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How Does Depression Manifest in the South-Asian Context?

Updated: Mar 12, 2021

Note: This Article was originally written by Ayesha Sharma and published on TherapizeIndia's website.



“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.

Picture credit: www.quotevscaptions.com


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. Below are 3 ways in which depression has sneakily shown its face in elaborate disguise within the South-Asian context, as I have seen in my work:


  1. 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. I remember a male 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”, the innocence in the question points towards our helplessness as larger patriarchal systems and structures trickle into our emotional and personal lives.


2. Aches and pains in your body


When emotions are not allowed to be verbally expressed, they become expressed in a way that can draw attention and care without revealing much about the emotional source of concern. A middle-aged woman reluctantly came to therapy upon the suggestion of her physician who suggested that her unexplained chronic pain complaints were not only to do with her physical health but also her emotional health. She insisted that chronic physical pain in the body was the only concern, often saying “There is nothing wrong with me! I only need to get rid of this bodily pain but they cannot find a source for it”.


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. 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.


Over time, as we explored the woman’s emotional life in therapy, she gradually noticed reduced intensity of her physical pain and better sleep. What has changed? An embodiment of her emotions, allowed them to be heard, seen and helped.


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.


3. The ‘All is Well’ facade

You know the popular cultural reference “All is Well” from the cult classic 3 Idiots, while meant to represent self-affirmation, has now become a sticky mask we wear in our social lives to conceal the realities of our emotional lives to affirm others rather than ourselves. A popular belief our elders have drilled in our heads from a young age has been “never wash dirty laundry in public” or “only share the good in your life, not the bad”. These beliefs reinforce the quality of shame in talking about when we are not okay. Rarely do we feel it is appropriate to share our struggles or the true extent of our problems with even our close ones. We have learned to value sharing only positive aspects of our life, or when we have tried to share the things we feel vulnerable about, they may not have been 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.



You can reach out to Dialogue Mental Health for psychotherapy services at dialoguementalhealth@gmail.com.


#counselling #depression #southasian #mentalhealth #indianmentalhealth





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