Decolonizing Mental Health and the South Asian Diaspora

I invite you to take a deep breath in, feel your chest rise, your belly expand and a long slow exhale.

Hello sweet friends and sweet strangers,

Happy beginning of summertime. Hugs to those of you who are feeling endings along with new beginnings. I cannot believe that this Monday I will be graduating from my Master’s in Social Work program (!!!!!) It has been a long journey (being in school in the pandemic, transferring grad schools, dealing with SO many white women) but it also has been a beautiful incubator of growth for myself. It has pushed me to remember how much I love learning and I fought for every opportunity to customize this program to meet my needs.

This past semester I decided to do an independent study on decolonizing mental health + the South Asian diaspora. I have accepted that one semester and one thesis thrown together will never fit the lifetime of love I have for this topic, but I am very proud of the work I’ve done and wanted to share my thesis with you all. Thank you to every single one of my friends that has listened to me ramble, my mentors that have supported all my ways of knowing, and to my ancestors for walking hand in hand with me.

Decolonizing Mental Health and the South Asian Diaspora

I invite you to take a deep breath in, feel your chest rise, your belly expand and a long slow exhale. Before you begin to read the following paper filled with buzzwords and popular concepts like “decolonizing mental health” or “political care” – can you check-in with yourself and see if there is anything you need to read more comfortably? A blanket? Some tea? Do you want to sit outside and feel the air while you read? In a world that continues to pressure us to disconnect from our bodies, how can we remember that every moment we are fully present in our bodies is an act of resistance? How can we remember the moments where we chose to dissociate and float away are also ways that our body is taking care of us? This paper will explore decolonizing mental health frameworks, provide background on the unique needs and history of the South Asian Diaspora, and draw connections between Western therapeutic practices and South Asian cultural and spiritual practices. I will also provide examples and ways of implementing and practice body-based therapy modalities, South-Asian cultural/spiritual healing practices within clinical settings.

I write this as an Indian-American who immigrated to the United States as a child, an artist, a dancer, social work student, someone who has a deep love for my own diaspora and someone who is trying to walk towards their purpose. I hope that there will be a million different and unique iterations written by individuals who are trying to carve their own path in the realm of not only social work but healing work at large.

“There is nothing new written on these pages. No new discoveries. Everything written and learned here has existed across multiple traditions and for multiple generations…We want to start by lifting up the many ancestors and traditions that exist in your—and our—family lines. Remember that many of those traditions and ways of healing have been lost due to the impact of generational violence, colonization and assimilation. And that you and your people have survived. And that you are beautiful” (Raffo et al., 2022)

What is decolonizing mental health?

Western clinical therapy has adopted and appropriated spiritual and cultural practices from communities of color and is often rooted in power structures and colonial histories that have caused an immense amount of harm across time. Decolonial mental health practices seek to dismantle and create new approaches to mental health care rooted in culturally specific practices, center the experiences of people of color, and acknowledge role of colonialism, racism, and systemic oppression in the lived experiences of both clients and clinicians (Bird, 2020; Das et al., 2022).

Decolonial mental health practices will vary based on the needs and identities of the client as well as the clinician. I believe it is possible for a clinician to facilitate decolonial mental health practices with a client who is from a different racial and ethnic identity than their own. In practice this has looked like acknowledging the systems of power that impact clients, as well as supporting clients as they independently learn about cultural histories, practices, and communities as a part of their healing journey. It is important to acknowledge that some clients may not be interested in connecting to ancestral or community practices and the importance of respecting their decisions, boundaries, and personal goals in therapy.

Clinicians should also be able to refer clients to other clinicians that may better meet their needs as well as help brainstorm with resources, people, and places that might support a client’s therapeutic goals. By decreasing stigma around traditional healing modalities, clinicians can normalize that there are multiple avenues for a client to receive support. Centering community healing practices is a critical component of decolonial mental health (Das et al., 2022; Bird, 2021). The Western therapy model often is extremely individualistic and works against the collectivist values of many cultures.

Trauma informed care in this context recognizes the impact of historical and ongoing forms of systemic oppression for clients and the multiple ways it can manifest (Menakem, 2021). In Social Work School and Clinical/Counseling Psychology programs the DSM-5 is taught as the standard for understanding and diagnosing mental health conditions. However, many clinicians rooted in decolonial, queer, and feminist practice articulate the ways the DSM-5 does not take into consideration the multiple ways systemic and historical trauma have present day impacts on the emotional, physical, and spiritual wellbeing of clients. Through this lens of trauma-informed care, we as clinicians can provide treatment and care for clients that also addresses the ways trauma lives in the body even if it is nor formally recognized by mental health institutions such as the American Psychiatric Association. 

South Asian Diaspora and Colonization

South Asian clients have unique histories, experiences, and cultural norms that can impact their mental health and the ways they move through the world. It is necessary to remember that we are not a monolith. The nuances of the South Asian diaspora have been flattened by white supremacy and larger stereotypes and norms popularized by media. The experiences of a client who is Guyanese and grew up in Queens within a working class family will be drastically different from a client who is upper-caste, Indian, grew up in Delhi and moved abroad for higher education.

Within this diverse diaspora, there are several groups that may be considered minorities based on various factors, such as ethnicity, religion, language, and caste. For example, there is often discrimination towards members of the diaspora who are Indo-Caribbean, Guyanese, and Indian-South Africans who were forced to migrant because of exploitive indentured servitude contracts; this of course is inherently tied and connected to the ways anti-Blackness shows up in our communities. Dalits, historically known as “untouchables” are individuals that have been excluded from society and faced an immense amount of discrimination and violence (Soundararajan, 2022). Despite the fact caste has been banned, it is an identity that has carried over generations, migration, and still plays a large role in the present-day experiences of South Asians (Soundararajan, 2022). The experiences of Muslims within the South-Asian diaspora is also unique, many individuals describe the ways they do not connect to the diaspora due to experiences of Islamophobia both from other South Asians and the world at large. These are only brief overviews of the nuances of identity, oppression and lived experiences that often are overlooked within the diaspora. It is necessary for clinicians to understand the psychic and historical imprint that may live within the bodies of clients, as well as allow client’s to name experiences for themselves.

The impact of colonization on the South Asian diaspora is often overlooked despite the generations of harm it has caused on the social, economic, political factors within South Asia, and the profound impact it has had on mental health. Traditional healing practices and art forms such as ayurveda, yoga, and bharatnatyam became stigmatized, erased, and criminalized underneath British colonialism. As a result there has been a separation of cultural knowledge and practices that had been passed down for generations. But it is also important to note that many practices were exclusionary to individuals that held marginalized identities within the diaspora such as Dalits, Muslims, and women (Soundararajan, 2022). The legacies of a violent partition following Indian and Pakistani independence also continue to impact members of the diaspora today. Individuals were forced to leave their homes, had new national identities thrust upon them, and led to one of highest rates of sexual assault and abuse marked in history (Ghosh, 2013). These histories are critical to comprehending the present day legacies and unresolved traumas that clients may be coping with in therapy consciously or unconsciously (Haines, 2018).

Appropriation of South-Asian Practices in Clinical Therapy

Mindfulness and meditation practices have become more popularized and watered down in therapy and mental health spaces. We see the integration of breath work, visualizations, and energetic practices in Western therapy modalities such as DBT, CBT, Polyvagal, and Internal Family Systems. Meditation also has become popularized as a way of increasing productivity or spiritual bypassing which feeds into capitalistic goals rather than its’ original radical purpose of liberation (Barkataki 2021; Ballard, 2022; Shah, 2023). Yoga is often prescribed as an intervention for clients who are coping with trauma or stress. However, it is often seen as solely a physical exercise or body-based intervention and rarely do interventions integrate the spiritual, philosophical, and cultural foundations of the practice (or the complex gatekeeping, violence, and histories associated with the practice).

Western Clinical Frameworks and Yogic Psychology

Mindfulness and Meditation

Mindfulness is the practice of drawing attention to the present moment, noticing internal and external experiences, and observing oneself with a sense of acceptance, attention and compassion. Mindfulness can play a critical role in trauma treatment and research has demonstrated the role it has in reducing psychological suffering (Briere, 2015). It is necessary to acknowledge that mindfulness has grown in its popularity in the West and in psychotherapy over the years. Despite that mindfulness and meditation practices primarily come from East Asian and South Asian spiritual practices such as Buddhism and Yoga (Briere, 2015; Barkataki, 2020), the primary educators, writers, and researchers who speak on mindfulness in psychotherapy tend to be White. It is necessary for clinicians to understand the origins of these practices in order to prevent further white-washing and appropriation of these practices within clinical treatment.

Within the limbs of yoga, key concepts of pranayama (breathing techniques), dhāranā (focused concentration), dhyana (meditative absorption), and samādhi (bliss) are all practices that can be integrated into clinical treatment (Satchidanada, 2020). Mindfulness engages in 5 main psychological processes; observing personal experiences, being able to identify and label the experiences, responding non-reactively, non-judgmental acceptance of the present and acting with awareness of the present (Niles et.al, 2020).

Mindfulness techniques and breath work practices can also help clients stay within their therapeutic window and provide grounding towards the end of sessions when they’ve been working at the edge of their window. These practices also integrate neuroception and non-judgmental observation; for example when clinicians ask the clients to describe or identify how they were feeling in the past versus in the present moment. The ability to have “interoceptive awareness” helps clients recognize when they might be holding tension in their bodies, or if their heart is racing more quickly. Simply drawing attention to these physiological experiences and their connection to certain emotions can help a client better self-regulate or recognize their needs (Yamasaki, 2022).

Mindfulness practices are also highly efficacious for the clinician in promoting safety in trauma treatment. When the clinician can utilize mindfulness to have a consistent, safe, and open relationship this can allow the client to progress in therapy by experiencing trust and security in the therapeutic relationship, allowing them to more easily process or access traumatic memories or emotions associated with past experiences (Niles et.al, 2020). Transference and countertransference often arrive in the therapeutic relationship, especially when clients have overlapping identities and experiences. Mindfulness serves as a protective factor for both the client and clinician in this context that can foster emotional safety and prevent vicarious trauma.

Framing Trauma

The self-trauma model is a modality that utilizes emotional processing to reduce PTSD distress symptoms related to trauma triggers and memories (Briere, 2015; Niles et.al, 2020). Mindfulness in the self-trauma model can be used to strengthen a client’s ability to stay in the present moment and notice emotions or feelings that may arise as they return to past traumatic memories or experiences. Within yogic philosophy there are multiple energy centers throughout the body. There is also a flow of energy that runs through every living being described as “shakti”. Within yogic philosophy an individual’s lived experiences of the world impact the flow of energy within us which then can lead to what Western psychology describes as trauma symptoms (ie. difficulty sleeping, nightmares, feelings of isolation and depression). Samskaras are described as impressions that encrust the valve of the spiritual hear- that build up and restrict the flow of energy that stem from stored memories of harm as well as patterns of behavior that are no longer supportive (Iyengar, 2020; Desikachar, 1995). Similar to the self-trauma model, yogic psychology and healing practices describe how samskaras can be triggered by details such as smells, colors, or interactions that bring up past memories. To fully process samskaras, individuals are asked when triggered to utilize mindfulness practices to allow themselves to fully feel the emotions that perhaps they weren’t allowed to feel at the original moment of harm.

Integrating the Body and Bilateral Stimulation

Bilateral stimulation involves crossing the corpus callosum (the midline between the left and right hemispheres) and activates both sides of the brain. This leads to the creation of new neural pathways, by facilitating a connection between hemispheres. Bilateral stimulation also facilitates memory retrieval and accelerates the processing of the memory along the proper neural pathways (Shapiro, 2017). Bilateral stimulation plays a significant role in EMDR, but can also be used in clinical therapy and yoga therapy to help clients self-regulate.

 While working with a client who was struggling with sleep; we worked together to build a sleep routine informed by yoga practices. One of the breath work practices I offered her (which was taught to me by my yoga therapist Melissa Shah) involved gently gazing at her hand as it moved across her body to her opposite shoulder while she slowly exhaled “Ha”. This practice had a multilevel impact; bilateral stimulation can act as a form of orienting that engages a parasympathetic response, soothing the client and increases the body’s felt sense of safety (Shapiro, 2017; Korn and Shapiro, 2020). Bilateral stimulation also works as a titration mechanism to allow the memory to operate in manageable doses rather than all at once. The long slow exhales with audible components also engage the vagal nerve, slow down the heart, and allow the body to experience a sense of calm.

Yoga Therapy

Yoga therapy stems from the viniyoga lineage, it is unique from traditional yoga classes as it integrates the practices of yoga, such as postures, breathing exercises, meditation, and mindfulness, as a tool for therapeutic healing in a customized, individual and ongoing relationship. My own experiences in yoga therapy have been critical in supporting my daily living, connecting to purpose, and learning about ancestral practices. It is rooted in an approach to mental health that acknowledges the interconnectedness of the mind, body, and spirit. It is often used as complementary treatment to traditional therapy but also can be a strong initial intervention for clients who are not ready for talk therapy, want to address physical symptoms, or feel more comfortable in non-clinical settings. Yoga therapy emphasizes meeting the individual where they are and accommodating practices to ensure accessibility.

Community Healing

Given that one of the key components of decolonial mental health practice is centering community based healing, encouraging clients to connect to spaces that allow them to foster new relationships. There often are experiences of harm or judgement that occur within the diaspora and those who have been most marginalized may have strong and valid boundaries related to connecting with other South Asians. Exploring these histories in therapy may allow for clients to both process past samskaras and create space for new possibilities for connection. Through emphasizing and remembering that the diaspora is not a monolith, clinicians can uplift the unique needs and experiences clients might have when looking for South Asian community – such as finding a LGBT South Asian Support Group or an Anti-Caste organizing group.

Conclusion and Future Implications

Decolonizing mental health is a complicated and ongoing endeavor. When we consider the global impact of colonization and the multitudes of different communities and cultures that have been impacted by historical violence and continue to be impacted by present day forms of injustice and systemic oppression; we recognize the need for multiple different perspectives and avenues in providing mental health care for communities of color. Through acknowledging the role South Asian cultural and spiritual practices have had within Western clinical therapy, we can begin to appropriately acknowledge their origins as well as learn how to integrate these cultural and spiritual practices to support members of the South Asian diaspora and non-South Asian clients as we all move towards our collective liberation.

With love,

Debs