Speaking up: Prince William (left) and his brother, Prince Harry, are seeking to remove the stigma around mental health

By Dr Raj Persaud
Consultant Psychiatrist

PRINCE William has grabbed the headlines this week by pointing out that the traditional British “stiff upper lip”, a response of reserve and manfully pressing on no matter how terrible you feel, the infamous “mustn’t grumble” approach to life… can damage your health.
His comments follow from his brother, Prince Harry’s frank admissions surrounding mental health difficulties which had been bottled up for two decades following the trauma of coping with the death of his mother, Princess Diana.
While losing a parent in any circumstances, such as divorce or separation, is widely understood to be one of the most stressful experiences a child can endure, losing a parent to death might be even worse. The latest psychological research finds that losing a parent in this way, if that death is traumatic, such as through an unexpected accident, as happened in the case of Princess Diana, then the psychological impact is especially devastating on a child.
Prince Harry spoke of pushing away thinking about his mother, the trauma and loss for 20 years, before finally seeking help in the form of counselling.
There remains a persistent stigma surrounding mental illness, and one consequence is people take ages to start seeking help, unlike with serious physical problems.
Postponing engaging with the problem tends to make things worse in the longer term, which is what the princes are getting at, reading between the lines. Mental health difficulties are eminently treatable and the prognosis is excellent, with the right kind of care. Perhaps if there was more optimism about the eventual outcome, there would be greater readiness to seek help early.
Even to this day when people come to see someone like me, a psychiatrist, for the first time, it remains impressive the widespread ability to keep some deep or grievous inner turmoil or upset secret, often undisclosed even to those most intimately connected, like spouses or close family.
But I find that of all groups of society – those who are now most likely to take the longest before plucking up the courage to step through the door of the clinic – these are no longer the aristocracy, nor the privately educated at boarding school, or even the ex-army types; no, it’s the Asians.
The UK is making attempts to open up on mental health, spearheaded no less than by bastions of the establishment, like the royal family. But can the same be said of the Asian community? The princes hail from aristocracy, the army and Eton, not seen as repositories for the “let’s share how we feel”, approach, which makes their message all the more powerful.
Yet the “stiff upper lip” which is being called into question today by our future king, is alive and well within the Asian community, even nurtured there with pride.
The greater stigma surrounding mental health issues among Asians, in my opinion and from my clinical experience, partly arises from a suspicion that in a competitive world, opening up to vulnerability will not help you cross that finishing line first. Going to see a mental health professional begins to look like the kind of pit stop in the race of life which is going to harm your prospects against the rest of the field whizzing past.
Asian culture tends to be competitive and so Asians tend to be some of the more culturally and economically successful immigrant groups wherever you find them in the world.
Asians have often experienced adversity and sought to rise above it, as opposed to ‘”caving and complaining”, they embrace resilience. As a result, they tend to take the view that overcoming adversity through individual self-reliance is always the correct strategy.
The problem is that this community, famous for their supposedly close family ties, end up paying a heavy price in terms of alienation between family members and close friends, because of terror from disclosing what’s really going on inside their heads, dread of paying a heavy price in terms of ostracism.
There is already a very high suicide rate among young Asian women in the UK which the community should be doing much more about. But just how well hidden the problem can be comes from a recent study entitled “An analysis of suicide and undetermined deaths in 17 predominantly Islamic countries contrasted with the UK”, published in the journal Psychological Medicine.
The researchers, Colin Pritchard and Shabbir Amanullah, point out that suicide is expressly condemned in the Qu’ran, and traditionally few Islamic countries have reported suicide, but maybe other violent deaths, such as, possibly, car accidents, could be disguised suicides? This study found that “other violent death” rates in 10 Islamic countries were considerably higher than the Western average, and eight had “other violent death” rates considerably higher than their suicide rates.
The authors of the study conclude that high rates of violent death, especially in the Middle East, may hide culturally unacceptable suicides.
You can try to bury mental health problems in all sorts of ways, but it tends to come back to haunt you.

Dr Raj Persaud and Dr Peter Bruggen are authors of a new forthcoming book, The Streetwise Person’s Guide To Mental Health Care, published by Edward Everett Root, Publishers, Co. Ltd

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