Cultural differences play a crucial role in defining what is considered normal versus abnormal. I am writing this blog to target the Hispanic community. As a Latin woman, I have dealt with consolidating varying, often conflicting, perceptions of mental illness as defined in the Hispanic community.  Whether we refer to anxiety, depression, or any other mental illness, the Hispanic patient population is one that lags behind others in both seeking and obtaining mental health treatment. Underlying this lack of treatment are multiple factors, including cultural expectations. These may lead to shame in seeking treatment for an issue that may be culturally considered a behavioral flaw, often thought to be solvable through perseverance or prayer. Also, there is fear in being labeled as “loco”, in a culture that considers mental health illness one of loss of mental control and personal failure. One particular example is how the Hispanic community views the act of crying. For a Latin male, it is viewed as a sign of weakness. Men in our culture often grow up with the idea that men don’t cry, “Los hombres no lloran”. If they begin to cry in the setting of what one may consider a validated experience, they may be labeled as feminine. How accurate is this statement? If we sit and think for a moment, can we be labeled as ‘weak’ because we are simply able to show emotion? Can it be that emotions actually exist and there are different ways to express them?  In this blog I will talk about the Hispanic cultural views and facts and myths associated with their perception of psychotherapy.

Being Latina for me is also being a strong woman
— Natalie Martinez

Let’s begin by addressing the cultural expectations that apply to the Hispanic community.  In the initial stages of my career, my parents served a supportive role. Still, I remember noticing their unawareness, and lack of understanding about what psychotherapy was. It became more obvious to me that there was a disconnect between my definition of psychotherapy and theirs when I recommended that a family member obtain counseling to manage their distress. A frequent response was, “No mija, yo no estoy loca! [No, I am not crazy!]” This sparked my curiosity, and I went to the strongest, oldest member of my family, Mami Nilsa, my grandmother, for clarity. She never welcomed the name “abuela”, so we grew up referring to her as Mami Nilsa. When I think of a strong Latin woman, I think of her. She is a woman that is self-sufficient, hardworking, and always planning the next step. She often told my sister and I that a man was not needed to survive, “all you need is a good career, if you can succeed alone, you can succeed in life”. She took pride in doing things by herself and raising a family on her own. There was no time for what we call “emotions”, and the strength that she always showed was the most noteworthy way to tell everyone that she was okay. This is a simple example to demonstrate how Hispanics think. As Latin women, we take pride in our independence, and “needing help” is not a concept that we can easily relate to. Men also grow up with similar standards, except they are the providers, the bread winners, and so they too take on a role of superman. Nothing will stop them from accomplishing their task. If kryptonite is on the table, they will find its market value, sell it, and bring home the money to provide for their family. So far, it doesn’t sounds like it is that bad right? Independence, strength, role separation ... what’s wrong with that?

In my work experience I have learned how these assumed roles can lead to poor outcomes. I have received referrals from primary care physicians to aid in the treatment of Latin men and women who have had multiple visits to their office for physical symptoms without medical correlates. After several visits, doctors, trained in recognizing overt signs of anxiety and depression, suggests the idea that “You may be suffering from anxiety or depression”. The patient tenses up, and internal alarm goes off, and suddenly her flight and fight system is activated to defend this “crazy” idea. A typical response occurs, “But I am not worried about anything. How could I be depressed if I have a home and a car?” Often, after several such visits, these individuals finally come to me. Slowly, like layers of an onion, we start peeling back through defensive layers, recognizing and discovering multiple sources of worries, we find symptoms such as a lack of motivation, feelings, like that of helplessness. The person begins to recognize that some of these things are exhausting, and limiting to living a purposeful, more fulfilling life. I remember clearly when one of my patients came to me and shared that her son had been murdered 4 years ago. She stated “I dealt with it”, and when I asked how, she replied, “I still have his clothes and pictures around my house, and when I think of being sad, I just push those feelings away and start cleaning the house”. When I asked why she never sought treatment or talked about her son, she replied, “it’s too painful and I don’t want to talk to my husband because it makes him sad”. What would happen if for a minute she accepted that sad feelings are part of the grieving process? And that hurting is a crucial part of healing?  However, acceptance of sad or helpless emotions is not viewed as something positive. As a result, it seems more acceptable to “bury” these feelings, “distracting” oneself from living the emotional experience, and “carry on”. Consequently, Hispanics tend to come to treatment after the suffering has been present for a prolonged period of time. They have spent the majority of the time attempting to “just deal with it”, which translates into avoidance. Avoiding and waiting for time to heal all often exacerbates problematic symptoms, results in isolation, and often leads to functional deterioration as avoidance of any emotional distress can lead to avoidance of any action. Part of being a strong individual is having the ability to accept what is not working, and look for ways to change it. This includes recognizing and utilizing the resources that are offered to us.

People think of Latina women as being fiery and fierce, which is usually true. But I think the quality that so many Latinas possess is strength. I’m very proud to have Latin blood
— Zoe Saldana

Another factor that keeps the Latin community from using psychotherapy as a form of treatment are the underlying myths about therapy.  These include the following:

Therapy is only for people that are crazy. MYTH

Therapy is for anyone who is looking for deeper awareness. Therapy is for anyone who feels “stuck” and needs some guidance as to how to continue moving in the right direction. Therapy is for anyone who has experiences grief, episodes of depression, anxiety and frustration. Therapy is for anyone who is willing to search for their own meaning of happiness and who is ready to take the path to get there. Therapy is for anyone who is undergoing a life transition or experiencing family problems.. Basically therapy is for anyone!!! There is no shame in wanting a better life.

I can talk to my friends and family, that’s therapy enough!  MYTH

In the Latin culture, family or “la familia” plays a major role in each of its members’ life.  In many cases individuals don’t see a need to seek help outside of their family, friendship circle, church, or community. There is an embedded belief that these issues are to be dealt with independently or to be “kept in the family”.  Still, think about the times when you have shared something with your family. Did you omit information, or maybe limit your own emotional response? Did you hold back your own thoughts about the situation knowing what the person in front of you was thinking? Were you being completely honest and sharing every detail? Probably not, for a multitude of reasons. For example, we care about what our family thinks about use. Secondly, we are concerned about how the sharing of information is affecting theme individually of how it may be affecting us. Thirdly, families and friends will have biased opinions and advice. 

All therapist are the same, they just want to medicate you... You will become a zombie!  MYTH

First off, no one can shove medication down your throat, this is a choice that will be made with your psychiatrist/ medical doctor, and it is solely up to you whether or not you choose to take it. You therapist may make the suggestion, only if it is considered an appropriate addition to your individualized treatment. Medication management requires a referral to a psychiatrist/MD or to a Nurse practitioner. They will conduct a full intake to assess any presenting problems, symptoms, medical issues and come up with the best treatment strategy. This process also includes ruling out medical ailments that may be affecting your mood or sleep. The recommended treatment may include medication, but this is not always the case.

It is important to be aware that medications are meant to balance emotions, if it is putting you to sleep or making you feel “zombie” like, then it’s time to reassess the type of medication, dosage, and efficacy. Furthermore, the therapeutic relationship is the main foundation for good treatment. It is most important that you feel comfortable with your therapist, and if their approach does not work for you, it is okay to search for someone else. Identify those things that matter to you, and find them in your therapist. If cultural diversity is important to you, make sure you satisfy those individual preferences.

Therapy can help anyone even with minor issues “pendejadas” Fact or myth: What do you think?

If you answered FACT then you have gotten the point!! MUY BIEN!!

Unfortunately we will continue to struggle with skewed perceptions, but it is extremely important to understand how therapy can be helpful. Therapy is all about empowerment; it is a safe space where all the attention is focused on you. It is a process of self-discovery that will help you find the hidden tools that you have always had and use them in ways that can cater for growth and positive change.

“People go to therapy to cope with disorders, relationships, stress, grief, to figure out who they are, and learn to live life to the fullest,” said Howes, who also writes the blog, In Therapy, “There’s no shame in wanting a better life.”

Although the rates of mental illness among Hispanics and whites in the U.S. are roughly equivalent, whites are about 60% more likely to receive mental-health treatment, according to a 2008 study. According to a 2001 Surgeon General's report, only about 20 percent of Latinos with a psychological disorder consult a general health-care provider about their symptoms, and just 10 percent contact a mental-health specialist. "When Latinos think of mental illness, they just think one thing: loco," says Clara Morato, whose son, Rafaello, was diagnosed with bipolar disorder at age 18. "[Latinos] don't want to be labeled, and they don't want to be labeled as the family with a relative who's crazy."

This is a struggle that we continue to battle, but with education and helpful resources, I am hopeful that we can reach an understanding on how seeking treatment is not a sign of weakness, and instead notice that it is a sign of strength. You were brave enough to take action, and to take control of your own life.

Asking for help often requires more strength than passively staying stuck
— Howes

To learn more about the connect between mental health and the Latin community -- or any of the other topics in this post – contact us at info@insightbrookline.com through this webpage.

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