Mental health and the Asian American Pacific Islander experience

By David Li | Guest Writer

In 2021, counseling or therapy is generally an accepted form of self-help, but this hasn’t always been true, especially for the Asian American Pacific Islander (AAPI) community.

The term “mental health” was first coined in 1946, 50 years after the first modern Olympics were held. As Olympians like gymnast Simone Biles and tennis player Naomi Osaka open up about their own mental health issues, there’s no doubt that mental illness impacts people from every background. 

With the rise of recent attacks on AAPI individuals, we’ve seen the toll racism takes on mental health. So where does the AAPI community seek help for hurting hearts and minds?  

[READ MORE: AAPI voices speak to the silences around anti-Asian racism]

Assessing the Costs

As a second generation Chinese American living with depression and anxiety, the answer is complicated. The model minority myth blatantly ignores the fact that our success can’t account for all our lived experiences. We aren’t a monolith. The same goes for how we process emotional pain, and it’s about time mental health education and service delivery mirrored that.

I’m okay with not being okay, but when does it become unmanageable to suffer alone? The mental gymnastics of constant psychological torture is enough to break even the world’s greatest athletes. 

Mental illnesses include mental, behavioral, or emotional disorders and can range from being manageable to fatal. Left untreated, individuals with mental illness are at increased risk for cardiovascular diseases, cancer, and death. For Asian American youth aged 15-24, suicide is the leading cause of death. 

The National Alliance on Mental Health (NAMI) estimates that untreated mental illness costs the U.S. up to $300B each year due to losses in productivity. In the AAPI community, where topics of mental health remain taboo, the costs are greater. 

[READ MORE: The economic and human costs of health disparities]

Historically, cultural incompetence has led to the misdiagnoses and underdiagnoses of mental illness in the AAPI community. I’m only here today because I chose to get help when just being okay wasn’t enough.

Cultural Barriers to Getting Help

Although I was formally diagnosed with generalized anxiety disorder and chronic depression with mild psychosis in 2015, it didn’t account for the multiple times I ran away from home during my teens, the countless panic attacks I mistook for asthma, or the recurring thoughts I had of dying throughout my young adulthood.

Growing up as one of the only Asians in South Florida, none of my friends looked like me, much less felt the same. I experienced trauma in the form of bullying, loss, familial instability, and violence. 

I spoke Mandarin at home, English at school, struggled to read, and my grandparents picked me up at the bus stop — feelings weren’t included in those routines. Processing emotions like anger, sadness, or fear was a lonely experience. 

If I was experiencing a depressive episode at school, church, or work, I was told to study more, pray harder, or keep working.

With hopes of leaving my trauma behind, I moved to Chicago in pursuit of a psychology degree, volunteering and working as a mental health professional at local clinics. Despite accompanying individuals with disabilities and mental illness, no amount of busyness or prayer would help me understand my own. 

In addition to the stigma mental illness carries in many AAPI communities, there’s the problem of what “help” looks like. Setting foot in the door of a mental healthcare provider is hard enough, let alone communicating our mental health needs to someone who doesn’t look, speak, or think like us. 

If I was experiencing a depressive episode at school, church, or work, I was told to study more, pray harder, or keep working.

Since there isn’t a Mandarin equivalent for the term “mental health,” my family didn’t have an effective way to communicate complex feelings like grief, shame, or duty. When my grandparents were widowed, helping ease their pain was like a guessing game, and we never found a solution. 

Knowing how to admit help is pointless if the help you get doesn’t accurately address the cause of your problems.

My Story: Over a Decade without Diagnoses

I saw about a dozen or more mental health professionals before landing a good fit. It took me 10 years to get the treatment I needed from the time I first recognized my symptoms for what they were — and the national average is 11. 

In second grade, I had trouble breathing at school, practicing the piano, and taking tests. This led my parents to think I had asthma, so a doctor prescribed me to use a nebulizer, an assistive breathing apparatus. 

What I didn’t realize until much later was that I only had trouble breathing when I was anxious; this was something my current psychiatrist explained to me as a panic attack. Today, my anxiety is manageable as a result of five years of intensive counseling and medication.

Nuance in the Next Steps

The risk of being invisible can be fatal, but it doesn’t have to be. Yet the solution is not as simple as simply seeking help. 

America’s disenfranchised mental health system has excluded AAPI communities (and other communities of color) for over 70 years, but we can change the way mental health is done by changing the way we think about it. The United States is multicultural, yet its health systems do not adequately serve all residents.

One way to develop better access to quality care is to ensure greater representation in the psychology workforce. The American Psychological Association (APA) estimates 83% of the psychology workforce identifies as white, with only 4% identifying as Asian (the APA doesn’t include the Pacific Islander designation). These ratios have remained largely unchanged since 2000. 

Secondly, have designated interpreters and translators more readily available throughout the entire healthcare process. Over a third of Asian American Pacific Islanders have limited English proficiency, and almost half cited language as the main challenge in accessing mental health treatment. 

Language is interwoven into health literacy, the ability to find and understand care. In a 2013 Medscape Provider Survey assessing patient language needs, only a third of over 4,700 providers asked about language needs at intake. Nearly 40% of providers reported that they asked family members to interpret for them. 

How does “mental illness” translate to a heterogeneous group with over 38 spoken languages here in the U.S.?

Finally, include “neurasthenia” in diagnostic manuals (DSM-IV & DSM-V). It’s important to note that even though mental health has exploded as an industry, little progress has been made to incorporate culturally diverse manifest symptoms into Western diagnostics (DSM-IV/V). 

In other words, AAPIs might experience distress characterized by fatigue, weakness, poor concentration, irritability, or a loss of appetite. Otherwise known as neurasthenia, these somatic symptoms mask the more “severe” or “frequent” depressive symptoms warranting formal diagnoses. 

In fact, among all major ethnic groupings, AAPIs are the least understood when it comes to rates of psychiatric disorders using traditional diagnostic tools.

It’s about time we redefined mental health as a multicultural concept and adapted educational efforts and mental health care to reflect all of us.

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