Why Won’t Your Korean Mother Go to Therapy? (정신 건강)
“Surgeons can cut out everything except cause.”
- Herbert M. Shelton
“Health is the greatest possession.
Contentment is the greatest treasure.
Confidence is the greatest friend.”
- Lao Tzu
The stigmas that surround mental health slowly disintegrate in the waves of rising awareness, but the ocean remains vast between knowing when to get help and actually getting it.
This remains stubbornly and alarmingly true especially in the case of Asians, both in home countries and those who live in Western societies like the UK or US. Why might this be? I believe we need to address the importance of cultural understanding when addressing mental health issues.
In the 20th century, health was defined plainly as an absence of illness. Nowadays, it has been replaced by a model that not only seeks to heal physical ailments but one that also emphasizes the role of the socio-cultural forces that might be shaping your health.
Health, as it turns out, is a complex and multi-dimensional thing - just as you are, as well.
If our mental health is partly shaped by cultural forces, let’s try to figure out what those forces might be.
CULTURE
Structures and institutions
Shared values
Traditions
A way of engaging in social life
and ideas that are shared implicitly and explicitly among members of that society.
As you can imagine, defining through empirical work how culture plays a role in mental health isn’t easy. Regardless, it is still imperative to understand cultural differences when it comes to health. Culture influences how someone might show symptoms, how they might communicate their symptoms, how they might try to cope with psychological difficulties, or affect how willing they might be and where they might seek treatment.
For example (and you may have heard your parents say this before)
“Mommy’s not anxious, my heart is just always beating fast.”
“Oh, I can’t sleep lately because my back hurts.”
“You need to talk to the pastor and pray.”
“I don't trust the medicine American doctors give me. I’ll go to the 한의원.“
Modern health care in the US is rooted in western science and medicine. And modern western medicine has become the cornerstone of health care worldwide. But does this form of health care allow for the cultural nuances that make up an individual’s mind?
Speaking primarily to mixed asians or those who live elsewhere from their parents’ homeland, there’s a lot of pressure that occurs from trying to cultivate one’s ethnic or cultural background while also trying to adapt to the more individualistic culture of western societies.
Now, we know culture can’t be broken down into just This or That, but for the purposes of understanding my point, we’ll simplify here into individualism and collectivism.
Individualistic cultures,
like predominately seen in the UK or the US,
prizes the independent self,
having personal autonomy
Self expression.
Ultimately, YOU are responsible for your decisions and your actions.
These cultures focus on the positive outcomes they hope for, rather than on negative outcomes they hope to avoid.
‘Don’t miss your chance!’
You choose the relationships in your life! and if you realize you're the captain of your own ship, why, you can sail anywhere you like.
In Collectivistic cultures,
the self is interdependent
the self is embedded within the social context and defined by social relationships and belonging to the group.
The Korean language itself reinforces this idea - the grammar structure changes accordingly to who the person is in relation to you rather than on how you might think or feel about them.
Decisions are influenced by social obligations and a fulfillment of the group’s expectations. You want to fit in and maintain social harmony. It's better to miss the opportunity and avoid social disruption than to make a mistake and disappoint others. Avoid the negative outcome rather than strive for a possible, positive outcome.
Though a severely limited view of how cultures influence an individual, already we can see how there may be factors leading to mental health issues and why asians, mixed asians, and asian immigrants might not seek out help as easily as their Western counterparts.
Some common sources of stress:
speaking about mental health may be taboo
It’s better to dismiss or deny issues because of negative stigmas surrounding mental health. Although this does exist in white communities, it’s especially noticeable in Asian communities.
social values are rooted in Confucianism - the idea that your ability to care for your family is equatable to your personal value. If you’re mentally ill, how can you take care of your parents?
Mental illness may be perceived as poor parenting or a genetic flaw passed down - making your parents look bad or you as a defunct being
Traditional asian culture may suggest that mental health problems exist because you cannot control yourself, and because of that, it’s shameful that you reveal your issues to the public.
Looking at asian minority groups in western countries, there’s an extra layer of difficulty weighing down.
discrimination, language barriers
trying to balance two different cultures and a bicultural sense of self
The different struggles first generation immigrants might have faced compared to their second generation children. The inability to speak to your parents about your issues either because of language barriers, a traditional asian mindset to save face, or them simply not being able to understand what you’re going through.
Sometimes, first generation family members might not even recognize that their child is having mental health problems until it’s much too late. The Virginia Tech shooter is a horrifying yet prime example.
This is a common thing I’ve heard from friends: I don't want to tell my parents because it will worry them, because they’re stressed enough already, because they’ve sacrificed so much for us to get where we are… how can I let them down?
This internalization of stress and guilt can manifest in depression and anxiety.
This is a view that portrays asian immigrants as successfully integrating into mainstream culture and having overcome the challenges of racial biases. But this tends to hide legitimate historical influences and allows society, media, and powerful figures in the system to overlook the trauma that exists in many of the lives of asian immigrants; trauma that can carry through generations.
Media already tends to portray Asians as one dimensional, uncomplicated, industrious, integrated… who is always the doctor in the movie? Here in one scene to bolster the main character, then gone without an impact. Trying to live up to that stereotype when there is a simultaneous dissonance with reality can feel like it’s splitting your mind in half!
There’s an assumption in mainstream psychology that talking about yourself and your issues will make you feel better.
But oftentimes, especially Koreans, tend to speak about their mental health symptoms in terms of physiological symptoms. I'm dizzy, I have headaches, I can’t sleep well. A western-studied psychiatrist may just prescribe sleeping pills. But does this address the root of the cause? Because the Korean person might not actually be addressing the emotional issues at hand, but deflecting into physical symptoms since that’s more acceptable to talk about, especially with a stranger.
Health disparities in the form of discrimination and prejudice can be tackled by having an understanding of the cultural basis of such problems.
Think about how anorexia is primarily prevalent in developed western societies. Or consider Hikikomori (acute social withdrawal) that is seen specifically in Japan. Han or 화병 in Korea. The outpouring of grief and anger magnified in African American communities after the death of George Floyd.
There is a hand in hand relationship with cultural understanding and treating mental health.
Going with that, I think there’s a direct connection with the ability to openly acknowledge race and racism, and the health of the people who live in the country.
Every single country, city, community, and home is first made by the individual. And if the individual, the first building block, doesn’t get the support to hold themselves up, the whole structure will crack. Every person’s health is important.
In 2021, Seoul National Hospital held a seminar on the enhancement of mental health in the society and resolving prejudices. They asked, “why aren’t Korean people going to the psychiatrist?” After all, among the OECD countries, South Korea ranks among the lowest of happiness and the highest of suicide rates.
The reasons I mentioned already play a major role, as well as the country’s history. During the Japanese occupation, psychiatric patients were considered violent and dangerous, and removed for “social hygiene”.
In the 1960s and 1970s, the government labeled mental illness as abnormal people, potential criminals. Korean government wanted to build a healthy and whole society, so the abnormal people had to be removed for the sake of the country’s overall happiness. Sounds familiar? Mixed kids were being adopted out of the country in droves during this time. Here, collectivism played a role. There are inevitably going to be those who don’t fit inside that concept of the desired singular image; place that against the cultural fear of being different.
It’s imperative that we talk about mental health; and couple that with cultural understanding. Especially when we’re talking about mixed families. That’s an area that is sorely lacking in resources.
I can’t be your psychiatrist or give you all the answers. But what I can do is introduce an open discussion about how to get help, what might constitute as a need and the importance of talking about your mental health, specifically as someone who is multi-racial or in a mixed home.
We released two videos with our friend Jen Whang, who is a licensed counselor, mixed-Korean and a child of immigrant parents from Korea and Egypt. She contacted me some time ago (and I've never met a mixed Korean counselor, so I was just as excited as you might be hearing this), and we’ve been discussing the topics that we think would be enlightening, helpful or even life-changing for some of you.
Jen and I talked on topics like exploring grief, loss and forgiveness in terms of family dynamics, balancing different cultures while establishing personal identity, and addressing that feeling of not being enough. I hope you’ll watch her two videos on The Halfie Project channel.
Feel free to share with us any topics you’d like us to discuss concerning mental health by getting in touch at hello@thehalfieproject.com