CULTURAL CONSIDERATIONS IN ASIAN AND PACIFIC ISLANDER AMERICAN MENTAL HEALTH Cultural Considerations in Asian and Pacific Islander American Mental Health Harvette Grey EDITED BY Brittany N. Hall-Clark AND 1 1 Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Oxford is a registered trademark of Oxford University Press in the UK and certain other countries. Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016 © Oxford University Press 2015 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license, or under terms agreed with the appropriate reproduction rights organization. Inquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above. You must not circulate this work in any other form and you must impose this same condition on any acquirer. Library of Congress Cataloging-in-Publication Data Cultural considerations in Asian and Pacific Islander American mental health / edited by Harvette Grey, Brittany N. Hall-Clark. p. ; cm. Includes bibliographical references and index. ISBN 978–0–19–024337–1 (pb : alk. paper) I. Grey, Harvette, editor. II. Hall-Clark, Brittany N., editor. [DNLM: 1. Asian Americans—ethnology—United States. 2. Mental Health—ethnology—United States. 3. Mental Disorders—ethnology—United States. 4. Mental Disorders—therapy—United States. 5. Oceanic Ancestry Group—ethnology—United States. 6. Socioeconomic Factors—United States. WA 305 AA1] RC451.5.A75 616.890089′95073—dc23 2015000070 9 8 7 6 5 4 3 2 1 Printed in the United States of America on acid-free paper Contents Foreword by Tony Leong Jr. | vii Preface | xiii About the Editors | xxi Contributors | xxiii 1. Treating Asian Americans: An Overview | 1 Wei-Chin Hwang and Julia Ting 2. Treating Depression in Asian American Adults | 13 Wei-Chin Hwang 3. Depression among Asian and Pacific Islander American Elders | 29 Donna K. Nagata, Amy H. Tsai-Chae, and Teresa U. Nguyen 4. Psychodynamic Treatment of an Asian American Male with Dual Diagnosis | 55 Soni Kim INDEX | 73 Foreword This writer was in attendance at a local city council meeting years ago, together with other service providers and representatives of community-based organizations requesting funds for vital employ- ment, social, child care, and other services. Representatives would take turns standing up and speaking on behalf of the organizations they represented. One such representative of a community-based organization that served Blacks stood up and spoke. As he was making his points to city council and to the crowd of people in attendance, he turned and gestured to me; he had a serious and determined look on his face, hoping to drive home a point with this writer’s acknowledgment, and declared, “Tony, you speak Asian, and you know what I mean, right?” The term Asian or Asians evolved from an antiquated, offensive, and derogatory term originally used to describe the ethnicities and cultures of this group, namely, Oriental. Just as Blacks fought to eventually erase the term Negro from this nation’s political and cultural collective consciousness, the battle to eliminate use of the term Oriental was won, and the term was replaced by the word Asian. The word Oriental objectified Asians and is now considered politi- cally incorrect. Now this term is used ironically to describe objects as opposed to people, such as Oriental art or Oriental rug. (Refer vii viii | Foreword to “‘Ornamental Orientals’ and Others: Ethnic Labels in Review,” Benjamin Tong, Focus, 4, 2, June 1990). The word Asian is casually used to describe a group whose facial features appear similar but who are, in fact, of different nationalities, cultures, and ancestries. The term Asian also is an Asian American phenomenon. Foreign-born people from Asia do not describe themselves as Asians. Rather, they describe themselves as a specific ethnicity from the country of their birth and upbringing. In “‘Ornamental Orientals,’” Tong writes, “Asian American is of a recent coinage” and “was . . . ini- tially heard at San Francisco State University during the now his- toric 1968–1969 Student-Faculty Strike [at which this writer was both a student and strike participant] for the creation of the very first American college program in ethnic studies.” Asian is also a politically convenient term. After President Lyndon B. Johnson’s declaration of War on Poverty in 1964, a num- ber of ethnic community-based organizations (CBOs) sprang up to meet the needs of Black, Latino, and Asian communities. His decla- ration enabled communities to receive government funding to help break the cycle of poverty. Many Asian groups formed to serve the specific communities they represented. Chinese, Korean, Japanese, Vietnamese, and other specific nationalities preceded the titles of their CBOs. As funding became scarce, many CBOs were compelled to unite and offer services under one roof. This was what happened in the Asian community. Many groups formed, with the title Asian preced- ing the service it offered to the community to attract funding. They provided services to a group of people with different ethnicities, cul- tures, and languages. Race, language, and culture are the cornerstones in working with Asians. Race, language, and culture not only define one’s identity but also one’s conscious and unconscious history, whether one was born in America or abroad. America has been described metaphorically as a melting pot or as a salad bowl of peoples and cultures. The melting pot view holds Foreword | ix that there are different types of people living together in this society who gradually create one community. The salad bowl view connotes a pluralistic society of people mixed together but continuing to main- tain their different traditions, languages, and interests. In the Asian or Asian American psychological literature describing these charac- terizations, the former is referred to as assimilation and the latter as acculturation. (See discussion about the assimilation and accul- turation of the Marginal Man in “Chinese-American Personality and Mental Health,” Amerasia, 1, 1, 1971, by Stanley Sue and Derald Sue.) This writer’s research and dissertation topic concerned mental health issues among unemployed non-English-speaking (NES) or limited-English-speaking (LES) Asians. Although it is essential that service providers be able to speak and understand the native lan- guage of clients they are treating or counseling, consideration and awareness of the client’s culture, race, and generation when treating both American-born and foreign-born Asians are also essential. In my research, I posit that mental health concerns such as depression, anxiety, self-doubt, domestic violence, and anger are manifested when people are unemployed for long periods of time. Because of cultural constraints, Asians generally will not seek mental health counseling: loss of face, guilt, and being stigmatized by their culture are examples of self-imposed barriers due to cultural upbringing or expectations. (In Chapter 1, Hwang and Ting point out that “cultural competence requires therapist cultural self-awareness as well as understanding of the client.”) When providing mental health or other services to an Asian cli- ent, the service provider should consider clients’ cultural generation and the family’s multigenerational structure or “multicultural iden- tities” (Melba Vasquez, “Foreword,” Cultural Considerations in Latino American Mental Health, Grey & Hall-Clark, 2015). Many NES and LES families live in extended-family situations in which three or more generations of family members live together. How old is the client? What country is the client from? Is the client a refugee from a war-torn country? (In their discussion of the mental health needs of elder