Interview with Mental Health Researcher Sandhya Subramanian
A candid conversation about mental health among Asian-Americans
Sandhya Subramanian is a current MPH student at Emory University’s Rollins School of Public Health. She graduated from the University of Pittsburgh in 2016 with degrees in Health Sciences and French. As an undergraduate researcher she worked on a project to better understand mental health issues as they relate to Asian-American students.
How did you get interested in mental health issues — specifically among Asian Americans?
“From personal reasons — I went through a really rough time in high school and then in college with my mental health, and I really wish that I had had more resources. I found that having a lack of people to open up to, especially among my family, was something that was shared with a lot of Indian friends that I grew up with. We felt that we couldn’t open up about any sort of mental health issue, even if it was really minor, like having a stressful day, or something more severe, like actually thinking that you needed medication for anxiety or depression. It was something that I started to openly talk about when I became comfortable and once my friends became comfortable they would open up and say similar things, like ‘Yeah I wish I could tell my mom about this but every time I even mention the word ‘depressed’ she freaks out and runs away.’ I really want it to be less of a stigmatized topic and I think presenting it in an academic way makes it more accessible, especially to older generations. I hoped I could talk about my research with my parents and that it could bring about a more open conversation surrounding mental health in my personal life, as well as for other students who didn’t really have a space to talk about mental health with their parents.”
At what point during college did you decide this was something you wanted to work closely on?
“I started when I did the Community-Based Research Fellowship at Pitt. I thought about what I really cared about that would be a really interesting research topic, which I could spend hours looking into and that would bring me actual insight. That’s when I ultimately came up with a research question which looked at one’s willingness to seek mental health services as a function of acculturation status. So all that jargon basically means your willingness to go to therapy as it relates to how ‘American’ or ‘Asian’ you consider yourself to be or how you self-identify.”
So how did you go about answering this question?
“This was challenging because no one had done this research at Pitt before, so I went to the public health school and finally found a professor who was excited to work with me. I shared a lot with her about my life, my upbringing, my parents, my friends, and other friends in the Asian community. She was curious too because she had a lot of friends in the Asian community and she didn’t even know this was a big issue. I was like, ‘Oh my god, I finally have the space to talk about mental health without being shut down. There’s someone who actually wants to hear what I have to say and values my personal experiences and wants to see if other people experience the same things that I do.’ And it was something I’m not used to at all, finding a researcher that really appreciated the value of a topic that I brought to the table. And it was also a personal achievement for me to be able to talk about it.”
Did you face criticism or push back during the course of your project?
“In the Indian community or more broadly in the Asian community mental health is not something that’s discussed, so I was really afraid of getting criticism not only from my family, but also from my peers in general.”
Even from college-aged students?
“Yeah, I think I was still afraid because it is a sensitive topic, it is unique to everyone, and everyone has their own experiences. I noticed that when I presented my research to certain student groups, the reception to what I was talking about was very different. I always left a space where we can talk about our personal experiences and I noticed that in one of the presentations people were like ‘Yeah I really like that you’re doing this with mental health — not that I’ve ever experienced anything like that’ or ‘It’s really funny, this one time my mom thought that I was depressed but I wasn’t just because I got a B instead of an A on my test because I had a rough week.’ They would make up these stories to avoid any sort of identification with a mental health issue because they still thought it was something that they really shouldn’t associate with themselves. I think they felt some sort of shame if their name was tied to a mental health issue. It was really frustrating for me to give that presentation and open myself up and let them know that I had mental health issues, but people didn’t get the point of the presentation or they didn’t want to open up in front of their friends.”
Do you think it’s possible that some people don’t recognize that they have these issues because in their communities there’s a tendency to invalidate those feelings?
“I think that was the case for a lot of people. If your parents are ingraining in your head that you cannot have a mental health issue then maybe you cannot recognize it because you don’t know the signs. So maybe it’s not their intention to be careless about what I’m talking about because that’s genuinely how they perceive it. They may not consider having a rough couple of months a mental health issue. Some groups were totally open to talking about it and I had to recognize that even though I’m open talking about my experiences, not everyone else was, and that’s ok.”
What were the overall findings from your research study?
“My hypothesis was that the more acculturated people were with American values, the more open they would be to receiving mental health services, and vice versa. To be a part of the sample you had to self-identify as Asian or Asian American and you had to be a university of Pittsburgh undergraduate student. I collected over 130 surveys and I ultimately found that there was no association between acculturation status and openness towards receiving mental health services among the sample. There was a lot of bias though, because I was talking to a lot of people about mental health services and why they are important, and a lot of people saw that presentation and then may have taken the survey. There was additional bias because some of the people who are not receptive to mental health services didn’t even want to fill out the survey.”
Mental health and perceptions around it is a larger issue in general, but what is your sense about why this is uniquely difficult for Asian communities, especially for young adults in the United States?
“When I was posting about my research on social media, talking about the issue and why it was a big deal to me, I had a lot of people who weren’t Asian would say ‘Do you think Asians are more important than the rest of us? Do you think these issues only exist in your community? They exist in our community too. Why do you think Asian people are so special?’ Well, I don’t think they’re any more special than anyone else. This was just my interest — I wanted to study Asian-American mental health because I’m part of that community. I think all cultural groups have their own reasons as to why mental health is or is not stigmatized, but in the Asian community the literature shows that the stigma huge, it’s deeply ingrained, its intergenerational, and it stems from a lot of the behaviors and societal expectations of Asian people in general. Academics is a really big focus for a lot of Asian-American families, especially for younger generations, so there’s a pressure to succeed and that puts a lot of mental strain on someone. In my research, a theme that emerged pretty often was the idea of upholding family honor, especially pertaining to Chinese communities. And when I presented to CASA (Chinese American Student Association) they all said the same thing: they not only have to fulfill personal goals but they have to fulfill goals of their cultural community, otherwise they wouldn’t be accepted or they’d be belittled. And in India, for example, the idea of mental and physical health is intertwined — there’s a concept called mind-body dualism, which is idea that the mind and the body are separate. Some people think that because mental health is a health issue, it has to do with a physical issue. Once I told my mom, ‘I’m so anxious today, I don’t know what to do’ and she said ‘Go for a run or have a cup of tea.’ I tried to explain that this issue had been going on for months and maybe I needed something else but she said ‘No, no, no, you just have to energize your body.’ It’s not that one way of viewing the mind-body connectedness is better or worse, it’s just different.”
How do you suggest we balance and navigate entrenched cultural traditions in Asian communities that are influencing the way we look at mental health?
“Mental health is a hard topic because it’s deeply ingrained in the ways in which people are brought up, so a key is to focus on intergenerational communication. If parents heard some of the experiences that their kids went through, or the friends of their kids went through, they might understand their perspective a little more. I think that another big key is finding those change agents in your community — people that have a lot of power and respect and that are comfortable talking to a wide array of people. For example, if my priest at my temple were to talk about mental health in a very positive light and work to encourage their parents to talk to mental health with their kids, the parental generation would automatically be more open to talking about it, because this is someone that they respect and trust and someone who they come to for difficult, challenging topics.”
Tell us about your current research project.
“Right now, I am an Master of Public Health student at the Emory University Rollins School of Public Health in the global health department. My current project, which is also my master’s thesis, is focused on the relationship between various dimensions of female autonomy and marital satisfaction among young married couples in Pune, India. This project, much like my research project at Pitt, is rooted in my personal experiences and desire to learn more about an issue that face my cultural community. I really like doing research about things that I’m passionate about — and I’m passionate about things that I’ve experienced. My personal experiences really fire my interest in my research projects. I’ve gone through some experiences in college where I was abused and that really stood out to me because I thought about how it related to my culture and how Indian women are treated in their marriages. So I’m now looking at marriage satisfaction in a specific slum in Pune, India as a result of female autonomy. I’m interested in seeing how women in India are treated. So I basically break autonomy into different groups: I’m looking at autonomy at a financial level, on a sexual level, on a family planning level, and an educational level. It’s a really complex research question and I still have a lot of work to do on my thesis, so I don’t have any results yet. Even though it’s a different topics it still has to do with Asian mental health. These are Asian women and marital satisfaction obviously contributes to their mental health because how satisfied you are with your life partner is directly going to impact your mental health, and in some cases your physical health. I think more broadly this is a large public health issue that is related to mental health.”
Do you think having more Asian and Asian Americans working in this space — public health, psychologists, psychiatry would be beneficial?
“Having Asian professionals in the public health space, in the mental health space, in the women’s health space can benefit these communities so much. Again, having people in an academic space automatically makes them more valid in the Asian community, especially among older generations. The Asian community specifically respects medical professionals a lot. If my mom could hear from an Indian doctor about the severity of mental health and how to recognize certain mental illness, maybe that would’ve made my life easier in terms of talking to her about it. People are more open to talking to people whom they relate to or feel connected to. A physician can recognize that they’re bringing up a sensitive subject and may know how to cater to it in a more culturally sensitive and appropriate way. And even if that’s not possible, it’s really important for physicians of any culture to learn how to speak to members of different groups, because that can have a huge impact on the patient’s health and their family’s health. I actually talked to the university counseling center and worked with them to develop a Cultural Competency Workshop for the counselors so that they could cater to the culturally specific needs in regards to mental health for the Asian American communities. But I do think we’re making really big strides even though we don’t necessarily recognize it. We are the guinea pigs — a lot of us. I’m the first person in my family to be born in the United States. The fact that our generation is now open to talking about these things, when during our childhood it was something that people didn’t talk about…that’s a huge stride. But it’s going to take time for us to see every single thing that we want to see.”
Sandhya Subramanian: sandhya.subramanian@emory.edu
