‘When it comes to creating change, it’s not a sprint–it’s a marathon’

How culture affects people’s approach to mental health and what it takes to change the narrative

By Yesenia Barrios, Urban Health Media Project 

Victoria Waltz was 17 years old when she attempted suicide by overdosing on Vicodin. It wasn’t until she woke up in the hospital and doctors said they feared for her safety that she realized she had depression.

Waltz, raised in a Black Christian family that didn’t believe in mental health treatment, told her story during a recent episode of Therapy Thursday, a monthly Urban Health Media Project Instagram Live panel discussion. 

Now working as an executive assistant at Levine Music, Waltz’s journey to raise mental health awareness in her family and Prince George’s County in Maryland has been hard. It started with the difficult task of ending the stigma within herself. “A lot of what was holding me back to therapy was cultural things like ‘what are people going to say,’” said Waltz.  

Once she understood therapy was nothing to be ashamed of, her mental health significantly improved. For a while, she continued to have depressive episodes and anxiety. Now, however, she said she has come a long way– she experiences fewer depressive and anxious times.

Janeth Ortega, a Mexican American Fordham University student studying clinical psychology, tells a similar story.  It was only when she was forced to go to therapy after experiencing a traumatic event at 18 years old that she realized she had been suffering from depression.

Her family dynamic included domestic and alcohol abuse. Ortega, now 29, never fully understood how much the alcohol and domestic abuse in her home affected her mental health until seeing a therapist.

“I thought I was just a teen going through something,” she said.

The first step to helping patients from different racial and ethnic backgrounds is to identify and accept their problems along with the labels their family and community assign to those issues, said Chi-Kit Ho, an Asian American licensed social worker and therapist in Queens, New York.

Many people hesitate to seek help because they are afraid of what their community will think, said Ho. 

“In Black families, and Black Christian families especially, you hear a lot of ‘I don’t need to talk to a therapist. All I need is Jesus -- just pray about it,’” said Waltz. 

Depression, anxiety or PTSD are perceived differently in each culture – with some being more understanding and accepting than others. 

Ho witnessed how culture affected his mother’s decision to not receive treatment as he watched her suffer from hallucinations and depression in his childhood. “I couldn’t understand what was going on. I only saw her cry hysterically everyday,” Ho said. Only when he went to college to become a counselor did he realize she suffered from depression. Shifting perception is pivotal to start a conversation about mental health, he said.

Stigma is so entrenched in some cultures that there is no language to express mental health struggles, making it more difficult to identify the problem and seek appropriate help. 

“If mental health is not the vocabulary in our dictionary, they cannot say it, they cannot use it,” said Ho.

Some parents are unaware that their children are struggling and do not understand the need for treatment, Ho said. Young patients who are suicidal need to be hospitalized. After explaining the gravity of the situation, some parents still ask, “do they really have to go?”

Setting Boundaries   

All panelists agreed that older generations were more focused on mere survival than mental health. 

“My parents and my family, they did the best they could,” said Waltz, “and also (I) realized they're not where I am in terms of their mental health journey.”

Still, a lack of understanding between generations means people find themselves needing to set boundaries more often.

For people raised in collectivist cultures, like in many Latin American, Asian and African countries, this is especially difficult. People are taught to be community oriented and consider others’ emotions. 

“A lack of boundaries is probably one of the largest contributing factors as to why a lot of people even have the mental health issues,” said Waltz, “especially when it comes to relationships with their families.”

Ortega lost friends and became estranged from family members after setting limits. Years later, she said that she doesn't regret that part of her healing process. “Sometimes you are the only person who has the courage to deal with the problems in your family,” she added.

Setting boundaries can be done in a gentle and kind way by communicating how the behavior made you feel, rather than shaming or blaming. “We can actually say that it's the behavior that you did, that I cannot deal with, so I want you to stop that behavior,” said Ho.  

Helping to redefine mental health problems in the context of living at home is key. “What can you do about the problem? And what can you do about things that you cannot control, you can actually help yourself feel better, you can help yourself get on with your life,” said Ho. 

Youth who are financially dependent on their parents face an added challenge: feeling stuck in a home where their mental health struggles are not understood can make them more vulnerable. 

Though Ortega moved out of her mother’s home a few years ago, she still struggles with cultural expectations. “Sometimes, I do feel guilty for not messaging her or not doing this or that because culturally I am expected to live with her and to be with her,” she said.

Waltz, Ortega and Ho agree that making a change is a lifelong process. “Sometimes it's just about starting the conversation,” said Waltz.