A QUALITATIVE STUDY ON TRUAl'v!A AFfECTING ASIAN AMERICANS IN THE BAY AREA A University Thesis Presented to the Faculty of California State University, East Bay In Partial Fuliillment Of the Requirements for the Degree Master of Social Work By Pollie Bith-Nlelander June2016 A QUALITATIVE STUDY ON TRUAMA AFFECTING ASIAN AMERICANS IN THE BAY AREA By Pollie Bith-Melander ~ Approved: Date: ! / It' / /t Dr. Sarah Taylor o,~r Abstract This qualitative study describes trauma affecting the Asian and Pacific Isl<J1c!ers (API) population to provide a deeper understanding of how these different ethnic population groups express symptoms of traumatic events and how these experiences impact their daily living. Tt examines the historical and cultural context oftrauma in order to shed light on how the API population copes with the symptoms of trauma in the U.S. This research used both observational and secondary data L'r anal: sis, tJtaling .28 clients in group observations ( 18 Cambodians and l 0 Chinese! and suffnotes Jor l (J29 clients. Out of the 28 observed clients, 17 were male and 11 \\ere fen1~de. Key findings seem to suggest that trauma appears to be contagious through<: manifcstatil)n of symptoms fi·om the past and through intergenerational experience. Findings also seem to suggest that u.:: impact oftrauma during migration and post-settlement conti~1ues to affect the lives of clients in ways that impair their ability to function daily. Clients in the observational groups expressed ongoing and constant challenges, incluJing language barriers, cultura: issues, and lack of support systems. as\\ ell as symptoms related to their past experiences or violence. Treatments based on \\'estern modalities seem to be JXlrtially effective and need tailoring that is linguistically appropriate and cultural!) sensitin~. This research study has important implications for mental health protessionals and others who serve the API population, suggesting that psychological issues should be treated as a part of larger interventions because such issues are often compounded by many factors and challenges . • • • iii -~< ______ Acknowledgements I would like to thank Dr. Sarah Taylor for all her support to ensure that I was progressing in all phases ofthis research project. Her comments and suggestions have made this project possible. I would like to thank two external advisors, Drs. Rose Wong and Lynn T. O'Leary, for their advice and suggestions. My long-time friend, editor and co-conspirator, Sharon May, for all her contributions in editing and fixing this thesis. 1 would also like to thank my son, Viking, for giving me the motivation to move forward and my spouse, Ronny, for his unconditional support and love . • • • iv Table of Contents Abstract iii Acknowledgements IV List ofTables Table 1: Group Observation 1 65 Table 2: Group Observation 2 65 Table 3: Group Observation 3 66 Table 4: Client Data 2016 80 Table 5: Common Diagnoses among Mainland Southeast Asians 81 Table 6: Under 18 Years Old 83 Chapter 1: Profile of Asian Americans Introduction and Background 1 History of Asian Migration to the United States 4 Cambodian Americans 9 The People of Laos 18 Lao Mien 19 T-lmong 20 Vietnamese 22 Demographics and Other Indicators 27 Mental Health Problems and Treatment 29 Conclusion 31 Chapter 2: Theoretical Approaches 32 Trauma and Other Related Experiences 32 Trauma and Its Conceptual Framework Transgenerational & Complex Trauma (Compkx Post-Traumatic Stress disorder) 34 Cultural Trauma 36 Evolutionary Perspective 39 Freeze, Flight, Fight, and Fright 41 Chapter 3: Research Methods 45 Research Questions 45 Methods 46 Research Procedures 48 Research Rationale 49 Data Analysis 51 Involvement of Other Organizations 52 Reflexivity in Qualitative Research 52 ••• v .. Participants 53 Recruitment Plan 53 Potential Risks/Benefits 54 Risk Reduction 54 Confidentiality 55 Consent Issues 52 Limitations 56 Research Purpose 56 Chapter 4: findings 58 Profile of Agency and Its Clients 58 Group Observation Findings 65 Participant Data Tables 65 Descriptive Statistics 66 Group Observations Overview 66 General Findings 69 Migration Experience 69 Western Modality, Treatments, and Side-Effects 71 Symptoms and Experiences Related to War 72 Daily Challenges and Barriers 76 Healing Through Art 77 Secondary Data Findings 79 Client Demographic Data and Diagnoses 79 General Findings 80 Rates ofPTSD and Diagnosis Complications 84 Trauma Manifestation and Perceived Psychological Control 85 Trauma, Stigma and Daily Challenges 88 Challenges of Western Modalities vs. Eastern Philosophies 89 Conclusion 92 References 94 ••• vi 1 Chapter 1: Profile of Asian Americans Introduction and Background Asian Americans are the fastest growing group in the United States and make up approximately 6% of the U.S. population. Out of this percentage, 67% are foreign-born and 75% speak a language other than English at home (U.S. Office of Surgeon General, 2001). One of the complex reasons why Asian Americans are generally ignored or overlooked by the U.S. government in terms of allocation of public funding is that Asian Americans seem to fall within the pretense of the “Model Minority” myth, the misrepresentation that they all live successful lives in the U.S. as compared to other minority groups. Asian Americans are in a precarious position as an immigrant/refugee group in America. Some Asian Americans fall under minority status, which allows them to take advantage of certain social benefits (e.g., Filipino and other Pacific Islanders), while others (i.e., Southeast Asian Groups) do not have minority status despite their poor socioeconomic standings. The reasons for minority status are political. The recent arrivals from Asia and Southeast Asia are excluded because they are simply new arrivals to the U.S. Among those included are mainland Southeast Asian refugees who arrived after the U.S. pulled its military forces out from Southeast Asia in 1975. This group received public assistance for a finite period of time due to refugee status. At the same time, they did not have minority status, which would have allowed them to access benefits from 2 foundations and corporations whose primary purpose is to provide scholarships to minority students. Another reason is that Asian Americans are perceived by other Americans as living the American dream. This image is in contradiction to the reality that many Asian Americans represent the two extremes in both health outcomes and socioeconomic status. What distinguishes Asian Americans from other ethnic minority groups, however, is their health-seeking behaviors, particularly in regard to mental health services. Various studies (Loya et al., 2010; Lin & Cheung, 1999; Li & Browne, 2000) have shown that Asian Americans are the least likely group of people to access mental health services. Only about 8.6% of Asian Americans sought mental health services compared to about 18% of the general population (Spencer et al., 2010). They have experienced and continue to experience various emotional and behavioral problems. The Centers for Disease Control and Prevention (CDC) ranked suicide as the tenth leading cause of death among Asian Americans and Pacific Islanders (CDC, 2016). This thesis focuses on Southeast Asians as they share a similar background and history that is distinct from groups from other regions of Asia, such as East Asia, South Asia, and Insular Southeast Asia. Therefore, particular attention will be given to people from Southeast Asia in this analysis. The majority of Southeast Asians arrived in the U.S. in the late 1970s after the Vietnam War. Cambodian Americans represent one of the three groups of people from mainland Southeast Asia; the other two groups are from Laos and Vietnam. In particular, Southeast Asians suffered serious trauma before they migrated; Cambodians in particular experienced atrocities that took place during the Pol Pot regime between 1975 and 1978. 3 Cambodian Americans, after thirty years of being resettled in the U.S., are still dealing with the past experience of trauma from torture and witnessing execution of loved ones during the Pot Pol regime, and this trauma continues to affect the younger generations. Trauma lingers on even after many decades. Southeast Asian refugees are still struggling to adapt, adjust, and make a new life in the United States because memories of the Vietnam War still haunt them. The Southeast Asian refugees who were seen as helping the U.S. in the war in Vietnam faced severe consequences at the end of the Vietnam War. Tribal groups, including Mien and Hmong, for example, were forced out of Laos and were perceived as traitors by the Laotian government. Similarly, Vietnamese pro-American individuals were not treated as friendly when the U.S. pulled out its forces. Those who were fortunate were able to leave the country at the same time as the Americans in 1975 (Seo, 1994). The Cambodians suffered most severely because of the consequences of the U.S. involvement in the war through a clever maneuvering of the U.S. policy and support, which allowed a xenophobic brutal ruler to take control of the country in a time of chaos and mismanagement (Chandler, 1996). The first large wave of Southeast Asian refugees started coming to the United States in 1975, after the end of the Vietnam War. Between 1975 and 1978, 178,000 refugees arrived from Cambodia, Vietnam and Laos (Seo, 1994). More than a million Southeast Asians now live in the U.S. (U.S. Census, 2010). Southeast Asians are only 13% of the total Asian American population in California, but they account for 87% of Asian Americans receiving public assistance (Seo, 1994). Their trials, tribulations, and challenges will be discussed sections below in order to gain a deeper understand of why this particular group of Asians is still struggling emotionally and psychologically. 4 History of Asian Migration to the United States The first groups of Asians to arrive in the United States came mainly for economic opportunities and as spouses for those workers.