In May of 2013, my cousin Neil took his life at the age of 23. He had struggled with depression since high school. It was one day before Mother’s Day and two weeks before my older brother’s wedding. It was the worst day of all of our lives.
I was at a Starbucks in Texas studying for medical boards when I heard the news. I will never forget the way my hands and knees toppled to the floor or the screams that followed. The experience affected me immensely as a person, family member, and mental health advocate.
Because it was sudden and he never left a note, I will never know what pain Neil silently endured, or for how long. I will never know the fear, doubt, shame, and sadness he may have felt. Four years later, I still wonder about these feelings, which are familiar to me too. I never found a space safe enough to share them until psychiatry residency, when feelings became my full-time job and I learned they are not as scary as they seem.
My story, in some ways, is like the story of the immigrant family experience – the pursuit of the American dream – but on steroids.
My parents were the first from their families to come to America from India 40 years ago. Over many years, they brought over their families – my four grandparents, 14 aunts and uncles, and 12 cousins. I grew up in a house with all of them. My parents converted four bedrooms into six to accommodate everyone.
Tijuana Baja, California, photo by Mach Bhati, MD
Photos from my childhood depict a horde of people celebrating birthdays, anniversaries, Diwali, Christmas. Every mealtime was a buffet. My mom drove the van each morning and afternoon to the elementary, middle, and high schools. At night, sleeping bags and bed sheets covered every floor.
In Sacramento, a mostly white community then, I was always aware of being different. Just by having brown skin, I stood out. I spent a lot of energy trying to feel “normal.” I lied about the type of dance I did, saying it was ballet, not “bharatanatyam,” the classical Indian dance I hated and could hardly pronounce then. I was angry when my mom brought samosas to parties instead of cupcakes. Compliments about my big, black eyes were reminders that I would simply never fit in. I was so insecure that I used paper scissors to cut my eyelashes off. When I discovered that colored contacts made my eyes look smaller, I wore turquoise contacts for a decade. I think the only person I was fooling was myself.
When my cousin died, I observed our largely South Asian Indian community react to his death. In addition to unfathomable grief, my family also experienced shame and guilt because of stigma.
Mental health services are underutilized by Asian Americans. Unique cultural and social barriers, like focus on somatic symptoms, familial shame and resistance, guilt, embarrassment, belief in self-help, and a lack of support keep Asian Americans from accessing mental health services.
I have struggled in ways not unlike my patients related to isolation, anxiety, and social pressures to be “successful.” I believe patients struggle more when they lack role models who share their voices. We all struggle more without shared voices.
After struggling in silence for so long, the weight of these feelings began to empower me to be heard. Things that once made me feel different and isolated – anxiety, insecurities about my appearance, the DO degree I pursued against the advice of my undergraduate program and MD-focused Asian American community – have shaped me as a person.
Thanks to my childhood experiences, I have a unique relationship with my extended family. I will forever be grateful for the rich Indian culture and community I grew to cherish, and for the value of hard work instilled in me by a family where ten members were already, or grew up to be, “Dr. Mehtani.”
Now, I want to be a voice for the silenced. Our unique stories and what drives us are what makes humanity unique and psychiatry fascinating. I am passionate about decreasing social stigma related to mental health and helping those who are struggling with shame, guilt, or fear to share their voices. My dream is for a world where all of us feel safe enough to share our stories. This is why I chose psychiatry.
Siya Mehtani is a third year psychiatry resident at San Mateo County Psychiatry Residency.