Across the world, bi-cultural women are silently burning out. Raised between cultures, they navigate an exhausting emotional terrain shaped by dual expectations, unspoken family obligations, and under-acknowledged social pressures. Their psychological struggles often remain invisible. 

The silent struggle: Amina's story

Amina, a 36-year-old corporate lawyer, appears confident in meetings. From the outside, she seems to have it all: a successful career, polished presence, and a voice that commands respect. But behind closed doors, Amina is unravelling under the pressure of cultural guilt and the relentless expectation to be everything to everyone, all the time.

Her weekends are consumed with caring for ageing parents, managing subtle but persistent pressure to marry, and attending endless cultural obligations. Yet she feels unseen even by those she supports most.

She internalises messages like:

• “If I put myself first, I’m being selfish.”

• "My mum went through so much, who am I to complain?"

• "My parents sacrificed so much; I must make them proud." 

Amina’s story is far from unique. It reflects a quieter crisis faced by countless bi-cultural women. 

The invisible crisis in mental healthcare

This internal tug-of-war between cultures, values, and self-worth is often ignored in mainstream wellness conversations. On paper, these women are resilient. In practice, many are over-functioning.

Their distress doesn’t always show up as classic anxiety or depression. Instead, it looks like perfectionism, people-pleasing, burnout, chronic fatigue, or imposter syndrome. These coping mechanisms are often misread as strengths, especially in high-performing professionals.

Therapists unfamiliar with the cultural and identity-based dynamics beneath the surface may miss the deeper picture. Without understanding the expectations that shape these women’s inner voices, clinical interventions can fall short.

For many, setting boundaries feels like betrayal, not self-care. In collectivist cultures, the idea of prioritizing the self can be alien, even selfish. Family and community often come first. Personal needs are secondary, buried under guilt, duty, and cultural loyalty. 

How cultural identity shapes mental health

Cultural psychologist Harry Triandis (1995) outlined key frameworks that help us understand how culture influences well-being:

• Collectivism (common in Eastern cultures): values harmony, family loyalty, self-sacrifice, and respect for elders.

• Individualism (dominant in Western societies): emphasizes autonomy, personal expression, and self-reliance.

Bi-cultural women often straddle both worlds. Their heritage encourages them to serve others; the society they live in urges them to serve themselves. This split creates constant inner conflict—choosing oneself can feel like rejecting one’s roots.

Many women in diaspora communities have also experienced parentification, taking on adult responsibilities far too early, often translating into emotional labour for the whole family. In some cases, this burden is often compounded by the broader impacts of migration, war, racism, and economic hardship that their families have endured. For them, success becomes an act of redemption, carrying not just personal meaning but the weight of unspoken generational trauma.

Mental health advocates, programmes, and therapists must all recognize and address these complex layers when dealing with this client group. 

The double burden: Sexism, racism, and intersectionality

Bi-cultural women carry an amplified burden at the intersection of racism and sexism.

South Asian women, for example, are often labelled "too sensitive," "too emotional," or "too aggressive". These descriptors pathologize their assertiveness and passion, even as those same traits are praised in males within the community. At home, they're expected to be selfless caregivers. In society, they're expected to perform, excel, and smile through the pressure.

Many therapy clients eventually voice the same painful realization: they are living out dreams that are not fully their own. Shaped by cultural ideals, male approval, and societal narratives of what a ‘good woman’ should be, some women say "yes" to marriage not out of joy, but quiet surrender. To belong. To meet expectations. To make others proud, even if it costs their own sense of fulfilment.

Many ethnic individuals have experienced a common microaggression: being asked, “Where are you really from?” sometimes by white Europeans visiting London for the first time, unaware of the irony: the visitor is new yet assumes the local doesn’t belong.

There is nothing wrong with genuine curiosity. Asking about someone’s heritage or background isn’t inherently offensive. But assuming that a person cannot be from here based solely on their skin colour conflates ethnicity with nationality, and that assumption communicates exclusion.

For many Asian and Black individuals, this question can feel particularly jarring, especially when they have two or three generations of family history rooted in the city. Grandparents who arrived in the 1950s, parents born in London hospitals, children raised and educated in local schools, often with deeper roots in the community than those questioning their right to belong.

As research by Sue et al. (2007) shows, racial microaggressions may seem small but have cumulative effects, including anxiety, hypervigilance, and low self-worth. Many individuals feel too British in their ancestral homelands and too foreign in the UK, leaving them with nowhere they fully belong.

The most recent UK report addressing disparities in mental health among ethnic minorities is the 2023/24 State of Care report by the Care Quality Commission (CQC). Released in 2024, it report highlights significant inequalities in mental health services, particularly affecting Black, Asian, and minoritised ethnic groups. This underscores the urgent need for culturally informed support to address the higher rates of misdiagnosis, under-treatment, and poorer mental health outcomes experienced by ethnic minority groups compared to the general population. 

Intersectionality: Naming the overlap

Kimberlé Crenshaw’s (1999) theory of intersectionality helps us see how racism and sexism intersect. For bi-cultural women, even strengths like faith, family, and cultural pride can become barriers to emotional expression. They are praised for being strong, but punished for being honest about the toll it takes. 

Culturally attuned therapy: A new model of care

Culturally attuned therapy doesn’t just treat the individual. It treats the context, the culture, history, and identity that shape who the individual is.

It acknowledges:

• That perfectionism is not a personality flaw but a survival strategy.

• That self-sacrifice may be deeply embedded in identity, not just low self-esteem.

• That shame, guilt, and over-functioning often have cultural roots.

This therapeutic approach empowers bi-cultural women to:

• Recognize and name cultural pressures without shame.

• Honour their heritage while learning to set healthy boundaries.

• Reframe mental health struggles through a culturally compassionate lens.

It also requires a shift in mental health systems to:

• Understand how colonial history shapes modern definitions of health.

• Include non-Western models of healing, community, and well-being.

• Address systemic barriers to access and representation.

• Invite worldviews that make space for spirituality, family duty, and collective healing.

The research: Assimilation doesn’t equal healing

Studies show that assimilation often increases emotional distress. Tabor and Tay (2020) found that abandoning cultural identity to adopt Western norms can heighten anxiety and loneliness. In contrast, maintaining ties to cultural communities can protect mental health but may also increase pressure to conform or silence individual needs was concluded by Wang and Leung, (2019).

This tension must be navigated, not erased.

Can they have it all?

The dream of "having it all" is seductive, but for many bi-cultural women, it comes at the cost of emotional dissonance and quiet burnout. They are expected to be ambitious but humble, independent but self-sacrificing, and outspoken but respectful.

Lean in but not too far. Set boundaries but not at the expense of family honour. Speak up, but not in ways that might risk being seen as a traitor to their roots. Every decision is filtered through two cultural lenses what's praised in one world may be punished in the other.

True healing begins with naming this duality, the ongoing negotiation between cultures, identities, and expectations. It requires acknowledging that setting boundaries isn’t selfishness; it’s essential for survival. It means recognising that perfectionism and people-pleasing aren’t personal failings but adaptive survival responses to navigating complex cultural terrains. 

A path forward: What needs to change

Mental health providers must evolve. They must:

• Train in cultural intelligence and humility.

• Learn how racism, history, and cultural values impact mental health.

• Make space for bi-cultural identity without expecting assimilation.

Employers must also take responsibility. The emotional labour many women carry at home, at work, in their communities needs recognition, not dismissal.

If you’re ready to heal with your whole self in mind

If you're seeking therapy that respects your culture, faith, and ambition, visit here. It's time to stop choosing between success and wellbeing. You can have both, and you don't have to do it alone. 

Author’s Note: This reflection draws from clinical experiences and does not represent all women from diaspora communities. It does not encompass the full diversity of ethnic, religious, or socioeconomic experiences, nor account for the additional challenges faced by those with disabilities or other intersecting identities.

 References:

• Care Quality Commission. (2024). The state of health care and adult social care in England 2023/24. 

• Crenshaw, K. (1991). Mapping the Margins: Intersectionality, Identity Politics, and Violence against Women of Colour. Stanford Law Review, 43(6), 1241-1299.

• Tabor, A. S., & Tay, L. (2020). The impacts of individualism and collectivism on immigrant well-being: A longitudinal study. Journal of Cross-Cultural Psychology, 51(3), 229–248.

• Triandis, H. C. (1995). Individualism & Collectivism. Westview Press.

• Wang, Y., & Leung, K. (2019). Cultural values as predictors of mental health dimensions in Chinese and immigrant populations. International Journal of Intercultural Relations, 72, 84–93.