The 'Invisible Enemy' of Vietnamese descent over the past half-century

The story was originally published in Nguoi Viet with support from the 2023 Impact Fund for Reporting on Health Equity and Health Systems.

The first article shows that the complex historical background of Vietnam has subjected its refugees to a range of psychological challenges, leading to a more significant occurrence of mental disorders among the Vietnamese population compared to other ethnic groups. As such, the psychological conditions experienced by successive generations of Vietnamese immigrants are notably diverse in nature and severity.


Dr. Giao Nguyen made a statement regarding the Vietnamese community in Little Saigon.

"Forty percent of the reason behind mental illness is related to environmental factors,” he said. “Many immigrants, including myself, face immense pressure upon arriving in America. We have to adapt to a new language, culture, and lifestyle without having any friends or family to support us. It's a massive burden that can cause significant mental health issues for those who go through it."

It's important to remember the Vietnamese nation's refugee history. According to research by, Vietnamese refugees and migration can be divided into three waves. The first wave was at the end of the Vietnam War in 1975. The second wave, marked by many people risking their lives to escape by boat, occurred in the late 1970s. The third wave was throughout the late 1980s and 1990s. After that, the Vietnamese community in the United States continued to grow, with immigrants coming as family sponsors or international students.

No matter the wave of immigration, most newcomers to the U.S. are in the same situation: They do not know the language, have few friends, communicate little, and know little about society.

"They're very lonely. That loneliness builds up over time, leading to depression and mental illness," Nguyen said.

"Loneliness is a matter of great concern worldwide. Loneliness was and still is one of the invisible killers of the Vietnamese refugee community."

4 people standing together

Dr Giao Nguyen (left) at the refugee camp 

Courtesy Giao Nguyen

The two words "mental illness," according to Nguyen, can be easily said by people who do not have scientifically correct concepts. Still, with medicine, not all "abnormal" understandings are considered mental illness.

"It ranges from mild symptoms, then depression, to the highest level of suicidal thoughts," he said.

When asked what mild symptoms people with mental health problems experience, he replied: "They feel like they can't eat, they can't sleep, they feel sad all the time. Some even have nightmares when sleeping about scenes when crossing borders, cannibalism to survive, nightmares about torture in re-education camps."

"Like I've had nightmares personally. It sounds funny, but it used to be a nightmare for me. I dreamed I didn't know how to pay for school," Nguyen said.

Mental illness is diverse. It's invisible. In a cozy little room at Southland Integrated Services in Garden Grove, California, psychologist Suzie Dong says that around a decade ago, more patients began seeking counseling services.

Dong said one of the primary reasons people are affected by disabilities is because they witness those who are living without the same abilities as others. “This can lead to commuter disruptions and negatively impact school attendance due to financial loss. Additionally, those with disabilities may experience family problems or face obstacles preventing them from progressing in various areas of life,” she said.

Man sitting in front of a window

Michael Quan Nguyen

Courtesy Kalynh Ngo

Santa Ana resident Michel Quan Nguyen is an active member of the Vietnamese American Mental Health Association (VAMHA), a non-profit organization that supports the Vietnamese community with mental health issues. Nguyen and his wife came to the United States under family reunification (The Orderly Departure Program—ODP). As such, neither of them experienced the trauma of crossing.

He shared his family's story:

"My wife has symptoms like whenever she is unhappy or disagrees with something, she screams and throws things. I said nothing in silence each time because when I repeated it, she reacted more severely. I know it's a symptom of mental illness."

"It's possible that the losses in her family have contributed to my wife's current symptoms. For example, she was forced to leave her parents' house by her sister-in-law so they could obtain a new house. Additionally, her family is Buddhist, while I am Catholic. When she agreed to marry me, her entire family opposed the idea. Perhaps she had been under pressure from her family and suppressing her feelings for a long time. It seems that everything has finally come to the surface,” he said.

Since he married her, he has loved and protected her while understanding the family situation. For the last ten years, he has accepted what was happening with his wife and provided her with loving care.

Every symptom and intensity of mental illness can manifest in any family or situation, with a unique story behind it. It's possible for a person who cares for a sick loved one also to develop psychological health problems. The tale of Phan Chieu Ha, an 80-year-old resident of Westminster, is an example of this.

She recounted her story: "I have been caring for my husband, 87 years old, for 18 years. He had Alzheimer's disease. The first step is light, but each stage has a different suffering. Initially, he was just irritable, annoyed, grumpy, catching himself, this and that. At first, he didn't know he had the disease. I don't know either. Because I didn't know, I was disappointed."

She was disappointed that "the old husband wasn't that kind of person. Now, naturally, he changed again. So, it's sad."

And the truth is, "three times I've wanted to die because it's beyond my imagination," she said.

Person on computer screen

Phan Chieu Ha recalled her story

Courtesy Kalynh Ngo

Inheritance to the next generation

While 40% of the causes of mental illness are environmental, "the remaining 60% of the causes of mental illness are genetic," said Dr. Giao Nguyen. He explained in detail:

Over the past few decades, research has indicated that life pressures can cause changes in people's DNA. These changes occur gradually over several generations, resulting in fundamental chromosome alterations. 

"The heredity of mental illness explains 60% of the causes of illness."

Explaining genetics from another perspective of expertise, Dr. Clayton Chau, former director of the Orange County Health Authority (OCHCA) said:

"When parents suffer from depression and do not seek treatment, it can hurt their parenting. They may become overly strict with their children because they cannot understand their emotions, causing a rift between parents and children. As a result, the next generation of children may also develop depression due to growing up in an environment with depressed parents.”

This is the unintentional "interaction" of psychological wounds from the previous to the next generation that psychologist Suzie Dong mentioned. She further explained:

"Some young people come to me who have experienced various forms of abuse at home, from childhood to adulthood. Science has proven that trauma can be passed down from generation to generation, and we understand this well. It's important to note that abuse can take many forms, including mental, emotional, and physical trauma.”

Intergenerational trauma 

"One of the big causes of mental health problems in younger generations is intergenerational trauma,” Dr. Clayton Chausaid said. “Children of the next generation grow up with the duality of their parents' and their culture.”

The study, "Conversations on Mental Wellness in Vietnamese American Coummunity" by Linda Vu and Laura Quynh Nhu Nguyen was conducted in 2021. It was published in the Asian American Research Journal of UC Berkeley.

"Since many Vietnamese American students are the first in their families to enter college, there is also an additional pressure caused by the expectation for success from their parents,” the study said. “The large number of people suffering from mental illnesses, therefore, can be mainly attributed to the stigmas and values that are deeply rooted in the culture and the history of Vietnamese in America.”

Dr. Giao Nguyen said that the intense pressure to succeed in fields like engineering or medicine can lead to mental health problems for young people.

"The more their families expect of them, the more pressure they are under,” he said. “That leads to lies and guilt, which then causes depression."

"When parents, who are the first generation, have expectations for their children, it usually means that they will do their best to provide them with an education. The following story illustrates how cultural differences and expectations can impact the mental health of an entire refugee family. The narrator has requested that the character's name be changed.”

Around three years ago, everyone in a small Vietnamese community in Arkansas knew about Tammy Nguyen. She was born and raised in the United States, and her family had immigrated to the country during the late '80s. Tammy was a high academic achiever and considered the best student in Arkansas. Her future was bright, and she had many higher education options. Tammy was the pride of her family and was set to become a doctor, a great accomplishment for her clan.

Tammy's parents have been factory workers since the first day they arrived in the United States. According to her cousin, Tammy’s parents worked two jobs. They worked day and night and rarely took days off. In nearly 30 years in the United States, the family seldom had a family trip to spend time together. Working to earn and save money is essential for them.

Adversity also ensues. The symptoms of mental deterioration in the young girl occurred without the family's knowledge. Until one day, Tammy didn't come home. "Tammy joined a group that neither of her parents could meet, and she refused to see her parents," her cousin said.

"There were several times when I got a call from the hospital saying my child wanted to kill herself. I ran in, but I couldn't say anything to her," Tam said.

When she returned home, she chose to stay with a relative rather than her parents. Consequently, the door open to her future career as a doctor is also wholly shut.

Tammy, along with her brother and sister and parents, have all experienced a significant "intergenerational trauma." Even though they are Vietnamese, Tammy's parents never had a friendly conversation with their children because they grew up speaking English. Tam has always wanted to sit down and eat together as a family and have conversations, but unfortunately, that never happened.

Tammy Nguyen, a once happy and intelligent girl, now lives with acquaintances and is disconnected from her parents. Her parents, Mr. and Mrs. Tam Nguyen, still work eight hours daily and live in a large, joyless house. Tammy's room remains unchanged from when she lived there.

Generational gaps within one's family and cultural discrepancies in one's environment can result in various consequences, including loneliness. "Loneliness is a significant problem in society nowadays. Research indicates that many individuals worldwide, particularly in the US, currently experience loneliness. This has become an ‘epidemic’ that leads to mental and physical illnesses, and its impact is equivalent to smoking ten cigarettes a day,” Dr. Nguyen said.