This article is a followup of a Strive Conversation on the Influence of Culture on Mental Health, a part of Asian American Pacific Islander Heritage (AAPI) Month and Mental Health Awareness Month. The experiences shared in this article do not apply to all AAPI experiences. We acknowledge other minorities also experience the effects of mental health stigma, cultural influences, and lack of resources. We believe in the beauty of diversity, shared human experience, and would love to hear your experiences in the comments!

Mental health has become more mainstream in the past few years as younger generations are demanding access and resources to heal, treat, and maintain a better quality of life. Naturally, with the rise in depression, anxiety, and suicide has skyrocketed, the need for awareness and advocacy are also in high demand. Although younger generations are more accepting of seeking help, their parents and predecessors are not as quickly jumping on board to acknowledging mental health and the benefits of treatment, especially amongst minorities.

Mental health is still considered a taboo in many countries, as well as many communities in America. Older immigrants are not so quick to join on the self-help boat as their Americanized children, due to the cultural differences and norms they grew up in. For example, mental health in Tagalog, a Filipino dialect, is “sira ulo”, which translates literally as “broken head”. Danielle Flores, a revenue growth consultant for early venture startups in NYC and Baltimore, shares her personal experience with the mental health stigma. 

“I also have a friend whose Filipino mom once told her, ‘In the Philippines, we don’t have depression.’ The cultural emphasis on being positive all the time leaves little room for us to admit that we’ve ever, even for one moment, not felt ‘happy.’ What’s not acknowledged can’t be treated, and lacking adequate language for mental illness or emotional health, we’re behind the curve.” – Danielle Flores, a revenue growth consultant

Try growing up with this belief and explaining to your parents about depression, bipolar disorder, and/or any other mental illnesses. Cali Tran, a Mezzo/Macro-Level Social Worker & Advocate, with Masters in Social Work, empathize that the misconceptions about mental health and therapy may vary for minorities and people “because there are so many environmental and sociopolitical factors that impact their mental health.” She continues, “racism has been proven to have deleterious effects on all aspects of health in minorities and people of color, and it manifests in overt AND covert barriers to healthcare access and wellness”.

Deeply ingrained stigmas towards mental health makes it extremely difficult for those suffering to communicate their need for professional help and treatment. Furthermore, it causes complications when seeking emotional support, such as fostering a deeper connection, understanding, and empathy amongst one’s family and community. To be clear, it is not due to a lack of love, a refusal for support, or even toxic masculinity. Instead, the rejection to discuss mental health and engage in emotional intimacy stems from a lack of skills and tools to connect and reach a deeper sense of vulnerability. 

“Our (Asian culture) affects how we deal with vulnerability and authenticity in making it socially unacceptable to be open about our struggles. The need to have pristine reputations and saving face overshadow being truly honest with ourselves and each other when we need help.” – Cali Tran, a Mezzo/Macro-Level Social Worker & Advocate

The lack of emotional capacity to hold space and host these conversations act as a psychological and commutative barrier between family, friends, and societal circles. This physically manifests as parents, family members, and elders changing the subject, dismissing the emotions/needs discussed, and/or giving unrequited responses. Jess Song, a mental health advocate and founder of Back to Self, identified a need among AAPI therapists and mental health professionals, who wanted to learn more tools and resources to better connect with their AAPI clients. As a solution, she created a two-day conference to help bridge the gap by equipping AAPI therapists with better emotional language to empathize with their clients, and AAPI individuals to better connect and communicate with those in their personal lives. 

A conversation on awareness, representation, and more

In a recent Strive Conversation, an event series focused on personal development, entrepreneurship, and social change, I spoke to Licensed Clinical Social Worker, Brian Nguyen, on his experience growing up as a Vietnamese American and career as a mental health professional. A part of the conversation, we were also joined by other mental health professionals and advocates, primarily from AAPI heritage, who shared similar struggles on their dual cultural identity and upbringing, struggle with getting the help they needed for their mental health, and the impact of outdated culture biases had on their familial relationships when talking about mental health. 

Brian acknowledged that there was a lack of mental health professionals, stemming from issues with representation. He discussed the barriers to enter the profession as an Asian American due to the mental health stigma amongst the Asian culture and shared his personal struggle:

“I had internalized oppression. I hated my culture and who I was as a kid so I made a huge attempt to avoid Asians and [developing] relationships with them. I had a strong dual identity crisis and that [led] to multiple anxious and depressive issues. I saw my mom try to commit suicide, and even had my own thoughts. I wanted to make sense of why the world was like this and find answers to hard experiences.” Brian Nguyen – Licensed Clinical Social Worker

Many others in the group agreed and shared a similar sentiment. A few also expressed their desire to seek therapists, who “looked like them” and understood major issues affecting their upbringing, identity, and experiences, such as intergenerational trauma, cultural beliefs, and systematic oppression. 

“Intergenerational trauma is complex and not many people understand it. In minorities, especially [amongst first generation AAPI], there is a higher expectation to do better than the previous generation. This is exacerbated when the previous generation is refugees of war. It helps to normalize and empathize with the previous generation. They want us to succeed so that we do not experience the same pain that they did. It is unfortunate that we do not have as much freedom and control in our lives as we want. I always say people do the best with what they have. And unfortunately, they do not have much aside from fear and pain. They simply do not want us to experience their lows. It also plays a part in that they are not familiar with mental health and are not as educated (some not all). As for us, trying to pave our own way is important, and trying to do things that keep us grounded in our reality/identity is vital for us. Appreciating what we have and also utilizing support from our peers and other less stricken family members.” Brian Nguyen.

When it comes to overcoming the taboo of mental health, audiences wanted to know how to communicate the relevancy of mental health, as some denied the existence of mental health issues and their own symptoms. Brian touched upon how different cultures have different perspectives on mental health issues: “In the DSM-5, there are three different cultural disorders: Taijin Kyofusho (Interpersonal Fear disorder in Japanese), Shenjing Shuairuo (weakness of the nervous system In Mandarin) and Khyal cap (wind attacks in Cambodian). These three often describe anxiety. Many of our family members understand the concept of anxiety, in fact, it probably drives most of them. However, the concept of depression is a little more abstract to them.” He also encouraged having “culturally competent professionals”, having open, vulnerable discussions and if possible, disclosing one’s own personal struggles, issues, and disorders to better communicate with nonbelievers and further the understanding. Furthermore, an increase in representation, especially those with mental illnesses and disorders that are high functioning, will help destigmatize the topic. 

Similar to acknowledging the influence culture has on mental health, acknowledging the symptoms that could lead to a diagnosis and treatment are also important steps moving the conversation forward. For many like Danielle, her mental health has affected both her life and career stating, “riding the highs and lows of my condition has stalled my career in some ways but enriched it in others.” Bipolar disorder runs in her family and after being diagnosed with bipolar disorder in 2016, she was able to get the help she needed to better manage her symptoms. She now is able to better connect with her clients and peers through her experience of better understanding her mental health. 

Not everyone is as lucky to get treatment. Many suffer in silence and ignorance. Those that are aware something “isn’t right” are too afraid to speak up due to their fear of being ostracized. Ultimately, as frustrating as that may be, Brian mentioned you can’t always change the mind of others, especially parents and/or older family members. Instead, he advises others to communicate their personal importance and relate it to something they prioritize and value like “explain how our mood affects our success”. By tapping into their empathy, we’re able to help deepen the connection and understanding between opposing views. He continues, “At the end of the day, they want us to be successful, so maybe tell them how mental health is important to the success and how to make money.”

Progress in the industry

Many believe the stigma regarding mental health will remain as long as it is treated with less care as physical health in social acceptance, medical attention and liability, and government policy. Psychologist and author, Guy Winch, breaks down the inequality in treatment in his infamous TedTalk “How to practice emotional first aid”. Similarly, the Patriot Act with Hasan Minhaj opened Season 5 of his political satire show on Why It’s So Hard To Get Mental Health Care acknowledging the different treatment of mental health and treatment in American’s healthcare system. Although there is government acknowledgment on mental health, such as in 2008, Congress passed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) to ensure equal coverage of treatment for mental illness and addiction advocated by Rep. Patrick Kennedy, Hasan points on the system has a long way to go for equal treatments and accessible care. 

Another obstacle, which was a recurring theme in our conversation, was the lack of diverse representation in the mental health space. Jess points out, as minorities, we experienced the world a bit differently, furthermore have different psychological treatment needs than the original fathers of psychology, who happened to be older white men. It’s undeniable that the leading influencers did incredible things in the field. That said, the experience is a bit different for those amongst different cultural backgrounds as their challenges, traumas, and healing would also need a fresher perspective. 

Whether it’s intergenerational trauma or experiences based on our cultural beliefs, the experience is different from those of color and it can be a lot easier and potentially more comforting for some minorities or persons of color to communicate to someone of like or similar cultural or ethnic backgrounds due to the shared experience, beliefs, and values. This is why representation is so important. Not only does representation help bridge the gap between those who are originally turned off by therapy and getting support for their mental health needs, but it also diversifies what a mental health professional looks like and helps inspire others to the purpose of the mental health profession as a career option. 

A step towards change

Although we were not able to eradicate the mental health taboo in this article and Strive Conversations, we were able to accomplish a few things:

1. Have an open discussion about mental health
2. Foster change-thought and perspectives towards therapy (please see the Strive Conversation with Brian and colleagues)
3. Acknowledging the influence of culture, discuss solutions on how to heal and better empathize one another
4. Increase the number of representation of mental health professionals across a spectrum of backgrounds, cultures, and lifestyles
5. Provide resources to those looking to learn more and/or access mental health resources (please see below)

All of the above are all good starts to destigmatize mental health as a whole and amongst minorities and those of various cultural backgrounds.

What more can be done? Great question! You can build on what we started here and…

1. Continue to have open and honest conversations about mental health
2. Encourage and share mental health resources
3. Practice mental health and hygienic activities like journaling, meditation, deep reflections, and more
4. Speak to a mental health professional – there are many accessible options including therapy apps, sliding scale therapy, and more! Please see the resources below and share in the comments what resources have helped you!
5. Advocate for equal treatment on mental health care

We would all like to see a more inclusive and healing future! 

“What I would like to see happen in the mental health space, especially for minorities is the acceptance and validation of mental health being a priority. I would especially like to see the reduction and eventual elimination of the systemic obstacles that continue the cycle of oppression for minorities/people of color” – Cali Tran, a Mezzo/Macro-Level Social Worker & Advocate

We also received very specific questions when it comes to mental issues and disorders. Please see below for Brian and other mental health professionals and advocate responses. Note: Nothing discussed was an official diagnosis. Please check out the resources listed below and seek a mental health professional directly. 

I would like to thank Brian and everyone that helped contribute to this article. Check out their bio and their work below.

Many thanks and we look forward to continuing our work to make personal development and social impact more accessible! 

Strive Conversation with Brian Nguyen and others

You can see the full Strive Conversations video on my conversation with Brian and other mental health professionals and advocates. In it, we discuss more of Brian’s pathway to becoming a therapist, my experience as an Asian American who pursued psychology in college, insight on therapy, and so much more. 

Additional questions and answers: 

What are the different ways to help relieve stress?

“Eat a good meal, exercise, appreciate the small things, breathe, drink water, high five your best friend, go down happy memory lane, dance, take a smol nap, take a break, eat spicy food, etc. So many things, but everyone is different. I’d say go down memory lane and find out what your favorite past time is.” Brian Nguyen

“ I relieve stress by doing a number of things in the name of self-care. This is most recognizable in protecting my boundaries! Professionally, I try not to answer work emails outside of my scheduled work hours, though this was a little hazy to figure out when I first started working remotely due to the pandemic. I also made great use of supervision with my supervisor, who is very supportive and incredibly competent. Personally, music plays a huge role in my stress relief. I listen to music almost every day, as often as I can.” Cali Tran

What is your relationship with mental health and how it affects our careers?

“Mental health, or the lack thereof, is at the forefront of my personal life. I was diagnosed with bipolar disorder in 2016, as have multiple family members as far as two generations back. Riding the highs and lows of my condition has stalled my career in some ways, but enriched it in others.

It has touched my academic life as well. College was the first time I realized that something was amiss. Despite having excelled in high school, the lows my first semester were so bad that I couldn’t focus well enough to write papers or handle the prospect of failure, so I dealt with it the only way I knew how. There were weeks I barely ate, drank to quell anxious thoughts, and slept for entire days. For years I flirted with the idea of pursuing a full-time MBA, but I don’t yet feel stable enough to make it happen.

The highs that come with my condition have affected my job prospects in more than one way, but they’ve also created warmth between me and my home care workers, whom I placed for over six years. I shared enthusiasm about the work they did, spoke honestly and compassionately when I didn’t have the full-time jobs they needed, and listened intently to their feedback, in bad times and in good.” – Danielle Flores

What is your upbringing to study mental health in the Asian population?

“My upbringing to study mental health consists of a lot of lived experience with several things, such as mental illness, domestic violence and intimate partner violence. I have an incarcerated parent that struggles with substance use and intergenerational trauma. I eventually realized that my father’s situation was not unlike many other Southeast Asian refugees; he was a statistic in a system that let him fall through the cracks. The trickle effect of the trauma impacted me, and I had my own mental health issues – to which I later learned originated in my home life and all of the immigrant history that came with it. All of this compounded into my motivation to enter the field of social work. I was fortunate to have a parent who was supportive of my mental health treatment, but I know we’re probably the exception to the norm.” Cali Tran

What are the steps that we can actively take towards safely healing?

“In addition to pursuing my own medical treatment, rounded out by social and spiritual support, I’ve found it therapeutic to articulate my own experiences through writing. Many of my friends who are social workers and educators heal themselves by healing others, and my contribution is to share pieces of my biography with those who are just starting their healing journeys, and inviting them to look at the resources out there.” – Danielle Flores

What strategies have worked best for clients with BPD diagnosis? Also, with difficult teens?

“Strong, strict boundaries for BPD. Call 911 if they threaten self harm ( Plan, action, etc). Even if they say they’ll hate you, etc, it’s better that they receive help. Make sure you talk to your care team to avoid splitting. Teens are hard/fun. Talk to the parents and educate them, and meet the teen on their level. Most of the time it’s the parents.” Brian Nguyen

Is there any research surrounding the impact of transracial adoption and mental health?

“So back to dual identity. It’s hard because they are raised in a very different setting as opposed to many immigrants. They are often seen as different, with really no culture to fall back on. There is research stating that they are prone to lower self-esteem, ethnic identity issues, etcs. I have met a few people, and they have similar experiences. Not connecting with their cultural peers, yet not being able to be integrated into their majority peers. Depending on when they were adopted they may not share the same experiences as many of us, so they cannot have those same connections we innately have. They also do not “fit in” completely with their parent peers, due to physical appearance.” Brian Nguyen

Resources

• National Suicide Hotline  1 800 273 8255
• National Institute for Mental Health
• National Mental Health Organization (support groups)
• Substance abuse and mental health Service administration
• Subtle Asian Mental health (FB Group)
• Mental Health Translation/ Therapy (California)
• NY Asian American Mental Health
• Call your insurance for a provider

Mental Health Professionals & Advocate Bios:

Brian Nguyen, Licensed Clinical Social Worker

Brian Nguyen is a Licensed Clinical Social Worker in New Jersey. His passion lies in helping others lead their lives with complete unfiltered passion and drive. He believes, “our experiences, once processed, can lead us to amazing success and prosperity”. He earned a B.A. from Stockton University in Psychology, and an M.S.W from Rutgers University with his primary focus being trauma, cultural identity, and violence against women and children. His goal is to help those overcome the internal struggles that take place within themselves and to strengthen all aspects of people’s lives

As an LCSW, his modalities include Cognitive Behavioral Therapy, Eye Movement Desensitization, and Reprocessing (EMDR), Mindfulness, Hakomi, Solution Focused Therapy, ACT, Exposure Therapy, REBT, Group Therapy, and Motivational Interviewing, with specialties in Trauma, Asian American Issues, depression, anxiety, grief, sexual identity, gender identity, addiction (behavioral and substance), anger management, Men’s issues.

You can follow Brian:

• Website: https://www.daowellness.org/
• IG: https://www.instagram.com/brian.the.therapist

Jess Song, Founder of Back to Self

Jess spent 12+ years creating sustainable emotional development programs for underserved / immigrant + diaspora / trauma-surviving populations. She is passionate about mental health access for underserved communities.

Cali Tran, a Mezzo/Macro-Level Social Worker & Advocate

My name is Cali Tran, and I am a recent graduate of West Chester University’s Master of Social Work program. I am 2nd generation Vietnamese American and am based in the Greater Philadelphia area. My hobbies include art, watching anime, cooking, baking, and house TV shows!

I graduated with a department-wide distinction in my undergraduate anthropology program and the award for excellence in advocacy and policy in my Master’s program. Causes that I especially wish to fight for are AAPI immigrant and refugee rights and resettlement, domestic violence/intimate partner violence, and comprehensive sexual health education.

Danielle Flores, Revenue Growth Consultant

Danielle is a revenue growth consultant for early venture startups in NYC and Baltimore. As a Business Development Consultant with HostHome, a social impact tech company working with transitional housing services, Danielle plays an integral part in building relationships with both nonprofits and funding sources.

Danielle holds a B.A. in Economics from Fordham University and is Mental Health First Aid certified. She can be reached via her LinkedIn profile or email address: danielleeflores7@gmail.com.

Contributor’s Bio:

Melissa Thi Le is the Founder of Strive With Me, a business owner, and community leader. She loves learning about personal development, business, and social impact as she builds a life dedicated to combating social issues affecting millions of people. She created Strive With Me to build a community to support each other on their journey towards achieving their goals.

You can reach Melissa by sending her an email at Contributor@strivewithme.com or joining our Facebook Group. You can read more about what Melissa is striving for here and more of her articles here.