Issue 14: My parents don't believe I'm depressed. Now what?
Issue 14: My parents don't believe I'm depressed. Now what?
How to refocus on your own healing when you feel dismissed
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
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
A massive thank you to M, Dr. Sharon Lo, Marissa Evans (that art!) and my editing champs, Hanaa’ and Farah.
Sources
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
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
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/
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!
Fiza this issue was fantastic. Solid tips.