July 07, 2021

By Diana Chao

woman with long hair

I almost flinch at the pity in her gaze.

“So,” the therapist sighs, “I’m guessing you’re this way because your parents were tiger parents?”

“I’ve seen a lot of patients like you,” she continues, as she tells me what my story must be.

I was born in 1998, the Year of the Tiger. My mother, 24 years older than me, was born two cycles of Tigers prior. The Chinese zodiac divides not just years, but also hours, into 12 animals. I, a 5 a.m. baby, cried for the first time at the tail end of the Tiger’s Hour.

I also attended Princeton University. Its mascot? The tiger. You could say that I have carried the tiger spirit all my life. But my parents were not the “tiger parents” of modern myths — neither obsessive about grades nor strict about my whereabouts.

My bipolar disorder, which brought me into the therapist’s office that day, does reflect elements of my upbringing. However, the assumption that I grew up with “tiger parents” could not be further from the truth.


The Color of My Skin Does Not Tell My Full Story

I spend the rest of that therapy session staring at the timer on the office microwave. Thirty minutes left. She is telling me something about how “people like you” shouldn’t place so much emphasis on what families say. Fifteen minutes left.

Her blonde bangs keep coming untucked from behind her ears, and I can’t focus on what she’s saying, except something about “helicopter parents” and academic pressure. I think maybe this is all just a bad dream. Five minutes left. She tells me if I ease up a bit on my “test stress,” I’ll be on track to heal. Finally, our time is up, and she says goodbye to the wrong name.

About 86% of American psychologists and psychiatrists identify as white — a far less diverse breakdown than the American population itself. Sometimes, this means that the color of my skin tells therapists a story far different from my reality. I believe that my practitioners approach our sessions with no foul intentions, but sessions get exhausting when most of the time is spent rebutting my own “yellowness.”

As the discourse surrounding race advances, more and more therapists are training in cultural competency and learning about the nuances between eye folds and heart tales. That’s good. That’s promising. But it is not the key to care that cares — a basic understanding of cultural differences cannot be the final step forward.


Effective Communication Requires Specific Strategies

Over the last eight years, I’ve immersed myself in mental health advocacy through my organization, Letters to Strangers. Between my sophomore year in high school and now, my college graduation year, I’ve developed a few best practices for communicating mental health concerns to my family and people of similar backgrounds.

  1. Make analogies to more-commonly accepted culture-specific syndromes that could help elders better understand that mental illness isn’t your fault — such as 神经衰弱 or 화병 or mal de ojo.
  2. Frame the conversation in terms of healing from a hurtful family cycle for the sake of future generations and not just the individual self.
  3. Combine elements of traditional healing, like meditation, alongside western psychiatric medication in doctor-approved, safe (non-drug-interactive) ways to get the best of both worlds.
  4. Preemptively address fears and stigma by emphasizing that mental illness is not necessarily a reflection on parenting or family relationships — that mental health conditions are not a moral indictment of lineage or ancestry, but a challenge in life that can be managed if faced head on.

And yet, communicating my mental health concerns to people of different cultural backgrounds than my own elicits a whole range of emotions. Frustration. Anger. Exhaustion. Desperation. We are more alike than we are different, so why do these stereotypes and assumptions keep getting in the way?


The Key Is to Listen to Individual Stories

I’m a first generation Chinese-American immigrant from the poorest province of China. My ethnic minority family grew up with intergenerational trauma punctuated by assaults on our indigenous land. Now, my family faces assaults on my non-English-speaking parents who work night and day to bring our heart’s recipes to folks who pay $5 and call us “chinks” and “a virus.”

What I carry in my diagnosis is not an entire race obsessed with academic perfection or parental stringency. It is not 60% of the world’s population speaking in “oms” or using violent child-rearing traditions. It’s my own story — my family’s story — a story that no stereotype or cultural competency training can relay for me.

As we highlight people who are underserved in the mental health care system, I implore us all: Listen. Sometimes our stories will match assumptions, and maybe that makes solutions easier to explore. Other times they will not, and solutions will require empathy, time, patience and creativity. The answer exists within the story itself — whether it aligns with pre-existing notions is irrelevant.


Several resources exist to help you find providers who may share your cultural background, which may be helpful in discovering a compatible practitioner. A few examples include:

Asian, Pacific Islander, and South Asian American (APISAA) Therapist Directory

Therapy for Black Girls Search

Latinx Therapists via Psychology Today

Indigenous Therapists via Psychology Today

National Queer & Trans Therapists of Color Network


Diana Chao is a first-generation Chinese-American immigrant from Southern California. She founded Letters to Strangers (L2S) as a high school sophomore after bipolar disorder nearly ended her life and she began to heal through writing letters. Today, L2S is the largest global youth-for-youth mental health nonprofit, impacting more than 35,000 people on six continents and publishing the world’s first youth-for-youth mental health guidebook for free. For this effort, Diana has been named a 2020 L'Oréal Paris Women of Worth, 2020 Princess Diana Award winner and Oprah Magazine's 2019 Health Hero. As part of Adobe's inaugural class of global Top Talents, she seeks to further the intersection of creativity and social impact through conceptual photography. Her “Minority Mental Health Month” self-portrait series went viral with 2+ million views, and she teaches and speaks on youth mental health.

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