Why Are So Many of Us Secretly Depressed? Excavating the Layers of Asian Americans’ Struggle with Mental Health
INTERVIEW OF J.R. KUO BY CHARLENE WANG
This piece was published in the 29th print volume of the Asian American Policy Review.
Our parents, immigrants, they left the country because they want a better life for themselves and for their kids. They have been in survival mode. Their whole life they don’t have the luxury to talk about mental health, to talk about feelings, to talk about self-discovery. They don’t have many resources, and they’re trying their best and acting on what they learned from their parents, from their culture.
Over and over again, I cannot help but notice how many Asian Americans, particularly women, suffer from isolation and poor mental health. My interest on this topic is, admittedly, personal. I’ve been depressed to the point where, while I wasn’t actively suicidal, I wouldn’t have minded a collision with a stray bus. In my intermediate family, I worry about my sister’s depression and my mother’s untreated depression and her unwillingness to seek out professional help. In my extended family, my cousin is being treated for bipolar disorder. And that’s just within my family. I won’t share too much of my friends’ details since it’s not mine to share, but my god, I know so many Asian-Americans who are struggling although it’s not apparent from the outside. I think about an Asian American acquaintance that took her life in college. And so many Asian Americans, particularly women, who have difficult, complicated relationships with their families. As I like to joke, we are living, breathing, highly functional dysfunction. And yet, I rarely see this fission being addressed in mainstream society.
After doing some research, I see that there is data to support my experience. According to a report released by the National Alliance on Mental Illness (NAMI), Asian American young women ages 15 to 24 have the highest rate of depressive symptoms of any racial, ethnic or gender group1. I reached out to JR Kuo at National Asian American and Pacific Islander Mental Health Association (NAAPIHMA), one of the few organizations that focuses on AAPI mental health, for a conversation on the state of mental health in Asian America.
AAPR: Can you provide a general overview of the work that National Asian American and Pacific Islander Mental Health Association (NAAPIHMA) does?
KUO: NAAPIHMA’s mission is to advocate and improve the well-being and mental health of Asian Americans, Native Hawaiians and Pacific Islanders by recognizing the impact on mental health on all aspects of a person’s life. We were founded by Dr. DJ Ida in 2001. We are probably the only national AAPI-focused mental health organization that has received grants from federal agencies like the Department of Health and Human Services and the Department of Justice, specifically the Office of Minority Health and Substance Abuse and Mental Health Services Administration (SAMHSA). We have worked directly with community organizations to develop mental health policies, training, and awareness and outreach programs to improve AAPI mental health.
AAPR: One of NAAPIMHA’s focus areas is to translate mental health resources. Is that challenging? Are there equivalent words in Asian languages?
KUO: As you know Asia has many different languages, Chinese alone has over 70 different dialects. The idea and concept of mental health is still very westernized. Historically and traditionally, Asian languages don’t have mental health concepts in our vocabularies. For example, mental health in Chinese is called “Sen Jing,” and “Sen Jing Bing” means illness, but it also means crazy.
AAPR: I only heard that term as an insult when my parents were arguing with each other.
KUO: The concept of mental health is just so foreign in China. We’ve worked with Cambodians and Khmer communities, and there is no language for mental health. Korean and Japanese have words for depression and anxiety, which are not widely used. The best equivalent is a sentence or two description. This translation project did struggle, it’s a real challenge. There’s not a lot of resources. First, it’s hard to find the right translators, and even then, it’s hard to find the concepts and words in these native tongues.
AAPR: What was the approach to get around that? Did you just describe things for mental health outreach? Like “Are you feeling sad?”
KUO: Two things I’ve witnessed. Like what you were saying, it’s explaining the feeling of struggle. The second thing is using human faces, human expressions. That’s universal. Pain, happiness, joy, depression, sadness, jealousy, confusion. No matter what race you are, how westernized, or even how “civilized” you are, all of us have almost identical emotional facial expressions. There are studies on this. When people laugh, when they’re happy, the way the muscle moves across their face is something universal across the board no matter your cultural background. It’s just incredible, right?
AAPR: Some of your funding sources included the ones you mentioned earlier, as well as Centers for Disease Control (CDC) and the Catholic Church Archdiocese. Has the model minority myth prevented AAPI groups from getting funding?
KUO: It’s definitely harder to get grants for AAPI-centered mental health initiatives. Often the money went to bigger or other minority organizations. Although there are about 20 million AAPI in this country, we are a relatively small population.
The challenge is representation and visibility. Jewish people in this country have the Anti-Defamation League (ADL). In African American communities, they have influential black churches, black national caucuses, spokespeople on TV advocating for black rights. We just don’t have that representation yet. When it comes to mental health issues, we don’t have the numbers, and so we also don’t have the data. On top of that, the model minority myth has perpetuated the idea that Asian Americans are doing ok, and therefore, we don’t need mental health support.
AAPR: How are you able to secure funding from a mainstream organization that’s not AAPI-focused? Is there a tendency for a certain type of project to get funded?
KUO: The type of past funding we get mostly focuses on physical health with mental health as an add-on. For example, a program we were part of called the Legacy Project, which brought awareness and gathered data on Southeast Asian Americans and their struggles with diabetes, heart disease, and mental health issues.
AAPR: That makes sense because physical health is so tangible.
KUO: We struggle with being vocal about our issues. For example, compared to the Jewish community after their horrible tragedy in World War Two, they were able to talk about their tragedy. It’s one of their ways to overcome and heal. The Jewish community has been talking about their history, advocating for their rights. Their community organizations raised significant funds and they do a lot of amazing work. Compare this to Asian Americans. We don’t like nor want to talk about it due to our historical and political past. Historically in Asia, those that voiced their suffering were likely to have their heads chopped off. Yes, there are a lot of successful Asian American families and businesses, but the needs and struggles are there. We need to start sharing our stories and issues first, otherwise the money is not going to supporting other Asian Americans.
AAPR: I’m glad you bring this up. As a student going to the Kennedy School, where my classmates are going to set public policy, I took a class on Native American issues. I had this internal debate as to whether I should draw a parallel with Asian American women and how race plays a role in domestic violence. A Bureau of Justice study showed that Asian women are the only race of women that have the most violence committed against them by men of other races (this study only included white, black, and Asian women). Asian women suffer the most violence at the hands of white men, actually3. I realized there was a parallel with Native American women because the Violence Against Women Act was passed specifically to address crimes committed against Native women by Non-native men4. I hesitated to bring it up, and ultimately didn’t, because I felt guilty for bringing up the struggles of the community. It doesn’t feel like something to call attention to. You don’t want people to pity you.
KUO: Exactly. I do the same thing. It’s ingrained in us culturally. It’s mind-boggling even for someone like myself that’s been in this work for over 10 years. I still feel uncomfortable. I feel guilty talking about myself because it feels self-serving. Even yesterday, we began discussing mental health, and then someone starts asking questions about ethnicity and said that Asians are doing fine in this country and questioned that they need mental health support. While explaining the model minority myth and sharing the mental health struggle that Asian Americans go through, I feel self-serving, a little bit guilty. “They don’t need to know this, they probably don’t care. Does it matter? Am I being selfish?” I have to catch myself and have the internal dialogue like “JR, let it go” because everyone at the table was white. It’s important, they need to know about this.
AAPR: This conversation helped me realize that that’s hurtful for us collectively. Speaking up is a service for the wider Asian American community, not a selfish thing.
KUO: My advice to my students is that there are people out there who need to shut up, loud speakers who just cannot stop talking. When it comes to us Asian Americans? Don’t even worry about that. No, you’re not being “too loud”. Cultivate that voice.
AAPR: Haha, I will try. Well last time we talked, you mentioned holding a lot of mental health workshop for AAPI college students. What was the approach and focus of these workshops? What brought those students to attend these workshops? Were there common themes that you found among the students?
KUO: The mental health training program is called “Friends DO Make a Difference” and began in 2011. We’ve trained college students at over 30 different universities. The younger Asian Americans are fed up. They want to talk. We want to resolve this. We are sick and tired dealing with depression and sadness. They think that what they are experiencing is unique and isolated, and there’s something wrong with them. I have done so many workshops and the biggest feedback I receive is “holy s***. I’m not alone”. Sorry about my language. Growing up with that idea of saving face, you don’t want to talk about your personal struggles. Finally, when they started sharing, they know what they are going through is exactly what others are going through.
AAPR: I certainly identify with that theme of isolation. How do you think this kind of isolation persists within our community in the United States? Does it take on a different form when we are minorities?
KUO: The moment you talk about your vulnerability, your non-successful, non-happy experiences, your family immediately deems that disgraceful. It doesn’t get interpreted as a mental health issue if your kid has depression or is suicidal.
AAPR: What is it about Asian culture that makes us afraid of bringing shame to the family?
KUO: You’d have to go back 3000 years ago. In another conversation, I can give you the whole Chinese history. It began with Confucianism and this mentality that you have to be “proper” and a “gentleman.” You have to follow these societal rules. It’s very communal, collective. There’s a lot of complexity in the history.
AAPR: What are the differences in mental health challenges do you see in first generation immigrants and those of us who are American-Born?
KUO: 1.5 or second generation face a lot of mental health challenges because of the bi-cultural challenge, the challenge of wanting to be American, at the same time holding onto their Asian family culture and family expectations.
AAPR: The acculturation process causes mental health problems. A study found that older Asian American women have the highest suicide rate of all women age 55 and older. Do you have any thoughts on why this is?
KUO: It’s definitely not a good thing. I don’t know why. My theory is that these older Asian American women immigrated here when they were older–they likely have a harder time learning English, so they face social isolation, especially if their kids live in different cities or countries. Due to language barriers, they also face financial hardship.
AAPR: My theory that is that in Asia they would be living their children. They’re losing out on that because that’s not as common in the United States. That might compound the isolation.
Let’s move on to discuss the George Qiao piece. Do you have any thoughts or reactions to what he’s saying?
George Qiao writes in “Why are Asian American Kids Killing Themselves” a critique of the dominant model of looking at the poor state of Asian American mental health as being caused by “a pressure cooker of parental expectations and cultural stigma.” He says:
“I am not surprised that our movement seems to embrace a model of mental illness that cuts down immigrant narratives and identifies Asian cultures as a source of weakness rather than strength. In the fight to assert ourselves, a colonial, anti-Asian ideology remains rooted in our memories of pain.”
“When a therapist or counselor believes that Asian Americans suffer solely because of familial pressures, they buy into the idea that Asian families are unnatural and inhuman.[…] Little wonder the follow-up rate for Asian Americans who do visit therapists is virtually nonexistent”
“The idea that Asian families and Asian-ness are uniquely harmful to Asian Americans needs to be abandoned. If we refuse to examine the way that this country’s prejudices condition us to be in conflict with our own parents, we will never be able to heal and thrive as a community.”2
What’s your take?
KUO: I agree a lot with what he says, but he needs to provide more data. I teach a workshop about intergenerational conflict. Asian Americans do get a lot of family pressure to succeed and the whole immigrant experience is extremely stressful. At the same time, these Asian American youth want to be Americanized. A lot of them will sacrifice their Asian culture. And sadly, some are chasing something they can never achieve: to be white, to be completely accepted in this country.
Unfortunately, some parts of this society will never accept us. So that’s one part. There are some therapists that have unconscious bias. I like his conclusion that what’s equally harmful to Asian Americans is the prejudice and discrimination that we face in this country. When I grew up in the 90s people would make fun of the food, like Kimchi and now Kimchi is everywhere. What the f***. Unfortunately, this American culture, they will always try to crush something that’s different.
Our parents, immigrants, they left the country because they want a better life for themselves and for their kids. They have been in survival mode. Their whole life they don’t have the luxury to talk about mental health, to talk about feelings, to talk about self-discovery. They don’t have many resources, and they’re trying their best and acting on what they learned from their parents, from their culture. What they are is different.
AAPR: Asian cultures can produce shame, but I appreciate how Qiao addresses a larger problem of the field that ignores the discrimination that Asian Americans experience. I’ve never seen any mental health literature that acknowledges the history that our parents went through. It’s not really known since they don’t talk about much. There has been a lot of social upheaval, war and poverty in Asia. The trauma from that gets passed on, and it’s also probably what contributes to a lot of issues. That’s rarely acknowledged.
KUO: No, it’s not. Through my intergenerational workshops, one of the solutions that I’ve been sharing with my students is to ask your parents some simple questions about their history. Our parents don’t really like to talk, they don’t want to burden us with sad stories. Ask questions in small pieces so as not to overwhelm them.
AAPR: Can you share with us about your immigration story?
KUO: My family followed the trend of East Asian families sending their kids to the United States to get a better education. I’m nine years old; I get this opportunity from this boarding school in Northern California that accepted me and gave me a scholarship that would pay for my room and board. My mom dropped me off and left. I did not know any English. I only knew “A, B, C, D”. That’s it. I was in ESL. I was there until I graduated at 18 or 19 years old. My experience at the boarding school, in a nutshell, definitely contributed a number of emotional and psychological traumas.
Throughout the whole time at boarding school, I was under a student visa. In order to stay in this country, you have to constantly go to school. If the student visa is discontinued, you have to leave the country. There are only two ways to get a green card to permanently stay in this country: one is through marriage, the K1 visa, and the other is the highly specialized skilled worker visa, H1B. The only way to go from a student visa to a permanent work visa is through sponsorship from a company. It can be very challenging to get sponsored for the H1B visa. The hardest thing about having a student visa is that legally I couldn’t work outside my university, and I could only work 20 hours. It was really hard financially.
AAPR: How did you figure out how to stay in the United States?
KUO: I am not a citizen yet. I have my green card: permanent residency. After college, I moved to Hawaii for work, and the company couldn’t sponsor me for my work visa. I went back to graduate school. That is the only way I could continue to stay in this country. A lot of Americans don’t understand how hard it is to get a green card. Even though I grew up here and am as Americanized as almost everyone, I always feel like a second-class citizen.
Immigration has a big impact in Asian communities because about 60% of current Asian Americans are either themselves are immigrants or their direct relative or parents are immigrants. Twenty million U.S. Asians, and out of that, 13 percent, 1.4 million is undocumented.
Immigration and mental health are so related and so interconnected. Discrimination is also part of it, particularly for Asian Americans with accents. I heard all sorts of racial jokes, I would be particularly sensitive because of my immigrant status. “Go back to where you are from” would hit such a nerve because I’m not a citizen.
I finally got my green card in 2017. I can apply for my citizenship in four years. I will have been here 31 years for me to become a citizen. Back in the 80s and early 90s it was easier for people, especially highly-educated foreigners to get a visa and a green card. After 9/11, it has become tougher.
In 2012, in between applying for visas all my documentation, my student visa, expired, so I had no legal status. I couldn’t drive. I couldn’t work. I couldn’t get health insurance. I was like undocumented. If anything happened to me, I would be f***ed, they could put me in an immigration detention center. I was living with so much fear and shame during this time.
What I went through pretty much could be avoided. There could be more resources to make the United States Immigration office more efficient. But there’s no incentive.
AAPR: At what point did you seek mental health support?
KUO: I started seeking therapy in college. I worked, studied, and partied hard, but internally I was so depressed because I was so afraid to talk about my immigration and my trauma from boarding school. I did talk to a friend or two and it went over their heads and that hurt a lot. I began therapy at University of Colorado at Boulder because you get eight weeks of counselling sessions for free per semester. Years later, a therapist offered to see me even though I couldn’t afford to pay. Even today, I’m still seeing her regularly. After eight years I have seen myself make tremendous progress in terms of my mental wellness.
I used to have pretty severe seasonal affective disorder. Whenever fall came, I would get so depressed. The first time I experienced fall was when my mom dropped me off at boarding school. It was cold. I didn’t have proper clothing. I was from Taiwan, a tropical island. I missed my mom, and I was in a foreign land. I couldn’t speak the language. I didn’t have any friends. I was miserable, and so I associated the changing weather with trauma.
It took me a couple of years to pinpoint the source and more to slowly overcome. When the leaves started changing in Colorado, my friend would accompany me to the mountains in Aspen to see the leaves change. It’s beautiful. Slowly I re-educate my brain and my perception. I’m telling myself I’m in control. I have power over this. It took me a couple of years.
AAPR: Congratulations. That takes a lot of effort. I always assumed that seasonal affective disorder is one of those things you can’t change.
KUO: Exactly. A lot of times those conditions they don’t go away, but the recovery is how you manage these conditions. The depression is still there, but over the years I have learned healthy ways to balance that out. I am stronger, more empowered.
AAPR: Thank you so much for sharing your story. That message of empowerment is meaningful.
My biggest takeaway from my conversation with JR is that intergenerational conflict and the silencing effect of the model minority myth lies at the heart of so many of the mental health challenges that I see second-generation Asian Americans experiencing. JR’s immigration story serves as a reminder for the discrimination and struggle that our community faces. Perhaps for those of us who feel anger towards our parents can, with time, transform that into empathy and compassion once we understand and unpack the history of conflict, colonization, and militarism that we rarely study in US education–the Korean War, the Vietnam War, the civil war in Cambodia, the Secret War in Laos, the Cultural Revolution in China, the Indo-Pakistani War, the civil war in Sri Lanka, ongoing conflicts in the Philippines, and many others.
There is so much unspoken trauma and hurt that has impacted our parents’ generation and is passed onto the second-generation. According to the Asian American Psychological Association, two protective factors against suicide are a “strong identification with one’s ethnic group” and “strong family cohesion and parental support”5. Unfortunately, the acculturation and assimilation process work against both these protective factors and lends insight into why our community struggles the way we do. Like many of us, I struggle with the desire to be white, internalized racism that this country has taught us. To heal, let us begin unveiling the inner turmoil of our lives. Let us seek to fully understand and embrace our Asian heritage, our Asian families, and our Asian histories, and remind ourselves, in the words of Sandra Oh, “It’s an honor just to be Asian”6.
JR Kuo is a firm believer that everyone holds an infinite amount of space within, calling us to express our truest selves. Everyone matters! He wants to invite everyone to experience the wonder of what it means to be at ease and free to create the life you crave. JR is the CEO of CoffeeWithJR and a professional speaker, trainer, and coach. He is also the Co-Founder and Program Director of Friends DO Make a Difference, a mental health training program specifically designed for college students. He has facilitated and trained students at over 35 universities and conferences across the United States, including Harvard University, Stanford University, and Vanderbilt University. He has taught leadership, cultural competency, and mental health classes at the University of Colorado Boulder and Regis University. In additional to professional speaker, JR has 7 years of experience managing NAAPIMHA, a mental health nonprofit organization and multi-years of running businesses in Denver, CO.
Charlene (she/her) is a Chinese-American woman in her second year at the Harvard Kennedy School of Government and current Student Body President of the Kennedy School. She’s a current recipient of counseling services of the HAVEN Program (Hospitals Helping Abuse and Violence End Now) at Massachusetts General Hospital. She was elected as a student representative of Masters of Public Policy program, Class of 2020 and the interim Student Government President. Prior to the Kennedy School she was the Head of Outreach Strategy, Analytics, and Technology at the NYC Department of Education for early education programs, particularly Pre-K for All and Head Start, focusing outreach to shelter, low-income and minority and immigrant communities in New York City. She also served as a regional Data Director for 2016 Hillary Clinton campaign in Virginia. She received her B.A. in Earth and Environmental Engineering from Columbia University in 2012.
1“Asian American Teenage Girls Have Highest Rates Of Depression; NAMI Releases Report”. National Alliance on Mental Illness. January 01, 2011. https://www.nami.org/Press-Media/Press-Releases/2011/Asian-American-Teenage-Girls-Have-Highest-Rates-of.
2Qiao, George. “Why Are Asian American Kids Killing Themselves?” Plan A Magazine. October 08, 2017. https://planamag.com/why-are-asian-american-kids-killing-themselves-477a3f6ea3f2.
3Rennison, Calle. “Bureau of Justice Statistics Special Report: Violent Victimization and Race, 1993-98”. U.S. Department of Justice. National Center on Domestic and Sexual Violence. Table 14. Race of Victim, by perceived race of offender, 1993-98. http://www.ncdsv.org/images/BJS_ViolentVictimizationAndRace1993-1998_3-2001.pdf
4Nagle, Rebecca. “What the Violence Against Women Act could do in Indian Country — and one major flaw”. High Country News. December 11, 2018. https://www.hcn.org/articles/tribal-affairs-what-the-violence-against-women-act-could-do-in-indian-country-and-one-major-flaw
5“Suicide Among Asian Americans”. Asian American Psychological Association. May 2012. https://aapaonline.org/wp-content/uploads/2014/06/AAPA-suicide-factsheet.pdf
6Snierson, Dan. “Diversity problem ‘solved’ in Emmys’ opening musical number”. Entertainment Weekly. September 17, 2018. https://ew.com/emmys/2018/09/17/emmys-2018-opening-bit/