Author Talks: We need to talk about Asian American mental health

In this edition of Author Talks, McKinsey Global Publishing’s Christine Y. Chen chats with Dr. Jenny Wang about her new book, Permission to Come Home: Reclaiming Mental Health as Asian Americans (Balance, May 2022). Wang says that children of Asian immigrants often have to maintain a balancing act of traditional parental expectations, Western cultural norms, and their own personal desires. Managing this tension can take its toll, which is why Wang is working to destigmatize mental-health conversations and promote self-advocacy in the Asian American and Pacific Islander community. An edited version of the conversation follows.

Why did you write this book, and why now?

As Asian Americans, we have been through such a trying few years. Anti-Asian racism is not new in the history of the United States, but I think its visibility—through social media, news platforms, and things like that—really ignited a sense of: Who are we? What is our identity? What is our place here in the United States?

The book was born out of a desire to help our communities start to integrate parts of ourselves that, through immigration and assimilation, we feel we might have lost. Now feels like a really critical time because the pandemic forced us to silence some of the external noise. We were in lockdown, we were isolated, and it highlighted the importance of mental health, which traditionally has been a highly stigmatized area within Asian culture.

My hope is that this book will invite readers to reframe or reclaim mental health and realize that it permeates every single aspect of our lives. It’s not just a diagnosable condition or something for which you may need to go to the hospital. It shows up in how we interact with people, how we make decisions, and how we perceive our world.

Who is this book for, and what is the problem that you are trying to solve with it?

At its top layer, this book is for Asian diaspora communities. Although the title says Asian Americans, I’ve heard from many Asian people living in the UK, Australia, and Latin America who say, “These things show up for me as well, even though I may not identify with the American experience; being an Asian immigrant, this is still relevant to how I’m processing my identity.” So the target audience is Asian immigrants and children of immigrants—individuals who have grown up as first, second, or third generation in a new country outside of Asia.

This book is also for people who are leaders, managers, and directors—people who are impacting or leading Asian-identifying individuals—because part of our role as leaders is to meet people where they are. Racial and ethnic identity is one facet of that. If we don’t understand how some of these cultural experiences with racism impact how Asians are showing up, then we have clear blind spots in how we might lead and engage with our teams.

What can you tell us about @asiansformentalhealth, your Instagram account with nearly 90,000 followers?

I started the Instagram account @asiansformentalhealth in September 2019. It had a two-pronged approach. One was that I was trying to identify Asian American therapists who were providing services for our community. The second goal for this account was to start talking about mental health through the lens of Asian immigrants.

[At the time,] there were so many social-media accounts that focused on mental health, but very few of them talked about the Asian American experience. What’s interesting is the timing of this account—this was prior to the pandemic arriving here in the United States. A couple months later, we started to see this rise in anti-Asian sentiment, harassment, and attacks. As people were trying to process the trauma of watching our people be attacked in the streets, I was actively processing this—even for myself—on a public platform, Instagram.

That really created a safe space for people where they could come to this platform and read about other people’s experiences, understand that they were not alone, and also verbalize some of the complexity that we, honestly, as a community, didn’t really have language for.

As the account grew, the book almost felt like a natural next step because there are people who don’t access social media. There are people who don’t understand what Instagram is. This book was a way for me to go deeper on the themes that I discuss on the social-media account while also providing a tangible resource for our community, which they could then share with their own parents, who often really struggle with mental health and understanding its importance.

What should people understand about the intersection of Asian American culture and mental health?

One important aspect is the idea of taking up space, or self-advocacy. Within Asian culture, there is a strong emphasis on being part of a unit or part of a community. There isn’t a lot of value in somebody self-advocating, self-promoting, or being prideful of who they are or their accomplishments. Instead, there’s an emphasis on humility: staying under the radar, doing our work, and trusting that that will speak for itself.

Yet in Western culture, self-promotion is one of the necessary skills to advance, one of the skills that we need in order to advocate for promotions or speak up and lead. In the context of the “model minority” myth here in the United States—which frames Asian Americans as being docile, compliant, hardworking, high-achieving individuals who don’t really speak up for themselves—it impacts how Asian Americans are viewed in the workforce, in our neighborhoods, and in our relationships.

We have competing dynamics: the cultural value of being humble and not sticking out, and the sociological effect of the model minority myth. When you see an Asian American and they aren’t as assertive as what you would expect for somebody who has grown up in America, one thing to question is whether or not they feel psychologically safe to take up space and to speak up.

Psychological safety is an aspect of mental health. So what can leaders, managers, and directors do to build psychological safety in their companies? And what can they do to allow members of their community to have the safety necessary to challenge, question, and offer ideas without fear of judgement or retaliation?

You write that ‘the dominant culture rewards us when our behavior fits their expectations and punishes us when we don’t play by their rules.’ Can you unpack that?

When I’m talking about the dominant culture, that’s not necessarily just White culture—it’s actually lots of different spaces in which there is a hierarchy, be it power, gender, race, ethnicity, or ability status. These are all stratifications of hierarchy that exist for human beings, and we all fall along different parts of that spectrum. Dominant culture is the part of that spectrum in which they have the most access to power, privilege, influence, and control.

When we think about those systemic structures, if we’re talking about race, we’re not just trying to move toward diversity for the sake of having a variety of backgrounds. We’re trying to move toward a space in which there’s a sense of belonging for people who exist in spaces that are dominated by a certain culture or hierarchy. Belonging is not just that I’m allowed to exist here. It’s not just that I’m allowed to have a membership or be part of a group—it is a sense that I am safe, I am valued, and I will be protected in that space if there is potential harm.

In a lot of corporate structures, academic spheres, and even nonprofits, I don’t think we’re quite there yet, because people are not necessarily feeling safe and protected, especially as Asian Americans. I do a lot of corporate speaking, and one of the things that has arisen through the pandemic is, suddenly, companies are building affinity groups for Asian Americans.

We have to question why they haven’t been in existence this entire time. I think that speaks to this idea that, as Asian Americans, for a long time we’ve been the invisible race in America. It’s been said that we are people who, due to our proximity to Whiteness, have kind of bought into this idea that our race didn’t matter, that if we just worked hard enough and if our competency was sufficient, then we wouldn’t be judged by our race.

Over the course of the pandemic, we realized that was not true. Those are the structural pieces that I’m referring to. As individuals, when we think about taking up space, it triggers a sense of fear. If you don’t feel safe, then the idea of sticking out, speaking up, and advocating becomes a threatening experience. As people of color, it is not our responsibility to break down toxic systems on our own—that could potentially retraumatize us. So what does it look like to build those networks from the ground up and move forward through coalition building and solidarity?

How can immigrant trauma manifest itself within secondary generations?

I frame trauma as a false sense that “I’m not safe due to some type of experience that I have personally gone through.” There can also be secondary, or vicarious, trauma: trauma experienced by somebody we know or trauma we’ve witnessed.

As Asian Americans, over the last several years, many of us have experienced secondary or vicarious trauma. I got to a point where I couldn’t open up any social-media accounts for a while because all I was seeing was people getting attacked—it was activating my body and my nervous system, retriggering some of my past racialized trauma and experiences. When we talk about trauma in the here and now, it might unearth past trauma that we’ve worked really hard to protect against or suppress.

We have to be able to step away and create boundaries so that our mental health can be preserved sufficiently, so that we can heal and start moving through that trauma. As a community, we are doing that in a variety of ways. People are finding ways to heal, but it is a journey—it’s not a stopping point. It is going to be an iterative process for our community. When we think about intergenerational trauma, we’re talking about the trauma that is carried from one generation into the next, through how people show up in relationships, or the behaviors they may act out toward the next generation.

When we think about Asian immigrants, some came seeking opportunity. They came for job opportunities or educational attainment, but many came fleeing war-torn regions. Many came fleeing imperialism and colonialism, as well as poverty and their own family trauma. When this first wave of immigrants came to the United States, not only had they gone through some pretty traumatic events in their homelands, many of them were perhaps on their own, underresourced, and unable to speak the language, all while having to survive and build stability for the next generation.

There are several pathways within which intergenerational trauma gets perpetuated in the next generation. Someone might have a parent who is working three jobs and going through their own experience of PTSD [post-traumatic stress disorder], trying to process what has happened to them. How they parent may not be the most adaptive or healthy. Maybe they’re not present physically because of job responsibilities, or they’re not present emotionally—in which the second generation then has to carry the burden.

If a parent is unable to manage their own emotional life and mental health, they may secondarily, inadvertently, or consciously abuse the next generation as a way to process their negative emotion—their own trauma. That’s another way in which that trauma is carried forward.

What is filial piety?

Filial piety is this concept which came out of Confucian values. It is a value system that sets expectations for how a child should engage with their parent. Filial piety is this sense of duty or responsibility that we might hold for our older generation as a sign of honor, respect, and perhaps gratitude. What becomes complex, though, is that there is this tension between the needs of our parents—in terms of finances, time, energy, or attention—and our own needs. Perhaps we have young families of our own, so we’re sandwiched between the older generation and the younger.

We may feel torn trying to meet the needs of all these different people in our lives. When we choose ourselves or choose our own families, that may feel like we are not honoring or adhering to that filial-piety value set because we’re diverting resources away from our parents. That can trigger a deep sense of guilt within our generation. On top of that, many of our parents came here and struggled. As children of immigrants, we witness that struggle, so in some ways, there might be a sense of indebtedness or wanting to give back to our parents’ generation for all the things that they sacrificed and provided for us.

When we choose professions that don’t meet parental expectations or when we marry someone who is not what they’re expecting, that may feel as though we’re not honoring them, respecting them, or giving them the payback—in a way—that they may expect or that we may expect from ourselves. I think that tension is very real. As children of immigrants, we’re constantly navigating that space and figuring out how we keep ourselves a part of the equation in these relationships. That becomes a crucial point in how we protect our mental health.

How do hierarchies play out in the workplace?

Hierarchy is something that is felt almost at a primitive level. For example, I feel differently when I walk into a conference hall filled with people of color or Asian Americans compared to what it feels like when I walk into a conference hall filled with people who self-identify as White. That’s just how hierarchy is ingrained and has seeped into our framing in how we perceive the world. In the workplace, that’s why we’re trying to build on that idea of diversity—people feel different things when they’re in the presence of different types of people within certain hierarchies.

That’s not to say that people at higher levels of the hierarchy are bad or are trying to maintain a hierarchy. They may not even realize that that’s at play for people. In the workplace, one of the things that we have to think about is how we start to equalize these relationships a little bit. For people who are in places of power, how can they build trust? How can they build connection with people who don’t identify with them? Perhaps these leaders can work toward being more vulnerable and humbler and really try to meet people in spaces where they feel like they’re not maintaining the hierarchy but instead disrupting it.

That’s how organizations can try to build psychological safety—by asking how we could start to reduce the hierarchy that exists between people, and by emphasizing a shared humanity and dignity regardless of your seniority, rank, or identity status within the hierarchy.

When we think about the importance of representation, one: it has an internal effect, psychologically. When I am able to see somebody who is in a higher level or position, a place of visibility, and internalize a sense of what’s possible for myself, that has a transformative effect in terms of how people can dream for the things that they’re hoping for. The thing with representation is, when you are the first and only, you’re left with a choice: Are we going to get in through the door and promptly shut it behind us? Or are we going to get in through the door and realize that perhaps we can hold open that door for people who come behind us?

This highly emphasizes mentorship, which often, as people of color, we don’t have a lot of access to. We also don’t have access to the kind of promotion structure that often exists within organizations but is not openly discussed. Promotion structures are often very abstract, so people are left to their own devices to think about what the path to advancement is. Being the first also means that you might have a sense of responsibility for helping others create more clarity in their path forward.

How has your personal experience in academia informed this book and your other work?

Among Asian Americans, there’s a running joke: doctor, lawyer, engineer. My own dad is an engineer. We are constantly surrounded by people who pursued medicine and things like that. It just felt like those were the only choices. This speaks to model-minority-myth frameworks, but at the same time, it also speaks to how, in our parents’ value set, the idea of scarcity was constantly in the back of their minds, so they wanted to give the next generation a leg up in order to build stability at an earlier point in our lives.

Psychology was something that was so outside of the framework of a career that was viable. At that time, I don’t think I knew any Asian Americans who were in the field of psychology. Making that switch really was, in a way, manifesting some of the ideas that I talk about in the book, especially the chapter on permission to choose. In choosing this profession and this career, I had to ground myself in the idea that this might be a very risky path for somebody with my identity and with my background—and yet perhaps this is how our community breaks out of these boxes that we are traditionally placed in.

To be honest, it was not an easy journey. Graduate school and academic settings are very White dominant. For much of my training, it was a dance of code switching between spaces and feeling as though there are parts of my identity that perhaps were not valued and were not seen as important within my professional realm. At times, I felt as though my identity might actually make me seem less professional and I feared that perception. I communicated to my parents that I was going to give up the stable career that they felt accounting would provide me and instead move into something that they had no framework for. There were no models, no representation, for successful Asian psychologists, so it was pretty anxiety inducing for them as well.

It makes sense why they emphasize these careers that seem very linear in path and very structured. There is no ambiguity about the steps you need to take in order to become a doctor. That felt safe, and I think that safety was prioritized in our parents’ generation. I think the context has changed for our generation. Our parents, in their hard work, set us up to be able to receive the benefits or the gifts of their hard work. That is in our ability to choose for ourselves and to also to prioritize values that may not have been something that they necessarily focused on, such as mission, purpose, meaning, or impact in our work.

What is the significance of the book’s title?

I knew the title of this book before I even wrote the book. I see it as two parts: the first is within Asian culture, we’ve talked about that deference to elders, that wanting to honor and respect the older generation. Throughout my childhood and into adulthood, I was always looking outward and seeking permission; I was constantly wondering, “What should I do next? What would be the appropriate decision? What is the right thing to do?”

I was always thinking to myself that I needed to ask others for permission to make different decisions in my life. Over the years, and through my own work in journeying with clients, I realized that one of the things that may support our mental health is realizing that we can claim permission over many different spaces, that we are allowed to have an opinion, that we are allowed to have agency in our lives. Permission is rooted in this idea that perhaps we can offer ourselves permission to focus on the things that we care about, to live through the values that we uphold, and to choose with intentionality about the lives we want to build.

Secondly, there is this idea of coming home as an Asian immigrant. I have always felt like I live in this in-between space. When I go back to Taiwan, I’m too American; I’m too Western. When I’m here in the United States, I’m seen as sometimes other; I don’t belong; I’m foreign. As an immigrant, it can feel as though we live in this in-between and don’t have a home. There is no land or space that is a homecoming for us. I wanted to focus the book on this idea that perhaps, as Asian Americans, home is a place or condition that we must build for ourselves, individually as well as communally.

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