Many individuals from, and working alongside, Asian diasporas in Aotearoa New Zealand have consistently called for a greater focus on mental health issues. Our just-launched Asian Mental Health Project responds to this call by highlighting the various discussions, understandings, and perspectives on mental health of significance to Asian communities in Aotearoa. Here, project lead Mehwish Mughal offers a deeply personal insight into why the mental health concerns of Asian communities need to be addressed.

My name is Mehwish Mughal. First and foremost, I am a sister to five siblings and a daughter to one of the strongest women I know. I am a Muslim. I am a 1.5-generation Pakistani. I am Brown. I am a feminist. I am a survivor of family violence. I am an activist. I am a researcher. This is the order of my many identities that makes sense to me.

I have recently completed an MA in Sociology from Massey University exploring how Pakistani diaspora in Aotearoa constructs mental health. The research was as much about understanding how my community makes sense of mental health as it was about me making sense of my personal struggles with mental health issues. To a very large extent, the process of this academic research gave me a voice to articulate what previously seemed like a problem within the confines of myself. I felt liberated, to say the least:

I was 16 when I moved with three younger sisters and father to Aotearoa from Karachi, Pakistan. I did not have a choice in the decision to migrate, and I left behind my mother and two other siblings. I was grieved to have been made to leave my mother and had not even begun to recover from this grief when myself and my sisters were faced with family violence in our new home. Being the firstborn in the family, the protection of my younger siblings rested on my shoulders. Within one and a half years of moving to Aotearoa, my sisters and I had escaped the violence perpetrated on us by our father. While I was still in high school, I was in family court, trying to assure a New Zealand judge that I could look after three younger sisters. The judge believed me, and I became a guardian parent to my sisters (15, 14, and 14). As a Pakistani Muslim, I was born and raised within a collectivist culture and family background, which places immense importance on family honour. Defying my father’s authority and leaving his home tarnished our family honour; it meant that my sisters and I were ostracised from our family both in Pakistan and Aotearoa and received no family support.

Becoming a legal guardian at seventeen placed considerable pressure on me – looking after my siblings, attending school, and working in paid employment. These everyday pressures were coupled with the constant fear of being located by our family and regularly watching my back when out in public – on the bus, on the road, in the supermarket. The trauma of family violence, the lack of adult guidance, the responsibilities, and the fear resulted in extreme paranoia, self-harm, and several suicide attempts. I was in and out of respite, never saw the same doctor or psychiatrist more than once, and was never asked by medical professionals where all of this was coming from. I was clueless about what was happening to me, and in one session with a psychiatrist, I gathered the courage and asked, “What is wrong with me?”. He said, “You have borderline personality disorder”. I had a label, my first label. I researched about it, believed it, and lived the next eight years with it, but the underlying cause of my distress was never talked about in the multiple counselling and psychiatric consultations. I felt like I was a mere label, a medical condition rather than a human being with a very personal and unique set of life experiences. From 18 to 24 years of age, I would attempt suicide, wind up in the hospital, a psych team would assess me, and a “professional” decision would be made as to whether I would go into respite or if I was deemed safe to go back home. And repeat.

My education, work opportunities and social relationships were severely impacted. I moved from house to house, from job to job, from degree to degree. Unsettled and scared. When I faced rejections, I would return to my self-harming behaviours.

The tensions around how I should perform my mental health issues were apparent. On the one hand, I felt I was expected to hide my mental health issues from prospective employers and at university. On the other hand, in order to receive financial support from the Government, I was expected to prove that I had mental health issues. The cycle continued. Over the years, I was prescribed medication and engaged in one-on-one and group therapy. Over the years, the labels given to me changed. Sometimes it was clinical depression, sometimes borderline personality disorder, sometimes bipolar disorder. I was considered a lazy student at the university by the dean, lecturers and tutors, and my absence from work for bouts of severe depression meant I was considered an unproductive worker. Despite explaining (to lecturers and employers) my ins and outs of hospital and respite, and my struggles with mental health issues, I was made to feel useless and a burden on society.

In 2012, at the age of 25, I had my first breakthrough. I discovered the power of reading. I read around 100 books a year, from science to religion and everything in between. I found comfort and consolation in the books and the knowledge. I fell in love with the authors and revered them. I felt I was understood by people who were long gone. I felt a shared connection.

Around the same time, I found a community, those who showed up, those who were willing to give me a chance and welcomed me, both socially and professionally. I openly talked about my journey with mental health issues with these people. Sadly, my healing journey never included support from my extended family, mental health services, welfare system or education institutions. *

Why mental health services failed me

When I revisit what I have written, it feels like a story that has an ending and a beginning. It feels full and complete. It wasn’t so. What’s missing is the pain and suffering of not being understood, of going through life as less than a human, of the endless amount of tears, of fear, and of rejections.

For a decade, as someone who was “aware” of mental health issues and who did her best to seek support for it, I failed in the therapy room. Again and again. My therapy sessions were devoid of my cultural context or my social positioning or the deep social issues that exist in Aotearoa. All I accumulated in these sessions was abject frustrations with my faultiness and my lack of drive to get better.

It was much later when I came across Dr Debbie Hager’s talk delivered to professionals in the family violence sector. She asked a simple question, “is it mental illness or a reasonable response to abuse?” She went on to explain how the response to abuse, i.e. anxiety, paranoia, etc. are misinterpreted as symptoms associated with mental health issues. It suddenly all made sense. I was not the problem anymore. It took eight years to hear this. It happened outside of a therapy room.

I remember I was dealing with a toxic work environment, being bullied by a manager on a regular basis. I reached out to the counselling services provided by the organisation. It was around the same time I was engaged with my academic research, so I was able to articulate the issues of a toxic work environment well in the therapy session. The therapist was visibly confused as I kept on bringing the issue away from myself and locating it in the workplace. The suggestions to deal with the distress were essential oils and moving my bed around so I could sleep properly. I was enraged at the end of the session, but also felt a gap, a glitch in the way therapy fails to include an oppression analysis.

Time to address the structures oppressing Asian communities in our health system

I share my story in the hope that it demonstrates the urgency of the project we have embarked on. I see quite a bit of emphasis placed on educating our communities about mental health issues. This is rightly so. We need to be aware of what mental health issues are and how to respond to them. What seems to be largely missing though is – what happens after the communities are made aware? Do we ask if the services are accessible to all populations in all areas? Are they affordable? Are they available? Are they appropriate? Do we see the multiple intersections of race, gender, and class acknowledged? Do we incorporate oppression analysis in our therapy rooms? We remain stuck in a frame – our communities are unaware of mental health issues and the solution is to educate them. We do not move beyond it. If we moved beyond it, we would recognise and respond to the failings of our health system.

We need to move beyond looking at mental health issues from a western psychiatric lens. We need to recognise the plethora of ways people from Asian and other minority communities conceptualise and respond to mental health and mental health issues. We need to honour these pieces of knowledge and practices.

We need to move beyond the stereotypical representations of Asian communities in the mental health space. We need to move beyond changing attitudes and behaviours of individuals and question the structures and systems which influence these attitudes and behaviours.

Over the years, I have supported and have been supported by the community of remarkable individuals. My healing began in the community. I strongly believe that our communities need to be strengthened and resourced to respond to issues of mental health collectively. Perhaps all of the above is why I feel such strong emotional proximity to the project. It is my hope that through it, we can address some of the broader and urgent questions of representation and context.

Reference

* Excerpts (adapted) from forthcoming thesis. Mughal, M. (2022). An exploration of social construction of mental health: perspectives of Pakistani diaspora in Aotearoa [Unpublished master’s thesis]. Massey University.