No matter how conspicuously present, mental illness in Korean American families is nearly always held in secrecy, often under a cloud of denial and shame.
“It would have been so much easier for my sister if we were able to speak openly about her schizophrenia and bipolar disorder,” said John Lee, not his real name, who occasionally helps his sister Jane, not her real name, who had her first episode of serious mental illness 25 years ago. His family and Jane, a medical doctor, chose not to reveal her schizophrenia to her husband before marriage, John said, citing taboo around schizophrenia as a reason. Jane’s husband did know that she had bipolar disorder because he saw her taking lithium on a regular basis. Even among Korean Americans who are educated to view health medically, mental illness is not discussed with the same level of candor one might speak about cancer, heart disease or diabetes.
Only about 12% of Asian Americans compared to 25% of Euro-Americans would disclose their mental illness to a friend or family member, according to studies cited in the 2001 Mental Health Supplement of the Surgeon General’s Report. Not surprisingly, Asian Americans are less likely than other ethnic groups to seek professional help for mental health issues and frequently confront cultural and linguistic barriers in finding professional help.
“There is a poor understanding of mental illness as a public health issue among Korean Americans. This situation leads [them] to deny the existence of their own mental illness, often resisting treatment and resulting in significant delays of treatment,” said Shin Woo Kim, LMSW, president of the Korean American Behavioral Health Association (kabha.org), a Queens, NY-based membership organization of Korean American multidisciplinary behavioral health professionals—the only one of its kind on the East Coast. Ms. Kim is also a licensed master social worker at Creedmoor Psychiatric Institution, a facility for people with severe mental illness.
“Often times the stigma of mental illness is attached not only to the individual with mental illness but also the family members, particularly the parents,” Ms. Kim said. Because the stigma of mental illness in traditional Korean culture brands the entire family, not just the individual with mental illness, the denial runs deep.
The Korean cultural norm is not to disclose to those outside of family about struggles with depression, anxiety, and other more serious mental illnesses (SMI). 1.5 and second generation Korean Americans are also reluctant to seek help, according to the first major study on Asian American mental health, the National Latino and Asian American Study, which studied the help-seeking behaviors of Asian Americans with SMI. Ironically, such isolation can exacerbate the condition of the person with SMI, who needs empathy and support in order maximize their chances of recovery.
Because mental health education or awareness of psychological issues was minimal in many institutions of higher education in Korea, many Koreans, particularly first generation, have little formal education or knowledge about mental health. Many Koreans associate mental illness— “jung-shin byung”— with psychosis, defined by the Diagnostic and Statistical Manual (DSM-IV-TR) as a category of serious mental illnesses characterized by a distorted or nonexistent sense of objective reality. Some Korean American harbor myths about mental illness—believing it to be unequivocally the fault of the parents, says Ms. Kim. Some mental illnesses such as bipolar disorder are 60-80% genetic in origin while other mental illnesses such as post-traumatic stress disorder (PTSD) are the direct result of an extremely traumatic event such as rape, abuse, torture, or starvation. Most experts agree that most of the research shows that most mental illnesses are caused by a highly complex interaction of biology and environmental factors. However, among Korean Americans, the most prevalent cultural beliefs—which have little scientific basis— arbitrarily assign blame on the parents, family genetics, and characterological weakness. Such myths serve to hinder early, sometimes life-saving, professional interventions.
While there is large body of research on the intersections between stress, trauma, genetics and mental illness, the origins of mental illness are not fully understood scientifically. Even among the most inheritable types of mental illnesses like bipolar disorder, the probability of an identical twin, developing the disorder when their twin already has the disorder, is 60%-80%, suggesting that there are other unknown variables which contribute to its development.
“We all need to understand that mental illness could affect anyone without any wrongdoing on their part,” said Ms. Kim, “Their guilt and misunderstanding about mental illness are the factors which make the situation worse and the individual suffer more.”
Many first and second generation Korean Americans with mental illness only seek professional help after they can no longer conceal the symptoms of their disorder—which is often years after the initial onset. In the case of Jane Lee, the police found her in a fast food restaurant, engaging in unusual behaviors and she was immediately taken to the hospital. Sadly, she broke under the stress of accumulating student loans for medical school and became delusional, without any warning signs, says her brother John.
By the time some Korean Americans find professional help, their illnesses have worsened and thus their prospects for recovery lessened.
“I’ve had psychiatrists ask me why Korean patients always seem to be much more ill than other patients and have to stay longer,” Jennifer Lim, LMSW at Flushing Hospital psychiatric inpatient unit. The difference is that many Korean patients often have had years of no treatment for their mental illness, resulting in a far more decompensated state that requires more intensive psychiatric care.
“In contrast to white families, Korean families have a very high tolerance for the manifestation of their family member’s symptoms,” said Ms. Lim.
One of the strengths of the Korean family unit is the sense of collective responsibility that often results in the family taking care of their member with SMI. This care is a protective mitigating factor among Asian Americans with mental illness, resulting in lower rates of homelessness and incarceration. A significant percentage of the homeless and the incarcerated have a serious and persistent mental illness. However, some Korean families attempt to take care of their family member with SMI in lieu of medically necessary psychiatric care, which may increase the person’s suffering and decrease the person’s chances for long-term recovery.
The stigma of mental illness is universal, and pervasive among white Americans as well as other minority groups. However, the stigma of mental illness was a stronger deterrent for all majority minority groups, including African-Americans, Latino-Americans and Native Americans than for white Americans, in seeking treatment, according to the 2001 Mental Health Supplement of the Surgeon General’s Report.
“On top of the general societal stigma against mental illness, there is a distinct stigma in Korean American communities, which could be due to strong bonds of family and the lacking sense of individuality.” said Ms. Kim.
“Chae-myun” the Korean word for family pride or honor was to be maintained at all costs in traditional class-based Korean society. And still today in some Korean American communities, the disclosure of mental illness, physical disability, or other type of family mark that may be linked to a weakness in the family lineage is basis for social ostracism. Such exposure is losing face — a serious loss of status and social capital— for the entire family, which can render the siblings of the person with mental illness unable to marry. Thus to maintain the family’s honor by hiding “shameful” family secrets is viewed as a moral imperative.
For many traditional Korean Americans, marriage is often viewed as a contract between families as opposed to between individuals. And one family member with a “bad reputation” was grounds for a family to refuse to marry their son or daughter off to that family. In some Korean American communities, such traditions, which are rooted in Confucian morality, still prevail. Thus the revelation of any shameful family secrets is considered morally wrong since it jeopardizes the well-being of the entire family lineage. In contrast, more white Americans speak openly, often in casual conversations, about the experiencing mild to moderate forms of mental illness or having been in psychotherapy.
While many Koreans equate mental illness with psychosis—which affects about 2% of the general population—there are more than 300 different types of mental disorders according to the DSM IV-TR. The most common mental illnesses are depressive and anxiety disorders, with nearly a fifth of Americans experiencing these disorders in their lifetime. Though depressive disorders can range from mildly to severely debilitating, all are considered types of mental illnesses. For many Koreans, depression and anxiety are not considered forms of mental illness. All are treatable and some forms of depressive and anxiety disorders, with treatment, have a high likelihood of recovery.
“Korean Americans need to change their perception and understanding of mental illness at an individual level as well as on a societal level,” says Ms. Kim. Much unnecessary suffering may be alleviated through earlier acknowledgement and treatment of mental illness. Greater understanding of mental illness as a medical phenomenon, not a characterological weakness, may help to decrease the perception of stigma and internalized shame.