Growing up, I noticed more and more of my peers telling me they were diagnosed with ADHD. I did not quite understand it at the time, other than the fact that they received more testing time and were placed in a separate room. Coming from an Asian household, I was raised to face challenges directly – if I was distracted, it was a mindset issue, so my tangible change was in adjusting my attitude. I assumed blaming ADHD was just an excuse for mental weakness. It was not until I had a roommate who explained her attention struggles from the way her brain worked without medication, that my beliefs shifted, and I began suspecting my sister also had unaddressed ADHD.
The first time I brought this possibility up to my parents, my mom brushed it off, saying my middle school-aged sister just had an “active, growing brain and that no medication should ever be relied on”. The second time was when my sister was a high school freshman, and my mom gave her a lecture, saying academics were a vital part of her life and she could not afford to miss major assignments and grades. It was brought up several more times when she did in fact miss these assignments and was nearly put on probation, despite her diligence. Only after her senior year did my parents finally relent in asking our pediatrician about a potential diagnosis at her annual checkup. When the physician asked questions to her privately, there were still two problems: 1) my sister was too old for the office to test or diagnose her so she would have to find a psychiatrist to do so, and 2) my sister herself did not acknowledge any of her own attention struggles. Although I had hoped for better, my sister has now started college, and our family is still in the conversation stage of finding a psychiatrist for her. Our whole family has had hesitancy in broaching the subject of mental health, which reflects the cultural values of endurance and restraint shared by many in the Asian-American community.
There are numerous barriers to utilizing mental health resources for the Asian-American community, including but not limited to linguistic differences, limited access to care due to cost or lack of insurance coverage, and lack of awareness of these services. However, one study revealed that second-generation Asian Americans (U.S. born sons and daughters of immigrants), were closer in their use of mental health services than to third-generation individuals. Why might this be?
Many second-generation Taiwanese Americans grow up struggling with Eastern values and Western expectations. Writer Leona Chen expresses this tension in her blog: “While I cannot uncritically inherit all of my elders’ beliefs, I will not let them bypass my careful consideration.” Prevalent in Western society is the model minority myth, a stereotype, presenting Asian Americans as quiet hard workers who “succeed” in comparison to other racial minorities. Expectations to conform to this harmful stereotype have been cited to be one of the strongest sources of stress for Asian American youth. Cultural norms such as emotional restraint, fear of stigma, and a desire to preserve family harmony have been shown to discourage help-seeking behaviors among Asian Americans. One study pointed out that over the course of one year, Asian Americans had lower rates of mental health care use (8.6%), versus 17.9% in the general U.S. population. Eunice Yeun, an assistant professor of psychiatry, shared that “AAPI folks tend to have really low service utilization, meaning they don’t get help until they’re severely sick, and then show up in the emergency room and need to be hospitalized. And it is not uncommon to hear an AAPI teen or young adult having depression and suicidal thinking for three to four years, and their parents having no idea until it’s really severe.”
Even when younger individuals recognize they need support, family values may discourage seeking help. Cultural beliefs equate mental health care with weakness or “losing face.” In a CAPS (Chinese American Physicians Society) scholarship statement, one student shared: “When I suggested that I may need therapy, many of my family members and friends were supportive, but the elders were repulsed… they believed only ‘crazy people’ needed therapy.” Part of the disconnect comes from lived experiences. Many Asian elders have gone through hardships like war, political instability, and immigration. Additionally, according to Taiwan News, over 75% of Taiwanese over 50 who have experienced some form of depression do not seek help. When younger generations express their mental health concerns, their experiences may be dismissed in comparison, further discouraging open communication about mental health.
But, is resilience only a barrier to mental healthcare within our communities? It can also be deeply protective when adapted to our changing times. In Asian-American adolescents, higher self-esteem and strong family connection, both integral components of resilience, were linked to significantly improved long-term mental health outcomes. Even in the face of racial discrimination, Asian Americans with high resilience and a strong sense of cultural identity experienced greater stress-related growth during the COVID-19 pandemic. True resilience must be rooted in navigating adversity with flexibility, cultural connection, and understanding. There’s a time for pushing through, but there must also be open space for speaking up. Strength can mean persistence, but it also means knowing when to ask for help and feeling safe enough to do so.
Overall, cultural expectations around endurance, duty, and family honor have shaped Asian American generations, so what can our communities do to promote “healthy” resilience?
Here are a few ways our community is working to discuss this narrative—and what more we can do
- Elevate mainstream attention to Asian American mental health and cultural themes of familial piety. Public figures like Jeremy Lin and Constance Wu discussing the subject and movies like the Farewell help to spark meaningful conversation
- Being in community, such as joining youth programs that foster cultural connection with other like-minded individuals
- Destigmatizing mental health at familiar spaces like Taiwanese cultural centers and churches, to allow members to become more comfortable with asking questions and accessing support
- Promoting accessible resources, such as utilizing the therapist directory on websites like the Asian Mental Health Collective, Anise Health, and TACL’s Mental Health Resource Page
By meeting people where they are and applying a cultural lens, “endurance” can be reframed: not just as pushing through, but as the strength in asking for help and supporting one another across generations.”
Bios:
Evelyn Fung is from Bellaire, TX, and majored in Business Honors with a biology minor at Texas A&M University. She is currently a D1 Dental Student at the Woody L. Hunt School of Dental Medicine in El Paso, Texas, a designated Health Professional Shortage Area and a border city. Outside of spreading confident smiles, Evelyn is also passionate in public health, cultural exchange, playing guitar or violin, and dance.
Stephen Chien is a 4th year medical student at Drexel University College of Medicine pursuing PM&R. Originally from Rowland Heights, CA, he graduated from UC Berkeley with a Bachelor of Arts in Public Health. At Drexel, he served as Co-President of the school’s local APAMSA chapter and has continued to serve on the National Board as the Mid-Atlantic Region Director for the past 3 years. Stephen’s professional interests include medical education, health disparities, and global health. Outside of medicine, Stephen enjoys sharing riddles, collecting sports cards, all things basketball, and exploring the local food scene.