within climate change policy creates a number of co-benefits beyond the preservation of important cultural practices and assets of migrants. The creation of oral histories, exhibits, and other forms of documentation can simultaneously educate on climate change, build social connections between city institutions and migrants, and foster a sense of inclusivity and belonging in their new home.”

Want some #inspo? Check out these innovative preservation strategies already playing out (via Christian Science Monitor):

• In Syrian refugee camps in Jordan, "residents are being helped to plant gardens to help them settle in – and being given seeds specifically of the familiar herbs they used to grow at home."

• "In Iraq, ancient buildings threatened by Islamic State extremists have been preserved digitally with 3D scanning equipment that can help project or reproduce an exact model of a building. This technology could also 'save' important buildings threatened by erosion, flooding or other climate impacts."

Peruse the UN’s “Preserving intangible culture for future generations” page for more creative approaches from around the globe.

Do you have any tips or resources you’d like to share? Send to 4nbodies@gmail.com.

DOES THIS ISSUE SPEAK TO YOUR SOUL?

Sorry for the all caps lol but I'm looking to speak with immigrants who identify as climate activists (either professionally or personally) + immigrants who worry about the implications of climate change on their home countries and cultures for an upcoming news feature.

Respond to this email or reach out to 4nbodies@gmail.com to chat! - Fiza

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For LitHub, Qatari journalist and author Omar El Akkad wrote this wrenching personal narrative on returning to the vacant lot where he snuck his first kiss and finding it unrecognizable. He wrestles with the realization that within the next century and possibly within his lifetime, Qatar’s landscape itself become uninhabitable. Read here.

Activist and scholar Leanne Betasamosake Simpson’s 2017 book, As We Have Always Done: Indigenous Freedom Through Radical Resistance, could teach us a thing or two about how indigenous peoples have persevered in the face of “continual ecosystem and species collapse since the early days of colonial occupation,” writes Malcolm Harris for Pacific Standard. In an ideal world, perhaps the text would empower an anti-colonial approach to limited territory. Read here.

“Brazil’s indigenous Manoki have been watching fires tear through their ancestral land for weeks, fearing the devastating damage to their forests may mean the end of their cultural heritage as well,” Vice reporter Sarah Sax wrote in September. According to tribe member Giovani Tapura, only eight of the remaining 400 Manoki still speak the native language. Read here.

In Greenland, up to 70% of organic material in Viking-era Norse settlements is at high risk of melting away by 2100. “When we lose certain kinds of materials, and especially the organics, we actually erase the experience of certain kinds of people,” says archaeologist Douglas Bolender. Similar losses are occurring in Russia, Canada and Alaska. “Among Arctic archaeologists, there is already a sense of mourning,” writes Stephanie Pappas. Read here.

“Many indigenous cultures worldwide have spiritual beliefs, ethical values and/or traditional practices that are directly linked to the environment,” according to D.K. Pandey of India’s Central Agricultural University. His research, reports Monga Bay’s Sahana Ghosh, adds to a growing body of work linking biodiversity and mental well-being. Read here.

“Inuit are people of the sea ice. If there is no more sea ice, how can we be people of the sea ice?” In this 36-minute documentary titled “Lament for the Land,” five communities of Nunatsiavut (Canada) acknowledge a crisis of culture and identity amid ecological loss. Watch here.

Foreign Bodies is a monthly e-mail newsletter dedicated to the unique experiences of immigrants and refugees as they relate to coping with mental illness and wellness. It’s written and curated by Atlanta-based writer Fiza Pirani with copyediting and fact-checking help from New Jersey-based independent journalist Hanaa’ Tameez. Want to contribute your time or share your own #ForeignBodies story? Send an email to 4nbodies@gmail.com or say hi on Twitter @4nbodies. Special shout-out to Carter Fellow and friend Rory Linnane for the adorable animated logo!

If you're thinking about suicide or worried about someone who might be, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 741741 to connect to a crisis counselor. You can also find a wealth of culture- or language-specific recommended resources on our site, foreignbodies.net.

In the days leading up to my trip to New York earlier this month, I woke up with blood on my pillow.

Apparently, I'd been biting my lower lip in my sleep. My lips were swollen, I felt uneasy, fidgety, anxious and just ugly. No medications or ointments were helping. Then came the headaches, further aggravated by the newsroom's fluorescent bulbs. I stopped coming into the office and worked under the dim lighting of my bedroom.

The heart palpitations followed, triggered by the headlines of the day. I didn't have the energy to cope with the onslaught of news, so I kept saving stories to read "later." I’ve yet to get to them.

But worst of all, I could feel my spinal nerve injury preparing for a comeback.

One fall day two years ago, feeling a bit dizzy, I left work early and fell asleep before 5 p.m. When I opened my eyes, I instinctively attempted to reach across my bed to check the time on my phone, which sat on the bedside table to my right. I sleep on the left. My fingers were tingling, and I couldn't move.

Maybe if I rolled over, I thought, I could make it from the bed to the ground, crawl over to my phone and call for help. When I tried, an excruciating pain shot down my back like bullets of wildfire aiming at the vertebrae along my spine. As the fire finally struck my tailbone, I jolted. Before I could even muster up the strength to make another move, I had passed out.

I don't know how long I was in the dark. It could've been half a millisecond, maybe a minute, maybe 20. But when I woke up from the strange fainting, my puppy’s body felt warm and heavy lying on my chest, like she'd been on top of me for a while. She began incessantly licking my face in panic as I flinched. Her unsettling whimpers eventually turned to squeaky, joyous howls as I whispered, "Hi, gorgeous," the morning greeting I'd been using on her since she was just a five-week-old ball of fluff. How long had I been out?

I finally managed to crawl to the bedside table and pick up my phone. It was a little after 10 a.m. the following day. I immediately called my mom.

The pinched nerves in my coccyx, or tailbone, were all induced by stress, doctors said. I had no other underlying medical issues of concern.

This was around the time the President of the United States ended the DACA program, around the time Hurricane Maria had devastated Puerto Rico and our government failed to help our fellow countrymen. I was also in the middle of interviewing a father coping with the suicide death of his teenage daughter.

Ever since I died and came back to life—as I tend to remember the coccyx injury—I've been obsessed with managing my posture and prioritizing comfort while working. I bought a standing desk, a desk cycle, wrist splints and typing gloves. I keep a coccyx pillow in my car, one at work, one at my parents' place and one in my apartment. I have a foldable one for travel. It goes to coffee shops with me, sometimes even to lengthy interviews. I also book at least one back massage every couple of months.

My friends, coworkers and family tend to joke around about the lengths I'll go just to feel comfortable. And I get it. Typing gloves? What the hell are typing gloves? (They're just fingerless gloves). My hands freeze up sometimes and the pain is unbearable. Cold office temperatures make the chronic pain worse. The dumb fingerless gloves actually help. I try to make light of all this, chalk all my "self-care" purchases and habits as my being, well...extra, a little selfish even. I can imagine my parents rolling their eyes. I constantly feel guilty for doing so much for myself.

But in all honesty, I'm just trying to keep up.

I am so afraid my body will give up on me again and that next time, maybe I won't reopen my eyes. When you deal with bouts of depression, your mind has a way of disappointing you when you least expect it. If my mind and my body both fail me, then what? What’s left of me?

My family and I left for New York just a few days after the mass shooting at a garlic festival in Gilroy, California. I remember being in so much physical pain that week. In a span of just 10 days, I'd booked three massages and purposefully ignored my bank account.

Faiz and I had tickets to a Saturday afternoon showing of Aaron Sorkin's "To Kill A Mockingbird" on Broadway and I was eager to sip on some Pinot Grigio, turn my phone off, and get lost in the arts.

By intermission, my mascara proved unworthy of its waterproof label. I looked around and realized I was the only one sobbing uncontrollably, and that made me feel even worse. Strangers asked if I was alright. My brother didn't know what to say, what to do. I've always internalized pain to an extent he never quite understood. The arts (and the wine) let me spill, I guess.

After the show, I turned my phone back on. It was a little after 4 p.m. on August 3.

The number of victims eventually skyrocketed to 22.

"Did you hear about El Paso?" my brother asked as we settled back into our hotel room.

"Yep."

I kept to myself, put on a smile for my parents and joined them for dinner.

The next morning, I woke up lightheaded, my back in pain, my lips bloody and swollen. I walked down to the hotel lobby. Engrossed, guests held the The New York Times' El Paso coverage in their hands as CNN's chyron spelled out the loss of another nine lives overnight, this time in Dayton, Ohio, on all three lobby TVs.

I haven't had news notifications or news apps on my phone for a couple of years now, so I didn't know about the second shooting until I walked into the hotel lobby that Sunday morning. I fell deeper within myself, but didn’t let my body react.

When I hugged my brother goodbye the following day, I was ready to erupt.

"Here, a valid excuse!" my brain justified to the rest of my body as its audience. "You're dropping your baby brother off. Sure, you've lived without him for over a decade and not once have you felt living apart hurt your close relationship, but if you cry now, it's like...normal! Right?? Like, you...love him a lot and will miss him! THE TIME IS NOW. CRY!!"

I sobbed like a maniac as we called a cab to the airport. My parents were confused. Faiz was confused. My brain understood.

The three of us landed in Atlanta that evening, and I drove back to my apartment. Around 4 a.m., I texted my mom.

"I think I’m going to take some time off from work, ease into a different role," I wrote, shocked by how quickly my fingers were able to hit send.

I told my mom I think the news industry might be taking a toll on my health. That I’m not itching for life, and I might be itching for the opposite instead. That I need to spend my time really writing, on my own. To heal, to create, to be. I finished each sentence off with a reassuring “I don't know.” I know it's not just the industry to blame. It's everything. The rhetoric. The helplessness. And so on.

After sending the text, I breathed for what felt like the first time in days and tried to shut my eyes for a couple of hours, knowing I wouldn't be able to properly sleep until I got more closure.

It's not like me to make rash decisions. I’m not a risk-taker and tend to weigh the pros and cons and "see all sides" to the point that I find myself playing devil's advocate with what I know and feel is right.

"What am I doing?" I thought to myself. "Why would I leave a full-time gig with benefits at a legacy newsroom for...for the unknown? Is this a mistake? Am I just weak? Why can't I handle this?”

I called upon a leader I trusted in the newsroom. Before she even sat down in the conference room chair across from me, I broke down.

Again, very unlike me.

She told me to get out now, to make the decision soon, before I changed my mind. Nothing in the world is more important than taking care of my health, she reminded me. The next morning, I told my boss, and that was that. My last day at The AJC: Friday, Aug. 30.

I haven't been in physical pain since I gave my notice three weeks ago, and that says something, I think. My body feels invincible, my brain unclogged. My lips, by the way, are completely healed.

I am excited for the first time in ages, eager to do more, whatever "more" might look like. I can't wait to just write, to feel less burdened after every headline, to have more time, to express myself, to just be.

The uncertainty doesn’t scare me.

Is this what it's like to want to be alive? Did I just need to leave a sense of "stability" behind to get hungry for life again?

"Or," a ghost whispers in my ear, "are you just taking the easy way out? Are you simply too weak to handle pain? Where’s your resilience? Will you always let your depression control you?"

At the end of the day, we're all struggling, aren't we? Some more than others, sure. But we can either find viable ways to cope, or do nothing. Trust me when I say I know I'm privileged. I do not have children to care for, and if in six months I can't support myself financially, I have people to lean on.

But as someone who's had no real thirst for life since she was a teenager, if letting my depression control me means cutting the cord from stressors that keep me from wanting to live another day, from feeling strong in my skin, I'll gladly let it pave the way.

There is, however, one aspect of all this risk-taking that's letting the ghost of guilt tiptoe closer to my ears.

And that's the guilt that comes with being an immigrant, a child of resilience. As immigrants, we're taught to power through when the going gets tough. That's how we've survived as a people. Other minorities and groups with limited power can relate, I'm sure.

It's that "keep your head down and do your work" mentality, my friend Sonam Vashi wrote to me in an email. A mentality that applies “to a lot of different immigrant groups, but particularly ones who feel like they're 'lucky' to be in the U.S. and were afforded an opportunity that their communities back home weren't."

I feel that to my core. I am lucky.

"There's much to be celebrated about that humble way of thinking," Sonam says, "but it's also unrealistic—and harmful—to go through life thinking you can do it alone."

She's right.

It's that mentality of private resilience that's kept our elders and previous generations from asking for help and potentially embracing a happier, more fulfilling and healthier life. It might even contribute to generational resentment, to the constant debate around: Do we deserve to put ourselves first if our parents didn't get the same chance?

I felt the universe was reaching out to me in a way, because just as I was writing this all down, I found this story from journalist Kimberly Lawson, a fellow Georgia-based writer who left a salaried newspaper position to take the full-time freelance plunge. Mostly, she said, she was just unhappy.

“My mom, of course, couldn’t wrap her head around the idea of me voluntarily leaving the security of a regular staff position — with benefits, mind you — for work that was so unpredictable,” Kimberly wrote. Her mom suggested she go back to school instead.

Like Kimberly’s mom, my parents, too, have fallen under the impression that racking up academic degrees will somehow lead to better-paying work no matter the industry.

“Rather than try to understand why I didn’t want a PhD… or the reasons behind me taking this leap of faith to work for myself, she said nothing,” Kimberly wrote. “She never asked about the stories I wanted to write, how I thought I was going to get assignments, or even what I planned to do if this didn’t work out.”

Even as Kimberly’s freelance business began to succeed, she could feel the growing disconnect between her and her mother, their silence “so deafening that I didn’t even bother to tell her about my first New York Times byline last year.”

This isn’t uncommon in immigrant families, Angie Y. Chung, sociologist and author of Saving Face: The Emotional Costs of the Asian Immigrant Family Myth told Kimberly.

“Part of it has to do with the context in which people live their lives,” Angie says. “Immigrants usually leave their home countries for a profound reason: war, poverty, persecution. They’re often looking for a way to give their children better opportunities in life.”

Many immigrant parents don't think to prioritize emotional satisfaction, personal happiness or fulfillment the way their children have learned to desire in contemporary America.

For them, it was just about surviving.

“Even if they become successful themselves,” Angie said, “they can’t get out of that mentality, because, again, they sacrificed a lot to get to that point. Because of that, they don’t understand our need for personal fulfillment. They still see this antiquated version of their homeland country, where it was always about survival and competition.”

Kimberly still worries she’s disappointed her mom by choosing a career that won’t necessarily guarantee the big bucks.

“As one second-generation interviewee in Chung’s book said about feeling obligated to repay his parents for their sacrifices, ‘You want them to think that what they did had some meaning and you don’t want to be a fuck-up.’”

Kimberly wants her mom to know and feel “her sacrifices made a difference, not only in my own life, but maybe also in the lives of the people who learn something from my stories… I wouldn’t be where I am today without her.”

My mom has always had an open mind since she was a kid, and she was incredibly supportive of my decision to quit. My dad isn't in the exact headspace; He’s quite vocal about his doubts and I think it’ll always be an uphill battle trying to prove to him I’ve got what it takes to succeed.

But despite hinting at going back to school and getting a PhD (in what exactly, I don’t know), even he was surprisingly supportive. “You seem really excited,” he told me. I have been visibly enthusiastic since making my decision.

“Maybe one day I’ll get you to actually read my stuff,” I said, only half joking.

As news of my leaving spread around the newsroom, colleagues have asked where I'm headed next, some expecting me to say I've got a great gig lined up with better pay, better visibility, more power. I knew to expect that reaction because it’s the exact reaction I’ve given anytime someone left a full-time job in journalism. These gigs aren’t easy to get or keep, as folks in the industry know.

But no, nothing of the sort. I’ll be writing a lot more, spending time on stories and people I care about. Making room in my life for pleasure. Creating art. Maybe actually going back to school for my MFA, not because my parents will be outrageously elated, but because I think it’s time for some structured learning. I’ve got books to publish and places to see. Maybe I’ll move abroad. Maybe I’ll stay right here in Atlanta. Maybe I’ll become a digital nomad with a 60-pound mutt sidekick.

I honestly don’t know what the future holds, but I can’t explain how reinvigorating it feels to actually see a future for myself at all.

Guilt and mental health: What's the connection?

What exactly is guilt?

Guilt, considered one of the “sad” emotions along with agony, grief and loneliness, “follows directly from the thought that you are responsible for someone else’s misfortune, whether or not this is the case,” according to Psychology Today.

From a cognitive approach, people who suffer from chronic guilt or feel guilty on a regular basis “mistakenly suffer under the illusion that they have caused other people harm.”

Guilt and mental well-being

Guilt often leads to self-doubt, shame and overall lower self-esteem. It’s also common for those feeling guilty to struggle with concentration, productivity, creativity and efficiency. It brings out “The Dobby Effect,” which Psychology Today refers to as “a psychological tendency for people to employ self-punishment to ward off feelings of guilt.”

People with mental illnesses often feel guilty just for having a mental illness. This has to do with the idea that you’re burdening your loved ones with your pain. People with bipolar disorder and major depression may have heightened levels of guilt during their depressive episodes.

There are multiple types of guilt, but the one today’s issue focuses on is called survivor’s guilt.

Survivor’s guilt

A majority of first-gen immigrants leave home and go to college to “repay” or help out their families. While many are labeled “savior” or “delegate,” students also struggle with what’s called breakaway or survivor’s guilt, conflicted feelings that their “desire for education and upward mobility may be viewed as a rejection of their past,” not to mention the guilt of physically leaving loved ones behind. (London, 1989)

Other studies have reiterated that: “An emotion central to key motivations in the migration process is guilt. In the words of one migrant daughter; ‘Guilt, guilt, guilt is what all migrants face!’” (Baldassar, 2014)

More research:

• For undocumented Latino youth, compounding guilt, anxiety and despair is becoming increasingly common in America’s volatile anti-immigrant climate where their futures are already at risk. (Vargas and Ybarra, 2017)

• Documented immigrant students safe from deportation have “a hyper-awareness of the vulnerability of loved ones,” a survivors’ guilt that can interfere with their education. (UCLA)

• Refugees who survive traumatic events like war or illness often experience survivor’s guilt that can lead to issues that keep them from positively settling into a new society. (Simich and Andermann, 2014)

• In general, children who show excessive guilty behavior may be at risk for a host of mood disorders in adulthood. “Children whose parents used guilt-inducing tactics were far more likely to internalize their problems.” Depression and anxiety are both examples of internalizing disorders. (Belden, Barch and Oakberg, 2015)

• A generational outlook: Immigrant parents are known to be primarily concerned with making the best of a new environment and retaining traditional family life, and that leads them to focus on the future, emphasize discipline and scholastic achievement. When children respond to these demands “in an unexpected way,” parents wonder, “Can’t they understand that I wouldn’t have chosen a life here if it hadn’t been for them? What should I do to keep my children from losing their cultural roots and from assimilating too much?” (Zhou, 1997)

Note: There is much more academic research on adult immigrants and less on their offspring or subsequent generations. Have you read a study that debunks or perpetuates some of the experiences you've read in this issue? Send to foreignbodiesnewsletter@gmail.com!

What can you do if you're struggling with survivor's guilt?

As I mentioned above, it’s normal for people with mental illnesses to feel guilty or fear you’re burdening loved ones with your pain. If you struggle with this, HealthyPlace Medical Director Dr. Harry Croft suggests asking yourself this question:

Am I truly responsible for what happened?

No one is responsible for simply having a mental illness.
If you’re dealing with survivor’s guilt and that’s compounded with a mental illness, work on upping your confidence. According to Healthline, doing so ultimately helps prevent self-blame.
What can you do to build more confidence? Here's what I've gathered from Healthline and from personal experience:

• Get to know yourself.

• Give back.

• Slow down and unplug.

• Celebrate small victories.

• Take extra care of your personal hygiene and don't be afraid to pamper yourself every now and then.

• Recognize who isn't adding kind energy to your life and consider spending less time around them. This also goes for workplaces.

• Talk to your parents or loved ones.

• Therapy, therapy, therapy...

Have any practical tips I can share with the group next time? Send 'em my way!

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I mentioned this one up above, but take some time to read Kimberly Lawson’s essay “My Korean Mother Doesn’t Understand My American Success” for ZORA. It’s lovely and I still can’t believe how it found me just when I needed it. Read here.

Survivor’s guilt can keep you “solely in survival mode,” as Laura S. Veira-Ramirez wrote in a column for The Harvard Crimson. It can worsen your mental health by keeping you from talking about your problems with family. “I struggle with my self-care, as I keep my struggles silenced: I’m used to minimizing them, since it always feels like there’s somebody who has it worse. That’s the mentality I grew up with.” Anytime there was a tragedy in the news, Laura’s mom reminded her to be grateful for their lives. But that’s invalidating. “One person’s suffering shouldn’t erase someone else’s.” What we need to keep in mind, as Laura realized, is her mom’s reactions were just coping mechanisms. “She doesn’t have the same access to mental health support that I do now.” Read here.

“No matter how flawed it is I keep thinking that I can power through it, fix it, push through. But I rarely take the time and actions to fix the damn thing. I’m still here. I won’t give up. And that’s how boxers go brain dead.” I love this stream-of-consciousness post from Asian American Hyun Kim, “The Courage to be Courageous.” It’s quite fitting with today’s theme, I’d say. Read here.

In “I Make More Than My Immigrant Mom Ever Has. But I Can Never Repay Her,” Matt Ortile talks candidly for BuzzFeed News about the guilt of succeeding or chasing the opportunities of generations past. “Once, my mother told me that I’d wound up living her own dreams. In Manila, she’d wanted to work in media, but her mother had insisted there was no money in it… I have ‘a better life’ only because my mother placed hers at the American altar. That tang of guilt is how my own immigrant privilege tastes.” A must-read. Read here.

Lots of great stories here in this Bustle piece highlighting 10 first-gen women going against the grain. “With my dad, we actually had more issues when I decided to quit my corporate job. He said that I had all this stability: a near-six-figure salary, health insurance, and more. It makes sense he would crave a steady income and predictability considering what he had to do so I could have the opportunities he wished he had growing up,” says aspiring lawyer-turned-wedding planner Michelle Perez. Read here.

“Every night I unceasingly feel like I should be doing more. Mentally, financially, and creatively. Are my choices good enough?” Julia Khait Bruce, a first-gen immigrant whose parents escaped the anti-Semitism of the former U.S.S.R for a better life in San Francisco, writes for Kveller.com about feeling guilty for choosing to be a stay-at-home mom. Read here.

ICYMI... Meet our new copyeditor, Hanaa’ Tameez!

Hanaa’ Tameez is an independent multimedia journalist based in New Jersey. She helps fact-check and edit the newsletter. Hanaa' was previously the diversity reporter for the Fort Worth Star-Telegram in Texas where she covered race, identity and social equity. She holds an M.A. from CUNY Graduate School of Journalism with a concentration in bilingual journalism. She has previously worked for Animal Político and The Wall Street Journal in Mexico, Americas Quarterly and The Council on Foreign Relations in New York and the Green Bay Press-Gazette in Wisconsin.

love from lady (and scamper!)

Foreign Bodies is a monthly e-mail newsletter dedicated to the unique experiences of immigrants and refugees as they relate to coping with mental illness and wellness. It’s written and curated by Atlanta-based writer Fiza Pirani with copyediting and fact-checking help from New Jersey-based independent journalist Hanaa’ Tameez. Want to contribute your time or share your own #ForeignBodies story? Send an email to 4nbodies@gmail.com or say hi on Twitter @4nbodies. Special shout-out to Carter Fellow and friend Rory Linnane for the adorable animated logo!

If you're thinking about suicide or worried about someone who might be, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 741741 to connect to a crisis counselor. You can also find a wealth of culture- or language-specific recommended resources on our site, foreignbodies.net.

It seems I officially gave up on India on June 29, 2011, the day I renounced my citizenship for the nation I'd called home (at least on paper) for 16 years.

I remember the swearing-in ceremony, sitting next to my mother and father amid rows of fellow migrants, all of us glued to the plastic black folding chairs, our mini red-white-and-blue flags in hand, the lyrics to "The Star Spangled Banner" on our tongues. I remember crying, a lot. Whether those tears were a product of joy or of guilt, I still don't know.

I became an American that day and was meant to be proud of it. Proud of the tempestuous trek that led us to that very room on that very Saturday. I was meant to be grateful to the American people for making room for me among its 3.8 million square miles, 47% of which remain unoccupied. I was meant to feel lucky, even after living in the country for 16 long years, after watching the rug pulled from under my parents' feet again and again and again, after being denied to programs because my religious affiliation made neighbors uncomfortable, lucky that although I'd made the mistake of being born elsewhere, I was eventually deemed worthy enough to hold the coveted U.S. passport in my hands. I'm also great at holding a grudge, btw.

Becoming an American citizen meant two things to me in that moment: It's less likely that I'd be holding up my friends at the airport from now on and, more importantly, I'd get to have a voice in the upcoming presidential election. This... this would matter.

Every country has its evils, some more than others. I know I've felt proud of America in the past, though I'm having a hard time remembering the last time. But I don't have to be blindly proud of a nation to belong, right?

The truth is, I've never felt I truly belonged anywhere. For those first 16 years in America, at least, it was as if I was floating around, waiting for someone to take notice, to realize my parents deserved better than this. I was a foreigner, a resident, but never "one of us." It was exhausting having to explain to classmates I wasn't actually here illegally, that no, I didn't understand what the hold up was, either.

No matter. Official documentation did little to convince me I belong. And it certainly did little to convince you.

Sometimes I wonder what it would be like, going back to India. I was born there on Oct. 14, 1991, in the central city of Indore. I left for Saudi Arabia as an infant and have never been back to either. Everything I know about my hometown is seeped into my memory by way of my family. But I don't belong there. Not anymore.

My feelings of detachment from both my homeland and my current land seem to be worsening as dehumanizing rhetoric and policies are normalized, not just here in America but all over the world. This issue of being in limbo—it's primarily what led to my diagnosis of clinical depression in 2016.

I had a therapist at the time recommend I spend more time outdoors. It was wintertime and I thought she was being ridiculous. How's some fresh air going to help me figure out who the hell I am, where the hell I belong?

Turns out her advice was sound, but it would be some time before I'd take it to heart. Rescuing a dog kind of forced me out the door, even on days I'd call in sick solely because my heart ached. I read a book that pushed me into the forest, among trees and among dirt roads, no phone signal or traffic in sight. A book that helped me feel grounded for the first time in my life.

The more often I stepped into the wild, the more I realized I do belong. I belong to the Earth below me and to the skies beyond. I belong so fiercely to these lands, my existence transcends your imaginary borders.

I'm a citizen of the goddamn world. And so are you.

Sense of belonging and mental health: What's the connection?

According to the Mayo Clinic, sense of belonging is "fundamental to the way humankind organizes itself." Without it, we'd live solitary lives, wouldn't have families, communities or organized government. We'd return to each other solely for procreation and leave our children behind as soon as they're able to walk.

How important is it for our mental well-being?

Well, let's start from the very beginning. When we're born, we crave attachment. Research shows children without a healthy attachment to a caregiver after birth and in young life "have lower self-esteem, a more negative worldview, are mistrustful and can have a perception of rejection," according to Mayo.

And throughout our lives, "the social ties that accompany a sense of belonging are a protective factor helping manage stress. When we feel we have support and are not alone, we often cope more effectively with difficult times in our lives. Coping well with hardships decreases the physical and mental impact of these situations."

A lack of a sense of belonging has been linked primarily to depression, anxiety and suicide and further interferes with one's ability to connect to others, ensuring the cycle continues.

What about immigrants in particular?

So. Research consistently shows life satisfaction is heavily influenced by immigrants' sense of belonging. The spread of dehumanizing narratives about immigrants makes many feel unwelcome, unwanted and, well, like they simply don't belong.

These narratives tend to minimize legitimacy, whether an immigrant is undocumented, naturalized, even if they took their first breath on American soil.

There's the term "anchor babies," given to youth born in the country to an undocumented mother. Using the term is a "political tactic" that "questions the very legitimacy of U.S.-born children of undocumented parents and aims to justify ending birthright citizenship," according to Dell Medical School professor Carmen Valdez.

Many of us are also quite familiar with the phrase, "Go back to [insert country here]." If you need a refresher on this particular delegitimizing tactic, the 45th President of the United States recently used it against four Democratic members of Congress, all of whom are American citizens (and women of color).

POTUS has also called immigrants, Latinx immigrants in particular, "rapists" and "animals." The recent rise in anti-immigrant rhetoric from up top, researchers say, has correlated with an increase in hate crimes.

In fact, according to the more than 150 cases of hate crimes Reveal News found in ProPublica's Documenting Hate database, 75 involved attacks on immigrants, with many perpetrators invoking the president's name. And the numbers are probably understated. Experts say immigrants without authorization are becoming increasingly afraid and unwilling to report such crimes to authorities in the first place.

What the research says:

• Generally, belonging to a minority group in the host country can negatively affect health and increase the incidence of depressive symptoms. (Bernstein, Park, Shin, Cho & Park, 2009)

• There's also an overwhelming propensity in the country to ascribe the American identity to European Americans rather than to ethnic minorities. In other words, "American" = White. (Devos & Banaji, 2005; Devos, Gavin, & Quintana, 2010; Devos & Heng, 2009; Devos & Ma, 2008; Rydell, Hamilton, & Devos, 2010).

• In general, individuals who have a strong orientation toward both their own group and a new culture experience better levels of mental health than those who feel they belong to only one group—or to neither. This is referred to as acculturation theory. (Berry and Hou, 2016)

• Second-gen immigrants may be at higher risk of poor mental health due to the demands associated with navigating two cultures and feelings of not belonging in the immigrant culture or the host population. (Montazer & Wheaton, 2011; Rumbaut, 2005).

• Compared with immigrants who felt a sense of belonging to both Norway (new country) and their country of origin (Pakistan, Bosnia, Poland, Afghanistan, Somalia, etc.), those who only felt affinity to one country had 37% higher odds of mental health problems. Those who felt connected to neither had 62% higher odds. (Straiton, Aambø, Johansen, 2019)

• In this cross-cultural study of Asian American, African American and Latinx college students, awareness of the "perpetual foreigner stereotype" significantly predicted lower hope and life satisfaction for Asian Americans. The stereotype was also a marginal predictor of greater depression for Latinx immigrants. (Huynh, Devos, Smalarz, 2011)

• Recipients of the Deferred Action for Childhood Arrivals program (DACA) have a greater sense of belonging as valued and contributing members of our society and report improved psychological well-being after receiving the designation. (American Immigration Council)

• For Asian Americans, being treated as an alien in one’s own land is associated with feelings of inferiority, discomfort, and isolation. (Sue, Bucceri, Lin, Nadal, & Torino, 2007).

• Common microagressions that drive migrants to feel they don't belong: Questioning an individual’s home-town, complimenting his/her command of the English language, or mistaking him/her as a foreigner (Liang et al., 2004).

• Targets of racial microaggressions report experiencing anxiety, stress, helplessness, academic disengagement, anger, and frustration. (Smith, Allen, & Danley, 2007; Solórzano, Ceja, & Yosso, 2000).

• Other real-life implications: Immigrants who internalize feelings of being "un-American" may not be as involved in civic life, including voting, volunteering, military service—all important factors linked to the "American" identity.

Citizenship and belonging

Citizenship does further an immigrants' feeling of belonging in their host country, but only when host nationals also believe migrants who become citizens belong in the country. Essentially, policy itself doesn't influence how immigrants experience belonging, but rhetoric and public hostility can.

What can you do if you're struggling with belonging?

If your life feels like one giant identity crisis, perhaps you'll find comfort in knowing you're not the only one out there aboard the lonesome boat. I'm going to speak from personal experience here and not as a medical professional, so please keep that in mind.

First and foremost, take the step to seek therapy. It could just start with a Google search. Email a few psychologists or psychiatrists you're interested in connecting with. Schedule that first appointment.

Make the effort to talk with other immigrants and share your thoughts with loved ones. I've connected with some strangers on Twitter over shared immigrant experiences, and they've become dear friends. In my opinion, the key to feeling somewhat at peace with a mixed, misunderstood or even a lack of definitive identity is realizing you're not alone. It's one of the reasons I started this newsletter to begin with.

Another huge source of therapy when I feel I belong within no particular borders: I identify as a citizen of the globe. I connect with the planet at large, the trees and the oceans and the beings all around. Fair warning, though: Doing so exacerbates my already heightened concerns about the environment.

Have any practical tips I can share with the group next time? Send 'em my way!

Updates

Meet fact-checker Hanaa' Tameez!

Hanaa' Tameez is an independent multimedia journalist based in New Jersey. She'll be helping fact-check the newsletter beginning next month. Tameez was previously the diversity reporter for the Fort Worth Star-Telegram in Texas where she covered race, identity and social equity. She holds an M.A. from CUNY Graduate School of Journalism with a concentration in bilingual journalism. She has previously worked for Animal Político and The Wall Street Journal in Mexico, Americas Quarterly and The Council on Foreign Relations in New York and the Green Bay Press-Gazette in Wisconsin.

Want to join the #foreignbodies team behind the scenes? Send me a note: fiza.pirani@gmail.com.

Have a few bucks to spare?

We've opened donations from the public to help fund the newsletter domain, access to research, and well, our time! Here's how you can help keep the lights on:

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2. Donate through PayPal or Stripe

In April, Longreads published an excerpt from Delphine Minoui's "I'm Writing You From Tehran," a family memoir and making of a reporter told by "someone both insider and outsider―a child of the diaspora." It's gorgeous. Read here.

"Will My Home Ever Feel Like Home Again?" by trans Malaysian Chinese writer Nic Dinan follows Dinan's return to a home country plagued with both memories of harassment—and motherly love. During the trip, Dinan is surprised by this realization: "For the first time in many years, I feel closer to Malaysia... I have a responsibility not only to my family but to a community of trans Malaysians, which weaves thread into rope and tethers me to Malaysia no matter how far I go. These ropes are fixed, and their influence guides me." Read here.

Here's another piece published in ZORA from Sharine Taylor, who interviews Zalika Reid-Benta following her debut short story collection, "Frying Plantain," on the search for identity in the diaspora as an Afro-Caribbean. Read here.

For Penn Today, political scientist Nicholas Sambanis uncovers the roots of discrimination toward immigrants and how its accumulated impact shapes perceptions of identity and belonging. Read here.

"Identity isn’t a prescriptive solution. But when you’re uncertain of your place within society, it can help to have ready-made categories or narratives, even if you choose to reject them." Literary critic Hua Hsu on "The stories we tell, and don't tell about Asian-American lives" for The New Yorker. Read here.

Undocumented immigrant and poet Yosimir Reyes penned this essay for Teen Vogue in February 2018. Titled "In a 'Nation of Immigrants,' Who chooses Who Belongs?" Reyes reflects on UCIS' call to remove the phrase "nation of immigrants" from its mission statement. Read here.

I haven't yet read "The Other Americans" by Moroccan immigrant Laila Lalami, but it's come highly recommended. The novel explores "a fleeting sense of home" and revolves around a central character who was never rooted to her hometown nor did she feel a sense of belonging in her host country. (#relatable) Buy here.

In his book "The Land is Our Land: An Immigrant's Manifesto," Indian-American author Suketu Mehta draws upon years of personal experience and reporting to argue "the West is being destroyed not by immigrants but by the fear of immigrants," and how civil strife and climate change will continue to displace and reshape the planet. Buy here.

Foreign Bodies is a monthly e-mail newsletter dedicated to the unique experiences of immigrants and refugees as they relate to coping with mental illness and wellness. It’s written and curated by Atlanta-based writer Fiza Pirani with copyediting and fact-checking help from New Jersey-based independent journalist Hanaa’ Tameez. Want to contribute your time or share your own #ForeignBodies story? Send an email to 4nbodies@gmail.com or say hi on Twitter @4nbodies. Special shout-out to Carter Fellow and friend Rory Linnane for the adorable animated logo!

If you're thinking about suicide or worried about someone who might be, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 741741 to connect to a crisis counselor. You can also find a wealth of culture- or language-specific recommended resources on our site, foreignbodies.net.

For many brown kids, coming home to family after some time away means you're in for an impromptu analysis of just how much weight you've put on or lost since you've been gone.

"You look thin! Good for you!"
"Have you been dieting?"
"Be careful, you're starting to gain again!"
"I don't even recognize you anymore!"

It's common to hear any iteration of the above before anyone even asks about your new gig, how school's going or what-have-you. While our loved ones usually don't intend to hurt us, for many of us struggling with body image or diagnosed mental illness, that repetitive emphasis on weight can exacerbate our already fragile relationships with our bodies.

Take Brown Girl Magazine's Vaidehi Gajjar, a 24-year-old Gujarati grad student in South Carolina. She's been suffering with anxiety and depression since she was a teenager. Over the years, her illness has left her physically exhausted and without much of an appetite.

For about two years, Vaidehi ate the bare minimum. Sometimes that came in the form of a glass of milk or one item off the Taco Bell menu. "I was shriveling away, and to a certain extent, I wanted to do nothing about it," she says.

Here's how she describes the experience: "It was as if the weight of my thoughts had trickled from my brain into my bones, and I was left dragging myself around, or rather my anxiety and depression were left dragging me around."

People often equate being skinny with being healthy and even happy. But for Vaidehi, the comments about her weight, which were often positive, only made her feel further invalidated. She couldn't look in the mirror because seeing her protruding bones made her feel sick. She was known as "that girl," the one who covered her full plate with napkins to hide how little she was eating. But at least she wasn't overweight, people said.

No one seemed to understand why or how she could possibly be unhappy, making it even harder to talk about mental health, an already taboo subject in her South Asian community. Instead, Vaidehi struggled alone, didn't seek professional help and silently fell apart.

She did, however, find some comfort in writing before a friend who happened to be a professional offered some guidance.

In August, Vaidehi wrote about her personal struggles with anxiety and weight in The Lily. Her story made it back home to the Nehru Science Center in Mumbai, India.

"The biggest thing I want people to know is that my experience isn’t something new or different," she says. "I don’t want sympathy from anybody. I don’t want pity. I want understanding. And that’s not just for me. It’s for every individual suffering in silence day in and day out, simply because they’ve been made to feel like they don’t matter."

My brother's story is a little different.

Whereas anxiety fueled Vaidehi's weight loss, his social anxiety only erupted after he dropped 170 pounds. The persistent chit-chat about his weight hasn't helped.

Faiz is a 23-year-old soon-to-be law student. His dramatic weight loss story has been the subject of nearly every family dinner, extended reunion, family phone call, etcetera. I don't remember the last time we hung out with our grandparents, aunts and cousins without someone mentioning the big drop in poundage. And it was certainly a significant change. At his heaviest, Faiz weighed 332 pounds. At his lightest, 161.

I wanted to know how his weight loss and the subsequent spotlight was affecting him personally.

"In high school, it's like I fit some kind of trope. The funny fat guy trope," he says. People adored him. Faiz wasn't ever bullied for his weight, nor did he lack self-confidence. On the contrary, he was one of the most confident people I'd known at the time. At no point during high school, even when he crossed that 300-pound mark, did he feel compelled to lose weight. The constant outpouring of lectures and tears from our folks (and me!) only encouraged him to rebel a little harder.

Things changed when college came around. Faiz moved to Los Angeles and was on his own for the first time in a city of beautiful people. He wanted to create a new identity for himself, let the high school trope stay in high school. He wanted to look like the people around him. At the same time, he struggled to walk to class; his body always ached.

Health concerns drove Faiz to make some kind of lifestyle change, but body image and anxiety kept him on course.

"The way I lost the weight was not emotionally healthy. I need people to recognize that," he says. "I still see myself as 300 pounds."

At his worst, Faiz would weigh himself twice a day, consume 500-600 calories per day, open up Instagram just to scroll through photos of male fitness gurus, then close the app, determined to starve himself.

"It was a catch-22. I wanted to lose weight to feel comfortable around strangers, but when I stopped eating, I was too exhausted to go anywhere," he says.

In fact, the more weight he lost, the harder it was to be around people in general.

Our folks didn't really understand the anxiety that came with extreme weight loss or why he needed therapy at all. He looked great, he was graduating, what could possibly be wrong?

But there was the unexpected issue of loose skin.

"I remember lifting up my shirt—and maybe I'm exaggerating in retrospect—but it seems like mom and dad were a little disgusted," he says. They immediately recommended cosmetic surgery, something I wasn't personally advocating for, just because I wanted Faiz to fall in love with the body he had.

That was a tough moment for him. "I think I've always had a poor understanding of how my body looks like to other people," he says about his body dysmorphia. But our parents' reaction to his loose skin made him feel the insecurities were somehow rational.

Faiz has since had surgery, and doesn't regret it at all. If anything, the surgery, which he worked up in his head as the final fix to his body image issues, reminded him yet again how unrealistic it is to expect a magic solution.

Therapy has helped him unfurl the underlying issues behind his poor self-esteem and social anxiety, and how weight loss (among other big life changes) have played a role. As his big sis, I've definitely seen a significant improvement in Faiz's self-esteem since he found this new therapist.

But what hasn't really helped is the constant conversation around his weight. Like I mentioned earlier, there's no escaping the subject in family settings with Faiz nearby.

"Anytime someone isn't explicitly asking for advice, it only contributes to my anxiety. I'm constantly wondering whether they'll say something next time. And if they don't, does that mean I've gained weight? Even when someone's asking for advice, it's not like I want anyone emulating the lifestyle choices I made when I was losing 150 pounds," he says.

That's not to say he isn't happy people are proud of him, especially dad, who undoubtedly gained a new level of respect for his son after watching him accomplish something he's always personally struggled with.

And it's not to say he totally regrets losing the weight. One big change since his high school days: His dreams are bigger, and he can imagine himself doing more in this body than he might have done in the old.

"I just don't like that it's become the central point of my identity," Faiz says. "It's strange, having people portray the weight loss as this big positive thing in my life when there was so much negativity associated with it."

Faiz also recognizes how the constant emphasis on weight during family outings (usually at a not-so-healthy Indian restaurant) might be hurting the people around him, particularly our younger cousins growing up in the highly image-focused world of social media.

It's such a layered issue, weight and image, particularly in immigrant cultures like ours where food is central to community, where lack of nutrition education is the norm and where what's most affordable and available has always been something unhealthy off the dollar menu at McDonald's.

It's not that Faiz blames our upbringing, though mom's expressed some guilt about feeding us fast food on the daily as kids. It's so much more complicated than that. Like lots of families, we didn't grow up with parents who had time to cook every day. And when you're financially struggling, it's hard to justify paying $4 for one salad entree when you can feed the entire family for the same price.

But I'll save that topic for a future issue. Want to talk food culture and mental health (or health in general)? Reach out.

For now, maybe we can rethink how and when we talk about weight around each other, especially when there's food on the table. Faiz says if you'd like to talk about weight loss, he'd love to chat. But individually. Not in group settings. We're all dealing with our own body image problems, and while some might find it helpful to commiserate out loud, Vaidehi and Faiz can tell you that's just not the case for everyone.

The research on weight, body image among immigrants

For immigrants in America, a growing body of research shows the longer we live in this country, the worse our rates of obesity, heart disease, high blood pressure and diabetes. But why?

The New York Times had a great analysis on this in 2013.

"For the recently arrived, the quantity and accessibility of food speaks to the boundless promise of the United States." Supersized food = Supersized success.

“You work so hard, you want to use your money in a smart way,” Aris Ramirez, a community health worker in Brownsville, Texas, told the Times. “So when they hear ‘twice the fries for an extra 49 cents,’ people think, ‘That’s economical.’”

On the other end of the spectrum, you have struggling parents working odd jobs and eating hamburgers because of the convenience. You have nightshift workers losing control over their children's diets because they're rarely around at mealtimes.

“In Mexico, we ate healthily and didn’t even know it,” Esther Angeles told NYT. "Here, we know the food we eat is bad for us. We feel guilty. But we eat it anyway."

Couple all that with a general pressure to adhere to certain beauty standards and you've got quite the recipe for disaster. I did some browsing and reading to learn more about the immigrant groups at high risk for body image dissatisfaction and eating disorders. As always, research is scarce.

But in general, research shows the greater the number of migrant generations born in the United States, the more likely they are to acculturate to U.S. body ideals perpetuated in the media.

And overall, negative body image is strongly associated with mental health issues and eating disorders.

Here's more data:

• Male and female Latinos are as likely, if not more likely, to develop eating disorders versus any other ethnic group. (Schooler and Lowry, 2011)

• In Indian cultures, body image is highly influenced by social comparisons to actors and actresses on the Bollywood screen. While Bollywood used to feature more shapely women and men with average bodies, actresses now fit the slim Hollywood ideal and actors, a more chiseled muscular ideal. The changing media portrayals have affected body image perceptions at least in Indian women. (Kapadia, 2009)

• Chinese women are increasingly attaching a greater importance to body image. In recent years, more and more women are labeling underweight bodies as "normal weight" and normal weight bodies as "overweight." Researchers noted associations with rising body dissatisfaction, shame and anxiety as well as higher risks of depression, eating disorders and sexual dysfunction. (Zhang, Qian, Fu, 2018)

• South Asian immigrants have high susceptibility to eating-related psychopathology and food addiction (Rehman, 2018).

• Among African residents in Europe, ethnic groups living in great isolation or with low incomes still have an ancestral idea of beauty, preferring a shapely body. Those living in urban areas are moving toward Westernization of beauty ideals, preferring underweight or normal weight bodies and are at increased risk of nutritional disorders as a result. (Toselli, Rinaldo, Gualdi-Russo, 2016)

• Compared to populations living in Africa, African immigrants in Europe have higher body dissatisfaction. (Toselli, Rinaldo, Gualdi-Russo, 2016)

• In Latinx individuals, cultural disparities in body ideals heavily influence the messages they receive about their bodies. A pressure to acculturate to American ideals (more thin) has led to increased body image disturbance. But social support from friends and family can help. (Menon and Harter, 2012)

• Binge eating disorder among black individuals of Caribbean origin may be explained by the abundance, variety, and availability of foods in the United States. Additionally, Caribbean black teens may yield to pressures to over consume in order to fit in with their peers. (Taylor, Caldwell, Baser et al., 2013)

Read something lately that you wish I included? Shoot me an email.

• NEDA helpline at 1-800-931-2237: Toll-free, confidential helpline available Monday - Thursday from 9-9 and Friday from 9-5.

• How to recognize triggers and environmental causes behind body image issues

• Know the signs of negative body image

• How to help loved ones with body dysmorphia

• For teens

• For parents

• Understanding trans body and gender dysmorphia

• I Love My LGBT Body (Facebook page)

More stories

In this 2011 NPR interview, plastic surgeon Dr. Anthony Youn talks body dysmorphic disorder in rhinoplasty patients and why it's actually more prevalent among ethnic minorities. Hint: 'Cause we're a society heavily based on the Caucasian ideal of beauty. Read or listen here.

Slate's Michelle Konstantinovsky wrote this incredibly well-reported piece titled "Eating Disorders Do Not Discriminate" in 2014 to debunk the dangerous myth that only white women deal with eating disorders and body dysmorphia. Read here.

HuffPost lifestyle editor Arti Patel penned this essay titled, "Growing Up As A Brown Girl, I Was Used To Being Called 'Fat'" in 2016. "The words 'fat' and 'skinny' were thrown around my community like 'hello' and 'goodbye' ...I would hear people suggest skipping meals and fad diets like it was a one-stop easy fix." Read here.

"Would I have developed anorexia nervosa had we not emigrated from India to Canada?" Don't miss this beautiful first-person essay from Dr. Amba Balu for nationaleatingdisorders.org. Read here.

"Fresh Off the Boat" author Eddie Huang got super real in this 2017 GQ essay about male body anxiety and growing up as "the fat kid" in his Asian family. "A lot of times, as a man, you don’t feel empowered or enabled, or you’re not given the opportunity to speak about negative body image or how insecure you are about the way you look. We’re supposed to just be measured on our abilities and our work." Read here.

Read about racialized body dysmorphia from Black Youth Project's Gloria Oladipo and her essay on how African features aren't just "obsessively viewed as beastly and unattractive," but are subsequently criminalized. Read here.

I love collections of personal anecdotes, so I definitely want to share this list of seven Latinas on body image and insecurities from Hip Latina. "Growing up as a Latina was hard because I wasn't curvy and I didn't look remotely close to J.Lo or Jessica Alba," writes Columbian and Peruvian Giselle Castro. Read here.

Unhealthy body image and body dysmorphia is still rampant in the gay community. This Vice piece examines how, for queer people of color, impossible standards of male bodies are compounded by the overwhelming whiteness of the LGBTQ community in the media. Read here.

Refinery29 ran this piece last year on how the body positivity movement as we see it has primarily targeted cisgender women and men. So, they asked trans men and women and non-gender conforming folks what exactly body positive means to them. Read here.

Interested in helping fact-check this newsletter? I could use the help! Send me a note: fiza.pirani@gmail.com.

Foreign Bodies is a monthly e-mail newsletter dedicated to the unique experiences of immigrants and refugees as they relate to coping with mental illness and wellness. It’s written and curated by Atlanta-based writer Fiza Pirani with copyediting and fact-checking help from New Jersey-based independent journalist Hanaa’ Tameez. Want to contribute your time or share your own #ForeignBodies story? Send an email to 4nbodies@gmail.com or say hi on Twitter @4nbodies. Special shout-out to Carter Fellow and friend Rory Linnane for the adorable animated logo!

If you're thinking about suicide or worried about someone who might be, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 741741 to connect to a crisis counselor. You can also find a wealth of culture- or language-specific recommended resources on our site, foreignbodies.net.

"A good man makes everyone happy. Works hard. He's ethical. He realizes there's more to the universe than this little world," my dad tells me.

That's...um...vague. But truth be told, it's exactly what I expected. Coming from me, a daughter known to criticize every little thing through her feminist lens as some form of misogyny, he probably (and rightfully) felt defensive just hearing the question.

The conversation could've ended there. It usually would. But I waited, gave him a little more time to think on it.

"I don't like to do anything without mom," he says, breaking a somewhat uncomfortable silence. Then he goes on and on. He wouldn't dare go see a movie without her, let alone book a trip. If she's stuck at home in the evening finishing up some office work, he'll do the laundry or air-fry some salmon for dinner just to keep her company, even if he wants to go to mosque himself. My mom would have no problem doing any of the above on her own, btw.

"But dad, what about your anger?" I interrupt, fully realizing he's in the middle of playing some hardcore defense.

"Look, I wasn't always angry," he tells me.

Dad grew up in Central India. Unlike many boys, he wasn't taught to suppress his emotions. He was actually quite expressive, participated in theatre and once dreamed of making it to Bollywood. He was known as the class clown. Then he grew up, got married and left India.

After moving to Saudi Arabia and eventually to the United States, a wave of depression took over. My parents, both doctors back home, turned to working night shifts at Dunkin' and selling phone cards to NYC convenience stores to get some grub for the kids on the table. As foreign graduates, they weren't able to practice again until at least a decade after moving to America.

I didn't notice dad's depression at first. But it was impossible to dodge the anger.

He and I have always been good at hurting each other, from all the times he labeled me selfish for wanting to put myself first to the night he told me no man will ever fully love me if I actually expect to be treated equally.

But all the word vomit came in the heat of the moment, in the midst of completely unrelated arguments, with blood boiling and sweat dripping and anger I've grown to accept as misdirected.

The more I read about learned masculinity, the more I understand and forgive my dad for the verbal pain. The last time he called me selfish, I had just revealed I'd been looking for apartments. This was about a year after college and I'd been living at home to save money while I worked at a local law firm. To my surprise, he uh...didn't take the news very well.

Dad told me my decision to leave home meant I wasn't just self-centered, but that I didn't care about my 8-year-old dog. Told me if I actually moved out, he'd take Scamper back to the shelter. (Lol what?!?!? After 8 years!? I bawled).

But that's when I realized where the anger was coming from. My dad was closer to Scamper than any of us—and still is. This wasn't about me being selfish and putting my needs and wants before my family dog. It was about his daughter moving out. About me leaving him behind. I was moving 20 minutes away.

That second incident—when he essentially told me not to expect equal treatment from a man? Rooted in guilt. I called him out for raising his voice at my mom, and he didn't like it. The next day, he apologized. But I have a bad habit of never really forgetting the sting.

My dad no longer takes medication for depression, and he never really opened up to the idea of talk therapy. Mom says he's not really depressed anymore; that it was all situational; that treatment isn't necessary at this point. He's jolly more than angry now. And he apologizes—often. But in my opinion: Therapy is always beneficial and usually necessary.

When I was reading the research on how masculinity manifests itself in migrant men and their mental health, I found significant parallels with my dad's experiences.

For one, whether my dad wants to admit it or not, there are still plenty of cultural gender norms he struggles with. It frustrates him when my mom vocalizes her independence. He loves her dearly, but I think in some loving yet twisted way, he needs her to need him more.

When my dad was most depressed, his primary issue was failing at being the so-called breadwinner, as cultural norms would have it. Anger, of course, is another major parallel. Research consistently shows men with masculinity-related depression turn to rage. While my dad, one of the kindest souls on the planet, never turned to violence himself, the global stats on traditional masculinity and violence against women can't be overlooked.

What's so toxic about masculinity?

How toxic masculinity hurts everyone

Toxic masculinity typically refers to actions that discourage emotional responses in men (apart from anger) and, at the same time, encourage "dominant" behaviors. Think: Boys don't cry! Man up! Don't cry like a girl.

In boyhood, dismissing feelings of pain can teach children to avoid expressing themselves as they really are. And over time, those feelings can manifest into a mental illness, most often depression, PTSD, body dysmorphia or anxiety. Young boys then grow up burying their emotions even as men.

In adulthood, men typically deal with their depression by over-working or self-medicating through drugs and alcohol (Psychoanalytic Psychology).

Then there's the anger. Men with internal conflicts tend to direct their frustrations at those around them, including partners and children. In fact, research by the World Health Organization shows men and boys who adhere to rigid, traditional notions of gender roles and masculinity are more likely to report having used violence against a partner. More on that at acalltomen.org.

Toxic masculinity and the LGBTQ community

One of the consequences of toxic masculinity ideology involves fostering homophobia (Kupers 2005).

"For a lot of gay men, just by being gay, there is this sense of insecurity of being a failure because they're not performing their masculinity in the way that they (feel like they) are expected to," Adam Davies, who studies education, gender and sexuality at the University of Toronto, told HuffPost last year.

"There is a constant dissonance between what they are trying to achieve versus what they actually want, which slowly has an effect on one's mental health, sexologist Alex McKenzie added. "It erodes your well-being the more it goes on."

Individuals who identify as transgender often see both sides of sexism.

Toxic masculinity and immigrants

There still isn't much research on how immigrant men and women navigate dominating forms of masculinity in their destination countries. Generally, "one of the reasons masculinity's 'toxic' effects aren't well known might be that few men seek treatment from psychologists — making them harder to study," says research psychologist Michael Addis. Immigrant men are even more hesitant than natives to rely on professional help.

But here's what I've found on my research spree:

• Finding and keeping a job = one of the top factors in male disempowerment among migrants in a system that favors advanced skills and/or cheap labor

• It's common for migrant men to come from cultures where they're expected to be the breadwinner and provider. Adjusting to a dual-income household (or one in which a partner brings home the bacon) can be mentally challenging in cultures adhering to rigid gender roles.

• The breadwinner challenge is especially problematic in African men who also face uneven race and class discrimination. (Wa Mungai, Ndungi and Pease, Bob; 2009)

• Asian cultural masculinity also relies heavily on scholarship and not showing weakness, something rooted in history: "everything from the treatment of Chinese immigrant laborers in the nineteenth century to representation in contemporary media." (Catapult)

• Chinese women in some cases are expected to prioritize domestic workloads over their own careers, especially during family settlement, leading to downward mobility of women migrants. (Ho 2006)

• Gender socialization in South Asian cultures continues to prescribe qualities of strength, toughness and aggression to men. Women, on the other hand, are presumed to be weak, nurturing and submissive. Toxic masculinity in India in particular is a significant problem, especially when it comes to violence against women. Bollywood films, at least historically, haven't helped. (Dutta and Ganguly, 2019)

Do you have a piece of research you'd like me to highlight? Send me an email!

For all who identify as men: The Good Men Project is apparently having "the conversation no one else is having." In this specific piece, a Dr. Joe Kort discusses the assumed requirements of patriarchy, misandry, and microaggressions. The Book of Man offers various things men can do to end toxic masculinity plus an ENTIRE section on mental health!

For my LGBTQIA friends struggling with masculinity issues, turn to: ItGetsBetter or the Trevor Project, both highly recommended by the National Alliance on Mental Illness. If you're thinking about counseling, the Association of Gay and Lesbian Psychiatrists offers a directory of LGBT-friendly therapists.

For parents: In this NYT piece, authors Caroline Crosson Gilpin and Natalie Proulx suggest ways to deconstruct definitions of masculinity as they manifest in our society and our lives. If you're a book reader, check out "How To Raise A Boy: The Power of Connection to Build Good Men" by psychologist Michael C. Reichert.

For mental health professionals: The American Psychological Association recently unveiled its guidelines on psychological practice for men and boys. From APA: "Thirteen years in the making, they draw on more than 40 years of research showing that traditional masculinity is psychologically harmful and that socializing boys to suppress their emotions causes damage that echoes both inwardly and outwardly."

For domestic violence victims: Know the signs of abuse. Save the National Domestic Violence Hotline number, 1-800-799-7233. You can also chat with an advocate on the official site. Read survivor stories.

If you know a victim of domestic violence, refer to this Domestic Shelters toolkit.

Meet Aymann Ismail, host of Slate's "Man Up" pod!

(Photo: Lisa Larson-Walker)

As a boy growing up in Newark, New Jersey, Aymann Ismail quickly picked up on the gender cues his immigrant parents had themselves inherited back in Egypt. Men were meant to be unemotional, but resilient. They were to marry a wife from their own Muslim community and have dutiful kids who'd grow up to do the same.

"I didn’t much question who I was meant to be," Aymann wrote earlier this month in an introduction for his new kickass Slate podcast "Man Up," dedicated to unraveling our experiences in this hyper-masculine world.

"I took it for granted, shut down my doubts in my teen years, and took on an air of tough indifference. If I acted like that man, then I would be that man."

When he got married, Aymann realized he didn't really know what his wife needed from him, nor did he understand what he wanted from himself.

Did I ever have a say in what was normal? How'd we get here? Why do men fight before we talk? How can we change? Those are some of the questions he digs into on the new pod.

Available on iOS, Stitcher, other podcast players and on Slate.com.

This excellent 2017 essay at Bad Hombres features 12 Latino men on the dangers of toxic machismo—and how to stop it. "All of us, no matter how enlightened we think we are, have blind spots with respect to others’ life experiences and struggles," says Salvador Pérez. "As men, the best of us can and occasionally do fail to overcome unconscious sexist biases." Read here.

Siddharth Dube, a New Delhi journalist, writes about how he came to learn "homophobia was as much a part of Indian culture as it was of American or British culture." Dube, who came out in adulthood, recalls the taunting in childhood of his pretty-boy looks and feminine nature. Read here.

In this first-person piece for Voice Male Magazine, Indian UK student Shannon Philip writes about how he was taught to be a certain type of boy: messy, stoic, sports-loving. He connects his own experiences to the country's overarching history of masculinity norms following the horrific gang rape of Jyoti Singh in 2012. Read here.

"I honestly don’t know whether my father would describe his sentiments for me as love or not," Chinese American Mimi Wong writes for Catapult. An excellent first-person account on what felt like conditional fatherly love through the lens of an "Americanized cultural perspective." Read here.

The Chicago Tribune's Joanne Yj Km interviewed first-gen immigrant Asian Americans about their dads ahead of Father's Day in 2016. Perry Li, a second-gen Chinese-American born in Chicago, said he resented his father most of his life until recently because he rarely showed him affection. But he wants to be more understanding of the struggles his father endured. Read here.

Rohini Nilekani highlights an urgent need to turn to Indian boys and men "with as much urgency and focus as we spend on the millions of young women and their multiple needs" in her essay for Quartz titled "Boys can't be boys. Here's how to fix India's toxic masculinity problem." Read here.

Interested in helping fact-check this newsletter? I could use the help! Send me a note: fiza.pirani@gmail.com.

Foreign Bodies is a monthly e-mail newsletter dedicated to the unique experiences of immigrants and refugees as they relate to coping with mental illness and wellness. It’s written and curated by Atlanta-based writer Fiza Pirani with copyediting and fact-checking help from New Jersey-based independent journalist Hanaa’ Tameez. Want to contribute your time or share your own #ForeignBodies story? Send an email to 4nbodies@gmail.com or say hi on Twitter @4nbodies. Special shout-out to Carter Fellow and friend Rory Linnane for the adorable animated logo!

If you're thinking about suicide or worried about someone who might be, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 741741 to connect to a crisis counselor. You can also find a wealth of culture- or language-specific recommended resources on our site, foreignbodies.net.

Sehrish (left) and her younger sister Shazia (right) moved to America from Karachi, Pakistan back in 1999, ultimately settling down in Atlanta.

Growing up, Sehrish and her family couldn't figure out why Shazia was struggling so much with her grades. She'd already been held back twice before middle school. Because she was taking ESL classes, teachers assumed her poor academic performance was simply due to a language barrier.

Then Shazia met Ms. Davis, a 7th grade special education teacher. In 2005, with the guidance of Ms. Davis, Shazia was officially diagnosed with Asperger's and autism spectrum disorder.

But acceptance hasn't come easily.

Sehrish had trouble getting her parents, her dad in particular, on board. He'd blame her for her mood instability or erratic behavior, common symptoms of ASD, saying it's all because Sehrish didn't include her in all her social gatherings and intentionally ostracized her. It wasn't a disability to him. It was a problem with a simple fix: sisterly love.

It's true that when Sehrish was younger and knew little about the spectrum, she felt detached from her sister. Despite being just a year apart, Sehrish couldn't seem to connect. Shazia wouldn't laugh at the same jokes or respond appropriately in conversations. As a teenager, Sehrish felt no one would want to hang around her if she brought Shazia around. So she didn't.

Sehrish continued to internalize the guilt. When Shazia would get laughed at or bullied in her religious education classes, Sehrish blamed herself. Perhaps she could have been more supportive. A better sister. Eventually, mom and dad began to exert blame on themselves, too.

It was easier to believe she was struggling because of them. Simply admitting she's struggling and always will was far too painful.

But over the years, Sehrish and her family have been slowly learning to acknowledge that some things just aren't under their control.

The family relied on the few people they knew for help, a culmination of teachers, family members and religious institutions. But what little money they were able to conjure up through Medicaid led them to services that just weren't up to par. Multiple therapists resulted in multiple diagnoses and re-diagnoses. Still, mom was relentless. A champion for Shazia through the pain, she sought help from everyone she could reach, encouraged Shazia to begin medication and attend therapy sessions twice a week.

And this May, 14 years after her initial diagnosis in 2005, Shazia will be graduating from college.

As an adult, Sehrish has learned more about autism and her younger sister's unique world. Their first one-on-one time? Just a few years ago, when Shazia visited Sehrish in Austin, Texas. Since then, the pair's traveled the world together, devoured Belgian waffles in Brussels and learned to appreciate each other's quirks. Fun fact: Shazia is a hardcore Bollywood film buff and can identify every actor and movie plot from any year.

Everything Sehrish was, is and wants to be has been shaped by her relationship with Shazia. While the stigma still stings—mom and dad still implement the "don't ask, don't tell" policy—Shazia's skills and progress leave her beaming with pride.

When she reluctantly introduced a significant other to her little sister this year, Sehrish didn't know what to expect. Shazia reminded her that happiness is a blessing. And blessings should always be shared with the ones you love.

Sehrish is a graduate of Emory University and the University College of London. After teaching for three years, she'll be pursuing a doctorate in educational psychology, specializing in special education with a focus on autism spectrum disorders. She begins this fall.

Here's what she wants you to know:

Sheer compassion can really start to change things. And that comes in a two-part process. First, learn about autism spectrum disorders and spread the word. And second, learn to be okay and comfortable with individuals with autism. Promote hiring and training them, open college programs to include them, invest in valuable school support services early on. Everyone deserves to live a life of respect and dignity. Everyone.

Q&A

Meet Sehar Ali, a Board Certified Behavior Analyst Intern and Registered Behavior Technician based in Houston, Texas. She has worked with children on the spectrum for five years now.

How often do you work with immigrant children on the spectrum?
Of the 12 patients that I currently work with, a little over half of them are first generation American. Their families come from a variety of countries including Mexico, India, Iran and Nigeria. In the past, we have also had patients who moved specifically to the United States to get treatment for the child.

Do you notice differences in the ways immigrant parents approach situations vs. non-immigrant parents?

The answer to this is slightly complicated. The thing that we need to understand, and it took me some time to understand this as well, is that no parent, regardless of their immigrant status or education level or even understanding of developmental disabilities, wants anything to be wrong with their child.

But cultural expectations do affect how parents approach situations. For example, one of my patients, let’s call him Luke, is first-gen American and his parents were raised in Eastern Europe. As far as parental investment and willingness to work on therapy goes, these guys are superstars.

Another patient, let’s call him Peter, is Nigerian. Peter’s mom is totally on board with everything we discuss, but it took us a little longer to get his dad on board. Dad insisted that nothing was wrong, and that Peter was just a late bloomer and a rambunctious little boy.

A third patient from India has parents willing to accept the diagnosis for what it is but they remain extremely reserved about talking about their son's diagnosis outside of the clinic, which gets in the way of our collaborating with school teachers and speech therapists.

What do you wish you could tell parents reluctant to get help?
I wish that I could tell them to stop caring about what the rest of the world thinks or says about their child. None of that matters. As a parent, you know your kid better than anyone else and you know what they need.

What do you feel the public (or media) gets wrong about autism?
I wouldn’t say that media gets it wrong, but I will say that it is a little one sided. There are a lot of great TV shows out there (i.e. Atypical or The Good Doctor) that I think do a pretty good job of showing what it can look like when interacting with someone who has ASD and is high-functioning (emphasis on high functioning). Most people might think of Dustin Hoffmans’s character in Rain Man, but that is generally not the case. The most current statistic I could find said that 1 in 10 people with ASD have varying degrees of special skills, ranging from what we call "splinter skills" to "prodigious savant."

You're a Pakistani Muslim. What have you noticed about your own community's approach to ASD?
I see a lot of denial. A lot of it. And it’s really sad. In general, our community usually writes off individuals with disabilities as lost causes. I am doing my best to change that with the interactions I have with people in mosque but it is going to take a lot more than just one girl in one mosque to change the mindset of a whole community.

How can people learn more about autism?
The first place I like to send people is the Autism Speaks website. They have all kinds of information about ASD, treatment options, school resources, etc. Another way is to find events in your community such as autism walks. April is Autism Awareness months and a lot of places have events that everyone is invited to throughout the month. If you want to learn more about the diagnosis itself the National Institute of Mental Health is another great resource.

Are immigrants especially vulnerable?

Does migration actually play a role in autism? Maybe. A 2009 meta-analysis of 40 international studies examined factors that seem to track with an increase in autism risk. On the list: having a mother who was born abroad.

Here's more:

• Swedish children with parents born in sub-Saharan Africa vs two native parents. A 2012 study on ~5,000 Swedish children on the spectrum found rates of autism with intellectual disability were nearly twice as high among children whose parents were born in "resource-poor" countries (in sub-Saharan Africa) compared with families with two Swedish-born parents. (British Journal of Psychiatry)

• Intellectual disability most prevalent when born within one year after maternal migration. The 2012 study also found intellectual disability was most prevalent among Swedish children born within ~one year after their mothers moved, which may suggest stressful migration plays a role.

• Children born to women in war zones especially vulnerable. In a similar vein, a 2014 study on 1.6 million LA County kids found children born to women from current or former war zones may be vulnerable to autism. Autism was 76% more common among children of foreign-black moms compared to white children of US-born moms. (Pediatrics)

• In Australia, children of some African immigrant families at increased risk. This 2017 study of Australian children found children of immigrant families from East Africa were 3.5 times more likely to be diagnosed with autism with an intellectual disability compared to children of white moms. (Child Neurology Open)

• Autism rates are unusually high among Somali children in Minneapolis, but we still don't really know why. An emerging theory: lack of vitamin D, which some research shows is imperative for brain development. (Scientific American)

Get involved in research. Here's a nationwide opportunity via Emory University:

"The nationwide research program All of Us, sponsored by the National Institutes of Health, has now enrolled more than 100,000 participants in a historic effort to advance individualized disease prevention, treatment and care for people of all backgrounds. The goal is to enroll 1 million or more participants nationally." More here.

The barriers to getting help

In general, folks from immigrant backgrounds who have a child on the spectrum tend to have greater difficulties in "accessing, using, and complying with intervention services for their child." (Journal of Child and Family Studies)

Why? So many complexities lead to misdiagnoses or lack of diagnoses! From stigma, communication barriers, culture clashes, lack of topical education...

And:

• A fraught parent-clinician relationship: Immigrant parents often perceive interventions from healthcare professionals regarding delayed child development as offensive. (Journal of the Canadian Academy of Child and Adolescent Psychiatry)

• Quick dismissal of classic autism traits as cultural differences: Anecdotal evidence has found results of routine school screenings didn't line up with official evaluations by clinicians because interactions "were tinged with cultural confusion" or written off as language barrier issues. For one Minnesota patient, misinterpretations during an official medical evaluation after the school screening led to no diagnosis. The patient was indeed on the spectrum, as subsequent evaluations noted. (Scientific American)

• Gender clash in parental intervention: Moms of children with ASD tend to focus on positive aspects, while the majority of fathers tend to emphasize the child’s difficulties. This tends to make an already challenging experience much more challenging in the household. (Journal of the Canadian Academy of Child and Adolescent Psychiatry)

• Fear of losing hope: Immigrant moms may fail to acknowledge ASD diagnoses in their kids as an attempt to preserve hope for the future "instead of having to accept that their child had a disorder associated with more long term disabilities." Instilling hope is, therefore, essential to parental investment. (Journal of the Canadian Academy of Child and Adolescent Psychiatry)

• Costs: According to the CDC, on average, medical expenditures for children or adolescents with ASD are 4.1-6.2 times greater than for those without. In 2005, average annual medical costs for Medicaid-enrolled children with ASD were $10,709 per child, ~six times higher than costs for children without ASD ($1,812). And in addition to medical costs, intensive behavioral interventions amount to $40K-$60K per child, per year.

This painful Splinter piece from Katy Reckdahl tells the story of Christopher San Martin, a 6-year-old in New Orleans who physicians and therapists believe is likely autistic. Christopher's loving father, who is undocumented, is being detained at an immigration facility and faces deportation. Read here.

In this AJC story titled "Nuestra Comunidad" Johanes Rosello of Mundo Hispanico talks to Hispanic parents in the Atlanta community with children on the spectrum and how lack of community knowledge about autism makes life that much harder. Read here.

The Atlantic's Jocelyn Wiener and Kaiser Health News published a story back in 2017 addressing the deportation fears of immigrants with disabled children. If the parents are picked up by authorities, what happens to the kids? Read here.

Angie Kim's debut novel "Miracle Creek," has been dubbed a "courtroom thriller." Kim, who left South Korea for America as a child, is a former trial lawyer. In her book, she tells the stories of a group of women whose children have autism. Listen to the NPR interview. Buy Kim's book here.

This 2018 radio interview on 89.3 KPCC talks about how having a child with autism or any developmental disability isn't easy, but in some immigrant communities, like Koreans, the stigma makes it even harder to get help. Listen here.

In this story for Spectrum, writer Emily Sohn addresses the gender gap in autism research, highlighting the story of West African immigrant Morénike Giwa Onaiwu, who grew up showing signs of autism without realizing what made her so different. Today, she's co-executive director of the Autistic Women and Nonbinary Network and chair of the organization's Autism & Race Committee. Read here.

Interested in helping fact-check this newsletter? I could use the help! Just want to send some feedback? Email away! fiza.pirani@gmail.com.

A very special thank you to Sehar and Sehrish for sharing their stories.

Foreign Bodies is a monthly e-mail newsletter dedicated to the unique experiences of immigrants and refugees as they relate to coping with mental illness and wellness. It’s written and curated by Atlanta-based writer Fiza Pirani with copyediting and fact-checking help from New Jersey-based independent journalist Hanaa’ Tameez. Want to contribute your time or share your own #ForeignBodies story? Send an email to 4nbodies@gmail.com or say hi on Twitter @4nbodies. Special shout-out to Carter Fellow and friend Rory Linnane for the adorable animated logo!

If you're thinking about suicide or worried about someone who might be, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 741741 to connect to a crisis counselor. You can also find a wealth of culture- or language-specific recommended resources on our site, foreignbodies.net.

For Mucaad, Naeem, Talha, Haji, Muhammad S., Husna, Khalid, Hamza, Junaid, Mohsen, Areeb, Lilik, Muhammad E., Jahandad, Harun, Amjad, Osama, Muhammad Shahid, Abdelfattah, Ali Mah'd, Kamel, Maheboob, Arif, Ramiz, Ansi, Ozair, Mounir, Ahmed, Ashraf R., Ashraf al-Masri, Matiullah, Muhammad R., Ghulam, Karam, Muse, Abdukadir, Hussein, Mohammed K. and those whose names have not been released as of this writing.

I first heard the news on Twitter. It was a Thursday evening here in Atlanta, Friday afternoon in Christchurch, New Zealand, where local Muslims had gathered at Masjid Al Noor and the nearby Linwood Islamic Centre for Jummah prayers. We lost 50 brothers and sisters between ages 3 and 77. Fifty others were injured. You've seen the reports. You may have even seen the footage.

Sleeping was out of the question that night, but I did stop reading the news around 11:30 p.m. That's when I began to experience what I recently learned was a full-on panic attack. I was in my kitchen filling up a glass of water when I dropped it all on the tile floor and watched the sharp slivers crawl under nooks I'll never be able to reach with my cheap Ikea broom. I looked down at the mess floating in Brita-filtered water, a little blood mixed in, and I completely lost it. I cried and cried and cried as if I'd lost my own mother. My back ached, my muscles cramped and the headache wouldn't simmer down. It took me back to that day in 2017 when two men protecting Muslim women were stabbed to death in Portland by a white supremacist. That was the last time I panicked in response to a miles-away tragedy in a painful, physical manner. A few months after that 2017 panic attack, I was diagnosed with severe depression.

"The believers in their mutual kindness, compassion and sympathy are just like one body. When one of the limbs suffers, the whole body responds to it with wakefulness and fever."
- Sahih Bukhari Book 1, Hadith 224

In the wake of Christchurch, Sana Saeed of AJ Plus shared an iteration of the above hadith with a video of Palestinians offering prayers for victims at Al-Aqsa mosque. Hadiths, for those who may not know, are considered sayings of the Prophet Muhammad. The Arabic word translates to "news" or "story." In Islam, hadiths might offer a blueprint of religious law and moral guidance. For many practicing Muslims, they're second only to the authority of the Qur'an.

Reading that hadith, which I vaguely remembered from childhood, I finally felt like something clicked for me. The Ummah, or our community, is like a body. When one limb aches, we feel the pain everywhere. Is that why I'm reacting so strongly? Why I feel anxious just thinking of the Rohingya, the Yemeni, the Palestinian, Fulani, 7-year-old Zainab Ansari, the victims of Christchurch, the Portland men killed for defending Muslim women? Does the hadith explain it all? How could that be? The last time I stepped foot in a house of prayer was a year ago, I think. My du'as have for years been replaced with researched meditation rituals free of Arabic. My religion, if I subscribe to one at all, is nothing I can really name. So why does that explanation of an Ummah in pain together bring me so much peace? Because it helps me make sense of the recurring agony. It offers reason, in a mystical way. It helps me connect and feel less alone.

But there's more to this. Not just faith, but science.

The research on negative hyper-empathy and mental illness

• Tragedies have a particularly negative effect (stronger symptoms, needing additional help) on those with mental illness or who have had traumatic experiences in the past. Others at risk: those with ongoing stress, who lack support from friends and family. (National Institutes of Health)

• If you weren't near the scene or didn't lose a loved one in the event, you may still be experiencing traumatic stress. This is often exacerbated by constant exposure to news and social media and can be alleviated by disconnecting, leaning on loved ones and getting professional help. More here.

• If you have social phobia, you may be more likely than others to demonstrate "a unique social-cognitive abilities profile with elevated cognitive empathy tendencies and high accuracy in affective mental state attributions." (Journal of Psychiatry, 2011)

• Individuals with bipolar personality disorder often have trouble regulating emotions and may be hyper-empathetic to the point that "perhaps due to these propensities, they are also more likely to experience 'empathic distress.'" (Psychiatry Research, 2015)

• Latinx college students may internalize traumatic, discriminatory acts and rhetoric and then struggle with "self-hate." (University of Colorado-Denver, 2018)

• Undocumented immigrant children: The visualized threat of detention and deportation alone negatively affects the mental health of undocumented immigrants and their families, particularly children. (USC Suzanne Dworak-Peck School of Social Work, 2018)

• Gendered differences: Women generally tend to internalize, whereas men tend to externalize. (National Institutes of Health survey, 2001)

As always, we need more research. And you can help. Here's a nationwide opportunity via Emory University:

"The nationwide research program All of Us, sponsored by the National Institutes of Health, has now enrolled more than 100,000 participants in a historic effort to advance individualized disease prevention, treatment and care for people of all backgrounds. The goal is to enroll 1 million or more participants nationally." More here.

OK. What next?

First, if you have a diagnosed mental illness, take extra care of yourself.

Tragedies might hit you more intensely than your colleague or sibling or friend, particularly if there's some unique personal connection. This doesn't mean your anguish isn't warranted, that these horrific incidents shouldn't be felt, but know that amplifying pain resolves nothing for your own health. I've realized this rings true for my own experiences.

Second: Loved ones, employers, strangers... Reach out.

If you know or see someone with a history of depression or anxiety or panic attacks or any mental illness, or somebody who has a link to an event, whether that's religion, identity, birthplace, whatever, please reach out. They may not always be willing to talk, but push a little harder so they know you care. I ask this of my loved ones too, many of whom have definitely helped me talk through the pain or encouraged me to lean on professional help.

What's worked for me:

• Turn off news notifications if you know they have a tendency to stress you out. I did not have notifications on before, during or after the Christchurch attack. Still don't. In the same vein, if you are physically far from the tragedy and your life is not in immediate danger as a result of said event, don't bother with the news until you feel ready. I didn't read anything but an initial story and the next day, committed to focusing on stories of the victims and community response. Still don't know the terrorist's name. I understand I have a unique privilege compared to many in the news biz as I was not covering it. I actually took the day off to prioritize my health, yet another privilege I'm highly aware of.

• Look for the heroes. Look for the compassion, the acts of kindness and calls for unity. You need 'em to remind you of the good. You've got to remember there is good. Many found examples of compassion in New Zealand's PM Jacinda Ardern's leadership, her immediate action on gun control. Some found it in the 95-year-old WWII vet who took four buses to protest racism in the country or in Hussein Al-Alami, the victim who died trying to tackle the gunman. The way Christchurch cried together, holding their Muslim brothers and sisters up as neighbors should. Look for the love.

• Write. I tend to get angry when someone tells me to just breathe; that there's nothing I can really do from all the way here; that internalizing someone else's pain isn't healthy. As someone who values empathy more than anything in the world, I hate that mindset. I fear apathy. But I know that hyper-empathy, as Octavia Butler showed me in Parable of the Sower, is a self-mutilating disease. So when I'm in pain, I write. I make sure the pain is there, on print, permanently. I don't want to forget that pain. I want to revisit it and remember. But I do want to release it from my head and heart, and make some room for hope. Writing is my release. Find yours.

• Read. I write to release and read to connect. Poetry was my go-to after Christchurch. I seemed to find solace in Khalil Gibran's "The Prophet." Highly recommend. “And a woman spoke, saying, 'Tell us of Pain.' And he said: 'Your pain is the breaking of the shell that encloses your understanding. Even as the stone of the fruit must break, that its heart may stand in the sun, so must you know pain.'"

• Talk to a professional. Friends and family are great when you're hearing exactly what you want to hear, and sometimes they're not so bad when they dish out the truth! But in times like these, I personally find it hard to connect with friends or family that don't feel the magnitude of pain that I feel. It makes me feel misunderstood and alone. If you can, make an appointment with a therapist equipped with the appropriate experience and knowledge to help. And if it's your first time with a therapist, be patient and give them a few sessions before you even consider moving on.

• Meditate. I promise Headspace isn't paying me to say this, but the app really does work for me. When I feel panicked, I often rely on the anxiety meditation to help me take a few minutes to breathe and reassess. I'm also currently in the middle of a sleep course and have used the ones geared for fear, anger, stress, hunger and more. Let me know if you have any questions. Again, I'm not being paid to write this lol.

Do you have any tips of your own? Send me a note!

Following the March 15 mosque shootings in Christchurch, Texas Imam Omar Suleiman wrote this gutting op-ed for The Washington Post titled "Islamophobia kills. I watched this with my own eyes when I helped bury New Zealand victims." Suleiman helped bury 3-year-old victim, Mucaad Ibrahim. Read here.

In "Let Me Tell You About My Mosque," a beautiful 2015 story by Tasbeeh Herwees, the LA-based writer talks about the diverse personalities, identities and experiences that made up her hometown mosque—from "exiles of war and oppressive regimes" to children trading "Britney Spears albums and issues of J-14 magazine." Read here.

The Atlantic's Paul Bloom wrote this piece called "The Dark Side of Empathy" back in 2015. It starts with "I’m not usually in favor of killing, but I’d make an exception for the leaders of ISIS." In the story, Bloom addresses previous research on hyper empathy as a factor favoring aggression. "Our reaction to these atrocities can cloud our judgment, biasing us in favor of war. The benefits of war—including avenging those who have suffered—are made vivid, but the costs of war remain abstract and statistical." Read here.

A little different, but something I really wanted to make note of in today's issue. In this academic interdisciplinary syllabus on Islamophobia as racism, you'll find a downloadable PDF with endless resources. Highly recommend looking into the readings, learning from them and sharing the syllabus with your friends and family. The syllabus is inspired by the #FergusonSyllabus, the #StandingRockSyllabus, the #BlackIslamSyllabus and comes from Su’ad Abdul Khabeer, Arshad Ali, Evelyn Alsultany, Sohail Daulatzai, Lara Deeb, Carol Fadda, Zareena Grewal, Juliane Hammer, Nadine Naber, and Junaid Rana. Read here.

Interested in helping fact-check this newsletter? I could use the help! Send me a note: fiza.pirani@gmail.com.

Foreign Bodies is a monthly e-mail newsletter dedicated to the unique experiences of immigrants and refugees as they relate to coping with mental illness and wellness. It’s written and curated by Atlanta-based writer Fiza Pirani with copyediting and fact-checking help from New Jersey-based independent journalist Hanaa’ Tameez. Want to contribute your time or share your own #ForeignBodies story? Send an email to 4nbodies@gmail.com or say hi on Twitter @4nbodies. Special shout-out to Carter Fellow and friend Rory Linnane for the adorable animated logo!

If you're thinking about suicide or worried about someone who might be, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 741741 to connect to a crisis counselor. You can also find a wealth of culture- or language-specific recommended resources on our site, foreignbodies.net.

"Dad, we're in public. Why are you speaking in Hindi?"
"If you speak Arabic at the airport..."
"Can you wait until we get home to make the international call?"
"Yo—if you're going to talk in another language, whisper."
“This is a country where we speak English, not Spanish.”

I grew up, like many immigrants I know, ashamed of my loud-mouthed Indian family and the native tongue(s) I never quite perfected enough to keep my grandparents satisfied. I remember my non-foreign friends (and my fellow South Asians, actually) mocking the thicker accents of uncles and aunties and, indirectly, my own dad. It'd start with giggles, then caricatured imitations. I remember learning to react similarly at a very young age. When I'd watch TV with my folks, similar caricatures made an appearance on the silver screen. I remember laughing at age 10. I don't remember my dad laughing on the couch beside me.

Though I was technically born in India, my parents and I left for Saudi Arabia when I was very young. That's where I learned to speak American English at an American school eight hours north of the holy city of Mecca. After many years of AP classes, my Spanish isn't so bad, either.

These days, after working with Spanish-speaking staffers and serving Spanish-speaking patients for several years and, ok, maybe after visiting Spain for the first time—my parents are quickly taking up Spanish, too. In addition to learning "British" English growing up in Pakistan and India, my mom and dad are also quite fluent in Urdu, Hindi, Gujarati, Kutchi and in Arabic. I might even be missing a few dialects.

Yet somehow I was conditioned to believe my English-speaking skills, my English-only tongue and my "accent-less" identity made me somewhat better, more educated, more proper. And somehow my parents were conditioned to believe the same: that they were less—less educated (despite being doctors), lower-ranked, second-class. It seemed my dad, who carries the heaviest Indian accent in my family, bit his tongue into submission anytime an accent-less man spoke. The more "American" the man, the more powerful.

Having a strong accent, or speaking a native tongue aloud and in public, might signify a failure of assimilation for some. As if you as an immigrant didn't try hard enough to perfect what you should apparently learn to perfect. Even in my own South Asian community, I've heard plenty of folks refer to more eloquent English-speakers as more educated, smarter, better, more. And hey, it's not like the economics don't prove it, either. There is empirical evidence suggesting a positive association between English skills and earnings for immigrants.

Overall, English proficiency is "a primary social status variable for immigrants and their children because it is closely associated to socioeconomic factors (i.e., earning and employment status) and social interactions." (Am J Public Health. 2010 Mar; 100(3):563-9)

Limited proficiency—or speaking English with an accent—is also associated with a "foreigner" stereotype and can trigger discrimination.

How proficiency might relate to an immigrant's mental health:

• Generally: Individuals with limited English proficiency worry they're being victimized or stigmatized as a result of their difficulties with language and communication or worry about interpersonal discomfort and embarrassment that could lead to social isolation and undermine self-worth (Health Soc Work. 2007 May; 32(2):119-27)

• In Asian men: English proficiency is strongly associated with lifetime depressive, anxiety, and substance use disorders (AJP. 2017 May; 11(2): 3-5)

• In Mexican American youth: Acculturation stress and English proficiency are significant mediators when it comes to high rates of social anxiety and loneliness (Journal of Clinical Child & Adolescent Psychology. 2009 April; 38(2):273-85)

• In Spanish-Caribbean women: Spanish Caribbean women have higher rates of mood and anxiety disorders compared to women from English-speaking Caribbean (Am J Public Health. 2007 January; 97(1): 52–59)

• Among Chinese-American youth: Low levels of English proficiency in middle school were related to speaking English with an accent in high school, which in turn, contributed to the perception of being stereotyped as a perpetual foreigner, discriminatory experiences, and depressive symptoms (Dev Psychol. 2011 Jan; 47(1):289-301)

• Among Vietnamese immigrant and refugee women: English language proficiency as the sole predictor of somatic distress (Journal of Multicultural Counseling and Development. 2011 Dec; 38(2))

And how proficiency may affect immigrant mental health care:

• Generally: Limited language proficiency is closely associated with underutilization of psychiatric services (Psychiatric Services 2015 66:8, 798-805)

• Among insured Latinos: Low English language proficiency is associated with worse reports of the quality of primary care (Med Care. 2007 Nov; 45(11): 1020–1025)

• Among Latino and Asian Americans with mental disorders: Limited English proficiency contributes to longer duration of untreated disorders (Med Care. 2010 Dec;48(12):1097-104)

• Among Asian Americans with schizophrenia: Limited English proficiency was associated with lower adherence to antipsychotic medication and excess prescription filling (Psychiatr Serv. 2010 Aug; 61(8): 765–773)

• Without trained interpreters: Evaluation in a patient’s non-primary language can lead to incomplete or distorted mental status assessment (Psychiatr Serv. 2010 Aug; 61(8): 765–773)

• With professional interpreters: In Switzerland, more asylum-seekers were referred for psychiatric care when professional interpreters were used or when language concordance was considered adequate by providers (Australian and New Zealand Journal of Psychiatry. 2002;36:499–503)

Note: Most studies targeted Latinos and Asian Americans as the racial/ethnic minority groups most likely to face English language difficulties. There is also a growing need for research on the effects of using professional interpreters in psychiatry.

OK. What next?

As the world becomes more globalized, it's important to realize cultural stigma as just one of immigrants' many barriers to mental health care. We need to keep an eye on both linguistic discrimination and a lack of multilingual interpreters in the medical environment as barriers, too.

Participating in research

There is still significant under-detection of depression and other mental illnesses among the less-acculturated ethnic/racial minorities. This makes it hard to pinpoint the magnitude of the problem and, in turn, results in little movement in actual healthcare or policy changes. Maybe you'll want to encourage your friends to participate in research. The National Alliance on Mental Illness may be one place to start. (If anyone hears of a new study opportunity, please send along!)

Addressing our own prejudices

Something I wish all immigrant parents would believe themselves and teach their children:

"We must make allowances and be understanding, of course, but at the same time we have to instill in our children that other languages and cultures are nothing to be ashamed of, on the contrary. Tell them that even though your English is not perfect, you have two languages at your command, and that other parents do not have this option and must do with only one language and one culture. Tell them that, in this day and age, the more communication tools we have, the better off we will be." - Mamiverse

I'm learning to challenge my own accent prejudices. And I hope to learn as many languages as I possibly can. It ain't easy—who knew?!

#Tunetime: The universal language of music

Cali Pachanguero - Grupo Niche (1984)

An ode to Cali, Colombia, "the capital of salsa"

Olive Tree - Chyi Yu (1979)

To the Taiwanese olive tree in my dream

Al Quds El Atiqa - Fairuz (1971)

A song for Old Jerusalem

In her 2017 essay for Blueprint titled, "Dear Mum: I’m sorry I used to be embarrassed by your accent," Sienna Hewavidana, an English daughter of Srilankan immigrants, talks about the shock of hearing her mom's thick accent as she spoke to her class. "Shrinking into myself, I prayed for her to stop talking... It took me a while to realise that what I was shushing was more than an accent. I was shushing my culture, rolling my eyes at my history, cringing at my origins. I shushed brownness in the fear that I would be tainted by it." Read here.

Comic Celeste Yim penned this fantastic essay for Vice addressing the mockery of Asian accents in the industry. As a Korean-Canadian herself, she needed to know "why people who know better still laugh." Read here.

Voice actor Arthur Chu (also a former Jeopardy! contestant) wrote for NPR's Code Switch about the strangeness of speaking roles that demanded a "Chinese accent" despite his meticulously correct English grammar and enunciations. "To attack our language, our ability to sound 'normal,' is to attack our ability to be normal. It's to attack everything we've worked for. And make no mistake about it — to sound like a 'normal' American is to wield privilege." Read here.

In this lovely Complex essay titled "Why I'm No Longer Ashamed To Be The Daughter of Refugees," Sahra Vang Nguyen grapples with the resentment she had for her Vietnamese parents—and their accents—growing up in America. "Now, the source of my pride always goes back to one thing: I am the daughter of Vietnamese refugees." ​Read here.

Jamaican-American Kasheda Daum wrote this gorgeous love letter to her "superwoman" mom in PopSugar last year, and it really hit home. "Her patois accent, thick on the tongue like molasses, kept her almost mute during her first three months here, as she was skeptical of the English vernacular and of also being misunderstood... [I want] to squeeze my mom's hand in hopes of taking away any indignation that she perceived." Read here.

Interested in helping fact-check this newsletter? I could use the help! Send me a note: fiza.pirani@gmail.com.

Foreign Bodies is a monthly e-mail newsletter dedicated to the unique experiences of immigrants and refugees as they relate to coping with mental illness and wellness. It’s written and curated by Atlanta-based writer Fiza Pirani with copyediting and fact-checking help from New Jersey-based independent journalist Hanaa’ Tameez. Want to contribute your time or share your own #ForeignBodies story? Send an email to 4nbodies@gmail.com or say hi on Twitter @4nbodies. Special shout-out to Carter Fellow and friend Rory Linnane for the adorable animated logo!

If you're thinking about suicide or worried about someone who might be, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 741741 to connect to a crisis counselor. You can also find a wealth of culture- or language-specific recommended resources on our site, foreignbodies.net.

2,500 years ago, Confucius wrote the Classic of Filial Piety (or 孝), which amped up the whole bring-honor-to-the-family virtue common among East Asians communities. In many South Asian and Middle Eastern groups, this concept might be referred to as "izzat" or "nāmūs."

The lauded virtues of the modern model minority (most often attributed to Asian Americans): One must be respectful to elders, family-oriented, hardworking, studious, adaptable, submissive, introverted and highly successful. Not a bad stereotype to have, huh? Wrong.

The stereotype, though it may seem positive, distracts from the many issues community members face, particularly under a federal administration many view as especially hostile to immigrants.

How the myth affects mental health

In traditional Asian culture, mental health problems only exist because one can't control oneself. Such shameful problems must be kept quiet to maintain family honor. The shame or loss of "izzat" often discourages first- and second-generation Asian Americans from taking advantage of mental health services.

Traditional virtues coupled with being part of this model minority and adopting its stereotypes means taking on the unique stresses of academic and economic achievement, acculturation and unique obligations to family.

When communities embrace the notion that you're destined to succeed because of your racial background, "failure comes as a devastating hit to your mental health," Jennifer Cheang wrote for Mental Health America.

Children of immigrants or refugees also feel guilty for speaking out about their own personal struggles.

"Growing up as the child of a refugee who fled the Khmer Rouge in Cambodia, I felt like I had no right as a first-generation American to talk about my mental health problems. I hear this from Asian-American friends as well. When presenting a problem or struggle to our family members or friends, we are told that we do not understand what struggling is, or that our problems are invalid." - Jennifer

Research suggests this kind of high-achieving, subordinating entrapment is quite poisonous to one's mental health.

• Depression. Despite the fact that 57 percent of Asian Americans are reportedly moderately to severely depressed, they're three times less likely to seek help compared to other U.S. populations. And even if some do seek treatment, they worry their families will find out or dismiss them, only adding fuel to the fire.

• Suicide. Young Asian American and Pacific Islander women in particular have the highest rate of suicide deaths (14.1%) of any racial/ethnic group. Rates by group: White (9.3%), Black (3.3%), Hispanic (7.4%). Males have the second highest.

But the myth of the model minority isn't just harmful to one minority.

History lesson: How the myth pinned Asian Americans against African Americans

"Whites love us because we're not black." - Frank Chin, 1974

Asian Americans have faced varying forms of discrimination in the country, yes. Just look at FDR's Executive Order 9066 in WWII, which succumbed Japanese Americans to mass deportation and horrific internment over fear of Communism, an event black Californian columnist Rev. Hamilton T. Boswell called "the greatest disgrace of Democracy since slavery."

But when it became politically convenient, discrimination against Asian Americans faded. Before the Cold War, the idea of this model minority as studious, hardworking, successful and submissive "was quickly co-opted by white politicians who saw it as a tool to win allies," NPR reported in 2017.

The myth was also used by white politicians as a tactic to denigrate African Americans in a country ripe with racism.

There was this misconception fueled by white America that the Japanese "were rising up out of the ashes" because of who they were as a people. If Asian Americans could make it after internment and discrimination, and keep crime rates low, why weren't black Americans rising up? It must be them.

This strategy, scholars argue, allowed white Americans to forgo responsibility for racism when in reality, Asian Americans weren't "making it" because they cared about education or career development any more than black Americans. It's because the country treated them better and afforded them the opportunities to move up.

During the Civil Rights Movement, overt anti-black sentiments in some Japanese American communities, many of which had integrated with white Americans and enjoyed opportunities still withheld from African Americans, spread to the surface. Hokubei Mainichi editor Howard Imazeki famously challenged African Americans to “improve their own communities before asking for equal rights," according to Densho.org.

Some Japanese Americans stood up against the blatant racism. Civil rights organizer and founding member of the Congress of Racial Equity Ina Sugihara championed the belief that "the fate of each minority depends upon the extent of justice given all other groups." Yet her marriage to African American Willis Jones left her ostracized within her own community.

Anti-Blackness in many Asian American communities continues to leak through generations, "no doubt stoked by racist narratives perpetuated by American white supremacy and the model minority myth," PRI reported.

In 2014, Akai Gurley, an unarmed black man was fatally shot by New York Police Department officer Peter Liang. Liang was indicted, and Asian American groups even protested the decision.

"They thought that we weren't going to speak up," one protester said, citing the history of racial tensions between black and Asian communities in the area. "They thought that we were just going to be a model minority. But this one has touched everyone. It's 150 years of racism and mistreatment coming out."

The model minority myth and America's unfair criminalization of black Americans has actually given many Asian Americans "a false sense of honorary whiteness and severed us from building coalition with other communities of color," writer Kim Tran wrote for Everyday Feminism.

"The Black community frequently serves as our negative definition — the people we don‘t want to be. White supremacy fed us anti-Black racism and many of us believe it out of fear — and hope."

The truth is, the racism Asian Americans have experienced couldn't even compare to the systematic dehumanization that black people faced during slavery and continue to face today.

And if society was historically able to use the myth of the model minority to create a wedge between Asian Americans and black Americans, it can undoubtedly pit them against others society deems the "problem minority" at any given time.

In his essay, "Why We Struggle to Say I Love You," New York Times contributing opinion writer Viet Thanh Nguyen, an Asian-American, talks about the rarity of hearing those three words from his parents, why so many in his community can relate and why it's on the parents to learn better, too. Read here.

Ramishah Maruf, a South Asian student at the University of North Carolina Chapel-Hill penned this column for her student newspaper. She writes about affirmative action, and how the model minority myth drives a wedge between minority groups. Read here.

Lawrence-Minh Bùi Davis wrote this fascinating longform essay for Offing Magazine in 2015, but it's still worth a read if you get some time. In "Dispatch From the Floor of the Minority Model Factory," Davis explores the overwhelmingly Asian American SAT preparation industry. Read here.

He's the first DACA beneficiary to win the prestigious Rhodes scholarship, but when he leaves the country in October to study at Oxford with his fellow scholars, he may not be able to come back. South Korean Jin Park pens an op-ed in the Times, arguing "a human being shouldn’t have to be a 'genius' or 'economically productive' to have access to equal opportunity." Read here.

In "Asian Americans Are Not Your Model Minority," Pacific Standard's Massoud Hayoun explores the compounding struggles facing Asian Americans, Pacific Islanders and other communities in San Gabriel, California, often deemed resilient and successful based on their background. Read here.

Scott Kurashige's 2007 book, "The Shifting Grounds of Race: Black and Japanese Americans in the Making of Multiethnic Los Angeles," examines the historical roots of LA's Japanese American and African American communities and how the shift in racial cooperation gave rise to a multicultural LA. Purchase here.

Foreign Bodies is a monthly e-mail newsletter dedicated to the unique experiences of immigrants and refugees as they relate to coping with mental illness and wellness. It’s written and curated by Atlanta-based writer Fiza Pirani with copyediting and fact-checking help from New Jersey-based independent journalist Hanaa’ Tameez. Want to contribute your time or share your own #ForeignBodies story? Send an email to 4nbodies@gmail.com or say hi on Twitter @4nbodies. Special shout-out to Carter Fellow and friend Rory Linnane for the adorable animated logo!

If you're thinking about suicide or worried about someone who might be, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 741741 to connect to a crisis counselor. You can also find a wealth of culture- or language-specific recommended resources on our site, foreignbodies.net.

Aadita's story

Stuck between feeling not quite white enough for white kids or brown enough for the South Asians in her Toronto hood, Aadita Chaudhury felt tribe-less as a teenage Indian immigrant in Canada. The cold season further diminished her mental health, which she wrote off as a "call to explore my own imagination and to indulge my creative side," through books, for example.

But every year, as winter came around, she prepared for the sadness, even when she did find her own tribe. Thoughts of suicide frequently surfaced.

"Winter became a depressing yet romanticized escape for me in a way I was never told was actually quite unhealthy... My chronic sadness, I assumed, was caused by nothing other than my own indolence during winter. I thought if I got out enough and lived my life as I had during other seasons, I would do just fine. Just as culture shock had left me, eventually, so would the winter blues."

As with other types of depression, seasonal affective disorder can get worse if left untreated.

Aadita's bouts soon began creeping up in the summer months. In 2015, she was officially diagnosed with year-round clinical depression and began taking medication. Here's how she describes her first winter after the diagnosis:

"It felt as if I had woken up with a new lease on life. I felt amazed by simple things like being productive, not sleeping till noon, and not being tired for no reason. It wasn’t an immediate process — I still had very, very bad days — but on the whole, it felt like the parts of me that had been frozen in the Canadian winters for years on end were being gently thawed by some benevolent universal spirit."

Aadita penned her story for The Toast back in 2015. I reached out to her (@ThylacineReport) to see where her head's at three winters later.

"I'm managing," she said, having recently decided to wean off her medication after noticing an improvement in symptoms. She was never formally diagnosed with SAD, but looking back, "it seemed like the most probably cause."

"Community, therapy and loving what you do" have been helping her cope, but she's unsure how much of a "cure" it'll all be in the long term. If it doesn't work out, she's happy to return to medication.

I've been reading some of Aadita's recent tweets and I gotta say, they're hella relatable.

This thread in particular:

Read Aadita's 2015 story for The Toast.

The science behind SAD

You've probably heard of seasonal affective disorder, appropriately abbreviated SAD. Unlike the milder often-called winter blues, SAD symptoms (similar to major depression's) are more likely to interfere with daily functions.

The condition's been linked to a chemical imbalance in the brain catalyzed by light deficiency, which is why folks often blame winter's short days and long nights for their crap moods.

In a given year, about 5 percent of the U.S. population experiences seasonal depression.

Summertime SAD, also a thing, is believed to be linked to the heat. (The Lana del Rey song is about an estranged lover, not the disorder.)

Are ~aliens~ at higher SAD risk?

There really isn't enough evidence to back up this claim.

Generally, the people most at risk for SAD include women (*sigh*), populations far from the equator and folks with a family history of the illness.

But I did find a few studies suggesting some immigrant populations may have a disproportionately high risk of developing SAD.

• In Norway, a massive survey of its five major immigrant groups found Sri Lankans were least likely to experience SAD. Iranians were most likely to experience the disorder. (2013)

• Another survey found African-born students enrolled in D.C.-area colleges and universities were more likely to develop summer SAD compared to their African-American counterparts. (2004)

• A study of seasonality and health problems in native and non-native populations of Chukotka in Russia suggested native groups were more likely to tolerate extreme conditions during summer and winter. (2018)

As you can see, the research on SAD's prevalence among immigrant populations is scarce. Research on depression in general among immigrant populations is a little less scarce, but still limited.

One possible reason why: under-recognition and under-reporting of mental disorders. For example, the way we express our problems to doctors varies across cultures. A non-native individual with depression or anxiety might come in with complaints about back pain or headache or with other culture-specific idioms that leave them undiagnosed. But I'll save this topic for another time.

The point: If you're ticking off symptoms for SAD (listed below) or for any other type of depression, you're not alone.

More than 300 million people around the globe suffer from some form of depression. I'm one of 'em. And so is Aadita.

Symptoms of recurring fall/winter SAD:

• fatigue and low energy

• pervasively sad mood

• loss of interest in activities you once enjoyed

• excessive sleeping

• craving and eating more carbs

• weight gain

• difficulty concentrating

• feelings of hopelessness or despair

• frequent thoughts of suicide

Source: Mayo Clinic

Not sure if you fall into the bucket? Reach out to a loved one, make an appointment with your doctor and get screened for depression right away.

If you're thinking about suicide or worried about someone who might be, call the National Suicide Prevention Lifelinee at 1-800-273-TALK (8255) to connect with a local crisis center. You can also text a crisis counselor by messaging 741741.

Elvia Magaña, 61, is a Mexican immigrant living in Yakima, Washington. She copes with seasonal sadness every year and finds comfort in embroidery and caring for her plants. Read here.

Raifa Rafiq, diagnosed with SAD in 2016, turns to books for some distraction or consolation. Read here.

How writer Wei Tchou told her hesitant Chinese immigrant parents why she needed a shrink. Read here.

Foreign Bodies is a monthly e-mail newsletter dedicated to the unique experiences of immigrants and refugees as they relate to coping with mental illness and wellness. It’s written and curated by Atlanta-based writer Fiza Pirani with copyediting and fact-checking help from New Jersey-based independent journalist Hanaa’ Tameez. Want to contribute your time or share your own #ForeignBodies story? Send an email to 4nbodies@gmail.com or say hi on Twitter @4nbodies. Special shout-out to Carter Fellow and friend Rory Linnane for the adorable animated logo!

If you're thinking about suicide or worried about someone who might be, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 741741 to connect to a crisis counselor. You can also find a wealth of culture- or language-specific recommended resources on our site, foreignbodies.net.