A taboo topic: mental health issues in the Vietnamese community

By DAMIEN NGUYEN

IT’S OKAY TO LAPSE
IT’S OKAY TO MAKE IT THROUGH THE DAY BARELY DOING ANYTHING BUT SURVIVE
IT’S OKAY TO FEEL SHIT. It does not mean you are a shit human okay. 
IT’S OKAY AND IT WILL BE OKAY
You have made it this far. You will make it out alive. 

For Trang Lu, who wrote the above letter to herself, depression has all the hallmarks of a “deep and dark hole”, a space where she felt useless and unworthy.

And she is not alone. Suicide rates have climbed to an all-time high in 10 plus years, according to Lifeline Australia statistics, and show no signs of decreasing. For every death by suicide, it is estimated that as many as 30 people attempt to end their lives.

This means there are about 65,300 suicide attempts each year.

Ms Lu’s story echoes across the Asian-Australian community. There is very little data on the rate of suicide among young Asian-Australians, but in other Asian countries, suicide rates are among the highest in the world. 

Cultural differences between East and West have a marked effect. For many traditional Asian families, suicide can pile “shame” on family honour. Mental health issues are not discussed; it’s a taboo topic, heightening the sense of isolation felt by young Asians when they do experience mental health issues.

For Ms Lu, the lack of awareness and education on mental health in the Asian community is a big problem.

“Traditionally, Vietnamese people don’t perceive mental illnesses as real illnesses … people who suffer from mental illness are shunned,” she says.

“They are seen as the cause of all their problems and that ‘it’s all in their head’ and that if they stop thinking a certain way or stop imagining things, their problems will disappear.”

In many Asian families, mental health is a taboo topic.

Associate Professor Harry Minas, the head of the Global and Cultural Mental Health Unit at Melbourne University, says Australian and Asian approaches to dealing with problems among loved ones are vastly different.

“In an Australian family, if one of the members of the family has problems or is behaving badly or whatever, the responsibility for that behaviour tends to be regarded as just the person who is actually engaged in such behaviour. Whereas in an Asian family, for instance, if one person is doing the wrong thing, then that reflects very directly on the family.”

A/Prof Minas says Asian families typically delay treatment, and only ever seek professional help when things “become unmanageable”.

There are also important communication problems on both sides. Mental health services are inadequate in educating themselves on different cultural approaches and attitudes to mental health, while Asian families often have a lack of education and awareness of the facilities on offer for mental health.

The issues collide when an Asian person with mental health problem comes in contact with a local health service, A/Prof Minas says.

“There’re also then difficulties around the different understandings between, let’s say, the health service staff and the family. Because the family will want to be involved at every point, they’ll want to know everything about what’s going on, and they will want to contribute to, or sometimes continue to make the decisions on behalf of the young person,” he says.

“And then, that creates tension and conflict between the family and the treating staff. Because the treating staff will likely say: ‘Look no, your son is 19 years old. We can’t tell you anything about what’s happening with him, unless he gives us explicit permission to do so, because he has a right to privacy’.

“And the family in those circumstances is often outraged and, in my view, justifiably so because they say, ‘look, how can we excluded from knowing what is happening to our own son?’ Or ‘how can we be excluded from the decisions that are made, in the best interests of a member of our own family?’.”

This lack of understanding between culture and the mainstream health service often adds to the stress of the patient and, in a lot of cases, hampers their efforts to get effective treatment.

Nowhere is this schism between West and East more apparent than with Andy Nguyen*, a young Vietnamese who is dealing with depression and social anxiety, and who has had suicidal thoughts.

He says the generational and cultural divide was obvious when he told his parents he was seeking counselling, and he was rebuked for spending so much on a psychiatry session, with the $100 cost described as a “luxury”.

“They don’t think it’s an on-going process. It’s not clear cut, everyone progresses differently. They’ll say: ‘you need to read Buddhist readings or go to a temple and do some praying’ or ‘do some meditating with me’ and they’ll impose their own ideas on you because that’s their idea of how to handle the issue.”

It was painful for him to bring his parents to counselling sessions. On their side, the language barrier and their preconceived notions clashed with his counsellor;  while the counsellor didn’t understand “the cultural dimensions” of his mental issues

North Richmond Community Health Service Coordinator Huong Tran has seen many Asian patients at her workplace, often for physical ailments that are correlated to psychological trauma. In her capacity as a private tutor, she has seen how stress and academic rigour play a significant role in contributing to mental health problems.

“I have seen many serious consequences – loss of life, near loss of life to young people, family break-ups, alienation, isolation, impact on health like obesity, drug addiction – that has stemmed from mental health issues and conflict within the family,” she said.

She agrees that the “mental health issue in Vietnam is considered a shameful thing” and that often the blame is placed upon the victim rather than environment around them.

“It’s either the fault of that person or the wrong-doing of that person in their previous life, if you consider the Buddhist belief, it’s karma and things; must have done something wrong in the past life, and now he/she is like that,” she said.

For Ms Tran, the only way forward in this issue is to address how the older generation of Vietnamese-Australians view their culture and their ways.

“The most important thing in Vietnamese culture is academic success, obedience. Respect to elders, looking after the elderly when they are old. Following traditional Vietnamese values. Those are at the very heart of the culture,” she says.

It takes a lot of effort to understand those attitudes, brought over by so many migrants and refugees, and also to consider how much is still applicable here, she  says.

“We have to change our expectations towards our young people,” says Ms Tran.

“And also for older generation like me, sometimes we want our children to live our dreams, what we missed out. Our children are not ourselves … It is totally unrealistic and absolutely unfair to expect that of another person.”

Vivienne Nguyen, the president of the Vietnamese Community of Australia in Victoria, says there is a “huge generational gap” in understanding. 

“[Our parents] came with nothing and they worked hard to establish a new life, so when you are born into what is a much more well established environment, they find it hard to understand why it is difficult for a young person,” she says.

Ms Nguyen says that, from the parents’ point of view, the children have many opportunities and advantages, as well as parents who love and care for them.  

A younger generation of Asian Australians is hoping for a change in the expectations placed on the younger generation.

“So for … them to see a young person experience mental health issues and take their own life, it’s difficult for them to comprehend,” she says. 

A/Prof Minas credits the rate of cultural change as contributing to the development of mental health problems among young Asians.

“It’s been so fast, and so complete in many ways and such a radical kind of disjunction between the culture of young people and their parents and grandparents,” he said. 

The stereotype of Asian academic high achievement, and the extra work expected, is also a major contributor to the development of mental health problems, he suggests.

“In some places, children are almost no longer allowed to be children. They are there to achieve and they work as hard as any adult does and the pressure on them to achieve and then for those who are unable or unwilling to achieve then the consequences are severe. They’re failures,” he says. 

“They bring shame upon their family because they haven’t been successful, they’re lazy, they’re this and that … sometimes, intense pressure from family to be educationally successful, for some kids is disastrous.”

For Ms Lu, though, the mental health issue among young Asian-Australians is highly personal.

“Back when I was severely depressed, the thing that bothered me most about depression was the inability to live life. Simply live life. Every single day was a battle, a battle between me and the demons in my own head,” she said.

“It was absolute chaos and destructive to my life. I couldn’t do anything that I truly wanted to. It held me back – there were a lot of missed opportunities.

“There are a lot of other people like me, silently struggling their way through life. This is a big issue that needs to be addressed as the number of people suffering from mental health issues is rising.”