An Asian Mental Health Story

Transcript

Ellie Pike:
As Carrie Zhang, the founder of the Asian Mental Health Project grew up, she felt as though she had no right to talk about her struggles with mental health.

Carrie Zhang:
My dad went through so much hardship, the effects of the cultural revolution, famine, poverty, violence, losing his parents, all these really deeply traumatic things that I never had to go through. And so growing up the narrative was like, oh, you're sad. These are all the things that I went through in my life.

Ellie Pike:
Her parents, immigrants of China and Taiwan, simply could not understand how their daughter could be struggling, especially after all they had endured to raise her in the United States.

Carrie Zhang:
I moved to the states to give my kids a better life. They have it so much better than I ever had it growing up. Why are they unhappy?

Ellie Pike:
Yet the family's perspective on mental health stunted her ability to process difficult emotions and experiences, skills she was forced to learn as an adult when the stakes were much, much higher.

Carrie Zhang:
And so I wanted to create a space and resources that would allow people to be able to talk about their mental health at whatever stage they're in and feel empowered to seek help that they need.

Ellie Pike:
On today's episode, we talk with Carrie about her personal awakening to mental healthcare, the cultural stigmas and institutional bias preventing the Asian Pacific Islander Desi American community, APIDA for short, from receiving the help they need. And finally, what we can do about it. You are listening to Mental Note Podcast, I'm Ellie Pike. Thank you so much for joining this podcast and sharing with us about your story personally, and also what drives you behind the Asian Mental Health Project. So can you just tell me a little bit about yourself and your background?

Carrie Zhang:
Yeah, totally. So a little bit about me. Well, I am a daughter of immigrants. My mom is Taiwanese, my dad is Chinese. They came to the states, had me and my sibling, and I grew up very Asian-American. I grew up in an area that was predominantly Asian, which is, I think pretty, I think it's a unique situation to be in just because there's not very many communities that are heavily, heavily Asian, but there are pockets of that, especially in Southern California, which is where I'm from. So grew up very Asian-American, grew up with an onset of specialties and issues, I would say that, because of my identity. And really sought out to unpack that in recent years, especially from a mental health perspective. So happy to dive more into that, but that's who I am.

Ellie Pike:
Can you tell me a little bit about growing up Chinese and Taiwanese, maybe one of your favorite family traditions, or things that you identify with specifically in the Chinese, Taiwanese culture?

Carrie Zhang:
Oh, I love that. Oh, one thing that I really identify with, with the Chinese and Taiwanese culture, family is really a lot, means a lot to me. And I think recently I've been trying to understand, really getting in touch with my cultural background and maybe a little bit of spirituality, food was a really big unifier for us. So learning my culture through cooking and eating foods, my family would always come together and eat at the dinner table every night. I don't know if that's necessarily uniquely like Chinese, Taiwanese thing. That's something that my family really did and we would always eat together. And that's something I definitely really appreciated about it, because we really got to talk and connect in ways, not about everything, but that was definitely one thing that I had there, one thing that is also pretty, I think uniquely, maybe Taiwanese, Chinese is a sliced fruit.

Carrie Zhang:
So I mentioned earlier that I also like trying fruit and it's because I grew up in a household where my mom wouldn't necessarily talk to me about things, or it'd be like, hey, how's your homework? Here's a bowl of sliced fruit. And that was such a way of showing affection, just always having food on the table, always having fruit specifically, cutting it for you. That's just such a nice act of love that I feel is often uniquely Asian and something I definitely bring now. So, now when I'm with my friends, I'll be like, here's a plate of sliced Kiwi, you want some. And I realize I carry that over from my mom.

Ellie Pike:
I really like that tradition, and that there's affection through that act of giving and the service that it entails. It sounds like you're able to see what might be just your family, but also you're very much influenced by the Asian and American culture. Can you talk about some of the themes in Asian culture that impact mental health?

Carrie Zhang:
Yeah. There's a number of things. Firstly, there's the big elephant in the room is that, it's heavily stigmatized, mental health in Asian cultures. I think it's definitely getting better from what I've heard, but growing up, I was never really able to talk about my feelings at all, never really had the vocabulary to open up. And there's a couple of things, not necessarily having to do with culture, but also language barrier where I couldn't express what I'm feeling simply because I didn't really know how to say it. My parents speak mostly Mandarin, and I speak Mandarin too, but not to the extent where I'd be like, hey mom, I'm having an anxiety attack. I wouldn't have been able to say that, both because it's cultural stigma, also because of language barriers.

Ellie Pike:
Do you want to talk a little bit about why it was uncomfortable to talk about feelings? Is there an answer to that?

Carrie Zhang:
Why are feelings so hard to talk about in Asian households? One, I feel like, you're never primed to talk about feelings. I think in my house, I'll speak from my household specifically. I think if there was any divergent from normal, or happy, or whatever, it was processed as something that was wrong with either my parents' parenting style, to which they took offense, which I can so understand, it's very stressful to raise someone in a new country. There's also the concept of generational trauma and also the concept of I moved, as an immigrant, I moved to the states to give my kids a better life. They have it so much better than I ever had it growing up. Why are they unhappy? So I feel like that is a really strong concept that permeated a lot through my life.

Carrie Zhang:
My dad went through so much hardship. He lived through the effects of the cultural revolution, famine, poverty, violence, losing his parents, all those sorts of things, being separated from his mom and his brother. All these really deeply traumatic things that I never had to go through. And so growing up the narrative was, oh, you're sad. These are all the things that I went through in my life, which is, I appreciate him sharing that part of his history, because a lot of people don't even get that, but it was really intense for me as a kid to have gone through that. And, of course, he had mental health issues that permeated through his life because of what he had gone through. Very understandably so, but that trickled into my life and therefore it felt like you could never complain. You could never say anything wrong because, who am I to complain about my life when I didn't go through these things? And when my parents gave me all that.

Carrie Zhang:
I think one thing that we see is as people pleasing, that's a very large trait that I see in a lot of Asian folks and Asian-Americans, because it's the idea of, we came all the way here just so you could have this kind of life. So you better do exactly what I say exactly when I say it. And so really highly developed that people pleasing trait that I have for myself. And I'm constantly trying to unpack why that is.

Ellie Pike:
And can you talk a little bit about the shame culture?

Carrie Zhang:
Yeah. Oh my gosh. Shame is a big thing. Shame and guilt. Things I struggle with a lot today, and I think a lot of it was because of the household that I grew up in, where it's like, again, if you are feeling sad, if you are not performing well, if you don't do well in school, you have dishonored the family essentially. And there's a great deal of shame and guilt that goes through that. It ties back again of not living up to family expectations than being heavily chastised, criticized for it. And then you constantly feel like you're not enough. So it's a constant cycle of feeling guilty and ashamed of what you are, and at the certain point who you are. I feel like for a lot of Asian folks, I see their self-worth and self-value, or my self-worth and self-value is really tied to my academic success, or how many extracurriculars I could do, or what college I got into, what job I got.

Carrie Zhang:
Even now talking to my parents, they've expressed that they're proud of me, which is a privilege and a luxury. I'm so happy that they've done that, but it's always, oh great. You did that. What's next? It feels like the job is never finished. I actually had a really interesting conversation with my therapist about this, where she was like, I was really struggling with not feeling enough, feeling very guilty, feeling ashamed of things that I've been doing, even though I know I work a lot of hours a week. I know I'm doing what I'm "supposed to do." And I'm like, I talked to my [therapist 00:10:29], I was like, I can't rest. I don't know how to rest. It's very, very hard. And she was like, well, when you were growing up and you finished a piece of homework, you finished a page, you showed your parents, look, homework's done. What did they do? Did they allow you to go like, okay, great, good job. You're done. Go play, or was it like, okay, you finished that, here's a harder piece of homework?

Carrie Zhang:
And I just had the biggest flashback of, oh my God, that's exactly what my parents did. That's what they knew. And now I'm better able to empathize of, again, they came to this country, they want their kids to succeed. They think success is hard work, hard work, hard work, but they failed to realize that rest and play was also very important. So yeah.

Ellie Pike:
While Carrie's journey is specific to her and her family's unique experiences, it can also give us a window into the broader challenges of mental healthcare in the APIDA community. Here to talk some more about this is Crystal Chen, a primary therapist at ERC Pathlight in Washington. Thanks so much for being here. We are going to be talking about the APIDA community. And I was wondering if you could start with defining and explaining what APIDA is.

Crystal Chen:
Yeah. So APIDA stands for Asian Pacific Islander Desi American. And this is really a term to then encompass all of East Asian, Southeast Asian and the South Asian as well. And it's really a move towards uni unifying all of the Asian communities within the US.

Ellie Pike:
And what are some of the major obstacles and barriers that the APIDA community faces, especially when seeking mental healthcare?

Crystal Chen:
Yeah, so largely I would say is just a lack of services that target that population specifically. And that would be having language specific providers who can provide bicultural or bilingual services for this community. And I would say oftentimes also a stigma towards seeking mental healthcare, a fear of authority figures, and a fear of being judged for cultural practices. Traditional values are all about saving face. So mental health is seen as a disgraceful thing to have within your family. It's that, we have a few sayings in Mandarin about similar to, don't air your dirty laundry. And so to have to seek mental healthcare is seen as then you must be crazy or something in order to have to seek that. And oftentimes actually in East Asian countries, therapy is not covered by insurance. So your medical doctors are covered by insurance, but any mental health things, they are not covered by insurance. And so that already creates a stigma within community of, this is an extra additional thing that only certain communities can afford.

Ellie Pike:
And do your clients in the APIDA community share any common concerns or challenges? And if so, can you speak about those?

Crystal Chen:
Yeah, I would say, especially for immigrant families, like my own family being immigrant, I'm second generation Taiwanese here in the US. And I would say that second generation guilt of, first it's like what your parents had to go through in order to sacrifice in order to give you new opportunities in the US that drive for success, that drive for perfection and achievement, not only in academics, but in career are, add a lot of pressure to, especially our second gen, third generation APIDA community folks. Another challenge is when I was working in community mental health, it was really difficult to find licensed providers that spoke the languages of the community. And part of that is the exams that are administered to licensed providers are only in English. They don't provide language credits for those who do speak the language as their native language and English as a second language.

Crystal Chen:
And so I had colleagues who, they graduated, but they weren't able to get licensed because these exams weren't making accommodations for English as a second language. And so then as a whole, we have a lack of providers who can, one, our providers that look like the community can provide culturally proper care and speak the language of the community as well.

Ellie Pike:
For Carrie, you can see how these broader challenges affected her individual quest for emotional wellbeing.

Carrie Zhang:
So a lot of my anxiety and depression did, I think begin in middle school, mostly anxiety, I would say, that's when people were looking at grades more seriously, you're very hormonal, so you're growing up and doing all the things. I just watched Turning Red, the Pixar film. And it's about a Chinese American girl growing up middle school, it's very relatable, because she was changing, puberty was happening and all the feelings that come with that. And she wasn't able to express it to her mom. And there's a big, she turns into a red panda, it's a big metaphor. And I really related to that, because I think in middle school I didn't feel like I could open up at all and I didn't feel... But I was going through all these things that I would've needed to open up to someone about.

Carrie Zhang:
So really felt really trapped in my own body of sorts, in my own mind. And that went through to high school and in high school, heavy, I was so performance oriented and college oriented, and there was such a heavy pressure. I wasn't allowed to bring home anything. If I got a B, a B is not good, that's bad, things like that, that I just never felt proud of myself, never felt good about myself, and everything I did was never enough because you want to pad more things for your college application to be successful. So you don't end up whatever. All those sorts of concepts are really heavily drilled in my brain. On top of that, growing up as a girl, becoming a woman, there's all these body image issues as well and beauty expectations. And that played a heavy role in my life that I'm still struggling with today.

Carrie Zhang:
And again, under the amalgamation of all those things I developed disordered eating patterns, anxiety and depression and really feelings of hopelessness that went throughout high school and carried through college. But in college, I had gone through trauma. There was a big breaking point where I had been sexually assaulted a few times and didn't realize what had happened until I went to the doctor's office, got examined. I made a little joke about my current mental state, and my gynecologist she immediately called the relationship and sexual violence prevention center, so RSVP. And so from there that really kick started my mental health journey against my will a little bit. I was like, what is going on? I don't need this. I don't have anything wrong with me. I don't even know what anxiety is, I didn't have the vocabulary really until that point.

Carrie Zhang:
And so from then that point on, I started seeing a psychiatrist, a therapist, and then a group therapy. So those three things. So I was doing that weekly and it was very, very intense. Albeit I learned so much, I learned that I did have anxiety and symptoms of depression and PTSD, not just from the trauma, the immediate trauma that I was put there for, but from this complex journey of my life that really set that mental health journey there. And again, ultimately I'm so grateful for the doctor that noticed something alarming and put me into those services, because now I've grown so much. And I think when I think about my friends who are starting their mental health journeys now, or even later in life, I'm very grateful to have started that early. I feel like it's helped me evolve a lot, but it was definitely traumatic.

Carrie Zhang:
And I felt like, and why I started Asian Mental Health Project is, I felt like a lot of the things that I found out at that time could have and should have been addressed at a younger age, or could have been barely even talked about at a younger age and they weren't. And so I wanted to create a space and resources that would allow people to be able to talk about their mental health at whatever stage they're in and feel empowered to seek help that they need.

Ellie Pike:
Well, and it sounds like there was so much misinformation, or even just lack of information for you as you were growing up around mental health, around anxiety and depression.

Carrie Zhang:
Yeah.

Ellie Pike:
And personal boundaries, what's okay and what's not okay, that it really took external forces to help you see that you needed to seek treatment and you needed support. And I think that, that takes a lot of courage to say, yes, I'm willing to do it. So first I really commend you on that journey. I imagine that was extremely, extremely hard. And then second of all, to use it to really better the community and provide those resources so that others can get help earlier and have these conversations earlier is such an important asset to the community. And I want to jump backwards for a second, because I remember the first time I talked to you, you talked about some of the symptoms you experienced in your mental health and that they weren't all, they didn't feel all mental. There were some physical stressors that you felt in your body when your mental health was suffering. So I was wondering if you could talk a little bit about that.

Carrie Zhang:
Yeah, absolutely. So I think one of the indicators, or the many indicators that I needed, as you were saying, were external that I needed mental health support, because I feel like when things are in your head, you're like, or when things are in my head, I was like, ah, I'll just think it away. It'll be fine. It's all in my head. But then it started appearing in my body. So I call this my yearly faint. Every year, throughout college and a little bit after, I would literally pass out, I would faint. One year I was so stressed, I fainted in my kitchen and all my roommates came and they were like, what happened? Why is Carrie on the floor? And I think that had a lot to do with stress in the way I was treating my own body for one thing, but also the actual symptoms of anxiety itself. So fainted there.

Carrie Zhang:
The next year I was feeling super overwhelmed. I remember I was walking home and I passed out on the pavement. And again, I was like, oh my goodness, these are really physical symptoms that I think had to do with my mental health, physical health as well, because when I went to go see the doctor, it was just like, are you under extreme stress? And the answer was always yes. And so along with that, there were little things too, it didn't always have to be so dramatic, or I would say I, again, developed disorder eating patterns if I was feeling really stressed out, or I felt like I didn't get enough work done, or didn't work out, I wouldn't eat things like that and those are things I still carry to this day.

Carrie Zhang:
I also had a lot of chest pains, hyperventilation, any stressing. If I was in a stressful situation, I would either go into a panic attack, or start to have the symptoms of them, which is chest pain, hyperventilation, a difficulty staying still. I was just really, really antsy all the time. And I would have these really extreme mood swings as well. I would laugh, I would just uncontrollably laugh for an hour. And then I would uncontrollably cry for several hours. And then all of a sudden, the episode started at 6:00 PM, all of a sudden it's 1:00 AM. And it was just so weird to experience that. But then that's when I realized, oh my gosh, there's something going on here that I need to unpack and unravel. And I did found out anxiety, depression, PTSD, all those things.

Carrie Zhang:
Once I was able to receive, not just the diagnoses, but talk to my therapist about it and talk to my psychiatrist and then group therapy, all these experiences, I was like, wow, it was validating because I didn't feel so alone. Two, I was like, maybe there's a way that I could not feel this way. Maybe there's a way out of it. And it gave me a lot of hope and I am very happy to say that it's been over a year since I've had a panic attack now, and I've been working on that for years. So, that was really awesome. And it was really cool to, now in hindsight look back at all the progress that I've made because of the mental health care that I've received. Yeah. It's been a long journey.

Ellie Pike:
Well, and it sounds like you're still on it, like all of us are, where there's no end point and we always have to take care of our mental health. And it's always really helpful to have that therapist point of contact, whether or not you need that therapist weekly or not is, everyone's journey is different, but it's so important to have the resources there for when you do need that mental health support. And also congratulations on a year without a panic attack. I imagine that, that's very relieving to feel that way. And I think also what an incredible year to go through, this last two years really has been the pandemic, the Stop Asian Hate movement. And just a lot of xenophobia in our nation. And so I'm wondering what are the alternative ways that you learned to cope under stress? Because obviously stress hasn't just gone away.

Carrie Zhang:
Yeah.

Ellie Pike:
But instead you've really learned some ways to really help yourself move through the stress.

Carrie Zhang:
So along with the self-care mechanisms that I've practiced, therapy, medication, going outside, getting fresh air and a little bit of exercise and things in, I realize community is so important, especially when you're dealing with collective trauma. And so this helped me tremendously, but I'm very grateful to say that I feel like it's helped a lot of folks in our community, the people who engage with Asian mental health projects specifically, we are really tuned into the idea of community care. Of course, therapy is a really powerful and good option, but you have to have community to support you behind you. So what we did was we had these virtual wellness check-ins, and we just hit our two year anniversary for that, which is really exciting.

Ellie Pike:
Congrats.

Carrie Zhang:
Thank you. Yes. But basically every week we would have an open session for people to come in and share whatever is on their mind. Most people are Asian, but it is open to anyone. And then we would also have someone come in who was a mental health, or wellness practitioner, and talk about a topic of their choice. So it was half an educational opportunity and giving access to mental health care professionals where as on a day to day basis would not necessarily get to access. But also it was just so nice to get together in a virtual room full of people who had similar, but very different experiences and be together and be with each other. And that was so important for me personally, I think the best advice I'd gotten in starting that, I was a little apprehensive in starting it, because I was like, I didn't really know how to run it, but my friend was like, only do this thing, only start facilitating this group if you think it's going to help you.

Carrie Zhang:
And it has helped me. And one of the things that keeps me going and has kept it going for two years is that I know it's helping other people and I know we really need to be with community above all. And that's been very, very powerful, and definitely helped a lot with my personal stress throughout the pandemic.

Ellie Pike:
I really like that not only have you found that on your own, but you've created community for others and that you're welcoming all people who are curious and could benefit from it, including the Asian community, but then those who might also want to join in to learn more. So Carrie, what is the best way for someone listening to tune into Asian Mental Health Project and just follow along?

Carrie Zhang:
Yeah. So the best thing to do is our Instagram, everything goes on Instagram first for us, it's just been a really good tool. So if you follow on Instagram at Asian Mental Health Project, that's a really good way to tune in. If you sign into our weekly wellness check-ins, you can definitely do that. We have a Google form where you can sign up and not only will get invitations to these weekly sessions, but you'll also get resources that we funnel through our newsletter. And those are sometimes more in depth than what we can do on Instagram. We also have a website, Asianmentalhealthproject.com, where you can get connected and reach out to us. Yeah.

Ellie Pike:
Thank you so much, Carrie. Your personal story is just absolutely inspiring. And then what you've done with it to create such a positive community and environment for others in a safe space, especially in such a tumultuous world is just incredibly, incredibly special. So thank you Carrie. And we look forward to staying in touch.

Carrie Zhang:
Yes. Thank you. Thank you so much for having me, Ellie. I really appreciate it

Ellie Pike:
Throughout my conversation with Carrie, I repeatedly noted ways that the mental health of Asian Americans has gone under the radar, from stigmas that prevent people from asking for help, to a lack of accreditation from mental healthcare professionals, with English as a second language. There are a lot of barriers to break through for millions of Americans to find accessible mental healthcare. So let's list a few good places to start. Obviously go check out all the amazing community Carrie's found through the Asian Mental Health Project by visiting their Instagram at Asian Mental Health Project. From there, follow the links in their bio to sign up for the wellness check-ins and lists of their resources. I'd also like to highlight OCA National, a community partner of ERC Pathlight. OCA National is a national nonprofit with over 50 chapters dedicated to advancing the social, political and economic wellbeing of Asian Americans and Pacific Islanders. Visit their website, OCAnational.org.

Ellie Pike:
Mental Note Podcast is brought to you by Eating Recovery Center and Pathlight Mood & Anxiety Center. If you'd like to talk to a trained therapist to see if treatment is right for you, please call them at (877) 850-7199. If you're looking for a free support group, our sponsors offer a wide variety, including a group specifically for people of color. Check out eatingrecovery.com/support-groups, or pathlightbh.com/support-groups. If you like our show, sign up for our eNewsletter and learn more about the people we interview at mentalnotepodcast.com. We'd also love it if you left us a review on iTunes, it helps others find our podcast. Mental Note is produced and hosted by me, Ellie Pike, and directed and edited by Sam Pike. Till next time.

Presented by

Ellie Pike, MA, LPC

Ellie Pike is the Sr. Manager of Alumni/Family/Community Outreach at ERC & Pathlight Behavioral Health Centers. Over the years, she creatively combined her passions for clinical work with…

Presented by

Carrie Zhang

Carrie Zhang is the founder of Asian Mental Health Project Founded in 2019, the project currently uses social media, multimedia content creation and community events to de-stigmatize topics of mental…

Presented by

Crystal Chen

Crystal Chen is a board-certified Creative Arts Therapist, currently working at Washington Eating Recovery Center as a Primary Therapist on the children & adolescent team. Previously she worked…