Society of Bioethics and Medicine
To ‘Save Face’ in Asian Communities Is To Neglect Mental Health
By - Jonathan Gao, Edited By - Anling Chen
There is an unspoken etiquette that Asians are generally accustomed to – the concept of “saving face.” Rather than involving a person’s actual face, to save one’s face refers to an abstract social value about protecting the individual’s reputation, social standing, and self-esteem. The person is saved from feeling discomfort or embarrassment in public.
In Asia, “saving face” dictates behavior in many social settings. For instance, the
Japanese business industry is centered around knowing what is considered rude in the workplace, who holds seniority, and when to bow to others. In another scenario, it’s polite to initially refuse a gift and to refrain from opening them immediately, as is the common case during Lunar New Year gatherings when relatives give out red pockets containing money.
Although saving face allows one to hold another person in high regard and helps raise their self-worth, there are cases where saving face actually does more harm than good. At least once, we’ve heard about the “model minority” myth – an inaccurate notion that all Asian Americans are smart, do not require assistance, and essentially, excel in attaining the American Dream. For many first and second-generation Asian Americans, being fit into this stereotype comes with feeling pressured to be highly productive, intelligent, and capable members of society. If an individual is clinically depressed or has suicidal thoughts, cultural norms suggest that they are unable to assert control over their life and thus, cannot achieve academic and professional success – which is how one can lose face (Lee, 2008). That is why, rather than seeking professional help, communities will save face by opting to tuck these health concerns away within the folds of an idealized Asian American identity.
Several articles that discuss mental health neglect cite a study titled “Model Minority at Risk: Expressed Needs of Mental Health by Asian American Young Adults'' which presents the results of focus group discussions among eighteen Asian American (AA) young adults representing Asian Indian, Cambodian, Chinese, Indonesian, Korean, Taiwanese, Thai, and Vietnamese backgrounds in Montgomery County, Maryland. During the discussions, the main recurring major theme was that the parental pressure to succeed in life, difficulties balancing two cultures, strict family obligations, and cultural discrimination and isolation were the main culprits of poor mental health in AA communities. The study states, “In many Asian cultures, it is a taboo to openly discuss mental health-related problems, and oftentimes people tend to hide, neglect, or deny symptoms rather than seek help.” (Lee, 2008)
In another study, Asian American youths were reported to utilize formal mental health services less often than White, Latino, and Black Americans. With roughly a third of Asian American participants using specialty mental health services, this pales in comparison to the two-thirds of White American participants reporting having used such services. Instead, the participants reported having sought out informal services such as self-help groups, religious counseling, and alternate healing (Garland, 2005). Such findings suggest a projection of mental health help onto forms deemed more socially acceptable by Asian Americans, which is notable
but does not directly address the root causes of the stress, anxiety, and depression often felt in youthhood.
Asian culture tends to downplay the value of the individual in favor of an emphasis on the collective, and with it, block out any mention of mental illness, which often starts in the household. Furthermore, Asian Americans are often inaccurately reported as a monolith in racial and ethnic research, which can lead to overgeneralizations about mental illness among this ever-increasing population in the United States (Vespa, 2020). In fact, Asian Americans are a diverse group with diverse experiences and different stories to tell about their struggles.
There is a long way to go before the negative stigma surrounding mental illness is
entirely dispelled. The reality is that there is a lack of substantial literature that delves into Asian cultural values and beliefs. If researchers were to conduct more insightful research into this underemphasized issue, medical professionals can use these findings to implement culturally-sensitive practices. Only then can we get back to saving face during the next family gathering.
Bureau, U. (2020, March 07). Demographic Turning Points for the United States. Retrieved December 25,
2020, from https://www.census.gov/library/publications/2020/demo/p25-1144.html. Garland, A. Lau, A.,
Yeh, M., McCabe, K., Hough, R., Segal, S. (2005, July 01). Racial and Ethnic Differences in Utilization
of Mental Health Services Among High-Risk Youths. Retrieved December 25, 2020, from
https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.162.7.1336. Lee, S., Juon, H., Martinez, G.,
Hsu, C., Robinson, E., Bawa, J., & Ma, G. (2008, October 18). Model minority at risk: Expressed needs
of mental health by Asian American young adults. Retrieved December 25, 2020, from