Triumph Through Tenacity and Therapy

Stephanie (pseudonym) exudes a quiet confidence. She prides herself on her self-efficacy and analytical mindset and speaks candidly about her lifelong struggles with anxiety, depression, and socialization.

Stephanie's parents immigrated from Asia to the United States in their late twenties and settled in Northern California. Neither of Stephanie's parents received a formal education and after arriving in America, they worked in blue-collar jobs like food service and tailoring. These jobs were intense. Stephanie recalls her father working a minimum of sixty hours per week, not spending time with his kids as he was busy trying to provide for his large family. Stephanie's mother worked for a period of time before shifting her focus to becoming a homemaker; after all, there were four young children in the house that needed care and attention.

Stephanie and her three siblings are close in age and were raised in a traditional and conservative household. From an early age, Stephanie noticed that she and her siblings were not always treated equally within the family. Her brother, five years her elder and the only son, was often granted disproportionate attention. Stephanie summarized her parents' preferential treatment and lack of discipline towards her brother as "little emperor syndrome," a common phenomenon in Chinese culture. Stephanie feels that an unofficial "pecking order" determined the way she and her siblings were treated. In large part, Stephanie was left to her own devices, becoming what she describes as "the outlier of the family."

Stephanie's childhood home felt chaotic and cramped. They had only a small number of bedrooms to share among many people. At one point, Stephanie and her three siblings all had to share the same room. Stephanie recalls wishing she were an only child. When she was engrossed in a book or doing schoolwork, noises or talking from her family would interrupt her concentration. There were often others around, and as an introvert, Stephanie needed personal space. To this day, she sees solitude as integral to her mental health.

Many of Stephanie's classmates were also of Asian heritage and did not speak English as a first language. Similarly, English was Stephanie's second language as neither of her parents spoke it. As Stephanie grew older and more independent, she became less and less fluent in her parent's language, Cantonese. It was a challenge to try to express complex thoughts and ideas to her parents, and she could not convey her thoughts accurately to them with the nuances of the English language intact. This gradual erosion in communication intensified over time. Stephanie recalls several specific instances where she lacked the vocabulary to explain, for example, what she had learned in school or what she was feeling. Stephanie grew resentful as she felt the oversimplified language prevented her from expressing herself to her parents in the way she wanted. At the same time, Stephanie's parents did not have the same educational advantages, and frequently lacked the foundation or knowledge to grasp what she was explaining in the first place.

Surviving Cultural Stigma

The gap between Stephanie and her parents broadened when she began experiencing mental health issues in early adolescence. When Stephanie opened up about her issues to her mother and father, they refused to acknowledge that these problems were real. Stephanie observed that "Mental health was certainly not a subject for discussion or conversation, especially in the API [Asian and Pacific Islander] community" and that mental health was very much stigmatized amongst Asian families and typically dismissed as "noise" or "drama." She felt that sharing her experience of depression or anxiety would most likely elicit a response along the lines of "Get over it, it's nothing." Stephanie believes her situation is not unique, and that most children of Asian immigrants would have a similar story to tell.

Stephanie's most pressing mental health issue at the time was depression. It was chronic and persistent, and she dealt with intrusive thoughts and lethargy on a daily basis. After reading a book in which one character encouraged another to attend therapy, Stephanie focused on convincing her parents to allow her to see a therapist. She believed therapy could cure her mind just like medicine could cure the body.

By the time that Stephanie asked her parents to bring her to see a therapist, they had witnessed enough of her symptoms and were frustrated and confused by how their daughter was affected by this mental health "noise." Stephanie believes they did not understand or know how to help her, but they eventually agreed to Stephanie's request and signed Stephanie up for therapy sessions through an Asian community health service.

Stephanie would walk by herself to the therapist's office, which she continued to do throughout her freshman year of high school. However, she gradually lost interest and disliked the logistical challenges of journeying to the therapist's office every week. Stephanie does not recall making much progress in therapy. Her therapist instructed her to change the way she thought and reacted, but Stephanie found this task baffling. Stephanie believed that her thoughts were inherently tied to who she was: how could she possibly change them? After each session, Stephanie grew more frustrated and irate. She resented that her therapist was not delivering the results she had expected. Her mental health had not improved.

In high school, Stephanie's mental health problems worsened and evolved. It was a challenging period of her life, as she felt lonely and misunderstood. She could not relate to anyone. Stephanie found her peers self-absorbed and crippled by their superficial preoccupations and she disliked the surface-level discussions and drama.

Stephanie decided to eschew social interactions with her peers in favor of more global pursuits. She began looking at opportunities for traveling and studying abroad. She learned French and Arabic and studied German by going to weekend school. Within the span of her four high school years, Stephanie spent time in three different continents. While abroad, Stephanie liked feeling independent and mature, away from her family and classmates. Stephanie also engaged in more social interactions, appreciating the camaraderie with other American students as they navigated their way through a foreign country and exchanged notes and observations about how things were done differently. Overall, these trips were a positive experience for Stephanie, and although her mental health issues did not disappear, she had found a worthwhile pursuit. She credits these international experiences as formative to her growth and an essential part of who she is today.

In addition to traveling, Stephanie also focused on academic achievement, believing college would be her "ticket out of poverty." Because she had only her parent's modest background to draw from, Stephanie had no context for what exactly a white-collar career would look like, or how to obtain one. However, she was determined not to live through the same insecurity or "survival mode" that her parents did. While Stephanie was able to watch her older siblings' journeys, their paths did not align with Stephanie's academic ambitions. Stephanie placed mounting pressure on herself to succeed in school, earning top marks. All the while, Stephanie felt as if her parents offered her no support or encouragement. They never pushed her to complete her homework or receive good grades. In fact, Stephanie's parents would often dismiss her academic achievements, "throwing a wet blanket" on her successes. Eventually Stephanie stopped sharing her scholastic achievements with her parents. In spite of that, she continued to be self-motivated and focused resolutely on her goals.

When it came time to apply for colleges, Stephanie set her sights on attending an East Coast liberal arts college known for educating a line of well-respected leaders. Just before her orientation, Stephanie and her parents traveled to the East Coast, staying in Canada for a short time before helping Stephanie settle into her new dorm. She was eager for this new chapter of her life to begin. Immediately, Stephanie fell in love with her humanities and language classes. Stephanie began to find like-minded students; she was finally connecting with her peers and had, for the first time, "real friends."

Unfortunately, Stephanie's depression and anxiety had followed her from California. Now, however, Stephanie had the added challenge of adapting to a small, snowy town and acclimating to a white, homogenous culture. Stephanie decided to give therapy a second attempt.

Friday afternoons were spent in the office of the school's mental health school-assigned therapist. Stephanie found her therapist unhelpful and difficult to connect with, describing her as a New England, "white bread" woman who could not relate to an inner-city Asian kid. Additionally, Stephanie noted that she prefers having tangible homework and activities for her mental health treatment, which her therapist did not provide. Looking back, Stephanie feels as if her college therapist could not understand what she needed and how she needed it. There may also have been implicit biases at play that affected the therapist's approach to Stephanie's treatment. More specifically, the therapist made a couple of offhand comments based upon stereotypes of people of Asian heritage. Stephanie is uncertain if these were deliberately malicious, but the comments triggered some relational distance.

Triumph Through Therapy

Stephanie graduated from college post-recession and moved back to California. The job market was bleak. Stephanie felt defeated and demoralized because she couldn't find a job that aligned with her education and skills. Her early years out of college were difficult, and she began her career as an entry-level assistant to pay off her student loans. Determination to achieve financial freedom motivated Stephanie through her early twenties. She would work two, sometimes three, jobs so that she could throw as much money as possible into paying down her debt. Two years after graduating, she paid off her loan balance in full.

After achieving her goal, she lost her motivation to stay at the entry-level job and her mental health plummeted. During her second year in the role, she felt she no longer had a purpose. Stephanie would cry on the phone in the ladies' room, feeling hopelessly demeaned, disrespected, and underappreciated. While Stephanie was fighting to stay afloat in her toxic workplace, her father passed away. His death was relatively sudden as her family had only discovered his cancer diagnosis eight months prior.

Stephanie and her siblings sorted through their father's possessions and tried to pick up the pieces after losing the patriarch of their family. Stephanie remained at the job she despised for another year, largely due to its familiarity and to keep her health insurance so she could attend therapy. She could not manage any more changes in the wake of her family's loss. She attended weekly sessions and was quick to open up to her therapist about her trauma and grief. From her two previous experiences with mental health care, Stephanie went in knowing she needed a provider who could understand her and who was fully committed to helping her improve. Finally, for the first time, she found a therapist who could fulfill her needs.

When seeking therapy, Stephanie had requested to receive a provider specializing in dialectical behavioral therapy (DBT). She preferred this more structured style of mental health treatment. Stephanie was aware that she had unhealthy patterns of behavior, and realized they were adversely affecting herself and her relationships. Through DBT, the therapist trained her to become more mindful of how she was reacting or responding to a trigger event. Then, Stephanie learned to link that reaction to a specific trauma or memory that had been "stored" in her mind and body.

With the same therapist, Stephanie also practiced cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR). In CBT, Stephanie achieved a breakthrough in connecting her actions and habits to original experiences or preexisting beliefs. She was then able to understand why these rooted thoughts informed her behavior. Stephanie also benefited from EMDR, a mindfulness practice where she would receive a minor electric jolt from a machine and respond to these stimuli by touch. EMDR helped Stephanie process past traumas. Exploring these new methods of therapy helped Stephanie gain stability and a deeper understanding of herself. These tools helped her move forward into a healthier and more promising future. Stephanie continued to work with this therapist for five years.

In her thirties now, Stephanie feels more assured and conscious of her mental health. She began working in the tech sector in a role she finds both challenging and fulfilling. While her depression has not disappeared, she is better equipped to acknowledge it and perform self-care. When faced with this challenge, she tries to work backwards to identify what is lacking in her life. For example, after a long or frustrating day at her desk, she likes to swim laps to calm her mind. Stephanie finally feels like she has the tools to align herself and support her mental health.