Why Asian-Americans and Pacific Islanders Don’t go to Therapy

I walked into my first group therapy session when I was in my early twenties. Not only was I the only Filipina-American in the room, I was the only person of color. I didn’t realize it at the time, but this made me a bit more guarded than usual. I agonized over having to explain my upbringing, so I rarely participated. No one in the room could relate to my experience as a daughter of immigrants. My peers in group would question my experience and try to give me advice—and while it was well-intentioned, I didn’t find their advice as helpful as if it were coming from someone in my community.

But I knew I couldn’t reach out. There’s an underlying fear among the Asian-American and Pacific Islander (AAPI) community that getting mental health treatment means you’re “crazy.” If you admit you need help for your mental health, parents and other family members might experience fear and shame. They may assume that your condition is a result of their poor parenting or a hereditary flaw, and that you’re broken because of them. Seeking help from those outside the immediate family also conflicts with the Asian- and Pacific Islander-specific cultural value of interdependence. After all, why would you pay to tell a stranger your problems when you should be relying on the strength of your community?

And after my disappointing experience in that group, I didn’t want to go to therapy anymore either. Part of me wondered if therapy was only meant for white people. And this belief stopped me from getting the help I needed for many years. Many AAPIs try to justify why we shouldn’t ask for help by doing exactly what I did—by believing and repeating things that just aren’t true. To show the community that mental health is important, though, we need to shatter these incorrect beliefs:

“I must be successful and cannot show signs of weakness.”

According to SAMHSA, AAPIs are less likely to reach out for help than other races and ethnic groups. This may be due to faith and religious beliefs, cultural values and language barriers, to name a few. Additionally, AAPIs are mistakenly thought to experience economic stability. This stereotype, known as the “model minority” myth, incorrectly assumes that all AAPIs are wealthy and highly educated. This, compounded with the family and/or cultural expectation to be a highly skilled professional, like a doctor, lawyer or engineer, can be overwhelming. It may lead you to feel you need to succeed, regardless of the toll it may take on you.

“It’s a burden to share my emotions.”

In many Asian-American households, children grow up controlling or hiding their emotions. If you’re “too emotional,” you may be perceived as someone who complains too much and doesn’t try to solve anything for themselves. This often translates to family environments in which silence is a sign of strength and feelings aren’t likely shared. You may be expected to move forward regardless of how you’re feeling, or risk being perceived as someone who easily accepts failure. While opening up to a family member may not be an option, receiving guidance and treatment from a mental health professional is not a burden on anyone.

“I’m ungrateful for all I have.”

Many AAPIs learn about past family sacrifices that led to a better life in America. Parents or grandparents might have emigrated to the U.S. in search of safety and opportunity. With this in mind, there is a belief among younger generations that their elders experienced far more challenging hardships. For example, many Southeast Asians, who may be refugees or asylum seekers, may have experienced trauma due to oppressive regimes or economic instability back home. With this in mind, AAPI teens and young adults might feel guilty sharing their mental health struggles knowing their relatives faced something “more” stressful just to survive.

“It’s disrespectful to my spiritual beliefs.”

In many Asian and Pacific Islander cultures, faith plays a major role in everyday life. For example, the Philippines is a majority Catholic country. Filipinos are taught to rely on prayer even when dealing with a challenging time. If you’re going through something tough, loved ones may encourage you to pray the rosary or read the Bible. And suicide is considered sinful. So it makes sense that anyone experiencing mental health symptoms or suicidal ideation may be afraid to tell others, for fear of being judged. However, mental illness is not a sin, and so those with a condition should not be treated as less than.

“I don’t know how to talk about mental health with my relatives.”

Like other people of color, many AAPI parents and elders may not believe in mental illness and its potential impact on their community. Additionally, they often express negative emotions by describing physical pain, like symptoms of heartache and extreme fatigue. Younger generations raised in the U.S. often have a better understanding of mental illness and access to mental health care than their elders. But this doesn’t make it easier to open up to relatives who have little understanding. The AAPI community should become educated on mental health conditions, which are legitimate health conditions that should be treated with urgency.

“I’ve tried therapy before, and I didn’t find it helpful.”

My past experience in group therapy is likely similar to other AAPIs who have trouble getting help. Because I didn’t know of any mental health professionals who understood my experience, culture and heritage, I assumed it wasn’t worth it to continue seeking help. However, now I have identified what I need: a mental health professional trained in cultural competency.

We need to encourage the AAPI community to ask for help and prioritize mental health. Eliminating stigma is critical. Like in Virginia and New York, we need legislation that requires mental health education and awareness in schools, and that even goes a step further by being tailored for AAPI communities and other communities of color. Until such legislation is passed, it’s up to us individually to break down stigma within our own circles of friends and family.

Note: This blog was originally published in July 2018.