A recent essay contest about mental health underscores the problem. The contest, sponsored by the Alamo-based Culture to Culture Foundation, drew 127 entries from high schools across the area, including Pleasanton and San Ramon Valley high schools.
While non-Asians wrote about problems including body image and bipolar disorder, most of the Asian students wrote about stress and its consequences, including despair, self-loathing and High Achievers Syndrome.
"Many of my friends physically and mentally succumb to the inability to satisfy the expectations of their parents," wrote one essayist, Calvert Chan. "It is unacceptable for teens who are working hard to suffer from anxiety and depression and have no means of venting their stress."
Another student, Edward H Wang, wrote: "I hear a little voice in my head, and as much as I try to stifle it and smother it, it continues to whisper to me. It tells me that I can't succeed, that I can't triumph, that I can never live up to my hopes and dreams and why -- because I am lazy, slothful, cowardly, the embodiment of the ills of human nature."
Sal Fu wrote: "after I kicked the year off with a D in AP Chemistry -- my focus went from learning the wonders of science to frantically trying to raise my grade. Soon after, education became a drag. It was all about meeting deadlines and neglecting others for the sake of balancing grades. The stress had built up to the point where I detested school, and hated doing things in general."
While those are just a sampling of the essays, the students are not alone in how they feel, with dozens of others making similar points. Nor are they alone as part of the larger Asian American population of the area.
Culture to Culture founder Chia Chia Chien said Asians face a stigma about seeking help for mental health issues.
"Most of the Asian American population, they wait until very late or they're in crisis or when a tragedy happens," Chien said. "Even now, for the second generation, it's probably better because of cross culturization, but there still are some problems because they wait until the last stages."
She said adults may rely on traditional remedies first, and even after getting medication, they might take a half dose instead of what's prescribed.
Matthew Narron is a doctor of psychology at Axis Community Health in Pleasanton. He said it's hard to talk across the board because the label Asian American fits so many cultures, but generally, people from China and Japan often show what's known as the "polite face."
"Displays of strong emotions are frowned upon," Narron said. He added that if they are prescribed a pill for a mental disorder, "that's sign of weakness."
He said other cultural differences come into play as well, including how counselors and clinicians relate to patients.
For some, he said, the approach is, "I come in and you're going to tell me what the problem is," as opposed to a counselor, who wants to ask that the problem is.
"People will come in with a problem in the family that cannot be dealt with," Narron said. "They'll come in if they can't figure it out."
He noted that some people come from what he described as "the collectivist concept," where the group is more important than the individual.
But, he said, "Most clinicians are fairly culturally competent."
Narron said Axis sees its share of young people struggling with mental health issues.
"We definitely see kids that are coming in here and are getting B's," he said. "That clashes big time."
He explained that in some places, such as Japan, there aren't enough slots to fit every student.
"When they get out of class, they go to cram schools, that's when they actually do their work. There are only so many slots, elementary to middle school to high school. If you don't fit into that system, you go to private school -- you are now shameful," Narron said. "You're killing your kid over getting an A, but they're saying we have to fit in the national system."
Kathy Kane, clinical director of the Discovery Center in Danvile called Asian American mental health problems "a big issue."
She said the center has a contract in place with the San Ramon Valley school district to provide counseling, but "there are very, very few that actually make it into the counseling office."
"As we are able to see through our Culture to Culture essay contest, there are people who are really suffering. They can't reach out for help," Kane said.
While she says the center does see some families in its clinic, "part of the issue is the difference between the children who are being raising in the American tradition and their parents, who are more connected to their culture of origin."
Her big concern, however, is for the teens.
"Mostly they're internalizers. They're keeping things inside themselves instead of acting out -- staying up all night, not getting any rest, carrying a lot of anxiety -- super high expectations," Kane said. "The adolescent culture, particularly at Dougherty, the whole peer culture is about hyper-achievement, so they've now getting it from their peers as well as inside the home."
And she said bullying now has a new face.
"It comes around grades. Your status is based around your GPA and how many AP classes you're taking," she said.
"Kids are not being children any more," she added, explaining that she sees fifth-graders feeling pressure over AP classes.
But she said, "The biggest tragedies are the ones who wind up being suicidal or self injuring."