Is she “faking depression?”

I watched as the adolescent patient draped in a burka began to twitch her hands, every movement a product of a fear cultivated and groomed by her culture. She turned towards the doctor and, with hesitancy written all over her lips, uttered “No.”

“No”, doctor, this patient wasn’t experiencing any depression…or so her Southeast Asian culture claims.

According to a culture that treats mental health as seriously as they do women’s rights, according to a culture that equates anxiety and depression to imaginary consequences of boredom, according to a culture that refuses to accept non-physically manifested illnesses as true problems, depression simply does not exist.

I stood at the back of the examination room, wondering if the patient was about to reveal her truth - a truth so taboo to her culture, but a truth that would indubitably emancipate the patient from a life of blind loyalty to cultural stigmas.

What if she said she was depressed? That she felt lonely stuck in a cycle of sadness with seemingly no escape? That what her culture classifies as fake is so real to her?

Though I badly wanted to hear the answers, she chose an answer she grew up believing to be morally correct -- silence.

When immigrants like this patient travel to a land that encourages open discussion of their feelings, they feel stuck -- they’re forced into a world of contrast with the Western world openly validating the presence of mental health issues while the Eastern world tugs back, laughing at the mere idea of a problem created by the mind. Though they may experience every symptom of depression or anxiety, they never visit a clinician for confirmation because their culture says they shouldn’t. Because when Southeast Asian immigrants even call a psychologist’s office, they feel they are letting down their entire culture.

In a city with an over 15% Asian American population, this underspoken conflict demands immediate attention and significant changes to our current mental healthcare system.

Southeast Asian immigrants need an alternative that all allows them to address their mental health concerns in a private way, limiting the public shame they receive from their culture. They need an alternative that permits private access to professionals who understand their cultural background and values. They need an alternative that gives them a sense of comfort and safety when sharing their feelings or a process their culture calls blasphemous.

The mere creation of a counseling service in the Greater Boston Area strictly available to Southeast Asians validates their struggle. No longer will immigrants feel as though they are alone in experiencing mood changes and disorders. By ensuring that this service is provided over the phone anonymously, these immigrants will no longer feel pressured to publicly signal their need for counseling.

They can sit at home, in a classroom after school, or in their car alone and speak whatever comes to mind as quickly and as boldly as they so choose. The person on the other end of the phone is someone they trust will not expose them to their relatives, someone who understands the struggle of coming from a culture that shuns mental health issues, someone who wants to create change for people like them -- people who want to seek help to better themselves despite the judgement of their ancestors.

While this implementation will not abolish the struggle these immigrants often experience, it will perhaps ameliorate the feeling of helplessness.

Growing up, I have witnessed my Indian American friends silently struggle with a feeling of depression they couldn’t seem to shake. Every time I proposed they speak to their parents to ask for professional help, they told me they tried but their parents responded with the infamous “it’s all in your head.”

So my friends continued on with this gut wrenching feeling that they were experiencing something they weren’t supposed, that they were absolutely crazy for having the thoughts that they do, and that they felt judged at home for every single day from their very own parents. They came to school everyday to focus on their academics instead of their silly thoughts as their parents advised hiding every bit of fear behind a textbook.

What my friends could have really used during that time is someone to talk to.

What my friends could have used is someone who could validate that their thoughts can be and are real even if they don’t align with what their Southeast Asian culture values.

What my friends could have used is someone to confide in without requiring the impossible consent of their parents.

What my friends could have used is a professional source to help them cultivate a sense of self-assured stability without an overwhelming feeling of guilt from their culture.

What my friends could have used is the private mental health resource I am proposing.

My friends' cases are certainly not unaccompanied; millions of Southeast Asian immigrants silently struggle with mood disorders all across America. With a small amount of commitment to this targeted mental health resource from every one of us, they can get the chance to feel better, to feel like themselves, once again.