Exploring Vietnamese American intergenerational trauma

In thinking about building generational wealth and community among Vietnamese Americans, I wanted to understand something that affected me deeply growing up as a son of refugees following the Vietnam War, and that is intergenerational trauma. In my personal life, I would bear witness to matters concerning close friends and family, including problem gambling, divorce, childhood neglect, social isolation, silent coping, depression, suicidal tendencies, burn out, financial duress, bad financial behaviors, hoarding, filial piety pressures, and family disgrace and disowning. With May being Mental Health Awareness Month, I felt this was an important topic to cover.

If you do see any of the scenarios I present here being parallels in your life, I encourage you to seek professional help. If you are in crisis, please seek help immediately. If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat 988lifeline.org. Text MHA to 741741 to connect with a trained Crisis Counselor from Crisis Text Line. Or call 911 or go to the nearest emergency room.

Ways of looking at intergenerational trauma

There are several terms and distinctions which I think are important, because we tend to conflate terms, and it’s important to understand the connection among one’s psychological state, behaviors, and social relationships, all of which ultimately impact community well-being.

1. Collective trauma - The psychological distress that a group—usually an entire culture, community, or another large group of people—experience in response to a shared trauma.

2. Secondary trauma - the natural emotions and behaviors that result from knowing about a traumatizing event experienced by another person.

3. Childhood trauma - trauma that occurs during childhood, which can lead to risky, unhealthy, or problem behaviors that can endure into adulthood.

4. Complex trauma - exposure to multiple traumatic events and the wide-ranging, long-term effects of this exposure, e.g. abuse, neglect.

5. Transtrauma - examines how structures of domination inflict and extend trauma, perpetuating marginalization of the affected community.

6. Mental health - pertains entirely to a person's psychological state.

7. Serious Mental Illness (SMI) - used to describe mental, behavioral, or emotional disorders that significantly impair a person's ability to function in daily life.

8. Behavioral health - a term for a wide-reaching field that looks at mental health, lifestyle, substance use, patterns of behavior, interpersonal relationships, and more.

9. Social health - the well-being of the relationships we have and how we interact with others.

10. Communication problems - a breakdown in the individual's ability to effectively convey their thoughts as a meaningful message.

11. Culture gap - any systematic difference between two cultures which hinders mutual understanding or relations.

So with these distinctions, hopefully it’s somewhat easier to see that someone might not be currently mentally ill—they are still able to function daily—but still have problematic behaviors and/or communication that stem from, for example, childhood trauma, which could contribute to strains in relationships, or even develop complex trauma (for example, long-term verbal abuse).

There’s also a few terms that’s useful in addressing intergenerational trauma:

1. Applied psychology - the study and ability to solve problems within human behavior.

2. Applied anthropology - the use of research methods and cultural studies to solve practical, everyday challenges in communities and organizations.

3. Emotional intelligence - the ability to manage both your own emotions and understand the emotions of people around you.

4. Spiritual intelligence - the ability to access higher meanings, values, abiding purposes, and unconscious aspects of the self and to embed these meanings, values, and purposes in living richer and more creative lives.

Mental illness stigma and barriers to treatment

Let’s explore the barriers among Vietnamese in utilizing behavioral health care. One study, “Mental Illness Public Stigma and Generational Differences among Vietnamese Americans” (2020), summarizes many previous studies on the issue, which I’ll paraphrase the points I think are important:

• Stigma and social rejection: In Vietnamese culture, mental disorders are often labeled điên (literally translated as “madness”). A điên person and their family are often severely disgraced and consequently the individuals and their family become reluctant to disclose and seek help for mental health problems for fears of rejection. One older participant said, “They see less of you, when they see a flaw in you they don’t talk to you or care about you. That’s one thing the Vietnamese people are bad at, spreading false rumors and discrimination.”
  
  Key cultural values, such as familism, put priority on families over individuals, resulting in those with mental illness being likely to hide it to protect their family’s reputation. Mental illness is also often seen as a sign of weakness or possession by supernatural entities. It may be considered a consequence of one’s improper behavior in a previous life, for which the person is now being punished. Furthermore, because of how mental illness was managed in Vietnam, Vietnamese often associate it with being institutionalized and imprisoned.

• Economic, language, culture barriers to treatment: For recent immigrants, there can be significant barriers to diagnosing and treating mental illness. These barriers can include lack of adequate health insurance, limited culturally and linguistically accessible services, and providers’ lack of knowledge about the needs of different ethnic groups.

• Service model design issues: Vietnamese immigration to the U.S. has occurred in three major waves. This pattern generated different needs for services, including counseling and social services, for different generations of Vietnamese immigrants as they settled in the U.S. and experienced different immigration and acculturation related stressors.

According to U.S. Department of Health & Human Services, Office of Minority Health, “Mental and Behavioral Health - Asian Americans”, in 2018, Asians were 60 percent less likely to have received mental health treatment as compared to non-Hispanic whites.

As far as what the study revealed, here are some interesting observations:

1. There is a generational difference in how mental illness is viewed. The older generation would see it as a temporary phase that could simply be overcome through emotional or financial support, whereas the younger generation tend to view mental illness as something that required professional help.

2. There was no evidence of the public separating the mentally ill (“them”) from “us”. It was nearly uniformly reported that participants felt sympathetic to those with mental disorders and their family, and that all recognized that they needed help, although what was appropriate help was perceived differently across groups.

3. Vietnamese-speaking psychologists and psychiatrists also reported a struggle that they often faced in practice and in daily life: while they were usually preferred by Vietnamese Americans over English-speaking providers, it was also much harder for them to gain trust of their Vietnamese clients as clients would fear that Vietnamese psychologists would spread gossip themselves.

4. With regards to how Vietnamese dealt with mental problems, in one school of thought, the hardship that Vietnamese have endured through decades made mental problems like stress and depression viewed as temporary and thus easier to overcome on one’s own. Another school of thought was that “you are supposed to be strong. You have been through a lot already, you should be able to be strong” as one priest reported.

5. One sub-theme that was apparent was the mistrust in Western medicine. Not understanding how counseling or medicines work made one worry about approaching service providers or staying in treatment: “Growing up in Vietnam, we never got to go to the therapist so we don’t know how it is like.”
   
   A young man summarized the influence of culture on mental illness stigma: “Us Southeast Asian, like, from my parents specifically as Vietnam War refugees. I think the reason why they don’t talk about it is because it’s a barrier that they have to overcome themselves, right? As refugees, as people who have been through the war…They don’t want to believe that they need help, and so the trauma that they carry when they give birth to us is carried on us as well. But due to the language barrier and also the, like, they say with the whole health care, in Vietnam I know that they don’t really believe in Western and Eurocentric medicine. So, from their understanding of how, like from their experience with colonization or French people, and how medicine works, they don’t believe in it.”

6. The lack of vocabulary to express mental illness and symptoms in the Vietnamese language proved to be a challenge, even among those who had some understanding of mental disorders. One young man said, “When you classify depression as an illness, no one wants to be sick,… if you call it an illness, no one wants to have that sort of illness, and it’s not an illness that you can physically see…”
   
   One of the psychologists interviewed said “In English, when we jokingly say ‘Are you crazy?’ it’s just a joke. It is something lighthearted, nothing serious. In Vietnamese if you say that ‘Mày điên à?’ (Are you crazy?) it’s like putting down.”

7. One characteristic of the Vietnamese culture that was also often mentioned was the lack of sharing and openness (aka silent coping) between generations, even within a family. Grandparents, parents, and children did not usually share and discuss each other’s problems. Ms. Catherine, a community leader, who was in her 40s, said: “Sharing and talking doesn’t happen in our culture. I came over to America in 1975 at the age of five. I can’t remember a single day, a single time, when I was young when my mom and dad sat down and we talk about how we feel. I grew up in a family – and nothing wrong. I mean my parents provided, good parents, but we just never did that.”
   
   Parents and grandparents did not talk about problems because they needed to appear strong and good in front of their children; children did not talk about problems because they were supposed to do well in all aspects, particularly in school. The competitiveness of Vietnamese and high expectations of younger generations came into play here and create a vicious cycle. Young people were expected to do well in school, which put pressure on them and may result in mental health problems, yet, they could not talk about it with their parents because they were not supposed to feel bad about school, and sharing was not encouraged. The Asian model minority myth and the expectations of parents that their children would do well in school and become doctors and lawyers were cited by many as a cause of mental health problems among young people.

8. Young people will rely on someone – a friend, a colleague, a trusted community member – that is distant enough from their own family for support in case of mental illness and if/when the needs for mental health care arise, at least in the short term.

The study underlined the need for culturally appropriate health care, and suggested three necessary characteristics of culturally appropriate mental health care for Vietnamese Americans: 1) bicultural skills education for providers, 2) supporting families in transition to and from professional care, and 3) provider’s knowledge of Vietnamese culture.

Impact of mental health needs on the economy

A White House brief, “Reducing the Economic Burden of Unmet Mental Health Needs” (2022) best summarizes the economic impact of mental illness:

Mental health disorders result in large economic costs to those afflicted, their families, and society as a whole. As discussed in this year’s Economic Report of the President, good physical and mental health are essential inputs into a productive economy, helping create educated, productive workers. Poor mental health is associated with worse educational outcomes. Mental health diagnoses such as ADHD are associated with lower school attendance, lower test scores, and higher dropout rates.  Research also shows teens and adults with mental illness and substance use disorders are less likely to be in the labor force. Data from Denmark shows that mental health disorders such as depression, schizophrenia, and bipolar disorder carry significant earnings losses. These negative outcomes, among others, may further lead to what Case and Deaton have termed “deaths of despair.” These deaths from drugs, alcohol, and suicide—caused by pain, economic distress, and mental health difficulties—more than doubled between the 1960s and 2017 and have continued to rise.

The effects of mental health disorders can persist into the future, and even extend to the next generation. Depression during adolescence has been linked to longer-term consequences, such as higher engagement in crime. Mothers with inadequately treated mental illness often adopt less effective parenting strategies and struggle to develop close, emotionally healthy relationships with their children. This can result in poor emotional development in young children, lower cognitive scores and academic performance, and higher rates of behavior and mental health problems. The magnitude of intergenerational transmission is substantial, with one study finding that children of parents with mental health problems were twice as likely to develop mental health problems in adulthood.

One study found behavioral health conditions cost the U.S. economy more than $1 trillion each year.

Difficulties with Vietnamese American community engagement

I had a group text banter with a few of my friends who do organizing work within the Vietnamese American community. One of them brought up this post by Queenie Ngo, a professional Community Engagement Director at LifeSTEPS (a nonprofit provider of services to residents needing affordable/supportive housing in California), who helped put together a ceremony for Vietnamese Americans in San Jose, especially ones who were connected to the former South Vietnam. I’ll quote the important points of her post:

Never have I felt as disappointed and lost after an event under my supervision as I do today. After each event, I eagerly reviewed the photos, promptly posting them on Facebook to thank all the volunteers, those unsung heroes who helped me accomplish the mission. But not this one.

Today, for many, the flag-raising ceremony at San Jose City Hall was a resounding success. However, for some, today's event encountered shortcomings that I could have controlled and avoided from the start. Because of me, many were affected, including the Mayor, the Councilmember, and the Secretary General of the Former Vietnam Armed Forces Alliance.

For many days, I sacrificed my personal life to organize a truly solemn and splendid flag-raising ceremony… I know that my involvement in the flag-raising ceremony, the action of holding and honoring the flag, or organizing such a ceremony, could affect bringing my father's ashes back to Vietnam. However, I still did it. I placed the Vietnamese Heritage flag above all else.

Unfortunately, not everyone understands or sympathizes with me; they do whatever it takes to achieve their goals or agenda. Regardless, I fully accept responsibility for the shortcomings in today's ceremony program. Whatever anyone desires, they have achieved it. However, the bottom line is that the yellow flag has finally been raised at City Hall, and the lights will be lit in its shape for 7 days.

I understand that my regrets will not alleviate the frustration of many senior leaders in the community, and I sincerely apologize. I hope that if someone sees my heart, they will understand that their desires align with mine, but circumstances prevail. I have done everything I could.

Now you might be wondering… what happened? Now for those unfamiliar, the flag mentioned here is the Vietnamese Freedom & Heritage Flag, which is essentially the flag of former South Vietnam. After South Vietnam fell, a large number left as refugees/asylees, eventually settling here in America. Thus there is a critically emotional connection to the flag for the Vietnamese community here.

Although the post was vague to the specifics of the criticisms levied against the event, the challenges of working within a community deeply affected by intergenerational trauma were all too familiar among my community organizer peers. Because of these experiences, even when the positive impacts are in the far majority, they whittle away my peers’ morale, leading to burn out, and consequently sabbaticals with unplanned return dates. We occasionally would see public relations blunders by nonprofits and politicians who try to reach out to the Vietnamese American community. Probably one of the more well-known incidents (in Vietnamese America) was Councilmember Madison Nguyen’s handling of the naming of a Vietnamese business district in San Jose where many vocalized their desire for the name Little Saigon, but several elected representatives voted against it, leading to backlash by many Vietnamese Americans.

There were other challenges that my peers faced while organizing events: One recalled having their planned schedule “hijacked” and having to go off script because some elders felt the event was not organized correctly. Another recalled dishonesty in communiqués to potential sponsors about attendance numbers by ten-fold in order to project an image of community strength. Yet another recalled the feeling of working hard on a project under a senior, only for the senior organizer to get all credit and giving absolutely no recognition to the younger volunteer. And all of my friends, because of their nature of being public servants, had to vent their frustrations in the backroom. I guess there’s just a limit to how professional we all can be.

Healing intergenerational trauma

Jammie Pham, LSWAIC shares her tips on healing intergenerational trauma:

1. Acknowledging & Validating The Pain and Suffering Of Past Generations: This process involves recognizing the experiences of our ancestors, including the hardships they endured during war, displacement, and resettlement. By honoring their struggles and acknowledging the impact of historical trauma on our families and communities, we validate the validity of their experiences and the depth of their pain. This validation creates space for healing and allows us to confront the legacy of trauma with compassion, empathy, and resilience, paving the way for healing and collective wellbeing.

2. Fostering Intergenerational Communication & Understanding: This involves creating open and safe spaces for dialogue between different generations, where experiences, emotions, and perspectives can be shared and validated. By opening up this dialogue, intergenerational bonds can be strengthened, fostering healing, connection, and a sense of shared identity across generations.

3. Cultural Reconnection: This involves reclaiming and revitalizing cultural practices, traditions, and values that may have been disrupted or lost due to the trauma of war and migration. This allows us to reconnect with our roots, language, customs, and heritage, which can foster a sense of belonging, identity, and pride. By embracing and celebrating our cultural heritage, we can draw strength, resilience, and healing from the rich tapestry of our ancestry.

4. Community Support: This involves coming together as a collective to provide mutual aid, solidarity, and understanding to those who have been affected by trauma. Through community support networks, we can access resources, share experiences, and receive emotional and practical assistance in navigating the challenges of healing and recovery. 

5. Self-care Practices: Self-care practices involve prioritizing our physical, emotional, and spiritual wellbeing through activities that promote relaxation, mindfulness, and self-reflection. Examples of self-care practices can include meditation, exercise, spending time in nature, journaling, engaging in creative pursuits, and seeking out culturally relevant healing modalities such as acupuncture or traditional medicine.

6. Combating Mental Health Stigma: This involves challenging negative stereotypes, promoting education and awareness about mental health, and fostering open conversations about mental illness. By sharing personal stories, advocating for equal access to mental health resources, and supporting those who are struggling, we can break down barriers and create a culture of acceptance, understanding, and support. Additionally, addressing cultural beliefs and attitudes surrounding mental health can help reduce stigma and encourage help-seeking behavior. Through collaborative efforts, we can create a more compassionate and inclusive community where everyone feels empowered to prioritize their mental health and seek the support they need.

7. Accessing Culturally Responsive Mental Health Resources: This involves seeking out mental health professionals who understand the cultural nuances and historical context of our experiences, and who can provide culturally competent care. Additionally, it means utilizing community-based organizations and resources that offer culturally specific services, such as therapy groups, support networks, and educational workshops tailored to the needs of our communities.

There are a few Vietnamese cultural practices that also deal with social/mental health:

• Giỗ is a ceremony and ritual to remember those who have passed away. Often the extended family are invited to a feast, allowing for an emotional bond among family members. It is common to see homes containing family altars featuring pictures of late loved ones.

• Mindfulness and meditation is practiced especially by Theravadin Buddhists. Mindfulness means staying aware of mind and body conditions in a present moment context.

• Before Tết, Vietnamese New Year, it is customary to clean the house, settle debts, and forgive old grumbles.

Thus I would be curious to see how one might use applied psychology and anthropology to innovate on event formats and creating new cultural/behavioral practices that are designed around intergenerational/collective trauma. For example, there is an article “Kinder Tools: How to Improve Enterprise UX Design for Mental Health” by Danae Botha, a user experience designer with a focus on accessibility, who explores tactical design ideas that are mindful of people with mental health needs. Creating this kind of cultural framework would be an enormous undertaking, but one I feel strongly to be a cornerstone for intergenerational prosperity.

I conclude this post with a story of newly adopted cultural/behavioral practice that emerged in my generation, known as an affirmation circle. I used to be part of the Vietnamese American youth networks, UNAVSA and NorCal UVSA. On the final day of their conferences, all the youths would gather in an assembly room and seat themselves in a large group circle with eyes closed. Every few minutes, a subset of youths would open their eyes, stand up, walk around the room, and place their hands on their peers’ shoulders, as if to say (without actually saying it) “you matter”, “I appreciate you”, and “I know how you feel”. And all stay silent when the tears start rolling down faces that, for some, have been long overdue.

More information

1. International Vietnamese Mental Health Association
   There is a planned symposium on October 3–4, 2024 in Orange County, California.

2. Viet-C.A.R.E
   A nonprofit aiming to reduce mental health disparities and enhance quality mental health care services, especially within the Vietnamese American community.

3. “How to talk about mental health in Vietnamese” published in the Los Angeles Times