How To Talk About Mental Health When No One Wants To Hear

https://www.huffpost.com/entry/how-to-talk-about-mental-health_n_5b450d8ce4b0c523e263b100

Dr. June Cao, the founder of Mind Connections, Inc. was interviewed by Huffpost on How To Talk About Mental Health Issues When No One Wants To Hear. 

Minorities and Mental Health

Huffpost: Why do you think it’s hard for minorities to share their experiences in regards to their mental health?

Dr. Cao: Different reasons prevent minorities from seeking professional help and sharing experiences in mental health.

Lack of awareness of mental health issues

First of all, many minorities may lack information about mental health, therefore, they do not recognize the signs and symptoms of psychological or psychiatric issues. Compared to people growing up on Upper East Side, minorities, particularly recent immigrants, do not have exposure for the type of treatment as “talk therapy”, nor are they used to sharing personal issues with a stranger. Some people even self-diagnose or are misdiagnosed. As a result, the right treatment could be delayed. Meanwhile, undiagnosed or untreated mental illness may develop to more severe level and cause emotional distress. In my practice, I have run into several cases where people have been to different specialists for headache, insomnia, and stomach pain, but eventually learned all these are physical symptoms of anxiety.

Stigma about mental health

Another important reason is stigma and shame involving mental health issues. Having mental illness is perceived as “crazy” in some traditional values. Such a label suggests that sharing emotional issues with others is like “airing your dirty laundry in public”. Clearly it damages family pride and honor. This is particularly true for collectivist cultural norms among Latinx, Asians/Pacific Islanders, and African Americans. Asian culture for example, emphasizes harmony and believes emotional sharing could burden others, therefore, should be discouraged.

Language barrier and lack of culturally competent professionals

In addition to stigma, another factor, language barrier and lack of culturally competent professionals, also get in the way of minorities’ help seeking behaviors. Research has consistently shown that minorities respond best to mental health professionals who share their backgrounds, understand them and speak with them on a deeper level. It could be in terms of attitudes, values, beliefs, and views. However, the American Psychological Association found that one in two Asian Americans living with mental illness will not seek help due to language barriers.

It is not a surprise that other barriers also make minorities suffer from mental illness silently. For instance, due to past negative experiences with professionals, some minorities believe there is no point to talk. On the other hand, lack of health insurance leads to fear of financial burden. Besides, undocumented immigrants may not seek professional help because of the fear of deportation.

Transgenerational Trauma in Minority Communities

Huffpost: Do you think transgenerational trauma plays a role in how we think about mental health in minority communities?

Does transgenerational trauma exist?

Dr. Cao: Transgenerational or intergenerational trauma happens when parents or grandparents were traumatized and untreated, each generation of that family continues to experience trauma in some form. The source of trauma usually traces back to a devastating event, such as Holocaust, slavery, refugee, etc. Research shows mixed findings regarding this subject: many reported psychopathological findings related to transgenerational trauma and some has found no evidence of this phenomenon.

I believe transgenerational trauma plays a role in mental health in minority communities. Research showed that chronic stress and exposure to stress hormones alter our DNA. That is, parental distress could be imbedded and transmitted through DNA passing down to next generation, or in parents’ “life lessons”, maladaptive parental behaviors, and child-rearing behaviors. As a result, this may become “norms” in certain minority groups. Eventually, such norms may resemble typical symptoms of posttraumatic stress disorder (PTSD) without them recognizing it.

Transgenerational trauma and PTSD

PTSD symptoms usually include intrusive thoughts or flashbacks about the trauma, avoidance of people, places, or reminders of the trauma, anxiety, easily irritated and angered, concerns about safety, and emotional numbness. Symptoms specific to slavery trauma in African-Americans, for example, may include avoidance of white people, fear of danger (in the presence of law enforcement), paranoia, irritation and anger, excessive worries about safety, chronic sorrow, and impaired parental function.

Such transgenerational traumatic symptoms, together with continued discrimination and prejudice, need to be addressed on a system level. When some says “Get over it”, most African Americans do not even know what to get over. Awareness of this issue may be the first step to advocate and assist minorities to better cope.

How to Have a Mental Health Conversation with Family or Friends

Huffpost: Can you provide a few tips on how to effectively have a mental health conversation with family/friends who aren’t willing to engage?

Dr. Cao: I have a few tips here:

Somatic issues

1. Start with somatic symptoms, such as appetite, insomnia, indigestion, and pain, rather than going directly about mood or feelings. Minorities may find it easier to communicate about physical symptoms first because there is no stigma or shame attached.

How to help your family and friends with mental health issues

2. If families or friends are dealing with mental illness,

• • Normalize the issues families or friends are dealing with. This way could help to let their guard down and open up more. For example, “A lot of people are dealing with this issue”, “It is normal to feel this way after what happened”, “It’s OK to not feel OK.”
  • Encourage your family/friends to talk to a trusted health care provider. You may suggest a visit to a general physician and offer to accompany them to the appointment. Alert physician’s office with your concerns. Your loved one may find it more acceptable if the general physician addresses their mental health issues or makes a referral to a psychologist.
  • Refrain from using general and weighted words like “mental illness” or “abnormal” to avoid possible labeling. Focus on concrete examples and sharing life experiences for a better understanding of the roots and triggers of the issues.
  • Show your support, empathy, and understanding without judgment. Tell them, “I’m concerned about you”, “You don’t have to deal with everything by yourself”, “I am always here for you”, “It’s not your fault”.
  • Be willing to show your own vulnerabilities and your own weaknesses. Share your fears, difficulty times, or experiences seeking help to let your family/friends know they are not alone. This kind of self-disclosure can also help them to know that mental health could feel less foreign.

How to tell your family and friends about your mental health

3. If you are dealing with mental health issues and need to communicate with family or friends,

• Genuinely and assertively request a conversation. “I need to speak with you”, “I need your help”, “Please listen to me before you say anything”.
• Avoid using general and weighted vocabulary such as “mental disorder” or “abnormal”. Try to give concrete examples and specific symptoms such as, “I don’t feel well”, “I feel tired all the time, I can’t sleep, It’s been difficulty”.
• Use authority figures such as doctors, teachers, and mentors to make sure family/friends may trust and respect more. “Doctor said I should talk to someone”

Why Family or Friends Don’t Want to Discuss Mental Health

Huffpost: What are some of the reasons you’ve heard from clients about why their family members or friends don’t want to discuss mental health with them?

Dr. Cao:

• One client’s mother said, mental health? Isn’t that a white person problem? We are Latino, we don’t believe that. Let’s not talk about it.
• An Asian American client’s parents insist that there is no point to let anyone know about depression and anxiety in their family because “Everyone knows everyone else’s business. You want them to know the nice things in your life, like your kid went to an Ivy League college, not that you are depressed, then everyone would talk about you and how crazy you are. That’s too embarrassing for our family”.
• Another Chinese American client shared that silence was the default mode of communication between her family members. Her parents told her over and over that she just needed to endure and tough through, then her depression would be gone.
• An African American client’s mother refused to discuss it because “put ‘bipolar’ on your record and then you can never get a job or find a boyfriend.”
• “Forget it. Doctors would give you medication, then you’d be addicted and rely on medication for the rest of your life.” Another Chinese American client’s parents hold this belief.

Other Outlets or Resources for Mental Health

Huffpost: What are some other outlets or resources you can go to or use if you are unable to talk to relatives or friends?

Dr. Cao: There are a lot of other resources and outlets people can use. For example,

1. Seek professional help from a psychologist, psychotherapist, mental health counselors who speak your language and understand your cultural background. For undocumented immigrants, seek out clinics and resources that care for all persons regardless of legal status. For people with financial difficulty or without insurance, seek help from hospitals and clinics that accept sliding scale.
2. Join a support group. Share your stories, listen to each other, learn the language of mental health, and give and receive support from each other. Besides, learn to put words to feelings, thoughts, physical wellbeing and emotional states.
3. Use the Internet to connect with others and empower yourself, whether being online forums or apps, monitor your own feelings, thoughts, and behaviors.
4. If you are religious, receive support and friendship from the church and use it as a form of release for mental health issues you may experience.
5. Form self-compassion to relieve self-judgment and self-criticism, listen to your own needs and the needs of others, and taking better care of yourself.
6. Use hotline services in case of emergency 1-800-273-8255 (TALK), 24-hour National Suicide Prevention Hotline, more than 150 languages are available.

Written by Dr. June Cao