South Asians: Stigma around therapy is harming us

The silence surrounding mental health and therapy is deafening in South Asian communities. Conversations about seeking professional help are often whispered, if they happen at all, due to the cultural weight of shame, honour and the fear of social judgement (Prajapati and Liebling, 2021). 

This invisible barrier to accessing mental health support services is not just about avoiding uncomfortable discussions or sidestepping family criticism. The pervasive stigma around therapy in our communities is a matter of life and death, damaging our nervous systems and trapping people in a state of perpetual survival mode. Failing to seek therapy because of this stigma is truly and profoundly harming us as a community (Chadda and Deb, 2013).

This article delves into the deeper layers of this issue, exploring the biology of emotional threat and the neurobiological consequences of chronic shame. It also examines the glimmers of change happening in Bollywood and beyond, as more South Asian voices begin to reframe therapy not as a sign of weakness, but as an act of radical courage. By unpacking how stigma is harming us, the article emphasises that healing begins by speaking the unspeakable. The crucial truth that South Asians must learn is that talking therapies are a vital intervention for mental health support, enabling the processing of one's emotional world.

What is stigma, and how does it stop you from receiving support?

Stigma is one of the most powerful silencers of emotional pain. It cuts across our biology, our neurobiology and our social instincts. We are hardwired for survival, and from an evolutionary lens, our brains developed a highly attuned threat detection system, predominantly governed by the amygdala and limbic system, to help us identify and avoid danger (LeDoux, 2015).

Emotional unsafety - like fear of being judged, rejected or shamed - triggers the same neural pathways as physical threat. Our brains cannot distinguish between the two in terms of emotional unsafety and physical threat, as well as the timing of each either. So when someone is struggling with their mental health and considers seeking help, even informally, their brain may perceive this as a risk to belonging or identity, lighting up the same neural network pathway - neural alarms, so to speak - as if they were under physical attack (Porges, 2011).

As such, someone in emotional distress may subconsciously avoid seeking help or talking about what they are going through to minimise perceived threat, due to the fear of being exposed, vulnerable or labelled, which could consequently impact one's social standing.

The effects of stigma can be particularly acute in certain communities, where cultural beliefs and practices may perpetuate negative attitudes towards accessing mental health support. This neural wiring means that when society holds negative attitudes about mental health, individuals internalise these beliefs. They may avoid reaching out not because they don’t need support, but because they fear being “othered” or “outcasted”.

This internalised stigma becomes a biological blockade: elevated cortisol levels, hypervigilance and increased sympathetic nervous system activation can keep people in survival mode, with increased diseases like autoimmune diseases, inflammation and digestive issues to name a few (Fogleman, 2024), as well as disconnected from the very support systems they need - relational, therapeutic or communal - that could soothe and regulate them (Siegel, 2020).

Why does stigma exist?

Stigma persists because, fundamentally, it reflects our own unresolved fears projected onto others. When we encounter someone struggling with their mental health, it activates our own neural patterns around our discomfort, helplessness or confusion. Our brain seeks cognitive shortcuts from our ego - judgements - to manage that emotional discomfort (Jacobsen, 2024). We project what we are uncomfortable with and what we cannot tolerate in ourselves (Siegel and Drulis, 2023). So, instead of feeling compassion, we might label, distance or dismiss the person struggling in order to subconsciously manage and regulate our own emotional state (Jacobsen, 2024).

Our need for simplification and categorisation also fuels stigma. The human brain is designed to create order and meaning from chaos. Mental health conditions are often complex and nuanced, which can feel threatening to our innate need for predictability (Almeida and Sousa, 2022). Stigma provides a false sense of understanding and control by creating simplistic narratives, even blaming them on taboo phenomena (Ibrahim et al., 2019).

Instead of embracing the complexities of mental health, which often involve various factors such as genetics, environment and personal experiences, our society tends to rely on stereotypes and misinformation, contributing to stigma (Giebel et al., 2014). The media and misinformed content distributed on social media play a significant role in perpetuating stigma (Gangi, 2021). Sensationalist or inaccurate portrayals of mental illness in the news and entertainment reinforce negative stereotypes and fear (Almeida and Sousa, 2022).

Furthermore, the lack of open and honest conversations about mental health contributes to its persistence. Many people simply lack education and awareness about mental health conditions, leading to misunderstandings and misconceptions. For example, did you know that if you are stressed, it means you have a mental health concern? Humans are wired for connection, but also for categorisation. Our brains are constantly sorting information to make sense of the world, and that includes placing people into “safe” and “unsafe” compartmentalised boxes based on social conditioning and implicit bias (Barrett, 2017).

When emotional dysregulation or difference doesn’t fit our internalised blueprint of what’s “normal”, we respond not with curiosity, but with distancing because of the emotional unsafety and misunderstanding. This is less about the person struggling and more about the fears and shadows we each have not yet integrated within ourselves. Stigma continues to exist as a societal phenomenon partly because of a lack of understanding and the persistence of negative stereotypes (Ibrahim et al., 2019).

Why are some mental health problems more stigmatised than others?

Stigma isn't evenly distributed. Conditions like anxiety and depression are now more socially accepted because they align with our narratives of vulnerability and stress in a modern world. The increased awareness of anxiety and depression has helped us to further understand them. Diagnoses like schizophrenia, borderline personality disorder or dissociative disorders carry heavier social judgements. These conditions are often misunderstood, linked with media stereotypes, or feared due to their complexity. The human brain is wired to avoid what it cannot understand - this is a basic survival function (Gilbert, 2010). This is amplified with these conditions.

The impact of stigma varies depending on individual experiences and intersecting identities. Internalised stigma, where individuals internalise negative beliefs about themselves, can lead to shame, self-isolation and a reluctance to seek help (Rüsch et al., 2014). Individuals with mental health conditions often face devaluation and reduced opportunities, exacerbating the challenges associated with their disorders (Hinshaw and Stier, 2008).

Moreover, belonging to a socially excluded group, based on characteristics such as socioeconomic status, ethnicity or culture, can compound the stigma of mental illness (Dinos, 2014). The intersectionality of these identities creates unique experiences of prejudice and discrimination, further marginalising individuals and limiting their access to appropriate care. When societal regulations systematically disadvantage individuals with mental health conditions, such as through poorer funding of mental health services compared to physical health services, structural discrimination arises, leading to poorer quality of care and reduced access to mental health services (Rüsch et al., 2014). The interplay between different forms of stigma - public stigma, self-stigma and structural stigma - creates a vicious cycle that perpetuates negative attitudes and discriminatory practices (Dinos, 2014).

Mental health stigma can affect one's psychology by isolating people and limiting their social interactions (Keller et al., 2019). People living with more stigmatised conditions often feel profoundly invalidated, not heard or seen, both socially and biologically. Neurobiologically, chronic invalidation and social exclusion can lead to decreased vagal tone, increased inflammatory responses and disruption to neural integration, which in turn intensifies the very symptoms being stigmatised (Craig, 2015).

It's a vicious loop: stigma fuels shame, shame fuels disconnection and disconnection fuels worsening mental health. Some people may conceal their illness or treatment history from employers, relatives or potential partners to avoid the possibility of rejection or opt for limiting social interaction altogether (Barke, Nyarko and Klecha, 2010). This further perpetuates societal silence and a lack of understanding around mental health.

Judgement is often a mirror, not a window. When we judge someone else's pain, it’s usually our own vulnerability whispering through the cracks of our projected certainty.

Healing begins when we turn toward discomfort with compassion rather than control, and when we remember that beneath the labels, the diagnoses and the neurodivergence, we are all wired the same - for safety, for connection and most importantly for love.

South Asian stigma and mental health

Despite the growing global conversations around mental health, for many South Asians, therapy remains a taboo topic, one spoken of in hushed tones or avoided altogether. The stigma tied to mental illness within South Asian communities runs deep, influenced by cultural, generational, religious and societal narratives that can deter individuals from seeking vital psychological support. But the impact of this stigma isn’t just social - it’s deeply biological, neurobiological and embedded in the very way our bodies process threat, belonging and emotional pain.

The neurobiology of shame and silence

As a therapist, I usually counsel South Asian clients in a warm, empathic, non-judgemental space, where I share helpful and supportive information tailored to their mental health concerns. I have extensive experience of working with South Asian clients and approach this with culturally sensitive counselling. Being South Asian myself does not mean I automatically know what it means for you to be South Asian - and that’s why it is important I work alongside you, supporting you, and offering mental health, neuroscience, neurobiological and biological insights so you can truly understand how therapy works. Through authentic communications, greater awareness begins, and acceptance is then reached. You can work toward meaningful change. This is why therapy works.

We are wired for connection, and yet our survival brain is equally wired for protection from social threat. From a neurobiological perspective, the amygdala and limbic system - our brain’s fear and emotion processors - fire up in the face of judgement or perceived rejection (LeDoux, 2015). This means that when a South Asian person considers accessing therapy, the fear of being labelled as "crazy" or shaming the family can activate the same brain pathways as a physical threat (Porges, 2011). Belonging to a collectivistic society versus an individualistic one will impact an individual’s behaviour and motivation to access what they need. In these circumstances, adhering to what the nuclear and extended family group wants and needs is more important than assessing what the individual needs.

Stigma, in this context, becomes a biological blockade. Chronic stress responses can elevate cortisol, suppress immune function, increase inflammation and maintain individuals in sympathetic nervous system overdrive (Fogleman, 2024). The fear of being emotionally exposed is processed by the body as unsafe, pushing individuals further from support systems that might soothe them and bring neural regulation (Siegel, 2020).

Cultural conditioning and identity conflict

In many South Asian families, there is an intergenerational belief in enduring hardship silently. This stoicism, often rooted in a history of colonial trauma, forced migration and cultural resilience, can become counterproductive. Seeking therapy may be perceived as weakness, selfishness, or worse, a betrayal of familial loyalty.

Bollywood, often reflecting societal norms, has historically reinforced stereotypes of mental health concerns - characters with psychological conditions portrayed as dangerous, broken, or comedic relief. The tides are turning. Films like 'Dear Zindagi', 'Tamasha', and 'Judgementall Hai Kya' depict therapy in a more nuanced light. Stars like Deepika Padukone and Anushka Sharma have spoken openly about depression and anxiety, breaking cultural taboos and humanising mental health. These shifts offer new scripts for South Asians to adopt - a re-authoring of what it means to struggle and to heal.

Intersectionality: Where culture meets stigma

Mental health stigma does not exist in a vacuum. South Asians navigating the intersection of race, religion, gender, caste, and immigration status may experience compounded forms of stigma. Someone may already feel like an outsider within dominant Western society, and so, admitting to emotional distress can feel like confirming harmful stereotypes about their community. Some mental health diagnoses - like schizophrenia or borderline personality disorder - carry heavier stigma due to misconceptions and a lack of understanding (Gilbert, 2010). Internalised stigma, compounded by cultural silence, can lead to shame, self-isolation and physiological changes that worsen mental health (Craig, 2015).

Healing requires cultural attunement

It’s not enough to say “therapy works.” For South Asians to truly benefit, therapy must feel culturally attuned. This is what you can get from culturally sensitive counselling. Therapists must understand collectivist values, respect religious and spiritual worldviews, and create spaces where clients don’t have to explain their culture before they can explain their pain. 

Healing begins when we recognise that stigma isn’t just a cultural issue - it’s a biological response to emotional unsafety. And by creating culturally safer therapeutic environments, we soothe the nervous system, allowing integration, regulation, and eventually, transformation.

As Deepika Padukone once said, “Depression is just like any other illness, and there is nothing shameful about it.” Deconstructing stigma requires rewriting cultural narratives, educating families and remembering that seeking help is not a sign of weakness, but an act of profound strength and courage (Letteney and LaPorte, 2004). 

Working through stigma: From silence to self-compassion

Stigma doesn’t dissolve overnight - but it can soften when we name it, understand it and begin relating to it differently. If you're South Asian and struggling, know this: you are not broken, and you are not alone. The fear, shame or confusion you may carry about seeking therapy isn’t a personal failing - it’s a biologically wired, culturally conditioned response to protect you from perceived threat. It’s not your fault. And protection isn’t always the same thing as healing.

Healing begins when we give ourselves permission to be curious rather than critical. It deepens when we enter a therapeutic space where our cultural identity is seen, honoured and explored with sensitivity and care. And it grows when we learn how our nervous system responds to stress, why shame feels so paralysing, and how we can build internal safety through conversation and connection.

If you feel the weight of expectations, the pressure to stay silent, or the burden of being “strong”, therapy can be the safe private space where you put some of that down. Stigma may be loud, however, your life story is louder. Your healing matters, and it doesn’t have to wait for permission from anyone.

You are allowed to choose understanding over fear. You are allowed to ask for support. And you are allowed to begin again - with softness, with science and with culturally sensitive support by your side.

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