Tackling the Taboo

In the 11th-floor radio broadcast studio, with the glimmering lights of the Southwest Freeway before her, psychotherapist Hanh Vo adjusts her headphones. Twice a month she discusses mental health issues on Voice of Vietnam. Leaning forward into the microphone, she urges listeners to call in with problems and questions.

Five minutes pass. Then ten. Another five. Finally, a single button on the phone lights up.

By the end of her one-hour show, only two people have called in. One asks what causes depression; another where to get help. In spite of the low response, Vo knows listeners are out there, that they may feel too embarrassed to speak on the air, but that they are tuning in. Voice of Vietnam, on KENR (1070 AM), reaches over 120,000 Vietnamese-Americans from Beaumont to Port Arthur.

Across town on Friday mornings, Tammy Tran also talks about mental well-being, on Radio Bolsa, broadcast on KGOL (1180 AM). Tran is not a therapist, but an attorney. Personal grief -- the loss of her husband to liver cancer -- prompted her to bring a message of overcoming suffering nearly a year ago.

"Vietnamese people keep everything inside," she says. "For a year I was depressed, but I didn't talk about it very much. We just keep it inside. We don't seek help."

Often assumed to be economically well-off with strong family bonds, many Asian-Americans hail from war-torn countries like Vietnam and Cambodia, where they lived through genocide and loss of family. Resettled in a different country, the immigrants must create new identities while adjusting to western society and its values, often the opposite of eastern ones.

The situation is ripe for psychological problems, yet culturally sensitive services that provide counseling for people in their own language are severely lacking, even in an international city like Houston. For many Asian-Americans, getting help never happens, in spite of alarming indicators.

According to the National Center for Health Statistics, segments within the Asian-American community have high suicide rates, and in the case of the elderly, the highest. The National Research Center on Asian American Mental Health found that Asian-American women between the ages of 15 and 24 have the second-highest suicide rate, after Native American women.

Yet mental illness remains a taboo topic among many Asian immigrants who come from countries where the field of psychiatry doesn't exist and emotional problems are considered a sign of weakness.

Tellingly, there are no words for "psychological" or "psychiatric" in Vietnamese. On the air one night, among the constant lull of Vietnamese, Vo resorts to a few English terms: depression, psychological condition, psychiatric diagnosis, schizophrenia, bipolar.

"Everything is just summed up in one word: crazy," Vo says. "Sometimes I make up terms."

Psychotherapist Dorothy Wong says, "They feel like it is a matter of will. Don't dwell on it, or it will get worse.And you don't talk about your family things. Asians don't believe in happiness. It's not that they don't want to be happy, but as long as you have no problems, you're supposed to be okay."

Hanh Vo, who speaks in a soft, measured way, studied psychology after her own bout with depression. One day she woke up with a devastating headache that lasted nearly two years and forced her to drop out of college. Retreating to an aunt's house, Vo realized her physical pain stemmed from trauma she thought she had buried.

Vo had fled Vietnam with her family when she was 12. Her parents had not told the children about the escape plans, drugging them instead. Waking up in the middle of the ocean on a small boat, Vo realized they had left her grandmother behind, never to see her again.

Studying psychology and undergoing therapy herself, Vo found her personal belief system clashed against the western concepts she learned in school.

"I came to an integration of the two, and that's when my pain was relieved," she says. "My pain was like a symbol of the acculturation conflict. I have to find my own peace before I can offer it to anyone else."

She now practices this amalgamation of ideas with her Asian patients, even American-born ones.

"If you use westernized concepts with Asian people, it doesn't work. The client will fly out the door," Vo says. "For western people, the goal is to become individualized from the group and to become a unique self. And that's very incongruent with the eastern belief that we have to sacrifice ourselves for other people."

Until March, Vo headed the Southeast Asian Mental Health Services program at DePelchin, one of Houston's largest mental health providers for children. DePelchin terminated the program amid community protests, claiming the nine-year-old program was not large enough to warrant a full-time counselor, even while acknowledging that that population is underserved.

Vo says DePelchin played number games, pressuring her to see more clients while not understanding why she took extra time with them. Refugees, she says, need to fulfill basic needs first, like jobs and housing, before emotional ones.

"They wanted to sell the concept of middle-class psychotherapy to Asian people," she says. "But Asians don't come in automatically and talk to us. You have to earn their trust.I guess DePelchin does not have the patience to work with Asian people."

DePelchin now contracts with the Asian American Family Counseling Center, which Vo joined. Formed in 1995 by a handful of Asian-American mental health professionals in Houston, it is the only nonprofit that specifically serves that population. Employees like Vo make rounds on radio and television shows and in temples and schools to publicize mental health issues. The agency also offers internships and programs to educate non-Asian mental health workers. After initially providing only screening and referrals, AAFCC received enough funding last year to hire two part-time counselors to treat clients on a sliding scale.

Even so, coaxing people to come in has proved difficult.

Among the agency's clients are a Korean girl who was raped just two weeks after arriving in Houston, a Cambodian teen who tried to hang himself, a Chinese woman whose husband has beaten her ever since she joined him in America three months ago, and many Vietnamese refugees.

"I think my work is fixing the damage of a 30-year war," Vo says.

Mr. and Mrs. Le were at their wits' end. For years their 14-year-old grandson had been misbehaving. He talked back to teachers. He ran away. He stole from his classmates. The boy often filched items only to toss them in the trash can later. Then he was arrested for shoplifting. Twice.

Where are his parents? the cops wanted to know.

"She in Vietnam," Mr. Le said. "No father."

Le, his wife and grandson immigrated from Vietnam in 1991. The young boy picked up English quickly, but the language eluded his grandparents. Le explains in hesitating, broken English that since age nine, the boy has spiraled increasingly out of control. Something was wrong.

"His head not good," says Le, who would give only his last name.

Last year Le tried to find treatment for his grandson.

"But I don't know where," Le says. "I cannot speak English well."

The elderly man went to the Mental Health Mental Retardation Authority of Harris County, but the agency takes only severe cases, so it referred him to other counselors. Le sometimes lacked transportation to make appointments. He signed papers he didn't understand.

Although the teen returned for visits at a few agencies, Le says no one ever explained to him what exactly was wrong with the boy. Not until a friend recommended Hanh Vo. The problem: kleptomania.

"Can you imagine the frustration?" Vo asks. "They cannot control him at home. And he is put in a position where he ends up translating for the grandparents. That gives the child a lot of power. And who knows what he is translating."

Now on medication, the boy has improved some and attends a court-ordered discipline school. Le now shares Vo's goal of educating this immigrant community. If Asian-Americans don't help themselves, who will?

"We need to have Asian counselors," Le says repeatedly. "We need to have Asian organization. We need it for our children."

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