Almost a year before the March 16 shootings in Atlanta that claimed the lives of eight people, six of them Asian women, a petite Japanese woman in her 60s was shoved down “like a football player” on her way home from buying groceries in New York City. The woman, who spoke on the condition of anonymity because she is still worried about her safety, initially was reluctant to report the incident to the police, even though she was convinced she had been singled out because of her race. Her son eventually did it for her; the perpetrator was never caught.

“The culture is not to speak up,” said the woman, who emigrated from Japan in 1977 and added that she had never felt harshly discriminated against until Donald Trump was elected president and hate crimes against Asians began to increase. “We woke up and we really saw what America is about, unfortunately,” she said.

Since the woman was attacked, the number of hate incidents against Asians has surged and has left the community feeling under siege. And in the face of cultural as well as systemic barriers, many Asian Americans and Asian immigrants are struggling with the constant emotional onslaught.

Therapists and community members say it’s common for immigrants, Asian or otherwise, to want to avoid making trouble or drawing attention to themselves. But Asian immigrants in particular, as well as many Asian Americans, also face some traditions that discourage speaking up and turning to mental health resources.

In many East Asian cultures, “there’s this sort of implicit understanding that you’re to suffer and you are to endure it,” said Steven Sust, a Chinese American who is a child-and-adolescent psychiatrist at Stanford University. “There’s a Chinese statement like ‘bitter life,’ or ‘life is bitterness’ — ‘meng fu,’ ” Sust added, which, he said, means “to just sort of grin and bear it.”

Charissa Cheah, a Chinese American psychology professor at the University of Maryland at Baltimore County, added that culture, immigration status, the language barrier, the “model minority” myth, and a lack of resources for and research about the community all play a role. “Don’t make too much noise, don’t make trouble where your legal status or legitimacy as an American is often questioned. . . . This narrative continues where you don’t feel as if you have a right or the legitimacy to complain when these things happen to you,” she said.

Song Kim, a social worker who emigrated from South Korea at the age of 5, can relate. “I didn’t grow up with my parents teaching me how to have a voice to be able to speak up when something happens,” she said. “I’ve experienced bullying in my life. I’ve experienced harassment in my life. I was never taught the skills to speak up or seek help.” In addition, “I didn’t really see my own parents standing up for themselves, either.” 

This sensibility can have a devastating effect, experts say, compounded by a lack of mental health resources in the necessary languages and a shortage of counselors who are not only sensitive to these realities but who share Asian heritage. Asian psychologists make up about 4 percent of the profession, while the Asian share of the nation’s population is closer to 6 percent, according to Helen H. Hsu, past president of the Asian American Psychological Association, and it can be difficult to find Asian therapists in some areas of the country, especially the South.

In the past year, there has been much fear, anger and sorrow to bear. According to Stop AAPI Hate, a national coalition aimed at addressing anti-Asian American discrimination, there were a total of 3,795 self-reported incidents against Asian Americans and Pacific Islanders (AAPIs) across the United States between March 19, 2020, and Feb. 28, 2021, ranging from verbal harassment such as being called “coronavirus,” to physical assault including being coughed at, spit on and punched. Experts say the number of incidents is probably underreported, because of cultural obstacles barring community members from speaking out.

Racism takes a toll on mental health, these experts add. In spring of 2020, the American Academy of Pediatrics conducted a study co-written by Cheah on the effect of coronavirus-related racism on the Chinese American community. It found that coronavirus-related “experiences of racial discrimination were associated with higher levels of reported generalized anxiety and depressive symptoms,” the researchers wrote, a finding that was “consistent with previous studies on daily discrimination” among Asian Americans.

Meanwhile, Mental Health America said the percentage of people who identified as AAPI and requested screening for anxiety and depression increased from 10 percent of its screening population in 2019 to 17 percent in 2020. In February of 2020, 79 percent of AAPIs screened had moderate-to-severe depression. But by the end of 2020, the percentage had grown to more than 86 percent. And the Census Bureau found that in June, during the height of the racial protests, Asian Americans with symptoms of anxiety or depression increased from 28 to 34 percent, a spike that represents an increase of about 800,000 people.

Although the numbers of Asians experiencing anxiety and depression is rising, Asians in the United States access mental health care at half the rate of other racial groups, according to a 2019 study published by the American Psychiatric Association.

This study cites “feelings of shame, stigmatization, and an unwillingness to burden others” as reasons Asian immigrants and Asian Americans did not seek out therapy.

In the past few years, however, social justice and grass-roots Asian American organizations have come together to encourage to Asians speak up and to challenge the bias against mental health care. They’ve held rallies, offered free intervention workshops and created directories of resources. And they’re not shy about taking on the cultural norms that have kept Asians silent.

For example, when Hollaback, an anti-harassment nonprofit, teamed up with Asian Americans Advancing Justice to offer bystander intervention training, one of the biggest issues was that “some folks are taught to just keep your head down,” said Jorge Arteaga, deputy director of Hollaback. “The way we try to address it in the training is saying, ‘If it happens to one of us and we don't do anything, that means we’re okay for it for it to happen to all of us.’ ”

 Since March 2020, the partnership has trained 16,000 people as bystander interventionists, and in the past couple of weeks interest has grown exponentially. After the Atlanta shooting, 6,000 would-be trainees signed up for a workshop, so the groups have had to add more training dates.  

Other organizations have stepped up, as well. The Asian Mental Health Collective, a nonprofit that seeks to bridge the gap between the Asian community and such resources, created a database of Asian therapists. New grass-roots organization Stand With Asians recently held a discussion on the new social media platform, Clubhouse, asking community members to take off from work on Friday in solidarity. And the Asian Mental Health Project has been hosting Instagram Live sessions, including one after the shootings that addressed how to cope with the trauma of hypersexualization in the Asian American experience.

“Times are changing, and we certainly see a generational shift in many ways that we see across other races and ethnicities, but our younger cohorts are absolutely more open to discussion and are really bringing families along as part of that,” said Theresa Nguyen, chief program officer of Mental Health America.

With all of this “ugliness right now,” said Hsu from the Asian American Psychological Association, it’s important for Asians to take steps to feel more in control, whether they’re ready to seek therapy or not.    

She advised turning off the news, getting more sleep and spending more time with family. Another important step is to grant oneself or others the permission to process feelings of trauma.  

“Give yourself some time to feel,” said Christopher Vo, a Vietnamese American therapist in Houston who co-founded the Asian Mental Health Collective. The Atlanta shootings, he said, are “just a reflection of hundreds of thousands of minor interactions that we’ve encountered in all of our lives growing up. Take the time to step away from your workspace, from your friends, if you don’t have the energy. Take the time to grieve.” 

When a community feels threatened and under siege, said Russell Jeung, San Francisco State University professor and one of the co-founders of Stop AAPI Hate, it often turns to what he calls the F’s: fighting, fleeing or freezing.

 But the most important “F” that he recommends to his students is flocking to one another to share what they’re feeling. 

The Japanese American woman who was assaulted a year ago relates to this approach. She says the focus shouldn’t be on cultural traditions that may discourage Asian and Asian Americans from speaking out or seeking therapy, because she thinks that further victimizes the community. Instead, she said, the focus should be on how therapy can take many forms; she chose to confide in her friends and express herself through art.

“Storytelling has power,” said Cheah. “It emboldens others to share their stories as well,” she added.

 Sharing her story is what especially helped Kim, the social worker from South Korea. Although she grew up in a culture that did not promote speaking out, she said, the candid conversations she had with her friends were a source of relief.

It’s created a “ripple effect,” she said. “When we’re able to have this conversation with one person, it gives us the strength to have more.” 

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