These Chinese-Canadians are looking to break the silence on mental health

This story was originally published on Nov. 18, 2021.

You can read a version of this story in Chinese here.
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Warning: This story deals with mental illness, including mention of suicide.

The shuffling and clacking of domino-like tiles reminds Kayla Mak Harrison of when her late grandmother and her friends taught her how to play mahjong, a Chinese tabletop game. It didn't take long for Mak Harrison to learn her grandmother was a "mahjong shark." 

"She was pretty happy when we were playing with her. When there were bets on the table, she kicked our butts. It was pretty funny," she said.

Mak Harrison, who is half Inuk and half Chinese, recalled a woman devoted to her husband. She steamed chicken wings for his dinners. She made him take his medications. She turned on the TV so he could watch the news. She even helped him do his exercises. 

Mak Harrison said her grandmother was lost when he died. Her cooking became infrequent. She hated watching TV alone. She spoke to family members less.

Expressing emotions is not encouraged in the Mak family.

That's not uncommon. Chinese-Canadians living with mental illness tend to face stigma and shame because of cultural perceptions and pressures. Since there's a tradition of suppressing emotions to achieve harmonious relationships at all costs, it can worsen mental health and create barriers to accessing help.

• Are you a Chinese-Canadian with an experience with mental health you'd like to share? Contact reporter Florence Hwang at florence.hwang@cbc.ca.

Mak Harrison, 23, was raised by her Chinese father and identifies more with that side of the family. Mental illness was never an open topic among her Chinese family members, but neither was it a stranger in their lives. 

She was in junior high school when she first noticed symptoms of depression. She got regular headaches. She slept too much but never felt rested. And, like her grandmother, she withdrew from people.

By late 2016, Mak Harrison was experiencing "racing" suicidal thoughts. She visited the hospital many times, and was passed from doctor to doctor without answers. 

The following year, she moved to Regina, where she experienced a manic episode and was admitted to a psychiatric ward. It took two more episodes before she was diagnosed with bipolar disorder.

Mental illness stigma magnified in Chinese culture

The barriers caused by shame and stigma are well-documented. According to the Asian Journal of Social Psychology, only about a quarter of Asian Americans who have been diagnosed with psychological problems seek treatment, compared more than half of the general population.

Last year, another study found only 2.2 per cent of first-generation Asian Americans, 3.5 per cent of second-generation Asian Americans, and 10.1 per cent of third-generation or later Asian Americans sought out specialty mental health services. 

In North America, it's widely accepted there's a spectrum of mental health: someone could fall between having mild and severe depression, for instance. However, in the Chinese community, people tend to be seen as either mentally ill or not, said Dr. Serina Hsu, a psychologist based in Markham, Ont. That can lead to further stigmatization, she said.

Hsu said Chinese-Canadians can have difficulty identifying or expressing their emotions, let alone recognizing mental health disorders or seeking professional help. And when they do, it's often believed that it's the person's fault. 

When Mak Harrison began experiencing symptoms of bipolar disorder as a teenager, her relationship with her father's side of the family became strained. Her grandmother visited her in hospital, but didn't understand why she needed medical care. 

Instead, Mak Harrison found understanding and acceptance through a newly discovered passion for filmmaking. A mental health worker signed Mak Harrison up for a program for psychiatric patients to learn the basics of making films as a platform to express themselves, and also as a way to provoke audiences to challenge their perceptions about mental illness.

Mak Harrison produced and starred in her first documentary, Romeo and Mental, about her experience with bipolar disorder. It was featured in the 2019 Regina International Film Festival. After the screening, people thanked Mak Harrison for helping them better understand depression and bipolar disorder.

But her father was irate that she included his photo.

Culture shapes perception of mental illness

Filial piety, a Confucian value, strongly guides Chinese family dynamics. It emphasizes the importance of children honouring their parents and ancestors. Dr. Ren Yuan, a retired University of Regina philosophy professor, said the parent-child relationship was one of the five relationships that Confucianism scholars started to uphold during the Han Dynasty.

"If you did this kind of [shameful] thing, how could you explain it in front of your ancestors' graveyard?"

As a woman, Mak Harrison feels additional pressure to prove herself to her father because in Chinese culture, sons are traditionally valued more than daughters. 

It isn't easy for the parents of children with mental illness, either. 

A Chinese-Canadian family with a child struggling with a mental illness often feels ashamed because, as Ovid K. Wong wrote in Distilling Chinese Education into 8 Steps, it is assumed the parents did a poor job of raising them. According to the National Centre for Biotechnology Information, Chinese mothers' feelings of worth were more dependent on their children's performance than that of U.S. mothers.

Hsu and other mental health professionals say that the fear of embarrassment or shame can prevent Chinese-Canadians from seeking help until it is too late. 

Ahlay Chin wished she could have prevented the death of a colleague and his family. After Joe Cheng feared he would lose his job at the University of British Columbia in the mid-1980s, he took the lives of his wife, two children and himself.

The incident precipitated Chin to discover she was suffering from severe depression, as well as post-traumatic stress disorder. 

It also illuminated for Chin the need for mental health support for Chinese-Canadians, so she started a small group in Richmond, B.C., which is now called the Community Mental Wellness Association of Canada. 

When she first rented a space to provide counselling in the 1990s, no one showed up. People called her the "crazy lady." But she says they slowly started to appear — in secret — asking:  "Do people see me coming here for counselling?"

While there is growing awareness about mental health in general in Canada, the stigma isn't fading as quickly in the Chinese-Canadian community. Still, Hsu is hopeful Chinese-Canadians will increasingly seek professional help thanks to education and encouragement to discuss mental health issues, even mild problems, on an individual level.

Mak Harrison's phone chimes. It's her dad, asking if she wants anything from Tim Horton's before he stops by the house. They talk about what to do with her grandparents' belongings. Boxes of dishes, glasses and utensils from her grandparents' restaurant are stored in the house where she now lives.

Her dad has trouble letting go of his parents' things. Some days, he agrees to relieve a box or two. Other times, he doesn't want to face it, so they get shelved for another day.  

Slowly, he is coming to accept his daughter's dream of becoming a filmmaker — which is good, as she began film studies at the University of Regina this fall.

No matter how people react to her films or her diagnoses, Mak Harrison knows she has found her calling. 

You can contact the Canada Suicide Prevention Service by phone at 1-833-456-4566 or text 45645 (4 p.m. to midnight ET only). Find them online at crisisservicescanada.ca.

Learn more about the Community Wellness Association of Canada.

Those in the Greater Toronto Area can access culturally competent care through the Hong Fook Mental Health Association.