As COVID-19 lockdowns in early 2020 ushered in an era of fear, confusion, and uncertainty, a second deadly virus was born. It began with references to the outbreak as “The Chinese Virus” and soon escalated into a full-scale tragedy. An elderly Thai man was shoved to his death on the unforgiving sidewalk while taking his morning walk. An 89-year-old Chinese woman was attacked and set on fire outside her home. An Asian American family was berated with racist slurs while trying to enjoy a birthday dinner at a restaurant. The lives of six Asian women were cut short in a vicious shooting spree across three spas and massage parlors in Atlanta.
Asian American and Pacific Islanders (AAPI) have collectively been subjected to continuous stories of unprompted, drastic attacks targeting people in their communities since the start of the COVID-19 pandemic. These incidents have thrust their struggles into the spotlight to a level unseen in recent memory. While these outward acts of hate have had an undeniably devastating effect on the AAPI community, they are only a part of the larger picture when it comes to AAPI mental health.
Some other threats are far quieter, but no less deadly. Data from the Centers for Disease Control and Prevention state that although suicide is the tenth leading cause of death in the United States overall, it is the leading cause of death for AAPI youth ages 15-24.
AAPI individuals have the lowest help-seeking rate of any racial or ethnic group, with only 23.3% of AAPI adults with mental illness receiving treatment in 2019 according to the National Survey on Drug Use and Health. Though the reasons why are complex, one commonality is that AAPI people don’t feel their needs are recognized or understood.
“I recently asked a client how they had found me. The answer was through an Asian therapist directory,” says David Songco, Psy.D. in Clinical Psychology alumnus of The Chicago School of Professional Psychology and licensed clinical psychologist. “It was important to them that they work with an Asian therapist because they were being negatively affected by the tragedies happening during COVID-19 and the rise of anti-Asian hate. They believed that I would be more understanding of their experience.”
To help break the toxic cycles perpetuating these tragedies, the mental health care community needs a more comprehensive understanding of the challenges AAPI people face in the U.S. today.
Sharing the pain of racism and vicarious trauma
“One thing we find in the literature is that when other racial minorities see racially motivated violence on TV, or through YouTube, or social media, even though they are not there as the direct victims of the violence, they have an automatic and oftentimes significant psychological reaction, which is known as vicarious trauma. The same thing is happening with the Asian community,” says Bina Parekh, Ph.D., associate chair of The Chicago School’s Department of Clinical Psychology at the Anaheim Campus.
Vicarious trauma is the indirect exposure to a traumatic event through a firsthand account or narrative of that event that results from what is known as vicarious traumatization. Commonly found in the helping professions, it can also affect greater communities when combined with collective trauma—the psychological reactions to a traumatic event that affect an entire society. When individuals witness racially motivated violence against people of their same race, they may become traumatized due to the combination of mourning and fear of further violence.
Dr. Songco speaks to his experience witnessing violence during COVID-19 as a Filipino American. “Even for me personally, I have to check in,” he says. “When I go out, I’m always asking myself, ‘Is this a racist community? Am I traveling alone? Am I with white friends?’ These reactions can almost fade into your subconscious until you actually stop, pause, and realize how much armor you’re wearing in order to survive.”
The model minority myth
A quieter yet equally insidious type of racism is more specific to the AAPI community. The “model minority” myth is a predominant and racist perception in American culture that assumes all AAPI people are uniformly well-adjusted and have attained, or are more capable of attaining, socioeconomic success than other minority groups through strong work ethic, conforming to social norms, and excelling academically. This assumption has been largely debunked; however, the misconception persists.
“You’d be surprised that even to this day, a lot of people don’t realize it’s a myth,” says Sue Bae, Ph.D., faculty at The Chicago School’s Department of Clinical Psychology at the Chicago Campus.
To some, the model minority myth might not sound like a negative issue—it has even been referred to as a “positive stereotype.” Yet the myth has profound negative effects on the mental health of many AAPI people. “Even the positive stereotypes are harmful because the community continues to be marginalized and alienated,” Dr. Bae explains.
The assumption that AAPI individuals are stable and don’t have problems, mentally or otherwise, pressures them to remain quiet.
“There hasn’t been what I would call structured and targeted outreach toward this community because they’re always seen as ‘higher functioning,’ according to the model minority myth,” Dr. Parkekh says. “It obfuscates what’s actually going on in that community. It creates this pretty picture, and they’re not being reached out to because people think they’re fine.”
Model expectations create an isolating existence for AAPI individuals, not only because they don’t receive the same offers for help, but because the constant expectation for perfection leaves individuals feeling as though they cannot ask for help for fear of backlash.
“The inherent pressure to succeed both academically and professionally puts a huge weight of expectation on the individual,” Dr. Songco says. “And it’s that expectation that deters individuals from seeking out help, from seeking out additional resources. It’s an expectation that puts an undue amount of pressure on them.”
Internal stigmas
Stigmas from within their own communities also play a role. According to a 2018 survey from the Substance Abuse & Mental Health Data Archive, AAPI people cited confidentiality concerns and fear of neighbors’ negative opinions as factors for not seeking treatment.
Most would rather seek out family members or community members to get help and to get advice, rather than talking to somebody whom they don’t really know and therefore don’t trust with their mental health.
—Sue Bae, Ph.D.
“One thing to consider is the cultural differences between individualistic and collectivist cultures,” Dr. Bae says. “In the U.S., we’re generally more individualistically oriented, so it’s highly encouraged to seek out help and advocate for yourself, whereas people who come from collectivist cultures usually view their identities in a more interdependent way. You have your own identity, of course, but you also depend on the members of your group, and you always consider the needs of the group first.”
Focusing on the needs of the group often results in a prioritization of the views of the group, and a privatization of issues that don’t reflect a positive outward appearance. Thus, traditionally, many problems have been dealt with behind closed doors among family members only, resulting in a strong hesitance to reach out to anyone outside of the family for help.
“I’d hypothesize that it leads back to Confucian beliefs for keeping things in the family, and the worry that talking about mental health-related issues might reflect badly on your family or your community. It feels like airing out too much dirty laundry,” Dr. Bae explains. “Most would rather seek out family members or community members to get help and to get advice, rather than talking to somebody whom they don’t really know and therefore don’t trust with their mental health.”
Intergenerational conflict
This tradition can become challenging when families are a source of stress for AAPI individuals. Struggles to come to terms with ones’ own identity can manifest when the traditions of immigrant parents clash with Westernized ideations their children acquired growing up in the U.S. “The juxtaposition between holding onto one’s cultural roots and embracing the host society can feed into family conflicts and create a lot of family stress,” Dr. Parekh says. “Many Asian Americans walk around holding a lot of family stress on their back that they don’t speak about.”
By working with clients, I’m trying to help them understand that they can incorporate aspects of their family’s culture that they may still find meaningful, but also reject those that have been harmful.
—David Songco, Psy.D.
This phenomenon has been documented as acculturative stress, as individuals attempt to function in a host or dominant society while still balancing values and expectations from another, causing strain from the extra mental energy exerted in this balancing act.
“When I’m working with AAPI youth, we have to take a look at how holding onto aspects of their identity might be serving them, and how even if the answer is to let some of that go, it’s OK to grieve for it too,” Dr. Songco says. “In many family situations children might come to recognize that their parents hurt them but also genuinely love them, and it’s not always all or one. By working with clients, I’m trying to help them understand that they can incorporate aspects of their family’s culture that they may still find meaningful, but also reject those that have been harmful.”
The road to healing
Ultimately, the AAPI experience encompasses a huge variety of cultural traditions and experiences, accentuating the need to expand studies in mental health education to prepare future mental healthcare professionals to understand their AAPI clients.
“One thing that’s been very helpful in my own clinical practice is cultural humility, which is understanding how the patient understands their culture, not how I understand their culture as the therapist,” Dr. Parekh says. “Having a culturally humble framework helps clients not feel judged or like they’re not seen as just one representative of a specific ethnic group and that they have their own nuanced ways of understanding the world.”
This concept of cultural humility, or cultural competence, has been incorporated into the curricula of many medical and psychological programs, including those at The Chicago School. Studying cultural expectations for as many diverse communities as possible can help professionals better understand their clients and how to help them with their identity struggles, whether their cultural experiences have been positive or negative.
Having a culturally humble framework helps clients not feel judged or like they’re not seen as just one representative of a specific ethnic group and that they have their own nuanced ways of understanding the world.
—Bina Parekh, Ph.D.
“At my practice, I’ve worked with AAPI individuals who have very traditional beliefs, and I find it’s helpful to look to their traditions to find coping methods that align with or incorporate those beliefs,” Dr. Parekh adds. “They can be simple things. For example, some people have religious or self-care rituals that give them peace and calm. Or reaching out to wisdom leaders within the community whom they may feel the need to reestablish a connection with.”
The collectivist natures of many AAPI communities could also be harnessed in solutions to outreach and accessibility. “Community-based intervention can be used as a model,” Dr. Songco says. “Utilizing the collective culture of the Asian community could produce some great interventions and treatments specific to their needs.”
For too long, the mental health needs of the AAPI community were ignored—but the time to change that is now, while the spotlight is still on. Institutions that have made
strong commitments to diversity, like The Chicago School, are ideally positioned to take the bold action needed to support AAPI communities and understand their mental
healthcare needs.
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