Mental Illness Carries Stigma Among Asian Cultures, Too

The Laotian teenager was hearing voices saying that he needed to die. He wasn't sleeping or eating. He was losing weight. And he was convinced some force was trying to push him from a second-story window.

Diagnosed as having some of the classic signs of schizophrenia, he was prescribed heavy medications.

After being treated in a psychiatric hospital, with little progress, he was sent to the Asian Counseling and Referral Service in Seattle.

The nonprofit organization has a bilingual staff fluent in 15 Asian languages and dialects, serving about 1,000 clients each year. Many are Vietnamese, Cambodian and Laotian refugees.

A Laotian-speaking staff member began working with the youth and scheduled a series of meetings with members of the Laotian community, said Yoon Joo Han, who oversees the organization's behavioral health program.

His fellow Laotians recommended an unusual remedy: The teen should shave his head and become a Buddhist monk.

His condition did improve, Han said. And the nonprofit organization continues to work with both him and his family, providing medicine to help him sleep.

Asians often feel intense shame over being diagnosed with mental health problems or seeking out psychological services -- a stigma counselors say also is common in Latino culture.

In many Asian cultures, the stigma is so strong that people don't want to associate with or marry into a family with someone who has mental illness, Han said. "People don't understand it's just like a physical illness, not because you have a weak will."

In the case of the Laotian teenager, community members made their recommendation after hearing the family's story, Han said.

His grandfather had committed murder in the family's homeland. The boy's troubles, they said, were a result of his grandfather's sin. Because the grandfather took away a life, a spirit was trying to take away the grandson's life.

"Our approach is, there's a reason people believe in that; they've had that belief for thousands of years," Han said.

"If you don't understand the culture and make the wrong assumption, you'll misdiagnose the problem. Then whatever service or treatment you provide will not be effective."

Some Asian languages have no similar words for mental health problems such as depression, psychotic symptoms or schizophrenia.

Yet these illnesses can be talked about in ways that are both understood and are more culturally acceptable, Han said. "It takes someone who has the ability and skill to translate an experience into something they can make sense of."

In Vietnamese, it might be explained as simply as having trouble waking up and getting out of bed in the morning, having bouts of crying and even "your heart and liver is heavy," she said.

A self-help group that meets at the center used Buddhist chanting, rather than Alcoholics Anonymous meetings, to battle and recover from alcoholism -- another example of the ways traditional customs are incorporated in the treatment of patients.

"You have to understand the Western approach and the Eastern approach," Han said. "You're a scientist, but also an artist."

Refugees forced to flee their countries by war, political oppression or religious discrimination, may suffer from feelings of dislocation and severe culture shock, she said.

In their homeland, they may have been respected and hold status or power because of their skills: reading the wind for changes in weather, knowing when rain is on the way or the right time to harvest.

"In this country, that is not useful, not respected," she said. "Their status and power are all gone. You have to depend on grandchildren to communicate."

Others suffer from the lingering emotional trauma.

"When you hear an individual story, you'll understand how traumatic it was," Han said, "like going through the jungle with no food and water, bugs sucking blood from your legs, the fear from footsteps on the other side of the jungle, a family member being killed and seeing their brain blown open, a baby dying due to lack of breast milk.

"They were victimized, yet they are a survivor," she said.

"They might have lost hope ... they may not understand that help is available.

"Our job is finding the hope for them."