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Brief Historical Context of �the Asian Diaspora in the U.S.

Asian Americans, Native Hawaiians, Pacific Islanders represent people from at least 40 different Asian ethnic groups, speaking 40+ languages, and representing 20+ different countries.
Although people from these groups are often categorized together because of similarities in physical features, and similarities/overlaps in cultural values and belief systems, they are quite diverse in languages, customs, and migration experiences.
AANHPI cultural values and living experiences largely continue to be an understudied, under-researched in an empirical sense. Exploration of AANHPI immigrant experiences, which date back to the 1800’s, highlight the racism, oppression, segregation including but certainly not limited to the Chinese Exclusion Act of 1882 and Executive Order 9066 of WWII, resulting in the internment of Japanese- Americans. These events have contributed and perpetuate modern-day “other” and “foreigner” labels and stereotypes which still hold true for many today.
In recent years, due to social media, speed in which media information is shared and accessed, global events such as COVID-19, and recent waves of Anti-Asian sentiment, there is more attention, and campaigns to raise awareness of AANHPI concerns . The word “representation” has gained momentum and has contributed to increased visibility of AANHPI in positions of leadership, arts and entertainment, and advocacy. AAPI Heritage Month was signed into law in 1991 by President George H.W. Bush and is now celebrated every May.

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The Role Asian Culture/Values Plays in �Mental Health Issues

Asian cultural values and expectations influences relationships, behaviors, personality, customs, communication patterns, and general sense of well-being.

Historically, these values include: 1. collectivism (thinking as a part of a larger group, not individually) 2. internalization of emotions (keeping emotions inside, not verbally expressing one’s emotions/feelings, especially negative) 3. filial piety (one’s duty/loyalty to family) 4. social conformity/harmony in community (avoiding conflict, maintaining peace) and 5. saving “face” (not causing shame or embarrassment to your family)
Cultural pressures and expectations by their family of origin to succeed and accomplish at a high level (academically, professionally, and financially). AANHPI are also expected to get married, have children (preferably males), taking care of aging parents, and gaining social status through material wealth.
Acculturation, the process of assimilating into a new culture for immigrants, can also affect mental health. People of 1.5 or second generation face bi-cultural challenges of wanting to feel American, to fit in with their peers at school, and at the same time trying to hold onto their Asian values. Navigating two distinct cultures causes stress and anxiety.
Decision-making is not made in an individual sense, but in the context of family, does it make the family proud ? There is often a script of a “certain way to do things” that many Asians feel they must follow to be successful and maintain “face” for their families.

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Mental Health is Taboo in the AANHPI Communities

Meeting Asian values and expectations, can often come at a great cost to one’s mental health. Prioritizing mental health is a minimized, and sacrificed for the sake of following cultural norms, family expectations, and maintaining harmony. Productivity is a strong virtue and supersedes the need for self-care, emotional wellness, and overall mental health.

High value placed on “stoicism”- the ability to endure pain or hardship without complaining. Feelings of distress are not to be displayed outwardly. Children learn this early on to internalize, suppress, and push down any negative feelings. Even overly positive feelings are not encouraged and often minimized for the sake of appearing in control and not appearing “too emotional.”

Strong stigma persists- admitting MH struggles is a taboo and seen as “weak” causing the family “shame and embarrassment.” Suffering in silence and a refusal to acknowledge mental health issues becomes the norm.

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The Model Minority Myth: How it Harms and Perpetuates Stereotypes, Stigma, and Shame

…SMART… HARDWORKING … GOOD WORKERS…DOESN’T COMPLAIN…QUIET…RELIABLE…

These words represent stereotypes are born of the Model Minority, a term that has been used to refer to a minority group perceived as particularly successful, having achieved the “American Dream” despite struggles , especially in a manner that contrasts with other minority groups. This perpetuates the stereotype that AANHPI as a group are monolithic, one dimensional, and all having the same experiences. Despite its positive overtones, this term is actually damaging for AANHPI and other people of color.

The Model Minority myth pits people of color against each other and ignores the reality of systemic racism and oppressive structures that people continue to encounter in life.

The assumption that all AANHPI are all successful, don’t struggle, and have “made it” is a myth. One measure that challenges the myth, income inequality, a measure of the economic gap between the rich and poor within AANHPI communities. From 1970 to 2016, the gap in the standard of living between Asians near the top and the bottom of the income ladder nearly doubled.

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The Model Minority Myth �Harms Mental Health (cont’d)

Perpetuates stigma because it has resulted in many ethnic minority individuals in the U.S. internalizing the stereotypes it promotes, including AANHPI.
It prevents people from seeking mental health support. It becomes a self-fulfilling prophecy, instilling a mindset of self-stigmatization. Example: “I see my Asian friends all doing well and not struggling so something must be wrong with me?” when in actuality, many AANHPI do struggle emotionally, but have just learned to hide their struggles.
Many people, without even realizing, have bought into the myth that there is only one way to define success and that they have to be hardworking, academically gifted, and ultimately successful in their careers and economic goals. This is a myth that keeps perpetuating, generation after generation.
When people aren’t able to live up to the standards held by the Model Minority, feelings of shame and despair are often internalized, which perpetuate the stigma, and feelings of inadequacy.

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Common Stressors contributing to �Mental Health Issues

In addition to Model Minority Myth, other stressors that affect mental health include:

Lack of agency or autonomy. Frustration with having to do what is expected by family, feelings of guilt around wanting to think/act individually. Examples: “I am really creative and love to draw, but I am not allowed to study art because my family expects me to study to be a doctor… or… I feel like I can’t be myself. I have to be what my family expects.”

“Check off the Box” syndrome- “I’ve done everything what I was supposed to do, I checked off the boxes of what I’m supposed to do…but I feel restless, stuck, and/or unfulfilled.” But not being able to share these feelings with family.

“You think you have it bad?” Feeling minimized or dismissed by family of origin because previous generations suffered far worse circumstances or trauma, so it is shameful for children or young adults to share their struggles knowing that others before them survived so much worse.

LGBTQ+ Identity- Distress related to families not accepting of identity and lifestyle. Internalizing shame.

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Depression and anxiety are the two most commonly diagnosed mental health disorders affecting about 3 million people. The number of people with clinical depression and anxiety is likely higher because many people will likely not seek treatment.

Other mental health issues include: PTSD, bipolar,

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Common Stressors contributing to �Mental Health (cont’d)

Loneliness, making friends, and navigating friendships is very prevalent in adolescents and young adults. Many young people did not grow up having role models for how to handle interpersonal conflict in their own family of origin so when conflict arises, they lack the skills to resolve the conflict. This can causes emotional stress.
Scarcity Mindset - This is the idea that everyone lives in competition with each other and that there is a finite amount of resources to go around. It is also the automatic feeling of never having enough and always assuming the worst will happen and that whatever you do, it is never enough. Low self-esteem and self-worth, lack of confidence, making “safe decisions” and fear of failure. This is a thought process that is rooted in anxiety and basic survival. It is very prevalent in the early days following immigration but never fully goes away.
Imposter Syndrome- The feeling of doubting one’s abilities and feeling like a fraud even despite one’s education, experience, and accomplishments.
Social comparison with peers at school or workplace resulting in feelings of inadequacy or questioning one’s choices. Pressure to keep up, fear of judgment, worrying about how one measures up within a social group.

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COVID-19 and AANHPI �Mental Health

Perception of COVID-19 pandemic originating in China has been stressful for Asian communities resulting in xenophobia and bigotry. Reported incidents range from verbal harassment, insults, and jokes, such as referring to COVID-19 as the “kung flu” to violent attacks in schools, businesses, and other public spaces.

This has resulted in increases in anxiety, depression, sleep problems, and a general sense of not feeling unsafe.

In response to the Atlanta Shootings in March 2021, social justice and grass-roots organizations have been organized to encourage to AANHPI to challenge the stigma against mental health care. Webinars, social media, workshops, educational campaigns and mental health resources have been provided to communities.

Many people are challenging the cultural norms that have kept Asians silent for many generations. Younger generation are educating the older generation on how how suffering in silence has been damaging.

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How to De-Stigmatize AANHPI Mental Health

Adjust how you think about mental health. Decide it is a source of “strength” to talk about feelings (especially unpleasant feelings). It a part of the human condition. There is no shame in it. The more we talk about it, the more it gets normalized. Start with “I didn’t have a great day today,” “I am worried that I didn’t do well on my test,” or “I don’t feel great about my career and would like to explore my options.”

Talk to your family, friends, and peers about mental health. Learn to be OK with sharing your emotional struggles with others. Talk about choices you can make to improve your mental health. Even if others don’t approve or feel uncomfortable initially, recognize that this is a function of the taboo that has persisted. Change needs to start somewhere.

Openly talk about seeking mental health treatment. Seeking counseling is perfectly OK even when there is not a crisis. Treat it the same way as you would if you were to seek treatment for a medical condition, like diabetes or cancer. Look at counseling the same way you would yoga, meditation, exercise, and other self-care practices.

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How to De-Stigmatize MH (cont’d)

Show compassion and empathy for those who do struggle with mental health issues. Respond with emotionally supportive words and gestures. Do this in the presence of others.
Call of out language that perpetuates MH stigma. Try to avoid self-stigmatization and embrace empowerment over shame. Help to shift the narrative in your family of origin.
Read books, watch movies, TV programs that openly discuss mental health issues in Asian communities. Discuss these with your friends and family. Normalize the talk.
Look for positive role models in the AANHPI community who are open about their own mental health struggles. Some examples include: U.S. Figure Skater Vincent Zhou, Tennis Player Naomi Osaka, and Surgeon General Vivek Murthy.

All of this is easier said than done, but we need to start somewhere!

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What to Look for in a �Mental Health Provider�

When looking for a mental health provider, do your best to research providers. Look for culturally competent providers with proper training or lived experiences. Find someone fluent in the relevant language (if needed). Most therapists will offer a 20 minute free consultation. Talk to a few of them, if possible, to get a feel for different styles and approaches.

Ask if a provider has:

Experience treating AANHPI issues.
Specialized training in how to treat this population. Learn about their approach and modalities of treatment.
Knowledge of how cultural backgrounds may influence communication about treatment.
Considered how aspects of cultural identity may affect approach to treatment.

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The Future of AANHPI Mental Health

AANHPI are the fastest growing demographic in the U.S currently, comprising about 7% of the population. Although AANHPI still do not seek mental health support at the same rates as other groups in the U.S., slow shifts are starting to happen.
Studies have shown that second-generation immigrants are more likely than their parents to seek MH care. Public information campaigns and engagement efforts to increase awareness of mental illness are encouraging people of all backgrounds to speak up and ask for help.
Younger generation AANHPI are shifting the narrative to reduce stigma and sending message that reaching out for mental health treatment is not only OK, but necessary to help cope with mental health distress and dealing with events of the world.
As more AANHPI seek out mental health treatment, it is increasingly evident we have a supply and demand issue. There is a shortage of culturally competent providers. More providers are needed to accommodate the increase in clients reaching out. Students should consider behavioral sciences (psychology, sociology, social work) as a field of study to ultimately meet the demand.

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Resources for AANHPI Mental Health

Asian American Psychological Association aapaonline.org
Asian Mental Health Collective AsianMHC.org
National Asian American Pacific Islander Mental Health Association naapimha.org
National Alliance for Mental Illness nami.org/Your-Journey/Identity-and-Cultural-Dimensions/Asian-American-and-Pacific-Islander
Asian American Health Initiative aahiinfo.org
Very Well Mind verywellmind.com/mental-health-resources-for-asian-pacific-islander-communities-5116843
Multiculturalcounselors.org Seattle-Area Directory of AANHPI/POC MH providers