Asian Americans, tell us how you talk about mental health with your family and friends

The constant, rapid conversations of mixed Vietnamese and English create a comforting hum in my parents’ home.

“Lấy rác ra!" my mom would say to my brother. “Rồi tưới cây nữa. Hear that?”

“Dạ. OK," my brother would respond, en route to our backyard to take out the trash and water the plants.

Or one of my family's most important questions of the day: "What's for dinner?"

“Mình có chè chuối," my mom would say, suggesting we have the Vietnamese sweet banana dessert given by my aunt who lives nearby after our meal.

But last March, when I tried to talk to my dad about the Atlanta-area shootings and the reality of anti-Asian hate, the humming ceased. We grasped at the Vietnamese language, trying to find terms that could fully express how we felt.

We didn’t know how to accurately translate Western mental health terms and expressions into our language. After stumbling through words that still didn’t feel quite right, we resigned to speaking English the rest of the conversation.

I know my family isn't alone in our struggle to open up about mental illness. I've read dozens of studies and talked to friends who have had similar experiences.

During the last few years, we've seen a surge in reported anti-Asian attacks and hate crimes. It has been hard to feel safe in our own communities as fear-mongering politicians amplify misinformation about COVID-19 while we grieve the lives the disease took from us. Plus, even when we seek care at psychiatric hospitals or clinics, many Asian clients are too often met with language barriers and a lack of cultural sensitivity.

Ajita Gupta, a licensed clinical social worker in California, receives almost daily requests from South Asian Americans for services in Hindi. Gupta said many of her clients reported their insurance provider won't refer them to a Hindi-speaking therapist if they are also proficient in English.

“Clients prefer to work with a Hindi-speaking therapist as they find it easier to explain certain things relating to their culture in Hindi," she said. "They are told to choose an English-speaking therapist or there are no mental health therapists currently available. I have many South Asian clients willing to be on a waitlist so that they can choose to speak in their language."

We can't fix the mental health system in a day, but we can start having more conversations and compassion around our mental, or emotional, health.

The general stigma around mental health in the United States stems in part from how the country institutionalized people with mental illness and subjected them to cruel and unethical treatments. It's an approach that created myths that are still seen in the media.

But this stigma and shame is particularly intense in many Asian American cultures, and likely contributes to them underutilizing mental health services, said Derek Hsieh, who directs the L.A. County Department of Mental Health's Long Beach Asian Pacific Islander Family Mental Health Center.

Mental health concerns are not often communicated or expressed openly among Asian communities. Our cultures revolve around family and the collective community, and these cultural values can contribute to a strong sense of connectedness. But those same values can unintentionally fuel stigma around seeking mental health treatment, even within one’s family.

“It can be seen as disgraceful to [your] family honor,” said Jung Ahn, a licensed clinical social worker and training coordinator for the L.A. County Department of Mental Health. Ahn discusses mental health topics on Radio Korea and has initiated several outreach programs to engage the Korean community. “Since family status takes central importance," she said, "individual feelings, emotions and thoughts can be suppressed.”

While there is tremendous diversity among Asian Americans in terms of levels of education, income, acculturation, exposure to war or other trauma, about 60% of all people of Asian descent were born outside the United States, according to 2020 census data. As immigrants, securing basic needs for themselves and their family is often at the forefront of their concerns, Hsieh said.

“Focusing on feelings, especially negative ones, is considered a misguided indulgence and unproductive when you have a child to feed or need to get a roof over your head,” Hsieh said.

Most Asian Americans have also experienced horrendous historical trauma, which explains why the recent increase in hate crimes and discrimination might be so triggering, Hsieh explained during a recent presentation at a county mental health meeting.

Then there’s the language challenge.

“In many Asian cultures, the concept of or the term for 'depression' or 'anxiety' as a syndrome or a cluster of symptoms that manifest an underlying mental disorder, does not exist," Hsieh said, "or often these are imported terms from the West, much like ‘coffee’ or ‘hamburgers,’ although unlike ‘coffee’ and ‘hamburgers,’ terms like ‘depression’ or ‘anxiety’ are generally not used in ordinary public discourse.”

Instead, there are cultural differences for how Asian American people perceive distress, and in many cases, they will describe physical or bodily pains instead of mental ones, said Kathy Trang, a postdoctoral research fellow at Harvard and co-founder of the Southeast Asian Mental Heath Initiative and Biennial Conference.

"Slowing down ... feeling tired all the time ... experiencing loss of appetite ... they might not interpret that as depression," Trang said. "There won't be a conversation about mental health if they never perceive it as mental-health-related. So [we have to think] through what are the ... ways ... people might be understanding their distress and how that shapes communication."

At the same time, there are beautiful terms for emotions in our languages that English cannot capture. For example, Vietnamese has the phrase “xoa dịu," an expression that describes the act of rubbing circular motions over a physical wound to alleviate the pain. But when you say it to someone in distress, it means you are soothing their emotional pain and giving them spiritual comfort. Saying "to soothe your pain" in English doesn't capture the depth or tenderness of saying "xoa dịu."

Andrew Subica, a health disparities researcher and an associate professor at the UC Riverside School of Medicine, adds that Asian Americans often understand the connections among the mind, body and spirit, offering another way to talk about mental health.

“There’s a strong spiritual element, and it fits into this nice little health box in a way that it doesn’t in the U.S.," he said. "So that can also be an avenue to talk about mental health, by incorporating spirituality and the spirit."

I, along with my colleagues at The Times, want to learn about how mental and emotional health are described and talked about among you, your family members, friends and fellow Asian American community members. If you’d like to share your thoughts and experiences with us, please use the form below.

My aim, and hope, in doing this research is to expand the work our communities have already started in documenting what does and doesn't exist in different Asian languages regarding mental health terminology. I hope to connect with professionals, leaders, activists, concerned residents and others to produce journalism that encourages family discussions, services and research. Your responses will help us better serve our community.

In the last few months as I've researched this topic, I've had more conversations with my family about mental health than I've had at any other time of my life. It has brought me and my parents closer together. I hope that, through this work, we can help many others build those same connections.

Thank you for your time and perspective in answering our survey questions. If you'd like to read more about our coverage of mental health or find resources, you can visit our page.

This story was published with support from The Solutions Journalism Network through its Health Equity Initiative.

P.S. We understand this is a sensitive subject and want to provide another option for folks to participate. If you’d like to share your story anonymously, have questions about the reporting process and how we would use your submission, or want to reach out about this story in any way, feel free to send me a message at phi.do@latimes.com.

Mental health language survey

This story originally appeared in Los Angeles Times.