Last year, KALW began a series on Asian American mental health. We introduced you to the Lieu family, who described their challenges as immigrants finding care for their schizophrenic daughter.

Albert and Anne Lieu run a support group in Oakland to help Chinese families navigate the complex American healthcare system. Their hope is to remove barriers to care, including stigma, and get families to open up to treatment. Asian Americans tend to wait longer before seeking mental health care, and often have more serious problems when they finally see a specialist.

This plays into a surprising statistic among Asian American women. According to the National Alliance on Mental Illness, Asian American women aged 15 to 24 have the highest rates of depressive symptoms of any ethnic or gender group. The CDC reports that young Asian American women have the second highest suicide rate among their age group – the same goes for Asian American women over 65.

In this second installment of KALW’s series, “Asian American Mental Health: Inside Out,” Erica Mu introduces us to two women who have stories that shed light on that statistic.

Difficult upbringings, worlds apart

Isabelle Thuy Pelaud and Danise Sugita are both technically Asian American, but they couldn’t have more different backgrounds. Isabelle is half Vietnamese and half French. She was born in France and moved to the United States when she was 19 years old. Danise Sugita is fourth-generation Japanese American, born and raised in the Southern California city of Ontario.

These two women grew up worlds apart, but at the age of 19, they both ended up at the same crossroads: Each woman tried to kill herself. What led Danise and Isabelle to that point is a combination of factors, including their life circumstances and the state of their mental health.

Let’s start with Danise Sugita. When you meet Danise, you might think: nice… upbeat. She’s 28 years old, lives in Berkeley, and works on a campaign for underserved youth. She’s not an outspoken advocate-type, though. She’s quiet, and has trouble making eye contact when she talks about herself and her family.

“Since I was really, really little, just having the first memories of me hiding in my room, holding my dolls, or just trying to comfort myself, just hearing my mother and father yelling at each other and my dad throwing dishes around,” Danise remembers. As she says this, she pushes up her glasses with her thin hands, and looks to the table. She continues to explain how fear was one of her greatest emotions as a child – something she says has probably carried into her adult life. Danise also remembers school life as being an extremely lonely experience.

Thousands of miles away in France, while she was in high school, Isabelle Thuy Pelaud was feeling the exact same way. Her Asian features made her an outcast among her peers and extended family.

“My mother was not accepted by her husband’s family in France, and they always treated her and I as total not only strangers, but very foreign and like we came from another planet,” Isabelle remembers.

Isabelle says that her parents’ relationship was an example of colonialism – her words. And like Danise, she recalls her parents getting into violent fights. Today, she teaches at SF State University. She’s beautiful, confident, a poet and an artist – identities she wouldn’t have even dreamed about as a child. She remembers how kids at school ignored and made fun of her, when they made the time to acknowledge her at all.

Both Danise and Isabelle struggled through middle school, and then high school. And at age 19, both came to the same tipping point.

Pushed over the edge

Danise flips through a thick, black, leather-bound journal she kept when she was 19. It only captures a few months, but important ones. She reaches one particular entry, dated December 2nd, 2002. Danise was still living at home in Ontario at the time.

“I think this last entry it says, one of the last sentences: ‘I can hear my grandmother and mother talking, I think they want to call poison control or something,’" she reads.

When Danise says these words out loud, it sounds like she’s reading someone else’s words. But when asked to describe that day’s events, she shifts in her seat, and explains. That night, she was in the family bathroom with a bottle of pills...

“I just was at the sink, I think I poured a lot in my mouth and just got the sink water and started drinking, just took that whole bottle,” she says quietly.

Danise’s memories after that are a little fuzzy. She remembers her sister finding her throwing up on the bathroom floor; her mother and grandmother panicking and yelling at each other; the 9-1-1 phone call, and waking up in the hospital.

“I was upset, angry – I wish I didn’t wake up,” Danise remembers.

In France, when Isabelle was 19, she was still suffering so much from her isolation that she even had trouble speaking.

“From birth to 19 I was totally silent, I was mute actually when I tried to speak, I was stuttering,” says Isabelle. “It’s not a natural condition, and it has nothing to do with being Asian or having any Asian blood – this silence was forced on me because of my environment, because I was not seen as it was my place to speak. And when you cannot speak or when you think it’s not your place to speak, you can internalize it and it can be self destructive.”

So much so that Isabelle attempted suicide. She wouldn’t describe what happened that day to push her over the edge, but she did admit that she made more than one attempt.

“I had no one to talk to,” she remembers.

Hidden cries for help

There’s no single indicator that says one person’s more likely to attempt suicide than another – there’s still very little known about why it happens at all, much less in Asian American women. But clinical psychologist and Palo Alto University assistant professor Joyce Chu says that experts do know that professional help for young women like Danise and Isabelle doesn’t come early enough, if at all.

“There’s a cultural practice of dealing with distress and feelings on your own before burdening others with them,” Chu explains. “By the time they seek professional help, the severity of their mental health problems are much higher than compared to every other group.”

Furthermore, even if you met someone who was suffering from depression or having suicidal thoughts, Chu says you might not know it.

“The literature shows that Asian Americans tend to express their distress more in their body rather than emotion terms, "Chu explains. "So if you talk to an Asian American person who is depressed, they might not say, ‘Hey I’m sad, and I cry everyday, and I’m blue’ – the questions that we tend to ask to assess for depression. Instead, they might say, ‘Hey I have a headache, I have a stomachache.’"

And so it’s not surprising that psychiatrists often miss these signals. That’s assuming that the patient comes in to see a doctor at all.

Divergent paths

After Danise and Isabelle both attempted suicide at age 19, they took divergent paths when it came to their mental illness. Danise sought therapy – even though she lacked support from her family. She tried inpatient and outpatient treatment, group therapy and antidepressants. But so far they haven’t worked, Danise says. Her last suicide attempt was in 2010, when she was 26 years old.

“I still feel the same way about life,” Danise sighs. “I don’t know. Like I don’t know if I could get better, or not get better. It’s just really frustrating I think for me.”

Danise says she’s still depressed, and not getting help. But at least now she’s able to talk about it, and is an open advocate for others to seek treatment early on.

When Isabelle was Danise’s age, she still hadn’t addressed her suicide attempts.

“I had put a lot of energy and drive to move forward and forget the person I was because I’m not very proud of it. I want to kill her. I want to act like she never happened,” Isabelle explains.

When Isabelle moved to the U.S., she says her English wasn’t good enough to get treatment – besides she didn’t have money or insurance. It wasn’t until her mid-40s when Isabelle was ready to accept her former self. That’s when she reached out to Asian American artist Cynthia Tom, who asked Isabelle an important question that would change the course of her mental health: “If you had a place of your own, what would it be?”

Cynthia created and directs the art project, “A Place of Her Own” with the Asian American Women Artists Association. When she first started the project, she didn’t know just how therapeutic the project would be for participants like Isabelle. After weeks of discussion, planning, crafting, and building, Isabelle finished her installation, a “wonderful kind of nest of beautiful cotton strings and yarns and bamboo slats," Cynthia explains. To finish the piece, Isabelle placed a single feather on top.

“And the feather is a symbol to remind me of my last suicide attempt,” Isabelle says, “because I had this little feather coming from the ceiling when I was in a bad space, and I just thought maybe it’s one of my ancestors being there for me. I didn’t think my parents were there for me, I didn’t have a community, I didn’t have a people – but I had this feather. And when that feather came into my hand, it changed my life around.”

In the fall of 2010, Isabelle showed her work at the Driftwood Salon in San Francisco. She enjoyed “A Place of Her Own” so much that she participated again in 2011.

“And the reason I liked the art, the project, was because I didn’t have to speak. Because I didn’t have to explain,” Isabelle says.

Cynthia Tom says that is the key benefit of art therapy: that it can help one begin to acknowledge past trauma without necessarily articulating it first. Still, Cynthia says it’s not a replacement for treatment, but Isabelle agrees that her experience participating in “A Place of Her Own” has helped her heal from her past.

“Although this process is slow and not like this cathartic thing like everything is fine, it’s a slow process where I can start to speak a little bit more about this, or write a little bit more about this, or make space for me to reflect on those times,” she says.

For both Isabelle and Danise, healing from a suicide attempt isn’t something that’s going to happen overnight, or in one year, or through one art project. It’s something they’re going to carry with them for the rest of their lives. But both women are beginning to find the courage to release what for so long they thought they had to hold inside.

This is Part II of a three-part series on Asian American mental health. Listen to Part I and Part III by clicking on the links.

Erica Mu has been reporting on Asian American mental health as part of The California Endowment Health Journalism Fellowships, a program of the University of Southern California's Annenberg School for Communication & Journalism.

If you or a loved one needs support, contact these organizations:

Richmond Area Multi-Services, Inc. (San Francisco): http://www.ramsinc.org/

Asian Community Mental Health Services (Oakland): http://acmhs.org/

Asian Americans for Community Involvement (San Jose): http://aaci.org/

Palo Alto University's Gronowski Center (Palo Alto): http://gronowski.paloaltou.edu/

National Suicide Prevention Lifeline: http://www.suicidepreventionlifeline.org

San Francisco Suicide Prevention: http://www.sfsuicide.org/; Crisis Line: 415/781-0500 in San Francisco; 800/273-TALK (8255) outside of San Francisco.

This story originally aired June 7, 2012.