Douglas Todd: Project battles stigma of mental illness among Asian men

posted on October 24, 2014

By Douglas Todd, Vancouver Sun | Link to Article

Many men in North America feel pressure to succeed and provide for their families.

Many men, as well as boys, fear being seen as weak.

By Douglas Todd, Vancouver Sun | Link to Article

Many men in North America feel pressure to succeed and provide for their families.

Many men, as well as boys, fear being seen as weak.

When they’re struggling emotionally, they often feel shame. It makes them reluctant to seek psychological help.

What’s more, when the man is of Asian origin, all those factors are magnified.

As a result there can be a strong stigma in Asian-Canadian cultures against men dealing head-on with mental health difficulties, either their own or those of family members.

That’s why Movember Canada, the international organization most often associated with November moustaches and prostate cancer, agreed to give a $3-million grant to a Canada-wide team of researchers and mental health specialists.

The goal of the three-year project is to reach 2,200 people of Asian origin in the high-immigrant cities of Toronto, Calgary and Vancouver and is called “Reducing stigma of mental illness among boys and men in Asian communities in Canada.”

Led by Prof. Sepali Guruge of Ryerson University in Toronto, more than 18 investigators are forging connections with men in Canada who have roots in places such as India, Pakistan, China, Korea, the Philippines and elsewhere.

“There has not been much specific focus on men’s and boys’ mental health. The field is still new,” said team member Marina Morrow, of Simon Fraser University’s faculty of health sciences. “But it’s been documented that men tend not to seek help as frequently as women. And that can be compounded for new Canadians and males of Asian background.”

The grant to connect with Asian men is part of roughly $12 million that Movember Canada handed out last year to strengthen the underfunded field of men’s mental health, including a $2.9 million award to a University of B.C.-led program combating men’s depression and suicide.

By being sensitive to what Guruge called “the richness and diversity” of Asian cultures, the team hopes to stimulate more productive ways for Asian men to face up to mental health problems such as anxiety, depression, obsessive compulsions, bi-polar disorder and psychosis.

Researchers into cross-cultural mental health have long found that many people from Asian cultures, particularly male breadwinners, are ashamed to admit to emotional crises. Studies show they generally shun Western “talk therapy” and, like Asian women, tend to see mental illness mostly as a religious challenge.

To create a dialogue about such issues, Guruge’s team is forming pilot programs across Canada called Strength in Unity. They’re engaging Asian men and women who are living with or affected by mental illness, as well as with influential Asian-Canadian leaders from the media, arts and religion.

“It’s a big project,” said Guruge, co-director of Ryerson’s Centre for Global Health and Health Equity.

It’s estimated roughly one out of four Canadians will at some time suffer with a form of mental illness. Since 43 per cent of the population of Metro Vancouver has Asian origins, there was special reason for the cross-Canada team to recently meet for training sessions in B.C.

Talk therapy unfamiliar

“The idea of talk therapy is very alien to a lot of Asian people, especially Asian men,” Rodrick Lal, a PhD candidate who teaches educational psychology at SFU, said in a break from the team meeting at UBC.

“(Film director) Woody Allen has helped make talk therapy popular in North America. But that’s not a construct in South Asian, Filipino and Chinese culture, where there is more of an indirect way of dealing with issues.”

Since most Asians have arrived from nations that are more patriarchal than Canada, Guruge said, there is tremendous pressure on immigrant Asian men to succeed.

“For example, men who have held very high status jobs in their home country — and who have been the only bread-winners — lose that status when they can’t find a good career in Canada,” said Guruge.

In Asian-Canadian populations, the team members say, the intense shame associated with loss of status and mental illness can throw up barriers against men seeking help — even from the limited free mental health resources available to the public.

“An Asian family that has someone with a mental-health problem could believe they’ll be stigmatized from a generational perspective. They’ll worry about promotions at work, or that no one will marry into their family,” Lal said.

Chi-Jen Hung, a counsellor in Burnaby, said an immigrant ethnic Chinese man is expected to be the protector of his family.

“He is likely to be very busy trying to help the family survive, find a place to live and to work. If a mental health issue comes along, it’s neglected.”

Since East Asian men are expected to “tough it out,” Hung said it adds to the barriers against seeking psychological help. Mental health problems are “pushed aside because it’s more important to work.”

With the team stressing their intention to be culturally sensitive, they noted how Asian men, when they come to Canada, can grow out of touch with their cultures’ traditional ways of healing, which often involve spiritual or supernatural approaches.

In many Asian cultures, Lal said, men with mental-health challenges often “go see a holy man. Even in Western societies, the first place many men make contact is with the priest, the reverend. It’s man-to-man.”

Hidden problems

The team members are exploring an array of options that Asian men have traditionally used to strengthen their mental health, which Lal said has included everything from yoga and dancing to aryurvedic medicine and ginseng.

To reduce the stigma about mental illness in male Asian populations, the team will be promoting a protocol developed by Ryerson professors Josephine Wong and Kenneth Fung to combat the stigma often associated with HIV-AIDS.

One key goal, Guruge said, is for “boys and men from Asian-Canadian communities to become mental health ambassadors who will take on leadership roles in building anti-stigma efforts in their own cultural communities.”

Mental-health specialists have detailed some of the ways ethnic Chinese and South Asians deal with emotional breakdowns and disorders in the book, Cross-Cultural Caring (UBC Press), edited by Nancy Waxler-Morrison and others.

“In South Asia mental illness is sometimes believed to have supernatural causes, such as spells or curses cast by jealous relatives or acquaintances,” writes a team of researchers represented by Shashi Assanand.

“These problems are resolved by visiting temples or shrines. Astrologers may also be consulted.”

Severely mentally ill people are not ignored or rejected in traditional South Asian families, Assanand says.

“But they may be kept hidden and thus remain untreated for long periods of time, only to arrive at hospital emergency rooms by ambulance or police car after uncontrollable outbreaks or suicide attempts.”

As for ethnic Chinese people in Canada, Vancouver family physician Ka-Ming Kevin Yue writes in Cross-Cultural Caring that mental illness evokes “considerable shame and guilt.”

Immigrants from places such as mainland China often try to minimize emotional problems, Yue says.

“Neuroses are under-reported, while psychoses, which are much more feared, are typically ignored and not reported at all.”

Schizophrenia, for example, has a worldwide prevalence of one per cent of the population, Yue writes. But, he adds, the rate reported in China is a mere fraction of that.

In many parts of East Asia, Yue says “mental illness is usually attributable to external factors, such as evil spirits, transgression or cold wind.”

To counter resistance to seeking help, Yue says Asian-Canadian patients can sometimes be reassured that mental illness is relatively common, is not caused by “possession” by spirits or moral wrongdoing and in some cases is a brain dysfunction that can be treated with medicine.

Even though most ethnic Chinese are not drawn to talk therapy, Yue added that some ethnic Chinese find value in a Western method known as Cognitive Behavioral Therapy (CBT), which takes a pragmatic, educational approach to mental illness.

Creating new models

Ultimately, the Movember team’s plan is, through consultation with Asian-Canadian men, to create new models for dealing with mental health complications.

As stigmas are overcome, those models might fuse emotional healing methods of the West and East. As Lal said, men in all cultures often value the vision of “going on a journey” to solve a problem.

With the project beginning to roll in Toronto, Calgary and Vancouver, Lal is excited that hundreds of Asian-Canadian boys and men and others could eventually become community leaders.

Some day, Lal imagines, those Asian male leaders could even improve how mental illness is handled in their countries of origin.

“They could go back to India, China and the Philippines and say, ‘Look what we’ve done in Canada.’”

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