We're Fine: What's Stopping Asian-American Millennials From Talking About Mental Health

The only time I’ve ever acknowledged my mental health problems with my Vietnamese parents, my mom had agreed to take me to a therapist during my junior year in high school, “just to try.” I’d finally admitted to her I thought I might be depressed, and even though she was hesitant, and didn’t grow up in a culture or generation where mental health was really discussed, she could see that I was barely eating and laying in bed pretty much every moment I wasn’t in school.

It took a lot to even broach the topic with her. Just a few years before, when my cousin was going through depression, our family had made fun of her behind her back.

“She’s a lawyer making a ton of money, what would she have to be depressed about?” they’d ask.

During that therapy appointment, I was officially diagnosed with depression and put on a 2-week trial of Lexapro. My mom told me not to tell my dad, mostly because she was protecting me — we both knew that he was much less receptive to the existence of mental health issues than she was. When the Lexapro ran out, she just assumed that it had “fixed” me, and we never discussed it again. We also didn’t have any money for me to keep going to therapy. My parents worked (and still work) for small businesses with crappy healthcare plans that don’t include family members in coverage. I barely saw a primary care doctor, let alone a specialist as “luxurious” as a therapist.

I don’t blame my mom for not knowing what to do after that one therapy appointment. Maybe she was worried what my dad would think and whether our family would make fun of me if they found out, or maybe she didn’t want to acknowledge that her kid had a problem. After all, there’s really no word for “mental illness” in Vietnamese — all we have is “bệnh tâm thần,” which roughly translates to madness, and carries a lot of shame.

That might be part of why Asian-Americans are three times less likely than white Americans to seek help for mental health issues, according to data from the National Latino and Asian American Study. And according to the Office of Minority Health at the U.S. Department of Health and Human Services, suicide was the ninth leading cause of death for Asian-Americans in 2014.

“Stigma and the notion of those suffering from mental illness as being ‘crazy’ is a big problem in the Asian and Asian-American community,” says Wei-Chin Hwang, PhD, clinical psychologist and professor of psychology at Claremont McKenna College. “In general, we don't talk about mental illness and there is a common belief that people should just get over it or be stronger.”

The need to be "strong" ties into the idea of filial piety: Some Asian parents may expect their children to be self-sufficient and capable enough to handle their own problems. In many Asian cultures, kids are meant to show their elders a lot of respect, which often translates to: Don’t cause problems for your parents. Before my mom realized what was going on, she thought I was just seeking attention with my mental health problem — which in turn made me shut down to the point of never bringing up my depression again. I didn't want to cause an issue.

While repressing emotional issues between parents and children is cross-cultural, the Asian community has seen that the ways it can have dire consequences. On the extreme end, in 2014, the case of a 24-year-old Vietnamese-Canadian woman, who was convicted of hiring hitmen to kill her parents, exposed the violent side of the pressure to be a high-achieving child of immigrants. And online forums, like the AsianParentStories subreddit, detail just how crushing it can be for Asian immigrants (or children of immigrants) to stay silent about mental health struggles. One user, who wrote that they developed OCD and obsessed over being perfect, said that their illness got to the point that they used to swallow their homework and redo it to have “the perfect grade.” They wrote that that their mom "dragged me to a priest for an exorcism... when I told her I wanted to see a psychiatrist.”

These are jarring, one-off anecdotes, but they speak to a much larger issue with how Asian immigrants view mental healthcare. Sumie Okazaki, PhD, a professor of applied psychology at New York University, says that it’s difficult for young people in immigrant families to talk about these issues because mental health just doesn’t feel as important as day-to-day survival.

“For families who are still struggling to ‘make it’ in a new country, discussing mental health may not feel like the most important priority,” she says. “Because immigrant parents have invested so much of their effort and resources into immigration and have an emotional stake in signs of success (e.g., parents making a good living, children doing well in school), mental health problems may be seen as signs of weakness and failure.”

The idea that asking for help means failure is only reinforced when your parents are immigrants, and you have the weight of the model minority stereotype (the expectation that Asians will be smart, hard-working, and uncomplaining) weighing down on your shoulders.

“The model minority stereotype and cultural expectations to succeed and work harder are not just part of the Asian culture, but they are part of the immigrant culture as well,” Dr. Hwang says. Further, other aspects of an immigrant parent's relationship with their children can complicate things. “Basically, immigrant parents and kids grow up in different cultural contexts, but also have problems in communication [with each other] exacerbated by difficulty speaking the same language.”

For Jamie*, a 26-year-old from Hawaii, that meant that even when she did get professional help, her Chinese mother was “extremely hostile” to the idea of her having any mental illnesses.

“When I was diagnosed with anorexia nervosa in high school, one of the first things [my mother] said was, ‘Why would you do this to me?’” she says. “That pretty much sums up her attitude: Mental illnesses weren't real, and if they manifested, it was my way of victimizing her. She also was extremely resistant to my going on psychiatric meds, her opinion was that I should be able to just cope myself.”

Jamie says that no one in her family really talked about mental health issues while she was growing up, and if they did, it was in a way that only made her feel ashamed or embarrassed.

“We were raised with the mentality that mental health issues were for white people; breakdowns and struggles were a luxury not afforded to us,” she says. “When I was in junior high school, a friend of mine, who was white, spent a month in a psychiatric hospital. My mother would make comments about weakness of character, how the white parents must coddle their daughter.”

But mental health issues aren’t a luxury, nor are they a weakness. The National Latino and Asian American Study also found that second-generation immigrants are more likely than their parents to be diagnosed with mental health disorders, something that Dr. Hwang says could be attributed to the cultural assimilation hypothesis, or the idea that when people move to a different country, eventually, they’ll develop similar rates of physical and mental health problems as that of the new culture. Because the rate of mental illness is higher in the U.S. than in most Asian countries, he says, after having lived in the U.S. for some time, immigrants and their children will experience the same risk factors as those who’ve been here longer, so they develop similar rates of illness. (This can also happen with physical health problems: A Huffington Post report from last year found that cultural assimilation might be the reason the rate of breast cancer is rising amongst Asian-American women.)

Another factor to consider? Younger generations are reporting more mental health issues than previous generations, regardless of whether we’re talking about immigrants or the general American population, Dr. Hwang says. Not to mention, people today are simply more open to talking about how they’re struggling with mental health. Still, that doesn’t mean that Asian-Americans are seeking out help as often as we should.

Dr. Okazaki says that while young people might think they’re sparing their immigrant parents by not talking about how much they’re struggling, they may only be making their problems worse — if you’re already feeling depressed or anxious (or any number of symptoms), then adding shame and isolation to that will only make things worse.

The shame around mental illness isn’t just limited to Asian culture. But we’re less likely to ask for help, and Dr. Okazaki says that even when we do, it’s hard to find therapists or counselors who are culturally competent enough to understand our intersecting identities.

“College counseling centers are often stretched thin and may not have immediate openings or counselors and therapists who are experienced and knowledgeable about common issues facing Asian-American young people,” she says. “These barriers can make it even more difficult for Asian-American young people to access culturally competent care.”

But as scary as it may seem, when we do talk about the emotional problems we’re going through, they can be easier to conquer.

Michael*, 25, a Filipino-American who grew up in California, says that when he first started experiencing anxiety and panic attacks a few years ago, he counted himself lucky — many of his family members had histories of mental illness, and were comfortable talking about it.

“I think I’m really fortunate because I had a lot of people to talk to about it, hence why I’m not in that deep hole as much anymore,” he says.

But, even if you aren’t lucky enough to have family members who can relate, opening up is still important. Stigma isn’t the only reason we’re not getting help, but it’s certainly a hurdle. And anyone who has suffered from a mental illness can tell you that you can’t get through it all on your own.

Last year, when I fell into a deep depressive spell for the third time, it never occurred to me to reach out to my mom. But as it turns out, I didn’t have to. She sends a “good morning” text every day to make sure we’re in contact. Beyond the customary “good morning,” last year, she started asking something she never asked when I was a kid: “How are you?”

I think part of it was that she knew how hard I was taking it that my best friend had moved away with very little notice, and that our friendship had fallen apart. Maybe she sensed during our weekly FaceTime calls that I was less buoyant. Either way, she started giving me an opening to let her in, and I did. I told her that I wasn’t doing all that great, but that I was working on it. And while that was scary, she seemed to understand. We don’t talk about everything, but I’m trying to let myself tell her more about my life. I know that even if she doesn’t always understand, she loves me. It's not up to her anymore to decide whether I need help. It's up to me. And I know she'll be there, supporting me through all of it.