Is depression just a Western problem?

“That’s how life is for everybody. Everything is fine! This is my destiny. People have it much worse.’ wrapped in nervous laughter.” Sounds familiar? If you’re from a South Asian background, you probably heard this a lot growing up.

As a young brown psychologist, training and interning in the United Kingdom, I was often struck by how articulate and expressive most people seeking mental health services were about their emotional distress. There, openly talking about mental and emotional distress from an early age meant that far more people knew they were struggling and had words to express how.

My mind would snap back to home in India, where women experiencing immense difficulties in the shape of abusive marriages, sudden loss of loved ones or even just feeling lonely and unsupported would brush away their distress Men on the other hand grow up being told that emotions are only for women, as if the worst thing a man can be is a human being with feelings.

Even if you are aware of, and bring your emotional problems to the awareness of others, a sea of powerful voices reciting internalised cultural messages about vague and self-righteous character traits like ‘strength’, ‘resilience’, ‘discipline’ or plainly the ability to forget if nothing else works, drown our feeble, singular pleas for help. Our culture often tells us that there is something ‘wrong’ with us because we can’t deal with life’s ups and downs. How many times have we wrongly heard symptoms of depression be labelled as ‘laziness’, ‘indiscipline’, ‘carelessness’ or ‘self-pity’ from significant others in South-Asian homes and communities.

As a practicing psychotherapist back in India, I now know that while we do not use words to express our distress, it is expressed nonetheless. So how does depression manifest in South Asian contexts?

Anger Outbursts and Irritability

A male-identifying client who had consulted me for his troubles with anger, looked perplexed when I asked him ‘What do you feel angry about feeling?’ in one of our sessions. But he was surprised at his answer when he spoke in a quiet voice, ‘I feel angry about feeling very sad and tired’, allowing himself to name and feel the emotion for the very first time.

In patriarchal societies, some emotions like anger are rewarded and allowed while others like sadness, fear, or pain are punished. Our culture expects men to be viewed as powerful, assertive, aggressive and manly when they display anger and irritation. Anger is the acceptable outwardly mask that hides more complex emotions underneath. It protects us from feeling vulnerable and hides what lies at the core of our disturbance.

Aches and pains in your body

I remember a client asking me, “Wanted to check with you, is it okay to cry sometimes? Does it mean something is wrong with me? I get worried if I have cried”. When emotions are not allowed to be verbally expressed, they become expressed in this way that can draw attention and care without revealing much about the emotional source of concern.

In the South-Asian contexts, our bodies and any related disease is given immense importance. People are constantly asking after your physical well-being, mothers are often worried about how much the child is eating. However, the same attention is rarely given to our emotional well-being.

Paying careful attention to our body can help us tap into it’s wisdom and expression of emotional health. Our bodies are the container for all our thoughts and feelings. It holds our traumas and hence is a great litmus test of emotional well-being too. As a somatic psychology-informed psychotherapist, I have often observed that asking about the body opens up clients to add a new dimension to their experience of distress. A simple inquiry about how the distress feels in the body allows a story to unfold that is often left out of our cerebral narratives. From being unable to sleep (insomnia), to medically unexplained body pains, headaches, chest tightness or digestive problems to fatigue, are all symptoms of holding difficult feelings in the body.

The ‘All is Well’ facade

“Share only the good in your life, not the bad” Sometimes we value sharing only positive aspects of our life, or we try to share the things we feel vulnerable about and they aren’t received well. This pushes us to have an exterior that only draws attention to the good bits, or positivity that does not exist for us in our internal realities. Forced happiness in this way can be a manifestation of the opposite feelings- sadness, hopelessness, helplessness, grief among others.

Depression is a layered phenomena that can present itself very differently for every person. Hence, use this list only as a guide to inform your knowledge on the topic rather than using isolated pieces of this as an absolutistic reading of any one or all of these manifestations as implying only depression. Use your discretion to process, understand and find supportive spaces that will help you make sense of your experiences, preferably with a trained mental health professional.