East Mind, West Mind

A few years ago, Dr. Lin Fang saw a patient at the Charles B. Wang Community Health Center in New York City's Chinatown. The man, a recent Chinese immigrant in his 30s, had come to see a physician and complained of five years of insomnia. The physician directed him to Fang, a clinician in the center's mental-health clinic, who quickly diagnosed the man with depression--something he hadn't even considered. A year and a half later, after taking medication and making regular appointments with the Wang Center's clinicians, the man was fine again, Fang says.

Fang can't count the number of patients like this man that she's seen over the years. There are indications that mental illness in the Asian-American community may be undiagnosed and undertreated, thanks in part to cultural stigmas against personal weakness, as well as some recent immigrants' ignorance of the Western concept of mental health. A 2003 study partly funded by the National Institute of Mental Health showed that while the rate of mental illness among Asian-Americans is lower than among whites, the former group is less likely to seek help than the latter. Now, though, community health centers across the country are finding that taking a holistic approach to mental health--combining primary and mental-health care, and integrating Western and Eastern philosophies--is often the most effective way to reach an underserved population.

And some of the national data point to a need for increased vigilance and treatment: Asian-American females, for instance, have the highest suicide rates among American females in the 15-24 age group, and Asian-American women who are 65 or older are 10 times more likely to commit suicide than are their white counterparts, according to numbers compiled by the Asian Counseling and Referral Service (ACRS). Forty percent of Southeast Asian refugees suffer from depression, and anxiety plagues significant parts of that population as well, according to the ACRS statistics. And because of language and insurance barriers, many Asian-Americans aren't particularly likely to seek professional help.

Unless there's an Asian-American in charge of a mental-health services organization, there tends to be little outreach to that population, says Dr. Marty Wong, a practicing psychologist in Boulder, Colo., and a fellow with the American Psychological Association. "In general, the squeaky wheel gets the grease, and Asian people tend not to squeak very loudly," he says.

In many cases, their problems are directly related to the immigrant experience: some Asian immigrants are depressed that they held highly respected positions in their home countries but can't translate their skills or their peers' esteem in America. Fang's patient had worked a high-powered bank job in China but could only find work at a restaurant in America. Others, especially older Cambodian and Vietnamese refugees, have posttraumatic stress syndrome.

Often, Asian immigrants who suffer from mental illness will assume it's a physical ailment and consult a physician instead of a mental-health professional; in some cases, they may even request or seek out treatment that doesn't address the mental roots of their symptoms. Ten years ago, a recent Korean immigrant was sent to Asian Counseling and Referral Services in Seattle. She'd complained of excruciating, unending backaches for years and had undergone several experimental surgeries, to no avail. But when Yoon Joo Han, now the center's behavioral-health program director, started speaking to the woman, Han found she was deeply depressed from an abusive marriage and culture shock. "She'd blocked her emotional senses completely and directed everything into the physical," Han says. In Seattle, "as many as half of Asian-Americans' visits to primary care physicians are due to conditions caused or exacerbated by mental or emotional problems," according to ACRS.