Electronic Winter 2022 | Issue 53

But, what will people say?: An experience tackling Cultural Biases against Mental Health

By Sneha Pamulapati, OMS-III at Midwestern University CCOM

“Log kya kehenge” simply translated from Hindi means “what will people say?” but the subtleties that lie in the cultural context of this phrase also imparts shame and disapproval on those seeking refuge for their mental health illnesses. I have heard this response many times while inquiring about how patients are feeling at the Indian American Medical Association Charitable Foundation free clinic over the past seven years. The population at this clinic is majority those of South Asian descent who are immigrants without insurance and access to healthcare. I have been volunteering as a translator and subsequently a medical student doctor for these patients, and I have always tried to make it a point to ask the patients how they are feeling about whatever they have shared is going on in their lives. Although we are often stretched thin for time during the scheduled 15-minute appointments, this is their only contact with a healthcare professional, or oftentimes anyone not in their immediate family, for months at a time.

Mental health is a taboo topic in South Asian culture, something I have experienced firsthand in my own life as well as observed when working with patients. One particular patient has stuck with me through the years, and it is her who inspired me to continue asking each patient that I see how they are doing mental health wise, even if met with resistance. This woman had come with her husband for a reported headache. Many of the questions that I asked were met by answers from her husband, rather than her. When asking her obstetric and gynecological history, her husband was infuriated why I needed to know all of that for her headache. I calmly asked him to step out of the room for the remainder of my history taking and physical exam, stating that it was our policy. As soon as he had left, I asked the woman how she was doing. She sheepishly replied that she was fine, and that it didn’t matter how she was feeling. I implored her to tell me why she felt this way, and she revealed that she had recently had a miscarriage that she and her husband were both heartbroken about. She was unable to tell her in-laws, who she was living with, how she felt, as they did not speak about such "emotional" topics. She furthermore told me that if her being upset was to be discovered by others, she feared what her other community members and family members back in her native town would say. I subsequently tried to urge her that her mental health was valued and important for her well-being, no matter what all these other people thought. Eventually I was able to give her resources for free mental health counseling in the area, as well as urge her to come back to this clinic if she displayed any warning signs.

From this experience, I realized the need to develop a culturally sensitive way to ask a PHQ-2 and/or GAD-7 for these patients. When bringing up any words relating to mental health, such as depression, anxiety, sadness, or even stress, they would write it off as something they didn’t need help with or to fix. I thus realized that the only way the patients would discuss their emotions was to ask how they were feeling generally at the end of their history taking portion. Sometimes patients would still question why I was asking that, others would verbalize their physical ailments and how that was affecting them, but a select few would finally reveal that they had been dealing with some sort of mental illness and didn’t know what to do next. Regardless of the response, giving mental health importance during their doctor’s appointment was essential to begin to reshape how patients of South Asian culture think about mental health.

Seeing patients who I had seen months or even years ago come back and be much more open with me shows that strong-rooted cultural biases towards mental illness can be changed with patience and cultural competency. I hope to continue this assurance to patients that it doesn’t matter “log kya kahenge,” rather it only matters what they themselves say.