Fighting Two Battles at Once

How I use therapy to manage OCD and cultural stigmas around mental health.

by Nabeeha Islam


When I was 8, I was adamant about having a strict daily routine. I woke up at precisely 7 a.m., brushed my teeth at 7:05, and got dressed in 10 minutes. I had to follow this schedule exactly. If not, I experienced panic attacks until I got back into my pajamas and into bed, in hopes to “restart” my day from the beginning until I got my routine right. This could delay my day by two to three hours. 

A couple of years later at school, we were learning about driving safety and were told about a family in an accident; the father was killed because he wasn’t wearing his seat belt. I trembled with fear as my mind replicated an exact scenario where that family was my own. I couldn’t stop thinking about it. 

After school, when my father picked me up, I refused to get in the car. My dad, despite his efforts to understand why I was standing at his car door crying, became frustrated. He asked me why I was acting the way I was. But I could not explain why I was so upset. He eventually coaxed me into the car, where I cried myself into exhaustion. 

For the next three months, the scene of my family in a crash was set on repeat in my mind. Not only did this emotionally drain me, I started to feel isolated at school. My classmates looked at me like I was crazy, recognizing me as the 10-year-old who cried in front of her dad’s car door at dismissal every day. Although I had a few acquaintances at school, I didn’t have any friends to spend time with outside of the classroom; I was too wrapped up in my anxieties to make any strong bonds. 

But in the eyes of my teachers, counselors, and parents, I was still a bright student, and they thought some of my out-of-character behavior—like my inability to leave the house or my obsessive fear of diseases—was a result of my anxiety to excel. My teacher even coined a nickname for me: a worry-wart. 

The Taboo Around Mental Illness

As a Bengali, I have always known that mental illness is a taboo subject in my community. It also takes little for someone to be considered mentally ill. I’ve heard of teenagers being accused of “acting out” or being “unstable” for, say, wearing supposedly revealing clothes or posting social media photos with their significant others. I’ve also heard of people being labeled as “insane” for simply showing potential symptoms of depression or anxiety, like being quiet or shy at social gatherings.

“I look at therapy as an outlet for feelings of frustration or a place to learn more coping mechanisms.”

For example, when I was 11, I was at a community gathering during the Bengali New Year, where neighbors gossiped in Bangla about another girl in my circle of family friends: “She keeps acting out! Only prayer could save that girl.” 

That particular girl was going through a stressful time at her elite high school. At the gathering, she barely left her room, and when she did, she didn’t greet any of the guests at her house. In Bengali culture, failing to greet guests, especially elders, is considered impudent. 

“I guess not everyone is cut out to handle a little bit of pressure,” one person said. Rumors started circulating that she “cracked” under the stress of school. 

My Symptoms Worsen 

A few months after I turned 10, I ran down the stairs for dinner with 20 bandages wrapped tightly around my fingers. At the time, I was scared of catching a virus like HIV, and I thought mummifying my hands with bandages would protect me. 

Rather than observe this incident with concern, my mom said: “Don’t use this situation to prove you have some illness. You just want to get out of being in trouble for wasting our hard-earned money on bandages!”

At other times, like when I couldn’t leave the house for fear of being in a car accident, my parents tried to reassure me. “Nabeeha, being paranoid once in a while isn’t a sign of an illness. Everyone has phobias once in a while—this is just the age where you overreact about small things.” 

Though this made me feel depressed and defeated, I accepted that my parents were right, because I couldn’t think of any other explanation for my behavior. 

Why My Parents Downplayed My Illness

I believe my parents chose to ignore the signs because they were worried that their daughter might be labeled as “unstable,” or even worse, “crazy.” But another reason my parents took so long to acknowledge my illness was because they believed that, compared to what they had endured back in Bangladesh, my life in the United States was relatively comfortable. 

When I was 12, I started having indirect conversations about mental health with my older cousins. I asked them vague questions about anxiety without admitting that I was nervous all the time, because I didn’t want them to tell my parents. During these talks, I discovered the context behind our parents’ perspectives on mental health. Our parents had lived through the Bangladesh Liberation of 1971. Families woke up to rounds of gunfire in their front yard. My own grandfather barely escaped after being thrown into a concentration camp in Burma (now Myanmar). 

Coming to the U.S. allowed my family to build a future for the next generation, away from the violence back home. After experiencing the atrocities of the Liberation, it was hard for my parents and other Bengali adults to understand that their American children could have their own struggles. Why would American-born kids suffer when they have food on their plates, clothes on their backs, and a safe place to call home? 

Receiving a Diagnosis 

During my annual physical when I was 13, my doctor asked me why I looked so down. “I’m not sure,” I said. “I’ve never felt so bad about myself before. It’s hard to concentrate or do everyday tasks and the only answer I can think of must be that I’m getting lazier.” 

I expected my doctor to laugh my comment off while she measured my weight and height. I had not confided in her about my intrusive thoughts before because I was scared that I could be labeled “unstable.”  

Instead, she said: “I wouldn’t say you’re getting lazier, Nabeeha. You’re a bright kid and this is a drastic change. Have you considered that you might be overly anxious about things?” 

We spoke about all the signs pointing to something more serious than just the blues and my trouble concentrating. I was also gaining and losing weight rapidly, a possible result of mental stress. 

My doctor called my parents into the room. Even though my doctor is not Bengali, I think that hearing about my behavior from a trusted professional opened their minds. Even as I started to ask my cousins about anxiety, I wasn’t completely sure that I had a mental health issue. My doctor’s concern, however, was proof that my concerns were valid. 

My doctor made recommendations that led to my sessions with a psychiatrist. I was diagnosed with severe depression and obsessive compulsive disorder (OCD), a mental illness that involves irrational thoughts and fears that result in compulsive behaviors. 

My parents supported me. They checked on me every time I showed signs of another depressive episode. For example, if they noticed that my room started to pile up into a mess, or that I was missing meals, they tried to help me. My dad cleaned my room and left sweet notes on my bed telling me I was doing a great job. My mom cooked some of my favorite Bengali meals. Their actions spoke louder than words; my parents were trying to comfort me in their own ways. I also began weekly therapy sessions, where I was prescribed anti-anxiety medication, which helped me to slowly heal. 

Learning to Heal 

Today, four years since my diagnosis, the techniques I’ve learned to manage my OCD and depression have made life easier. I still have moments where a random irrational fear feels paralyzing. Just a couple of weeks ago, I felt scared to leave my house for fear that something bad would happen to me. But now I know how to handle the situation when moments like those creep up on me again.  

I remind myself of the quote by German spiritual teacher Eckhart Tolle: “What a liberation to realize that the ‘voice in my head’ is not who I am. Who am I then? The one who sees that.”

After lots of introspection, I find comfort in knowing that I can use this quote to distinguish between the intrusive thoughts and who I really am. I am not my intrusive thoughts. 

I have learned breathing strategies for sudden anxiety. For longer depressive episodes, I use a visualization technique my therapist taught me: I build a mind-map of my favorite memory. I imagine how the air felt at that moment, who was around me, what was being said, etc. This helps to restore some of the imbalances of my brain during depressive states, reminding me of happy memories and helping me look forward to new ones.  

The real takeaway from therapy, though, was learning and accepting that depression and OCD were always going to be part of my life. Instead of convincing myself that I’ll be cured through therapy, I look at therapy as an outlet for feelings of frustration or a place to learn more coping mechanisms. 

Although my parents continue to make progress towards being kinder and more aware of their attitudes towards my hardships, sometimes they still speak about my mental illnesses insensitively. Once, my parents scolded me for making a mess of my clothes by saying, “Are you going to blame your depression for this?” Sometimes I hear them say, “What could she be depressed about? She’s living a better life than any of us did!” In these moments, I feel like I’m moving 10 steps backwards just when I thought we had moved two steps forward. 

But I know that changing their minds isn’t something I can do overnight, since it took years of trauma being engraved into them to establish their opinions and cultural views. Retracing the steps my parents and other Bangladeshi people took when making their way to the U.S. gives me a better understanding of their attitude towards mental illness. In the meantime, I can only continue to explain my perspectives while keeping an open ear to theirs, in an effort to make slow steps towards understanding one another. In my case, reflecting on my community’s history of trauma also helps me, in part, to heal my own scars.

Discussion Questions

1. What is the taboo around mental illness that Nabeeha faces in her community? Have you ever confronted a similar taboo within your own community? 

2. Nabeeha feels nervous about opening up to her parents about her mental health. Once they hear the doctor’s diagnosis, how do they respond? 

3. How do Nabeeha’s parents’ past experiences inform their expectations around mental health? Why is it important for Nabeeha to try to both understand and challenge her parents’ perspectives? 

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