What stigma actually looks like in practice
Mental health stigma isn’t usually a single, explicit belief. It’s a cluster of smaller, often unspoken assumptions that shape behaviour without being openly examined. In many Iranian families, these include:Therapy is for people who are broken. The logic goes: if you’re struggling, it means you are weak, or damaged, or failing at something other people manage just fine. Seeking help confirms the deficiency.It’s family business. What happens inside the family stays inside the family. The Farsi concept of aabroo (آبرو) — honour, face, reputation — is partly built on this. Telling an outsider about your struggles, your marriage, your children’s problems, your own mental state is understood as a form of betrayal, or at minimum, as a loss of dignity.Talking about it makes it worse. There is a widespread belief that examining painful emotions intensifies them. That the healthier response to hardship is to push through, stay busy, and not give problems more attention than they deserve.What would people think? For first-generation immigrants, community reputation is both a social resource and a form of insurance. In a small, interconnected community, being known as someone who “went to therapy” can feel risky — even if the risk is mostly imagined.The immigration layer
Migration itself is a form of grief that most people never name as such.Leaving Iran — whether in the 1980s after the revolution, in the 1990s and 2000s as the economy worsened, or in more recent years as political conditions deteriorated — meant leaving behind a whole life: language as a natural environment, family networks, professional status, a sense of being known. Many Iranians who came to Canada as engineers, doctors, or academics spent years rebuilding from scratch.That kind of loss tends to go unnamed, because the official story of immigration is opportunity, not grief. There’s often no cultural space to say: I lost something enormous when I left, and I haven’t finished grieving it.Unprocessed migration grief is one of the most common underlying currents in therapy with first-generation Iranian immigrants. It shows up as depression that doesn’t fit neatly into any clinical box, as anger that seems disproportionate to the current situation, as a pervasive sense of not quite belonging anywhere.The parent-child gap
For second-generation Iranian-Canadians — born or raised in Canada — the dynamics shift.Growing up bicultural means absorbing two sets of expectations that don’t always agree. Canadian culture generally supports self-expression, individual autonomy, emotional honesty, and the idea that your feelings are valid by definition. Iranian family culture, in many households, prizes collective harmony, respect for elders, restraint in emotional expression, and sacrifice of individual needs for family stability.Navigating these two worlds is its own form of psychological stress, and it’s one that many therapists trained exclusively in Western models are not equipped to handle well. The standard CBT question “what do you want?” can land very strangely on someone whose entire value system is organized around what their family needs.What’s changing
The stigma is real. It’s also shifting, particularly among younger generations and in communities with high education levels. Several things are driving this:Social media and Persian-language mental health content. There is now a significant body of mental health content created in Farsi, for Iranian audiences, by Iranian therapists and psychologists. On Instagram, YouTube, and podcasts, younger Iranians are encountering normalized conversations about anxiety, depression, trauma, and therapy.The political situation in Iran. The events of 2022–2023 — the protests, the violence, the grief that moved through diaspora communities around the world — pushed mental health into conversations that had previously stayed private. Many Iranian-Canadians who had never sought help before found themselves dealing with trauma responses that exceeded what they could manage alone.The normalization of therapy among educated professionals. In Iranian-Canadian communities concentrated in cities like Vancouver, Toronto, and Calgary, therapy is increasingly common among people in their 30s and 40s. When people you respect are open about going to therapy, the stigma decreases.Access to Farsi-speaking therapists. The availability of bilingual therapists — still limited, but growing — removes one of the practical barriers. When therapy can happen in your first language, with someone who understands your cultural context, the threshold to try it drops significantly.What good therapy looks like for Iranian families
A few things distinguish therapy that actually fits the Iranian-Canadian context from therapy that applies a generic Western model:The therapist understands what aabroo is, without needing it explained. They understand why a client might be reluctant to say certain things out loud, and they create space that makes it safer to do so.Family is treated as context, not as pathology. Western therapy has a tendency to frame family enmeshment or family loyalty as the problem to be overcome. Good therapy for Iranian clients doesn’t ask them to choose between their family and their wellbeing. It works with the family as a real and important part of the person’s life.Language is available. For clients who think primarily in Farsi — especially for emotional and relational material — being able to express themselves in Farsi is not a luxury. It’s a clinical necessity for the work to reach its real depth.Stigma is acknowledged, not dismissed. A therapist who says “the stigma in your community isn’t rational” is not a therapist who will be effective with Iranian clients. The stigma is real, it has real costs, and a good therapist works with the reality of it rather than against it.Dr. Samuel Ezzatilord is a Registered Clinical Counsellor (RCC) and Certified Canadian Counsellor (CCC) in Vancouver. He works bilingually in English and Farsi with Iranian-Canadian individuals, couples, and families. He has over two decades of clinical experience across Iran, refugee camps, addiction rehabilitation, and mental health authority settings in Canada. A free 20-minute consultation is available at drsamuel.ca/book-a-call.
Related Resources
Dr. Samuel works specifically with Iranian-Canadian clients navigating mental health stigma. Learn more about finding an Iranian therapist in Vancouver, Farsi therapy in Vancouver, and âbroo and the stigma of Iranian therapy. For families, see Iranian-Canadian generational gap and therapy and Iranian-Islamic culture. For individuals: individual therapy and couples and family therapy.
About the Author
Dr. Samuel Ezzatilord, RCC, CCC, DHSc is a Registered Clinical Counsellor in Vancouver, BC. He holds a Doctorate in Health Sciences and is registered with the BC Association of Clinical Counsellors (BCACC) and the Canadian Counselling and Psychotherapy Association (CCPA). He offers individual, couples, and family therapy in English and Farsi, specializing in trauma, PTSD, ADHD, neurofeedback, and EMDR. He also works as a Mental Health & Substance Use Clinician at BC Health Authority. Learn more about Dr. Samuel or book a free call.