Archive of ‘Racism’ category

Raising Awareness of Mental Health in the AAPI Community

May is recognized as Asian American and Pacific Islander (AAPI) Heritage Month and Mental Health Awareness Month. These two observances provide an opportunity for us to reflect on the unique challenges faced by the AAPI community when it comes to mental health and well-being.  The intersection of AAPI Heritage Month and Mental Health Awareness Month is significant because mental health is an essential aspect of overall health and well-being, and it affects everyone, regardless of cultural background.  For the AAPI community, Mental Health Awareness Month is particularly important as there can be cultural barriers to seeking mental health support.  In this blog, I would like to discuss some of the unique mental health challenges faced by the AAPI community.

The COVID-19 pandemic has had a disproportionate impact on AAPI mental health, with a rise in anti-Asian hate crimes and xenophobia causing increased anxiety, depression, and trauma.  Even before the pandemic, AAPI mental health was already a concern due to various factors such as racism, discrimination, and acculturation stress.  However, research shows that many AAPI individuals are less likely to seek mental health help or utilize mental health services among other racial and ethnic groups.  According to the Substance Abuse and Mental Health Services Administration (SAMHSA), AAPIs have the lowest utilization rates of mental health services compared to any other racial or ethnic group in the United States, only 8.6% of AAPIs with a mental illness sought treatment in 2019. 

There are many mental health challenges that impact the AAPI communities.  Some of these challenges include:

Stigma

In many AAPI cultures, mental health issues are often viewed as a personal weakness or a family disgrace. This stigma can make it difficult for individuals to seek mental health care.  One factor contributing to this stigma is the cultural emphasis on “saving face” and maintaining a positive image.  “Saving face” in Asian culture emphasizes the importance of maintaining harmony and avoiding confrontation, embarrassment, or shame.  The pressure to save face can have negative effects on mental health.  In some cases, individuals may feel compelled to hide their emotions or difficulties, which can lead to feelings of isolation and loneliness. The fear of losing face or being seen as weak may also prevent individuals from seeking help for mental health issues or from expressing their emotions in a healthy way.

Language Barrier

The language barrier is a significant issue for AAPI individuals seeking mental health services. Many AAPI individuals are not proficient in English, and may have difficulty communicating their mental health concerns to healthcare providers who do not speak their native language. This can lead to misdiagnosis, inadequate treatment, and other negative outcomes.  AAPI Individuals often find it difficult to find mental health professionals who understand their cultural background and experiences.  Some AAPI individuals may not have access to mental health resources in their native language or may not feel comfortable discussing mental health issues with a mental health professional who does not share their cultural background.

Cultural Beliefs and Values

Collectivism is often emphasized in many AAPI cultures, which places a strong emphasis on family and community ties. This can manifest in a sense of obligation to one’s family and community, as well as a willingness to prioritize the needs of the group over the needs of the individual.  This can create a sense of pressure to conform to societal expectations and norms, which may include downplaying or ignoring mental health concerns. This can make it difficult for individuals to seek help for mental health issues as they may fear judgment, shame or that seeking help may be perceived as a weakness or failure of the family or community as a whole.  In addition, there may be a cultural belief that mental health issues should be kept within the family or community and not discussed outside of it. This can lead to a lack of awareness of mental health resources outside of the community and a reluctance to seek help from mental health professionals who are not familiar with the cultural background and beliefs of the AAPI community. 

Lack of Culturally Competent Providers

AAPI individuals may be hesitant to seek treatment from mental health professionals who are not familiar with their culture or may not understand their experiences.  Furthermore, there may be a shortage of mental health providers who are trained to understand and address the unique mental health needs of AAPI individuals.

Historical Trauma 

AAPI individuals may also experience intergenerational trauma related to historical events such as war, colonization, racism, discrimination and forced migration.  These traumas can have a lasting impact on the mental health and well-being of AAPI individuals and their families, often leading to symptoms such as anxiety, depression, and post-traumatic stress disorder (PTSD).

Model Minority Myth

The “model minority” stereotype that portrays AAPI individuals as successful and high-achieving can create pressure and stigma for those who may be struggling with mental health issues.  The model minority myth can lead to dismissive attitudes towards the mental health struggles of AAPI individuals.  The model minority myth can also create a perception that AAPI individuals do not face the same level of discrimination and systemic barriers as other minority groups. This can lead to a lack of understanding and support for the mental health struggles that AAPI individuals may face, such as racism, xenophobia, and cultural marginalization.

To address mental health concerns among AAPI communities, it is essential to promote culturally sensitive mental health services that take into account the unique needs and challenges of AAPI individuals.  These services may include bilingual mental health professionals, culturally sensitive therapy approaches, and community-based mental health programs.  By recognizing and addressing the unique mental health challenges faced by AAPI individuals, we can improve mental health outcomes and promote overall health and well-being.  It is important for individuals within the AAPI community to prioritize their mental health and seek help when needed.  It is important to have mental health care providers who are culturally competent and able to understand and respect the unique cultural values and beliefs of AAPI communities so that the individuals seeking help will feel seen, heard and understood.  This can help create a safe and supportive environment for individuals seeking mental health help, and increase the likelihood that they will continue to seek treatment and support.

In conclusion, AAPI Heritage Month and Mental Health Awareness Month are important observances that intersect in meaningful ways. By working to reduce stigma and provide culturally sensitive care, we can support the mental health of the AAPI community and build a more inclusive and equitable society for all.  Let’s use this month as an opportunity to celebrate the diverse cultures, experiences, and contributions of AAPI individuals, and to raise awareness about the importance of mental health.  


This Pathology is Not All Yours… And Why Therapy Must Consider The Cultural Milieu

Psychotherapeutic training generally includes something called Universality as a healing technique. It stems from Irvin Yalom’s germinal Therapeutic Factors for facilitating group therapy. It basically means that when humans get to hear and witness another human facing something similar to their own experience, this communality engenders a sense of validation and fosters healing. Universality, with its relational delivery, inherently addresses the isolation any human can feel amidst a problem that had felt singular.

Normalizing Responses to Societal Issues

As a trauma-informed and relational therapist who specializes in climate change grief and disaster trauma; this is of interest to me for several reasons. A dominant one is that grief and anxiety created by several ongoing collective traumas are hard to separate from their myriad effects on a single person’s psyche, which at times is simply responding to these threats, pressures, and perils. Living within a colonial, imperialistic, and capitalistic society under threat of both climate change and continual pandemic pressures is not a cakewalk. Even that sentence stresses me out! The waters we swim in matter. Our collective ills contaminate human psyches and can show up as pain, depression, anxiety, panic, and the like. Our collective diseases become individuals’ problems.

And yet, as universality would have it, a clinician understanding these ills—as best they can from the purview of the client—is paramount to good treatment. Coping strategies alone are not sufficient, normalizing the client’s response to the collective deficiencies is part of alleviation of these pressures. Normalizing in this way may look like: “yeah, this is not, or should not be, normal.” This is a bit of disclosure from the therapist– a human to a human, both part of the same culture admitting where things stand.

I don’t think I am going out on a limb to note that our culture is currently struggling. As I write this, in Texas, transgender citizens’ rights are on the line. Gender-affirming care is slated to become criminalized, at times targeting trans children’s parents with threats of abuse. Recently, trans adults were added to the list with SB1029, which targets insurance companies and providers. Abortion is banned, though it is a medical intervention that can be lifesaving. To make matters worse, bounty laws that enforce this are creating an environment that is truculent and dangerously paternalistic. Books are being banned, and educators censored. A new Don’t-Say-Gay-esque bill was proposed just last week, modeled after Florida’s, which threatens an outright book ban around anything mentioning LGBTQ+, as well as censoring classroom discussions around the same. And the effects and human impacts of a climate changed are palpable and ever-increasing–in our area, we are recenrtly off the heels of another freeze. All of this on top of year three of the pandemic and its longstanding disruptions on learning, isolation, mental health, and physical health.

When Diagnostics Are Not Enough

And listen, I am not against diagnosing one’s mental health issues. Diagnostics as a part of comprehensive therapeutic treatment can be incredibly beneficial. They can certainly aid in devising and guiding successful treatment within the therapeutic consulting room. For the client who has been struggling with symptoms; a diagnosis can provide relief, an explanation, and a framework to describe their internal state or external behavior to themselves, family, classmates, work colleagues, and friends. Diagnostics on the whole can open up lines of communication within a treatment team, creating access to intervention avenues at the school level, or equally, funnel information to a psychiatrist who can better medicate. A correct diagnosis can create ease within a family system to remove the label of Identified Patient (IP) from a child’s role and help the system see their child or sibling from a more educated and supportive perspective. 

So- we can diagnose the person inside of the room however, we must also pay mind to the collective upheavals, distresses, and systemic issues that contextualize this individual. The medical equivalent might be something like this: we have a town next to a factory that is seeping toxic waste into the town’s water supply–a large and suspicious portion of the town comes down with a respiratory disease. Diagnostics alone would create a closed loop within the local medical system, with continuous siloed individual diagnoses reporting the disease created by this substance. AND/OR; the water supply could be addressed, and toxin mitigated. This is made more complex when we consider mental health as things tend to be created by many factors– and it can be tricky to suss out the causes, and the collective fixes. But complexifying our solutions, and as collectively as possible, is exactly the medicine called for in this era.

Psychologist James Hillman said (and of note, before the internet took hold):

“Of course I am in mourning for the land and water and my fellow beings. If this were not felt, I would be so defended and so in denial, so anesthetized, I would be insane. Yet this condition of mourning and grieving going on in my soul, this level of continuous sadness is a reflection of what is going on in the world and becomes internalized and called “depression”, a state altogether in me ─ my serotonin levels, my personal history, my problem…”

(Hillman, 1996)

Trauma-Informed Care as a Path Toward Healing

I know I am outting my politics, but alas—my last two blogs have been about porn and fairy tales so that cat is already out of the bag. Let’s take the example of gun violence. I see teens and work often with parents with young children. Both demographics are widely impacted by the nations’ lack of legislation on guns and are moreover the compensatorily-devised adaptation techniques that infiltrate our learning institutions instead of real action. If a teen client comes in saying; “I have had [X many] years of Active Shooter Drills at school and I am experiencing nightmares.” Yes, we can work to shift the nightmares, ameliorate the residual fear and treat the existence of such symptoms. But resounding data is against these drills and particular practices within. Why would I simply normalize them? 

A study quoted by Everytown bleakly reports:

“Active shooter drills in schools are associated with increases in depression (39%), stress and anxiety (42%), and physiological health problems (23%) overall, including children from as young as five years old up to high schoolers, their parents, and teachers. Concerns over death increased by 22 percent, with words like blood, pain, clinics, and pills becoming a consistent feature of social media posts in school communities in the 90 days after a school drill.”

Similarly, if a parent comes in citing concern their little one is going to be soon introduced to this practice at their new school, it would be wholly inauthentic of me to ignore not just the upset this future event is inciting but to not also see this concern within the structure of the collective climate. 

I speak here from a position of activism, allyship, and a desire to move forward as clinicians with eyes open, and as collectively aware as possible. No matter the source, symptoms and their manifestations are treatable. Therapy can provide meaning-making, the healing relationships can be sturdy-ing, and its structure and techniques can actively reify the resilience, connectivity, and vibrancy of the Self. If you love data, therapy has been shown in many forms to change the brain’s structure, namely in the frontal and temporal cortex, which enables more integration, processing capacity, and regulation of neural symptoms. When under the care of a trauma-focused and trained practitioner; trauma can be reprocessed to repair mental injuries from not only the initial trauma(s) but also any newer experiences that have been neuropsychologically linked up with the traumatic experience. EMDR, for example, uses bilateral stimulation as an adaptive information processing technique to reprocess and restore improperly stored, fragmented memories that can otherwise create interruptive and discontented states. The de-fragmentation and integration it engenders can be deeply impactful.

Therapy is helpful, and it is more helpful when it considers itself as a tool within a structure, that keeps in mind the structure’s influence on the clients it is aiming to help. I would be doing a disservice to clients to ignore the wider lens, and I hope that in and of itself is a helping technique. 

Resources

Clients

I am not telling you to do or not do anything, but here is a list of books that have been banned in Texas.

Other clinicians

Dr. Jennifer Mullan’s Decolonizing Therapy model provides trainings for Politicizing your Practice



How to Talk to Your Kids about Race and Racism

child at protest

 
There might be a misconception that children are too young to learn about race. However, it is usually adults who feel uncomfortable talking about racial differences with their child because it may “put ideas in their heads.” Or other adults may feel that children cannot see or understand race because they are so young, which is why conversations about race and racism go unexplored. 

  • Children learn most of their information through direct teachings and modeling from their parents, which is why it is important that parents have meaningful conversations with their children about these issues. 
  • There is an overwhelming amount of research showing that children are not only able to recognize race during infancy, but they also develop racial biases and prejudices between the ages of three and five. 
  • Children are not colorblind but rather are blank canvases. They cannot develop biases and prejudices about race until they are specifically taught to do so. 

So what can parents do to start open and honest conversations about race with their children? 

Parents, be aware of your own biases 

The first step parents can take is to understand their own implicit and explicit biases. Explore how these inclinations can mislead or misdirect your children’s perceptions of difference, race, and diversity. Instead of waiting for others to teach you, take it up on yourself to listen, learn, and ask questions about how your long-held beliefs may be creating barriers and influencing judgment. 
Some reflective questions to ask yourself: How do I navigate race ? How do I discuss race in front of my family ? How do I own up to my mistakes of racism ? 

Use books 

Books are a collaborative and educational resource for you and your child to have direct conversations about race. Stories connect the readers to the information being told, whether it may be about how we celebrate different holidays, honor people of color, or cherish moments in history. They can also be stepping stones to ask thought provoking questions like: What was the story was about ?  How were the subjects in the story treated ? Were there themes of discrimination, prejudice, or privilege present ? How does this story relate to my own understanding of race ? Do not underestimate children and their ability to understand and absorb these complex and important issues. 

Recommended Books: 

  • All the Colors We are (Age 3-6)
  • Don’t Touch my Hair (Age 4-7)
  • Mixed (Age 4-8)
  • Let’s Talk about Race (Age 4-8)
  • The Proudest Blue (Age 4-8)
  • New Kid (Age 8-12)
  • Young Water Protectors (Age 9-12) 

Teach your child to own up to their mistakes 

Inevitably, your child will say or do something explicitly or implicitly racist and in these moments you can teach your child a valuable lesson about responsibility. This can equip them with the tools to learn and understand the harm that was done and what they can do to repair it. There may be an inclination for your child to defend, excuse, or blame others for these mistakes; however, this is an opportunity to teach your child how they can repair ruptures using remorse and self-responsibility. 

Ask your child how they feel – directly 

Having direct heart to heart conversations about how your child perceives race and racism can create dialogues about what they are seeing, thinking, and believing. Over time, these conversations will evoke trust, acceptance, and understanding between you and your child. By no means is navigating race and racism easy. However, talking openly with your child and giving them a space they can be curious, will reinforce the belief that they can come to their parents to process and explore these difficult topics. 

Written by: Geetha Pokala, LPC-Associate, Supervised by Kirby Schroeder LPC-S, LMFT-S

Meet Geetha!


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