Even as the treatment of student mental health and wellness continues to evolve at Stanford, for many communities on campus such dialogue goes beyond the typical referral to Counseling and Psychological Services (CAPS) or The Bridge Peer Counseling Center. For populations such as the Asian-American and Native American communities, issues surrounding mental health may be steeped in cultural stigmas and influences, coloring the ways in which psychological health is addressed.

A code of silence

As a Vietnamese-American born to immigrant parents, James Huynh ‘15 said that he perceives a code of silence within the Asian-American community surrounding the issue of mental health.

“The big cultural stigma, for me at least, is that we often sweep mental health under the rug,” he explained. “We don’t see it as something as serious as physical health. If a family has someone who’s suffering from depression or other mental health illnesses, they try to keep that hidden.”

Huynh, who recently started using CAPS after a buildup of stress became too overwhelming, admitted his own tendencies to place his mental health on the backburner, brushing off feelings of sadness and stress with an ‘I’ll just deal with it, handle it and move on’ mentality.

“I didn’t really recognize my own needs,” he said.

According to Huynh, his background as a Vietnamese-American generates internalized pressure to keep it together in order to eventually get a good job and support his immigrant family. Because of this, he said, he doesn’t want to slow down.

When asked if his parents know that he is using CAPS, Huynh said that it never occurred to him to tell them.

“I don’t want to worry them too much,” he explained. “We like to keep our problems to ourselves … The East Asian concept of the self is we do things to satisfy our relationships with other people.”

Diane Lee, a doctoral candidate in the Graduate School of Education who conducts research on cultural stress and coping of Koreans and Korean-Americans, said that although Asian-Americans may go to family and friends to help with mental health issues, seeking formal or professional sources of psychiatric services is where many Asian-Americans draw the line.

“This becomes more of a problem if they struggle with serious mental health illnesses that require medication or certain specialized help like counseling,” Lee said.

Addressing the stigma

That stigma has had a tangible effect on campus. Asian-American students tend to underutilize CAPS’ resources in comparison to other populations, according to Oliver Lin ’93, a CAPS psychologist who also teaches the course EDUC 193F: Psychological Well-Being on Campus: Asian American Perspectives.

Lin explained that the impact of not seeking out professional help is compounded by the mindset that using such resources might indicate some sort of perceived inadequacy, weakness or flaw.

“I’m painting very broadly here, but I think even the notion of mental health as separate, distinct and valid from physical health may not be made,” Lin said. “Mental health issues are sometimes construed as being lazy or not disciplined enough.”

In 2007, the Asian American Activities Center (A3C) created the Asian American Health at Stanford Initiative and conducted a survey to gather information on views of mental health among the Asian-American community at Stanford. Based on survey data, the A3C launched its iLive series — previously known as the After Dark series — which seeks to foster open dialogue about mental health within the context of the Asian-American community.

The iLive series, which takes the format of small group discussions led by a professional staff member, most often a CAPS counselor, is specifically geared towards addressing issues that Asian-American students have identified as instigating the most stress. Some of these include the model minority myth, depression, body image, anxiety and perfectionism.

Cindy Ng, associate dean of students and director of the A3C, noted that the iLive series serves a dual purpose.

“It both addresses the topical issue at hand but also allows students to connect with campus resources,” Ng said. “Our center is a safe space … a more familiar setting for students to meet counselors for the first time and feel comfortable enough with them to pursue further one-on-one counseling if needed.”

Within the Native American community

Alfred Delena ’15, a native Zuni who grew up on a rural reservation of about 6,000 people in western New Mexico, cited “historical trauma” as one source of mental health issues within the Native American community.

“Our people have gone through lot of historical trauma — from the cycles of assimilation, to losing our culture and identity, to being forced to accept the western traditions,” he said. “As a people, we’ve had to deal with being removed off our lands and being forced onto reservations, with our constant battles with the federal government to get either federal recognition or gain back land we’ve lost.”

According to Delena, the statistically high rates of unemployment, violence, poverty, lack of education among Native Americans, as well as the greater prominence of alcoholism on reservations, are factors that lead to or exacerbate underlying mental health issues within the community.

“For me, it’s definitely hard going to a place like Stanford and having to carry all of that with me,” Delena said. “I’ve also been through a lot in my earlier years of being bullied, and having to carry all this baggage with me going into a different context — it’s hard trying to find a balance at Stanford.”

Natasha Daniels ’16, a native Alaskan whose family has a history of mental health illnesses, asserted that there is an expectation that Native Americans should be mentally strong given the oppression that that community has gone through.

Daniels has suffered from anxiety and depression for the past six to seven years of her life, but was only actually diagnosed this year with depression. She started seeing a CAPS psychiatrist at the end of fall quarter.

Both Delena and Daniels stressed the importance of having open mental health discussions within both the Native American community specifically and the greater Stanford student population at large, as well as the need for all students to be more accepting and less wary of conversations about mental health.

Creating safe spaces for conversation

To increase the accessibility of mental health services, CAPS counselors hold office hours — both drop-in and by appointment — at the various community centers.

For Delena, having psychologist Naomi Brown present at the Native American Community Center (NACC) “is a real blessing.” He said that he felt uncomfortable seeking help in the professional context of CAPS and just wanted someone to listen.

“Naomi is a CAPS counselor but at the NACC, she calls herself the ‘wellness coach,’” he said. “I prefer that kind of title because I feel that we’re more on equal platforms, and just having her be there and be very empathetic is a great comfort.”

Delena credited Brown’s presence in the physical space of the NACC, as opposed to Vaden, as lessening the shame that he feels in reaching out to people “and burdening them with [his] problems.”

For Daniels, speaking up about her depression during Muwekma-tah-Ruk’s “Crossing the Line” house activity this year was the first time she opened up about her mental health struggles in a public setting. While Daniels said that the responses from her peers were generally supportive, she felt that an overarching stigma against mental illness still prevails within the Stanford community.

“Some people have a hard time understanding that my depression is a biological thing, a chemical imbalance,” Daniels said. “I’ve been told, ‘Oh, what if you’re just suffering from something else, like the stress of being here?’ and ‘Why don’t you just pull yourself out of it?’”

“I’ve experienced periods of suicide ideation,” she continued. “My mental health issues are more chronic and less temporary … Sometimes you need professional help or medication. Some people don’t understand that. People have this idea that you can just pull yourself out of it. But that’s not always the case.”

Daniels recalled a recent occurrence in Muwekma in which someone had flyered excerpts of an article around the house that included the line “You are too blessed to be stressed.”

“I didn’t agree with that,” Daniels said. “I just want people to know that you can be blessed and stressed.”

Contact Minna Xiao at mxiao26 ‘at’ stanford.edu.