The Treatment Gap: An Asian American Experience

The Treatment Gap: An Asian American Experience

It is not new information that Asian Americans access fewer mental health services in comparison to the rest of the population (4). I have spent the past 5 years in my work trying to understand the patterns and trends behind the gap in treatment. I have worked with immigrants from Southeast Asia and their American born children, both from communities of poverty in southern California to tech executives and wealthy business owners in the Bay Area. The stigma of therapy is strong in the Asian culture and it does not care about social class. In my experience, this belief system continues to persist despite wealth and education.

One constant pattern I’ve noticed is that parents from both groups tend to focus very much on education and providing everything in their power to get their children to graduate from college and become a working professional. In my experience, Asian American children are often expected to be “successful” by their parent’s definition. Asians are not inherently smarter than any other race, so how does a child who is not academically inclined deal with this pressure? Who do these children become as adults?

Social media, online forums, and the expansion of quality educational health material online has helped normalize these experiences and encouraged more people to reach out for help. Despite more acceptance of therapy, mental health is still not a topic that is frequently discussed or valued in an Asian household. Until parents model mental health as a priority, the stigma of receiving therapy will continue to be passed down from generation to generation.

As someone who considers herself a part of this ethnic group, I understand the struggle it takes to recognize when things are not going well and when to seek support. Asian Americans are often not taught to seek outside help and that is one of the reasons for feelings of isolation. Parents often teach that family issues should be hidden and not shared with outsiders. Therapists are seen as outsiders, especially therapists from a different ethnic background.

Adult children of this style of parenting sometimes find themselves in situation where they are unsatisfied from working a job they don’t enjoy, confusion over their autonomy, issues with low-self worth, thoughts of suicide, and fear of disappointment. Statistics have shown that Asian Americans are 3 times less likely to seek help than their Black, Hispanic and White counterparts (1). These unresolved issues can seep into their professional and personal lives, affecting social interactions and romantic relationships.

Where does therapy play a role in all of this? Well, it really has not. Therapy can be a new and foreign place for many Asian Americans, mainly because the idea of sharing thoughts and feelings are not a natural occurring phenomenon in their household. Many have reported that it feels burdensome to share their struggles with their peers (5). Those who do share often struggle to identify how they feel and how to express these feelings.

Imagine a scenario where a teenager breaks their wrist while falling off a bicycle. It is likely that their parents will immediately take them to the ER to get an x-ray, a stint, and follow up with a cast. Now, imagine the same scenario above, but instead of breaking their wrist, the teen experiences depressive symptoms. Their energy is suddenly gone, they’re no longer interested in their hobbies, and they find themselves in a 3 hour spiral of excessive worries and self-doubt over a comment a friend had made. The parents may notice that something is “different” or even that the teen is “under performing”. They might talk to the teen, often offering solutions they think are best. For about the same cost of taking the teen to a doctor, they can take the teen see a therapist. Yet, this isn’t even a consideration for most Asian parents. Stigma remains a major barrier. Young adults have reported that their parents do not want to access therapy when they or their children are struggling emotionally. The fear of being perceived as “crazy” or “less than” can outweigh any benefits therapy may bring. Thus, these children learn to suppress their symptoms and grow up to dismiss therapy as a resource in adulthood.

Mental health issues that occur as a result of recurring pressure and stress can force the person to develop poor ways of coping. One such example I’ve repeatedly heard from clients is that they will deprive themselves of food and sleep to focus and then will “catch up” after the exam or project due date. While this tactic may temporarily work in the academic world, the professional world won’t allow for such extended relief. These same clients often find themselves in demanding positions where they have to push themselves constantly, with little room to decompress.

These seemingly harmless events of pushing limits and working overtime can bring results and success, but there is be a cost associated to those who do not take care of their mind and body. For those of you who have read this blog and found yourself relating to the issues mentioned here, please consider preventative care when it comes to your mental status. It is a lot easier to preemptively develop healthy habits to manage stress and anxiety than it is to wait until it is absolutely necessary. Therapists understand that there is a lot of hesitation and contemplation with reaching out for help. Whenever you are ready, we are here.

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Being Bicultural

Being Bicultural

Being bicultural for a young person means one must learn to navigate two different cultures/practices/beliefs and somehow combine them to formulate a unique identity. Identity formation for someone who is bicultural can be difficult due to the differences in values and ideas of these two cultures. For example, someone with immigrant parents may have been taught to prioritize learning English over learning the family language. This person may have had little opportunity to speak the language of their parents and struggle in communicating and identifying with the culture that they most physically resemble. 

It can be confusing to feel as if one has to choose one culture over the other and, sometimes, it’s hard to not succumb to the dominant culture. While we do not choose which cultures we are born into, we can work towards choosing how we view our bicultural self. The ability to have multiple perspectives is one of the benefits of being bicultural (see article below), yet, challenges can also arise if a bicultural person has yet to successfully integrate both cultures. Bicultural confusion can also show up in relationship with others including family, friends, and romantic partners. Therapy can be a helpful place to explore your current and preferred ways of integrating these cultures. 

The article below has great insight and research-oriented perspectives on being bicultural.