I was interviewed by Dr. Charles Phan recently for Vietnamese TV and radio. The interview was videotaped for later broadcast. In the Vietnamese community, there is lack of awareness of the prevalence of mental illness and its treatment. Mental illness is common in the Vietnamese community, yet few seek treatment. Public education is therefore vital. I was asked to come up with some questions for the interview. Below are some questions that I posed, and my answers to them.
1. What kinds of problems are considered mental illnesses? I mean, if someone is just depressed, and he’s obviously not crazy, does that mean he is mentally ill?
Mental illness is just another term for a psychological problem, a problem involving a mental function. To be considered an illness, the psychological issue has to cause significant disruption of a person’s life, either at home or at work. We all experience depression at times, but people with clinical depression have trouble getting out of the house and getting to work, performing their work, and taking care of their family. Similarly, we all experience anxiety at some point in our life, but persons with anxiety disorders have trouble in their everyday life. They may have trouble driving a car, to be in a public place, to speak in front of others, or to attend a social gathering. People with insanity make up just a small fraction of those with mental illness.
2. Let’s say you see somebody who suddenly starts acting weird, not himself, and paranoid, how would you determine what it is that they are suffering from?
A diagnosis can often be made after a thorough interview of the patient. In some cases, information must be obtained from third parties, such as family or friends, because the patient is unreliable. We need to know: how long has the abnormal behavior been going on? What were the recent stressors? What is the patient’s mood and thought process? Are they suffering from any medical illnesses or using any drugs of abuse? It is important to remember that a set of psychiatric symptoms, such as paranoia or psychosis, can be the result of different pathologies which have different time-courses or age of onset. A patient who becomes psychotic after using cocaine is likely to suffer from cocaine-induced psychotic disorder, not from schizophrenia.
3. A lot of patients may have psychological problems but they don’t want to see a psychiatrist. What can be done for these patients?
Many of these patients are in denial and do not realize that they have a psychiatric illness. Sometimes, they are concerned about somatic symptoms, such as headache, stomach pain, or insomnia, rather than anxiety or depression. I suggest that these individuals be referred to their primary care doctor. A family doctor can usually diagnose and treat common mental health conditions, such mild depression or common types of anxiety disorders. These disorders can be treated effectively with medications.
4. What about patients who do not want to take medications?
Many patients with anxiety or depression can be treated with just psychotherapy and lifestyle modifications. Probably the most important lifestyle change that will improve mental health is regular exercise. Regular exercise improves alertness, attention, energy level as well as overall health. It isn’t completely clear how frequent exercise sessions have to be in order to be beneficial, but most people seem to benefit from as little as two exercise sessions per week. If these behavioral techniques do not lead to resolution of symptoms, I suggest that patients try psychotherapy. There are many psychotherapeutic methods, but all try to get at the psychological mechanisms that maintain maladaptive patterns of thinking and behaving.
5. A lot of people are worried about getting addicted to psychotropic medications. Is that a reasonable concern?
Yes and no. Some psychotropic medications have abuse potential. These include some anxiolytics (such as Xanax) and all stimulants (such as Adderall). If these types of medications are necessary, I try to give the patient the lowest dosage required and advise that they take these medications only as needed.
6. What causes mental illness? Is it caused by stress? Can it be passed on from one person to another?
In general, we know that genetics contributes to vulnerability to most mental illnesses. We also know that severe stress such as childhood parental loss or abuse increases the likelihood of developing mental illness. But exactly how these forces cause mental disorders is not known. Their precise mechanisms are not known. Mental illnesses are not “contagious” in the sense that coming into contact with persons with mental disorders does not lead one develop the same disorders.
7. What kind of mental problems do you see in the Vietnamese community? Are the problems of the Vietnamese different from what might see in other ethnic groups?
The Vietnamese suffer from the same problems as other ethnic groups in this country. However, my experience is that anxiety is more frequently in the Vietnamese than in other groups. Possibly because most Vietnamese have experienced first-hand the effects of social upheaval and migration, the Vietnamese strongly value consistency and stability. But our existence is neither consistent nor stable, and this leads to uncertainty and anxiety. The importance of adapting to unpredictable change must be emphasized when working with Vietnamese clients.
8. Which issues are particularly important when discussing mental health with Vietnamese patients?
(1) The Vietnamese view mental illness with a high degree of stigma and those known to have mental disorders may be viewed unfavorably. This issue makes it difficult for mentally ill individual to seek treatment. (2) As recent immigrants, many Vietnamese encounter problems with acculturation, isolation and marginalization. Many develop depression because they lack social supports. Compounding this problem, their children may be assimilated into the mainstream culture and may not understand their problems. (3) Many Vietnamese may not view mental illness as a medical problem and will not bring up psychological problems to the attention of their doctor. They may not know that there are many types of medications which are effective for mental disorders. Psychoeducation is therefore very important in these cases.