By Stella Cao, MS, MPA, FACHE, Fellowship Class of 2022
Director of Managed Care, San Francisco Department of Public Health

At The Carol Emmott Foundation Annual Conference 2023, I had the opportunity to share a story of how I became my strongest self through a reckoning of my mental health. I shared this story with many of whom I had just met to provide a safe space for others in the conference to open up and talk about their own mental health journeys.

As a follow up to the conference, I wanted to share my reflections on the root causes that prevented me from seeking timely treatment, how I felt after treatment, and what I have been able to accomplish since my anxiety has been under control.

The root causes of my anxiety can be summed up in the following three areas:

1. My perception of mental health in relation to physical harm

I did not know what trauma or childhood trauma was until I saw my first therapist in 2011 in San Francisco. “Craziness” and “psychological abnormality” were the common terms used to define mental illness by villagers in my hometown in China. What we understood back then was that no one had ever died from mental illness or committed suicide because of it. On the other hand, everyone knew that if we did not have enough food to eat and clean water to drink, we would certainly die fast. Since we did not know anyone died from mental illness, no one had the time or resources to better understand what mental health really was and what the treatment options were in the 1970s and 1980s.

2. The stigma associated with mental illness

There were serious consequences once someone was labelled as psychologically abnormal. It could ruin one’s marriage prospects, for example, and the person with mental illness was very likely to be single for the rest of his life. This was because traditionally marriages were arranged, and both sets of parents would inquire about their child’s marriage prospect in the surrounding area before committing their child to a marriage, making sure that he was truly the person he and his parents claimed to be. No family wanted to marry off their daughter or son to someone who was “abnormal.” Since we did not have the resources to better understand, diagnose, and treat mental illness, the villagers assumed that mental illness was genetic and there was no cure for this “abnormality.” After all, no one wanted to possibly have defective children and grandchildren with uncurable diseases.

3. The myths about western medicine

My family and many around me believed in natural healing. We trusted that as long as we slept well, exercised, and ate appropriately, good health would come our way. Because of that, my family resisted any treatment of illness using western medicine unless we had life threatening health issues such as bodily injury, pain, or high fever. From childhood I had been programmed to be skeptical about western medicine. I was frequently told that western medicine may cure symptoms at a faster pace than Chinese medicine, but the latter could cure the root causes of our diseases even if it took longer. I was also told that all western medicine had side effects and could cause other health issues down the road.

All of this helped shape my early identity as Chinese and my perception towards mental illness and western medicine. My story is merely one of the millions of stories on how people from different cultures stigmatize their mental health starting at a young age. These perceptions, unfortunately, hindered my and many others’ willingness to talk about it, be diagnosed, and treated, even when we had the resources to do so in this country. According to the Centers for Disease Control and Prevention (CDC), mental illnesses are among the most common illness in this country. More than 50% of the U.S. population will be diagnosed with a mental illness or disorder at some point in our lifetime, and one in 25 Americans lives with a serious mental illness, such as schizophrenia, bipolar disorder, or major depression.[1] Mental illness, once defined by my villagers as someone being psychologically abnormal, is now the new normal around us.

In hindsight, I kept ignoring my anxiety syndromes because I learned at an early age that mental sickness cannot cause physical harm; because I did not want to ruin my reputation and be labeled as psychologically abnormal; because of my concern about the side effects of western medicine; and, more importantly, because of my competing identities as Chinese and as American. I was holding onto my initial Chinese identity formed in the first 23 years of life and was not able to recognize my expanded identity as a Chinese-American and use the resources available to me.

With over 15 months of weekly therapy that just ended in March of this year, educational classes, and continuous medication, I am so glad that my anxiety is finally under control. I have never felt so strong. Professionally, in addition to championing changes that strengthen the financial sustainability of our Medicaid and City programs and serving as a mentor to other city government leaders, I have recently been asked to take on a new role in a SWAT team for three months in one of our hospitals. The success of this project is estimated to have a cost impact of over $55 million to our organization annually. I may never be able to say that I am free from anxiety because of my early childhood trauma–chronic food insecurity until the age of 13, and favoritism played by many people around me due to sexism and colorism. But having it well managed has allowed me to take on this new challenge with plenty of excitement, curiosity, and confidence that I can help solve the problem that my organization is facing. Personally, it also allows me to enjoy my relationships so much more with family, friends, and colleagues, with a heart filled with gratitude, love, and joy.

So, please don’t wait to get help if your mental health is affecting your life and relationships.

 

[1] Centers for Disease Control and Prevention (2021). About Mental Health. Accessed on April 23, 2023.  www.cdc.gov/mentalhealth/learn/index.htm