When seeking therapy can seem like a betrayal.
by JINNIE LEE
To better understand what you’re about to read, there’s something you should know right off the bat: The majority of AAPIs (Asian Americans and Pacific Islanders) don’tseekhelp for mental health issues. According to the National Latino and Asian American Study (NLAAS), AAPIs are three times less likely to seek mental health services than white people. A staggering 2016 study by the CDC showed that half of all the suicides were committed by AAPIs in the U.S. Part of it is a holdover; in Asian countries, talk therapy is rare. Psychotherapy isn’t covered by the Korean National Health Insurance, so the access to get help in South Korea is limited. In Japan, hospitals privately set their own costly psychotherapy prices at about $100 (£80) a session. And India’s first-come, first-serve method means that people travel and wait for hours in hopes of seeing a psychiatrist for a few minutes.
But as a US-raised Korean-American born to immigrant parents, I didn’t need research to tell me that AAPIs don’t subscribe to psychotherapy. For many of us, talk therapy isn’t part of our vocabulary — we weren’t brought up to discuss our own emotions. Instead, we’ve been conditioned to think about how our actions could affect our greater community; that others’ feelings are more important than our own, and that there’s shame in airing dirty laundry. We’re taught to buck up and overcome these issues in isolation, like our parents and theirs had done before them. In turn, seeking professional help is viewed as a weakness in character, or a flaw in your upbringing. In the West, tending to our mental health is seen as courageous. In the East, it’s seen as indulgent and selfish.In lieu of therapy, some AAPIs cope by dissociating, compartmentalising, or suppressing negative feelings — techniques that research assistants Led Camille Soriano and Tiffany Tran at The Menninger Clinic in Houston, TX, point out are classic examples of avoidance coping. Rather than seek external help, AAPIs tend to use coping sources within the family structure, which could be due to their strong culture of respect for elders and authority figures. “Research says that these kinds of coping can be adaptive in the short-term during times of intense trauma or stress,” wrote Tran in an email. “But long-term, avoidance is a dysfunctional coping style because you’re avoiding your emotions rather than facing them.”
While in quarantine mode, I’ve been rewatching The Sopranos and I can’t help but recognise how Tony Soprano’s emotional distress, stemming from running a mafia empire, are similar to how AAPIs’ deal with mental health concerns. Like Tony and his chronic anxiety attacks, Asians may look into treatments only when they’ve reached a breaking point that’s caused a major disruption in their lives. In the first season, Tony is reluctant to talk to his therapist, Dr. Melfi: he can’t articulate the complicated relationship he has with his mother; he relies on a Prozac prescription as a quick solution; he outright rejects Melfi’s thoughtful and sound assessments that his unresolved emotional issues drive his anxieties. Tony is also embarrassed to admit to his wife that he’s seeking help.
The binary approach to mental health — talk therapy is correct; repression is wrong — isn’t helpful when presented so reductively, especially when you consider the many Asians who have been successfully avoidance coping for centuries. Research shows that techniques like expressive suppression can work. One 2014 study on Chinese individuals even stated that emotion regulation “might be as similarly effective as, or even more effective than, acceptance in regulating negative emotion in Chinese subjects.” And psychologists have found that repressing negative memories has proven to be an essential method in treating PTSD — and it’s gentler than forcing someone to confront their traumas head-on.
In a New York Times Magazine story, psychiatrist Bessel van der Kolk raised concerns that the desensitisation process of exposure therapy can be harmful, and that trauma “[is] not something you can talk yourself out of” when it comes to cognitive behavioural therapy.But the reality is that the majority of AAPIs don’t talk at all. When we fixate on internal struggles in isolation, depression and anxiety become exacerbated — feeling stuck between two sides can oftentimes lead to a sort of paralysis, wherein you don’t seek help in any form. The numbers prove that Asians are severely depressed. So, is there a middle path for Asian-Americans who are struggling?Thankfully, there are an increasing number of options available. “For some, it can feel strange or even inappropriate to be telling your family business to a stranger who isn’t Asian in any sense — like, if you’re feeling pissed about your parents’ somewhat patriarchal attitudes, or how they express love in a way that you don’t understand,” says NYC-based clinical psychologist Marcia Liu. “Those kinds of dynamics can be quickly minimised and labeled as ‘typical Asian parenting’ by the uninformed therapist, which then can feel incredibly othering and demoralising. There’s also pressure to be loyal and speak honourably of your parents in spite of abusive or even destructive dynamics, no matter what. It’s a conflict that many Asian-Americans must navigate.”…