“Don’t you dare go back to that doctor,” my mother growled into the phone. “He’ll put ‘bipolar’ on your record and then you’ll never be able to get a job.”

I nodded into the receiver. “Okay.”

I never went back. Seven years later, I woke up in a psych ward.

Growing up, I thought I was emotionally healthy. I had a large Chinese family on my mother’s side (my father is white). We were a lively, loud, tight-knit group consisting of around 20 blood relatives and 3 million non-blood relatives. Everyone knew each other’s business. Distant family members inquired about school, commented on my weight, and asked if I had a boyfriend. The only time it was “quiet” was when the Mahjong table came out and the only noise you’d hear was the click-clacking of tiles.

But when I look back, I realize that we shied away from the important topics. Mental health was rarely discussed, but when it was, it was always in a negative light. At no point did any of my relatives tell me having a mental disorder, theoretically at this point, was unacceptable — I could tell by their hushed tones, and their quick dismissals, that mental illness was not an option.

I never questioned it. If relatives felt comfortable enough teasing me about my grades or weight, then surely they’d be okay with talking about mental health? The reality was not even close.

Most people know the stigma associated with mental illness. But there’s even more stigma within communities of color, and within Asian culture, it’s particularly bad. It’s like Russian nesting dolls of shame.

Scientific research shows the severity of mental health issues among Asian Americans. Studies have found a few common causes — shame, fear, and avoidance, all of which have roots in the culture and the “model minority” stereotype. One could argue most people, regardless of race, are reluctant to discuss their mental state, but studies show Asian Americans are three times less likely than white people to seek mental health treatment. Another study carried out in 2011 showed that Asian Americans typically avoid mental health services because “opting to utilize such services requires admitting the existence of a mental health problem and may cause shame to the family if personal issues become public.”

For the first 27 years of my life, I kept my deteriorating mental health under lock and key for one straightforward reason: I was scared of embarrassing my mother. I believed I would be seen as broken or defective and bring shame on my family.

Any Asian person, especially women, will tell you about the pressures of growing up in many Asian households — the high expectations, the keeping up of appearances, and the toxic “model minority” stereotype that continually hums in the background of your life. There’s an expectation to stand out for the “right” reasons — meaning good grades, a fancy job, high salary, good social standing, and having a husband or wife. In my family’s minds, having a mental illness can prevent you from achieving those things. And if you’re not achieving everything, then why are you even here?

Asian women in particular feel the need to prove themselves. Historically, we’re on the back foot since birth because Chinese families have long favored sons over daughters. Those attitudes have changed over time, but the feeling still lingers — we weren’t born the first choice, but we’ll work twice as hard to prove we deserve to be here. On top of all of that, we’re pressured by society (and Chinese culture) to start a family at a much younger age than men, meaning we’re on a shorter timeline to achieve anything. No wonder Asian-American women have a higher lifetime rate of suicidal thoughts than the general population.

My mother took me to see a psychologist once. I couldn’t talk.

My depression started in my teens. I didn’t think it was a problem: I assumed it was normal to feel low and isolated for long periods of time. From the ages of 13 to 18, I had several anxiety attacks. A few of my friends knew, but I rarely talked about it, and never to my family.

I managed to hide all of this from my mother, except for one incident when I was 17 and going through an incredibly low period. Like many people with a mental illness, I showed no visible signs of anxiety or depression. But I retreated into myself, finding it hard to communicate or perform basic tasks like showering or brushing my teeth. I knew I felt sad, but I didn’t know anything was “wrong.”

My mother became frustrated I wasn’t my “usual” self. And because there wasn’t anything physically wrong with me, she took me to the emergency room to see a mental health professional. I sat on a chair in a windowless room, my mother next to me, while a specialist straight up asked me what was wrong.

I refused to say what was wrong. My mother was in the room, and I didn’t want her to know. I could tell she was annoyed I wouldn’t talk, and even more annoyed she had to bring me in the first place. As my silence deepened, I remember her saying, “I don’t know what’s wrong with her, but her breath smells.” She was disgusted by me.

The specialist asked her to leave the room so he could talk to me in private. He said he couldn’t help me unless I told him what was wrong. I couldn’t. After hearing the disdain in my mother’s voice, I was too ashamed of embarrassing her. I didn’t want to let her down, so I said I was “fine” and left.

My mother and I didn’t talk about it again. And, unlike my grades, who I was dating, and my physical appearance, it wasn’t brought up at family gatherings. Maybe my relatives knew I was “down” and simply chose not to discuss it with me. Perhaps they just didn’t know how. After all, this stigma has been around as long as mental illness. At the time, I didn’t care; I was more interested in maintaining my reputation within the family than my mental health.

It comes back to this specific Asian brand of shame and pride. The shame prevents us from talking about it within the family, and the pride covers up the shame for those outside the family. According to an article by psychologist Ben Tran, this particular behavior has a name: “hiding up.” Hiding up is the act of both keeping your mental illness hidden from the community and not doing anything to treat the illness itself. It’s a dangerous combination.

The problem with “hiding up” is that the behavior became so ingrained that I continued to do it when I left home. By the time I went to university, my commitment to the cover-up was unwavering. Meanwhile, my mental state felt like it was tearing at the seams. I went to see a campus doctor — this time, my mom wasn’t there, and I told him as much as I could. He told me he suspected I was bipolar but that I would need to see a psychiatrist for a proper diagnosis.

I left the appointment feeling a mix of relief and terror: relief that I wasn’t crazy in thinking I was crazy, but terrified of making that phone call. I never worked up the courage to do it. It would take another eight years and a life-threatening situation before I’d finally receive a diagnosis for bipolar II from a psychiatrist.

The last straw

I was 27 when I first tried to kill myself. I was admitted to a psych ward, then transferred to a psychiatric hospital. I was incapacitated my first day in the ward. One of the psychiatrists called my mother to tell her what happened. When I asked how she reacted, he said she was angry. The first thing she asked was, “Why did no one tell me?”

I was transferred to a psychiatric hospital in November. There, I called my mother to talk about Christmas plans; I’d booked my flights a couple of months earlier and was excited to come home for the holidays. She was curt on the phone. She said I couldn’t stay with her, making up excuses about the broken heating in the house. It quickly dawned on me that these were flimsy cover-ups for the real reason — she was ashamed and didn’t want me around. My mental illness had become impossible to hide from the rest of my family.

I ended up staying with a friend and her family for the holidays. I didn’t see my mother, nor did we have any contact during that time. There was a smattering of communication in the subsequent months that quickly petered out. Our relationship hasn’t been the same since. I realized I couldn’t have someone in my life who couldn’t accept my mental illness, even if that person was my mother. We’ve been estranged for more than four years now, and my contact with the rest of the family is patchy at best.

To be clear, I don’t judge or blame my family at all. If anything, I empathize with them. I’m sure they’ve had struggles of their own that they’ve had to repress. Maybe they were scared. Maybe it wasn’t that they didn’t want to talk about it, but instead didn’t know how. I have no idea what they’ve been through — not just because they refuse to speak about it, but also because I didn’t ask.

The stigma associated with mental illness is so deeply entrenched in Asian culture; it’s unrealistic to think people can change their minds that easily. But this pressure to hide our problems away has dangerous consequences. The shame is killing us — older Asian-American women have the highest rates of suicide compared to any other race.

If we want to see change, it needs to come from everywhere both big and small. In 2017, a new bill was introduced to reduce the mental health stigma in the Asian-American and Pacific Islander community through specific outreach and education. And while it’s promising to see changes come from the top, those of us who are living with mental illness can make the most impact. By continuing to share our experiences, we can give people the strength to come out of “hiding.”

Amanda Rosenberg is a writer based in San Francisco. You can find her work in McSweeney’s, the Establishment, Anxy Magazine, GOOD, Huffington Post, Quartz, and the Mighty. She’s an editor for Slackjaw and is currently writing her first book — a collection of essays on mental illness.

First Person is Vox’s home for compelling, provocative narrative essays. Do you have a story to share? Read our submission guidelines, and pitch us at firstperson@vox.com.