Koko Nishi learned gaman from her grandmother.
Gaman describes the act of persevering through challenging times, the seemingly unbearable, with patience and poise. It’s a mindset by which many Japanese people ― including Nishi, a third-generation Chinese Japanese born in the U.S. ― live their lives.
It’s also one of the reasons Nishi didn’t seek therapy in college, at a time she needed it the most. Nishi had failed her first class, an undergraduate organic chemistry course that was part of her plan to someday go to medical school, and it left her feeling emotionally wrecked.
“I thought there was something wrong with me,” Nishi, who is now a psychologist, told HuffPost. “I think that’s one of the times when I realized I was holding in so much, and it was really unhealthy.”
Nishi didn’t consider seeking help at the time because no one in her family ever talked openly about their emotions. And then there was gaman.
“[Gaman] taught me resilience and helped me overcome a lot of challenges, but at the same time, I internalized a lot of my emotions,” Nishi explained. “I didn’t get to process what was happening or understand how I was feeling, or communicate what I needed.”
Asians, which make up the fastest-growing minority group in the U.S., are three times less likely than any other ethnic group to seek help, though that doesn’t mean they’re not suffering. According to Mental Health America, 13% of Asian Americans and Pacific Islanders had a diagnosable mental illness in 2016.
HuffPost talked to several psychologists, including Nishi, to break down what stops Asian Americans from getting the mental health services they need ― and it begins with a complicated version of shame.
The shame to seek help comes from many sources, including the model minority myth.
Nishi now provides therapy to students at San Diego State University and hosts an organization that helps students with Asian and Pacific Islander backgrounds.
Many Asian cultures have a concept similar to gaman, which Nishi said “loosely translates to ‘suck it up,’” and it makes students hesitant to seek help because they’re ashamed of not seeming emotionally tough.
“I’ve had several students who identify as Asian American say that they feel bad for being here,” Nishi said, adding that many times it stems from their parents telling them to “get over it,” “suck it up” or “be strong.”
The pressures to be strong and save face is also compounded by pressure to be a model minority, according to psychologist DJ Ida, the executive director of the National Asian American Pacific Islander Mental Health Association.
“Asians do not have a monopoly on shame,” Ida said, noting that shame surrounding mental health can affect anyone from any race. “But it does go deeper [for Asians] because we’re so clearly identified as a particular population that’s either supposed to do well or be viewed as the less-than foreigner.”
The lack of data leads to a lack of resources for individual Asian communities.
If you look at federal data on Asian Americans, you might see that it reinforces the myth of the model minority. It suggests that Asians, as a whole, are affluent, well-educated and report fewer mental health conditions than those who are white. But it’s not that simple.
That data tends to lump all Asian ethnic groups together, even though Asian Americans have ties to more than 20 countries across Southeast Asia, East Asia and the Indian subcontinent.
The mental health issues facing one Asian community may be starkly different from those facing others, Ida said.
“One of the most important things is really understanding who Asian Americans are,” Ida said.
“Asian Americans” is an umbrella term used to describe many types of people, she said, including refugees and immigrants: “You could be fifth-generation, biracial with Japanese parents and a Caucasian mother … [or] a 15-year-old who’s been here for five years and came as a child.”
The needs of all those unique subgroups get lumped together, producing statistics that may suggest that Asian Americans as a whole don’t need much help with mental health.
The consequence? The needs of some Asian groups become invisible to policymakers who decide where funding for mental health programs, clinics and research go ― even as some subgroups, such as Southeast Asian refugees, are experiencing high rates of post-traumatic stress disorder, according to the U.S. Department of Health and Human Services Office of Minority Health.
The mental health resources currently being offered may make people of color feel out of place.
Simply put: There are not enough resources available to serve the needs of every Asian American group with mental health issues. And some of the services that are being offered now may be culturally inappropriate for those seeking help.
There aren’t enough practitioners who speak Asian languages, which creates a barrier that prevents individuals who cannot speak English from seeking care. There are also too few therapists of color. A 2015 study found that just 5% of psychologists were Asian, while 86% were white. This gives minority groups less of a chance to find a practitioner whom they feel can relate to them on a cultural level.
Nishi said mental health care is all about finding a good fit between provider and patient, and she encourages people to shop around for providers who make them feel comfortable.
Mental health is typically approached from a Western point of view — and that’s not always effective.
Asian individuals who do receive help often see providers who rely too heavily on Western styles of treatment that might make them uncomfortable, according to Ida.
“Western modes of therapy are not necessarily bad, but it’s not the only answer,” she said. “And there are times when it’s actually inappropriate.”
Talk therapy, for example, is very popular with Western providers but Ida said it may not always be effective.
“The kinds of things that may work for a refugee, who’s already been traumatized, is not talking about the trauma,” she said. “But it might be doing gardening, it could be exercise.”
Ida said there needs to be more investment in alternative mental health treatment options, including a focus on the mind-body connection, to see whether they can be effective alternatives for sensitive individuals within the Asian community.
The good news is that some organizations are changing the way providers interact with minority groups.
The Substance Abuse and Mental Health Services Administration, a federal agency, provides funding for organization and programs that tackle these problems, including the National Network to Eliminate Disparities in Behavioral Health.
Nishi co-created a workshop where people can share their stories about what it’s like to grow up as Asian or Pacific Islander in the U.S. and talk openly about the problems they face.
She sees it as a way for the community to understand they’re not alone in their struggles.
“I think we [Asians] tend to feel like we’re invisible,” Nishi said. “It’s a space for folks to get their story heard, have their voices heard and validated.”
If you or someone you know needs help, call 1-800-273-8255 for the National Suicide Prevention Lifeline. You can also text HOME to 741-741 for free, 24-hour support from the Crisis Text Line. Outside of the U.S., please visit the International Association for Suicide Prevention for a database of resources.