Why Asian-Americans and Pacific Islanders Don’t go to Therapy

JUL. 25, 2019

By Ryann Tanap


I walked into my first group therapy session when I was in my early twenties. Not only was I the only Filipina-American in the room, I was the only person of color. I didn’t realize it at the time, but this made me a bit more guarded than usual. I agonized over having to explain my upbringing, so I rarely participated. No one in the room could relate to my experience as a daughter of immigrants. My peers in group would question my experience and try to give me advice—and while it was well-intentioned, I didn’t find their advice as helpful as if it were coming from someone in my community. 

But I knew I couldn’t reach out. There’s an underlying fear among the Asian-American and Pacific Islander (AAPI) community that getting mental health treatment means you’re “crazy.” If you admit you need help for your mental health, parents and other family members might experience fear and shame. They may assume that your condition is a result of their poor parenting or a hereditary flaw, and that you’re broken because of them. Seeking help from those outside the immediate family also conflicts with the Asian- and Pacific Islander-specific cultural value of interdependence. After all, why would you pay to tell a stranger your problems when you should be relying on the strength of your community? 

And after my disappointing experience in that group, I didn’t want to go to therapy anymore either. Part of me wondered if therapy was only meant for white people. And this belief stopped me from getting the help I needed for many years. Many AAPIs try to justify why we shouldn’t ask for help by doing exactly what I did—by believing and repeating things that just aren’t true. To show the community that mental health is important, though, we need to shatter these incorrect beliefs:

“I must be successful and cannot show signs of weakness.”

According to SAMHSA, AAPIs are less likely to reach out for help than other races and ethnic groups. This may be due to faith and religious beliefs, cultural values and language barriers, to name a few. Additionally, AAPIs are mistakenly thought to experience economic stability. This stereotype, known as the “model minority” myth, incorrectly assumes that all AAPIs are wealthy and highly educated. This, compounded with the family and/or cultural expectation to be a highly skilled professional, like a doctor, lawyer or engineer, can be overwhelming. It may lead you to feel you need to succeed, regardless of the toll it may take on you. 

“It’s a burden to share my emotions.”

In many Asian-American households, children grow up controlling or hiding their emotions. If you’re “too emotional,” you may be perceived as someone who complains too much and doesn’t try to solve anything for themselves. This often translates to family environments in which silence is a sign of strength and feelings aren’t likely shared. You may be expected to move forward regardless of how you’re feeling, or risk being perceived as someone who easily accepts failure. While opening up to a family member may not be an option, receiving guidance and treatment from a mental health professional is not a burden on anyone. 

“I’m ungrateful for all I have.”

Many AAPIs learn about past family sacrifices that led to a better life in America. Parents or grandparents might have emigrated to the U.S. in search of safety and opportunity. With this in mind, there is a belief among younger generations that their elders experienced far more challenging hardships. For example, many Southeast Asians, who may be refugees or asylum seekers, may have experienced trauma due to oppressive regimes or economic instability back home. With this in mind, AAPI teens and young adults might feel guilty sharing their mental health struggles knowing their relatives faced something “more” stressful just to survive.  

“It’s disrespectful to my spiritual beliefs.”

In many Asian and Pacific Islander cultures, faith plays a major role in everyday life. For example, the Philippines is a majority Catholic country. Filipinos are taught to rely on prayer even when dealing with a challenging time. If you’re going through something tough, loved ones may encourage you to pray the rosary or read the Bible. And suicide is considered sinful. So it makes sense that anyone experiencing mental health symptoms or suicidal ideation may be afraid to tell others, for fear of being judged. However, mental illness is not a sin, and so those with a condition should not be treated as less than. 

“I don’t know how to talk about mental health with my relatives.”

Like other people of color, many AAPI parents and elders may not believe in mental illness and its potential impact on their community. Additionally, they often express negative emotions by describing physical pain, like symptoms of heartache and extreme fatigue. Younger generations raised in the U.S. often have a better understanding of mental illness and access to mental health care than their elders. But this doesn’t make it easier to open up to relatives who have little understanding. The AAPI community should become educated on mental health conditions, which are legitimate health conditions that should be treated with urgency.

“I’ve tried therapy before, and I didn’t find it helpful.” 

My past experience in group therapy is likely similar to other AAPIs who have trouble getting help. Because I didn’t know of any mental health professionals who understood my experience, culture and heritage, I assumed it wasn’t worth it to continue seeking help. However, now I have identified what I need: a mental health professional trained in cultural competency.

We need to encourage the AAPI community to ask for help and prioritize mental health. Eliminating stigma is critical. Like in Virginia and New York, we need legislation that requires mental health education and awareness in schools, and that even goes a step further by being tailored for AAPI communities and other communities of color. Until such legislation is passed, it’s up to us individually to break down stigma within our own circles of friends and family.

Note: This blog was originally published in July 2018. 

We’re always accepting submissions to the NAMI Blog! We feature the latest research, stories of recovery, ways to end stigma and strategies for living well with mental illness. Most importantly: We feature your voices

Check out our Submission Guidelines for more information.


AUG, 19, 2018 10:11:18 AM
Guys, let's not to generalize Caucasian Americans as a homogenous group. I am a linguistic minority, immigrant and also I'm blue-eyed and have rather light colored hair, I still can not find a therapist in a small 180K town where I live. I need somebody who would be able to relate to my experiences and it seems to be a problem. So, currently, I rely on medications and NAMI support groups.

AUG, 06, 2018 01:28:03 AM
I have absolutely no doubt that this article rings true for many (most?) Asians. I really believe, however, that the stigma represented in the article can be a human experience. My husband, American-born to a Caucasian Methodist family, adheres to every one of the beliefs stated in this article. He claims to "know better", but at age 71 he retains a firm hold on the stigma he was raised with. It's very sad for those of us who love him and want him to reach out for help with his mental health.

JUL, 28, 2018 09:18:43 PM
DJ Chuang
Thank you for writing this article and sharing about these common challenges. While not true for all Asian Americans, it has been my experience that it is commonly known that Asian Americans don't go to therapy. This is true for most other groups of people of color as well. That's why we do have July as mental health awareness month for minorities.

A couple of us started the ErasingShame.com podcast this year to have honest talk about healthy living. This summer video series focused on Erasing Shame on Mental Health in Asian American Communities. We believe by having honest conversations in an on-going basis will help struggling Asian Americans know they're not alone and it's okay to get help.

JUL, 27, 2018 05:12:05 PM
Hi, As an Asian American clinician, and client, I so appreciated this article. I could very much relate to each of your points on a personal level, and have seen many of them pop up in asian clients and with conversations with friends as well. A much needed topic of discussion.

JUL, 26, 2018 08:37:20 PM
I agree that for me, going up in a South Asian culture and being immigrants, we did not believe in therapy. Jenifer, I feel for you. The pain will lessen. My nephew took his life in Asia 5 years ago and I had to take a flight by myself and travel for 24 hours to reach the funeral. I was in a great deal of pain and my husband advised me to go for counseling when I returned to the US, but I refused to do so, thinking it would be a sign of weakness and also I did not believe in counseling. I did not think speaking with a stranger who did not understand my culture would help me. My family did not understand what I was going through and nothing helped, until I turned to meditation, which has been life changing for me. Recently, my child tried to harm herself and I took her for therapy and it has really helped her. It opened my eyes to the benefits of therapy. I will no longer think it is only for the white community or for people who dwell too much on their sadness or for "weak" people.

JUL, 26, 2018 03:51:54 PM
I can relate to this article very much. As a korean American I was brought up different than my Caucasian American friends. My mother is Korean and my father was American. Two years ago my father committed suicide and my world came crashing down. He was the nice parent the one who actually showed affection and interest in his kids lives. Not that my mother didn’t love us she just showed it in different ways. Growing up in Korea, post Korean War, was challenging and that generation had to be stoic and not show too much emotion.
I married a korean man and even though he’s Americanized like myself he still has korean tendencies and is not very sensitive when it comes to matters like suicide/death. It’s been two years since his death and I still cry in private every day. The whole situation was very traumatic. I flew 3000 miles to watch my father die in his hospital room. I then had to pick up the pieces and keep it together to plan his funeral and make sure my mom was set up financially before flying back home. I lost 10 lbs in two weeks, it was the hardest thing I’ve done in my life. Being surrounded by a korean family and community, there isn’t a lot of talking about these situations. Suicide is very taboo thing in asian cultures and it can bring shame onto the family members. My mom still tells people he died from a heart attack. I guess in fear that people will blame her for his death. This last father’s Day my husband asked when I’ll get over it so he could enjoy that day too. That day will always be a hard day for me.
My father was a great man who brought joy to everyone he met. I feel like the only sensitive loving soul I knew is now gone and there’s no one around me who can help me with his loss. My mom in law says to pray more, my husband is non responsive to my pain, my mom is self destructive now gambling and drinking her pension my dad left for her away. I tried counseling in the past and I didn’t feel they understood the family dynamics of an asian family so it was hard to even explain my situation.
I still have hard days but I’m realizing that time is what’s helping the best. Hopefully in the future I can actually think about him and just smile, no crying just good memories.

JUL, 26, 2018 03:17:36 PM
Jennifer Portnick
As a NAMI Ending the Silence lead presenter, I've been trained to use I statements instead of we statements. The title of this post is overreaching, as it's not true that all Asian Americans/Pacific Islanders don't go to therapy; may I suggest an alternative? "Why Some Asian Americans/Pacific Islanders avoid going to therapy" or "How the immigrant experience influence can influence therapy patients."

JUL, 26, 2018 10:45:22 AM
Patricia Offer
I have been a family member/teacher for the past 18 years and the Coordinator of the Family Resource Centre at Addiction and Mental Health Services-KFLA in Kingston Ontario Canada. This is one of the most satisfying things that I have done and I will continue to help as many people as I possibly can for as long as I am able to do so.

JUL, 25, 2018 09:04:01 PM
interestingly enough you don't have to be a child of asian immigrants to have these same experiences. My mother was born of Irish immigrant parents and I can totally relate to you couldn't be over emotional or talk about being anxious or depressed because you were just supposed to deal with it. Also my mother believed that if you went to a therapist that meant you were crazy so I understand the family issues completely. So basically she needed to be in a group where there were other first and second generation Americans as we seem to have a lot in common.

JUL, 24, 2018 07:14:15 PM
Thank you for opening up with your experience. Mental health clinicians need to focus on gaining insights into working with members of the Asian American community. Frankly, I believe we need more Asian American clinicians.

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We’re always accepting submissions to the NAMI Blog! We feature the latest research, stories of recovery, ways to end stigma and strategies for living well with mental illness. Most importantly: We feature your voices.

Check out our Submission Guidelines for more information.