Dr Shila Patel does not soften things. After more than 25 years as a licensed psychiatrist, working with children and adults across India, Africa, the United Kingdom, and the United States, she has sat with enough South Asian women in midlife to know that softening things is not what they need. What they need is someone who will name what is actually happening, without apology, and then ask: What are you going to do about it?
This is what she does.
Dr Patel was born in India and became what she calls a global citizen, carrying her South Asian heritage through four countries and four very different cultural contexts, watching, in each, how women, particularly South Asian women, navigate the particular bind of midlife. The cultural conditioning to sacrifice. The decades of putting family before self. The gradual, quiet erosion of a woman’s own identity, her own dreams, her own bucket, which, as Dr Patel puts it with characteristic directness, is given away and given away until there is simply nothing left.
She calls it Empty Bucket Syndrome. And once you hear that phrase, you will not be able to unhear it.
This conversation covers the mental health dimension of menopause that most healthcare professionals still aren’t asking about. It covers the stigma that keeps South Asian women suffering in silence. It covers intergenerational patterns, inherited sacrifice, and the particular psychological weight of reaching midlife, having spent most of it attending to everyone else’s needs.
But more than anything, it is a conversation about personal responsibility. About the moment a South Asian woman decides, perhaps for the first time, that her happiness is not something she is waiting to be given. It is something she is responsible for creating.
Dr Patel is not here to be gentle about that. And in her directness, there is a kind of care that is harder to find and more lasting than comfort alone.
You have lived across India, Africa, the United Kingdom, and the United States, carrying your South Asian identity through each of those worlds. How did navigating so many different cultural contexts shape your understanding of what South Asian women silently carry, particularly as they move into midlife?
It all depends on what type of South Asian family the woman was raised in. If it were a very conservative and rigid family, the woman would remain subservient, taking care of family needs before her own. She spends all day cooking, cleaning, and tending to children or grandchildren. However, if the woman had been allowed to pursue a career, she might be more independent, but the family’s needs are almost at the forefront in midlife.
In your psychiatric practice, you have worked with both children and adults for more than 25 years. When South Asian women in midlife do come to you for support, which many resist for a long time, what are they most commonly carrying that has gone unnamed for years?
By the time these women reach midlife, they have missed out on learning how to be independent. They have been taken care of first by fathers, then by husbands, and they have poor skills in being truly independent. They also put their needs aside and do not know how to speak up or pursue their own dreams.
The Sattva Collective hears from South Asian women who describe a particular kind of emotional exhaustion in midlife, not just hormonal, but the accumulated weight of decades of cultural expectation, caregiving, and self-erasure. As a psychiatrist, how do you understand that kind of long-held, unspoken weight, and what does it do to a woman’s mental health over time?
It is a very significant weight to bear, always caring for others and putting yourself last. Not surprising that there is a low level of depression and even anxiety, realising that their whole life has been devoted to others, and now they do not have the skills or means to do things that they may have dreamt of. I call it an empty bucket syndrome. They give and give, while getting very little back to fill their own bucket.
Mental health stigma within South Asian communities is something many of our women know intimately: the fear of being labelled, of bringing shame to the family, of being seen as weak. How has that stigma shifted, if at all, in your experience, and what do you think it will take to genuinely change the conversation within South Asian families?
The stigma of shame and being made to feel weak has not decreased much in the South Asian families. As women become more educated and are made aware of the balance between caring for family, which is so ingrained in women because of the culture they grow up in, and doing things that make them happy, they may seek this balance. Having a supportive spouse would go a long way in helping these women.
Perimenopause and menopause have a documented and significant impact on mental health, mood, anxiety, cognition, sleep, and emotional regulation. And yet so many South Asian women have these experiences dismissed as stress, or nervousness, or “just how you are.” What do you want South Asian women, and the healthcare professionals treating them, to understand about the mental health dimension of menopause?
Menopause brings about hormonal changes that affect the mood of many women. Sleep deprivation in itself lends to an increase in irritability, anxiety and fatigue. There are herbal and prescription medications that can help with different symptoms. Sexual activity can become painful, and women run the risk of getting more urinary infections due to dryness of the vaginal walls. Their Doctors can prescribe medications that help with these symptoms.
Your work explores the relationship between personal responsibility and change, individually and collectively. For South Asian women in midlife who have spent decades prioritising everyone else, how do you frame the act of finally seeking support for themselves? And how do you help women move past the guilt that so often comes with that?
Guilt never solves any problems. However, continuing down a path which keeps you unfulfilled, depressed and anxious is not good for the woman or her family. The saying “Happy wife, happy family” is where everyone benefits. Only when someone speaks up about what her needs are can she find the support she needs. People assume everything is okay and cannot read minds, even if they do suspect something is wrong.
You have written extensively about the intergenerational dynamics within South Asian families, the patterns that get passed down, often without anyone choosing them. When a South Asian woman reaches midlife and starts to question inherited patterns around silence, sacrifice, the body, and her own worth, what does that process look like psychologically? And how can she navigate it without losing her family relationships in the process?
It is a lost life if she does not start making changes. There is a choice: remain subdued, or start speaking up slowly. Do things that bring her joy and contentment, but ask for help with household duties so she does not feel overwhelmed by the burden of taking care of others and herself. Have expectations of children, young and old, and spouse to help out.
You have spoken about the importance of leaving behind a positive legacy. The Sattva Collective was founded on that same impulse, a mother building something alongside her daughter, for the generation of South Asian women coming after them. What does legacy mean to you personally, as a South Asian woman who has lived and worked across four countries, and what do you hope the next generation of South Asian women inherits that yours did not?
Being a positive role model is something I advocate. Young South Asian women are forgetting their role as women in the family. Being a caretaker, learning to cook, sew, etc. However, show the daughters that pursuing careers and dreams is possible while also being central feminine figures in the family. The next generation will have the support to do things outside the family that the older generation did not have.
South Asian women in midlife are often managing the mental health of everyone around them, children, ageing parents, partners, while their own goes unattended. What is your message to the South Asian woman reading this who recognises herself in that description, who knows she is not coping, but cannot yet find the permission to ask for help?
As I said before, it is a choice. Speak up and get help, or carry on what you are doing and feeling, and keep going down the same old path of self-destruction. No one is going to take care of you if you do not tell them how things are affecting you and whether you would like some things to change. Many men are oblivious as to what their wives need and are surprised when a woman wants a divorce in midlife or when the kids have left home.
If you could change one thing, in healthcare, in South Asian culture, or in the way society treats women in midlife, what would it be, and why?
Do not take the woman for granted; talk to her. Allow her to explore and dream. She does not have to lose her identity. Speak up. Stop being fearful of retaliation. Get support from children, friends and the community if the spouse is not understanding. You are responsible for your own happiness.
There is a moment near the end of this conversation where Dr Shila Patel says something that has stayed with me.
Not gently. Not with caveats or qualifications. Just plainly, as a psychiatrist who has spent over two decades watching what happens when South Asian women do not say it:
You are responsible for your own happiness.
For many South Asian women reading this, that sentence will land with complicated weight. Because it can sound, at first, like blame. Like the problem and the solution both belong to you, and no one else is accountable.
But that is not what Dr Patel means. What she means, and what her whole body of work points towards, is something far more empowering than blame. It is an agency. The recognition that waiting for your spouse, your children, your family, your community to notice what you need and give it to you without being asked is a long wait with an uncertain outcome. And that the only person who can begin to change the shape of your life is you.
That is not a small thing to ask of a South Asian woman in midlife who has spent decades being told, by culture, by family, by expectation, that her needs come last.
But it is, perhaps, the most important thing.
The empty bucket will not fill itself. And no one is coming to fill it for you.
You have to ask. You have to speak. You have to choose.
And as Dr Patel has shown across a lifetime of clinical practice, a life lived across four countries, and a career built on the belief that personal responsibility is the beginning of everything, it is never too late to start.
To find out more about Dr Shila Patel and her work: drshilapatel.com
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