As a psychiatrist who is also in therapy, I remember feeling misunderstood when it came to my culture as a filipino-american, but meant a lot to me to have my therapist express a genuine interest in understanding my culture and asking me for details regarding my experience. Oftentimes I believe clinicians don’t prioritize someone’s identity (ethnicity, culture, religion, sexuality) when it comes to health, especially mental health, yet these factors play a significant role in someone’s values and way of life.
July is Minority Mental Health Awareness Month and although today might be the last day, having knowledge of the disparities and struggles that several minorities experience is important if we’re going to eliminate stigma surrounding mental illness. I consider myself as someone who prioritizes cultural competency, yet reading statistics and information regarding certain minorities surprised me and I was happy that this month existed and motivated me to read more about it. Which is the reason why I’m sharing some of the following information with you here on my blog, in addition to some techniques that I use to incorporate someone’s ethnicity/culture/sexual identity, etc into the conversation during treatment (continue reading below).
Statistics:
- African American attitudes toward mental illness are another barrier to seeking mental health care. Mental illness retains considerable stigma, and seeking treatment is not always encouraged. One study found that the proportion of African Americans who feared mental health treatment was 2.5 times greater than the proportion of whites (Sussman et al., 1987). (1)
- A report from the U.S. Surgeon General found that violent deaths – unintentional injuries, homicide, and suicide – account for 75% of all mortality in the second decade of life for American Indian/Alaska Natives (U.S. Dept of Health & Human Services Office of Minority Health)
- Southeast Asian refugees are at risk for post-traumatic stress disorder (PTSD) associated with trauma experienced before and after immigration to the U.S. One study found that 70% of Southeast Asian refugees receiving mental health care were diagnosed with PTSD (U.S. Dept of Health & Human Services Office of Minority Health)
- Western culture makes a distinction between the mind and body, but many Asian cultures do not (Lin, 1996). Therefore, it has long been hypothesized that Asians express more somatic symptoms of distress than white Americans (1).
- Mexican immigrants who lived fewer than 13 years in the United States, or Puerto Ricans who resided on the island of Puerto Rico had lower prevalence rates of depression and other disorders than did Mexican Americans who were born in the United States, Mexican immigrants who lived in the United States 13 years or more, or Puerto Ricans who lived on the mainland. This consistent pattern of findings across independent investigators, different sites, and two Latino subgroups (Mexican Americans and Puerto Ricans) suggests that factors associated with living in the United States are related to an increased risk of mental disorders (1).
The following are a few questions I ask to promote discussion of someone’s identity and incorporate someone’s culture, race, ethnicity into treatment (some of these may sound so simple, yet raising the questions can feel awkward at first especially since the subject of someone’s identity might be perceived as a sensitive subject):
- What is your ethnic background?
- For someone who is mixed race: Is there a specific ethnicity/culture/race that you identify with most?
- What is your sexual identity?
- How has your cultural identity influenced the way you approach current issues in your life?
- How does your family cope with issues related to mental health?
- Tell me what are some of the most misunderstood aspects about your culture that you wish people could better understand?
If you’ve had any positive/negative experiences with clinicians in regards to addressing your health/mental health, please share and comment below!
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12 comments
I never really considered the specific challenges that would face minorities with mental illnesses. Thanks for shedding light on this.
Thank you for your comment! 🙂
Reblogged this on GUM | Growing Up Millennial.
Thank u for reblogging! 😃
Of course. Thank you for writing this much needed piece!
Thanks so much for your posting, which has helped spark my interest in how culture/minority issues impact and intersect with mental health and psychiatry.
I would also like to recommend the following TED Talk: https://www.youtube.com/watch?v=VrYmQDiunSc . I found 9:13-11:00 to be particularly interesting/the “high yield” portion haha. It reminds us that the often research-driven “expertise” we tend to seek as clinicians (or “student clinicians,” in my case!) may not even fully prepare us for the complexity with which an individual’s cultural background impacts their mental health.
I found this fact, and the whole talk for that matter, to be both humbling and enlightening. Thanks again for the post! Also a fan of your insta and snap (love the educational talks on the snap)
– 4th Yr med student applying into Psych
Hi! Sorry for the late reply — thanks so much for the link!! Will check it out. And yay, always nice to meet someone interested in going into psych! 🙂
I’m the daughter of Filipino immigrants and because of their beliefs, as well as the environment where I grew up– it took me until the last year of high school to be diagnosed with ADHD. It wasn’t until my school dean mentioned it as a possibility to get tested that my parents were open about trying to understand how ADHD manifested in women. Because my father is a clinician, it never occured to him that I may have a mental illness (other than depression because… apparently that was a thing my parents discussed, yet also never tried to seek out treatment for me due to the stigma) until an outsider pointed it out.
As a minority who grew up surrounded by a family deeply entrenched in the healthcare industry, I’ve never had a major problem with clinicians, but I’ve had mental health stigma prevent me from seeking out the best possible treatment due to my family’s concerns that people in their community (because, like I said, my dad is a clinician) may find out that I am “seeing a psychiatrist and could jump to conclusions.” It was appalling to me that this stigma prevailed, and it made me sad because this isn’t something that we talk about that much, even within healthcare. It’s why I seek to become a culturally competent physician in the future, hopefully preventing mental health stigma in the future 🙂
Hi! Sorry for the late reply — I’m filipino as well so I know what u mean! I’m glad to hear you were able to get help and support to address symptoms u were struggling with. Stigma is real and it even exists among clinicians, so you’re right — the conversation needs to be more open because only then can we work to eliminate stigma.
❤️ your blog
Thank you for your post! I am also asian raised Western–East Asian, and have a non-Asian therapist. Because of my particular situation, I couldn’t be choosy–but even if I could, there weren’t that many choices. The group that my therapist works for only has one Asian therapist that I know of, and although I haven’t worked with that one, it does bring up the question: what if I did, and that therapist wasn’t able to treat my specific condition? We definitely need to work on the stigma issue, not just so sufferers can find help, but so that there will be help for them to find (i.e., a sufficient number of therapists of all different cultural backgrounds who can understand the cultural complications and implications of having various conditions)
Yes, i can’t agree more! thanks so much for your comment and for sharing your experience!