Dr. Usha Tummala-Narra joins us to discuss how the South Asian & Indian Diaspora manage the complexities surrounding Hindu & Eastern belief systems, Immigration & Trauma. Usha is a professor of counseling, developmental and educational psychology at Boston College, and she's also a licensed psychologist with a private practice in Cambridge, Massachusetts. Her areas of research and clinical expertise include trauma and mental health among immigrant communities, South Asian American and Asian American psychology, and cultural competence and psychotherapy practices. Usha, welcome to the show.
https://www.bc.edu/bc-web/schools/lynch-school/faculty-research/faculty-directory/usha-tummala-narra.html
https://www.thetraumatherapistproject.com/podcast/usha-tummala-narra-phd/
Journal of Applied Psychoanalytic Studies, Vol. 3, No. 3, 2001
Asian Trauma Survivors: Immigration, Identity, Loss, and Recovery
Pratyusha Tummala-Narra
Counselor Referrals:
Diya Kallivayalil, Ph.D. in Cambridge, MA diyajk@gmail.com
Lisa Desai, PsyD, in Newton, MA (857) 353-8483
Anju Kaduvettoor-Davidson, PhD, in Austin, TX anju.kaduvettoor@gmail.com
Neha Patel, PsyD, in Chicago, IL nrpcspp@gmail.com
Soniya Gokhale (00:05):
Welcome back to another episode of A Desi Woman podcast. I am your host, Soniya Gokhale, and the voices I am seeking may have never been heard before, but their stories deserve to be told. What is a Desi woman? She is a dynamic, fearless and strong woman. She is your mother, your grandmother, your daughter, your sister. She is every one of us who is on an endless pursuit of self-empowerment and fulfillment. I am Soniya Gokhale and I am a Desi woman.
Soniya Gokhale (00:40):
Hello, and welcome to another edition of A Desi Woman podcast. I am your host Soniya Gokhale, and today we are so excited to be joined once again by Dr. Usha Tummala-Narra. Usha is a professor of counseling, developmental and educational psychology at Boston College, and she's also a licensed psychologist with a private practice in Cambridge, Massachusetts. Her areas of research and clinical expertise include trauma and mental health among immigrant communities, South Asian American and Asian American psychology, and cultural competence and psychotherapy practices. Usha, welcome to the show.
Usha Tummala-Narra (01:25):
Thank you, Soniya. It's great to be here.
Soniya Gokhale (01:27):
Well, it is always such a distinct pleasure to have you here. And the basis of our conversation today is actually from an academic publication that you authored in 2001 entitled Asian Trauma Survivors: Immigration, Identity, Loss, and Recovery. And what was so fascinating to me as I read this is it really is timeless in some respects, in terms of the issues it covers about our diaspora and as well those from the Asian background, culture and diaspora. And I think it sets a great dialogue for us to proceed. And so just absolutely phenomenal work you're doing, and I really wish we could clone you because there's not enough. And I guess if you could speak to that a bit more, what are the deficits, I guess, in getting those from our diaspora into the field of psychology and what are the barriers to that?
Usha Tummala-Narra (02:31):
Yeah, well certainly I can speak from my own personal experience. When I had thought about studying psychology as an undergraduate student, it was largely unknown within our communities what a psychologist might do, or somebody who studies psychology, what they ended up doing. And so there was a lot of unknown for me personally, but also certainly within my family. And initially, my own family were sort of like, "Well, do you want to become a psychiatrist and go to medical school?" Because that was the most relatable thing in their minds. And I told them, "No, I actually want to do research and I want to get my PhD."
Usha Tummala-Narra (03:08):
And so there was a lot of education that I had to do for myself, but also for my family. And then from there on, they were supportive. But I think in our communities there tend to be certain types of fields that are more familiar or even more acceptable for people to pursue. And so my profession is still something that's relatively new. Although these days I see more and more South Asians, particularly South Asian women, pursuing mental health professions and many of whom pursue graduate degrees in psychology.
Soniya Gokhale (03:46):
That is wonderful because boy... And we'll get into a lot of these questions. And I have to say that your podcast, which we did as a follow-up to the Indian matchmaking show, which has been such a big hit, is the most downloaded of all of my podcast episodes. And I'm not surprised because it's just been such a joy and pleasure to meet you. One of the finest individuals I've ever met on a personal note, but also professionally you're just so well versed in speaking to a lot of the issues that we face both as men and woman, whether it's contemplating marriage or throughout the course of our lives, really. And so as we dive into some of these questions, I think I will just start, that basically when an individual from an Asian culture relocates to the US, that person may be faced with enormous conflict and loss surrounding the notion of separation. And especially if we focus on Asian Indians. And the majority practice Hinduism, which I thought is a great point that you bring up in the paper. It is an underlying premise to a lot of how we're raised.
Soniya Gokhale (04:58):
And you connected it beautifully because you indicate that it's a philosophy which really permeates the emotional life of many Indians, regardless of whether or not they overtly practice traditional Hindu religious beliefs. And according to Hindu scriptures, there are no beginnings and no endings in life. And there's this great emphasis on selfless service to others. And it's characterized by an emphasis on group needs as a cultural ideal, and a belief in the omnipotence of the group. And so if you want to speak to that just a bit and how that presents itself in some of the populations that you see.
Usha Tummala-Narra (05:42):
Yes. So as you said, there is really an inextricable tie between Hindu philosophy and culture. So it's really hard to say what's Indian culture and what is a particular religious philosophy because they tend to be intertwined, whether you're a Hindu or Muslim or Sikh or Jain there are philosophies that are intertwined with each of the persons culture, which then we bring with us to the United States or another country that we might be migrating to. So there's a way in which we can't really separate out these religious philosophies and beliefs from what we see as a family culture or the culture of a community in the diaspora. And one of the things that comes up pretty frequently in the work that I do with my Indian clients or patients in my practice is this attempt to reconcile some of the cultural differences that people experience in Indian society within their families and what they experience outside their homes, such as in more mainstream circles in the United States.
Usha Tummala-Narra (06:52):
So one aspect that comes up a great deal is this issue around separation and individuation. So in Western Euro-American psychology, there's an emphasis on the ability to separate ans individuate yourself from your families and from your community. So what that means is that typically around the time that one leaves home, maybe around 18, 19, 20, young adulthood, that a person comes to make decisions that are fairly independent of their family, that they start to develop their own interests outside their family, their own viewpoints outside their family, which then become consolidated. And you're expected and seen as healthier if you're able to go with what you think is the priority as a personal priority, an individual priority. And this stands directly in contrast with what's valued in Indian society and certainly among Indian Americans as well, particularly in immigrant families, where the expectation is that a person as they become older into adulthood that they are consulting with family members around important decisions like who they might date or the career that they might pursue, who they interact with and how they live their life.
Usha Tummala-Narra (08:19):
And so that is seen as a healthier way of living from an Indian perspective. So even the way that we consider what might be healthy or less healthy or unhealthy, those actually depend a great deal on how we conceptualize this idea of separation. So another term that's used to describe, I think more accurately, the Indian perspective is the concept of interdependence. So rather than individuation, that we think of interdependence as a way in which we are connected with families, with family members, with community members and we rely on them emotionally and they rely on us. So there's this mutuality from the Indian perspective. But as you can see, they can present conflicts for people in terms of how do you negotiate that, what are my needs versus the needs of a broader group or family or community? So this is something that comes up all the time.
Soniya Gokhale (09:20):
Absolutely. And one of the statements or sentences in the paper, which I really, really found to be pretty profound is in many parts of India, it is common to find that the front door to the family house is closed, but within the home, all of the doors to the individual rooms are often kept open. And this is so absolutely true. These realities make for a very different perspective on oneself in relation to the world. And it's such a profound juxtaposition of our realities as Indians. We have no boundaries in our families as you stated to an extent that it can be distinctly uncomfortable and especially as immigrants to the US and as an Indian American, it wasn't until I read this passage from your academic paper that illuminated some of the struggles that I and my other Indian American peers who were raised here would face.
Soniya Gokhale (10:16):
I mean, on one hand, we are faced with a culture in the US which is focused literally on life, liberty and the pursuit of happiness or rugged individualism and personal freedoms. And yet, on the other hand, the cultural backdrop we face at home with our parents or extended family grew up immersed in India or Asian culture is the exact opposite. So it's almost as though we have to sort out and reconcile this dichotomy and contrast on our own without even really verbalizing it, but having this dual existence. And so this resonates across so many areas, whether marriage, if you choose not to marry within our culture, but it has a ripple effect. And so I wanted to see if you could speak more about the psychological effects of this both short and long-term, and maybe some of the associated dysfunctions that can result if it's not acknowledged or processed appropriately.
Usha Tummala-Narra (11:17):
Mm-hmm (affirmative). Yeah, there's so much conflict that comes up within families around this issue. And it is oftentimes... I describe in the paper the physical reality is kind of mirroring a psychological reality as well, like when I describe what a home might look like. And I remember my parents, that I couldn't be in my room for too long without them wondering what was I doing up there, as a teenager. And I think that's a very common thing. And I find myself that with my own kids actually, I find myself wondering, "Hey, that's maybe too much privacy." And I know that that's my own internalized value, the cultural value around us being together in each other's presence more. And I think it is a remnant of what a family structure might look like in India, a traditional family structure, an extended family structure where it's more permeable, those boundaries. It's not so separated. And the doors are open physically and emotionally.
Usha Tummala-Narra (12:27):
And so there's this in formality that I think is incredibly helpful within Indian families and communities that there's in the traditional sense, in my family in India, that you can stop by your neighbors, or you could come in and out, in ways that it's incredibly warm and comforting at its best. And the flip side of that of course could mean that a lot of people know a lot of things about each other and in ways that are not always one's choice. And so if you think about it in the continuum of this openness of boundaries being something very positive on one hand, and then on the other hand, at the other end of the continuum where a person's privacy might feel violated, or they might feel intruded upon in some way. So I think what happens though sometimes in immigration is that we don't tend to think about these things along a continuum. They start to feel almost like they're bifurcated, it's either one or the other. Either it's oppressive or it's really nice and warm.
Usha Tummala-Narra (13:40):
And I think sometimes, if it starts to feel intrusive and not accompanied by warmth and support from a family, then it can have very important implications for one's wellbeing, including one's emotional health, that it can start to feel like a person doesn't have choice. Like in the case of someone who might be facing violence in the home or their opinion is devalued, or there isn't this recognition that different people in the family might have different feelings and experiences. In those cases it can be very psychologically stifling for an individual. And it's difficult because it's accompanied oftentimes by the warmth and the support too. So it makes it confusing and almost feels like, "If I let my parents down..." And I'm speaking from the perspective of a younger person, that if I let my parents down in some way then there's a deep sense of guilt because of the fact that you also have the warmth and support from those same people who may also feel intrusive in other contexts or in other ways.
Soniya Gokhale (14:53):
Absolutely. I know Catholics talk about guilt, boy, we certainly rival them in that regard. I agree with you completely. And another aspect that you referenced in the paper, which really has a profound effect upon our communities and which I can attest to in my own family, pertains to acceptable forms of separation. And so for instance, it is common for children to move between extended family households, not only to complete their schooling in a city that might be remote from their parents' home, but it occurred in my family with my older sister. And as well, my dad and his aunt went to live with a relative who, unfortunately, it was a violent situation and they were children, but they had no choice. And similarly, my mom had to make a very difficult decision to leave my sister with her parents in India while she came to the US to pursue her medical residency.
Soniya Gokhale (15:56):
And I talk to people about it and they're just shocked. And yet, as you compared notes with others, it's not an uncommon story. Now, my sister joined her a few years later, but this whole concept is just so unique and a norm in our culture. Now I have to say, I could never do it. I could not leave my newborn child, but I recognize that was a different generation just one generation ago. And as your publication points out, all of these relocations tend to occur within extended family structures. And moving outside of and away from the family structure can present conflicts about the individual's loyalty and sense of security within the family. And so I just want to see if you had any thoughts on all this.
Usha Tummala-Narra (16:46):
Yes, yes, of course. And this is very important because it's not that separation doesn't happen within the extended family structure. So there is this traditionally a deep trust of family members who are aunts and uncles and grandparents, and that it's okay to move a child from one family who is in one village, for example, to another village where an aunt and uncle live. It was also not uncommon for children to be adopted by a sister or brother when that sister or brother was unable to have a child of their own for whatever reason. So there's this kind of movement that was fairly common within extended family structures. And I think that the thinking behind that is that truly that these other relatives are just as much of maternal and paternal figures as your own biological parents. So it's a very interesting kind of perspective.
Usha Tummala-Narra (17:49):
And in fact, if you look in many parts of India now that there are multiple caregivers for any one child. So it's not necessarily only the mother or the father or a primary caregiver, as we might see it in a more Western nuclear family context. So there were many caretakers. And so the attachment that children had to these multiple caregivers was it's very different, it's not as though the person may just have that deep attachment to one parent, but really looking to aunts and uncles as parents as well. And one of the things that's interesting that I've noticed in the last decade or so is that we actually have more grandparents moving from India to the United States to take care of young children in the US. So we see a trend of that too. So we have older people migrating to the United States from India who are older adults and coming at a very different time. And they're dealing with their own acculturation processes arriving at a much older stage and age compared to their children.
Usha Tummala-Narra (19:00):
And so the children growing up here with their grandparents have these multiple attachments as well. Some of the conflicts that come up have to do with what they might suggest in terms of appropriate parenting and appropriate behavior in the home of those children compared to their children and the grandchildren. So there are sometimes multi-generational conflicts that come from those migrations as well. But the other thing that I have noticed and learn from my patients that I've worked with is the complex nature of those relationships with extended family. That, as you mentioned in your example, there's very positive things to be gained from those relationships, and in some cases there are also abusive interactions as well. And I've certainly seen that in patients that I've worked with, and I'm happy to share an example of that from this paper, actually, that might elucidate this further.
Soniya Gokhale (20:06):
Absolutely. In fact, yes, both Meena and Sunjay, and we'll move into that. And I want to say that I grew up, my mom's parents lived with us and it was the most amazing experience. I mean, God bless their souls, they're no longer here, but boy, it added so much to my siblings and I and our existence. But as you indicated, these joint households are so common in our culture and community. And yet I do remember that when there's domestic issues with my mom and dad, that my grandmother was just obviously taking my mother's side. But it was just so funny because yeah, it's all sort of grouped together. There's no solid differentiation in the relationships. And as you stated, sometimes it works well and then as we move into this case or a couple of them, it can go very heartbreakingly wrong.
Soniya Gokhale (21:02):
And actually you do bring up that many times because of this concept of Dharma and duty, which your paper so brilliantly outlines its connection to this really irrevocable sense of family and intense connection and responsibility. And so what happens is you do push down the conflicting emotions. And so before we get into some of the horrific dysfunctions, you mentioned that it can present as headaches, GI problems and a host of other things, which I would add alcoholism, eating disorders and a plethora of other things. But just wanted to get your thoughts on that.
Usha Tummala-Narra (21:44):
Yeah, absolutely. In our communities, we typically are taught to not... And when I say taught, I don't mean sort of explicitly taught, but we're sort of socialized implicitly and sometimes explicitly to not verbalize our distress to other people. Partly because we worry that we might be burdening them with our troubles. And so sometimes the psychological distress presents itself in physiological symptoms, physical symptoms like headaches and leg pain and stomach aches and things like this. And certainly eating disorders and substance abuse, absolutely. That we sort of acted out in our body and through our bodies versus being able to talk about it. And sometimes we don't always have the language to articulate what it is that we're experiencing internally. And so that makes it also difficult to verbalize the distress. And I think sometimes there's a concern among both immigrant and first and second generation that others are not necessarily going to understand how we feel. There's a feeling of isolation too around, "Who can really understand what it is that I'm experiencing?" And so that is a very common feeling within our communities.
Usha Tummala-Narra (23:08):
Even trying to go see a therapist, "Which therapist is really going to get my family and the way things happen?" So if we think about all of the things that we just spoke about so far and the cultural differences and perspectives and the structure of a family, these are all things that might feel really foreign to someone who's not familiar with how families work and what families value and what people care about within the communities, and what those dynamics look like. So the feeling that somebody might not understand my experience, it's not something made up or fantasy, it is based on the reality that there are some real cultural differences in our backgrounds. So these are some reasons, some factors that contribute to why we might see more physiological symptomatology than people expressing verbally what's going on for them.
Soniya Gokhale (24:08):
Well, thank you. And I am so glad. I really hope to have you back again. Thank you so much, Usha.
Usha Tummala-Narra (24:14):
Oh, I'm so pleased to be here. Thank you so much, Soniya for having me again.
Soniya Gokhale (24:18):
Thank you.