When Asian American Men Seek Therapy: The Invisible Struggle

(Originally published for Psychology Today)

“It was getting so bad I couldn’t hide it.”

When his friends and family members started noticing his unusual behavior and expressions, Ryan*, a Korean American man in his thirties, realized he needed to seek help for his feelings of depression in his late teens and twenties. He says his starting place was shame, an admission of defeat.

While research shows that individuals in the Asian American community suffer from high rates of mental illness, this is a population that has largely gone untreated. As an Asian American therapist in San Francisco, I have worked with too many clients who suffered in silence for years before they finally sought help for their struggles.

According to a 2011 study from the National Institute for Mental Health, Asian Americans are less likely to reach out for help with emotional difficulties than white, Latino, and Black ethnic groups. In fact, only 17% of all Asian Americans have sought professional help, and only 6% sought this help from a mental health provider.

It became my mission to find out why. To this end, I’ve conducted a series of interviews with Asian American men in order to understand why this trend exists.

“My family was split, and you couldn’t reach out [for help] in my community. There were so many hot topics you couldn’t talk about. You don’t want to show your cards.”

Ryan tried to keep his suffering to himself. He said he would seclude himself alone for days, unreachable by any mode of communication. He found himself sending bizarre, cryptic emails to friends, and engaging in risky behavior like talking to random strangers in the middle of the night. Still he could not bring himself to open up about his suffering with friends or family and things grew worse, not better. Eventually he decided it was time to talk to a counselor.

Ryan’s story is common. Seeking therapy is generally not the first consideration and often the last ditch effort. Many of my clients grow up believing “Asians don’t go to therapy unless there’s something wrong with you” or that Asian men are not interested in their emotional life. They speak about the avoidance in their families of origin when it came to verbalizing thoughts and feelings, where the option of going to therapy was never even brought up.

The stigma of mental illness in Asian cultures can make it unsafe to express feelings of overwhelm and vulnerability, let alone talking openly about your symptoms of depression. For men adhering to traditional masculine gender roles, it often means that you keep your pain silent. I’ve heard many guys describe how they tend to bottle it up, hoping it will just go away. One wants to do whatever they can to “save face,” which means to avoid mention of any issue that could potential bring shame and humiliation to themselves, their family, and the greater community.

Unfortunately, these efforts to hide are precisely what can cause psychological symptoms and maladaptive behaviors to emerge.

For Mark, a Korean American who grew up in the Midwest, the emotional struggle was visceral.

“I would have pretty bad panic attacks and was having a really hard time falling asleep…I was in a ‘rabbit hole’.” He tells me of his difficult time working for an advertising company.

He was wearing himself thin, spending hours overtime into the night, and dreading going to work. The stress started to become unmanageable.

Mark, who is now in therapy, said he didn’t know what it meant to be depressed when he was growing up. But as he looks back on his childhood, all the signs were there. “I feel like a lot of things I’m experiencing, if I had voiced them then, I might have found different coping mechanisms.”

Because of the popular stereotype around being “model-minorities,” Asian Americans are under immense pressure to exemplify what it means to succeed in America, and are, in turn, denied lives that also include temporary setbacks or failure — lives that are also frustrating, conflicted, historically influenced, and subject to the pains of loss and death like any other person.

The lack of nuanced portrayals of Asian American perspectives in the media contributes to a belief that Asians are not complex people, although there have been major signs of progress with the emergence of television shows like “Fresh off the Boat,” “Dr. Ken,” and “Master of None”. When an Emmy-award winning episode of “Master of None” showed us two Asian American men exploring their relationship to their immigrant parents, it captured an experience that many have often felt alone in. More importantly, it made it okay to talk about, sometimes for the first time.

Mark* says being in therapy has greatly helped relieve his stress and anxiety. When I asked him about the shame factor, his answer surprised me.

“I don’t hesitate to say that I go to therapy. I’m not ashamed at all.”

Share your story, get in touch: nicole@nicolehsiang.com

All names and identifying information have been changed

The Villain has Won

It's real, folks. The villain has won. A man who has been named a narcissist, a sexual predator, a sleazy business man with zero experience in politics, as well as a racist hate-monger, now also holds a new name: President of the United States.  

In the aftermath of this troubling reality, you may feel more alone, more upset, and more anxious about how you should be, as a person, a citizen, and a human being. You may feel lost as to what actually "works" to accomplish anything good, and that maybe no one actually knows

Our general sense of security and common sense have been threatened, confronting us with our lack of agency and control over our lives. What kind of motivation can we have in making progress and change in a world that is allowing Trump to be our leader?  Do we just go back to work the next day?

For some, Trump's victory fulfills a fantasy of defeat. For others, a fantasy of the rise of white, rural, blue collar worker power. And still for many, it's simply an iteration of systemic injustice, revealing the race and class struggles that sorely divides our nation. 

Realizing our own part in the perception of reality can come to a tremendous relief, if we take responsibility for the world we want to see. If we really want to, we can make this into a hero story, a story about resilience and love conquering hate. I implore you to take up your power, speak out what you believe in, and choose intelligence over ignorance at each opportunity. The freedom we have as free agents was never about our choices. It's about the actions we take after the choice has been made for us. 

Kid Cudi's Letter

Rapper Scott Mescudi, aka "Kid Cudi" has checked himself into rehab for depression. We know this because last night, he posted a raw, emotional letter to has fans about the fact that he is "not at peace" and that he has made a decision to care about his life by seeking help. Within hours, his words of vulnerability inspired more words across the internet, myself included. Kid Cudi, your commitment to staying alive means more to your fans than your commitment to making good music.  

If you have listened to his music, you would immediately feel the intensity of his melancholic lyrics and sounds. He has surely already helped millions feel little less alone in their own suffering. And now, he tells us, it is time that he pursue his own happiness.  

What Scott wrote to his fans has the same apologetic tone and language as a suicide letter, yet the difference is that he is still alive. He will be around to witness the effects of his actions on himself, and on others. While we don't know what will happen to him, we are grateful that he has given himself the chance to find out.

Suicidal feelings are important because they create a turning point in our lives. They can push you to make the difficult changes needed in order to keep going on as "you." When you are seeking an escape, what you actually want is to exist in negative space, the space outside of the bounds of social definitions that shape your reality. You want freedom from that reality. But if you're dead, there will be no negative space because there is no existence left to create it. Thus the only way you can escape reality, is to find a way to live within it.

A Relationship Unlike Any Other

A therapist is a person with whom you can speak the most peculiar and difficult things about yourself. They can listen to you in a different way than other people in your life, and respond differently as well. Seeking out this “difference” is key to therapy; you and your therapist create a confidential space where you can separate yourself from the way others see you. Some might assume that this means that the relationship you have with a therapist is not a relationship at all, but this is not the case! It is just a relationship unlike any other. 

Here are 5 unique aspects of your relationship with your therapist:

1. You pay us to listen.
What is quite interesting about the therapeutic relationship, is the odd pairing of intimacy with formality. You are sharing your personal life challenges with a trained and certified person to whom you pay an agreed upon fee, and you never see her outside of a regularly scheduled time and place. The nature of this exchange and the rules that accompany it, is the very reason why you can share in a safe way and have a therapeutic experience. The relationship that unfolds between you and your therapist is also part of that experience.

2. You don’t have to be a good person.
When a thought comes up that you fear may come out as offensive and make you look like a “bad person”, your inclination may be to censor yourself. But your therapist will not be offended. She just wants to know what the thoughts are, and encourages you to speak to anything that comes to mind.

3. You don’t have to like us.
A therapist is not invested in you liking him. He knows that the way he can benefit you is by helping you with the challenging task of expressing your truth. And towards this end, he is open to hearing all about your feelings towards him, including the way he has let you down, angered you, or irritates you for no reason.

4. You are never wrong.
Therapists live in your reality, period. You get to explain to her how certain ideas fit together and make sense in your head, no matter how nonsensical, immoral, or ridiculous seeming. When it comes to your life, she doesn’t know anything you don’t know. 

5. We don’t think we understand you.
When you are talking with friends or family, the desire to understand is a natural motivation for forming close bonds with others. But your therapist on the other hand, is more likely to express curiosity as opposed to understanding. At the risk of appearing foolish, he can ask questions about a fact that you have been certain of your entire life. 

So, what do you think might occur in such a relationship?
Expect to have some unusual conversations. Say the things you’ve never been able to say, or never had the words to say. Out of these conversations, you might discover new directions that you want to take in your life that were right there in front of you the whole time.


All those "Self-Help" Books

In Portland, Oregon, I've made an obligatory stop at the famously enormous Powell’s Bookstore. Refreshed by the fact that people still enjoy the act of flipping through pages of paper, I aim to peruse their impressive collection of new and used books.

Upon entering the store, I notice that the books that are specifically designed to grab my eyes and pull me into the store to read more, are “self-help books." They promise confidence, assertiveness, achievement, money, and love. There's an entire wall of books with the word “happiness” in their titles, and it's hard to look away.

OK, I want “happiness,” but which book do I choose? The one that says what the true secret of happiness is, or the one that debunks the myth of happiness?

My favorite display was the famous book by Japanese cleaning icon Mari Kondo, “The Life Changing Magic of Tidying Up”, and right next to it is its sassy response-book, “The Life Changing Magic of Not Giving a Fuck.” This hilarious meta-message playfully invites the reader to opt for their own kind of self-help. Or in other words, the kind that they already believe in. The ones who think that tidying is the answer, will pick the tidying book. The ones who don’t give a fuck, will pick the latter. Someone else is wondering, “What do I do if I give a fuck but I don’t want to tidy up?” 

Like many other psychotherapists, I’ve been obsessed with the goal of enlightenment, self-actualization, happiness, or whatever you want to call it, for a long time. But I’ve realized that I merely enjoy being seduced by the writing of an Other, a knowledgeable Other who acts as a surrogate ideal-ego when I am feeling alone, far from enlightened, and at times just ridiculously unaware. 

Rather than seeking to understand my own experience that is defined by its invisibility to others, it was easier to just grab the next best thing to read and feel temporarily relieved from uncertainty. But the books are always an inadequate response to what I am ultimately looking for. Most of them end up in the giveaway pile when I’m tidying up.

Here’s what I have arrived at: The search for how you should be won’t be found in a book. Read them, but beware, don’t succumb to the temptation to be cured. Instead, try on the work of exploring yourself in therapy, where the Other just listens to you and all of your unenlightened thoughts and feelings. You will be surprised by how original and articulate you actually are. You will find yourself in the position to create your own answers. 

All I ask is that when you do, don't write a self-help book. 

Beginning Therapy

First of all, I want to assure you that you don’t have to know exactly what’s wrong when you go to your first session with a therapist. Ignore what your friends, parents, partner, other health providers, or boss say you "should" work on. You can simply describe in the best way that you can, using your own words, what is happening with you that is not synching up with how you want to live your life. Remember, the whole point of needing help is the fact that you don’t know how to solve your own problems. You might even feel stupid or embarrassed in the beginning because what’s being asked of you is precisely to speak of what you don’t know about! The invitation is to become as curious and honest with yourself as possible. If you have never had the chance to speak in this way, you will probably experience an immediate relief from painful feelings. 

Starting therapy isn't easy; resistance and doubt are natural yet uncomfortable forces to deal with. The obstacles to getting help are totally real, involving a significant investment of your time, money, and emotional risk taking. At times it might seem like a struggle with no end in sight. If you still want to do it, it means that you have decided that your desire is worth fighting for, despite all of the obstacles. You are ready when all of the reasons to not seek whatever it is you are looking for cannot drown out the voice that seeks it. Therapy starts with listening to that voice.