Grief and Prejudice – How Asian Americans Are Coping During the Pandemic

“Shortly after our loss, I was at the grocery store with a family member, and we ran into an acquaintance, who asked what happened,” says Dr. Nobleza, who is Director of the Student Personal Counseling Center and clinical assistant professor in the Department of Psychiatry and Human Behavior at Jefferson. “My family member answered, but didn’t say anything about COVID. I wondered – why aren’t they being truthful? Are they worried others would see us as ‘infectious’? Are they concerned about reinforcing prejudices because we’re Asian? Are they concerned people would mistreat us?”

The stigma stoked by ill-conceived notions about the origin and spread of the virus complicates an already unprecedented grieving process. Like many, Dr. Nobleza’s family had to face the heart-shattering reality of not being able to say goodbye to their loved one. Jefferson Hospital is one of the few places that are allowing family members to be at the bedside for those dying of COVID.

“I’m grateful for the healthcare providers who took the extra time to facilitate FaceTime conversations and phone calls, but it really is heart-wrenching to know your loved one died alone without family at their bedside,” says Dr. Nobleza. “And not being able to get the whole family together for a funeral because of the pandemic was rough.”

The Power – and Pitfall – of Cultural Collectivism

There is a powerful sense of community in many Asian cultures, and there is often a banding together in times of crisis. “In my extended family, we’ve had four losses in the past year, not all related to COVID,” says Dr. Nobleza. “So we’ve been meeting virtually two to three times a week. It’s allowed us to grieve and heal together.”

“It’s an example of how cultural collectivism can have a positive impact on well-being,” says Dr. Nobleza. However, this same emphasis on the collective can sometimes discourage individuals from speaking out about personal difficulties, especially struggles with mental health. “There’s a stigma in general towards mental illness, but it is heightened in the AAPI community,” says. Dr. Nobleza. “Some of it stems from being afraid of how you’ll be perceived by the rest of the community. There’s concern about bringing shame to the family, and fear that the family will then be shunned by the larger community.”

The hesitation to have an open dialogue about mental health discourages people from seeking help, which puts Asian Americans – the fastest growing minority population in the U.S. – at risk for under-recognition and under-treatment of mental health concerns including depression and suicidal ideation. A study by Jefferson researcher Hee-Soon Juon, PhD, highlights that prevalence and explores cultural differences in how members of Asian American communities express depression. This is compounded by barriers to mental health care, which includes the lack of representation of AAPI in the mental health field, resulting in few providers who are able to provide culturally competent care and cater to linguistic needs.

Addressing the Underrepresentation of BIPOC in Mental Health

“There is a real need for BIPOC professionals in the field of mental health,” says Dr. Nobleza. “When you’re a person of color and you don’t see mental health providers represented from your community, it’s a barrier to seeking treatment. Patients from underrepresented communities might wonder – Will I be discriminated against? Will there be bias – whether implicit or explicit? Can I trust that I will I be understood?”

National Minority Mental Health Month, recognized in July and created in honor of mental health advocate Bebe Moore Campell, aims to address this gap. Started in 2008, the campaign raises awareness about the unique mental health challenges faced by minority communities, educates about mental health within these communities, and strives to improve quality of and access to mental health care for these populations.

While there has been progress, Dr. Nobleza still worries about how cultural stereotypes about the AAPI community can further exacerbate mental health and hinder individuals from seeking help. “There is this concept of the ‘model minority’ and the presumption of compliance, passivity, and stoicism,” she says. “On one hand, these stereotyped beliefs about cultures can frame how others approach (or don’t approach) people in the AAPI community, they might think ‘Oh they seem OK, they must be fine.’ On the other hand, that dynamic can lead people in the AAPI community to internalize emotions, for fear of appearing weak or not put together.”

How Racial Prejudice Adds Layers to the COVID-19 Crisis

Mental health, just like the virus, does not discriminate and the current complexities and stressors of COVID-related racial prejudice and threats could create perfect storm for a mental health crisis in the AAPI population.

“People of all races are suffering right now,” says Dr. Nobleza. “But some communities have been hit harder than others, especially Black and brown communities, who are also dealing with the perpetual trauma of racial injustice. For the AAPI community, the racial discrimination, the hateful words, the fear of being targeted, it all adds another layer of suffering and anxiety.”

Dr. Nobleza admits that recent violence targeting the AAPI community has made her more cautious going for a walk – a form of self-care – by herself. “To some, anyone who looks Asian is somehow to blame for this pandemic. In a time when we are already worried about our health, no one should have to also worry about their safety.”

Finding Solace in Open Conversation

Ultimately, in the midst of all this turmoil, Dr. Nobleza has found solace in connecting with others. “I know I am not alone in my grief. This is a time when all of us, no matter what race or ethnicity, have to call on the connections that we have with our communities,” she says. “There has to be a willingness to admit when things are hard, and to really ask each other ‘How are you doing?’, not as a cliché, but with the intention of really hearing the answer.”

For her part, Dr. Nobleza has never shied away from these difficult conversations, and encourages openness about mental health in her own community, often using her experience as a licensed psychiatrist to offer advice on how to navigate the mental health system, and destigmatize therapy and medication. “I want to promote the belief that there is tremendous courage in vulnerability and self-compassion,” she says. “Only then can we overcome the stigma of mental health in our communities, and in society as a whole.”