East Mind, West Mind

Collectively, Asian cultures tend to stigmatize mental illness by valuing silence, modesty and face-saving, according to ACRS. Physical symptoms of different mental illnesses tend to be explained as manifestations of spiritual or moral weakness, and some Asian languages don't even have a word for "depression," Han says. "In some cultures, they'll say, 'My liver is bad,' and that is translated into, 'I'm depressed and sad'," she says. "The perspective on mental illness as something that can be treated is a pretty new, Western concept for many of our clients, so it becomes a family secret and people don't seek help until it gets out of control or really, really bad."

Terry Gock, director of Pacific Clinics' Asian Pacific Family Center in Rosemead, Calif., explains that the Chinese are more likely to say that they're tired or that their "chi is low," than to admit to feeling blue. "And so if we don't integrate the understandings, physicians will sometimes look at it as just a physical problem and miss the psychological, mental-health implications of what people are saying," she says.

Because treating Asian-American patients sometimes requires a holistic approach, doctors at ACRS will try to fuse Western and Eastern sensibilities as they introduce their patients to the concept of mental illness. Often, Han says, doctors will tell patients stories about other patients who've had similar experiences, or explain treatment options in terms of physical symptoms instead of getting too deep into mental-health theory.

They also are sensitive to cultural nuances: some clients believe medications are poison, and doctors have to make sure not to force treatments onto patients, she says. "The most important thing is respecting where they are at and not discounting their beliefs, but bringing the best package of services we can offer to that individual," Han says. In many cases, as with Han's Korean patient, the physicians will refer their patients to a local community center, where doctors and therapists can try to straddle Western and Eastern understandings to address the patients' illnesses.

Potential patients who don't seek out mental-health help, and even some who do, may turn to alternative remedies. They go to fortune-tellers like the ones who sit outside a park a few blocks away from the Wang Center, hawking guidance and insight with Chinese written boldly on the faded red drop cloths behind them. Others turn to activities like tai chi or traditional medications for help. Not all of these options are harmful; in fact, treatments like acupuncture and yoga are often beneficial, Fang says.

In some cases, though, these alternative remedies can worsen mental conditions. Two years ago, Fang saw a pregnant schizophrenic woman whose relatives were adamant that her symptoms came from bad spirits and wanted her to perform rituals at a temple to get rid of the spirits. But performing the rituals made the woman's symptoms worse--she began to hallucinate about the spirits--and when she eventually came to the Wang Center, "it was even hard for us to say, 'Take medications,' because the spirits in her hallucinations were telling her, 'You shouldn't eat those things'," Fang recalls. Eventually, the woman's husband was able to persuade her to go on medication, and the woman improved significantly through the course of her pregnancy.