When Dr. Yuanxia Zhang opened his office two years ago in Flushing, New York, he dreamed of becoming a successful psychologist for the Chinese community. But while a very harsh New York winter, the war with Iraq and the spreading of the SARS disease brought many gloomy faces to the streets of Chinatown, and the temples, churches, even the voodoo priests all found themselves more popular than ever, Dr. Zhang’s office is still as empty as it was.
It’s not because Dr. Zhang isn’t known. Since he opened his office, the Shanghai-born and partly U.S.-trained Dr. Zhang has done about 30 workshops at Flushing Library to raise awareness about mental health and the need for psychological counseling among Chinese people. The workshops were very popular, with dozens attending each. Dr. Zhang has therefore become a celebrity in the community.
However, it didn’t transfer into turnout in his office. Indeed he has been serving only about 10 patients each month, and most only came to see him because their companies required them to get general health counseling. They would do the minimum number of visits demanded by companies and never return. As a result, Zhang cut his working time in the Flushing office from six days a week to only one and a half days. During the rest of the week, he has to work “part-time” for a counseling clinic in another part of New York, where there are few Chinese residents. “SARS, war, whatever, even if the sky collapsed, Chinese immigrants just won’t come to see psychologists,” said Dr. Zhang.
It is not because Chinese people never need a psychologist. Although there are few statistics available, some psychologists believe Chinese immigrants encounter more pressures which could cause mental health problems than many other immigrant groups. “Besides the language barrier and cultural shock, Chinese immigrants face the loss of social relationships which they have been used to rely on to solve conflicts,” said Dr. Qiuxia Lan, a psychologist of the Asian-American Family Clinic at Zucker Hillside Hospital in Queens, New York. For example, Dr. Lan said in China when a couple argued with each other, the wife often would be go to her parents home and then return having received their advice on how to sort out the problems. But for many Chinese immigrants in the United States, this isn’t an option. Their parents are many thousands of miles away. Still, they are not ready to get outsiders’ advice, such as therapists, to make up for the loss of their social network. When Chinese people get psychological problems, “the psychologist will always be the last one in the world they would turn to seek to help,” said Dr, Lan.
“A large percentage of Chinese immigrants only believe in medication. They believe illness is biologically caused. Talking about psychological therapy is alien to them,” said Paul Yew, the director of the Chinese Family Consultation Center of the Hamilton Madison House, a social services organization for immigrants. Yew has worked with the program, the first licensed mental health program for Chinese immigrants in New York City, since it was set up in 1971. The CFCC has helped thousands of clients in the past 32 years. However, most of them are referrals by hospitals. “If they only feel stressful or depressed, they would just tolerate it and wait for a long time, until some day they lose control, physically break down and end up in a hospital,” said Yew.
When Chinese immigrants turn to the psychologist’s office, they tend to have been suffering a long time, and the mental health problems have become so acute that they have caused physical ailments. Unlike her Western patients, who can usually tell her their psychological symptoms, most of Dr. Lan’s Chinese clients complain first of headache, stomachache or dizzy spells. “They tell me they have tried various treatments including Chinese herbs or acupuncture but it didn’t get any better. As the last resort, they come to the psychologist. So I have to double check to make sure that their physical illness is actually caused by psychological problems,” said Dr. Lan. “I have to spend twice as long with a Chinese patient than I do with a Westerner.”
And that doesn’t include the time she has to spend on educating the patients’ families. “It is hard to get the family members to believe that a patient doesn’t like to go to work because of depression, not laziness,” said Dr. Lan. “Because depression is always thought of as the same as unhappiness in Chinese. Nobody thinks unhappiness could be an excuse for not going to work.”
And there are stigma issues too. “Stigma of mental illness is much deeper among Chinese people than Westerners,” said Yew of Hamilton Madison House. “When Chinese get mental problems, they will try their best to hide it from others, for fear of being laughed at or singled out.” After September 11, the Hamilton Madison House and Project Liberty held three group healing programs in Manhattan Chinatown so that the residents who live just one mile from the World Trade Center could get together and comfort one another. To their disappointment, not a single person showed up. “We realized later that people don’t like the word ‘healing,’” said Yew. “To them, attending a group healing is to announce they have a mental problem to the world.”
The attitude of the community toward mental illness is illustrated by the difficulty some social services organizations have in getting volunteers. Although its patients have increased to 20 now, from one or two when it opened in 1982, the staff of Chinese Continuing Day Treatment program in Manhattan’s Lower East Side Service Center Mental Health Clinic are still only two. The two have to not only be nurses, but they have to organize professional skill training, English classes and other day time activities as well. “We desperately need some volunteers to help,” said Rutian Lai, the director of the program. “But when people know that we serve the mentally ill, they just turn their backs on us. Many people think mental ill patients are all violent and can hurt them. But that’s not true.”
Some counseling program finds their niche in the community by providing confidential phone advice. Asian LifeNet, the only licensed phone counseling service for Asian people in New York City, received 300 phone calls through its hotline in March when SARS started spreading across the world, a 50 percent increase from its January record. “Phone counseling avoids the pressure of facing a counselor, so it is more easily
accepted by the community,” said Tracy Luo, the coordinator of the Asian LifeNet. “Even over the phone, many clients still claim they are calling on behalf of their friends. But at least this is a first step.”
However, the distance from the first step to the second is long enough to frustrate psychologists. The Asian LifeNet refers people with severe symptoms to professional psychologists who provide treatment to Asian patients. Dr. Lan and Dr. Zhang are among the approximately 20 licensed psychologists listed by Asian LifeNet for the 800,000 Aisan people in New York. Nationwide, the number of Asian psychologists for every 100,000 Asian and Pacific Islanders is 70, compared to 173 for whites, according to the U.S. Department of Health and Human Services.
“There is too much work to do to cultivate Asian patients. Fortunately, I work for the hospital. There is no incentive to open my own office,” said Dr. Lan. “You cannot make a living on that.”
For Dr. Zhang the social makeup of U.S. Chinatown is also a problem. “You definitely need a middle class social layer for the psychological counseling profession,” said Dr. Zhang. “You can’t find this layer in Chinese immigrants in New York.” Dr. Zhang explains, even when people earn $80,000 per year, they still don’t have the feeling of settling down in America. “They have too many things to worry about, status, job, kids and future. They won’t have spare time and money to think about their mental health,” said Dr. Zhang. Even if he only charges $35 per hour in New York, much lower than the $100 or more average price, Dr. Zhang’s business is not as good as that of his former classmates, who charge about the same price in Shanghai.
Indeed, Zhang finds there is much better opportunity in China’s major cities, where there is a burgeoning middle class who are ready to try new things. “When I left Shanghai and came to America six years ago, I thought the concept of psychological treatment was more accepted by Chinese immigrants here, because they had been exposed in the modern atmosphere in America for a while. But it seems my hometown provide more opportunities now,” said Dr. Zhang, who has decided to close his New York office and go back to China in one or two years.
This article was written as part of the Ethnic Press Fellowship of the Independent Press Association-New York.
