8 Tips for Talking About Mental Health With Your Asian Family
When I started my undergraduate degree in psychology, my grandmother said she was afraid I would become pagal (“crazy”) because of it. Her fears were well-intentioned and full of love for me, but they were reflective of a deeper problem I’ve seen in many Asian communities: misconceptions and stigma around mental health.
As a Pakistani therapist, I’ve spent a fair share of my time discussing and debating the legitimacy of mental health as a health care issue (both with clients, as well as within my own friends and family network). One thing I have noticed, which gives me immense hope—especially when it comes to conversations about Asian American mental health—is that talking about mental health is a powerful step towards destigmatizing it and increasing empathy between people. Sharing your mental health journey with your Asian parents can be daunting (for a number of reasons that I’ll get to below). But it can also be incredibly important, especially in the face of the increased violence we’re seeing against Asians and Asian Americans in the United States.
Broadly speaking, the term Asian American includes Americans from Southeast Asia, East Asia, and the Indian subcontinent. Of course, there are nuanced differences between these groups. However, they are all “collectivist cultures,” which means they tend to share similar themes in family dynamics. And given the porous nature of trade, migration, and borders over time in this region, these cultures have been in constant interaction with each other and have many shared traditions and structures. Finally, due to often having major religions in common, there are also many shared cultural myths and narratives found within the Asian American group. (For the purposes of this article, the term Asian American will not encompass Native Hawaiians and Pacific Islanders, who are often grouped separately from Asian Americans in mental health data and whose cultures are distinct enough to warrant a separate discussion.)
The cultural myths about mental illness within Asian American communities and the diaspora are strong and persistent. Research has shown that within Asian cultures, mental illness is often seen as a weakness or a lack of willpower. It can even be seen as contagious. Research in India found pervasive misconceptions around mental illness, particularly in rural areas. Cultural and religious beliefs about evil spirits, past life behavior, or bad luck may also discourage people from disclosing mental health issues or seeking treatment for it.
For Asian Americans in particular, pressure to live up to limiting stereotypes can also play a role. “The ‘model minority’ myth can prevent disabled APAs [Asian Pacific Americans] from asking for help, accessing appropriate services and accommodations, and self-identifying as a person with a disability,” Alice Wong, a disability rights activist and thought leader, writes in a piece for the Disability Visibility Project. Due to these cultural stigmas, it’s not uncommon for Asian Americans to hesitate to talk to their parents or families about their struggles, which can exacerbate the issue.
Honestly, though, if you grew up in an Asian household, you probably don’t need me to tell you that mental health isn’t usually discussed openly and it often carries the heavy weight of shame. But that silence around mental health translates into tragic statistics on a larger scale. According to the Office of Minority Health, suicide was the leading cause of death for Asian Americans between the ages of 15 and 17 in 2017. Asian Americans are also among the least likely to receive support for a mental health crisis. Data from the Office of Minority Health shows that Asian Americans who experienced a major depressive episode over the last year were much less likely to receive treatment than non-Hispanic white Americans (43.9% and 68.5%, comparatively). What’s more, the rates of mental health issues are rising in the United States, likely fueled by the COVID-19 crisis, and preliminary studies have shown that Asian communities are experiencing high levels of mental distress during the pandemic. (The apparent increase in anti-Asian hate crimes may unfortunately be a contributing factor as well.)
Sharing your mental health journey with your Asian parents (or family members) can be daunting yet powerful. If you’re thinking about doing so, there are a few strategies you can use to have an easier, more productive conversation. A lot of this advice incorporates the framework of collectivist family dynamics, and you can tweak these steps to make them work better for your specific culture and family.
1. First, understand why you want to have this conversation.
Before you have a discussion about disclosing mental health struggles, it’s important to consider your expectations around this discussion. Understanding your motivations and end goal will help you structure your conversation. It is also important to weigh the pros and cons of talking about it within your specific family. Since Asian families are closely connected and often live in intergenerational households, difficult conversations can often impact broader family dynamics. For example, could this potentially jeopardize your living situation if you live at home?
Before you sit down to have a conversation, ask yourself a few of these questions. You can discuss these prompts with a close friend or someone you trust. The goal of these reflections is to anticipate and be prepared for the many directions the conversation can take.
- What do I hope it will achieve?
- Am I seeking a behavior change in my parents and family, or acceptance?
- Will this make things worse for me or will it improve my circumstances?
- Will I be able to tolerate their potential inability to understand this?
- How can I strengthen my emotional support resources in the event that things change within my family?
If you choose to move forward with the talk, try to be open to the idea of having this conversation a few times. Mental health might be a new topic for your parents. It might be a topic they never expected to talk about with you. So they may not understand you immediately, or they might be defensive and dismissive at the beginning. If it is important for you that your parents are a part of your mental health journey, this may need to be an ongoing and evolving discussion.
2. Come prepared with information, examples, and descriptions that will be familiar to them.
Try to schedule this conversation or give your parents a heads up that you want to discuss something important. Ideally, you won’t need to drop it on them when they are unprepared or are in the middle of something else. This will allow them—and you—to be emotionally prepared for a discussion.
Many Asian families view mental health as a Western concept. This is where representation can be really helpful in getting your parents to see this as a universal health issue. Try to find public personalities from your cultural background, such as actors or politicians, who have spoken up about mental health issues. For example, popular Bollywood actors who have spoken about mental health and depression such as Deepika Padukone, or K-Pop stars who have publicly discussed their experience with anxiety. This may help your family see that this is an issue that affects everyone, regardless of race, gender, or religion.
Another helpful strategy is to learn what the words and terms related to mental health are in the native language that your parents speak. Even if your parents speak English fluently, seeing the representation of mental health in their native language is powerful. Try to find both the formal words and the colloquial ones. This will put you and your parents on the same playing field.
If you can, find resources within the Asian community to help normalize the issue. Local community organizations in your city can be helpful conversation starters and might have resources to support your discussion. Another good way to get the conversation going is awareness campaigns that emphatically include Asian communities, such as the Canadian Bell Let’s Talk initiative or the NYC Thrive campaign. These types of campaigns usually have flyers and pamphlets on their website in different languages; see if you can find one that your parents speak. It’s okay if you don’t live in the same city; any information can be helpful here.
In my work with South Asian families, I’ve noticed that they responded more openly to concrete symptoms—such as trouble sleeping, heart palpitations, and shortness of breath—rather than abstract emotions like feeling unfulfilled or empty. Research has also shown that Asian psychiatric patients tend to focus on the physical symptoms of mental health instead of emotional ones. Structuring your conversation to include physical symptoms you’re experiencing may be more effective in capturing the attention and empathy of your family.
3. Fold mental health discussions into conversations about current events.
One opportunity to bring up mental health and emotional difficulties is by checking in with your family and elders to see how they’re coping based on current events that affect your communities. For example, the recent and horrific mass shooting in Atlanta, climate events in your home country, or political events (such as the farmers’ protest in India and violence against the Uyghur or Rohingya community). Based on your relationship with your parents, this tip can be tough to even conceive of trying, which is completely understandable. But in some cases, it can also help you and your family feel closer to each other or at least understand each other better.
If you haven’t yet talked about your own mental health experiences with your family, talking about that while also talking about this kind of incident can be really difficult. Don’t push yourself to do both if it’s too much. But even without sharing about your own personal journey, this kind of conversation can be a good time to start normalizing the concepts of emotional health, stress, anxiety, or depression. Ask open-ended questions about your family’s emotional reactions to the events. For example, instead of asking, “Does X event make you feel bad/worried?,” ask, “What bothers/worries you about X event?” Let them know you’re always open to talking about emotional experiences, and try to mirror their language when describing their emotional experiences.
4. Use “I” statements to help get your point across.
Positive communication strategies can go a long way in diffusing the intensity in difficult conversations. These strategies also help to keep the conversation from becoming personal because they focus on the actions (behavior or words) instead of the person doing the actions.
An example of a positive communication strategy is using “I” statements. This is when what you say is centered on your experience, instead of the other person’s actions. “I” statements are a nondefensive, nonblaming way to begin a conversation.
All “I” statements follow a format:
“I feel _____ when you say/do _______ because [impact on the speaker].”
An example is: I feel hurt when you comment on what I eat, because it makes me feel bad about the way I look.
You can look up some worksheets for practice here. You may need to change exactly how you deliver this based on your own personality, your parents’ personalities, and the various dynamics of your relationships. That’s okay! The point is to focus on sharing how you feel in whichever way feels most natural to you rather than pointing to someone else’s behavior in a way that could make them feel more on guard.
5. Be prepared to answer questions.
Approach the conversation with an open mind, and be prepared to answer your family’s questions. They may ask the same questions in many different ways. Try to be as transparent about your experience as you can. Help them understand what you are saying and approach the conversation from a place of curiosity.
While you shouldn’t feel pressured to have all the answers, it could be helpful to do some research ahead of time and come prepared with a few basic stats, facts, and resources related to the mental health issue you’re experiencing. This way you’ll be able to provide unbiased information that explains what you’re going through outside of your own personal or family experience.
Many parents may internalize your mental health struggles as their fault. Others might default to problem-solving mode using religious frameworks. Be prepared to respond to their statements and questions, then give them time to process what they heard and learned.
6. Practice, practice, practice!
Being prepared and grounded before having this discussion is really important, so practice with a close friend or therapist if possible. Difficult conversations with our parents can bring up a lot of intense emotions and reactions. The more you prepare, the more in control of your emotions and the conversation you will be.
Preparing for this conversation will also allow you to plan when to have it, so it won’t be out of the blue for either of you. It’s also smart to plan some self-care and grounding activities to do before and after.
7. Think about how to extricate yourself if the conversation isn’t respectful.
This might be a difficult conversation, and it’s important to set healthy boundaries. Be prepared to end the conversation if it is becoming aggressive, threatening, or disrespectful. Remember: This is a discussion about you and your health, not about what your parents expect from you or their beliefs. You can even have mock conversations with friends or trusted family members on how to close out the topic in a nonconfrontational and nonthreatening way. You can try phrases like:
- “We can talk about this when you’re feeling better.”
- “Let’s take a break until…”
- “I’m going to go for a walk/to my room now.”
- “I want to help you understand, but I can’t talk to you about this if you will raise your voice.”
One very important note to keep in mind: If you think your physical or emotional safety might be at risk if you try to have a conversation about mental health with your family, that is unfortunately a strong reason to reconsider having this discussion in the first place. Hopefully, there are other people in your life who can support you in working through not only your mental health, but also not being able to safely share that journey with your family.
8. Do what you can to prioritize your own mental health in big or small ways.
This may not be an easy discussion to have, and it may not have the desired outcome. So it’s worth creating and sticking to a self-care plan that will help you to feel grounded and supported no matter what. This might include things like:
- Being physically active
- Staying hydrated
- Eating nutritious and satisfying foods
- Having a sleep routine
- Spending time alone in which you can engage in relaxing or joyful activities (watching your favorite shows, meditation, reading, etc.)
- Spending time (either virtually or safely in person) with friends and chosen family
- Finding a therapist if you can
- Making a safety plan for yourself and keeping it on your phone or in your wallet; this should include phone numbers of local crisis resources, safe friends and family members you can reach out to, and activities you can do to help yourself in an emotionally distressing moment
Our families can be a huge support in our mental health journey, especially at this time, but that often starts with difficult conversations. Becoming confident in talking about mental health with your Asian family may allow you to connect with a new source of support, even if it sounds scary at first.
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