(Photo: Sodanie Chea/Flickr)

During the fall semester of her senior year at New York University in 2011, Reera Yoo found herself struggling to remember simple things, like what she'd had for breakfast that morning. She would find herself holding pills and knives, but not knowing why. A couple of weeks before she was hospitalized for suicidal tendencies, anxiety about going outside kept Yoo from leaving her room. Friends started noticing her erratic behavior as well. Finally, after three months, feeling like she'd run out of options, Yoo spoke to a counselor at the NYU mental health center who immediately recommended that she be hospitalized. Since Yoo was 21 at the time, she opted not to have her parents notified. Instead, she called a close friend. "I told my friend that I was at the hospital because I wanted to tell somebody," Yoo tells me. "Because it was such a short message, she contacted my parents and told them. They were very surprised."

While suicides on college campuses aren't unique to students of Asian descent, the risk factors surrounding children of immigrant parents are comparatively higher. One 2010 study found that the number of Asian-American students suffering from depression was significantly greater than their Caucasian counterparts. A comprehensive review released in May surveying the risk factors for suicide and depression among Asian-American youth listed concerns over school performance, being subject to bullying, low parental support, and difficulty orientating to American culture as largely responsible for the pervasiveness of suicide and depression within the community. As an Asian-American woman myself, I've seen depression and mental-health issues treated with silent shame. When I confessed to my mother that I'd had a bout of depression, she assured me that she wouldn't tell anyone in our family, that she would keep it a secret. But people like Reera Yoo make it clear that we need to talk openly about our mental-health issues, before it's too late.

Yoo says that there is no word for depression in the Korean language. The closest way for her to describe to her parents her health-care issues when they found out she was hospitalized for suicidal thoughts was to emphasize her stress, to simply tell them she was "not herself." The news of her hospitalization hit Yoo's parents hard. They cried frequently, worrying about their eldest child.

It's been four years since Yoo was diagnosed with clinical depression and anxiety. And her well-meaning parents still struggle to understand her condition. "My parents ask me, 'When are you going to stop going to therapy?'" Yoo says. "They don't understand that depression doesn't go away. Even if you're feeling good, there's always that fear of relapsing." But Yoo has noticed a change in how her parents discuss her health. In the past, when she's mentioned feeling worried, they had told her to push through the mental strain. Now, they ask Yoo how she's feeling, and tell her, "When you're feeling stressed out, rest. It's not healthy to push yourself too hard." After they witnessed Yoo having a full-blown panic attack (including her breathing into a paper bag), her parents saw for themselves what happens when her anxiety takes over. But even still, Yoo and her parents never discuss her condition. "There is an agreement to not really talk about. That panic attack sparked more understanding than conversations."

"My parents ask me, 'When are you going to stop going to therapy?' They don't understand that depression doesn't go away."

The challenge for second-generation Asian Americans lies in the generational divide between our well-meaning parents and their misunderstanding of what it really means to be depressed, anxious, or unhappy. There's often a silence that surrounds our conditions. After MIT student Elizabeth Shin committed suicide by setting herself on fire in her dorm room in 1998, her parents found it difficult to discuss of the details of Shin's death within their community. While fellow Koreans pray for them at church, Shin's parents admit in a New York Times interview, no one dared to ask any questions about their daughter's death. This is, after all, a "mental health issue."

Wai-Kwong Wong, the assistant director for community-based services at Cornell University, understands why so many Asian and Asian-American students refuse therapy. "The idea of a talking cure is pretty new and alienable for relatively recent immigrants or international students, as opposed to growing up on the Upper East Side. There's not much exposure for this kind of help," he says. "Asian cultures don't privilege emotional sharing. Plus, counseling is seen as only for crazy people ... and it's a cultural imperative not to air dirty laundry."

Cindy Ng, the associate dean of students and the director of the Asian American Activities Center at Stanford University—which, in 2013, boasted a five percent acceptance rate—agrees with Wong's assessment. "Acknowledging mental health issues and seeking therapy can be viewed as an admission of weakness and/or failure. Seeking therapy can also be seen as bringing shame to the individual as well as the family," she writes in an email, explaining why Asian-American students are often the least likely to seek out counseling services on campus. Ng recognizes that these highly selective schools can add to any student's stress level, especially when "admitted students are high achievers." Coupled with the model minority myth—stereotypical expectations that all Asian-American students are brilliant in academics—"When a student does not meet the expectation that she will excel, especially in math and sciences, the stress can be intense," Ng says. "Often the expectations have become internalized, leading to feelings of failure and worthlessness."

Universities like Cornell, MIT, and Stanford are more than aware that their students need help. So they developed counseling programs; outreach to their most at-risk—but also least likely to seek help—students. In 2002, Cornell formed a special mental health-oriented Asian and Asian American Campus Climate Task Force, meant to assess the causes behind this high number of suicides. The task force in turn developed a program called Let's Talk, where trained counselors post up in 10 different common areas—like the freshman center and the international students area—on campus, waiting for students to walk up for an informal consultation, without any paperwork. The idea behind the program, Wong tells me, is that students who are undergoing high levels of distress might be more willing to talk in a setting they are familiar with, at a time of their own choosing. In the 10 years since the program was first implemented, 32 other schools have adopted a similar version on their campuses. "We also have another program that is specifically designed for faculty and staff who notice students who are distressed," Wong says. "We don't expect [faculty and staff] to be therapists, but [we emphasize to them that] you must tell someone about your concerns. If a student hasn't gone to class for three weeks and hasn't responded to emails, there's something you can do about it. This approach has helped a lot of people."

"Counseling is seen as only for crazy people, and it's a cultural imperative not to air dirty laundry."

After several student suicides in 2007, Stanford University, like Cornell, realized that it needed to make significant changes to its counseling programs. In 2008, the university conduced a telephone survey with almost 2,200 students, which found that 23.4 percent of the student body experienced a depressed mood, while 32.9 percent felt high levels of stress. A task force was put together to report on what could be done, and a closer look at Stanford's Counseling and Psychological Services revealed a need for more counselors and an expansion of outreach efforts beyond the confines of the counseling center.

For 21-year-old Stanford senior Annie Phan, these changes have made a huge difference for her and her fellow students. "Having a diverse list of resources for students, from anonymous hotlines to ethnic community centers to religious gatherings to professional counseling are important because people have different ways of dealing with stress," she writes in an email. After struggling with depressive episodes, panic attacks, and post traumatic stress disorder symptoms, Phan utilized the counseling and psychological services, along with iLive, an Asian-American mental health workshop series at Stanford. Phan admits that seeking professional help is still a struggle, but says her support system of friends and mentors keeps her in check. "Oftentimes I think to myself, 'Nah, this will be over with soon enough,' so it also takes my support system to check in on me and say, 'No, your feelings and struggles matter, and it's a perfectly normal thing to go to a therapist, just as it's normal to see a doctor when you come down with a bad cold.'"

In April 2014, for her 24th birthday, Yoo, the former NYU student, launched a fundraising campaign for suicide awareness, and publicly shared for the first time her struggles with depression. Admitting the truth was a big step in Yoo's recovery, because she felt like her sense of shame had lifted. "The major reason I decided to go public," she says, "is because I lost a few friends to suicide. I wondered, 'If I had talked to my friends about their mental health issues, would it have made a difference? Would it have made them feel safer?'"

Yoo is not alone in her activism. Phan has also been vocal about her PTSD and panic attacks to her peers, in hopes of raising awareness in the Asian-American community. As a co-chair for Stanford's annual Listen to the Silence conference, which addresses important topics in the Asian community, Phan included a workshop on mental health issues for Asian undergraduates. "I try my hardest to be transparent about my own mental health, as long as I feel safe to share it. Representation and visibility can make a big difference in showing youth that seeking help is OK and important," Phan writes.

When asked what we, the Asian-American community, can do to help our youth be more open about discussing mental health issues, Wong shares, "Shame is a big factor that leads people to hide and prevents people from seeking help. Among Asian Americans, there's a joke that we go crazy and commit suicide. But we need to have a conversation about this in a serious way. Mental health care is a real issue, and not just for Asian Americans."

We want to make our parents proud—no matter how hard they push us.

To understand why Asian-American students stay silent about their worrisome feelings, it's best to look at how we're raised. Asian-American parents care deeply about their children, but often that can be expressed in ways that are damaging. In 2011, Yale law professor Amy Chua wrote a much-discussed parenting book, Battle Hymn of the Tiger Mom, which extolls the virtues of strict Chinese parenting, and examines the reasons behind her daughters' academic success. One particularly chilling anecdote Chua shared in a Washington Post excerpt recounted how she forced her daughter to learn a song on the piano by refusing to let her leave it, "not for water, not even to go to the bathroom." When her Caucasian husband confronted Chua to stop insulting their daughter, Chua rolled her eyes and said, "Everyone is special in their special own way. Even losers are special in their own special way."

Not every single Asian parent treats their children this way. Still, the Chua anecdote highlights the culture of shame and harassment that's seen as a successful way of raising a hardworking, motivated child. One study in the wake of Tiger Mom noted that Asian-American children are more likely to view parental pressure as a positive interaction rather than negative. We want to make our parents proud—no matter how hard they push us. Combine parental pressure with a dose of depressive feelings, then drop that high-achieving Asian-American student off at a challenging university—it's no wonder that these festering feelings of worthlessness and failure (which can't be talked about) boil over into a raging, suicidal mess.

Instead of living in silence or shame, we should be honest about how we feel and what we're struggling with to create open dialogues so no other teenager feels how Elizabeth Shin felt—alone, frightened, and suicidal. Stigma can only be born through silence, and it's time we admitted the truth. We need help, and seeking help is OK.