James Lee, a well-dressed, articulate, 35-year-old Korean-American walks into my office. Lee tells me he has no one else to turn to for help in dealing with his gambling and compulsive use of and prostitutes. I asked if he’s shared this struggle with anyone close to him.

Although he has a strong Korean network of friends and also belongs to a Korean-American church, he isn’t comfortable sharing it with the pastors or other church members for of how they’d react. His wife recently discovered his sexual behaviors by finding email correspondence between James and the prostitutes, and she now insulates herself from him and family functions.

Other than his wife, his parents also know about his problems after he confided in them with this reasoning, “I was tired of coming up with excuses as to why Stacy wasn’t joining my family at various gatherings over the past few months”. When I asked him how his parents responded, he said his dad remained silent while mom yelled hysterically at him, “How could you?! We didn’t raise you to be like this!” So instead of getting any support through this process, he received a message of shame of having let down his family and the larger Korean community and culture.

In our sessions, Lee shared the conflicting messages of growing up as the oldest child to first-generation, Korean-American parents who immigrated to the United States in the mid-’70s. “As a Korean-American, I grew up with messages of conditional love, shame, and the need to hide." He believes this may have contributed to his today despite having a successful job in tech.

I can see the challenges Lee faced as he tried to navigate two worlds—honoring his Korean heritage while also trying to honor his sense of autonomy growing up. He saw getting help as bringing dishonor to his family and not an act of empowerment.

This is one cultural difference I see when Asian-American clients come in for that’s significantly different from Caucasians without an ethnic or cultural identification. Seeking help for addictions, while praised and encouraged in mainstream American society is seen as a major umbrage to the Asian individual, family, and extended Asian community.

It’s no wonder that when it comes to addictions, scant is given to Asians. Part of the limited attention lies in the age-old Asian custom of secrecy, silence, and shame. From an Asian addict’s perspective, it’s the ultimate blow of to be seen as weak since having an goes against Asian social norms.

“Most classical shame events simply center on failing to meet a minimum standard for social acceptability."

It’s the most difficult thing to admit to themselves, their families, and other loved ones that they have a problem and need help. The mere acknowledgment of an Asian person having a problem is going against cultural norms because it sends the implicit message to others that you have let them down.

“In Western understanding, internal shame arises when one feels he or she has not lived up to his or her own expectation of the self. However, internal shame in Korea comes when a person has not lived up to the community’s rules and expectations. This internal shame is very prevalent among Asians and Koreans. It functions to build group harmony and unity.”

In addition, Asian shame is intricately tied to the fear of rejection and loss of both familial and cultural community support. You can see why someone like Lee would have difficulty sharing his compulsive and addictive behaviors. His sense of shame is tied to the fear of being ostracized by causing disruption to his family and ethnic group’s sense of solidarity.

“Asians (Koreans) put high value on the harmonious integration of group members. So shame, possibly evidence (sic) by its emergence during the stage, is more profoundly associated with the fear that one’s inadequacies will result in the loss of union with or expulsion from the group.”

If you want to understand Asian addictions, you need to understand the principle of cultural shame and its underlying impact on those from Asian backgrounds. This concept of shame is what undergirds Asian societies, families, and thus individuals. When it comes to Asian people, our cultures revolve around some aspect of shame. Asian identities are forged early on in by learning that shame is used to bring about social order and harmony.

“Chinese parents readily discuss and disclose children’s transgressions in front of strangers to induce shame and to socialize children to behave properly … given the greater valuation of shame in collectivist cultures compared to individualistic ones, it should not be surprising that in many East Asian and other collectivist contexts shame plays a more salient role in everyday life.”

What this means is that in shame-based cultures, public humiliation, scorn, or censure are relied upon more heavily to keep individuals in obedience whereas the western notion of and corrective behaviors comes from an individual’s development of an internal .

“True shame cultures rely on external sanctions for good behavior, not, as true guilt cultures do, on an internalized conviction of sin … [Shame] requires an audience or at least a man’s of an audience. Guilt does not.”

Since people often use the terms shame and guilt interchangeably, it’s important to clarify the differences. Guilt is seen as remorse for behaviors, actions, or thoughts and can be viewed as separate from the person’s core. So guilt can help people acknowledge their mistakes and come to a point of reconciliation to repair ruptured relationships whereas shame, by contrast, is a perverse and distorted belief that the individual is internally flawed, defective, or bad for having certain beliefs, feelings, behaviors, or experiences.

Asian cultures, unlike American or Western society, are collectivist by nature. Unlike the United States, which prides itself on individuality and independence with the concept of “I” taking priority, Asian nations value interdependence, social harmony, and group cohesion making “we” paramount.

“Interdependent orientations depend on the reference group, and within Asian families, children are socialized to view the family as the focal reference group for interdependence … collectivist cultures emphasize interdependent relationships and prioritizing of the in-group’s over personal ones. Individualistic cultures, in contrast, emphasize independence and prioritizing personal goals over those of the in-group.”

Since the Asian view of “self” and one’s actions are seen as relationally interdependent upon family and their ethnic community, as a result shame also has a much broader impact as the shame can be experienced collectively, starting within the family system.

In other words, a traditional Westerner may experience shame as a result of something they did, whereas Asians entrenched in a shame-bound system or culture will experience shame not only individually but also collectively when someone has done something dishonorable. So much so that Asians will also experience shame in response to something that someone close to them has done.

In our earlier example, James Lee's mother was experiencing the shame of knowing her son was struggling with his gambling and sexual behaviors. The shame being communicated was the mother’s internalization that her son’s shame has tainted their family name and honor.

“Patients may not be willing to discuss their moods or psychological states because of fears of social stigma and shame. In many Asian cultures, mental illness is stigmatizing; it reflects poorly on family lineage and can influence others' beliefs about the suitability of an individual for .”

Upholding this concept of cultural honor is what drives Asian relationships, thus shame and honor are inextricably tied together. They are the yin and the yang of Asian life. They coexist together to bring harmony, cohesion, and order to Asian countries.

Because of the Asian fixation on honor, people of Asian descent learn early on to suppress emotions, personal inadequacies, and problems as a means to “save face.” Since saving face is seen as bringing honor to oneself and one’s culture, then hiding one’s true feelings also carries a degree of honor. Hence, the outward display of emotions is shunned since that would be seen as losing face.

Many Asians will do everything in their power not to show any negative emotions or feelings for fear of going against the cultural norm of collectivism. , disappointment, sadness, and issues related to shame such as poor grades, relational difficulties, bankruptcy, sexual issues, and addictions remain hidden in secrecy and shame.

“Collectivist tradition discourages open displays of emotions in order to maintain social and familial harmony or to avoid exposure of personal weakness. Saving face—the ability to preserve the public appearance of the patient and family for the sake of community propriety—is extremely important to most Asian groups.”

In James Lee’s case, he learned early on from his parents that strong emotions such as anger, resentment, fear, helplessness, and sadness were discouraged. Without a healthy way to release these emotions, many addicts (Asians or otherwise) will turn to various substances or behaviors to get their emotional needs met. It’s no coincidence, that James withdrew and used to pornography at an early age to soothe himself. He said, “Since my parents weren’t going to listen to me when I was upset as a child, I realized looking at porn and masturbating helped relieve those intense feelings.”

But James also realized the pain caused by his addictions meant he had to do something drastic if he was going to get better, even if it meant bringing shame upon himself and his family, rather than suffering in silence.

Disclaimer: To preserve the confidentiality of the people described, all the examples are composites. In each case, all names and identifying characteristics are fictitious.