Mental Health Experiences of Filipino Americans: Considerations for Cardiovascular Disease

1. Kevin L. Nadal, Ph.D. John Jay College of Criminal Justice- City University of New York Mental Health Experiences of Filipino Americans: Considerations for Cardiovascular Disease

2. Overview • Introduction • Multicultural Competence • Filipino American Cultural Values and Processes • Filipino Americans and Mental Health • Filipino Americans’ Experience with Mental Health Treatment • Discussion

3. Multicultural Competence • Knowledge • attaining of information about various cultural groups, including cultural values, traditions, histories, beliefs, and behaviors. • Awareness • insight of one’s own attitudes, biases, and beliefs that may impact one’s work with clients; awareness also includes relational dynamics that may occur between both parties. • Skills • techniques one can utilize to provide effective treatment with culturally diverse populations.

4. Knowledge of Cultural Values Indigenous Filipino Values • kapwa: fellow being • utang ng loob: debt of reciprocity • hiya: shame • pakikasama: togetherness and social acceptance • bayanihan: community spirit

5. Knowledge of Cultural Values Spanish Influences • Catholicism • Gender Roles • Indigenous Philippines was viewed as matriarchical or gender neutral • Spanish gender roles emerged • marianismo: female submissiveness • machismo: male dominance • Bahala na: fatalism (“leave it up to God”)

6. Knowledge of American Cultural Values • Individualism: The moral stance, political philosophy, or social outlook that stresses independence and self-reliance. • Conflicts with bayanihan(community spirit) which promotes collectivism: the moral stance, political philosophy, or social outlook that stresses human interdependence and cooperative action. • May lead to “Crab Mentality”: desire to outdo, outshine, or surpass another (often of one’s same ethnic group) at the other's expense • “The American Dream” was introduced • Filipinos may develop colonial mentality and/or an indebtedness to the US

7. Knowledge of Cultural Processes • Assimilation: A process in which members of one cultural group abandon their beliefs, values, and behaviors and fully adopt those of a new host group. • Acculturation: A process in which members of one cultural group adopt the beliefs, values, and behaviors of another group.

8. Knowledge of Colonial Mentality • Colonial Mentality: The concept that the colonizer’s values and beliefs are accepted by the colonized as a belief and truth of their own; that the mores of the colonizer are superior to that of the colonized. • Many Filipinos and Filipino Americans may develop colonial mentality and adhere to both Spanish and American values.

9. Filipino Americans and Mental Health • Some studies have found depression to be higher in Filipino Americans than in the general American population • Some studies have found suicide ideation higher in Filipino American youth, particularly Filipina adolescent girls • Some studies have found that substance abuse is more prevalent in Filipino American communities, suggesting that substance abuse disorders are prevalent as well.

10. Filipino Americans’ Mental Health Help-Seeking Behaviors • Asian Americans utilize mental health services less than any other racial/ethnic group, including Whites and other people of color • Moreover, when Asian Americans do attend mental health services, they prematurely terminate • Filipino Americans tend to underutilize health and mental health services more than other Asian American groups • Filipino Americans who do seek treatment had more severe or dysfunctional psychological disorders

11. Cultural Stigma and Psychotherapy • Cultural stigma is cited as a main reason why there is an underutilization of mental health services for Filipino Americans • Bahalana(fatalism or “Leave it up to God”) prohibits Filipino Americans from seeking help • Many Filipino Americans may turn to religious leaders or clergy for assistance with their mental health problems • Filipino Americans may foster a cultural mistrust or patient suspiciousness against mental health services in the same way other racial/ethnic minority groups might, which may then impact their inability to seek mental health services

12. Filipino Americans’ Experiences in Psychotherapy • Filipino Americans are more likely to admit to discussing personal and emotional problems in counseling than other Asian American groups, who were more likely to admit to educational and vocational concerns • This trend may be due to the emotional expressiveness that may be more prevalent in Filipino American communities • This trend aligns with research with Latinos and the need for emotionally closer psychotherapeutic relationships

13. Cultural Considerations • Some Filipino Americans may suffer from a “Smiling Depression” in which they do not exhibit external symptoms (e.g., difficulty eating, sleeping, functioning) but repress or hide internal symptoms (e.g., sadness, worthlessness) • Filipino Americans are sometimes diagnosed with schizophrenia; however, oftentimes it may be a normal coping method of dealing with death (e.g., a widow may claim her deceased husband “visits” her)

14. Impacts of Mental Health on CVD • Cultural-related stressors • Acculturative stress • Family pressures/ expectations • Faulty coping mechanisms • Inability to seek mental health services • Gender influences • Additional factors • Immigration status • Colonial mentality • Socioeconomic status

15. For more information Kevin L. Nadal, Ph.D. Assistant Professor John Jay College of Criminal Justice City University of New York knadal@gmail.com