I didn't even know Pakistani People could have such things (mental illness)

A patient's reluctance to share their address and anxious communication style puzzled one of my colleagues until I addressed the client's psychiatric profile. “I didn’t even know Pakistani people could have such things.” These were the words of the colleague—part of the BAME group, no less—when I explained that a client we were working with had Paranoid Personality Disorder (PPD) and schizoid tendencies. The comment caught me off guard, but it’s not an isolated incident.

Living in the UK, where 10.9 million people in England and Wales identify as belonging to non-white ethnic groups, accounting for 18.3% of the population, one would hope diversity would breed understanding. Yet, I’ve lost count of how many times I’ve heard statements like:

• “Mental illness is a white people thing. Work hard, stay strong, and you won’t have mental health problems.”
• “It’s all in the head.”
• “Social media made up all this mumbo jumbo.”
• “Psychology is a pseudoscience?”

At the time I might have smiled and brushed it off. However, these attitudes aren’t just frustrating; they’re damaging and detrimental to the fight for mental health awareness. They perpetuate stigma and alienate those who need help, especially in communities where mental health is already a taboo topic.

Understanding the Disorders

Paranoid Personality Disorder (PPD)

Individuals with PPD exhibit pervasive distrust and suspicion of others. They often interpret benign actions as malicious, hold grudges, and are hypersensitive to perceived threats or slights. In some cases, they may experience transient psychotic episodes involving delusions or distorted perceptions.

Diagnosis: Diagnosing PPD requires thorough clinical interviews and assessment against DSM-5 criteria, which emphasize patterns of distrust and suspicion that significantly impair functioning. Other medical or psychiatric conditions that could explain these behaviors, such as psychotic disorders or neurological issues, must be ruled out.

Treatment: Treatment focuses on psychotherapy, Psychodynamic Therapy, Dialectical Behavior Therapy (DBT), Schema Therapy particularly cognitive-behavioral therapy (CBT), which helps individuals identify and reframe paranoid thought patterns. Establishing a therapeutic alliance is crucial but can be challenging due to the individual’s inherent mistrust. In severe cases, antipsychotic or antidepressant medications may be considered.

Support: Family members and caregivers can support individuals with PPD by maintaining consistent and transparent communication. Avoiding confrontations and respecting their need for autonomy can help build trust and reduce conflict.

Schizoid Personality Disorder

Individuals with schizoid personality disorder display a profound detachment from social relationships and a limited range of emotional expression. They typically prefer solitary activities, show little interest in sexual or close interpersonal connections, and appear indifferent to praise or criticism.

Diagnosis: Schizoid personality disorder is diagnosed through clinical evaluation based on DSM-5 criteria, which highlight patterns of social withdrawal and emotional flatness. It is essential to differentiate this condition from autism spectrum disorder, depression, or other mental health disorders.

Treatment: Psychotherapy, particularly supportive therapy, can help individuals with schizoid personality disorder develop better social skills and coping mechanisms. Treatment often focuses on specific goals, such as improving workplace interactions or managing daily activities. Medication is not commonly used unless there are co-occurring issues like anxiety or depression.

Support: Supporting individuals with schizoid personality disorder involves respecting their preference for solitude while providing opportunities for meaningful engagement. Encouraging participation in structured activities or hobbies that align with their interests can foster gradual socialization without overwhelming them.

Personality disorders, including Paranoid and Schizoid Personality Disorders, can significantly impact neurocognitive functioning and daily life. These conditions often involve disruptions in cognitive processes such as perception, thought organization, and emotional regulation.

For example, individuals with Paranoid Personality Disorder may experience heightened hypervigilance and cognitive distortions, leading to difficulties in trust and collaboration. Similarly, Schizoid Personality Disorder may impair social cognition, reducing the ability to interpret social cues or form meaningful relationships. These cognitive challenges often translate into difficulties in maintaining employment, managing interpersonal relationships, and adapting to new or complex situations, thereby reducing overall quality of life.

If you approach Psychiatric Treatment, it could mean antipsychotics (e.g., Risperidone, Olanzapine, antidepressants (e.g., SSRIs like Sertraline), and anxiolytics (e.g., Benzodiazepines)

The Cultural Twist

For many in South Asian or other ethnic minority communities, acknowledging mental health struggles feels like announcing you’re the first alien ambassador on Earth. The reaction? A mix of disbelief, dismissal, a sprinkle of shame, and sometimes ridicule to invalidate. This hurdle exists for all types of concerns that stem from brain dysfunction including neurodevelopmental disorders, excerpt: watch

Stigma + Illness = Double Trouble

Imagine this: You muster the courage to seek help for your PPD or schizoid traits. That alone is like climbing a mental health Mount Everest. Then, you’re met with cultural backlash. People whisper, avoid eye contact, or worse, label you as “weak” or “broken.” It’s like running a marathon only to find out the finish line is a mirage.

Flipping the Script

Let’s sprinkle some positivity here. While the journey to understanding and acceptance is far from over, awareness is growing. Mental health discussions are becoming mainstream, and the narrative is shifting. Here’s how we can help:

1. Educate with Empathy: Bust myths like “mental illness is a choice” or “psychology is pseudoscience” with facts—but do it with patience. No one likes a condescending know-it-all.
2. Share Stories: Nothing beats real-life narratives to humanize mental health. Share your experiences (if you’re comfortable) to inspire others to do the same.
3. Normalize Therapy: Therapy isn’t just for “fixing” problems; it’s for building resilience and understanding yourself better. Think of it as a gym membership… for your brain.
4. Be an Ally: Whether it’s calling out stigma or simply listening without judgment, small actions can create ripples of change.

A Final Thought

Imagine if we treated physical health the way we treat mental health: “Oh, you broke your leg? Just think positive and walk it off!” Absurd, right? It’s time we extend the same compassion and logic to mental health. So, the next time someone questions the legitimacy of mental illness or psychology, smile and say, “If it’s all in the head, that’s exactly where we need to start.”

We are in an era where what we say, do, feel, and think is constantly being judged for both the good and bad. Some people feel that "this generation" has become oversensitive and can't take "jokes". While humor about these topics might seem harmless to some, in certain groups, it risks perpetuating stigma and alienating individuals who are already vulnerable. Let's start with promoting cultural competence, challenging stigma, and advocating for representation in mental health through education, sensitivity, supportive dialogue, and culturally informed practices.