Addressing Mental Health in Asia - Angela Zhang

Author: Angela Zhang

Instagram: @angelajzhang

Note* — previously published in Phillips Exeter's The Asian

Asian countries often have the highest numbers in terms of mental health issues and suicide rates, and it’s a concerning pattern we, not only as a collective race, but humanity as a whole, should seek to explain and mitigate.

From 1995 to 1999, approximately 287,000 people took their lives each year, ranking China as one of the countries with the highest suicide rates. In 2003, a report by China’s Center for Disease Control and Prevention revealed there was a suicide attempt every two minutes.

There is a stigmatization around suicide and mental health in Asian countries, and it is quite often a taboo topic that few families seek to have conversations about with their loved ones. It’s usually perceived in traditional Asian families that if you suffer from a mental health issue, there’s inherently something wrong with you. More commonly, mental health isn’t even viewed as a legitimate health issue and is often minimized as a minor problem that people just need to tough out. This all contributes to the stigma around mental health, with many individuals unwilling to admit their problems and seek help in fear of being shamed or invalidated.

The lack of understanding of mental health as a genuine health complication is prevalent in traditional Asian belief systems and values. For example, in Chinese and Japanese cultures, mental health issues are thought to be caused by “lack of harmony of emotions and evil spirits,” with many people seeking traditional herbs, acupuncture, or healers instead of professional medical help.

In Korean culture, mental health issues are thought to be caused by “ancestral spirits coming back to haunt [the] patient because of past bad behavior; bad luck or misfortune; payback for something done wrong in the past.” This leads to many patients denying their problems while still feeling helpless. Some may turn to Shamanism, which is a religion that relies on obtaining various states of consciousness in an attempt to initiate a healing process.

In Vietnamese culture, depression, a serious mental disorder, is viewed as just sadness. People are not ready to acknowledge the health implications of depression so they turn to home remedies, exorcists, or spiritual consultations. If the issue becomes acute, a family member may notice, but instead of seeking help, they personally try to cheer up or distract the victim from the root problems.

Asian cultures emphasize the importance of maintaining a positive public appearance; after all, everyone wants to seem perfect in the public eye, right? But the high pressure to maintain a good social image in combination with the extreme stigma around mental health leads to very few who are willing to admit they need help: it exposes their vulnerability; it may come off as weak; it may even reflect poorly on the family, bring shame, and tarnish reputations.

That’s why there needs to be a multi-sectoral approach to promoting mental health awareness in Asian countries. It’s difficult to change hundreds and thousands of years worth of cultural values and beliefs, but it’s important to educate people on the legitimacy of mental health issues. This can only be done if mental health conversations are normalized and encouraged by various sectors in society: government, public health, economy, private groups, and non-profit groups. Professional medical help should be made accessible and non-intimidating for those who seek it, removing any shame or ideas of weakness associated with reaching out for help.

But we must also be aware the high rates of suicide in some Asian countries don’t necessarily correspond to high rates of mental health issues. Some suicides are impulsive decisions caused by the extreme stresses and deeper problems in Asian communities. Other suicides are a result of unbearable social pressure regarding gender and family.

Xihuan Zhang’s impulsive suicide attempt epitomizes these deeper issues. She cites financial worries and social stress as the reasons for her impulsive decision to ingest pesticide. Liping Chen (name changed) also impulsively attempted suicide after she decided she had enough of the burdens related to and criticisms of maintaining a household and raising a family.

Being a female in Asian society often corresponds to fulfilling the role of being a mother, raising a family, doing housework, all while still generating income to support the family. It’s what’s expected of women. These cultural expectations can cause high amounts of stress that lead to impulsive suicide attempts like those of Zhang’s and Chen’s, even though they originally did not have underlying mental health issues.

Males also experience gender stereotypes that induce impulsive suicide attempts. Asian communities “[perpetuate] a masculinity or “man-up” sentiment”, which is a factor of “driving up the number of male suicides to double that of women” because “men are pressured to suppress their feelings instead of seeking out professional help.” Clearly, the social pressures related to gender are one of many root causes of suicides in Asia. We need to work to break toxic gender stereotypes, which again, would require multisectoral collaboration in normalizing and promoting conversations about the role of gender in society.

In 2007, the University of Maryland School of Public Health conducted research among Asian Americans to understand other common sources of stress. These include parental pressure to succeed in academics, family obligations based on strong traditional or cultural values, and a pressure to live up to the “model minority” stereotype. In Asian countries, people suffer from similar problems, like pressure to obtain a job when the workforce is incredibly competitive and cutthroat, financial instability, and high expectations from parents.

These problems reflect greater issues in society besides just the stigmatization surrounding mental health. Why is it that these sources of stress are so common? We need to address the competitive environments of education and employment. What can people do to support all students and job-seekers, to ensure that all of them will have a place in the workforce and financially support themselves? How can they alleviate the pressures and stresses commonly related to school and the workforce?

I know one issue many Asians, both Asian Americans and overseas, struggle with is fear of not doing well in school, which spirals them into a fear of unemployment in the future. They often correspond not doing well academically to utter failure in life. And who isn’t afraid of failure? But the “model minority” stereotype exacerbates this prevalent issue in Asian communities, contributing even more stress.

In Asian communities, we need to emphasize the fact that there is more to life than just earning high marks in school. There is not only one path to success, there is not only one job you can have, there is not one amount of income you must earn to be validated, and there is not one mold that you need to fit into in order to be considered a “successful Asian.” Families should reinforce this for their children, and it will be difficult to lift some cultural values, but it’s necessary for the well-being and acceptance of all Asians across the world.

Overall, in Asian countries, multisectoral collaboration will be key to encouraging mental health awareness, removing stigma, understanding deeper societal issues, and gently lifting cultural values that may have destructive effects. This is a pressing concern that needs to be addressed not later, but now, because no community should allow itself to lead in terms of mental health issues and suicide rates. Of course, though the issues discussed in this article are prevalent among Asian communities, they are not limited to Asian communities. We should not perpetuate any of these issues in any community, and we should all seek to promote mental health awareness and care, offer support to one another, and continue to collaborate to tackle these difficult problems.