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Caught Between Two Cultures

Efforts to reach Asian students with culturally appropriate mental health services are paying off.


In many ways, Asian students at Cornell University seem like a successful group. At the competitive Ivy League school, they make up about 17 percent of the student body — by far the school’s largest minority.

But the stereotype of Asians as brainy, quiet “model minorities” helps hide serious problems. Of the 14 suicides between 1997 and 2007, eight were students of Asian descent. In anonymous health surveys, Asians were more likely than White students to say they had difficulties with stress, sleep and feelings of hopelessness — and yet they were less likely to seek counseling.

White students may wrestle with the same problems, but tend to get help or be helped sooner, says Dr. Wai-Kwong Wong, a counselor at Cornell’s Gannett Health Services.

“To a large extent, it’s not just a mental health issue; it’s a community issue,” Wong says. “A lot of the issues that students were presented with have to do with their environment and their sense of community or lack thereof.”

Cornell officials were jolted into action after a university-sponsored report in 2004 detailed the sense of isolation and dissatisfaction among Asian American and international Asian students. Four of the 25 counselors or therapists at the student health center are now of Asian descent, compared to just one previously. Counselors have expanded outreach efforts to include walk-in hours at various campus sites rather than simply waiting for students to make appointments. And this fall, the university plans to hire an assistant dean of students who will focus on working with Asian students.

Breaking Through Cultural Barriers

Cornell has been unique in publicizing statistics such as the number of suicides, but other universities have also recognized the need to diversify their counseling staff and expand outreach efforts. Last year, the University of California-Davis launched the Asian American Center on Disparities Research, which focuses on mental health issues. The center, funded by a $3.9 million grant from the National Institute of Mental Health, coordinates research from 18 universities.

College can be a tough time for any student, regardless of ethnicity. But many Asians face particular stresses as they are caught between two cultures, according to Dr. Nolan Zane, director of the UC-Davis center.

Asians are expected by mainstream society to do well. And if they’re from an immigrant family, the expectations are even higher. Students may feel pressured into “safe” career paths like medicine or law.

“In immigrant families, the children essentially upgrade the status of the family and usually it’s through educational means,” says Zane, who is also a professor in the psychology and Asian American studies programs at UC-Davis. The same issues are seen among international students from Asia.

When problems such as social anxiety and depression arise, cultural barriers prevent many from seeking help. Talking about problems to outsiders is considered taboo and shameful. Getting help from family often isn’t an option either. Many Asians attach a strong stigma to mental health problems or simply deny their existence.

Zane recalls that the parents of a Chinese American student couldn’t understand why he recommended that their son get counseling. The parents thought their distraught son, whose grades were slipping, just needed to study harder. “Even for the ones getting into treatment, there are higher rates of dropping out [of therapy],” Zane says. “Counselors need to try to determine what kinds of cultural factors get in the way of appropriate care.”

Dr. Henry Chung, associate vice president for student health at New York University, says that outreach to Asians is harder also because they tend to not be identified as “problem” students.

“People who have disruptive behavior are more likely to be identified and receive help,” says Chung, a psychiatrist. “Asian people tend not to be disruptive. The culture is so enforcing and all encompassing about how you express your emotions in public settings. There’s a lot going on under the radar screen.”

Two years ago, Chung designed a study at NYU and seven other universities that required student health centers to screen every visitor for depression, regardless of the reason for the visit. According to Chung, most people are more willing to go to a primary health clinic than to a place that is designated for mental health services.

In several of the schools, the number of Asian students screened and helped was proportional to their population on campus. The result was encouraging, Chung says, because usually Asian students won’t seek help until their problem becomes an emergency.

“If we are going to do anything from a public health standpoint, we need to detect problems earlier,” Chung says. This summer, Chung began expanding his project to 30 campuses.

Erasing the Stigma

At Cornell, the efforts that started four years ago are starting to yield results. From the time he was a freshman until he graduated in May, Timothy Chow witnessed a dramatic change in awareness about mental health issues among his fellow Asian classmates.

In response to the university report on Asian students, Chow and several friends organized a group to advocate for changes. At the initial meetings, fewer than 10 students expressed interest. Chow says that many students likely shied away because they didn’t want to be associated with mental health issues.

But this past school year, two events on stress relief sponsored by the Asian/Asian-American Forum attracted more than 100 people each. The fairs featured massage therapists, yoga sessions and presentations from a nutritionist and counselors.

“We didn’t want to be really preachy to students and say if you’re sad and depressed, come here,” says Chow, who is now working in New York at a health care union. “We didn’t want to make our community feel targeted in any singular way. We talked more about prevention, that the environment of stress is there and this is how you prevent yourself from being stressed.”

Outreach efforts from Cornell’s counselors also seem to be attracting students who have shunned traditional counseling services, according to Wong, of the health services center. Preliminary statistics show that about 13 percent of those who use the informal walk-in counseling sites are Asian American and 17 percent are international students (most of them from Asia). The numbers of those who come into the clinic are lower: 9 percent are Asian Americans and 10 percent are international students.

But the good news about mental health awareness is also leading to other concerns.

Bhavna Devani, a graduate student in political science, says that Asian American issues are at risk of becoming synonymous with mental health issues. She feels that university officials are dragging their feet on creating an Asian/Asian American community center because so much progress has been made on mental health awareness. Both recommendations on improvements in counseling and creating a community center were part of the 2004 university report on Asian students.

Devani, a member of the community center committee, says the goals of a center are to help forge identity and social consciousness — not simply mental health. “When we make mental health synonymous with integration, we risk painting all Asians and Asian Americans at Cornell as somehow lacking in mental health,” Devani says.

In April, a student wrote a posting on a Cornell news blog joking that an Asian center would be built next to the library. Such a location, he wrote, would help prevent studious Asians from committing suicide.

The posting was written after the school administration officially approved support for a center. After the blog was overwhelmed with protests, the writer issued an apology.

Wong says he has feared such stereotyping of Asian students particularly after last year’s shooting at Virginia Tech. Seung-Hui Cho, a Korean American student, killed 32 people before committing suicide in the deadliest campus shooting rampage by a gunman in U.S. history.

“Mainly we want people to see that Asian and Asian Americans are like anybody else,” Wong says. “They’re not perfect like the model minority myth nor are they all time bombs waiting to explode. We have to try to find that balance.”  

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