Opinion: What explains the stigma surrounding mental illness among Asians? Blame ghosts

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A family burns offerings at their relative’s grave at the Diamond Hill Cemetery in Hong Kong on April 5, as people visit cemeteries to honour their ancestors during the annual Tomb Sweeping Day, known locally in Hong Kong as Ching Ming.PETER PARKS/Getty Images

Kevin Chong’s most recent novel, The Double Life of Benson Yu, is a finalist for the Scotiabank Giller Prize.

When my father died in 2014, I walked into every room of my parents’ house, cradling a small framed portrait of him and repeating the words my mother had coached me to say in Chinese: “Dad, you can come back any time.” Because Dad had died in the hospital and not in his home, it was my job as the eldest son to roll out the welcome mat should his ghost return.

Growing up in Vancouver, raised between two cultures, I was often swayed by Canadian influences over Asian ones. As a result, I didn’t believe in ghosts, at least not with the force one feels in Asian cultures. In 2011, for instance, a “fear of ghosts” led NIMBYs of Chinese descent in my hometown to protest when a hospice was planned next to their luxury condo development.

However, I unwittingly subscribed to another belief deeply held in Asian households: We don’t have problems with mental health. I clung tightly to this idea even after the weight of my unprocessed grief about my father’s death caused me to break out in hives, a nasty flu, and hypertension that spiralled into gout.

The need to uphold the myth of the model minority and a cultural imperative to suppress emotions for the sake of family honour are possible reasons why diasporic Asians (to a lesser extent for North American-born Asians than for recent Asian immigrants) are far less likely to seek mental-health services than the general population. At the same time, Asians might be the group that most needs support. In the United States, among women between 65 and 84, Asian Americans have the highest rate of suicide. As COVID-19 brought isolation, economic insecurity and anti-Asian violence, we’ve also been at greater risk of depression and PTSD.

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Cherry Tang lights incense as she observes Tomb Sweeping Day in Hong Kong, on March 25.DOMINIC CHIU/The New York Times

Part of the stigma surrounding mental illness among Asians is its long association with ghosts. In Chinese folklore that dates back thousands of years, the deceased would haunt their relatives because of improper burials. (Tomb-Sweeping Day, in early April, is an earmarked holiday designed to pre-empt hauntings. Families will visit their ancestors’ graves, often picnicking on the cemetery lawn.) In other stories, ghosts might possess the living to avenge a misdeed. In Japanese folklore, onryou are wronged women – such as Okiku, a servant girl who was murdered for refusing the sexual overtures of a samurai – who are seeking revenge among the living. Similarly, in Thai folklore, Nang Tani is a female ghost that lingers around banana trees who is considered benevolent, except when she encounters men who’ve mistreated women.

During the Tang Dynasty in the 7th century BC, Sun Si-Mao, the “king of Chinese medicine,” codified the link between ghosts and illness. Sun identified the 13 “ghost points” – locations on the body along the meridians, or Qi energy pathways, that are linked to epilepsy, schizophrenia, headaches and other maladies. Although in North America, practitioners of traditional Chinese medicine, including acupuncturists, are more likely to attend to joint and muscle pain, these points can be used to treat mental illness once attributed to spiritual possession.

Whether or not those remedies work, the concept of spiritual possession can deeply affect Asian families’ handling of mental illness. In her 2018 memoir, The Woo-Woo, Lindsay Wong wrote about how her Chinese-Canadian family blamed any mental disturbance, including those of her grandmother, who suffered from paranoid schizophrenia, to “woo-woo ghosts,” demons who possessed them. Early in the book, she recalls being six years old and having her mother calmly explain that she had heard the “staticky” voice of a ghost and felt its embrace in the kitchen. At another point, Ms. Wong’s mother replaces her grandmother’s antidepressant and anti-anxiety medications with Tic Tacs. “[The doctors] think Poh-Poh is fucking crazy, but they can’t see that she’s possessed!” Ms. Wong’s mother says. “The medication hides the demons, you see.”

The concept of ghosts, especially those that haunt family members, feels especially relevant to the intergenerational trauma experienced by those Asian Canadians who escaped political unrest and persecution and arrived in North America as refugees.

For instance, Therapy Ghostbusters, a radio documentary by journalist Stephanie Foo that aired on NPR last year, explored the mental-health struggles of a community of Cambodian survivors of genocide in San Jose, Calif., who passed on their pain to their spouses and children. When therapist Bophal Phen first heard these patients speaking about ghosts appearing at night, he related it to a commonly held belief that ties sleep paralysis to spiritual possession. Ms. Foo’s documentary shows the Cambodian therapist flummoxed in his attempts to discuss their memories of violence with his patients, who were reminded of their Khmer Rouge interrogators. Mr. Phen began to reframe his cognitive behavioural therapy techniques, where unhelpful patterns of behaviour are replaced by more positive responses, in terms of the Buddhist concept of karma. Mr. Phen also counselled his patients on parenting and repairing relationships damaged by their suppressed trauma. These interventions, informed by his understanding of Cambodian culture and language, highlight the need for more culturally responsive therapists.

Dr. Kaila Tang, a psychotherapist based in Atlanta and a program officer of the Asian Mental Health Collective, treats mainly East Asian patients and told me that most of them have experienced trauma. Many of them have also suffered increased anxiety as anti-Asian violence – such as the 2021 shootings in Atlanta spas that resulted in the deaths of eight Asian women – spiked during the onset of the pandemic.

A white therapist might pathologize an Asian patient’s experiences with racism and stereotypes. By contrast, Dr. Tang, whose practice is psychoanalytic and relational, says, “It’s very important to acknowledge reality. Because as someone who is also Asian, I’ve felt these things myself. I felt unsafe being outside after the spa shootings, which happened 10 minutes away from where I live.”

Recently, I worked through my own relationship with my deceased father and complicated feelings about my cultural heritage with a therapist of Asian descent, finding comfort that some aspects of my story didn’t need to be explained. Like with a ghost, racism is hard to see for those not preconditioned to seeing it. Whether you believe in it depends on your own lived experiences.

As someone who’s never believed in ghosts, I still yearn for the possibility of vengeful female spirits hounding misogynistic would-be shooters. Failing that, I’d settle for a world with more culturally informed mental-health care that helps Asian people exist with respect, love and safety in their families and communities.

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