An AAPI Perspective: Cultural Roots of Mental Health

As members of Harvard’s Asian-American and Pacific Islander, or AAPI, community, we have become painfully aware of the toll that stress and mental illness have taken on our peers and ourselves. We have noticed a worrying trend in recent years of Asian and Asian American suicides and an increasing number of our friends taking time off. We have noticed, too, the struggles of a healthcare and administrative system where our cultural perspective is often misunderstood. In sharing our experiences, we hope to bring these perspectives to light and to advocate for a more culturally sensitive approach to mental health services.

For many of us from East Asian immigrant households, holiday potlucks are not only a time of celebration, but also an occasion for parents to gossip about the younger generation and to engage in competitions to see whose child is better—an environment that leaves little room for weakness. This pride dictates the topics of conversation during both social gatherings and family discussions at home: College acceptances? Yes. Grades? Only if they're good. Doubts and emotional vulnerability? Not always. This preoccupation with perfection made it difficult to show signs of insecurity or fault, including internal struggles with mental illness.

A similar lack of attention towards mental health is also apparent in many South Asian families. Sara Surani ‘18 remembers conversations at home about mental illness being met with glib responses: "Oh, you think you're depressed. No, no, you just haven't been sleeping enough. You're not depressed; you are tired."

"Anxiety? Oh, no, that just means that you are not working hard enough so you are worried. Work harder, it will get better."

She recalls hearing stories of suicide—friends and family ending their lives for various reasons. However, just as shocking as the suicide itself was the community’s response: the conversation immediately shifted to the shame and disgrace brought upon the individual’s family and community.

This stigma around mental illness is ingrained into the very languages spoken in immigrant households. The Chinese phrase for mental illness (shénjīngbìng) is synonymous in many minds with violent psychosis; for Korean families, preserving family honor sometimes meant sequestering mentally ill members from society—one in which the term for a mentally ill patient (jungshinbyungja) can be used insultingly. The word for suicide in Urdu/Hindi, "khud kushi," is often mistakenly understood and pronounced as "khud khushi" or "self-happiness," perhaps because suicide is viewed as a selfish act.

These cultural contexts, which often make it difficult for students to find support among family, may explain the broader status of AAPI mental health. Studies show that Asian American students have a higher rate of depression than white students, yet are also one of the ethnicities least likely to seek mental health care. (These aggregate statistics may mask disparities in subpopulations such as Southeast Asians, who experience high levels of poverty and high-school dropout rates, as well as Pacific Islanders, who often have nuanced cultural backgrounds closer to that of indigenous peoples.)

The unique circumstances faced by members of the AAPI community necessitate a tailored response. There are evidence-based benefits in hiring psychologists and clinicians with diverse backgrounds to match Harvard’s diverse student population, and such diversification efforts need to be coupled with greater outreach and training for cultural and religious groups to create a stronger support system for underserved populations. This might entail clinician and cultural group meetings each semester to share resources and establish relationships. Longer-term initiatives, such as the creation of a multicultural center (similar to Yale's), will be vital for creating permanent support for minority communities.

The burden does not fall entirely on the administration. We as students need to continue striving for a more open and inclusive environment for discussion of mental health concerns; AAPI alumni can help advocate for improved methods and push for more AAPI counselors and psychotherapists at UHS; counselors and professionals with an understanding of the AAPI context can continue to lend their guidance to students.

We’ve worked with a number of Harvard-affiliated professionals who have provided such guidance, including Francis Chen of HUHS, Dr. Cindy Liu, the Director of Multicultural Research at the Commonwealth Research Center, Dr. Rohit Chandra of MGH and the Indo-American Psychiatric Association, and Meagan Moana Palelei HoChing, an E3! Ambassador working with the White House Initiative on AAPIs. Our four contacts are happy to meet with students and to connect them with additional local AAPI mental health care contacts and resources. And as always, resources are available through the house and student communities and for urgent care.

The diversity of viewpoints represented among students of Asian and Pacific Islander heritage is incredible. We recognize that we have not captured the full nuance of mental health within this community; nonetheless, our hope in sharing our perspectives is to continue the ongoing dialogue and to fight for a community of students, alumni, and staff that will address these challenges unwaveringly. We welcome readers to reach out with their own stories and ideas on how we can all continue to work to recognize the role of identity and ethnicity in mental health.

Waverley He ’18 is a neurobiology concentrator in Kirkland House. Kevin C. Ma ’17 is a chemical and physical biology concentrator in Quincy House. Sara Surani ’18 is an anthropology concentrator in Kirkland House. NaYoung Yang ’18 is a human developmental and regenerative biology concentrator in Lowell House.