Why Saving Face Doesn’t Work: 3 Ways to Combat Mental Health Stigma for Asian Americans

Source:  Samuel Zeller  

Source: Samuel Zeller 

Asians don’t go to therapy. Why would I pay a stranger to listen to me share about my feelings? I can figure things out on my own. When things are really bad then I’ll go talk to someone.

I often hear these statements in different pockets of Asian American communities. I’ve spoken with many people about the importance of therapy, and have often found that “mental health” is an unfamiliar term for many Asian Americans. Why is this so?

Traditionally, mental health isn’t really talked about. The focus of concern is about the physical well-being rather than the emotional state. We see this in the ways Asian greetings revolve around whether one has eaten. Love is conveyed through serving practical needs or giving gifts. Emotions take a back seat when duty, filial piety, and family loyalty demand harmony.

Particularly among immigrant families, there isn’t a culture of expressing emotions or having conversations about one’s feelings. Currently in my private practice, about 80% of my clients are Asian and are generationally diverse. A majority of these clients sought therapy to process typically suppressed emotions in order to improve their relationships. I recognize, however, that this kind of initiation isn’t the status quo. 

Even among Asian Americans, I see the generational influence of their family’s traditional way to cope with problems: we don’t talk about it, especially with outsiders. This is a by-product of the deeply traditional Asian culture of “saving face”.

Saving face means to preserve your dignity, avoid any embarrassment or disgrace, and uphold the image that all is well and you can handle it. They are the neatly polished doors that are tightly shut to protect the public's eye from truly knowing what are behind them.

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Why Saving Face Does Not Work

Statistically, Asian Americans have the lowest rate of utilizing mental health services compared to any other racial demographic groups. The U.S. Department of Health and Human Services found that in 2014, only 6% of all Asian Americans in the US sought mental health counseling.  However, lower usage doesn’t mean a lower need for support.

According to a 2015 study from the Center for Disease Control and Prevention, 

  • 18.9% of Asian American high school students report considering suicide, versus 15.5% of whites.
  • 10.8% of Asian American high school students report having attempted suicide, versus 6.2% of whites.
  • Asian American high school females are twice as likely (15%) to have attempted suicide than males (7%).
  • Suicide death rates are 30% higher for 15-24 year old Asian American females than they are for white females (5.3 versus 4.0). 
  • Suicide death rates for 65+ year old Asian American females are higher than they are for white females (4.8 to 4.5).

This feels both sobering and alarming to me.

Saving face is so deeply ingrained in the culture that the stakes are often too high to seek support even when issues are urgent. Seeking help is considered a weakness and viewed as shameful to the individual and family unit. Thus, alternatives are to rely on friends and family, or to try and work out problems on their own. This often delays the decision to seek out professional support until problems have become severe.

A teen’s parents are informed by his school that he is experiencing symptoms of anxiety from academic pressure. The teen has reoccurring panic attacks during class and has difficulty concentrating after it occurs. Parents decline the school’s recommendation to seek counseling, and support their son by getting him additional academic tutoring. It isn’t until their son has stopped attending school for over a month and he shares with them that he has suicidal thoughts that parents are open to seek services.

I want to acknowledge that some family members and friends do offer safe outlets for support. We all need a wide and safe support network. However, it is also often the case that family and friends do not have the clinical skill and tools to know how to support someone who is struggling with mental illness (i.e. Major Depression or Generalized Anxiety) or coping with difficult life situations (i.e. grieving through a miscarriage or processing a partner’s affair).

When these issues feel too shameful to even disclose to one’s community, this silences the individual and leaves him or her feeling alone, and at higher risk for depression and suicide.

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Saving face is detrimental when it comes to mental health, and it is time to shift the stigma.

Whether you are Asian American or not, here are 3 practical ways you can be a part of this:

1. Share your experiences

Do you find yourself in a position of not being able to open up to anyone, except maybe with family, and feel that no one is safe?

The truth is encountering pain is a universal human experience. We all have faced the disappointing, defeating, and heartbreaking parts of life. When we acknowledge and talk about our pain, whether past or present, we embrace our humanness and invite a deeper connection in our relationships.

Talking to someone outside of your family provides a neutral perspective into your situation. By opening up, you gain insights into your feelings and behaviors, which are consequential to your relationships and overall well-being.

Share with a trusted friend a situation where you feel stuck, depressed, or anxious and how you are dealing with it. Add a positive ask of how you would like to be supported.

For those of you who have gone to counseling or therapy, let me just say a quick word to you. If you have had any positive experience, please talk about it. Share about your initial feelings, how you feel about it now, and what was helpful. The more we talk about mental health, we normalize the conversation, elevate awareness, and give hope that resources are available. 

2. Join with someone struggling

We can spot behavioral changes in the people around us, and flags should go up when we notice a withdrawing from normal activities, isolation from family and friends, and an increase of unhealthy coping behaviors (i.e. alcohol, drugs, over/under-eating, etc).

Take the time to reach out to that person and offer compassion. By doing so, you convey to the person that you care and that they are not alone. The first step in being a safe space to someone is not to fix their situation, but simply listen and offer empathy.

3. Take a risk

If you are currently struggling and feeling frustrated or hopeless about something in your life, I want you to know that you are not alone. There are so many others who are or have experienced the same pain. I encourage you to take a risk today and reach out to a mental health professional. Initiating a phone call consultation or emailing is the first step in getting support.

Even as a therapist, I know what it’s like to be in your lowest place and reaching out: it is so hard. Yet, we are wired to be in relationships and connected to one another, and healing begins when we allow someone to join with us.

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Something miraculous happens when we start paying attention and tending to our emotional well-being: we change. We increase compassion for ourselves and cultivate healthier relationships. We learn to accept the painful parts of life and encounter hope in the healing.