What's your struggle?
Mental health advocates often encourage us to seek help when facing emotional struggles. This help-seeking can be either informal or formal, personal or professional.
Regardless of what form it takes, the ability to ask for help predicts mental and emotional wellbeing. However, many mental health advocates don’t consider cultural differences when suggesting that people “just reach out.” Often, ingrained cultural values impact whether or not we seek help from others.
Few cultures normalize mental health discussions, but this article centers around stigma in the Pinoy community. Among Filipino Americans, model minority pressure drives mental health struggles, while stigma prevents help-seeking. Why is it so easy to feel scorned for reaching out?
In the course of exploring this question, I had the pleasure of interviewing the following Filipino mental health experts. Their insights are included throughout this article, but a brief introduction to both of their work is provided here.
Josie Abuan, School Counselor
Josie completed her masters in community counseling, specializing in school counseling at the University of Hawai’i at Manoa. Josie has been a school counselor for 37 years. She has practiced in Hawaii and the Pacific Northwest, working on drug and teen pregnancy prevention, and crisis counseling.
You can find Ms. Abuan here.
Elaika Janin Celemen, Research Assistant
Elaika is a University of Portland alumni with a Bachelor of Arts in Psychology and a minor in Neuroscience. She has researched healthcare access with UC Davis, presented at the Bulosan Center Conference, researched transgender relationship dynamics with SFSU, and is now working on a manuscript concerning Filipino care workers during the COVID-19 pandemic. She plans on attending grad school for public health.
She can be found here, and her first published article can be found here.
Ruth Christine Dimagmaliw, LMFT, Dr. Therapinay Community Engagement Associate
Ruth is a Licensed Marriage and Family Therapist, and represents Dr. Therapinay in community events. She works in school-based counseling systems and facilitates workshops and community needs. You can find Ruth on Instagram @ruthiedlmft.
As an organization, Dr. Therapinay’s mission is to build Filipinx resiliency through connection, kapwa, and collective care. They strive to create a wellness space that is the simplest, safest way to connect with culturally responsive, local healers. Their focus is on mental health, colonization, our culture, and the stigma around it.
You can read more about Dr. Therapinay on their website, and find them on Instagram @therapinxy and @the.drtherapinay.
What factors impact help-seeking behavior?
Filipinos’ cultural values often impact their comfort with seeking help. Filipinos rely more on their kapwa (“neighbor”) rather than ibang-tao (“other people”). Filipinos’ collectivistic culture prizes social support.
Ruth Dimagmaliw, LMFT speaks to this truth, saying: “Kapwa is like being one, or having some type of shared experience with another. It comes with a lot of empathy and experience.”
Filipinos may feel more comfortable disclosing their mental health within their own social circles, rather than seeking professional medical help. Alternatively, they may avoid discussing these issues with those they know, avoiding hiya (“shame”).
“Historically, people in our community would rather go to their preferential support, talking to friends, relatives, priests at their church or traditional spiritualists and herbalists,” Ruth explains. “They go to these other people rather than going to a mental health professional.”
Tradition and misunderstanding
Research Assistant Elaika Janin Celemen has researched the help-seeking behavior of Filipino caregivers and has noted that these caregivers don’t often recognize their own need for mental health care. “Mental health is a different definition, a different nuance for them,” Elaika explains. “But the participants do display signs of stress, fatigue, and exhaustion.”
LMFT Ruth Christine Dimagmaliw also cites a lack of cultural responsiveness to the prevalence of mental health issues within the Pinoy community. People don’t seek help, if they don’t know it would help them: “In my experience, there are people that assume I only work with a certain population of people, those that seriously suffer from a mental illness, who are labeled as “crazy.””
Many Filipinos fear the implications of needing help, due to a misunderstanding that you either have serious mental health issues, or you have none. This concern relates to a fear of social rejection.
Collectivism: good and bad for mental health
Social rejection may feel like such a huge risk among Filipino Americans due to collectivism.
Social support, a beneficial coping resources, is already a facet of Filipinos’ collectivistic culture. Because collectivism emphasizes group settings and relationships, it can help foster mental wellness.
Filipino culture plays an important part for one’s identity. A study conducted in the Philippines found that those who experienced mental health-based discrimination coped best through Bayanihan, or community unity. Community members donated food and free housing, and this helped immensely. Filipinos felt valued as community members.
However, in collective communities, those who seek help may worry about judgement, stigma, and losing their social position. Feeling unable to ask for help without creating more suffering leaves people in a bind.
As a result of collectivism, there are two types of stigma that Filipinos may encounter. Social stigma is the fear that society will negatively perceive you. This can lead to discrimination or social rejection.
And as a result of social stigma, self-stigma festers. This means that a Filipino individual develops a strong sense of shame and self-blame when asking for support. They may see their struggles as a sign of weakness that can cost them social support.
Pinoy culture’s collectivist mindset holds both the stigma and the solution. However, societal pressures from outside the culture may exacerbate the impact of some Filipinos’ reluctance to seek support.
How Western prejudice increases the need for mental health support
Asian Americans are known to be viewed as a “model minority,” defined as the more well-educated and career-driven of the United States’ marginalized groups. Despite this seemingly “positive” stereotype, Asian American mental health suffers.
School counselor Josie Abuan discusses her own experience with this: “You have to prove your credibility more,” Ms. Abuan explained. “You feel like you always have to prove yourself, that you know your stuff.”
In a similar vein, Filipinos face specific racial expectations, often praised for being masipag (“hardworking”) and for their quick adaptability. However, it’s not always good to be seen as hardworking. Others may sometimes use these traits as an excuse for exploiting or mistreating Filipinos.
With the recent hate crimes against Asian-Americans amidst the COVID-19 pandemic, the model minority myth has prevented impacted individuals from seeking vital support. The perception of Asian-Americans as successful can easily become a perception that Asian-Americans have nothing to complain about. Josie recounts: “Some [people] say ‘Oh, Asian students feel that way? They don’t show it. I mean, they’re doing good in school, right?'”
Because of this attitude, Josie explains, many Asian students feel that their experience and safety isn’t validated or worthy of being prioritized.
Ruth adds that the impact this has on mental health is tangible: “We have this perception of how we ask for help, and how we work, and how we should be successful, and a lot of that cultural stuff impacts our help-seeking behavior. What does that mean when we’ve been colonized for so long, when these unrealistic values have been thrust upon us?” she questioned.
This cultural identity and the unrealistic mental health standards we have for ourselves connect to a long history of colonization.
Colonial mentality
Colonial mentality is “internalized colonialism.” This mentality perpetuates the belief that Western culture is superior to Filipino culture. Spain, Japan, and the U.S. have colonized the Philippines. These countries’ values greatly impacted the existing Filipino culture.
Colonial mentality is this history, persisting. Many Filipinos have effectively internalized this. As a result, many dismiss their culture and their unique identity.
This only further disconnects them from their own mind and their own mental wellness.
Some signs of internalized colonial mentality are:
- Feeling inferior
- Discriminating less-westernized Filipinos (i.e. making fun of their accent)
- Desiring more European features (e.g. lighter skin, a bridged nose)
- Tolerating or denying oppression against Filipinos
Colonial mentality also:
- Lowers self-esteem
- Lowers life satisfaction
- Heightens depression and anxiety symptoms
Colonial mentality can be isolating. It can impact the collectivist culture that many Filipinos rely on. Consequently, Filipinos may adhere strongly to an isolating obsession to be accepted by a culture that sought to erase them.
“There’s a lot of intergenerational trauma involved there, too,” Elaika says. “Of course colonization and immigration would impact mental health!”
Western and Filipino cultures blend together due to their history of colonization: these cultures both contribute to help-seeking behavior. Cultural stigma doesn’t allow the prioritization of emotional health. However, Western values make Filipinos feel even less safe disclosing their emotions to their family and friends, and this further isolates them.
How can Filipinos ask for emotional help, without exacerbating negative feelings?
Seeking help requires consideration of these cultural and societal barriers. The solution isn’t to simply push through these barriers, but consider them during the process.
Develop trust
School counselor Ms. Abuan notes that Filipinos have actually trusted her more because she is also Filipino.
“Parents trust me because I can speak Ilocano, and they can communicate with me,” she says. “That helps to develop a relationship.”
Another aspect of trust is knowing when you can really let your guard down. “This might need to be a continuous conversation,” LMFT Ruth adds. “Mental health professionals are meant to be neutral people in your lives. We don’t know your circle personally, so we can be that compassionate person and learn to get to know you for who you are.”
Decolonize your mind
“Recognizing that we’ve been colonized, that’s hard to deny,” Ruth says. “There have been hundreds of years of colonization, and unpacking that impact in our culture [is important.]”
Mental decolonization can include reflecting on how colonial mentality has impacted your mental health, building collective strength, and learning more about your Filipino culture. This isn’t an easy process, but it isn’t impossible.
Elaika explains that community-wide education and decolonization is a good first step to destigmatizing help-seeking. “If there are resources available, especially culturally-competent care, anywhere is a good starting point,” she said.
Elaika also suggests finding an organization that connects you with other mental health services. The organization Dr. Therapinay specializes in this work, connecting individuals to community resources.
Dr. Therapinay also focuses on mental health and generational wellness. Ruth responded that these goals can be fostered through awareness.
“It’s about increasing awareness for how we heal, and what wounds you notice in yourself. Notice how you are passing those healing practices to the next generation, or even in your current generation, with your parents.”
Practice empathy for yourself and others
Generations of Filipino immigrants can greatly differ, school counselor Ms. Abuan says.
“You really have to educate [families] on what mental health is for first-generation immigrants,” Ms. Abuan told me. “It’s not because they don’t believe in getting help for their child… You have to develop a relationship to help them understand.”
She explained, “You have to be careful not to point the finger at them, because then they will think it’s their fault, that they aren’t doing enough as a parent.”
LMFT Ruth cited similar advice, referencing Dr. Therapinay’s training.
“A lot of our training is based on being non-judgemental. We all have different stories, we’ve all made mistakes, but we need to keep an open mind,” she said.
“It’s always going to be an ongoing conversation,” Ruth said. “Mental health impacts all walks of life, no matter who you are.”