A young woman, daughter of a prosperous family who fled Saigon in 1975, appeared suddenly in the emergency room of a suburban Washington hospital. She told attendants she was seeking a young doctor who would marry her and take care of her.
A man, once a colonel in South Vietnam's army, worked as a restaurant busboy but became "so sad he just didn't talk anymore," a lawyer said. Frustrated, his wife demanded a divorce -- an action the family would have considered unthinkable in Asia.
Those are two examples of what local health and federal officials say are the alarming and -- until recently -- largely unrecognized mental health problems now surfacing amoung the 240,000 Indochinese refugees who have settled in the United States since 1975.
Admittedly the number of refugees suffering psychological problems is a minority, but mental health experts estimate that the percentage of refugees with such troubles is about three times that of Americans.
Interviews with social workers, federal officials and Indochinese community leaders indicate that behind the many success stories of former generals happily working as dishwashers are many troubling accounts of refugees who are experiencing serious traumas coping with American society.
Those problems are becoming increasingly visible in the Washington area, which is believed to have the third largest Indochinese refugee population in the country.
Local caseworkers tell of single young men without families who spend their salaries drinking and gambling, of depression and anger that results in wife-beating and child abuse and of an elderly woman so wretchedly homesick that she committed suicide by leaping from an Arlington apartment building a year after her arrival here.
More common, say these officials, is the breakup of long marriages among refugees, whose culture prizes family harmony and stigmatizes divorce, as well as serious conflicts between parents and children.
There are adjustment problems of refugees who find it hard to accept the transition from a palatial two-story villa in Saigon ith a staff of servants to a small, barren apartment in Arlington furnished with second-hand, mismatched furniture.
Neither federal nor local officials say they keep statistics on the number of refugees who seek help, but pat DeLeon, executive assistant to Sen. Daniel K. Inouye (D-Hawaii), said that according to recent HEW estimates, three in 10 refugees -- as compared with one in 10 americans -- are having problems serious enough to require professional help.
Officals say that most refugees are loath to admit adjustment problems and many are profoundly suspicious of Americans. "They are very polite and they'll just smile and tell Americans that everything is fine," said an Indochinese caseworker in Northern Virginia who asked not to be identified. "Often they'll even avoid us. In Vietnam, only crazy people [are thought to] need help."
"In Asia, you go to your family for help," said Bill Eckhor, associate director of refugee affairs for the Department if Health, Education and Welfare. "You never admit to anyone outside yoru family that anything is wrong.
"Some of the problems we're seeing are cultural differences," Eckhof said. "For instance, a family discipline problem in Vietnam would include physical punishment, but very often that runs counter to our child abuse laws."
One Vietnamese social worker recounted a recent case in which different Asian and American values dramatically collided. A 15-year-old girl who lives with her parents and younger brother in a suburban apartment complex was forbidden by her father, a once wealthy Saigon colonel, from seeing her 21-year-old Vietnamese boyfriend.
When the girl came home late one night after a date, her father beat her. The next day the girl called Fairfax County's Child Protective Services and told authorities she was being systematically abused by her father.
Two caseworkers found no evidence of child abuse, and they warned the father against hurting his children.
We told him that he could not beat the children, that he must talk to them," a Vietnamese caseworker said.
"The daughter told us that she wanted to be taken away from her parents and placed in a nice American foster home, because friends had told her that American parents please their children more and let them do whatever they want."
The idea that a child would in any way challenge her father's authority, let alone report him to authorities, is unthinkable to many Indochinese.
"It's very important to try to work things out with community leaders or in the family itself," said a Vietnamese community leader "Once you involve anyone else, especially the police, the loss of face is so overwhelming that there's almost no way to get the family back together."
Father Nguyen Quang Thuy, a Catholic priest now a mental health worker in Fairfax County, agreed.
"There's a lot of fighting among families here, which you would never see in Vietnam. There the man is the head of the house and the wife and children are supposed to be very subbmissive. The man has the right to do whatever he has to in order to preserve that."
Because there are no laws governing victims of child abuse or wife-beating, "nobody in Vietnam would have paid any attention" had these crimes been reported, said Dr Tran Minh Tung, a psychiatrist at George Washington University Medical Center."But in America, these thins are being reported either by neighbors or some refugees themselves and that confuses many refugees."
(But Dr. Tung is quick to point out that while occasionally wife-beating is accepted in Asian cultures, repeated and serious abuse of women or children is not.)
Many refugees are also confused and upset by the change in status of children within the family. "The kids go to school, and learn English very fast and the parents don't, so the child serves as the family interpreter," said HEW's Eckhof. "The child just usurps the role of older family members who in Asian culture are given great respect and authority."
While Indochinese parents are trying to cope with puzzling behavior in their children, husbands and wives often find that American views of women and marriage differ dramatically from Asian attitudes.
"In Indochina, the wife was the minister of interior, so to speak," said Ronald Seguin, Indochinese coordinator for Arlington's Department of Human Resources. "Women almost never worked outside the home, they directed the servants, took care of everything. But here, because women often get jobs more easily than their husbands, they're still expected do completely run the household. When an Indochinese woman asks her husband to, say take out the garbage, well he's just shocked, he can't believe it."
Area mental health officials say that they expect the current monthly influx of 600 boat people -- part of the 14,000 per month who are being admitted to the United States under under relaxed immigration quotas -- will present more serious adjustment and mental health problems than past refugees.
"Many of them have inflated expectations," Seguin said. "They came here and they see how some of the earlier arrivals are living -- that they've bought houses and small businesses -- and they think they should have these things too, in a matter of weeks. There are just enormous frustrations at not being able to adjust quickly, not learning English faster."
This year HEW is spending nearly $3 million on mental health programs through the Indochinese Refugee Assistance Program, which funds most local services for refugees.
"One of the major problems is that most refugees now do not use existing mental health services," said Dr. Tung; the problem has been compounded by American officials who have been slow to recognize that refugees are having serious psychological problems, he said.
"It's understandable that these problems might not be recognized right away," Dr. Tung said. "Things like depression, and family conflicts seem less serious than when someone comes here with no job, no housing and no knowledge of English. But in terms of Long-range effects, mental health problems are really much costlier because they require other Services. These problems really [affect] the whole refugee resettlement program."