What you are doing … is breaking the chains of oppression. By healing, you create an environment that is conducive to healing others.
A few months ago, I had a series of counselling sessions to try and make sense of an intense bout of stress, grief and low self-esteem. While emotionally offloading to someone over the phone felt like a period of light relief, the experience wasn’t as cathartic as I thought it might be. Even though my white counsellor was incredibly compassionate and encouraged self-reflection, she couldn’t quite grasp how factors such as race, gender, religion and class all shape my mental health.
In fact, a 2016 study in the British Medical Journal found that people of colour in England are less likely than white British patients to contact their GP about mental health issues, even though they tend to experience higher rates of mental health struggles.
“We know that what causes emotional wounding are systems of oppression,” says Dr Tina Mistry, a clinical psychologist based in Birmingham who specialises in working with patients who have PTSD, developmental or intergenerational trauma. She believes that the lack of treatment available to people of colour is partially to blame. “You’ve got patriarchy, you’ve got colonialism and racism. All these huge, massive factors continue impacting on people’s mental health.”
Once in the mental health system, PoC patients are likely to experience further inequality and discrimination, according to a 2020 report by the Race and Equality Foundation. The same study found that healthcare practitioners are seen to have an unwillingness to engage with patients when they try to discuss how racism could be affecting their mental health.
“People have tended to experience a therapist who has a Eurocentric approach to the world. Sadly often it creates a mismatch in the therapist’s understanding of that client’s world, so this is a huge problem,” says Dr Mistry. “The client then often feels not fully understood, often belittled or devalued.”
Saffya Fatima is a counsellor and psychotherapist based in London. Like Dr Mistry, she thinks that therapists need to understand how systems of oppression manifest in their own lives as well as those of their clients’. “I do not think a therapist can work successfully with a client from another race without first acknowledging their own racism and working on it, particularly white therapists in relation to working with clients of another race,” she says.
Fatima believes that therapists need to unlearn their internalised prejudice before attempting to work with clients from a different background. “It takes actively challenging oneself and where these notions come from because they are part of everyone’s psyche, despite what we like to tell ourselves,” she says.
In 2008, Dr Mistry began her doctorate degree. When she started practising, she remembers the lack of resources for PoC patients who had mental health struggles relating to social disadvantage, health inequality or racial trauma. “I felt massive unease. It was difficult because services aren’t equipped to deal with the complexity that black and Asian ethnic minorities have.”
She references buzzwords such as mindfulness as Eastern practices that have been repackaged for white communities. It was at this point that she decided to flip the script and began dismantling the Eurocentric models she’d been taught in order to decolonise therapy.
She encourages patients to look to their parents, and religious and community leaders for inspiration. “I’m sure we’ve been doing this for thousands of years. Let’s step back and think, ‘Well, what is it that our community is doing already? Why don’t we look at our traditional healing practices? Why not own that?’”
Navi Ahluwalia is a 24-year-old account executive and freelance writer in London. She began seeing a therapist in 2017 when she was struggling to find a job, which knocked her confidence. “I’ve always had insecurities, we all do. But the constant rejection, fuelled by job hunting, while many of my peers were easily entering the next phases of their lives made it a lot worse,” she says.
Aside from struggling to find a therapist who could help her explore aspects of her South Asian identity and upbringing, Ahluwalia remembers facing intra-community barriers when it came to soliciting therapy. “I was nervous about telling my mum. I didn’t want her to feel like she’d failed, which I think is common for South Asian parents when therapy is considered.”
Dr Mistry admits that for some South Asian clients, cultural shame, family honour and maintaining public reputation are potential hindrances for having productive conversations about mental health. “I think there’s a huge barrier because if we air our dirty laundry out in the world, we wonder what will people think? Will they invite me to the weddings, or will my daughter be able to get married? We’re trying to hold this perfect, clean reputation, which actually doesn’t exist,” she says.
When I ask Dr Mistry which topics surface the most when working with South Asian women, she references the three Ms: marriage, motherhood and menopause. These points of transition bring a different set of challenges, all of which encompass feelings of loss and identity and feeling unable to cope with a new set of expectations. “Nobody talks about the psychological impact that that transition is going to have on that person, and how daunting and anxiety-provoking this change is going to be,” she says.
The burden of expectation is something that Ahluwalia can relate to. “As young women, we’re taught to be quiet, to be ‘good’ and to exist to serve the men in our families and the guests in our homes. There’s never been a time for emotion and I think that’s a big part of why we don’t discuss it.”
When she was searching for another therapist, she wanted to find someone with a similar background to her. “It’s made a huge difference because we can now talk about what it’s like to be in an interracial relationship [my therapist is in one too], what growing up in a South Asian household can be like and what effects our culture’s repression can have on young women and their relationship with confidence.”
Saadia Faruqi is a 44-year-old writer based in Houston, Texas. Like Ahluwalia, her first encounters with therapy were skewed by the fact that her therapists did not understand the challenges she faced within her community. “When discussing my arranged marriage, issues with in-laws or my spouse, or talking about the burden I faced as a working mother, it was difficult for these therapists to understand or connect with me.”
Of course the taboo surrounding mental health is not limited to South Asian communities; there is a cross-cultural sense of shame and apprehension when opening up conversations about mental health and therapy. “We don’t talk about it – the pain, the grief, the loss, the trauma, because of the fear of how the other is going to react and respond. We’re so afraid,” says Dr Mistry. “If there is somebody with mental health difficulties, they are shunned, they’re kept at the back, they’re pushed to the side, they’re not spoken about.
“What people are failing to recognise is that it isn’t binary. It’s not mental health and mental ill health – it’s a spectrum,” Dr Mistry.
Since working with a South Asian therapist, Ahluwalia says that she’s able to discuss issues that go beyond surface-level. She emphasises that finding a good therapist can take some time – she had three trial sessions before she landed on her current one. And while she was fearful at first, therapy has changed her life for the better. “It’s an amazing feeling to be sitting in a session and realising that you’re ‘doing the work’. It gives you a sense of comfort in your darkest hours, knowing that you have a place that you can take those emotions and process them safely.”
Dr Mistry says that her job is to remain curious and ensure patients feel safe and welcome in her presence. She explains that while she does bring her experience as a South Asian woman in the UK to the sessions, she’s mindful that her clients will not occupy the same lived experiences as hers. “My job is always to make sure that I’m not making assumptions,” she says.
She hopes that by giving therapy and mental health visibility on and offline, it will encourage more South Asian women to want to heal. “What I say to anybody who’s having these conversations with me is that what you are doing by putting yourself first is breaking the chains of oppression. You are not only doing this for yourself, you’re doing this for all the other women who may be in your future, your legacy. By healing, you create an environment that is conducive to healing others.”
Follow Sana Noor Haq on Twitter: @sananoorhaq
Illustration by Riya Chowdhury www.ri-ya.co.uk
Links that readers might find useful
South Asian Therapists https://southasiantherapists.org
The Black, African and Asian Therapy Network: https://www.baatn.org.uk
Therapy in Color: https://smart.bio/therapyincolor_
National Queer and Trans Therapists of Color Network: https://www.nqttcn.com
Decolonising mental healthReRoute: https://www.instagram.com/reroute_org