With Asian American Pacific Islander month upon us this May, I wanted to focus on my specialty in working with Asian Americans. What exactly is Asian American mental health and how is it different from others?
Asian Americans struggle with mental health issues such as anxiety, depression, and addiction, just like anyone else. In addition, due to immigration, cultural, and generational patterns, a therapist needs to be even more aware of the extra layers that can possibly impact the underlying issues that bring clients into therapy in the first place.
“Cultural issues” is a broad term, but these issues often surface in how couples communicate with each other. Due to the Asian collectivist value of harmony and group cohesion, couples with Asian backgrounds (or just one spouse with an Asian background) may not have learned how to directly express their thoughts and feelings if it could lead to tension or discomfort. Asian traditional culture typically discourages expression of anything deemed negative and it’s up to the other party to infer displeasure via non-verbal communication and nuanced means of transmitting negativity (body language, tone of voice).
When it comes to diagnosable mental health issues like anxiety, depression, and addiction, the Asian worldview is that you are to figure these issues out yourself since seeking help is viewed as a moral failure in traditional Asian families. This is intertwined with Asian cultural shame that can keep clients bound to honoring their culture, thus short-circuiting their desire to get healthier.
Even when clients do get help and enter therapy, the baggage of cultural Asian shame often keeps Asian clients with a distorted view of their reality. They may disclose family neglect or physical, verbal, or emotional abuse yet struggle to see this as impacting them. They often walk around with the proverbial rose-colored glasses despite their self-report indicating otherwise. “My parents did the best they could”. “It wasn’t that bad, other Asian kids around me went through the same thing!” What this does is prolong hurt, shame, and pain as the lack of emotional honesty keeps them shackled to their fears, shame, and feelings of inadequacy.
Finally, Asian Americans are a minority in the United States. One of the struggles related to that is the perception that Asians here are viewed as “perpetual foreigners”, no matter how many generations they have lived in the United States. The constant mental energy for Asians to “prove” they are "American enough" weighs on my Asian American clients. Even if this isn’t the main issue bringing them into therapy, stories of being stereotyped and ostracized inevitably come out.
In the workplace, they may struggle to feel like they have an equal voice, as culturally they have been taught to be more reticent with expression. Chinese philosopher Lao Tzu states that, “Those who know do not speak. Those who speak do not know.” You can see how this understanding can impact Asian Americans in the workplace. Even for myself, I was indoctrinated by my parents to just let my work do the talking. But I learned in my early work life that this mantra doesn’t work in the United States but instead keeps me stereotyped as a meek Asian employee who doesn’t deserve to be considered for a promotion or to be in management.
The culture of upholding honor to one’s Asian family or deceased ancestors also adds a layer of complexity for those trying to find their way in academic or professional settings. Many young teenagers are struggling mightily to even go to school out of fear they will disappoint their parents or dead ancestors. For older Asians, expectations of marriage, job security, and being a badge of honor for their parents are paramount. Once these Asians in later adulthood get married and have children, their parents may keep the dysfunctional dynamics alive by transferring the cultural shame to the next generation, thus repeating the cycle.
All this to say, if an Asian American struggles with anything emotionally, relationally, or psychologically, it’s imperative to get help so the isolation and pain doesn’t build up and result in greater suffering, or at worst lead to violence, which we saw in January with two separate shootings in California involving Asian men.