BRANCHES | Let’s Talk About It Together – A Vietnamese American Perspective on Mental Health by Anh Thu Bui
Note: This article was originally published on the PIVOT website and has been republished here with granted permission. The Vietnamese translation can be found here.
Mental illness sounds like a curse, something horrible, inescapable.
We have a hard time talking about it, perhaps because the symptoms of mental illness are bound to expressions of speech and behavior, and at times, almost indistinguishable from one’s personality, or that we cannot help but respond negatively when we see the human mind, the organ of consciousness, lost in the grip of such fearsome ills.
One in four of us will have an episode of clinical depression in our lifetime. Three in ten will experience a psychotic episode, a break with usual reality as most of us define it. One in ten ultimately develops schizophrenia. All of us have known someone in our family or community with mental illness.
My grandfather was once so afflicted, and briefly institutionalized in French-occupied Vietnam, as a young man. The depression came from extreme stress, triggered by a malicious boss. He was unhinged, sleeplessly writing on the walls, expressing anger silently, madly. It is hard for me to imagine my mild-mannered, always smiling grandfather to ever lose his calm, let alone his mind in this way. I never knew this about him, until I asked my mother.
Once I became a psychiatrist and started asking the right questions, mental illness in my family history came out in multitudes of stories, unfolding over generations. My grandmother who rested on the divan most days, in her later years succumbed to a catatonic dementia. My uncle with addiction, with scars on his forearms no one talks about, who accidentally fell and died almost instantaneously from a brain hemorrhage. My father, who survived childhood abuse, famine, wars, expressed frequent anger outbursts and a hopelessness that I later learned were symptoms of Post-Traumatic Stress Disorder (PTSD). Many of my family members have attempted suicide in response to trauma, losses, conflicts. Even in a culture that values suicide as a legitimate form of “saving face”, bowing gracefully from loss, our family erred heavily on the side of extreme emotional stress and suicidal expressions.
This is all in hindsight, of course, and it may sound clinical, but for me, understanding my father’s PTSD helped me to let go of burdensome, painful memories, of the prolonged periods of withdrawal punctuated by unpredictable fits of rage, the chain-smoking and heavy drinking. That is, my father was not just mean or drunk, but someone who has suffered immensely, from a very young age. And that it was not my fault, that there was no way I could have helped him when I was younger, that by leaving the house I was not abandoning my family, but rather, I needed to find a different way for myself. And by speaking frankly about his mental illness, or mine, I’m not betraying my Vietnamese heritage or culture, but trying to pull it all together, finding connections that make sense of our war-torn history, and the legacy of trauma and disorder that passed through my family for generations.
Prone to melancholy from a young age, I suffered from years of nightmares and depressive episodes, once so bad that I wrote a suicide note and drove to the cliffs above the ocean, contemplating a way out. The police stopped me, and the officers were kind enough to gently suggest to me that the county psychiatric hospital was not likely a good place for me to find answers. At that point, in my early twenties, I had to decide to take a different path, not one weighed down in past trauma and history. I remember that fork in the road, the tragic one versus the hopeful one. It was a matter of survival. I had to find a way out; I chose to live. I plunged into reading all manner of self-help books; they did not have magical solutions, but at least they let me know I was not alone, in fact I was in very good company at times. I found out that I needed to be among people, in the world, and though I’m very introverted, too much time alone in my own thoughts ineluctably led to gloom and doom. So, instead of burying myself in studying history, I went off to medical school.
The rigorous academic activities were effective in keeping me focused. The dark terrors remained, however; one day I had to run out of a class on violence and sexual assaults, to hide in the bathroom, crying inconsolably, unsure of why. A good friend got me to see a therapist, who helped me survive the next four years. This formative healing experience was undoubtedly a key part of why I went into psychiatry later. By then, I had found a solid footing in life, happily married, and ongoing therapy not only helped me heal, it was essential to my growth as a psychiatrist. I went to a Freudian analyst, then many years with a wonderful Jungian analyst. I went to workshops on hypnosis and holotropic breathwork, silent retreats, and practiced mindfulness meditation. I thought I had it figured out.
After finishing medical training, my husband and I went overseas, following our dreams of working abroad in underserved areas. There were amazing discoveries and wonderful adventures. I learned to swim, overcoming a lifetime fear of water, then learned to scuba dive, with the help of incredibly patient friends. I always imagined that I would love the ocean, and I do, but turbulence and waves would bring about nausea, dizziness that I thought were just motion sickness, until I realized they were panic attacks. I had not made the connection to the long buried memory of escaping from Vietnam on a flimsy river boat, the disorienting, dark nights of lying on the bottom of the boat, with everyone moaning and vomiting from seasickness and fear. To this day, I still forget; eager to go off on some adventure, I get on a boat or plane, then when turbulence hits, the panic comes, bringing me right back to that place of being eleven years old, terrified, knowing that the adults around me are terrified, unsure of survival. (Most of us did not know how to swim, and barely fit on a tiny boat with only a week’s worth of food and river-water.) The only thing that got me through those long dark nights at the bottom of the boat was when the top door would open for air, and I could see Orion. I looked at that constellation in the sky as long as I could, until the sunrise.
The traumas of my childhood and adolescence stopped me from having a child, for many years. The ticking clock and a brief burst of optimism led to our beautiful daughter, born at home, days before my fortieth birthday. Once we got through the early months of newborn care, I was shocked to see recurrent nightmares again, of demons and terrors. Terrifying memories from a pre-verbal time, a pervading sense of impending doom, the threads of anxiety as a new mother untangled back to previous generations. My mother had lost her first daughter at three months of age, to diarrhea and dehydration, a not uncommon cause for infant mortality in Vietnam in the 1960’s. I was the replacement child, for whom bonding was complicated by my mother’s unhealed wounds of grief. (Later I found out that my grandmother also lost two children, my mother’s next older brothers, to scarlet fever – perhaps one of the many reasons for my grandmother’s ever-present malaise and distant frowns, and the subsequent disruption in bonding for her and my mother.) All those pains and fears came to me across time, so pervasive was the sense of frailty and precarious survival for a newborn child. I had to return to therapy, to find guidance through those dark stormy waters, seek ways to safe harbors. For the next five years my therapist helped me reach through decades of stored memory that passed through my genes, my blood, to understand that pain, cope with its recurrence, and ease my fear that I would pass that on to my daughter.
Even now, years later, I still succumb to periods of depression and anxiety. I now know they will pass. They are sometimes needed bouts of rest, of cocooning, to dig deep within myself, and then rise again. I think of the sunflowers at Plum Village in France, where I went (with my mother) in search of the healing wisdom of Thich Nhat Hanh. Sunflowers are heliotropes, always turning toward the sun, following its path. I turn toward that beacon of hope now, some days brighter than others, but everyday I hold that hope for my patients. As a community psychiatrist, I see many people with lifetimes of trauma. Some ask me whether I have experienced mental illness or addiction; I re-phrase the question toward an exploration of why they need to know, a search for empathy and connection. Our minds are more than just organs of consciousness; they are essential to our identity, our human-ness, and when our minds become ill, they become a virulent, sometimes lethal part of ourselves. Sometimes we try to isolate/quarantine that illness in us, but inevitably they burst out at the most unexpected moments.
For me, those were crucial moments of realizing I needed help, and being fortunate enough to find help, from friends, from therapists, who listened, and guided me through the dark landscape of trauma. There is no way I can summarize how therapy can heal – ultimately it is really about having a compassionate guide to bear witness, to be with me even in my worst of times, through tears and rage and hateful despair, to empathy and acceptance. I cannot say that the healing is complete, nor that our family is whole, but at my grandmother’s funeral, my father apologized to me, and I forgave him.
Long ago, in our childhood home, my father had large tomes of Vietnamese and Buddhist legends. One of my favorite stories is that of Muc Kien Lien*, who went down to the depths of hell to save his mother, who suffered for her lifelong meanness and wrongdoings. This story stayed with me, the image of this bodhisattva lifting his mother out of eternal misery, the lesson that helping others is one way to connect to our very own awakened nature. That the curse of mental illness need not continue through generations, that we can end the affliction in some way, by connecting to those deeply traumatized parts of ourselves, and bring them out of darkness, into the light. Talking about our mental illness connects us to all others who suffer, even if the suffering take different forms. It is by being together that we can hope to transform illness into a healing experience, and though often scarred, perhaps we can become a stronger, kinder version of ourselves.
The Jed Foundation – a national non-profit to protect emotional health and prevent suicide for teens and young adults
National Suicide Prevention Lifeline 1-800-273-TALK (8255)
Crisis Text Line 741-741
Substance Abuse and Mental Health Services Administration (SAMHSA)
National Helpline 1-800-662-HELP (4357)
Behavioral Health Treatment Locator
Suicide Prevention Center –Vietnamese
877-727-4747 daily 4:30 pm to 12:30 am
Disability Rights Legal Center
Mental Health America
National Alliance on Mental Illness
United Advocates for Children and Families
* Muc Kien Lien, known as Maudgalyayana in Sanskrit, was one of Shakyamuni Buddha’s disciples. His filial piety is described in the Ullambana Sutra. Many Vietnamese communities celebrate the holiday of Vu Lan, or Ullambana in Sanskrit, which is based upon this particular sutra.
Anh Thu Bui was born in Saigon. She became a refugee at age eleven, escaping on a boat with her family three years after the Vietnam War ended. She has worked as a community psychiatrist for twenty years, mostly in California.