MH Stigma

 https://www.medicalnewstoday.com/articles/asian-american-mental-health

Asian American mental health stigma: Why does it exist?

By Jennifer Hulzen (2021 Jan 29), medically reviewed by Jacquelyn Johnson, PsyD

·        Statistics

·        Why is there a stigma?

·        Other cultural factors

·        Combatting stigma

·        Seeking help

·        Summary

Mental health stigma can negatively impact people with mental illness, their loved ones, and caregivers. Stigmas are unfair, inaccurate ideas or beliefs that people use to negatively isolate and discriminate against others with certain traits or qualities.

Mental health stigmas exist worldwide and can impact anyone of any race or ethnicity, creating barriers to access available mental health treatment. According to Mental Health America (MHA), Asian Americans are the least likely racial group in the United States to seek mental health services.

This article discusses Asian American mental health statistics, common stigmas and why they occur, cultural influencing factors that impact different groups of people, how to combat stigmas, and how to seek help.

Statistics

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The Asian American population is the fastest-growing ethnic or racial grouping in the U.S., increasing 72% between 2000–2015.

In 2019, over 19 million people living in the United States identify as Asian American or Pacific Islander, representing 6.1% of the total U.S. population.

Of these, roughly 15% report having a mental illness in the past year, meaning more than 2.9 million Asian Americans experienced mental illness in 2019.

Findings from the National Latino and Asian American Study also found that 17.3% of Asian Americans will be diagnosed with a psychiatric condition at some point in their lifetime.

By some estimates, Asian Americans are three times less likely to seek treatment or help than other racial groups in the U.S. The MHA also state that they are the least likely racial group in the U.S. to seek mental health services.

Why is there a stigma around mental health?

The APA claim stigma may play an important role in someone’s likelihood to access care willingly. And according to the Substance Abuse and Mental Health Services Administration, mental health stigmas are common in Latino and Hispanic communities in the U.S.

While more research is necessary, mental health stigmas may exist for several reasons, such the below:

Fear of disability

A study found stigmas that associate mental illness with disability are the largest barrier to Asian Americans accessing mental healthcare.

Cultural norms and values

Shaming related to mental health is a cultural norm in some Asian American communities.

Many Asian Americans also have strong family obligations that center around traditional and cultural values. Ancient Asian philosophical traditions strongly identify someone’s self-value with their ability to care for their family and community.

These notions encourage the idea that people with mental illness, who may not live up to these stereotypes, obligations, and values, are failures, valueless, or have no identity or purpose.

These negative ideas can also discourage people from seeking treatment to avoid shaming themselves, their family, or their community.

Getting outside help may also conflict with the Asian American cultural value of interdependence, which stresses that family or community can meet all a person’s needs. This value perpetuates the idea that people should not seek professional help when relying on their family or community.

The ‘model minority’ myth

The model minority myth enforces the idea that all Asian Americans are fully-integrated, intelligent, industrious, and have overcome racial bias. This places pressure on those within this group to meet these standards or expectations.

Furthermore, it encourages people to hide their historical influences and deny the fact that their life includes frustration, let-downs, setbacks, failures, pain, and loss that everyone experiences. Media portrayals often further encourage this stereotype by presenting one-dimensional, uncomplicated, and “universal” Asian American characters.

Taboos

Talking about mental health is taboo in many Asian cultures, perpetuating the idea that mental illness is shameful and that people should keep these issues private.

Lack of mental health education

A lack of mental health awareness, coupled with negative stereotypes,may cause Asian Americans to overlook, reject, deny, or ignore mental health symptoms.

They may also be more likely to assume mental illness is related to poor parenting or a genetic flaw passed down from parents. This can discourage people with mental illness, or their families, from seeking outside help to avoid being labeled as defective or damaged.

Religious or spiritual beliefs

Several prevalent religions in Asian American countries promote the idea that mental illness:

• is a sin or divine punishment
• represents disrupted energy flow or an internal imbalance
• stems from a lack of faith
• can be cured with enough faith, prayer, or good behavior

Lack of culturally appropriate resources

Many healthcare professionals do not have the specialist training to accommodate or address different cultural needs, experiences, and values.

Some estimates claim Asian Americans also have the most trouble accessing mental healthcare due to language barriers of all ethnic and racial groups living in the U.S.

Because fewer Asian Americans seek mental healthcare than other groups, those who do may find themselves in settings without people of their race or ethnicity to whom they can relate. These factors may make it seem like mental healthcare services are not meant to be used by Asian Americans.

Learn more about mental health stigma here.

Other cultural factors

Various mental health stigmas impact certain groups of Asian Americans differently depending on certain cultural factors.

Factors influencing stigmas in children include:

• being pressured to excel in academic life and become a highly skilled professional regardless of the emotional, social, or physical toll
• being encouraged to hide emotions to avoid being seen as “too emotional” or a complainer
• the idea that previous generations suffered worse circumstances or trauma, so it is shameful for children or young adults to share their struggles knowing that others survived “much more”
• the idea among older adults that mental illness does not exist or impacts their community
• the idea that children and young adults should be thankful or grateful because of the sacrifices made for them regardless of their experiences

A study by the National Asian Women’s Health Organization also identified the following attitudes or beliefs impacting Asian American women:

• conflicting cultural values causing a reduced sense of control over life decisions
• feeling responsible or obliged, yet unable to meet unrealistic, biased family and societal standards
• fear of stigma and stigmatization of their family
• witnessing mental illness, such as depression in family members, but being encouraged to stay silent

Some factors surrounding traditional masculine gender roles and obligations may also influence Asian American males more heavily than other groups, such as:

• intense shame and guilt for failing to be the “head” of the family and care for family members
• the idea that Asian American men are less interested in their emotional life
• fear of being labeled as easily defeated or willing to accept failure
• the idea men should not “show their cards” or express their emotions with others
• the need to “save face” by avoiding discussing issues that may bring humiliation, shame, or disgrace

How to combat the stigma

The best way to combat stigmas is to become educated about mental health facts and engage positively with people who experience mental illness.

Other ways to combat stigmas include:

• talking openly with family, friends, or using social media
• promoting the idea that physical and mental illness are equal
• avoiding the use of language that may be negative or discriminating
• telling the media when they are promoting stigmatizing content or ideas
• showing compassion and empathy for people with mental illness
• seeking treatment and being open and honest with others about it
• trying to avoid self-stigmatization and embracing empowerment over shame
• committing to being StigmaFree

Seeking help

When choosing a healthcare provider, make sure they are culturally competent and fluent in the relevant language. Ask if a provider has:

• treated many Asian Americans or Pacific Islanders
• specialized training in how to treat Asian Americans or Pacific Islanders
• knowledge of how cultural backgrounds may influence communication about treatment
• considered how aspects of cultural identity may affect treatment

For more tips on how to choose an appropriate mental healthcare provider, click here.

Visit Mental Health America or The National Alliance on Mental Illness for a list of resources and organizations dedicated to improving mental healthcare for Asian Americans and Pacific Islanders.

Summary

Negative mental health stigmas may impact Asian Americans more than other racial or ethnic groups living in the U.S., likely due to negative stigmas.

Education is the best way to combat mental health stigmas. People with mental illness may also benefit from being treated by a culturally competent healthcare professional.

 

HIYA & SUICIDE

https://www.psychologytoday.com/us/blog/facing-trauma-together/202107/what-drives-asian-american-suicides

What Drives Asian American Suicides: Ethnic causes, bicultural conflicts, and racism.

Posted July 9, 2021 |  Reviewed by Devon Frye

Gayook Wong, MSW,* specialized in the ongoing management of trauma. She passed away in September 2021.

KEY POINTS

• Suicide is the leading cause of death among Asian American young adults age 15-24, according to the CDC.
• Pressure in Asian culture to preserve the honor of one's family or ethnic group can drive some to commit suicide out of shame.
• The trauma of racism in American society can predispose Asian Americans to self-directed violence.

 

According to data from the Centers for Disease Control and Prevention, suicide is the 10th leading cause of death in the United States. When broken down by race, suicide is the first leading cause of death among Asian American young adults age 15-24. This is true of no other racial group in this age range in America.¹

A young Asian American man of 21 died by suicide around two months ago. This happened to a family who are longtime church members. I didn’t know his parents well, and him, not at all. He grew up in this church, whose primary members are Asian American. However, what I don’t know is if they lived in a primarily Asian American community.

Due to my psychotherapy work with mainly trauma survivors, which included dealing with suicide, one of the pastors invited me to present this topic to their staff and lay leaders. The purpose was to help them understand how this could happen to an upstanding young man, on the cusp of adulthood, with a bright future ahead of him.

Personally, due to experiencing multiple traumas since conception, continuing after I was born, I remember the times when I didn’t know if I wanted to go on living. This post speaks specifically to how the Asian cultural background, the bicultural conflicts, and the xenophobic attitudes that constantly surround those of this ethnic background living in the U.S. lead to death by suicide.

Death by Suicide: How Asian Culture Contributes

Asians come from traditional collectivist societies that value interdependence over independence. Consequently, the need to preserve and perpetuate collective honor (family, ethnicity, society, etc.) is held in the highest esteem. Failing to do so leads to what I've coined as "Asian shame," where one feels they have so disgraced their kin they must hide oneself (physically and/or emotionally) or rid oneself from society and atone for their actions by suicide.²

As a Chinese-American, arriving on these shores in 1947 at the tender age of three, growing up bi-culturally, this is my story as well. However, I was one of the lucky ones, even with long-term multiple traumas throughout my childhood. I am alive to tell my story, in the hopes that others from my native culture know they are not alone. I also want the population at large to understand how we live in a state of trauma all our lives.

I was raised with learning how to let others “save face,” a well-known Chinese saying, meaning that the biggest sin was if I were to shame our family, our elders, basically everyone else. As a child, I learned to carry the shame inside me, stuffing my rage when bullied in school, afraid to tell my parents because I would be blamed; and beaten at home, forced to listen to how, as a girl, I was useless. I knew that, had I uttered a sound of protest, I would get hit harder and be forced to listen longer to the rageful words coming out of my father’s mouth when he took out his anger on me. And, because my parents left my baby sister in China when we escaped, there was always my fear that I would be abandoned as well. I stuffed everything inside, became the dutiful daughter, never asked questions, did everything my parents wanted. It didn’t matter how hard I tried or if I did everything they wanted. I eventually realized that, as a girl, I became the shame in my family, that I was being blamed for something over which I had no control.

On the outside, I hated the way I looked, the shame penetrating in the very way my “slanty-eyed, pug nose” would always be with me, powerless in facing constant violation for something over which I had no control. I had to learn to be two people—American outside and Chinese in the home—shamed for both, with no help from either side. I felt split. I didn’t know who I was or where I belonged, if anywhere. I wanted to disappear. But I couldn’t.

Nor could I report what was happening to me. My parents, not knowing the language or the American culture, would not know how to defend me. As it was, the teachers did nothing, saying I was “oversensitive.” And, again in my native culture, reporting would mean not “saving face,” that I would bring shame to my family yet again. My fault. My doing. Always to blame. Not belonging anywhere. Who am I?! Of course, as a child, you don’t even know to ask that question. Yet, isn’t that the crux of the matter? I was one small child, afloat in a world where anywhere I turned, there was no safe haven.

Xenophobia and Asian American Physical and Mental Health

The reality is that white supremacy runs so deep in America that even reversing racism would not undo the disparities in health outcomes such as suicide. This is because assimilation is “traumagenic.” That means the traumatic exposures of racist and xenophobic violence and discrimination hold the power to disrupt psychological and physiological functioning and alter genetic code for generations to come. Race-based traumatic stress holds the power to predispose entire populations, entire communities like Asian Americans, to self-directed violence.³

I remember wanting so much to be accepted as an American, but even today, especially with the pandemic, no matter how well we speak English, what degrees we have, how much money we make, what nice homes or good jobs we have, we are perpetual outsiders. We don’t belong. We are faced with xenophobia, the dominant group’s fear of those who don’t look, talk, smell or act like them. The fear disguised as disdain from those when it looks like we are assimilating all too well in “their” culture.

What We Can Do to Prevent Death by Suicide

While what I have depicted is some of the background to what leads Asian American Pacific Islanders (AAPI) to potential suicide, this was my personal experience as a first-generation growing up in the U.S. And, while racism and xenophobia still do exist here and native cultural ways are still part of the Asian culture, I do see that AAPIs have received some privileges that other marginalized groups are not afforded, some of which I’ve already stated.

I am happy to see that this generation of AAPI youth is beginning to organize in their communities as well as joining forces with other marginalized groups to fight for social justice. This not only makes a clear statement to me that we are fighting for what’s ours; that we are no longer willing to be forever outsiders. We are giving a statement that we belong and that we are not alone in this fight. In doing so, we are following a time-honored American way of instituting change in their psyche. Any time we take action, we begin to realize we are no longer powerless in our own lives and in the lives of our communities.

While I understand that the following are difficult for first-generation immigrants, those who grow up here and understand the language and culture can do the following:

·        Do not isolate; report abuses whether they occur in the home or outside.

·        Provide and encourage AAPI to seek professional mental health services.

·        Join support groups specific to one’s ongoing mental and/or physical health issues.

·        Join local groups to fight for social justice.

·        Speak up for others being attacked.

·        Mentor first-generation immigrants on the American culture.

·        Sign petitions for certain policies and laws to be enacted.

 

References

1. Noor-Ohiro, Amelia, Asian American Young Adults ARe the Only Racial Group With Suicide as Their Leading Cause of Death, So Why Is No One Taling About This, 158020, April 23, 2021. The Conversation.

2. Sam Louie, MA, LMHC, S-PSB, How Asian Shame and Stigma Contribute to Suicide, July 13, 2020, National Allicance on Mental Illness (NAMI).

3. Opcit, Noor-Ohiro, Amelia, April 23, 2021. The Conversation.

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*https://www.psychologytoday.com/us/contributors/gayook-wong-msw

Gayook Wong, MSW, had over 35 years of clinical experience specializing in the ongoing management of trauma, having received her Masters of Social Work Degree from Rutgers University in 1982. As a survivor of sexual, physical, emotional, and racial abuse herself, Gayook counseled countless others in facing the aftermath of trauma, including Vietnamese boat children in foster care, war veterans, prisoners of war, and members of the LGBTQ+ community. She also brought her expertise to the corporate world as a consultant for AT&T management on issues of sexism, racism, and homophobia.

Having descended from a long line of qigong¹ practitioners from her paternal lineage, Gayook offered a holistic blend of psychotherapy and qigong in her work with survivors over the years.

Born in Shanghai, China, Gayook and her parents escaped communism and fled to the United States when she was 3 years old. Gayook believed the psychological imprint of this event, along with her other early childhood experiences of trauma and abuse, eventually led to her cancer diagnosis in 2011. [age ~ 67]

From 2017 until its closing in November of 2020, Gayook moderated the Facebook Option B Support Group for Survivors of Abuse and Sexual Assault, established by the Sheryl Sandberg and Dave Goldberg Foundation, the former is COO of Facebook. Upon learning from the group how difficult it is to find trauma specialists, Gayook decided to answer the call for widespread trauma education and became a blogger for Psychology Today. She posted about different types of trauma, emphasizing the urgent need for survivors to heal unresolved trauma to lower their risk for disease and live longer, more fulfilling lives.

In her spare time, Gayook traveled the globe to learn about different cultures, practiced qigong exercises daily, read prolifically, and spent as much time as possible with her 5-year-old granddaughter. She passed away in September 2021. [~78 y/o]

¹Qigong is a 6,000-year-old Chinese energy practice and joins acupuncture and herbal medicine under the umbrella of Traditional Chinese Medicine (TCM).