Dr. Helen Hsu

Creative Survival

It's difficult to articulate what a therapist "does" in session.  Often people will ask how I "fix" people or "set them straight" or "manipulate" them.  I don't feel any of those things are my goal nor my role.

Sure, it's essential that any good psychotherapist have proper education, relevant work experience, and licensure.  But therapy is a process of co-creation, and not the only path to healing by any means. 

I always encourage clients to seek regular means of self expression, self validation, and self encouragement.  Eventually every client must graduate, so to speak, from therapy, and carry on the their growing new skills and evolving confidence on their own.       

Creative endeavors are such a fundamental human experience, so intrinsic within all human societies that I dare say it's a need.  Be it music, literature, sculpture, dance, painting, poetry - whatever the medium, creativity is healing.  Because constructive self expression is healing.  for example there have been studies which have demonstrated how singing relieves depressive symptoms, or how art therapy benefits traumatized children. 

Often, it's through our creative passions that we sort out our muddled motivations and thoughts and begin learning to accept and own our emotional lives.  It generally happens quite naturally, and is the ideal means for those who don't have the time, money, or verbal proclivities for talk therapy.  Often, we (therapists) utilize art and creativity into the therapy work.  Some of the most powerful moments I have had the privilege to share with clients came while discussing a powerful song, creating a symbolic work of graphic art, or acting out an emotional dilemma with physical tools.

Two small bits I wanted to share today which happened to have triggered this post:

While eating lunch & reading Writer's Digest tips from authors, I read Wade Rouse:

"Most of us, especially writers, are defined by our fears. They strangle us, prevent us from finding our voices, pursuing our passion, writing what calls to us. So, turn "FEAR" into Free Every Artistic Response. When you do, your true voice will be unleashed."

Wade Rouse 

How fantastic is that? Free Every Artistic Response. Imagine how your days would feel if that Artistic response governed your choices and moods instead of your fears.

Next, I watched a YouTube video featuring a song from a 19 year old Cancer Survivor. Megan McNeil wrote the song during some of her darkest days-and with the support of professional producers is helping to raise funds for childhood cancer research.  Her strong voice and will to fight for life are inspiring.  For those of us who have loved someone battling Cancer, her song is like a rallying cry to keep on fighting the good fight. What a luminous example of someone using her creative skills to channel fear and pain into something remarkable: 

Will To Survive

Suicide and Asian Americans

"My Story" Depression, Suicide, and Asian American Women

I was recently perusing the website 8Asians.com and came across a personal essay addressing the high rates of untreated mental health illnesses in our communities. 

The author June Shieh does an intensely honest job sharing her experience of how stigma and lack of education can manifest in tragedy.  She is also an example of the resilience of those who weather life's storms. 

A worthwhile read, and encourage more of us to speak up and speak out to spare others from their undiagnosed and/or untreated illnesses, and to share our own stories.

Asian Pacific American Mental Health Day

May is many things, National Mental Health Awareness Month, as well as Asian Pacific American Heritage Month. Both causes near and dear to my heart and life's work.

Richmond Area Multi-Services, Inc.(RAMS is a community based agency where many of my finest colleagues over the years have served the community.  Founded in 1974, they serve over 15,000 adults,children, youth, and families, in over 30 languages in over 75 sites, throughout San Francisco, with specialty expertise in Asian Pacific Islander and Russian communities and language access.

RAMS is spearheading the effort to establish May 10th as "Asian Pacific American Mental Health Day", in recognition of the importance of raising awareness about mental health in the Asian Pacific American community.

Starting in the year of 2010 and each year thereafter, the City & County of San Francisco shall recognize May 10th as "Asian Pacific American Mental Health Day", as it was introduced by San Francisco Board of Supervisor (District 1) Eric Mar and supported by the full Board. California State Senator Leland Y. Yee, Ph.D. introduced the resolution as SCR 97 at the State Senate and May 10th Asian Pacific American Mental Health Day is to be official in the State of California.

In establishing this reoccurring day, RAMS plans to launch Northern and Southern California Taskforces which would be the platform in order to
formally collaborate on efforts," says Kavoos G. Bassiri, President & CEO of RAMS, "As a community of Californians and Asian Pacific Americans, together,
the groups will identify best practices and strategies on outreach & promotion as well as discuss pertinent issues relating to mental health,
culturally competent healthcare practices, and the community-at-large."

There is a significant need for enhancing awareness of mental illness in the Asian Pacific American community. Approximately 25% of Americans in a given year are impacted by mental health conditions regardless of gender, age,race, religion and socioeconomic status, according to the National Alliance on Mental Illness (NAMI).

Asian Pacific Americans are no exception, but cultural stigmas and lack of culturally competent services contribute to the lack of awareness and high stigma levels that inhibit proper care.

Through the combination of psychosocial and pharmacological treatments and support, 70% to 90% of individuals with mental health issues have significant reduction of symptoms and improved quality of life.  Mental illnesses are treatable health conditions.

Asian Pacific American (APA) communities are among the fastest growing and most diverse racial group in the United States, yet APA's use mental health services at the lowest rate among ethnic populations.  I know from my experiences as both a community member and mental health professional that we are drastically under-served.  As a community it would benefit us all to raise awareness, demand education and treatment services and learn about preventative practices to improve the health and well being of our families. 

For More Information:  RAMS Inc.

National Autism Awareness Month

April is National Autism Awareness Month.  I encourage everyone to learn a bit about Autism spectrum disorders (ASD)and share your awareness and support with those families living with the challenges of ASD. 

The average person tends to associate the term "autistic" with very limited media portrayals. Many  assume that all autistics are "like Rain Man", the savant character portrayed by Dustin Hoffman.  Others think only of severely developmentally disabled children who may do scary or strange looking things such as self injure or flap their hands repetitively. 

In recent years, professor Temple Gradin has been recognized through her books, work, and an HBO movie as an example of a successful person living with autism.

HBO Temple Gradin movie   

ASD refers to a range of disabilities that generally develop within the first three years of life.  Children may have mild Asperger's or severe autism and everything in between.  The common denominator is that children with ASD have difficulties communicating with others, and they learn, perceive, and interact very differently than "normal" peers of their age range.

I was fortunate to work briefly with the Lovaas project as an undergraduate at UCLA, and to have worked with parents who are raising children with ASD.  I learned firsthand through hours of behavior modification therapy spent with ASD kids that their disorder was just one facet of their being.  Despite the perceptual and communicative barriers between us, they taught me that intelligence and personality traits were assets often untouched by the ASD.  

It is an exhausting task to implement the intense behavioral supports and teaching needed by a child with special needs.  Many of these parents became disability experts, fearless advocates, and activists who have reached out of their own tribulations to support other families. 

Parents have frequently tearfully or angrily shared experiences of feeling judged in public when their healthy-looking children are struggling.  The ASD child unaware of social norms may act "weird", or have a melt down when frustrated.  Strangers often throw disapproving looks or mutter about rudeness and poor discipline, not realizing that the ASD child has special needs and that the parents are making heroic efforts to support and integrate their child into the larger community.

According to the Autism Society of America, approximately 1 percent of children in the United States have an ASD.  We still know of no cure, but the condition is treatable.  As with most disorders, early detection and intervention dramatically improves outcomes.  Please remember that 1 percent of children means MANY families and children in our communities that deserve understanding and support.

The Lovaas Institute at UCLA

Friends of Children with Special Needs - Bay Area

For more information: look for and display the Puzzle Ribbon and check out the Autism Society website:

Communication Games

When it comes time to gather family & friends over the holidays, take some time to talk and play games the old-fashioned way...you know, before electronic gadgets.  I am not anti-electronics, heaven knows plenty of them exist in my home.  But I am very PRO-communication. Communication skills are hard-won, hard-earned and learned even in the best situations.

So why not practice listening, sharing, and getting to know those around you better while relaxing with some games? We often utilize these activities in psychotherapy (with children or teens in particular), but they have helped many families "break the ice" after forgetting how to connect.

National Day of Listening 2009

National Day of Listening

As an alternate or addendum to the usual Black friday retail frenzy, I would like to suggest that we contribute to the Storycorps tradition.  As an avid NPR listener, and an enthusiast of oral histories, I exepcted to enjoy the Storycorps project.  It all began when a private recording booth was set up in Grand Central station so that dyads of people could interview one another for one hour.  What I was not quite prepared for was how powerful many of the stories aired turned out to be. 

A key point of storycorp is the emphasis on the fact that "ordinary" people have extraordinary stories, studded with humor, love, pain, wisdom...and all too often left unsaid.  While driving home and listening to the radio, I was moved to tears but the first interview I heard.  Sisters were talking about their love for one another and how they suffered and battled one sisters' self-cutting compulsion.  Since then, stories have been recorded of marriage proposals, long lost family members, veterans' tales, and so much more.

In an electronic age where my 2 and 5 year old neices spend more time with their DS or my iphone than talking with us, the value of oral history and family traditions are easily be lost.  I hope you can join in the new national tradition of listening.  As someone who listens for a living, I can attest to the fact that every listener is enriched when someone shares their history and perspective, even for just one hour.

Psychotherapy in China – Privacy Rights?

I recently returned from a Chinese Mental Health Summit in Wuhan, PRC.  A blog can’t provide the space to fully describe the breadth of the experience, such as how finely we were hosted (17 course meal…) and the impressive caliber of my colleagues and new friends.  I have been pondering my growing pile of notes, marveling at the near book-length material generated from a mere two week journey.

 

Many of our hosts admitted that the professional field of psychology in China is decades behind other countries.  This was largely due to the political strife of years past when psychology was largely seen as unfavorably Western-biased (actually a legitimate criticism of much traditional academic psychology).  For a long gap in time, the field was not pursued if one valued their political and vocational livelihood. 

Fast Forward to 2009.  China is a rising giant in multiple fields and psychology is no exception.  Chinese hospitals and psychology departments are aggressively expanding their skills and knowledge at the same astonishing rate as China has bounded into other fields.  Us “Overseas Chinese” participants in the summit were welcomed as honored guests.  We were eager to exchange knowledge with our colleagues, and learn about cultural adaptations and mental health practices in China. Or at least within Hubei Province, where we were staying.

 

It was a little nerve-wracking for us to discover that what were billed in the programs as “roundtable discussions” or “ informal panel discussions” turned out to be jam-packed occasions often numbering well over 100 audience members.  My vision of cozy, interactive dialogue evaporated.  Nonetheless, we were honored that so many would be interested in our presentations.

My afternoon didactic covered Clinical work with Anxiety Disorders, primarily using a cognitive behavioral therapy (CBT) approach, and including case examples and discussions of Chinese American clients.  My audience was engaged, polite, intelligent.  They were patient with my rather limited Mandarin vocabulary, and fascinated by the notion of psychotherapy in general.

Yet we had a serious divergence. Before getting into psychotherapy, I emphasized the importance of confidentiality.  I explained how the case examples I presented were all composite characters or contained disguised personal traits – for the protection of client privacy. 

“Confidentiality”, I explained “is a basic right necessary for psychotherapy. It is essential that a person feels completely safe to disclose their emotions and pressures if we are to address deep rooted issues.”  

Their expressions were stunned when I explained that if I, the psychotherapist, violated client confidentiality – I would be liable for potential jail time and huge financial fines.  Doctoral degree or not, I was responsible even to a peasant or laborer.  Silence.  I added that of course, there were exceptions for true emergencies such as dangerous psychiatric crises, or abuse of children.  Puzzled looks. 

 

My audience was not opposed to the concept of confidentiality. But they were understandably flustered.  They were ambitious learners who wanted to practice psychotherapy and help others.  Was I implying that they’d be unable to do so within their current framework?

 

So this, is my current mental knot.  I believe that practices such as confidentiality, child abuse reporting, patients’ rights and clinician accountability are essential to doing this work safely and effectively.

Is psychotherapy as I understand and practice it (in line with the ethical codes of conduct taught by American graduate schools and upheld by the American Psychological Association), possible in a country that does not provide a right to privacy?  I do no believe that the desire for privacy is solely a Western phenomenon.  I have had numerous clients hailing from Asia who expressed their relief upon learning about strict U.S. confidentiality laws.

They say things like:

 “This has been so helpful, but I would never do it in China because everyone would know.”

“We would never have brought our son for treatment if we thought people/institutions could find out.”

It’s a culturally biased conceit to think that China is incapable of developing and practicing psychotherapy which works within their own country.  Yet I realize now, more strongly than ever before, how the formalized professional practices we practice are based on fundamental cultural and political values.  It is quite possible to assist clients even without confidentiality, but not in the manner with which psychotherapy is practiced here.  

I mean, we are talking about a place where I was unable to access simple sites such as facebook or Youtube.  Could I, or any Chinese citizen, come to trust that personal health information would be uncensored and unrevealed?

Consumer Champions speak at the Asian American Psychology Convention

With appreciation to: Maria Lourdes Torres, Jonathan Griggs, Adrianne DeSantis, and Jay Mahler

 

In 2004 California voters passed Proposition 63, the Mental Health Services Act.

Two programs developed and funded in Alameda County under this act include the Asian Access Service and the Pool of Champions.  Asian Access aims to provide multi-lingual, rapid response free initial screenings, resource information, stabilization, and education services.  Peer educators and other consumers are planned to become integral staff. 

It was through Asian Community Mental Health Services and the Asian Access Program that I initially met Pool of Champion members.  I was so impressed by their expertise, the kind of hard won knowledge no one teaches in graduate school, that I invited them to present at the annual Asian American Psychological Association convention when we met in 2007 in San Francisco.

Those who attended the session were privileged to hear the personal stories of Consumer champions.  They candidly shared challenges faced along the process of recovery.  Meaningful themes relevant to mental health treatment emerged which all clinicians and community members should bear in mind:

1. Identity and culture.  All our API panel members felt a vital struggle for a cultural and/or familial place.  As a bi-racial American Jonathan felt “I didn’t want to be me.”  Maria faced major adjustment stressors as an immigrant, which contributed to vulnerability for relapses. 
2. Information.  All our panelists have had frustrating or frightening experiences of not being informed of their own diagnosis.  Problems ranged from vague descriptions such as simply being told they had a “mental breakdown” to being given incomprehensible medical jargon.  Jonathan and Maria both benefited from learning practical information such as how to budget money and set healthy boundaries.
3. Individual expression.  Adrianne and Maria both utilize arts such as poetry and writing for coping and self expression.
4. Respect.  Jonathan still remembers the professionals who offered him choices in recovery, and who “related to me as a person, not a diagnosis.”  He has now been employed as a senior peer counselor for 5 years.  All our panelist have encountered professionals who “talked down” to them or made pronouncements such as telling Jay he was a “hopeless case.”
5. Traumas.  Adrianne’s son was killed by police despite being un-armed, and though the family clearly informed police that he was dealing with a mental health, not criminal, situation.  Jay noted that both he and his son have had experiences of police brutality.  Panelists also shared how grief and other family traumas impacted their illnesses and recovery.   
6. Hope.  Adrianne has immersed herself in advocacy work, channeling her immense loss into efforts that shall spare others from similar grief.  In addition to the Pool of Champions, Maria is an active member in an Alameda county vocational program.  Jay summed up a retreat that Pool of Champions members attended, “it was just people working, living, loving, and praying together.”

Our panelists are pioneers in the recovery movement.  They have not only demonstrated extraordinary resilience in the face of their illnesses, but have chosen to step forward as spokespersons and advocates.  They are speaking out against powerful cultural traditions of silence and shame, and have volunteered their time to do so. 

Many of us in the professional realm have not yet manifested the bravery to step forward and talk about the mental illness in our own family histories and communities.  In addition, few professional psychology educational programs allow future clinicians to hear about consumer and family responses and experiences.  I felt that talking with family and clients has been instrumental in improving my ability to comprehend the key challenges with any given diagnosis or crisis. 

Adrianne’s response to the question, “What do you want in life?” was simple yet eloquent.  Her response reminded me of the common ground every one of us shares: “To fit in, for life to make sense, to have love.”

 

Memorial Day should honor all of our Veterans

As the sister of an Iraq war veteran, as someone who has served clients suffering trans-generational trauma, or direct PTSD decades after war, I can personally attest the the fact that for many, war never ends.  As a country we honor those who died on the battlefield on Memorial Day-but I hope we can realize the importance of also honoring those who live with service related disabilities, or fall to suicide in the aftermath of their service.  The sacrifices of these veterans, and of their families who have borne so much suffering on behalf of the rest of us should be acknowledged and respected.

Military policies leave out our Veterans who died of suicide

There are many who feel that PTSD and other "invisible" injuries should render a military person eligible for a purple heart medal in the same way that an obvious physical injury should.  Some military families complain that our government chooses not to categorize mental health injuries and illnesses properly simply to avoid paying the benefits of proper treatment.  This country we all love, and those who have risked it all, is worth sacrificing a bit of funding for.

We were fortunate that my brother returned from the Gulf War safely.  But was he ever the same again, a normal citizen able to slip into mainstream college and relationships with ease? I don't think so.  And many of the promised benefits of enlistment never seemed to materialize.  I recall the tightly wound dread that permeated out home when he was away on deployment.  The tense way my parents would watch the war coverage each day on the news channels.  I can not imagine the pain and loss of those loved ones whose soldier/marine/sailor never came home again, or lives with massive permanent disabilities-especially the "invisible" ones.  Post Traumatic Stress Disorder, Sleep disorders, Tinnitus, Mood Disorders...these may not look as severe as the loss of a limb, but they can be equally disabling and lead to death by suicide.

Helping a loved one with mental illness

Over my years as a psychologist, I have been privileged to bear witness to the private suffering and bravery of many individuals. An unexpected group of unsung heroes that I would like to acknowledge are the loved ones, family, friends, lovers, colleagues, community members whose support can be priceless in the healing and recovery process.
There have been studies that the severely mentally ill have better life outcomes in poor countries such as India than in the United States. This, despite the staggering sums of money we spend on medications and hospitalizations. An obvious reason for this discrepancy? Social and family support. In so called less developed countries, those who are ill are generally still a part of their community. In the U.S. we tend to put people away or isolate them in private homes, which does not provide support, nor teach skills.
Some of the bravest and most loving individuals I have had the honor to meet are the parents, spouses, children, or friends of those with mental illness.  They provide laughter, structure, advice, and practical support to those who are in the midst of illness. I have seen them assist people in coming to appointments, paying for services, linking with community resources, managing medications and rebuilding dreams and goals.  These are difficult tasks for regular people who find themselves scrambling to understand complicated diagnostic jargon, battle insurance, and interact with someone who's illness may be deeply impacting their behaviors, or even be dangerous.  

Brief Guidelines if someone you care for is coping with a mental health condition:

• Educate yourself so that you will not act upon your own ignorance
• Help educate your loved one so they can understand and manage their condition
• Be a supportive and validating listener
• Seek professional consultation, a proper diagnosis and treatment plan needs to be made by experienced and licensed clinicians
• Express caring in supportive manner, but do not try to force an unwilling person into treatment in non-emergency conditions
• Encourage good lifestyle habits. Share healthy meals, go for a walk or bike ride together
• Remember that even if the condition has altered your loved one, they are NOT their illness. A human being is not a "schizophrenic" or a "bipolar", but a person suffering from schizophrenia or living with bipolar disorder.
• Encourage early and intense treatment, waiting for symptoms to become severe causes more pain and risk
• Fight stigma against the mentally ill, don't condone "crazy" jokes and stereotyping
• Seek support from others who are advocating for those who live with mental health conditions
• Don't tough this out alone. Utilize the National Alliance on Mental Illness network and reading resources below