My father is fluent in English. He has two master’s degrees and a law degree from India. He can debate policy, analyze contracts, rattle off political science, and write with precision.
But when he came to America in the early 1980s, he learned that fluency was not the same thing as belonging.
He arrived alone. Highly educated and capable. And yet, starting from scratch. He would return to school, pivot into finance, and build an entirely new professional identity. Along the way, people suggested he shorten his very Indian name. Make it easier and more pronounceable. Make it fit.
What does it do to a person to be told that their name is inconvenient?
Today, South Asians are one of the fastest-growing immigrant groups in the United States. According to U.S. Census Bureau estimates, more than 5 million people of South Asian origin live in the U.S., with Indian Americans representing one of the largest segments. Over 75% of Indian Americans hold at least a bachelor’s degree, among the highest educational attainment rates of any ethnic group in the country, and median household incomes exceed the national average by a significant margin.
These numbers are often cited as proof of success. But success statistics rarely capture the psychological cost of migration.
The Hidden Stress of Starting Over
Immigration is not simply relocation.
Research on immigrant mental health consistently identifies acculturative stress as a major psychological burden. Acculturative stress refers to the emotional strain associated with adapting to a new culture, learning new social norms, navigating subtle language differences, and often encountering discrimination.
Even highly educated immigrants may experience:
- Downward occupational mobility
- Invalidation of credentials
- Language-based marginalization
- Social isolation
- Financial strain in early years
- Visa or immigration uncertainty
Studies have linked these stressors to increased rates of anxiety, depressive symptoms, sleep disturbance, and somatic complaints.
Years after my father rebuilt his career, my husband would walk a similar path. He came to the United States in the 2000s and worked various jobs while studying for medical licensing exams. There is little glamour in retaking exams after years of prior training. There is no applause for survival jobs taken quietly while preparing for the next step. Starting over professionally is rarely dramatic. It is repetitive, humbling, and often invisible.
Research on skilled immigrants experiencing occupational downgrading has found associations with depressive symptoms, lower life satisfaction, and diminished perceived social status. Professional identity is intertwined with self-worth. When credentials are questioned or delayed in recognition, the psychological effects can be profound.
Different decades. Same blueprint: start again. Don’t complain. Keep moving.
Emotional Suppression as Survival
For many first-generation South Asian immigrants, mental health conversations were not normalized in the 1980s and 1990s. Therapy was often associated with severe psychiatric illness. Emotional endurance was admired. In this context, emotional suppression can be adaptive.
When navigating uncertain immigration status, financial instability, and the absence of extended family, there may be little room for vulnerability. Feelings are postponed. Anxiety is converted into productivity. You do what needs to be done.
But chronic suppression carries physiological and psychological costs. Long-term emotional inhibition has been associated with increased stress hormones, sleep disturbance, hypertension, and mood disorders. Distress may not present as sadness; it may manifest as irritability, perfectionism, overwork, or unexplained physical symptoms.
Mental health service utilization among South Asian immigrants remains lower than national averages, even when controlling for income and education. Barriers include stigma, limited culturally responsive providers, language differences, financial concerns, and fear of professional repercussions.
The “model minority” narrative further complicates matters. When a community is collectively framed as thriving, individuals within it may feel even greater pressure to appear strong.
The Immigrant Woman
Immigrant women often shoulder invisible burdens.
My mother came to the United States with me when I was nine months old. She boarded a long international flight alone, leaving behind her entire support system. My dad was waiting at the airport, but there was no large extended family. No siblings down the street. No familiar language filling the grocery store aisles.
In South Asian cultures, motherhood is rarely solitary. It is communal. Immigration can make it solitary overnight.
Research shows that immigrant women, particularly in early parenthood, may experience elevated risk for depressive symptoms due to social isolation, cultural displacement, and lack of extended support. Yet help-seeking may remain limited because of stigma or lack of culturally attuned care.
There were no casual conversations about postpartum mental health in those years. No language for homesickness layered on top of new motherhood. The loneliness may have been profound.
Who Is Most Vulnerable?
Not all immigrants experience migration in the same way. Certain subgroups face heightened psychological risk. Within South Asian immigrant communities, research suggests increased vulnerability among:
- Recently arrived immigrants: Higher acculturative stress, limited social networks, employment instability.
- Individuals experiencing occupational downgrading: Skilled professionals whose credentials are not recognized may experience identity disruption and depressive symptoms.
- Immigrant women with limited social support: Increased risk for anxiety and depressive disorders, particularly in the perinatal period.
- Older adults who migrate later in life: Greater risk of social isolation and depressive symptoms due to language and cultural barriers.
- Undocumented or visa-dependent individuals: Chronic uncertainty and fear contribute to sustained anxiety.
Research also describes the “healthy immigrant effect,” in which first-generation immigrants demonstrate lower rates of certain psychiatric disorders compared to U.S.-born populations.
Ambiguous Loss
Immigrants often experience what psychologists call ambiguous loss—grief without closure. The homeland still exists, but it changes. Family remains, but at a distance. Traditions evolve. Language shifts. Identity stretches. One can feel grateful and process loss simultaneously.
This duality can be difficult to articulate. Particularly in cultures that prize sacrifice, expressing sadness about migration may feel disloyal, so the grief remains unspoken.
Reframing Resilience
Resilience in immigrant communities is not the absence of struggle. It is persistence despite it.
It looks like:
- Retaking licensing exams after years of prior training.
- Working multiple jobs while studying.
- Rebuilding professional identity in an unfamiliar place.
- Maintaining cultural rituals in new environments.
- Sending money home while building stability here.
It also looks like love expressed through opportunity.
My daughters now run freely in a country my parents had to cautiously tread. They fit in where my father had to find his footing. They will never know what it feels like to have their name suggested for revision to fit in.
Their stability rests on invisible scaffolding: night classes, licensing exams, international flights taken alone, unfamiliar vocabulary learned through small moments.
They inherit not just opportunity, but courage. My parents credit their resilience to their faith, belief in themselves, and the community they formed. And my husband’s lifelong motto is to “face your fears,” bolstered also by his strong spiritual roots.
This piece is for my mother and father, who left familiarity for possibility. It is for my husband, who rebuilt his professional identity one exam at a time. And it is for the countless immigrants who suppressed fear long enough to build safety for the next generation. Between two homelands lies sacrifice and transformation.
And perhaps healing begins when resilience is honored not as silent endurance, but as a story told in full.
Vishwani’s opinions are her own and are for informational purposes only. They are not intended to diagnose, treat, or provide medical advice. Please consult a qualified healthcare professional for personalized medical care.
Vishwani Sahai-Siddiqui is a residency- and fellowship-trained psychiatrist, now a medical writer and editor. For more information, email vishwanipsychmd@gmail.com.
To view Vishwani’s full list of articles published on Behavioral Health News, please visit behavioralhealthnews.org/postauthors/vishwani-sahai-siddiqui-md.
References
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Hwang, W.-C., & Ting, J.-Y. (2010). Acculturative stress in Asian immigrants: The impact of social and linguistic factors. International Journal of Intercultural Relations. https://doi.org/10.1016/j.ijintrel.2009.10.004
Jing, F., Li, Z., Qiao, S., et al. (2023). Association between immigrant concentration and mental health service utilization in the United States. Health & Place. https://pubmed.ncbi.nlm.nih.gov/37311276/
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Migration Policy Institute. (2024). U.S. immigrants by age, region, and characteristics. Frontiers in Public Health. https://www.frontiersin.org/articles/10.3389/fpubh.2024.1382600/full
Park, I. Y. (2024). Acculturative stress and self-rated mental health among Asian immigrants: The mediating role of social support. Asian American Journal of Psychology. https://doi.org/10.1037/aap0000340
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