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This inaugural guest blog is by my San Francisco colleague and friend, Nicole Hsiang.

Nicole Hsiang, has a practice in San Francisco, where she specializes in working with the unique issues facing second and third generation Asian American men and women. See her website for more details: nicolehsiang.com.

When Asian American Men Seek Therapy: The Invisible Struggles of a so-called "Model Minority"

“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 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 over twenty 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 “If you go to therapy, there must be 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 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 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. The symptoms are a means to communicate what is going on in the heart and mind, behind the ‘face.’

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

“I would have pretty bad 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 company.

He was wearing himself thin, spending hours overtime into the night, and dreading going to work. The 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 , 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 have difficulty feeling accepted for their setbacks and failures. They cannot show that they have 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 . He appreciates that his therapist doesn’t provide answers, but guides the conversation, asking deep questions that challenge him to think differently. He has been able to make astute connections between his family history and his present problems, like realizing that his mother was probably depressed when he was growing up.

When I asked him about the shame of being in therapy, his answer surprised me.

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



*All names and identifying information have been changed

RC note: If you're interested in more about in Asian American Men and Women, I invite you to download my free ebook.

Source: Nicole Hsiang, MFT

(c) 2016, Ravi Chandra, M.D. F.A.P.A. (Except for content (c) Nicole Hsiang.)

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