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Mental illness: the Asian American experience

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Mental illness: the Asian American experience

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Content MENTAL ILLNESS: THE ASIAN AMERICAN EXPERIENCE

by
Winston Lloyd Chua

___________________________________________

A Professional Project Presented to the
FACULTY OF THE USC GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
MASTER OF ARTS
(ONLINE JOURNALISM)

December 2009

Copyright 2009 Winston Lloyd Chua

ii

Dedication
To the Ones I Love

iii
Acknowledgments
Time flies when you are having fun. But if I said it felt like just yesterday that this
journalism journey began, I would be lying. That being said, I am more than a tad bit
disappointed to be calling my time at U.S.C. "finished." I am tremendously thankful to
Laura Castaneda for her incessant availability through this process. I am thankful to Stan
Huey, without whom none of this could be possible. And thirdly, I would like to thank
Andrew Lih, who inspired the intangibles for this report.
Forgive me if I forget your name as you read this, but I am thankful for your
contribution and that of Dr. Wing-Ki Lee, Christine Lu, Elyn Saks, Bryce Nelson, Debby
Blake, Stephen Ng, Ryan Butler, Mark Chen, Mom, Dad, Joy, Barbara, Dr. Atkins and
Harvey Buzin. Where would this be without all of you? Thanks to those who made my
time at USC easier, Patricia, Stephanie and Tom. Each of my professors offered
something unique to this education: praise, criticism, etc. I come out of this program a
better person and a stronger one.
But enough of this Oscar speech…onto the feature presentation!

iv
Table of Contents
Dedication ii

Acknowledgements iii

Abstract v

Chapter One: Susie Lu
Susie Lu 1
Magnitude of the Problem 2
Cultural Complexities 3
Diversity of Asians 5

Chapter Two: The Internal Civil War
Pressuring Youngsters 6
Avoiding Help 9
Hard Struggle 12

Chapter Three: Resistance is Futile
Resistance to Treatment 18
Consequences to Resistance 20

Chapter Four: Rose
Rose 22
Religious Roadblocks 23
Never the Same 25

Chapter Five: Concluding Thoughts
The Need to Comply 28
Model Minority 29
Asian American Women 31
Where to Go from Here 32

v
Abstract
Extensive research shows that Asians do not make use of mental health services,
for reasons that range from their fear of Western medicine to the notion of “saving face.”
Studies also indicate that depressive symptoms are highest among Asian female
adolescents and college students ranging in age from 15-24. Women in this demographic
also have the highest suicide rate. This professional project features interviews with me
from mental health professionals, ethnic studies professors and those who have mental
illnesses themselves to probe the relationship between mental illnesses and Asian
Americans.

1
Chapter One:
Susie Lu
Susie
You could argue that Susie Lu was the perfect Asian child. In her teens she scored
a perfect 1600 on her SATs (several years ago, 1600 was the highest possible score),
easily received the highest possible GPA in high school, where she swam competitively.
Harvard University not only granted her early admission, it accepted her as an
undergraduate as one of only six freshmen students for its highly coveted Master's in
Business Administration graduate program.
She had everything going for her, enjoying a high-paying job working for
PeopleSoft before Oracle Corp. bought it out in 2005. Plus, she had international
expertise from her work in China.
"My sister was an Asian dream come true," Susie Lu's sister said. The world was
Susie Lu's oyster and in her grasp she held the brightest future all to herself. But despite
all her success and accomplishments, she found herself in 2002 powerless to a
psychiatrist’s diagnosis of clinical depression. She was 28 and full of life, but was
betrayed by the suicidal thoughts that mirrored the inner turmoil she felt. She thought of
driving her car off a cliff, of poisoning herself to sleep in her garage by connecting a tube
from her exhaust into the interior of her car, dying a slow death by inhaling carbon
monoxide.
But those were just thoughts, and thoughts that she would undoubtedly not act
upon. She saw a therapist. She took prescribed medicine, but the medicines did not
completely stabilize her moods or thoughts. She would try new combinations to get her

2
life back on track but at the same time wanted to feel free of drugs altogether. Her mind
raced from obsession to obsession, from labeling household items in great detail and
pestering an old piano teacher she had when she was a child, asking him for what would
be the perfect piano inside her new home with her fiancée. She pulled her seemingly
harmless thoughts together and married at the age of 30.
No one could prepare Susie Lu's friends and families for what would come a
month into her wedding. One October morning in 2004, Susie Lu killed herself.
This woman who had so much to offer, with the world at her fingertips, took her
life. She killed herself the way she said she would when her thoughts were just thoughts,
by inhaling the carbon monoxide exhaust fumes in her car in a garage that would fill her
lungs and steal her life. By all accounts and measures, Susie was at the top of the game of
life before it all went so wrong.
The Magnitude of the Problem
Asians have become notoriously known for not seeking professional help for
mental illness or dropping out of treatment when they do seek help. A nationwide survey
revealed that Asians were only a quarter as likely as whites and half as likely as African
Americans and Hispanic Americans to have sought outpatient help for mental illness.
According to the U.S. Center for Disease Control and Prevention, Asian Americans are
much more likely than the average American to take their own lives, and Asian-American
women are more likely to attempt suicide than other groups (16 percent to 13 percent).
Suicide is the second leading cause of death among Asian American women ages 15-24
and among Asian American men ages 15-34. Although about nine in every 100 Asians

3
suffer from a mental illness, only three of every 100 actually seek mental health services.
The stigma is so great that about three of every four Chinese Americans are embarrassed
to ask for help from any type of social service. Though Asians make up just a small
percentage of most college student bodies, they comprised a majority of suicides over a
10 year span that began in 1996 at Cornell University. In a three month span at Caltech
this year, the lives of three Asian students were cut short by suicide. Harvey Buzin, a
therapist and former professor of social work at the University of Southern California for
more than 20 years, has noticed an alarming trend among his current and past Asian
patients.
"Often what I find is that these patients often wait until there is a crisis situation.
Parents come to see me as a last resort when life becomes too out of control," he said.
Cultural Complexities
Asian Americans come from a tradition of achievement and hope for wealth that
leave little room for failure. In Susie Lu's case and countless others like her, parents who
have the resources pour in money, energy and time to make sure their children are
prepared for college and beyond. If Asians seek counseling of any kind, it is usually for
academic help, rather than to share one’s emotional or psychological problems.
Admitting or even considering that a family member has a mental health problem puts a
huge dent in the armor of public perception perfection that Asians would like to convey.
"Mental illness" carries with it pejorative connotations of being “weird” in society as a
whole, as evidenced by the characters in movies like A Beautiful Mind, Changeling or
One Flew Over the Cuckoo’s Nest. And psychotic episodes or suicidal thoughts are not

4
pleasant surprises people generally want to share publicly with others. Sometimes it is
more important to project a good image to the world, rather than look at a specific
situation with heartfelt honesty. It is also more culturally acceptable for Asians to seek
help through religion or “natural” forms of treatment like acupuncture, nutrition or herbs
than to trust in a science that is not necessarily intuitive to understand. Some Asian
religious sects do not even tolerate the idea of mental illness as it is understood today.
People in general have a hard time seeking help for what they do not see, but that
is especially true of Asians, who will typically not treat a mental illness they cannot
account for because cultural tradition teaches that body and mind are inseparable. So if a
patient cannot see anything wrong physically, he or she may not believe that something is
wrong mentally. Asians also are not encouraged to be forthright about personal problems.
But not trusting in the way Western medicine and therapy can work will exacerbate poor
mental health when patients prove to be a danger to themselves, to others, or both.
Among young people and their family, there can also be the dichotomy between the
difficulty of gauging a person’s mental condition (and having the whole science look
shaky) and appeasing an Asian family’s demands for tangible results. A person with a
mental illness will not necessarily “see” immediate change in the way a person with a
headache will feel relief after taking a Tylenol after 20 minutes. The healing process in
cases of depression, bipolar illness or schizophrenia can take months, years or even a
lifetime of pharmaceutical medications that, on the surface, can throw a wrench into
anyone’s traditional perspective of illness, let alone an Asian family’s, whose hope would
be to see any illness done away with 20 minutes after taking a swig of juice and

5
swallowing a day's worth of pills. Other than observing symptoms over an extended
period of time and the simple, yet uncertain, ways science has of monitoring brain
chemistry, much of mental illness remains a mystery. To some Asian groups, that
evidence simply is not good enough.
For Susie Lu, dependence on medication was simply not good enough. Susie
wanted to free herself off of drugs so fast that she recklessly put herself, her brain and her
life in a precarious state of being.
The Diversity of Asians
Mental illness is a difficult illness to track among Asians, who, contrary to some
beliefs, are not a monolithic group. Of the roughly 10 million people in Los Angeles
County, one of every eight people is of Asian descent, mostly of Chinese and Korean
descent. But across the L.A. County alone, the Asian population includes Filipinos,
Japanese, Thai, Cambodian, Malay, Vietnamese, Laotian, Indonesian, Hmong and more.
Treating someone from Korea may not be perfectly effective in treating someone who is
Thai, but for whatever reason, studies show that adolescent and college-aged Asian
women have the highest rate of depressive symptoms and that Asian Americans as a
whole are less likely to rely on mental health services. Despite the diversity that exists
among people who come from Southeast Asia and China, the similarities should not be
ignored.

6
Chapter Two:
The Internal Civil War

Pressuring Youngsters
The perspective Asians have of mental illness can undoubtedly effect whether or
not they get treatment for it. Those who have treated it as a deep, dark and lurking secret
may have already aroused the sleeping monster of fear and confusion that is in us all. But
national best-selling author and USC Associate Dean of Law Elyn Saks, who has dealt
with severe schizophrenia for more than 30 years, said that it has been helpful for her to
think of herself as one who has a “fragile brain." Saks said her brain simply cannot
withstand the pressures and chemical triggers a "normal" person’s brain might be able to
withstand, just as every human’s body has organs or bones that are more susceptible to
injury or damage than others.
For Asians, pressures can come in the form of academics or environment.
"Asians have high expectations for their children. The parents demand academic
achievement and children have more pressure to succeed,” said psychologist Florentius
Chan, who has worked in Monterey Park for more than 20 years. Most of his clients are
Asians who are new to the U.S. or second generation Chinese Americans. Sometimes, he
said, these expectations can seep into the veins of the children and create an internal
conflict when high standards are not met.
"If they keep their problems to themselves, the problem becomes bigger and
bigger. They can act out and hurt other people, like the Virginia Tech scenario," Chan

7
said, referring to the 2007 Virginia Tech school massacre carried out by a mentally
troubled Korean-American student named Seung-Hui Cho.
Asian parents in the San Gabriel Valley, in cities like San Marino and Arcadia,
have for years been infamous for pouring countless thousands upon thousands of dollars
into their children’s education, in the forms of private tutors or pre-SAT classes, in hopes
of providing for them an Ivy League education or something comparable. Stanley Huey,
an associate professor in the psychology department at the USC, noted that in general
Asians face great pressure to conquer their competition academically.
Alhambra based psychiatrist Wing Ki Lee has been a rock of support for the
mentally ill in the San Gabriel Valley, treating more than 2,500 Asian patients during his
25 year tenure there and in Monterey Park. In his 25 year career, he has found that such
pressures have the adverse affect of hindering, rather than helping, a student’s
performance, because a family insists on what lofty and unrealistic expectations “should
be” instead of what they really are. Such students are fed to consume the lesson “that
only grades matter,” leaving out recreation, healthy friendships and social balance.
Lee is a Cantonese-speaking doctor who said there is a shortage of Asian Pacific
treatment centers in the San Gabriel Valley, although he did work at a successful facility
targeting Asians at the Langley Porter Neuropsychiatric Institute in the San Francisco
General Hospital.
La Canada psychiatrist Richard Atkins, who has also seen Asian patients for 25
years, observed, “I think that whenever there is an ideal set, there are people who don’t
reach it. There is perfectionism at one end of the spectrum, which everyone is unable to

8
attain," said Atkins. People who try too hard to be perfect become disappointed and then
angry with themselves and turn this anger in against themselves, causing pain and
frustration.
“What is called a superego depression is not being able to live up to standards
you’ve set for yourself, these expectations from parents. Children feel like failures. Plus,
there is the added pressure on children from their parents to achieve excellence," said
Atkins.
One person who waited until a crisis struck in his life was John Kim. In his early
30s, this well-educated Korean American is close to completing his second master’s
degree at USC. Although he is in a better place now, he experienced dramatic mental
breakdowns after he experimented with LSD while at UC Berkeley.
"I don't remember exactly what I did, but I assaulted somebody, a telephone man,
who got a ruptured eardrum in the process," said Kim. "The charge was lowered from
felony to misdemeanor. That was the turning point for me." Not long after this episode (a
term frequently used by mental health professionals and patients to describe psychotic
mental breakdowns), Kim had another breakdown.
"One day I don't know what really happened, but I went out of control. I was
talking and then I couldn't stop talking and yelling and then I walked around the college
campus. After the paramedics picked me up I went to the hospital and then eventually
found my way back home," Kim said. After this breakdown, he regularly took his
medication and has put psychotic symptoms behind him.

9
Psychotic episodes do not just come spontaneously. Korean American Jimmy
Cho, 35, used to work for the Los Angeles Department of Mental Health and now lives in
the Bay Area. Facing mounting pressures from school and learning that his parents' dry
cleaning business burned to the ground in the 1992 Los Angeles riots, he willingly looked
to find healthy ways to cope with his stressful situation. Cho admitted that high academic
standards were always an expectation of his family.
Avoiding Help
One reason Asians may be less likely to seek help is because of shame. The
relationship between shame and treatment resistance has been an issue studied by Sumie
Okazaki in a study titled, "Treatment Delay Among Asian-American Patients With
Severe Mental Illness,” which was published in 2000 in the American Journal of
Orthopsychiatry. In one study in particular involving 62 Asians, she found that a
substantial portion of those with severe mental illnesses sought treatment only after the
onset of more severe symptoms.
Okazaki encountered self-conscious patients and family members during her
study. One Korean family grew irate when the doctor was late for an appointment for fear
others would see them in the waiting room of a mental health clinic. Also, a Chinese
American clinician observed that as families grew in their knowledge of mental illness
and its chronic characteristics, they exacerbated a family member's low self-esteem and
what Okazaki described as a "feeling of doom and apathy."
The Asian population has a number of factors stacked against them as they seek to
get their lives in healthier places. Their failure to be completely honest about mental

10
hardships put them at distinct disadvantages with those who have no qualms about
seeking help. They also face challenges with their inabilities to communicate to mental
health professionals and the shortage of services in the L.A. County. The biggest obstacle
they must overcome, however, is to have the courage to treat their mental illness is to
treat their condition as if it were no big deal. People take more time going to the
supermarket or pumping gas than one would taking some pills, and yet swallowing pills
that take just seconds of time has become a huge mental ordeal. In reality what makes
Asians who are mentally ill unlike everyone else is that a vast number of them treat their
illness as if it were a crime. People with mental illnesses do take pills, and some people
may need them for the majority of their years left on earth. But those pills and their
conditions are something they can own, if they fight to choose to, rather than having their
condition own them.
Kim said that for his family there is a different type of health perspective when it
comes to talking about the mental illness of his father's cousin. He described the stigma
in Korean culture as linked to a “hush, hush, don't talk about it” mentality. In order to
portray normalcy when his father's cousin was being treated for mental health issues, his
family would just tell inquirers, "he went to the hospital (for a physical illness) and he's
doing better."
The term "underutilization" means that a person or people group does not use
mental health services as much as would be expected based on the size of their group in
the general population. The U.S. Department of Health and Human Services reported that
Asian Americans have lower rates of utilization compared to Caucasians, partly because

11
they lack adequate English proficiency and partly because cannot find those who have
appropriate language skills. Embarrassment that mental illness will reflect poorly on the
family and self-conscious sources of guilt tied to Asian culture drive Asians to wait too
long before getting help, as the report also found that those who use services tend to have
more severe conditions, suggesting delay until problems become very serious.
Herrick and Brown in a 1998 study titled "Underutilization of Mental Health
Services by Asian-Americans Residing in the United States" published in the Issues of
Mental Health Nursing, shed light on other reasons why Asians underutilize mental
health services, including their tightly-knit family system, use of community-appointed
spiritual leaders and shame. Their research found that there is an underlying societal myth
that Asian-Americans are a "model minority" free of mental health problems.
On a more substantive level, Lowe, Atkinson and Matthews in a 1995 study titled
Asian-American Acculturation, Gender, and Willingness to Seek Counseling" found that
seeking help for problems can conflict with Asian values of self-control and solving one's
own dilemmas. They say that values of restraint and not bringing shame on the family
may conflict with values inherent in the verbal catharsis of psychotherapy. Asians instead
tend to overutilize academic counseling as it is more compatible with their traditional
values, while placing less emphasis on mental health counseling.
These are ideas shared by Eliza Noh, an assistant professor in the Asian American
studies program at California State University, Fullerton since her younger sister
committed suicide in 1990 after purchasing a gun and shooting herself in the head. Noh
said that despite a spike in Asian American understanding of mental health issues, Asian

12
still have the highest rates of any demographic of foregoing mental health services. While
more than half of general population seeks treatment for mental health issues, Asians
seek help less than a quarter of the time. In his research, Huey has found that Chinese and
Korean people generally distrust of mental health professionals. Reasons for this distrust
among Asians across the board could be a lack of faith in Western medical health
services, a lack of health insurance or a fear of being denied future health insurance.
The Chinese American Epidemiology Study (CAPES) indicated that Asian
American populations are three times less likely than white populations to use available
mental health services. Of those with mental health issues, less than 6 percent saw mental
health professionals, 4 percent saw medical doctors and 8 percent saw a minister or
priest. Asians are half as likely as whites to mention their health problems to a friend or
relative and one-seventh as likely to tell their problems to a mental health specialist. To
compound those problems, Asian Americans are more likely to drop out treatment early
than those of any other ethnic group. These alarming figures illustrate that there are large
percentages of people finding alternative treatments that, like Susie Lu, could lead to
disastrous consequences.
Hard Struggle
Sometimes the drive to succeed can hinder the healing process. In her late 20s,
Susie wanted to rid herself of what she felt was an unnecessary dependence to
medication.
“She had always been a person to have something to strive for, to give ‘face’ to
the whole family, to keep up with the ‘Jones’s’,” Christine Lu, the younger sister of Susie

13
Lu, said. Christine Lu knew Susie Lu better than anyone else. The difficult truth for any
patient to realize, however, is that medication is necessary to recovery; to have any
chance of even keeping the Jones’s in sight.
Contrary to popular belief, mental health professionals do not derive some sick
pleasure in giving patients something they do not need. The doctors and therapists
interviewed for this piece said they genuinely want to see their patients do well and
would even suggest their patients not to take medicine if they felt it was unnecessary.
True, journalist Nellie Bly did expose the atrocities of one mental institution when she
was a reporter in the 19
th
century, and institutions like the one in the movie Changeling
probably did exist, but we should be careful not to throw the baby out with the bathwater
and condemn psychiatry altogether. Time has shown, and patients have confirmed, that
medicines, in spite of the trouble they bring, do more good than harm. There are abuses
in every system, whether they involve schools, churches, hospitals or sports, but the man
does not generally bite the dog.
To stabilize and gather themselves for a functioning life, patients pour themselves
something non-alcoholic to drink (for it might interfere with the efficacy of the drug) and
flush a cocktail of pills into their body. At six pills a day taken after a meals (to offset
nausea), that total can add up to more than 2,000 pills a year. If properly diagnosed, the
benefits a patient receives from taking medication far outweigh both the cost of
temporary side effects and the repercussions that come from ignoring medication
altogether. The same lithium which powers batteries to give fuel to electronic devices, for
example, is, in much smaller doses, such a medication that may be used to treat bipolar

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disorder or depression and restore good moods and a functioning mind. Otherwise
peaceful people who become creatures of rage without medication can come back to
being the same, if not better, people they once were.
Patients have said that a difficult part of the process is accepting a psychiatrist's
diagnosis and trusting a doctor-prescribed prescription. After dozens of years of good
health, doctors are asking their patients to revolve their lives around pills they for decades
of their lives have never needed before. Some also are required to monitor their weight
and alcohol intake, mandating a more disciplined life.
Even after placing trust in both the doctor and pills, a patient still has to give the
drugs time to work, typically two weeks, which in Susie Lu's case simply was not
working to her liking. When patients do not seem to be functioning well after such a time,
doctors may switch their medications at which time a patient's mental state can hang in
limbo for another two weeks until further evaluation. At the time of her death, Susie Lu
appeared to have been in such a state of transition, while also going out of her way to
become the doctors of her own body. As a result, the drugs and therapy were not given
the fertile ground they needed to effect change in her life.
Alhambra's Lee said that when an Asian person takes a pill for a headache or puts
a cast on a broken wrist, there is typically little to argue about. But Western forms of
mental health treatment can pose a problem for Asian Americans who have no reason to
heal something they can’t see. Atkins said that Asians who are less acculturated into
Western society struggle most because the concept of a separate mind from one's body is
a foreign one.

15
In Susie Lu's case, Christine Lu said her sister was initially a compliant patient,
seeing both psychiatrist and psychotherapist. Her internal struggle would come as a
byproduct of her drive to continually live up to a life marked by higher standards, at war
with the reality of her need to stop and care for herself.
"When you have someone who comes from a culture of studies and pride, who, as
a person who has been used to achieving so much, it's hard not to want to wean yourself
off the meds…Her focus was to be off the meds," said Christine Lu.
Susie Lu came from what Christine Lu called a "textbook immigrant family
story," where the parents poured a flood of resources into their children’s education,
which included private schooling. The conservative parents, who condemned interracial
dating, provided every means for their daughters to decorate precollege resumes with Ivy
League worthy activities. While Christine Lu is divorced, her parents have been together
for 30 years.
Whereas medication helps a person to regulate an out-of-whack mind, therapy
helps people understand who they are. A good therapist might shed light on the meaning
of one’s ambient thoughts or unconscious behaviors. A series of sessions might give a
patient insight into their patterns of thought that might deal with an inability to trust, for
example. He or she might remind a patient that he or she needs to trust those who have
proven themselves to be trustworthy. During session, a patient sits in a chair or on a
couch, typically, and shares his or her struggles with the therapist. Sessions can range
anywhere from 30 minutes to an hour and a half and may take place once a week for

16
many years. In a form of therapy called cognitive behavior therapy, a therapist might
provide concrete ways, a sort of homework, for people to improve their lives.
Woody Allen spent more than 30 years in a more extensive form of treatment
called psychoanalysis, which investigates the mind’s unconscious thoughts or behaviors,
free associations and dreams. Allen would go three times a week. Cognitive behavior
therapy is typically much shorter in duration on average than the six year average of
psychoanalysis. Saks sometimes goes to her psychoanalytic sessions five times per week.
This form of treatment also helps people understand and examine their lives by delving
into childhood, for example. A session with a practitioner can run someone as much as
$300.
It is important to note that not every Asian who enters a therapist’s room has
severe mental health problems.
Lorena Cheng, 30, of Montebello, sought professional counseling because her
whole family was struggling with getting along. She said that she bottled up a lot of her
feelings to the point that something had to give or their family's problems of not getting
along would only increase in tension and conflict. Mark Chen, 31, of San Marino, went to
counseling because his ex-girlfriend had borderline personality disorder, defined by the
National Institute of Mental Health as an illness associated with intense bouts of anger,
depression and anxiety that may last no longer than a day. Depression and bipolar
disorder typically last weeks. Chen blamed himself for her frantic and unstable behavior.
A licensed therapist helped Chen get through some of the major issues he would not have
had help with if he were on his own. Both Chen and Cheng stayed in counseling for two

17
months. Still, depression, schizophrenia and bipolar disorder are three of the more
commonly known mental disorders that require extensive counseling and medication.

18
Chapter Three:
Resistance is Futile

Resistance to Treatment
"Therapy is my way of giving Asian people advice, like relaxation," Chan said, of
his sessions as a psychologist. Chan sees 40 patients per week, although some of them are
repeat visitors. "But Chinese patients want something tangible and practical. It can be
frustrating because they don't 'see' results right away. Many because of their high
expectations want the cure right away. Medicine is different because in 24 hours the
medication can affect brain function."
For this reason, parents of Asian children can sometimes be critical of the process
because they don't see change right away. In this scenario, Chan said, the child suffers
most.
"Parents in these cultures are not used to talking to kids about their feelings. They
are more concerned with the physical needs of food or clothing. They often do not talk
about with their children about a spiritual or mental need. Children have no model to talk
about their feelings," he said.
Once a patient sees a psychotherapist, visits with a psychiatrist like Lee also are
recommended, or vice versa. Scientific studies show that people with mental illnesses
who are treated by both psychotherapists and psychiatrists are able to recover from and
manage their illness better. Many of Lee's patients do not immediately see the correlation
between medication and good mental health.

19
Because Lee's Asian patients do not innately link the need for physical medicine
to help a mental problem, dancing around a diagnosis can help open the doors to
treatment, as patients sometimes argue that Western pharmaceutical medication can cause
more problems than it solves. Lee said he would not have a problem with tricking a
patient into thinking that a psychiatric pill would help cure a physical illness that a patient
of his may think he have. He said that patients with mental disturbances often imagine
that their body is not functioning well when there is nothing to verify the claim.
Lee said, “If you begin point blank and say it's a mental problem, they will resent
that idea and they will never come back to see you again. You must approach it from the
perspective that they do have a physical symptom but point out that it can be related to
mental distress.”
Mental problems that Asians do not confess are things like suicidal thoughts,
hallucinations or anxiety. In Lee's brightly lit office, with air-conditioning and an
ambiance of comfort, he tells me that he sees patients for about half an hour, although
new psychiatric graduates today strictly prescribe medication without engaging as much
with patients. Lee believes in close, personal contact as the best form of treatment.
Lee is one of just a handful of doctors who is Cantonese and primarily sees
Chinese patients in the densely populated Chinese area of Alhambra. He added that there
is another reason for medication resistance. Their perception of mental illness is deeply
stigmatized.

20
Atkins also spends about 30 minutes with patients. Both said that the time they
spend helps them monitor how a patient is doing and if there are any adverse side effects
with the medication they prescribe.
Consequences to Resistance
It can be difficult for those who have mental illnesses to dive into treatment
without testing the waters of what their life would be like without medication. In some
cases, the failures of their choices can hammer home and reinforce a doctor’s orders.
Stephen, who would not provide his last name, is a 34 year old who lives in
Arcadia. He is a Taiwanese American who was born in America but spent the years 4
through 12 in Taiwan. He had a much more difficult time with accepting his diagnosis of
schizophrenia. After graduating from UCLA, he worked as a journalist in Taiwan and
began hearing voices even when no one was around. One day the voice told him to stand
outside the hospital entrance in Taiwan for more than 10 hours. The voice told him not to
leave. So he didn't. But hospital staff alerted the police of his awkward behavior, and they
took him to a psych ward where he was diagnosed with schizophrenia.
Stephen was forced to leave Taiwan and join his family in the United States. He
would later go to Taiwan and be involuntarily hospitalized two more times before coming
back to the States, where he currently lives with his mother and grandmother. He would
be hospitalized once more in the United States at the request of his parents. He argued
and fought against going, but in the end consented to go to a psych ward in Pasadena. He
now acknowledges that he will be on medication for the rest of his life, a conclusion he
refused to acknowledge in both Taiwan and the U.S. Stephen is no longer a journalist.

21
Treatment resistance is not limited to Asians, and not all Asians fight their
diagnoses. But many do.

22
Chapter Four:
Rose Chau

Rose
Cynthia Chau (a pseudonym) is another resident of the San Gabriel Valley who
knows full well how powerful the grasp of mental illness can be if left untreated. Cynthia
Chau's mom, Rose Chau (also a pseudonym), has been officially diagnosed as having
severe schizophrenia for about 18 years, although she may have had symptoms even
earlier than that.
Rose Chau lived for several years in Arcadia and has been hospitalized
involuntarily around 10 times, according to Cynthia Chau, often for violent behaviors that
included shouting at odd hours of the night and pounding on walls to the irritation of
many different neighbors. She was a familiar face to the police who would frequent their
house at the request of their neighbors.
“She was screaming at night time, she was hitting a wall. She said she was hitting
the evil and that something was poisoning her,” Cynthia Chau said. "She kind of sits
there and stares at walls, has strange behaviors. She talks to things that aren’t there. She’s
tormented by something. She says there is a devil.”
Rose Chau had never been a violent person, but her actions gave other people the
impression that she was violent. When her symptoms were out of control, Rose Chau
would yell loudly at voices she heard in her head, causing disturbances in public places
like the YMCA in the broad daylight, where Cynthia Chau would take her to get exercise.
Snapping in anger and barking at the open air would scare the children in the Monrovia

23
YMCA away. Others would stare and giggle, wondering what was wrong. Rose Chau lost
friends and stopped exercising. Because of her mental illness, combined with the fact that
she spoke only broken English, Rose Chau even struggled to find volunteer work at the
Pasadena Public Library or the Arcadia Senior Community Center, causing physical
isolation that would exacerbate her symptoms.
“There was something odd about her. Something that wasn’t quite normal. It was
the way she acted around people,” said Cynthia Chau.
One of the major difficulties in treating Asians with psychiatric illnesses is that
they look outside the Western world for answers, sometimes in the form of Eastern of
Western religion, herbs, acupuncture, reflexology or more "natural" ways to solve their
problems. Sometimes, mental health professionals interviewed for this piece have said
that a patient's pursuits exacerbate already noticeable problems.
Religious Roadblocks
Rose Chau delayed treatment, in part, because of her deep Christian and Buddhist
faith.
“It is not uncommon in Asian culture to use spiritual reasons or superstitions to
explain abnormal thought patterns, like jinxes, curses or ancestral spirit possession,” Lee
said. “I’m not against anyone’s religion, but I insist on a medical and scientific
explanation, because medical intervention in this case is most appropriate. Viral
infection, for example, would be treated medically without disrespect to religion.”
In some Christian circles, practitioners would treat Rose as having a spiritual
problem, and not a chemical one. Take Michael Chen of Anaheim, a 31-year-old

24
Taiwanese American. Chen has spent much of his life in the church, teaching Bible
studies and leading youth groups for several years, also facilitating worship and reading
the Bible. In addition to being Stephen's cousin, he also has a sister (whose name he
chose not to disclose) who had been diagnosed as having depression. He said that true
treatment comes not from medicines but from God.
Michael Chen describes his sister’s struggle, which included suicide attempts,
when it was most acute:
“Her breakdown was a deep depression, it starts with a feeling of hopelessness
and darkness, a feeling that you’re alone and nobody loves you."
Asked what he would do if someone’s mental state was spinning out of control,
Chen said, “I would first recommend the gospel….to know the only one that can heal and
give salvation.” He associates mental illness with demonic activity, and would ask God to
cast out demons in certain situations.
Chen said that religion is his way of being part of someone's life, describing that
personal and spiritual relationships are what he believes are the "true" treatments of
mental illness. To be sure, religious forms of treatment are not uncommon in Chinese or
Korean circles. In fact, one 2005 study shows that Koreans have the highest percentage of
Christians than any country in East Asia except for the Philippines and East Timor at 29.3
percent.
According to Kwon, Chung and Warner’s 2001 study titled "Korean Americans
and their religions,” people seek Korean churches, because of their "accessibility and
affordability,” for various forms of salvation and familial ties. The authors also "view

25
with suspicion the discipline of psychology, which they consider Eurocentric
individualism and thus irrelevant to people coming out of a much more communal
orientation."
Chen believes his cousin Stephen's condition is made worse by his cousin's
distance from God and a religious life.
Justin Donaggho is another conservative Christian who suffers from severe
schizophrenia. When off his medication, he will experience psychotic episodes where he
could act in violent rage and veer off into addictive behaviors like gambling or drug use,
self-proclaimed “vices” from his past. Even with medication, he is prone to addictive
behaviors. He said he “hopes and is certain for the day when medications will no longer
be necessary” for him. Like Chen, Donaggho believes in the Bible to explain mental
illness and uses theology as the basis for his hope that he may no longer need medicines.
Neither the Bible nor other other-worldly intervention could stem the mental
descent of Rose Chau, who because of her schizophrenia has morphed into a woman who
Cynthia Chau said will need constant care for the rest of her life.
Never the Same
Rose Chau could no longer serve as mother to her four children, who were in high
school and college at the time. Today, and for years now, she has been the child. The
Chau family placed their mom’s care in the hands of the state through a system known as
a conservatorship. Patients who are repeatedly hospitalized involuntarily and can no
longer care for themselves, as deemed by the court, may be placed under the care of

26
friends, family or the state. Rose Chau spent a year in a Ventura County mental facility
before being released.
As she has battled with the schizophrenia throughout two decades, Rose Chau has
yet to find employment. She cannot even find a place that will take her as a volunteer.
Resisting and even forgetting to take her medicines, she has often relapsed, meaning her
behaviors have gone unchecked and fallen outside of what society would deem “normal,”
often times requiring her unwilling physical restraint.
Rose Chau decided for periods of her life that she would not take her medication,
her eight pill cocktail of pharmaceutical drugs. Rose Chau's life was a demonstration of
how the consequences for any severely distressed schizophrenic patient, when off their
medicines, can be potentially dangerous. Treatment resistance is a common thread among
Asians, according to Lee.
For Asians there is a belief system that Western medicines are wrong, from over-
the-counter medicines to prescription pills to substances than can be abused. There is a
belief that medications are artificial, purely chemical compounds and not natural. They
self-medicate with herbal medication or nutrition and sometimes cite misleading news
stories of pop culture as examples to show how medications are toxic.
Lee said that people do not want to be told they have a mental illness or tell others
they have one because they feel it will subject them to rejection and isolation and from
family and friends and signify to others that something is deeply wrong. Buzin described
this secrecy as giving power to something that is less shameful in the grand scheme of
things, the totality of one’s life, then people make it out to be.

27
Currently, Rose Chau has accepted that she needs to swallow her pills each day,
and her symptoms are much more under control. But she is at the proverbial point of no
return, with many medical experts saying that she will be permanently mentally
incapacitated. Her friends and family can only speculate as to what might have been if
she was more compliant with medication and therapy decades earlier than she was. Rose
Chau is just 62 years old.
“She regresses into an infantile stage; she even bought bottles and diapers. She
goes crazy,” Cynthia Chau said, in describing her mom’s mental state. “Then from that
she morphs in her mind into a teenager and then an adult.” Cynthia Chau said her mom
has a hard enough time remembering to take her medicines these days. Although she is
pleasant and optimistic about her own life, Cynthia Chau is in a tough spot, having a
responsibility that no one would envy.
Cynthia Chau and her husband last year chose to bring Rose Chau back to live
with them. Although Cynthia Chau is only in her 30s, she has taken on an immense
responsibility for her family and siblings. After a 40 hour work week, she devotes her
free time to cleaning up after her mother, making excuses for her in public and
monitoring her mother’s every moment in public and private.

28
Chapter Five:
Concluding Thoughts

The Need to Comply
Not all Asian patients, however, are treatment resistant. Take Cho, who had
family and academic issues that weighed upon his mind. Feeling pressure and anxiety, he
immediately sought the help of a psychiatrist who prescribed him medicine. He took
them without questioning.
Cho that mental illness is not only a sign of weakness in Korean culture, but also
a symbol of incompetence and poor judgment and willpower. The myth is that those who
need pills have a deficiency in who they are as people. But that creates a tension for those
who already have a hard time taking their medication faithfully because a problem that
can be managed with treatment can enter a crisis phase that may end up costing an ill
person extensive time in getting his or her life back on track.
“The saying in Korea is that men should be able to deal with their problems, no
matter how severe,” Cho said. “The Korean mentality is to suck it up and deal with life.”
Cho took his medicine upon recommendation and was never hospitalized.

(See Sidebar No.1)
Gayle Karen Young, a consultant and psychologist, faced a severe depression and
bipolar symptoms as a sophomore in Scripps College. She too was never hospitalized.
“Just showering for the day was a huge triumph,” Young said. “This could go on
for months. I had this off and on for a number of years. I hid from people, not wanting to
engage or talk with them.” Once spending thousands of dollars in mere weeks shopping

29
on clothes and accessories, she felt that her identity as a Chinese American was a
contributing factor to her illness.
“I think it was an identity perspective that pushed me over the edge. It’s what you
have to hide and the pressure to conform is the pressure that certain ways of being is right
and others are wrong,” Young said. “If you’re not in that mold then something is wrong
with you. As Asians you have to hide aspects of yourself from Chinese culture that are
non-traditional in American culture. As those who are raised in America, Caucasians
don’t have to hide.
She said that her parents, both Asian, were also averse to therapy.
“Asians don’t understand therapy at all,” Young said. “Most people don’t get
therapy and they say, ‘What’s it going to do?’ My mom tells my sister, (who also suffers
from depression) ‘Why can’t you just talk to me?’ Family can’t be therapists, they lose all
objectivity. Talk therapy provides continuity and prevention.”
Speaking in a separate interview, Gayle’s mother, Benny Young, added to the
picture, but more from a biological point of view. “Gayle also has thyroid disease, and
her aunt has schizophrenia,” Benny Young said. “The thyroid problem caused mood
swings and we didn’t pick up on the depression. She was sheltered at home.”
Model Minority
Beyond genetics, there is the idea that mental illness among Asians is quite hard
to detect. Benny Young, speaking about her daughter, said she “behaved so well.” Noh of
Cal State Fullerton said that the roots to these model behaviors have origins in Asian
history, that Asians are “culturally submissive and not very individualistic.”

30
Asians are often deemed a "model minority" because of they have the highest rate
of college degree attainment, the highest number of advanced degrees and the highest
percentage of workers in high-skill occupations, as noted by a study conducted by Reg
Weaver. Similar studies have shown that Asians significantly outperform the national
average when it comes to number of degrees. The model minority status also applies
because Asians give little indication that they need help, academic or otherwise, even if
the reverse is true. The silence that is sometimes conveyed in a classroom or otherwise is
not just based on being polite and non-confrontational, but also the strong emotions that
are bottled up inside oneself.
Mental health awareness and openness has been rising among at Cornell
University, where Asian attendance at mental health meetings spiked from 10 to 100 in
2008. The change, said students, was that there is no longer a great fear of being
associated with mental health issues. For Susie Lu, those discussions did not come soon
enough. She told her sister Christine Lu of her condition just six months before the fatal
day in which she would take her life. Her disclosure, which included the methodical ways
in which she might take her life, was an example not only of how destructive depression
can be, but also of how great the pressure was to be silent, even with her closest family
members and friends. It is also a testament to the ways in which people underestimate the
reality of the power mental illnesses can have. Tears streaked down Christine Lu’s face
and her voice quivered when she remembered her sister’s final days at the end of our
interview.

31
Asian American Women
Noh said that suicide is the second leading cause of death among Asian American
women ages 15-24 and that the suicide rate increases as women get older. In 2007 the
Department of Health and Human Services reported that Asian women between the ages
of 15-24 had the highest suicide rate of women of any race or ethnic group in that age
group. According to the National Center for Health Statistics, Asian Americans and
Pacific Islander communities have the highest rate of depressive symptoms than all other
racial or ethnic groups among adolescent girls and female college students.
The University of Washington in late August reported that U.S. born Asian
American women are more likely to both think about and attempt suicide than national
estimates of for all American women. Research from the "Archives of Suicide Research,”
which surveyed 2,100 individuals, revealed that Asian American women have
contemplated suicide more than the national average by 2.5 percent (15.9 to 13.5). Some
studies have shown that Asian women feel the need to be the perfect mother and perfect
wife, struggling to want to be more individualistic and feeling guilty if they go too far.
Noh believes that societal and cultural pressures contribute to Asians facing mental health
problems.
“There are pressures that come from school and parents and community. That’s
one piece of the picture. The other one is not family or community, but social. The social
ideology is the stereotype of them being successful economically as well,” said Noh. She
said that the “model minority” myth is just that, a myth. This false sense of reality both

32
internalized and externalized continues to put unneeded and unnecessary pressure across
a broad spectrum of the Asian population in America.
Noh said the Asians who do succeed have resources unavailable to most of the
Asian population. “Some [Asian kids] have parents who are highly trained and place their
kids in SAT courses so they can do well. But there are kids whose parents come from
working class backgrounds and have multiple jobs. These students generally do not do
well,” said Noh. “The myth does not look at diversity among Asian Americans.”
Where to go from here
Among certain sectors of the Asian population in America, studies have shown
that when Asian Americans are in treatment, there is a high likelihood the will stay in
treatment for a longer period of time, said Huey of USC. One reason for this is that those
who are immigrants will latch on to the little access to good health care that they have.
Mental health issues are complicated, whether they are based on age, education,
background, status, culture, family structure or history. Because every Asian ethnicity is
distinct, it is critical to find mental health professionals who are sensitive to specific
cultures so mental health services can be delivered appropriately and in a timely manner.
Services should be appropriate for every culture and for every individual person. Mental
health professionals hope to eliminate the stigma tied with the illness. It is important that
mental health professionals be prepared for any and every complicated issue that may
arise. The situations and circumstances that might be conducive to one person's getting
help for a mental illness may very well hamper a similar person’s quest for treatment.

33
Asians do share similarities, but with the diversity of Asian cultures found just here in
L.A. County, there are many differences as well.
Should anyone be wondering what to do when faced with a situation that has not
reached the heights of an emergency, Lee said that there is certainly nothing wrong with
suggesting, to an Asian or any other, a mental evaluation with a psychiatrist. The best-
case scenario would be that something catastrophic has been avoided. The worst-case
scenario would be that there was simply a harmless mistake made that will not affect
anyone’s future.
And if there are those struggling with the financial aspect of receiving treatment,
Medicare offers monthly disability checks. Those with Medicare may even find a
psychiatrist who will take Medicare reimbursements. For those with existing insurance,
like Blue Cross, there are discounted rates. With the current economy, there are doctors
who will accept reduced rates if payments are made in cash. There are also four locations
that provide mental health and case management services as part of The Saban Free
Clinic throughout Los Angeles.
Psychoanalysis is available for a fraction of the high regular cost of therapy
sessions at certain clinics, often because the therapists are students. Despite the cheaper
costs, money is an issue and an important consideration for any person with struggling
with finances, especially in this economic climate.
The question for potential patients and their loved ones is whether or not the
hazards of abandoning treatment outweigh the need to save one’s dollars, because a
fragile mental state can end up costing thousands upon thousands of dollars more in

34
medical and hospital bills if a mental illness is not kept in check immediately. Not to
mention the preventable pain and suffering many of those interviewed for this piece say
they would have avoided with some helpful intervention.
The stigma that is attached to mental health is quite a big one, according to
Arcadia's Buzin, who said that hardly any Asian patients with mental problems would
come to see him at all before going to hospital in emergency situations. Around 60
percent of Arcadia is Asian. “Now,” he said, “at least they come in." Mental health
professionals believe intervention is key to prevent mental health problems from getting
worse.
Perhaps the best way to help those with mental illness, Asian or otherwise, is to
reverse the stigma attached to it. We in the media carry the responsibility, according to
Saks, of portraying mental issues in the most sympathetic light as possible. Without the
change, Noh said, myths that portray Asians as "the model minority" and other unhelpful
designations may persist.
"The Chinese community should be more supportive, culturally speaking. It is a
broken culture," said Christine Lu. "The day of my sister's funeral, some people came up
to me at the reception and said their cousin committed suicide, or that they had
depression. So many people have it, but hiding it makes us part of a stupid secret club.
We've all become so good at covering it."
Sidebar No.1
Much of Korea, Cho said, is still highly conservative. For example, model Kim Ji-
hoo committed suicide in October, 2008 because of the public prejudice toward gay

35
people and the challenges they face in the entertainment industry. Ji-hoo was part of a
television program entitled “Coming Out” and announced his sexual orientation in a
move that did not sit well more conservative Koreans. After a racy scene in the Korean
version of "The Scarlet Letter" actress Lee Eun-ju took her life. Other popular Korean
actresses including Choi Jin-Sil, Jang Ja-yun and Woo Seung-yeon, also took their lives
struggling with depression within the past year alone, according to Korean reporters.
In 2005, 48 million people lived in South Korea, according to the World Health
Organization. There were 2.6 social workers, 0.8 psychologists and 3.5 psychiatrists per
100,000 people. By contrast, the United States had 35.3 social workers, 31.1
psychologists and 13.7 psychiatrists per 100,000 people. Despite the stark differences in
these numbers, Cho said, South Korean culture is improving. In China in 2005, there
were 0 social workers and 1.29 psychiatrists per 100,000 people.

Abstract (if available)

Abstract Extensive research shows that Asians do not make use of mental health services, for reasons that range from their fear of Western medicine to the notion of “saving face.” Studies also indicate that depressive symptoms are highest among Asian female adolescents and college students ranging in age from 15-24. Women in this demographic also have the highest suicide rate. This professional project features interviews with me from mental health professionals, ethnic studies professors and those who have mental illnesses themselves to probe the relationship between mental illnesses and Asian Americans.

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Asset Metadata

Creator Chua, Winston Lloyd (author)

Core Title Mental illness: the Asian American experience

School Annenberg School for Communication

Degree Master of Arts

Degree Program Journalism (Online Journalism)

Publication Date 11/26/2009

Defense Date 11/26/2009

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Asian Americans,Asians,bipolar disorder,Chinese,Depression,experts,Korean,mental,Mental Health,mental illness,OAI-PMH Harvest,schizophrenia,Treatment

Place Name Los Angeles (counties)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Lih, Andrew (committee chair), Castaneda, Laura (committee member), Huey, Stanley (committee member)

Creator Email study2live@gmail.com,wchua@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-m2771

Unique identifier UC1281217

Identifier etd-chua-3380 (filename),usctheses-m40 (legacy collection record id),usctheses-c127-278128 (legacy record id),usctheses-m2771 (legacy record id)

Legacy Identifier etd-chua-3380.pdf

Dmrecord 278128

Document Type Project

Rights Chua, Winston Lloyd

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Repository Name Libraries, University of Southern California

Repository Location Los Angeles, California

Repository Email cisadmin@lib.usc.edu