New research sheds light on the mental toll that heightened anti-Asian racism during the coronavirus pandemic has had on the community and how reporting can help.
The report, released by Stop AAPI Hate, Brigham and Women’s Hospital of Boston and the Asian American Psychological Association, found that 71.7 percent of Asian Americans who have experienced racism felt more stress over the anti-Asian hate than the pandemic. At the same time, those who reported incidents had less race-based traumatic stress, which the researchers defined as psychological or emotional harm caused by racism. About a third no longer fell under the category.
Dr. Warren Ng, psychiatry medical director at NewYork-Presbyterian Hospital who wasn’t involved in producing the study, said reporting can help a person regain a sense of control that’s often lost after a racist incident.
“So often, a part of the AAPI experience is being silenced and invisible. And so many of those things exacerbate the challenges we are facing,” Ng said of Asian Americans and Pacific Islanders.
Among the things “that help people manage things that they cannot control is the focus on the things that they can,” he said. “It’s taking action, whether or not it’s reporting to a mechanism.”
Researchers examined three studies that investigated the effects of anti-Asian racism on mental health. One, in which Stop AAPI Hate surveyed respondents who had experienced racism, found that 1 in 5 Asian Americans who have experienced racism during the pandemic displayed at least three signs of racial trauma, among them depression, intrusive thoughts, anger, hypervigilance, decreased self-esteem and numbing.
Ng said the symptoms often stem from what many victims may interpret as a loss of agency, when “you have no control over how you look, how you appear to others.”
“At the same time, it’s not something you can modify,” he said. “Therefore, you feel constantly in stress and are vulnerable to those kinds of experiences.”
Ng said the participants who no longer showed signs of racial trauma after reporting are likely to have felt that some of that agency had been restored. Many might not be comfortable disclosing hate incidents to law enforcement because of fear of retaliation or because of their immigration status, he said, and reporting forums like Stop AAPI Hate can offer a more trusted way to report.
Reporting forums that aren’t connected to law enforcement — and that let people choose whether they want to be contacted by police and how much information they want to reveal — alleviate some of those fears, Ng said.
According to the COVID-19 Adult Resilience Experiences Study, another survey in the new report, 1 in 4 young Asian and Asian American adults reported having been diagnosed with post-traumatic stress disorder, or PTSD, during the pandemic. It also found that even after accounting for pre-existing mental health diagnoses, those who experienced Covid-19-related discrimination were three times as likely to report symptoms of PTSD than those who didn’t report discrimination.
“When we think about PTSD, we often have to think about a life-threatening event, something very dramatic,” Ng said. “With racialized trauma … it’s related to microaggressions. We’re really thinking about what’s called death by 1,000 cuts. It’s much more insidious. It gets under your skin. And it really starts to affect how you think, feel, as well as behave.”
But getting help isn’t always accepted, Ng said. Asian Americans have long met major barriers to seeking assistance, and they remain among the groups least likely to use mental health services. Research shows that they are about a third as likely as whites to seek mental health help. And even though Asian Americans report fewer mental health conditions than their white counterparts, they are more likely to consider and attempt suicide.
Ng said cultural factors are still barriers to treatment. The concept of losing face and the fear of bringing shame to the family or the community weigh heavily on many Asian Americans who are dealing with mental health issues, he said. Internalized racism in many immigrant communities is also an obstacle to a victim’s getting help.
“There’s such an acceptance that ‘we’re going to be treated this way anyway, so get over it — instead of being bitter, be better,'” Ng said. “It’s always a concept of ‘we’ve already accepted that this is our fate, that we don’t have it any better. We are not equals.'”
The way Asian cultures across the diaspora prioritize the collective family and community over the individual also seeps into how they view mental health. To seek help is often interpreted as “really drawing attention to yourself,” he said.
“It goes against that idea of individualism versus collectivism and whether or not we are here for ourselves” or “are we here representing our families and our community,” Ng said. “There’s also the cultural issues related to interdependence, where you rely on your family or your close-knit people instead of reaching out outside of your network, because of that sense of idea of interdependence.”
However, treatment is too frequently seen through a Western lens, Ng said. It becomes difficult for many Asian Americans to find therapists who will understand some of the cultural sensitivities they may have. Even if health care professionals are of Asian descent, they might not be well-equipped to deal with some of the racial issues a patient is experiencing.
“If that person isn’t aware of their own baggage with regards to their own internalized racism or their own limitations for a social lens, or maybe they grew up in the U.S. and never even thought of themselves as different … that can really limit someone’s experience” of therapy, Ng said. “Just because it’s an identity doesn’t mean there’s an awareness.”
Ng said the way some health care professionals conduct their treatment can disregard how integral family structures are to Asian Americans.
“When you’re providing treatment to someone, depending on their API experience, you want to talk about themselves in the context of their family, their relationships. And that’s often not necessarily seen as a positive in a Western psychoanalytic perspective,” he said.
The medical field has yet to properly develop treatment options to best serve the Asian American community, Ng said, which means it’s sometimes ineffective in its approach to mental health.
“We overemphasize words and talking versus actions and behaviors, which is one thing that is very culturally determined,” he said.