Asian Americans' Reluctance to Seek or Use Mental Health Services Explored

Marlene Busko

August 31, 2007

August 31, 2007 — At the Asian American Psychological Association (AAPA) meeting in San Francisco, California, a panel of experts briefed the media about why Asian Americans do not use mental health services.

According to a press release issued by Alliant International University, in San Francisco, Asian Americans are affected by a variety of psychological problems, including child abuse, depression, domestic violence, suicides, bullying at school, gambling, eating disorders, and body image, yet they have an extremely low utilization of mental health services relative to other US populations.

Tai Chang, PhD, from Alliant International University, told the press: "The small amount of research that has been done on Asian and Pacific Islander Americans shows that they don't use mental health services, and when they do, they often stop treatment before solving their problems."

He added that even when Asian Americans seek therapy, they are less likely than European Americans to reveal their problems. This stems largely from the fact that Asian cultures stress "saving face" and relying on family rather than outsiders, he explained. "There's a stigma associated with personal problems, and Asians also hold beliefs that associate health with the environment, and they equate the physical with the emotional and spiritual," he noted.

While there are many differences between Chinese, Japanese, Korean, and other Asian groups, there are important similarities, too, he stated.

The experts noted that in addition to cultural differences, other factors that deter the use of mainstream mental health services among Asians include a lack of accessible and affordable services, a lack of staff who speak the same language and who are from the patient's ethnic background, and a lack of knowledge about available services.

When Asian Americans and Pacific Islanders do use mental health services, the severity of the disturbance tends to be high, possibly because they delay seeking treatment until symptoms reach crisis proportions, the press release stated.

They add that the Virginia Tech shooter, Cho Seung-Hui, is an extreme example of the failure of medical treatment to reach Asian Americans with mental illness. He was considered a danger by others and had been involuntarily committed in 2005, but he told the clinic he was not having mental difficulties, and he was never actually treated.

Saving Face, Losing Control

Laurence Hsin Yang, PhD, from Columbia University, in New York, who did not participate in the media briefing but who chaired a symposium at the AAPA meeting on the concept of "face" in Chinese society, told Medscape that the Chinese —and by extension, Asian — concept of saving face is more complicated than the Western notion. In China, a person's social world is governed by the people that person interacts with. Giving and taking favors within a person's network of social connections constitutes guanxi. A person's "social face" is mianzi, and their "moral face" is lian. A person who loses face can no longer function in his or her social network. These concepts are discussed in more detail in a paper he coauthored with Arthur Kleinman, MD, from Harvard University, in Boston, Massachusetts, which has been accepted by the journal Social Science & Medicine.

Dr. Yang said that Asians are not used to meeting with strangers and discussing their problems, and many of their cultural values act against this. He explained that, traditionally, Asians with mental health problems would speak first with a family member, then with a close friend, then with someone like a village elder or a trusted spiritual leader in the community, and only after that might they consider involving someone outside their networking community.

Talking to a therapist would be more accepted by a second-generation Asian person, he said, but a lot of traditional values still permeate the beliefs of later generations, although they become diluted.

He added that traditional Chinese beliefs are tied to Buddhism and include the concepts that mental health problems could be the result of someone not raising a person properly or an ancestor in a previous life who did something wrong. Other beliefs are that an individual's duty and purpose in life is not to increase his or her own ''face" but to increase the "face" of the family. "Having a mental illness is extraordinarily 'face-losing,' " he said.

Asian American Psychological Association Annual Meeting. August 16-17, 2007.


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