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The Silent APA KillerMental illness continues to be shrouded in secrecy and shame, but as suicide rates increase, so too does the silence.
The dark cloud of melancholy can be more than just a temporary nuisance. For some, sadness is like a blinding thunderstorm of hopelessness with no sign of relief in sight. Some seek treatment and swallow pills to make the pain go away, but many Asian Pacific Americans are still trapped in self-imposed silence. But the statistics scream loudly: APA women 65 years and older have the highest overall suicide rate in the United States, said the Office of the Surgeon General in a report. According to the National Asian American Pacific Islander Mental Health Association (NAAPIMHA), APA women between the ages of 15-24 consistently account for the highest female suicide rate, and Pacific Islanders (like Native Hawaiian adolescents) have a higher risk of succumbing to psychological pains. Depression, schizophrenia and posttraumatic stress disorder are some of the most commonly diagnosed psychological disorders among APAs, said mental health experts. But even with such startling numbers, studies have shown that APAs still underutilize mental health services more than any other community. “The number of [APAs] who seek professional help is small,” said Carol Lau, MFT. “Every family has some issues — marital problems, relationship issues — but many do choose to address the problem amongst themselves within their own families.” In 1998, less than 17 percent of APAs who experienced mental health problems actually sought help. Since then, more and more community-based groups have been helping patients with language and cultural needs. They are trying to peel away the stigma surrounding mental disorders, but even to this day, there is still a disproportionate number of silent sufferers. Lau is the supervisor of the Behavioral Health Program at Asian American Community Involvement (AACI), a San Jose, California-based nonprofit organization that works with the APA community to improve their quality of life. In her nearly 26-year tenure as a therapist specializing in marriage and children issues, she said the percentage of APAs seeking help has increased over the years. But of those, many have waited until “the very last straw is drawn” and have been pushed to breaking point of a psychotic episode before making strides towards her door. “Usually, a third party like a teacher or social worker will refer the client because of hospitalization or some other dire situation … many don’t seek help personally,” Lau said.
Still a Silent KillerMental disease is a bandit that lurks quietly and robs its victims of all remnants of security. And when it is ignored and only spoken of in whispers behind closed doors, it can grow more powerful and consume victims and loved ones whole. Recently, the bandit stole Iris Chang, the celebrated Chinese American author of “The Rape of Nanking” who died of a self-inflicted gunshot wound Nov. 9, 2004. She was only 36 years old and left behind many questions and mixed emotions, but the Chang family was able to push through the pain and point to a more important underlying issue — Iris could still be alive if mental illness didn’t carry such a strong stigma among APAs. Iris had been suffering with “brief reactive psychosis” for some time, but was so ashamed about her sickness that she refused medication. Asian culture places a lot of emphasis on honor and image. Sometimes the pressure to avoid bringing shame to the family is tragically stronger than any other emotion. “What’s so powerful about the stigma of mental illness that someone would want to take the knowledge of their illness to the grave with them?” Iris’ brother, Michael Chang, said at a recent fund raising event for mental health awareness. News of Iris’s death reverberated throughout the APA community and has elevated the issue of mental health awareness. Finally, APA mental health awareness may now have a poster child. “I think to a certain degree, the younger generation could be impacted by [Iris’s suicide],” said Lau. “They think, ‘What happened to her? How come she did that when she was so successful?’”
The Problem is on the Outside TooThere are many factors that cause and affect mental illness — every thing from predetermined biology to traumatic experiences — but the way a person is treated in society may also be a determining factor. APAs face many obstacles even when trying to seek medical help. Wrapped inside the social stigma is the shame of language incompetence and lack of medical insurance. But other times, the reasons are less tangible. Cornell University Counselor Wai Kwong Wong, Ph.D. attributes the school’s high percentage of APA suicides (50 percent) to a problem he calls “conceptual invisibility” or invisibility based on the model minority myth. “Asian and Asian American students are rendered ‘conceptually invisible’ when they are seen primarily through the distorting lens of this myth — that is, when they are seen merely as well-oiled, smooth-running academic machines devoid of emotions or needs,” said Wong in a Daily Sun column criticizing the university newspaper for running an “Antman” comic strip about super-smart “CyberAsians.” Wong is a staff member of Cornell’s Counseling and Psychological Services, an on-campus counseling service that helps over 2,300 students each year, very few of which are APA because they are the least likely to seek help too.
Help is Within Reach“When clients come see me for help, I look within their cultural norm to try to solve the problem,” said Josephine Laihin Cheung, a licensed clinical social worker in Sunnyvale, California. Cheung speaks four languages (English, Japanese, Cantonese, and Mandarin) and specializes in bridging the cultural divide for her clients, which she said is 85-95 percent Asian. “A first-generation Asian immigrant came to see me after going to see a non-Asian therapist. I asked her why and she said, ‘After 45 minutes, the non-Asian therapist told me to get a divorce!’” said Cheung with a laugh. “You have to use the cultural norm to try to help them deal with problems.” There are many more therapists like Cheung all over the country. Studies from the Surgeon General Office correlate an APA’s willingness to seek help with his or her level of acculturation to American life. But even as APAs enter into their sixth and seventh generations, experts foresee an increase in mental illness statistics. “With a little more education … the shame will decrease. We have to do a lot more reaching out, empowering and relationship building,” said Lau.
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