Mental Health and the Model Minority: Social Barriers for North American East Americans
By Chelsea Cao
By Chelsea Cao
In an age-old trope, Asian-Americans are perceived and characterized as one of the most well-educated and successful minority groups in America. Though outwardly positive, this “model minority” label can set unhealthy expectations and prevent Asian-Americans seeking mental healthcare from escaping this image. Consequently, East Asian students are uniquely understudied in the context of mental health, but the few studies done on East Asian populations reveal startling statistics. Only 8.6% of Asian Americans have ever utilized mental health services compared to 17.9% of the general population , yet 22% more Asian Americans than White high school students consider suicide . In addition, Asian American university students experience social anxiety to a degree that is up to twice as intense as that of European American students . These numbers suggest that the low reported rates of psychological distress among Asian Americans are more attributable to obstacles to accessibility than a lack of need .
Focusing this discussion on East Asians narrows this analysis to a manageable scale, as the category of “Asian” is a broadly comprehensive racial representation . Furthermore, this article will center around the experiences of young adult second-generation immigrants, who are defined as either the children of immigrants or immigrants who experienced much of their childhood and adolescence in North America.
East Asian Values and Culture:
The impact of cultural beliefs, familial obligations, and social pressures on young adults is multifaceted. East Asian values and culture play numerous and varied roles in the lives of second-generation immigrants. Individuals either embrace or distance themselves from the belief systems of their parents, ultimately leading to mixed effects on mental health. Adherence to cultural values can result in resistance to treatment and manifestations of physical symptoms in mental illness while rejection of one’s culture creates stress on its own. Taken together, these factors can promote mental wellness or increase personal reticence to obtain mental healthcare.
Several cultural commonalities link different East Asian populations and affect how individuals perceive mental health. Two of the most common attitudes are the elevation of the collective over the individual and the emphasis on respect for authority and elders. These values define the concept of the East Asian family, a unit in which individuals are prescribed certain roles and loyalties . To this end, young East Asians often hold obligations to their families and parents in the form of academic and vocational success . These values partially explain why East Asians with low self-perceived status are more likely to have difficulties with mental health .
Filial piety also interplays with another East Asian cultural value: loss of face. Loss of face is defined as a loss of dignity and respectability that arises as a result of an individual’s actions. Across East Asian cultures, mental illness is commonly perceived as an individual’s lack of self-control and consequently causes loss of face . Thus, individuals and families may seek help only when the disruption caused by mental health issues spreads beyond the reach of the immediate family . However, this delay can also be dangerous. In a study by Kalibatseva et al., loss of face and depression were shown to be correlated, giving rise to a vicious cycle .
In short, greater adherence to East Asian values is inversely correlated with willingness to seek psychiatric help . However, when young East Asian students run contrary to these values, they often encounter intergenerational conflict, subsequently creating more psychological stresses, such as increased depression and alcohol use [13,14]. Distinguishing between these often blurred impacts of cultural and familial values will be critical to increasing East Asian access to mental healthcare.
Bias and the Perceptions of Others:
The difficulties that East Asian students face are attributable to not only their own cultures and values but also to their social environment. The influence of peers, authority figures, relatives, and their beliefs may be a tremendous source of anxiety and mistrust .
East Asian stereotyping is pervasive in daily life: many believe East Asians to be smart but one-dimensional and fixated on academic or vocational achievement, and East Asian parents are believed to be demanding, cold, and stingy with affection [16, 17]. These stereotypes, though potentially accurate to an extent, are certainly not always true. The negative impacts of these stereotypes reach beyond casual settings. For example, experiments performed in 1980 showed that White therapists tended to view East Asian patients as more depressed and inhibited than Asian therapists did, and East Asian therapists thought White patients’ pathologies were more severe than White therapists did.18 Later studies also indicate similar biases; for example, Russel et al. showed that ethnically matched therapist-client pairs tended to evaluate patient psychiatric functioning higher than mismatched pairs .
The above examples indicate therapists’ willingness to overpathologize their patients, but the opposite is likely to occur as well. Therapists may attribute certain behaviours to cultural origins rather than psychological disturbances. For example, a client’s extremely reserved communication style could be ascribed to their cultural background rather than depression or other mental health conditions . Thus, detrimental delays in diagnosis and treatment arise due to under-pathologizing.
Therapist misinterpretations and biases against East Asians impede diagnosis and treatment. Ultimately, this leads to a 36% dropout rate from mental health services and a mean session length that is half as long for patients in mainstream services as for those in ethnic specific services [21, 22].
Despite these challenges to mental health, there is potential to help the East Asian community. Interventions for East Asians mainly focus on reducing psychological barriers and outsider prejudice in hopes of individuals more easily obtaining and remaining in treatment. Commonly presented solutions address all of these issues by reducing bias, promoting intergenerational understanding, and increasing access to resources.
One proposed solution that addresses culturally sensitive care is the use of informal resources to connect patients with providers. Spencer et al.’s research showed that East Asians were especially inclined to use community resources, such as spiritual leaders, in times of psychological distress. Given these advice-seeking behaviors, community health workers would be an effective bridge between patients and counselors .
Ethnic specific services (ESS) is another model of care that employs bicultural and bilingual providers and culturally relevant services that specifically address beliefs surrounding mental illness and treatment . Research done in Los Angeles County has found this model to be promising, with ESS patients returning more frequently, staying in treatment longer, and reporting greater gains in functioning . These positive results were theorized to be due to ESS’s ability to serve its clients in the least costly and restrictive manner.
Underutilization of mental health resources by East Asians in general is masked by a perceived lack of need. However, these individuals actually face barriers in accessing help due to their cultural values and others’ perceptions. Proposed solutions center around mitigating these barriers through special services to encourage East Asian access to and retention in mental healthcare. More studies of East Asian psychiatric distress will shed light on the truth behind the model minority myth, ultimately bringing greater gains in mental health outcomes for East Asian Americans.
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