The Hmong Memorial Statue at Fresno’s Courthouse Park depicts two Hmong soldiers rescuing a wounded American pilot. Southeast Asian veterans and survivors of that conflict, as well as their families, still suffer the effects and are hesitant to seek mental health treatment. Photo by Donald A. Promnitz.

According to her driver’s license, Lao-American and Fresno resident Tout Tou Bounthapanya just turned 43 — unofficially, she’s 45. A refugee, she said, has a real age and a fake one.

In 1987, Bounthapanya and her younger brother escaped from the forced labor camp where they grew up, bringing nothing but the clothes they were wearing. Bounthapanya’s father was an officer in the army and as punishment he was tasked with clearing out bombs to plant crops.

“Many people got killed, like the people exploded and they had their intestines going up to the tree Bounthapanya said. “My friend’s dad had that happen to him.”

Eventually, she and the rest of her family would join her father in the camp. For food, she scavenged the jungle for fruit or bugs. Other times, she would eat charcoal. Bounthapanya was 14 when she arrived in Thailand, but was so malnourished that she was mistaken for a small child.

She eventually made it to the U.S., but the memories of the camp came with her. Healing took years and even today, talking about it is enough to bring her to tears.

Bounthapanya was one of many Southeast Asians to bring her scars with her. Whether it’s from the Vietnam War—or the atrocities committed in Laos and Cambodia — posttraumatic stress disorder is a common health problem in the community, but social taboos, poor access and struggles to establish trust keep many from the treatment they need for this and other conditions.

 

No word for mental health

In the West, mental health treatment is commonly sought, and is viewed as just another part of general wellness. In Southeast Asia, however, these treatments were slower to arrive. For the refugees coming from this area, the concept is not only foreign, but something to avoid.

According to Zack Darrah, director of Fresno Interdenominational Refugee Ministries (FIRM), the most closely related word for “mental health” in the Lao and Hmong languages is “crazy person.”

“There are certain taboos attached to seeking treatment of that kind because you are essentially saying that, ‘I’m a crazy person,’” Darrah said. “And back in Southeast Asia, crazy people — so to use that terminology — were outcasts of society.”

Pao Yang, executive director of the Fresno Center (for New Americans) and himself a Hmong refugee, added that this stigma can bring shame upon the entire household. The effects can be far-reaching, harming the family for generations.

“It’s your lineage of that family that has somebody that’s crazy, so it prevents your family, your kids, your grandkids from marrying another family,” Yang said. “So the culture takes it that deep.”

 

Knowing who to trust

Social taboos are not the only obstacles to mental health treatment in the Southeast Asian community. According to Darrah and Yang, the clinical setting often doesn’t translate over well to the Hmong, Lao and other cultures. In order to treat many refugee cases — including the needs of the Southeast Asian community — those providing care will often need a certain level of what the workers at FIRM call “cultural competency.”

“You know, somebody walks into Kaiser who’s Hmong and doesn’t speak English or speaks limited English…you would have no idea what to do,” Darrah said. “The signs are all in English, everything is designed that way, so everything is not conducive for somebody in that situation to go on their own to seek services in an institution of that type.”

Other worries emerge from the very act of giving information to a therapist, even if they’re there to help. Back home, many refugees are considered “traitors” to the state for fleeing.

“You don’t know that this person is a spy for the communist government,” Darrah said. “You don’t know if they’re going to send your family to a labor camp, you don’t know if they’re going to kill your family if you share with them whatever it might be.”

Darrah added that this anxiety has only gotten worse with the subject of immigration and deportation in the current political landscape.

 

Reaching out to men

According to Yang, some of the stigma is starting to fade and people are coming into his office to seek treatment. However, he estimates that 90 percent of these clients are women, while men continue to avoid the treatment. The taboo is stronger with male members of the family and a breakthrough in men’s health is yet to be seen.

“We need to get them out of that ego,” Yang said. “That macho zone of: ‘You know what? I’m the man of the house. If I go there, it’s going to impact my whole family.’”

Many of the men who arrived in the U.S. were soldiers — recruited by the CIA as part of the “Secret War” against the North Vietnamese coming into the South through neutral Laos.

Peter Vang, head of Lao Veterans of America, Inc., is well acquainted with the issues they face, as his father was one of those soldiers. In terms of men’s mental health, Vang said that in addition to the expected trauma of fighting and escaping to the U.S., there’s also the stress that comes for many from losing everything and starting a new life in a new country.

“And you may have some colonel, some commander, some captain — over there, you’re a very important person,” Vang said. “But here, you start from scratch.”

According to Yang, there has been a campaign of outreach with elders and elected officials in the Southeast Asian community — especially the Hmong. Vang, is one of the community leaders working to tell Hmong men that there is no shame in treatment.

Yang said that the outreach has helped a little and some men are listening, but they are not yet where they want it to be.

 

Navigating two worlds

Vang has his own reasons for reaching out. In 2000, he lost his son, Richard to suicide. He was one of eight Hmong teenagers who took their lives between 1998 and 2001. And while the reasons varied, culture was often at the heart of the issue.

Just as their parents and grandparents have struggled to find a place in a new country, they’ve struggled to balance being American while holding on to their cultural roots.

“I don’t think we understand the difference between assimilation and acculturation,” Yang said. And when we assimilate too quickly, we forget who we are.”

“They have all this education that they go through and you have a gap between elder and younger generations,” Vang said.

The community has since responded to this issue through communication. One example to come from the tragic wave of suicides has been through youth-centered radio programming. Fresno station KBIF 900 AM began running its Generation X show as a response, and now they’re working to bridge the gap millennials and Generation Z have with their elders.

They do this with parents through topics and lessons on common American slang and encouraging both sides to listen to one another. They’re also playing contemporary-styled music by Hmong artists in their language.

“They’re starting to feel like being Hmong is cool again,” said Mai Chou Thao, one of KBIF’s hosts. “Because growing up, being Hmong wasn’t cool because you were ‘fresh off the boat,’ or you are a newcomer and you get made fun of.”

The KBIF staff says that it’s made a difference, especially with the help of social media, but the problem is still there and as recently as last year, the 15-year-old relative of one of FIRM’s former staffers committed suicide.

 

Finding closure

Despite the generational gaps, and the severe shortage of seeking and finding care, there have been breakthroughs and successes. Despite the hardships she faced, for example, Bounthapanya says that she’s found peace through her faith. It enabled her to work with others at FIRM, though she eventually resigned to take a less stressful job.

“You cannot concentrate on school or work or anything,” Bounthapanya said. “Some people just cannot do it, but I used to struggle a lot too. But the Lord Jesus helped me bring peace into my heart and the word from the Bible really helped me.”

Other ways of helping the Southeast Asian community have also emerged in the form of horticultural therapeutic community centers. Funded by Fresno County, these gardens help refugees by giving them something familiar with their old lives. The Fresno Center’s garden in Sanger has 66 families tending it, and Yang says that it’s a powerful method of prevention and early intervention.

Kaiser Permanente Fresno has also stepped in recently with a grant of $150,000 to FIRM to help improve access to mental health services in this community. This gives them enough funding to help 12,500 people. Funding like this helps, but the road remains long for thousands across generations.

“This is an issue that’s not going to heal today or tomorrow or next year Bounthapanya said. “It takes time. It takes years for the people to become healed or to become better.”