State of Mind

Our Asian American Elders Are Crying Out for Help. Here’s What We Can Do.

The back-to-back shootings send a clear message.

A man with greying hair on a black background, his back to the camera and hands in his pockets.
Photo illustration by Slate. Photo by glowonconcept/iStock/Getty Images Plus. 

Welcome to State of Mind, a new section from Slate and Arizona State University dedicated to exploring mental health. Follow us on Twitter.

I met Mr. Lee, a kind Korean-American senior who reminded me of my own late grandfather, at a practicum site for my master’s degree in social work, St. Barnabas Senior Center in L.A.’s Koreatown. Born in 1936 in Japanese-occupied Korea, Mr. Lee eventually made his way to America in 2005, after surviving colonization, wars, famine, poverty, the constant fear of imminent danger, and rapid industrialization. He hopes to live until age 120 and to continue to volunteer at the senior center, making wellness calls to other Korean seniors in the area.

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Mr. Lee is an example of an Asian American senior who has a lengthy trauma history, but who is also resilient and well adjusted thanks to his social support and purpose-driven life.  He is in constant contact with his community and with people who speak his language. He feels connected and valued, and belongs to something greater than himself.

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However, the same cannot be said for all elderly Asian Americans. Mr. Lee is lucky—he lives with his wife in one of the coveted affordable senior apartments in K-town, within walking distance of the senior center and his church. In K-town, home of the largest population of Koreans outside of Korea, he can get by without knowing a lick of English, which is a protective factor since humans are social creatures and biologically wired to connect.

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But for many older immigrants in the sprawling abyss that is America, this basic need goes unmet. The luckier ones are in senior housing in neighborhoods like K-town, Chinatown, and Little Tokyo, where they have access to social services, case managers, and therapists who can provide in-home services. Some are out in the suburbs, living with their families. The loneliest, most vulnerable elderly Asian Americans are off by themselves in faraway places like Hemet, California, a small town approximately 80 miles southeast of Los Angeles with a population of 89,833, of which 0.03 percent identify as Asian, according to the 2020 U.S. Census. Here, elderly people live alone—a stark contrast to the multigenerational homes of the motherland. It was here that Huu Can Tran lived, by himself.

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During my internship at St. Barnabas Senior Center, I conducted home visits and assessed senior citizens who lived alone for signs of elder abuse and mental health issues, and linked them to appropriate services. Most of them were happy and excited to finally talk to someone and to have someone hear them, a reprieve from feeling ignored and unimportant—which are common symptoms of depression and post-traumatic stress disorder that can lead to more severe mental health issues. Furthermore, research has shown that a combination of social isolation, physical illnesses, sensory deficits, cognitive changes, medications, age-related deterioration of the brain, and neurochemical changes, may increase the likelihood of developing psychosis, and a person’s susceptibility to violence. Recently, Asian American seniors have faced the additional challenge of being targeted for anti-Asian hate crimes spurred by the start of the pandemic—and the lockdown and stay at home orders didn’t help, either.  Moreover, one in 10 older Americans has experienced some form of elder abuse, with social isolation and mental impairment being risk factors.

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Unfortunately, the inherent patriarchal and collective values of Asian cultures exacerbate this problem: In 2020, 58 percent of homicides of AAPI women were related to intimate partner violence. In a 2001 study, 14.3 percent of Chinese adults, 22.8 percent of Koreans, 22.4 percent of Cambodians, and 54.2 percent of Vietnamese adults stated that they believe that a husband should have the right to discipline his wife. Furthermore, Asian Americans are three times less likely than their white peers to seek therapy due to shame and stigma, and often choose to suffer in silence, unintentionally normalizing abuse and violence instead.

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This is because immigrants are often culturally frozen in time. While the rest of the home and host countries socially, culturally, and ideologically evolve over the years, the immigrant remains stuck in that point in time and space in which they left due to social isolation and lack of access to people they can grow with and learn from in their own language and culture. When Asian American elders continue to feel misunderstood and unheard, this reinforces negative core beliefs instilled by American society due to racism and ageism, rendering them more vulnerable to mental disorders like depression and anxiety.

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This is why access and awareness of culturally sensitive mental health resources is so important. In my next practicum site during my masters training, I provided therapy in English and Korean at Asian Pacific Counseling and Treatment Center, an agency contracted by Los Angeles County that provides intensive outpatient and field based mental health services to Asian American individuals and families of all ages, who struggle with a range of mood disorders, personality disorders, and severe mental health issues. APCTC provides culturally sensitive therapy, medication support, and case management services in English, Korean, Mandarin, Cantonese, Vietnamese, Tagalog, Japanese, Spanish, and more. At APCTC, mental health and wellness, community, and social connection are celebrated and not ignored.

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Los Angeles County residents can obtain these services through the area’s mental health department, the largest mental health department in the country that accepts Medi-cal/Medicare.  Since all seniors age 65 and above qualify for Medicare in California, Asian American elders can obtain these services free of charge. Culturally sensitive mental health services can be searched by language on the Department of Mental Health’s Provider Directory.

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However, there is still a big barrier for Asian American elders seeking mental health services: the shame and stigma of asking for help, the susceptibility to which is a common trauma response. Instead of seeking out services, they hold shame in until they can’t anymore and their mental and emotional anguish manifests as hypervigilance, anxiety, depression, personality disorders, psychosis, or even murderous rage.

Chunli Zhao admitted during a jailhouse interview that he believes he suffers from some sort of mental illness and wasn’t in his right mind the day of the Half Moon Bay shooting. Zhao lived on the mushroom farm he was working at, in deplorable conditions, according to San Mateo County officials. Even if he wanted to get help, finding it would be a challenge—maybe impossible. Half Moon Bay, a population of 11,795, located approximately 30 miles south of San Francisco is predominantly white and Hispanic, with Asians making up only 0.06 percent of the population. Christopher King, nurse practitioner at the county health department, told the Washington Post that, “Due to language and cultural barriers, [the Mandarin-speaking farmworkers] are probably more removed from the ability to access health care than our Spanish-speaking population.” Most people who need help do not kill people, but they might perpetuate smaller acts of violence—and, of course, they are living in pain themselves.

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This is where we, their children and grandchildren, need to step in. Societal change starts with us. I’ve been a psychotherapist for five years and specialize in working with Asian Americans. Almost all of my Asian clients who are in their 20s to 40s hide that they’re in therapy from their parents and families. How can we expect older generations to embrace therapy when we are too ashamed to expose our own vulnerabilities?

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We can stop these intergenerational cycles of trauma by doing the work ourselves and encouraging our elders to process their trauma by learning tools to regulate their emotions, talk about their feelings, ground themselves, and cultivate positive coping skills in therapy.  We can ease our parents and older generations into it by sharing our own experiences with therapy and by leading by example.

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Although we can’t force people to go to therapy, we can show our loved ones how much it has helped us by demonstrating skills learned in therapy and this might plant the seed that it might help them too. I’ve also asked my parents to join me in my own individual therapy and later in family therapy to get their feet wet and show them that communicating and confronting difficult emotions—something Asian Americans are notorious for avoiding—is not only doable but also cathartic. My 62-year-old immigrant mother and I are currently in family therapy together, and in a way it feels like I tricked her into finally doing the work. Our Korean American therapist and I take turns, in Korean, empowering her to advocate for herself and put an end to archaic patriarchal customs that have the potential to get abusive if not checked.

The back to back shootings in California illustrated a clear message—our Asian American elders are crying out for help, and we’re the only ones that can hear and see them. We come from collective cultures, and we need to heal collectively. And, after a lifetime of living in survival mode, we all deserve some rest.

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