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Depression and the Asian Culture

by Kristina Randle, Ph.D., LCSW

Hi, I’m sixteen years old and living as an expatriate in Hong Kong Ever since I was about 12, I’ve been falling in and out of phases where I’d get really down and stop eating, and used to depend my emotional well being upon a boy.

Yet now, I’m scared because I know I’m getting too sad to function, and I can’t pull myself together. I don’t have an appetite, I never do my homework anymore, I can’t even wake up in the morning and feel like socializing with my friends is impossible. Its as if I’m trying to float in the middle of the sea, when its just so much easier to sink and die. On the topic of death, I always think about how much easier it would be to die, and often feel resentment towards the fact that I’m living, though I’m rational enough not to kill myself. I cope by not eating, which is easier because I don’t have an appetite anymore. I can’t stop restricting though, even when I want to. At one point I convinced myself I didn’t actually look like a human being and therefore needed to starve myself silly and deserved to die.

My main issue is I know that I need help, but in an Asian-dominated society, in which mental health issues are taboo. I want my school to notice me, but all it’s concerned with is academic excellence. I’m too afraid to ask for help.

I think you need to know a little about me.

My 3 closest friends moved away/were sent to boarding school against their will at the end of last school year. Just my luck.

My love life is very complicated. I’m in love with two people, one who’s always been there, who I’ve always known, and knows me like my best friend. The new guy is much better for me (I know this but my heart won’t believe it) and will take care of me, and doesn’t toy with me emotionally like the old guy.

I’m also quite upset because last year my childhood best friend died and my parents stopped me from going to the funeral because of a family feud that happened a few years earlier. I have so much regret and guilt.

One last thing, though my parents can be wonderful people, when we don’t get along it is hell living at home. My authoritarian father can never be wrong and has a major temper. My mother cannot let a grudge go and when angry, will make up things and continue to yell at me for other things I have done in the past to make her arguments stronger. They call me lazy and always focus on my negatives. I cannot confide in them.

Basically, I’m really unhappy. My grades are slipping, I can’t concentrate, and I just need to know how to get my school to notice me and recommend me to see somebody. Or just know how to pull myself together, because I can’t keep being this way. Thank you.

I do not think that you should only rely on yourself to “pull [yourself] together” because as you said you can’t help how you’re feeling. I’m sure if you could change how you felt you’d do it instantly. Individuals experiencing depression can’t just “snap” out of it. It’s not that easy. Depression can be complicated. It often requires treatment from mental health professionals, usually in the form of counseling.

You mentioned that you live in a culture in which mental health issues are taboo. It is important to identify these aspects of your culture. The fact that you recognized this about your culture indicates that you’re an insightful individual who is keenly aware of your surroundings. People are not always aware of their culture.

Let’s go one step beyond awareness and examine how this cultural mindset directly impacts you. There are personal ramifications. As you noted the cultural norms in Hong Kong dictate that mental health issues are taboo. For you, this means that even though you know you’re suffering you feel that can’t ask for help. The culture indicates that asking for help would be wrong. You fear what those around you will think if they were to learn that you have depression or another related mental health issue. Instead of asking for help and receiving it you’re left to anguish over your grades, starve yourself, ruminate about death and hope that at some point in time, you’ll be able to snap yourself out of it. In essence, by not going for help you’re allowing the cultural norms of Hong Kong to dictate your behavior. Followed to its logical extreme, your culture prevents you from accessing help, you may be destined to be miserable for the rest of your life. That’s the potential outcome unless of course you’re one of the fortunate individuals who are able to “snap” themselves out of their depression. I hope you can see that this is no way to live.

Every culture has it norms and rules. But what you cannot do is to let the beliefs of culture rule your life. You should move beyond behaving in ways that society identifies as the norm. You must do what is right for you. Do what is in your best interest. Yes it’s important to follow and obey laws and to be morally responsible. But it’s not okay to delay seeking help when you’re clearly in need of it just because it’s not the expected way to behave. What this specifically means for you is that you should not wait until someone notices that you’re experiencing a serious mental health problem before you can be helped. You need to alert the proper authorities (i.e. mental health counselors or teachers within your school or your parents) as to how you are feeling. You need to do this sooner rather than later.

I realize that it’s not going to be easy to ask for help. As you described in your letter, your parents may be difficult to deal with. They may have their own idiosyncrasies. That can make your challenge doubly difficult. But I think it’s important that you find a way to access treatment despite what your parents may think. Don’t wait for someone to notice you’re suffering. Emotional pain often goes unnoticed. That’s because it’s not visible in the same way that a broken arm or a gash on the head is. You have articulated very well in your letter the issues you’re facing. Your continued, unabated emotional distress should not be an acceptable outcome. It’s time to move beyond culture and access help before your problems become overwhelming. It’s the only correct way to handle this situation. Thanks for your question.

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