Disclaimer: In this particular article, focusing primarily on the Asian-American children of Asian immigrants, the broad use of the term “Asian-American”, is referring to a panethnic group that includes diverse populations who have ancestral origins in East, South and Southeast Asia, but does not encompass the experience of all Asian-American identities, such as transracial Asian adoptees, children of multiracial and mixed heritages not particularly brought up by Asian parents alone, and third culture kids (TCK) brought up abroad.
I first became exposed to the field of psychotherapy from being a client myself. I am a 2nd generation Korean-American woman. I didn’t know therapy was for people like me. I didn’t know my people went to therapy. For many years, when I sat in those awkward waiting rooms with odd collections of magazines and those white noise machines (which by the way, for the longest time, I thought were really tiny inefficient heaters), I was surrounded by white people and white therapists who entered from behind the closed door to summon their clients into their offices. I sat there, feeling like I had somehow betrayed the ways of dealing with my problems like “normal” Asians did.
According to the US Census Bureau, Asian-Americans are the third largest minority group in the United States. Yet, according to a study conducted by Abe-Kim et al., only 8.6% of Asian-Americans seek out any type of mental health services or resource compared to nearly 18% of the general population nationwide (Spencer et al., 2010).
One of the many reasons I became a therapist was when I was trying to tackle my own mental health issues. I found a wide gap between the need and quality resources available to Asian-Americans. Although it may be on a smaller scale, I personally know that the gift of therapy has significantly impacted my own life in positive ways. I wanted to become a part of the help that our Asian-American community so desperately needs.
However, it’s not always the literal obstacles that are in the way of seeking therapy. In my practice, other research and simply being out in the community, I have come across the following common myths that hinder Asian-Americans from seeking help.
Myth #1: "People will think I am crazy!”
Contrary to uninformed beliefs, most people in therapy are not psychotic, insane, “out of their mind” or deranged. Therapy is treatment for the mind and emotions, the same way a doctor treats your body. It is not exclusively for people diagnosed with a classified mental illnesses. We all have behaviors, cognitions, emotions or other personal characteristics that we can work on to help improve ourselves. Being in therapy reflects positive characteristics. There is nothing wrong with you for wanting to become self-aware and better cope with and understand your emotions, stress, change and relationships.
When people feel sick and they go to the doctor, there is little stigma. However, going to see a therapist to address mental health issues are highly stigmatized especially in many Asian cultures. Often times when Asian-American children receive a mental health diagnosis, many parents will refuse to agree it due to the fear that any mental or emotional problems will threaten their child’s future, such as being able to get into prestigious schools, obtain jobs or seek marriage prospects.
In Asian collectivistic cultures, where blending in with the group identity is highly valued, being different, abnormal or deviating from social norms can feel even more threatening. Therefore, for many Asian parents, mental illness may symbolize something greater than simply their child struggling with psychosocial stressors. It can represent fear and shame of it being hereditary or a flaw of their entire lineage and that it reflects poor parenting skills or dysfunction in the family. Psychotherapy or “talk therapy” may also be a foreign concept based on Western values and mental healthcare models that may not feel relevant to certain Asian-specific experiences. Children internalize these beliefs and as a result, many Asian-Americans tend to ignore, deny or neglect their own symptoms.
Myth #2: “I am well-educated, successful and make lots of money. My parents had it so much harder in their home countries. I have nothing to complain about and don’t have any legitimate reasons to feel depressed.”
Many ambitious and successful people often seek therapy. They view improving their mental health and relationships as another goal to achieve. One does not negate the other. However, things are a bit more complicated for Asian-Americans.
In particular, parental pressure to succeed in academics, as well as the societal pressure to live up to the “model minority” stereotype, are common mental health stressors that many Asian-Americans are challenged with. There are qualities that contribute to the inaccurate belief that all Asian-Americans have a successful immigration experience. Some of these characteristics may be high intelligence, unwavering work ethics, strong drive to assimilate to mainstream American culture and resilience of overcoming the challenges of racial oppression. However, the discrepancies between these projections and how Asian-Americans may actually feel on the inside further complicate how they deal with mental health issues.
A culturally-competent or fellow Asian-American therapist can help peel back these complex layers and help navigate how one’s Asian-American identity impacts their mental health and relationships with others and themselves.
Myth #3: “I have my close friends, family members and religious community members. Why should I pay a stranger to listen to my problems?”
This one is not unique to just Asian-Americans. However, the collectivistic culture of Asian communities value the needs of the group (such as the family unit) over the individual—placing strong importance on working together to create harmony and depending on one another is extremely valued. Sure, there will be times when you lean on your loved ones for support, especially when life gets particularly difficult, but you shouldn’t use them as a substitute for therapy. Unless your friends, family members or religious community members are a professionally trained and licensed therapist, you won’t receive the same mental health benefits from simply talking with them. Also, the consistency and continuity of weekly sessions with your therapist which is effective for your treatment may not likely be something a loved one can or should commit to.
First of all, therapy is confidential (with very few limitations regarding safety), which means you can speak freely about anything without embarrassment or fear that your private matters will leave the room. Therapists are trained to be aware of themselves and make sure that their own stuff doesn’t get in the way of helping you with yours. Therefore, this is not like any other social relationship that you would normally come across. Second, therapists listen without judgment. A good therapist will treat the person and their situation, not only their symptoms. Third, therapists are trained to help people discover the answers from within and find their own solutions to help create the most meaningful forms of change. This is different from giving advice, which is typical of what one may receive from loved ones. Lastly, therapists are trained to see your unhelpful patterns and give straightforward feedback in ways that won’t be so painful to hear.
Myth #4: ”Speaking badly about my parents is disrespectful, shameful and considered as not fulfilling my filial piety (a Confucius virtue that prescribes children to be obligated to provide adequate care for their parents, both physically and emotionally).”
Quite frequently my Asian-American clients are reluctant and overprotective around speaking poorly about their parents. There is a preconceived notion that therapy is a place to bash your parents. This is not true. Together, we explore and become more aware of how the traditional “Asian” parenting you received in a Western individualistic white world has shaped you. We do this with utmost respect, honor and acknowledgment that your immigrant parents did the absolute best they could with whatever resources they had at the time. Sometimes, values and beliefs that were meant to help you navigate the world are outdated, misaligned with reality and no longer serve you and get in the way of pursuing your dreams and goals.
Asian-American families often appear to have parentified children and this is pathologized by culturally-ignorant clinicians in the field. Parentification is a fancy term in psychology referring to when there is a role reversal between the children and parents—the parents aren’t able to serve the roles that they typically would. In many Asian immigrant families, the children serve as linguistic or cultural brokers on behalf of the family—taking on adult duties and roles inappropriate to their developmental age. However, this is not an uncommon characteristic for immigrant or refugee families. It is not a sign of dysfunction, but a sign of resourcefulness and resilience—an act of survival of the family system as a whole.
This gets even more complicated when repairing broken parent-child relationships. Asian-American parent-child relationships struggle with the typical generational gaps, as well as linguistic and cultural gaps. However, in many ways, immigrant parents may seem more traditional and “old school” than fellow parents from their home country that have progressed since the parents immigrated to the US. For instance, let’s say your parents are from Korea and they immigrated to the US in the 1970’s, their sense of “Korean culture” is locked in he 1970’s which means their parenting styles and values haven’t been upgraded since then. This further widens the gap and misunderstandings parents and children have of each other. In therapy and especially family therapy, all these things can be further explored to inform your struggles and help improve your relationship with your parents.
Myth #5: "Depression and anxiety are not real. It's not a real disease. They are just excuses for people who are too weak. You just have to become stronger.”
Despite the fact that awareness around mental health issues have become more widely spread and better understood by average Americans, many first and second generation Asian-Americans still adopt their parents’ generation’s traditional views of mental health, such as: it not being a real illness, excuses for laziness, playing the victim, lack of motivation, being spoiled or simply weak-minded.
Imagine telling someone who broke their leg that seeing a doctor meant that they were too weak to recover from their injury on their own. That would not even cross your mind! However, when it comes to dealing with mental illness, stress, trauma and relationship issues, people are often viewed or labelled as weak because they turn to therapy, rather than “toughing it out”. Asking for help is not a sign of weakness. Therapy is hard work and it takes immense courage to seek help to make changes to your lives. Depression and anxiety are very much real and complex mind-body illnesses with both observable and non-observable symptoms. They are never a flaw in a person’s character or a lack of strength and willpower.
Serious mental illnesses or painful events such as deaths in the family don’t have to be the only reasons for seeking therapy. Clients reach out to me for guidance navigating new phases in life, dealing with normal life events, repetitive conflicts in relationships and more. Nothing horrible has to happen for people to want a happier life. If you feel like your life is already great and your mind is healthy, therapy can maintain or improve that.
Myth #6: "Maybe it's just signs of stress.”
Have you ever noticed that your Asian parents or elders express their negative emotions through physical ailments? Unlike Western cultures, many Asian cultures use less direct modes of communication that are non-confrontational, especially when it comes to expressing emotions. In fact, controlling one’s emotions is a way to maintain family harmony. It is a symbolic gesture of selflessness and courtesy to not “burden” the group with one’s own personal needs.
In many Asian cultures, it is more acceptable to express physical pain than emotional pain and more acceptable to express positive emotions than negative ones. Therefore, I often find my Asian and Asian-American clients express their mental health problems and emotional disturbances with somatic complaints, such as neurasthenia, which is characterized by fatigue, headaches, irritability, weakness, poor concentration, gastrointestinal problems, sleep disturbances, and bodily aches and pains.
Stress can definitely have physical manifestations and effects on the body which can be addressed with other modalities of self-care. However, when doctors and other health professionals cannot identify a medical condition and they are more psychosomatic (physical illness caused or aggravated by a mental factor such as internal conflict or stress) symptoms, therapy can be the next thing to consider.
We unfortunately cannot pick and choose what feelings to feel and what feelings to avoid. Therefore, when we try to push down those negative feelings, we push down all the feelings—leading to a feeling of general numbness where we lose access to our positive feelings, such as joy and love. When you don’t have to work spend all your energy trying to bury the negative and painful feelings, you will most likely have more vitality and zest for life rather than feeling constantly drained.
In addition, processing your emotions in therapy will help you become more self-aware, know the difference between what you “think” you want versus what your needs are based on your feelings, change limiting beliefs about yourself and address the root cause of chronic unhealthy behaviors used for coping that you haven’t been able to stop on your own.
Myth #7: "I cannot find a therapist who is from my culture and I am afraid that White therapists will judge my Asian cultural values or the ways I do not conform to my Asian heritage.”
Yes, this is not particularly a myth. A huge barrier to therapy is the lack of access and resources. The field of therapy is still a heavily White-dominated profession and the shortage of diverse clinicians with various backgrounds is definitely an issue. Sadly, simply being a therapist doesn’t mean they are by-proxy culturally-competent or immune from racial bias, committing microaggressions or holding stereotypical beliefs towards certain racial and cultural backgrounds. I’ve had many Asian-American clients who have had horrific stories of past experiences with other other therapists—from mixing them up with their other Asian clients, to pathologizing them for living with their parents as an older adult.
It is important that you feel understood, reflected by and connected with your therapist. When searching for a therapist, if there is not a therapist from your background/culture or a therapist of color near you, you should ask the prospective therapists if they have experience working with clients from your background and if see if they demonstrate cultural humility. Cultural humility means willingness to accurately assess oneself, keeping an open mind, approaching each encounter with the knowledge that one’s own perspective is full of assumptions and prejudices, remaining respectful of the person seeking help, and helping to restore the imbalance of power. It is complicated and hard enough navigating two different worlds with very different expectations while struggling with emotional and mental health issues. You don’t want to be the one educating your therapist on how to do their jobs. They’re supposed to be the ones helping you.
These are just a few myths that may be getting in the way of Asian-Americans seeking therapy. I’m sure there are many more individual circumstances and reasons that make it difficult to seek help. But in fact, unlike the title of this piece, we Asian-Americans do do therapy. I have seen and continue to see many courageous Asian-American clients in my practice who inspire me to keep doing this work. We have our own stuff to look at too. We have our own stuff to work through just as much, less or more than the person next to us.
I always say that the best time for change is now. As the Chinese proverb goes, “The best time to plant a tree was 20 years ago, the second best time is now”.
So, what is getting in your own way?
Cultural factors influencing the mental health of Asian Americans by Elizabeth J Kramer, Kenny Kwong, Evelyn Lee, and Henry Chung in https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071736/
Spencer, M., Chen, J., Gee, G., Fabian, C., Takeuchi, D. (2010). "Discrimination and Mental Health-Related Service Use in a National Study of Asian Americans." American Journal of Public Health, 100(12), 2410-2417.